Characteristics of Dementia Care Provided by Nurse Practitioners: Findings From the Cedars-Sinai C.A.R.E.S. Program

Dementia affects over 6.5 million people in the United States. The centers for medicare & medicaid services (CMS) introduced the guiding an improving dementia experience (GUIDE) Model to standardize and address gaps in dementia care. Whereas social and educational interventions form a major part of dementia care management, certain patients require medical interventions, such as referrals and medication for behavioral issues. This study aims to describe the dementia care provided by nurse practitioner (NP) dementia care managers within the Cedars-Sinai C.A.R.E.S. Program, a CMS GUIDE Model site.

This retrospective observational study analyzed 394 people living with dementia enrolled in the Cedars-Sinai C.A.R.E.S. Program from July 2021 to October 2024. Patient demographics, dementia stage, and provided medical interventions were extracted from electronic health records. Logistic regression models assessed predictors of dementia care use.

Among 394 enrolled patients, 51% received a specialty referral, 30% were initiated on medication, and 4% underwent laboratory testing. NPs commonly prescribed dementia-specific medications (21.6%) and antidepressants (12.4%) and referred patients to neurology (36.6%), psychiatry (14.5%), and occupational therapy (4.8%). Whereas no significant disparities in care delivery were observed, Black or African Americans with mild dementia (CDR ≤ 1) had higher odds of receiving any medical intervention (aOR = 2.69, 95% CI: 1.07-7.78, p = 0.046) and starting medications (aOR = 3.37, 95% CI: 1.52-7.56, p = 0.003) relative to their White counterparts. Patients residing in care facilities, including board-and-care homes and assisted living communities, were significantly less likely to receive referrals (aOR = 0.31, 95% CI: 0.09-0.88, p = 0.038).

As dementia care managers, NPs can support the diverse dementia care needs of enrolled patients with dementia. Integrating NPs into dementia care models, such as the CMS GUIDE Model, may enhance care quality and equity, particularly for populations with complex medical needs or those facing barriers to adequate dementia care.