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An Emory clinic is transforming memory care

By Pam Auchmutey | Emory Nursing | Feb. 16, 2018

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Joung Ja Lee (left) is a patient at the Integrated Memory Care Clinic, which helps her daughter, Esther Lee, manage her care for multiple chronic conditions, including dementia and hypertension. 

Photo by Stephen Nowland

In her prime, Joung Ja Lee helped her husband Keun So run a convenience store in North Florida. Customers depended on the Lees for gas and groceries for many years. Now with advanced vascular dementia and Alzheimer's disease, Joung must depend on her daughter, Esther Lee, and the nurse-led team at the Emory Integrated Memory Care Clinic (IMCC) to manage her condition.

Open since 2015, the IMCC has quickly become a model of care for patients like Joung. It is the first nurse-led clinic in the nation specializing in primary care for dementia patients and the first nurse-led medical home at Emory Healthcare.

Esther recently brought her mother to the IMCC for a checkup. The normally feisty 78-year-old wasn't feeling well. Her arms and legs ached, her hands felt sore, and she was tired and cold all the time.

Joung takes several medications daily—for hypertension, arthritis, osteoporosis, and depression related to her dementia.

Her daughter talked calmly and candidly with nurse practitioner (NP) Alison Schlenger 07N 08MN APRN-BC GNP-BC, who manages her mother's care at the IMCC.

"We're reaching a crucial point, I'm starting to see," says Esther. "Mom stopped taking her medication for depression because she thought she was cured."

Schlenger listened carefully to Esther as she examined Joung and soon had an explanation as to why her patient wasn't feeling well.

Lab results showed that Joung's hemoglobin level and red blood cell count were consistently low, making her feel tired. Her GFR (glomerular filtration rate), a measure of how well the kidneys filter out protein, indicated stage 3 chronic kidney disease. The kidneys, Schlenger explained, are where red blood cells are made.

"This type of kidney disease is not uncommon in older patients with hypertension," she told Esther. "We'd like to get nephrology on board with a consult to make sure your mother stays functional."

By the end of her visit, Joung had completed new lab work, a dosage change in her arthritis and depression medications, and an appointment scheduled with an Emory nephrologist. When Schlenger noticed that Joung had two appointments scheduled at the Emory Brain Health Center in the same month, she switched them to the same day.

For Schlenger and the rest of the IMCC team, making life easier for dementia patients and their families is what it's all about. "Our goal," she says, "is to identify and manage symptoms of dementia, prevent and treat co-existing health conditions, and support families in order to optimize quality of life for every patient."

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