A Toolkit for Primary Care Teams

The GSA KAER Toolkit, Fall 2020 Edition, is intended to support primary care teams in implementing a comprehensive approach to initiating conversations about brain health, detecting and diagnosing dementia, and providing individuals with community-based supports. It includes practical approaches, educational resources, and validated clinical tools that teams can integrate into their workflow.

January 2022 Updates

• Under “Raise the topic of brain health and continue the conversation over subsequent visits” – added the USAgainstAlzheimer’s Clinician Guide on Risk Reduction, Primary Prevention Recommendations to Reduce the Risk of Cognitive Decline. See page 15.
• Under “Listen for people’s concerns about memory and cognition” – added the USAgainstAlzheimer’s memory questionnaire, BrainGuide, that may be useful for patients who are concerned about their brain health, that of a loved one, of if they are an Alzheimer’s caregiver, it provides the tools needed to move forward confidentially. See page 16.

June 2022 Updates

• Table K-2. Resources on Brain Health for Patients was updated to include the Global Council on Brain Health’s report, "How to Sustain Brain Healthy Behaviors: Applying Lessons of Public Health and Science to Drive Change." The report addresses actions that individuals, communities, and policymakers can take to promote healthy brain behaviors is also available in Spanish, and there are infographics to promote brain health available in several languages. The report was also added to page 15.

The Toolkit is based on the KAER Model, which consists of four steps: Kickstart, Assess, Evaluate, and Refer.

While the KAER Model was originally developed for the primary care setting, it can be valuable to other health care professionals, educators and students.

Other relevant resources:

• Download KAER Toolkit 2017 Edition
• The Gerontological Society of America Workgroup on Cognitive Impairment and Earlier Diagnosis: 2015 Report and Recommendations
• "Transforming the Alzheimer’s Disease Journal: The Role of Geriatric Specialists in Early Diagnosis and Patient-Centered Care" (A symposium held in conjunction with the GSA Annual Scientific Meeting)

GSA KAER in the News

October 2020: The Center for Disease Control and Prevention has awarded a $500,000, two-year research grant to review, refine, test, and evaluate components of the KAER Model in primary care. The recipient is Dr. Annette Fitzpatrick, Research Professor of Family Medicine at University of Washington and affiliate investigator of UW’s Health Promotion Research Center (a CDC Prevention Research Center). Dr. Fitzpatrick and her team will use the results from this study to provide recommendations for the practical application of the KAER Model and initiate steps for integrating tools into a broader reach of primary care practices within the multi-state UW Medicine network.

July 2021: At the Alzheimer's Association International Conference, Annette L. Fitzpatrick, PhD, presented on an ongoing quality initiative at the University of Washington based on the KAER Toolkit. The aim of the initiative is to increase and improve timely detection of cognitive impairment across primary care in 15 neighborhood clinics in the Pacific Northwest. Her presentation, titled "Evaluating a System to Promote Timely Detection of Cognitive Impairment in Primary Care Practice," described the Cognition in Primary Care Program which is working on implementing an adapted version of the GSA KAER Toolkit to all 16 primary care clinics at UW Medicine.

Inviting User Feedback

We are committed to the continuous improvement of the GSA KAER Toolkit. If you have input for us on the usability or content of the Toolkit, would like to work with GSA to develop new content or implement the KAER Model, please contact Karen Tracy (This email address is being protected from spambots. You need JavaScript enabled to view it.).

The 2022 KAER Program is developed by GSA and supported by Acadia Pharmaceuticals, Avanir Pharmaceuticals, Eli Lilly and Company, Genentech, and Otsuka Pharmaceutical.

2017 KAER Toolkit: 4-Step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia

Approaches and tools for primary care providers

This comprehensive toolkit is focused on the KAER model developed by the GSA Workgroup on Cognitive Impairment Detection and Earlier Diagnosis. The workgroup identified valuable tools and resources to implement the four steps in the KAER model. The resulting toolkit provides options for each of the steps so that PCPs, health plans and health care systems can select the approaches and tools that fit best with their existing primary care structure, organization, and procedures.

The toolkit is broken down by each section of the KAER model to allow quick and easy access:

• Kickstart the cognition conversation
• Assess for cognitive impairment
• Evaluate for dementia
• Refer for community resources

Each step in the model will help the PCP initiate conversations about brain health, detect and assess cognitive impairment, diagnose dementia, and provide post‐diagnostic referrals for education and supportive community services for persons with dementia and their family caregivers.

There also is a free companion webinar, "How to Use the GSA KAER Toolkit: A 4-step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia."

KAER Toolkit Table of Contents

List of Approaches and Tools Found in the Toolkit

• Two-page summary document of the toolkit's contents

Introduction

• The KAER Model (Page 6)
• Objectives and components of the toolkit (page 8)
• General tips for communications with older adults (page 10)
• Terms and definitions (page 10)
• Appendices — Tools to Use (page 11)

Additional Resources

• The Gerontological Society of America Workgroup on Cognitive Impairment and Earlier Diagnosis: Report and Recommendations
  • The cognitive assessment tools mentioned in this report are accessible from the following two websites: the Alzheimer’s Association and the National Institute on Aging
• December 2017 webinar: "How to Use the GSA KAER Toolkit: A 4-step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia"
  • Webinar slides
• January 2015 webinar: Medicare Annual Wellness Visit as Springboard to Detection of Cognitive Impairment, Diagnosis, and Post-Diagnosis Support
  • Webinar slides
• November 2014 symposium: Medicare Annual Wellness Visit as Springboard to Detection of Cognitive Impairment, Diagnosis, and Post-Diagnosis Support handouts

Workgroup Members

This program is developed by GSA and supported by Eli Lilly and Company.