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Hohenberg MI, Metri NJ, Firdaus R, Simmons D, Steiner GZ. What we need as we get older: needs assessment for the development of a community geriatrics service in an Australian context. BMC Geriatr 2021; 21:597. [PMID: 34696722 PMCID: PMC8543109 DOI: 10.1186/s12877-021-02553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to inform the development of a Community Geriatrics Service (CGS) that addressed the healthcare and social needs of community dwelling older people in an Australian context. Methods Stakeholders (N = 108) took part in a ‘needs assessment’ involving 30-min semi-structured interviews with general practitioners (GPs; N = 49), and three 2-h focus groups (community engagement meetings; N = 59) with older people, informal caregivers, allied healthcare workers, and nursing home directors. Data were transcribed and thematically coded, mapped to source and weighted to the frequency that the theme was raised across sources. Results Five themes informing CGS development and delivery emerged: active health conditions (management of behavioural and psychological symptoms of dementia, falls, multimorbidity, and other relevant conditions), active social challenges (patient non-compliance, need for aged care social workers, caregiver stress, elder abuse, social isolation, and stigma), referrals (availability of specialists, communication, specialist input, and advance care directives), access (lack of transport options, and inaccessibility of local geriatrics clinics and specialists), and awareness (lack of awareness, knowledge, and resources). Conclusions The CGS will need to address access, referral processes and health system navigation, which were perceived by stakeholders as significant challenges. These findings warrant the development of a CGS with an integrated approach to aged care, pertinent for the health and social needs of the elderly.
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Affiliation(s)
- Mark I Hohenberg
- School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Rubab Firdaus
- School of Health Science, Western Sydney University, Penrith, NSW, 2751, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia.,Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, 2560, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Katahira N, Tsukasaki K. Nursing care in multifunctional small group homes providing day, visiting and overnight services for older people living at home. Int J Nurs Pract 2016; 22:605-615. [PMID: 27653637 DOI: 10.1111/ijn.12482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 08/08/2016] [Accepted: 08/13/2016] [Indexed: 12/13/2022]
Abstract
Home care programs for older people have been developed around the world. Nurses are key to these programs. The aim of this study is to explore details of the nursing activities used in group homes to provide a basis for describing effective nursing practices in such facilities. A self-administered questionnaire was sent to 240 randomly selected facilities throughout Japan in 2013. Responses indicated that the activities of nurses in managing the health of older people included determining the need for medical consultations, dealing with emergencies, and making arrangements for the use of flexible care services. Nursing activities were directly related to the percentage of older people in each facility with diagnoses such as dementia or heart disease. Nurses reported low general self-efficacy for some of the more specialized nursing activities they performed. Nursing activities are performed with the aim of supporting older people with high health care needs to continue living at home; are tailored to the characteristics of residents and contribute to the provision of timely health examinations and flexible arrangement of services. Findings indicate that it might be advantageous to increase the nursing staffing at these facilities, to provide care guidelines and training opportunities to increase nurse self-efficacy.
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Affiliation(s)
- Nobuko Katahira
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.,Department of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Keiko Tsukasaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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3
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van den Dungen P, Moll van Charante EP, van de Ven PM, van Marwijk HWJ, van der Horst HE, van Hout HPJ. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care. PLoS One 2016; 11:e0156958. [PMID: 27310616 PMCID: PMC4910994 DOI: 10.1371/journal.pone.0156958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/22/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. METHODS In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. RESULTS Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. CONCLUSIONS We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. TRIAL REGISTRATION Nederlands Trial Register NTR3389.
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Affiliation(s)
- Pim van den Dungen
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Eric P. Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Primary Care Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hein P. J. van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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4
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Briggs R, Coary R, Collins R, Coughlan T, O'Neill D, Kennelly SP. Acute hospital care: how much activity is attributable to caring for patients with dementia? QJM 2016; 109:41-4. [PMID: 25956392 DOI: 10.1093/qjmed/hcv085] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People with dementia are among the most frequent service users in the acute hospital. Despite this, the acute hospital is not organized in a manner that best addresses their needs. METHODS We examined acute dementia care over a 3-year period from 2010 to 2012 in a 600-bed university hospital, to clarify the service activity and costs attributable to acute dementia care. RESULTS Nine hundred and twenty-nine patients with dementia were admitted during the study period, accounting for 1433/69 718 (2%) of all inpatient episodes, comprising 44 449/454 169 (10%) of total bed days. The average length of stay was 31.0 days in the dementia group and 14.1 days in those >65 years without dementia. The average hospital care cost was almost three times more (€13 832) per patient with dementia, compared with (€5404) non-dementia patients, accounting for 5% (almost €20 000 000) of the total hospital casemix budget for the period. DISCUSSION Service activity attributable to dementia care in the acute hospital is considerable. Moreover, given the fact that a significant minority of cognitive impairment goes unrecognized after acute admissions, it is likely that this is under-representative of the full impact of dementia in acute care. Although the money currently being spent on acute dementia care is considerable, it is being used to provide a service that does not meet its user needs adequately. It is clear that acute hospitals need to provide a more 'dementia friendly' service for acutely unwell older persons.
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Affiliation(s)
- R Briggs
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and
| | - R Coary
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and
| | - R Collins
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - T Coughlan
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - D O'Neill
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - S P Kennelly
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
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Mukadam N, Cooper C, Kherani N, Livingston G. A systematic review of interventions to detect dementia or cognitive impairment. Int J Geriatr Psychiatry 2015; 30:32-45. [PMID: 25132209 DOI: 10.1002/gps.4184] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 07/09/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Memory services have been implemented nationally to increase early dementia diagnosis, and further evaluation of their impact and other strategies to increase timely dementia diagnosis are needed. AIMS To systematically review the literature for interventions intended to increase the detection of dementia or suspected dementia or people presenting with memory complaints. METHOD We searched electronic databases, hand searched references and contacted authors of included papers, contacted field experts and UK charities and councils for data about their dementia awareness programmes. RESULTS We included 13 studies, of which four were randomised controlled trials (RCT). Two RCTs found that general practitioner (GP) education increased suspected dementia cases. One RCT found up to six home visits from a specialist geriatric nurse over 30 months increased the rate of accurately diagnosed dementia. There was preliminary evidence from non-randomised studies that memory clinics increase timely diagnosis, but no evidence they increase the overall diagnosis rate. CONCLUSIONS There is good quality evidence that GP education increases the number of suspected dementia cases but not accurate or earlier dementia diagnoses. One RCT reported that multiple visits from a trained nurse increase the diagnosis rate. There is no cost effectiveness evidence. Our findings suggest good quality RCTs are needed to test the effectiveness and cost-effectiveness of interventions to increase dementia detection.
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Affiliation(s)
- Naaheed Mukadam
- Division of Psychiatry, University College London, Charles Bell House, 2nd Floor, 67-73 Riding House Street, London, W1W 7EJ, UK
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Keiren SMG, van Kempen JAL, Schers HJ, Olde Rikkert MGM, Perry M, Melis RJF. Feasibility evaluation of a stepped procedure to identify community-dwelling frail older people in general practice. A mixed methods study. Eur J Gen Pract 2013; 20:107-13. [PMID: 24224607 DOI: 10.3109/13814788.2013.827167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Implementation of frailty identification methods in general practice has hardly been established. To achieve successful implementation, general practitioners (GPs) should be provided with an identification method that suits their needs. EASYcare-TOS is a new frailty identification method that uses a stepped approach and is specifically developed for use in general practice. The first step consists of the GP's frailty judgment based on his prior information on the patient. If the judgment is 'uncertain' or 'frail,' additional data are collected by a primary care nurse (PCN). The frailty decision is based on clinical reasoning by the GP, without applying predefined cut-offs in a numerical score. OBJECTIVE To evaluate the acceptability of EASYcare-TOS in daily general practice. METHODS A mixed-methods study was conducted. Questionnaires were sent to all professionals (n = 25) who participated in the EASYcare-TOS validation study. Subsequently, semi-structured interviews with primary care professionals (n = 12) and patients (n = 9) were conducted. RESULTS Time investment was generally perceived as acceptable. Twenty-two professionals (88%) found a two-step model (very) useful in the identification instrument. Seventeen professionals (68%) valued making the final frailty decision by their own clinical reasoning. Patients appreciated the broad assessment and the advice given based on the assessment. According to 24 (96%) professionals, EASYcare-TOS improved the quality of patient care. GPs stated that implementation will ask for reconsidering allocation of tasks in general practices and adequate reimbursement. CONCLUSION EASYcare-TOS is a new identification method that fits the needs of primary care professionals to a large extent and is acceptable in daily practice.
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Affiliation(s)
- Suzanne M G Keiren
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
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Engedal K, Gausdal M, Gjøra L, Haugen PK. Assessment of dementia by a primary health care dementia team cooperating with the family doctor - the Norwegian model. Dement Geriatr Cogn Disord 2013. [PMID: 23183640 DOI: 10.1159/000345435] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To describe how dementia assessment could be organized in primary health care and how it works. METHODS The project had two phases. In phase one 104 elderly patients were assessed by a local authority dementia team that used a standardized examination protocol, which enabled the family doctors to establish a dementia diagnosis. After evaluation and adjustments the model was extended to 31 local authorities and 474 patients were assessed. RESULTS The mean age of the patients was 84.4 (SD 5.6) and 81.8 (SD 7.8) years, respectively; 81 and 67% were women, respectively. The mean Mini Mental State Examination scores were 21.1 (SD 5.0) and 19.2 (SD 5.1), respectively. All patients in phase one and 70% in phase two were diagnosed with dementia. In 15 local authorities a specially assigned family doctor assisted in establishing diagnoses. In these local authorities 80% of the patients were diagnosed. CONCLUSION A local authority dementia team can collect the information required to enable a family doctor to establish a dementia diagnosis. Ideally, such teams should be assisted by a family doctor interested in dementia diagnostics.
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Affiliation(s)
- Knut Engedal
- Norwegian Centre for Ageing and Health, Oslo University Hospital, Ullevaal and Vestfold Mental Health Trust, Tønsberg, Norway.
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8
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Dementia skills and competencies for primary care liaison: a model for improving identification and timely diagnosis. Prim Health Care Res Dev 2012; 14:240-9. [PMID: 23127509 DOI: 10.1017/s1463423612000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The need to improve the response of primary care in terms of identification of people with undiagnosed dementia has long been recognised. The role of Primary Care Liaison was identified as a possible solution. An in-depth consultation was undertaken to identify professional competencies required in executing such a role. METHODS Comprehensive literature and policy reviews were conducted to establish draft competencies or different options/combinations of competencies and competency levels. Consultations with a wide range of professional stakeholders (n = 23) and over 70 users and carers were conducted through focus groups, electronic document circulation and telephone interviews. An Equality Impact Assessment was conducted concurrent to the consultation. RESULTS The literature demonstrated a clear need both to improve the rate of diagnosis for people with dementia and to improve the way in which the diagnosis is made. The stakeholder consultation repeatedly affirmed that without a diagnosis the person with dementia and their caregivers did not get access to the appropriate services, and validated the need for a role that would be able to improve a system that would deliver an early and 'timely' diagnosis. Competencies, based on the literature and policy documents, were developed and debated through the consultation processes. CONCLUSIONS Three main areas of competency were identified: counselling; screening; and health education and promotion. The competencies identified require a skilled experienced professional approach. A useful team model would be that the role is placed within a 'GP cluster' as accessibility to GP records and collaborative working with GPs is essential within the role. Personal continuing professional development has a high profile in maintaining these competencies.
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Mitchell AJ, Meader N, Pentzek M. Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatr Scand 2011; 124:165-83. [PMID: 21668424 DOI: 10.1111/j.1600-0447.2011.01730.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to examine the ability of the general practitioners (GPs) to recognize a spectrum of cognitive impairment from mild cognitive impairment (MCI) to severe dementia in routine practice using their own clinical judgment. METHOD Using PRISMA criteria, a meta-analysis of studies testing clinical judgment and clinical documentation was conducted against semi-structured interviews (for dementia) and cognitive tests (for cognitive impairment). We located 15 studies reporting on dementia, seven studies that examined recognition of broadly defined cognitive impairment, and eight regarding MCI. RESULTS By clinical judgment, clinicians were able to identify 73.4% of people with dementia and 75.5% of those without dementia but they made correct annotations in medical records in only 37.9% of cases (and 90.5% of non-cases). For cognitive impairment, detection sensitivity was 62.8% by clinician judgment but 33.1% according to medical records. Specificity was 92.6% for those without cognitive impairment by clinical judgment. Regarding MCI, GPs recognized 44.7% of people with MCI, although this was recorded in medical notes only 10.9% of the time. Their ability to identify healthy individuals without MCI was between 87.3% and 95.5% (detection specificity). CONCLUSION GPs have considerable difficulty identifying those with MCI and those with mild dementia and are generally poor at recording such diagnoses in medical records.
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Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicestershire Partnership Trust, UK.
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Koch T, Iliffe S. Dementia diagnosis and management: a narrative review of changing practice. Br J Gen Pract 2011; 61:e513-25. [PMID: 21801564 PMCID: PMC3145536 DOI: 10.3399/bjgp11x588493] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/04/2010] [Accepted: 05/20/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Early detection and management of dementia in primary care are difficult problems for practitioners. England's National Dementia Strategy 2009 seeks to improve these areas but there is limited evidence on how to achieve this most effectively. AIM This review aims to identify and appraise empirical studies of interventions designed to improve the performance of primary care practitioners in these areas. DESIGN A narrative review of primary-care based studies. METHOD Publications up to February 2010 were identified by searching the electronic databases MEDLINE, Embase, and PsycINFO, and bibliographies. The criterion for inclusion was that studies had to be of interventions aimed at improving detection or management of dementia in primary care. Exclusion criteria included studies in non-English publications, pharmacological interventions, and screening instrument studies. Quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. RESULTS Fifteen studies were identified, of which 11 were randomised controlled trials. Eight reported educational interventions, and seven trialled service redesign, either by changing the service pathway or by introducing case management. Educationally, only facilitated sessions and decision-support software improved GPs' diagnosis of dementia, as did trials of service-pathway modification. Some of the case-management trials showed improved stakeholder satisfaction, decreased symptoms, and care that was more concordant with guidelines. CONCLUSION The quality of the studies varied considerably. Educational interventions are effective when learners are able to set their own educational agenda. Although modifying the service pathway and using case management can assist in several aspects of dementia care, these would require the provision of extra resources, and their value is yet to be tested in different health systems.
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Affiliation(s)
- Tamar Koch
- Department of Primary Care and Population Health, University College, London, UK.
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Villars H, Oustric S, Andrieu S, Baeyens JP, Bernabei R, Brodaty H, Brummel-Smith K, Celafu C, Chappell N, Fitten J, Frisoni G, Froelich L, Guerin O, Gold G, Holmerova I, Iliffe S, Lukas A, Melis R, Morley JE, Nies H, Nourhashemi F, Petermans J, Ribera Casado J, Rubenstein L, Salva A, Sieber C, Sinclair A, Schindler R, Stephan E, Wong RY, Vellas B. The primary care physician and Alzheimer's disease: an international position paper. J Nutr Health Aging 2010; 14:110-20. [PMID: 20126959 DOI: 10.1007/s12603-010-0022-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
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Affiliation(s)
- H Villars
- Gérontopôle, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France.
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