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Al-Awad FA, Al-Zahrani MA, Bawazeer AO, Al-Qahtani FS, Al-Jabari SA, Jayaseeli NJ, Alabdulkader AM, Al-Harkan KS, Al-Shammari MO, Mohammedin AS, Rohaiem SN, Al-Muslim NI, Al-Shurem MA, Albakr DM. Physicians' attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia. J Family Community Med 2024; 31:160-167. [PMID: 38800787 PMCID: PMC11114870 DOI: 10.4103/jfcm.jfcm_230_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills. MATERIALS AND METHODS This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables. RESULTS The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding. CONCLUSION Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.
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Affiliation(s)
- Feras A. Al-Awad
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Abdullah O. Bawazeer
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal S. Al-Qahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Nithya J. Jayaseeli
- Research Support Unit, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assim M. Alabdulkader
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid S. Al-Harkan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak O. Al-Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed S. Mohammedin
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaimaa N. Rohaiem
- Department of Geriatrics and Gerontology, Ain Shams University, Cairo, Egypt
| | - Nora I. Al-Muslim
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed A. Al-Shurem
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dalal M. Albakr
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Oostra DL, Fierkens C, Alewijnse MEJ, Olde Rikkert MGM, Nieuwboer MS, Perry M. Implementation of interprofessional digital communication tools in primary care for frail older adults: An interview study. J Interprof Care 2022; 37:362-370. [PMID: 35862572 PMCID: PMC10153063 DOI: 10.1080/13561820.2022.2086858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Communication and coordination between primary healthcare professionals and informal caregivers involved in the care for frail older adults is suboptimal and could benefit from interprofessional digital communication tools. Implementation in daily practice however frequently fails. We aim to identify generic barriers and facilitators experienced by healthcare professionals and informal caregivers during implementation of interprofessional communication tools to improve their long-term use. Qualitative content analysis using individual semi-structured interviews was used for evaluating three different digital communication tools used by interprofessional primary care networks for frail older adults by 28 professionals and 10 caregivers. After transcription and open coding, categories and themes were identified. Barriers and facilitators were related to: tool characteristics, context of use, involvement of professionals and caregivers. The tool improved availability, approachability and users' involvement. The large number of digital systems professionals simultaneously use, and different work agreements hampered tool use. The tools facilitated care coordination, and professionals declared to be better informed about patients' current situations. Overall, interprofessional digital communication tools can facilitate communication in networks for primary elderly care. However, integration between digital systems is needed to reduce the number of tools. Organizations and policy makers have an important role in realizing the tools' long-term use.
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Affiliation(s)
- Dorien L Oostra
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlien Fierkens
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marloes E J Alewijnse
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Minke S Nieuwboer
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Academy of Health and Vitality, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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Qiu A, Xu L, Liu C. Predicting diagnosis 4 years prior to Alzheimer's disease incident. Neuroimage Clin 2022; 34:102993. [PMID: 35344803 PMCID: PMC8958535 DOI: 10.1016/j.nicl.2022.102993] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
This study employed a deep learning longitudinal model, graph convolutional and recurrent neural network (graph-CNN-RNN), on a series of brain structural MRI scans for AD prognosis. It characterized whole-brain morphology via incorporating longitudinal cortical and subcortical morphology and defined a probabilistic risk for the prediction of AD as a function of age prior to clinical diagnosis. The graph-CNN-RNN model was trained on half of the Alzheimer's Disease Neuroimaging Initiative dataset (ADNI, n = 1559) and validated on the other half of the ADNI dataset and the Open Access Series of Imaging Studies-3 (OASIS-3, n = 930). Our findings demonstrated that the graph-CNN-RNN can reliably and robustly diagnose AD at the accuracy rate of 85% and above across all the time points for both datasets. The graph-CNN-RNN predicted the AD conversion from 0 to 4 years before the AD onset at ∼80% of accuracy. The AD probabilistic risk was associated with clinical traits, cognition, and amyloid burden assessed using [18F]-Florbetapir (AV45) positron emission tomography (PET) across all the time points. The graph-CNN-RNN provided the quantitative trajectory of brain morphology from prognosis to overt stages of AD. Such a deep learning tool and the AD probabilistic risk have great potential in clinical applications for AD prognosis.
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Affiliation(s)
- Anqi Qiu
- Department of Biomedical Engineering, National University of Singapore, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Institute of Data Science, National University of Singapore, Singapore; NUS (Suzhou) Research Institute, Suzhou, China; School of Computer Engineering and Science, Shanghai University, China; Department of Biomedical Engineering, the Johns Hopkins University, USA.
| | - Liyuan Xu
- School of Computer Engineering and Science, Shanghai University, China
| | - Chaoqiang Liu
- Department of Biomedical Engineering, National University of Singapore, Singapore
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Challenges in disclosing and receiving a diagnosis of dementia: a systematic review of practice from the perspectives of people with dementia, carers, and healthcare professionals. Int Psychogeriatr 2021; 33:1161-1192. [PMID: 33726880 DOI: 10.1017/s1041610221000119] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disclosing a diagnosis of dementia is a key process involving people with dementia, carers, and healthcare professionals (HCPs) that can facilitate access to treatment and support. Receiving a diagnosis of dementia may represent a change in identity and loss of a planned-for future, resulting in an emotional impact for both people with dementia and carers. Delivering the diagnosis of dementia can be difficult and draining for HCPs. METHODS We conducted a systematic review that included studies which explored the experience of giving or receiving a diagnosis of dementia from the perspectives of people with dementia, carers, or HCPs. All study designs were eligible except for previous literature reviews. Findings were analyzed thematically and grouped into categories and then synthesized into a narrative review. The quality of all included studies was assessed. RESULTS Fifty-two studies were included in this review. Findings indicated that receiving a diagnosis is generally a negative process for people with dementia, carers, and HCPs and leaves carers in particular feeling uncertain over the prognosis and future of the person they care for. Disclosing a diagnosis of dementia is a difficult and complex process, for which formal training and guidance is lacking. Carers in particular would welcome more opportunity for realistic and hopeful discussions of the implications of receiving a diagnosis of dementia. CONCLUSIONS Changes in some aspects of disclosure, such as providing a truthful diagnosis to the person with dementia, have occurred over the last decade. A process approach involving pre-diagnostic counseling and follow-up appointments could enable discussions regarding prognosis and the future, create opportunities to clarify the diagnosis, and reduce emotional burden on HCPs. There is a need for more objective evidence that considers the perspectives of all individuals involved.
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Dorman G, Flores I, Gutiérrez C, Castaño RF, Aldecoa M, Kim L. Medicinal herbs and nutritional supplements for dementia therapy: potential therapeutic targets and clinical evidence. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:26-51. [PMID: 34370647 DOI: 10.2174/1871527320666210809121230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/20/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
Spices and herbs have been used for medicinal purposes for centuries. Also, in the last decades, the use of different nutritional supplements has been implemented to treat all kinds of diseases, including those that present an alteration in cognitive functioning. Dementia is a clinical syndrome in which a person's mental and cognitive capacities gradually decline. As the disease progresses, the person's autonomy diminishes. As there is not an effective treatment to prevent progressive deterioration in many of these pathologies, nutritional interventions have been, and still are, one of the most widely explored therapeutic possibilities. In this review, we have discussed a great number of potentially interesting plants, nutritional derivatives and probiotics for the treatment of dementia around the world. Their action mechanisms generally involve neuroprotective effects via anti-inflammatory, antioxidant, anti-apoptotic, b-amyloid and tau anti-aggregate actions; brain blood flow improvement, and effects on synaptic cholinergic and dopaminergic neurotransmission, which may optimize cognitive performance in patients with cognitive impairment. As for their efficacy in patients with cognitive impairment and/or dementias, evidence is still scarce and/or their outcomes are controversial. We consider that many of these substances have promising therapeutic properties. Therefore, the scientific community has to continue with a more complete research focused on both identifying possible action mechanisms and carrying out clinical trials, preferably randomized double-blind ones, with a greater number of patients, a long-term follow-up, dose standardization and the use of current diagnosis criteria.
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Affiliation(s)
- Guido Dorman
- Division of Neurology, Ramos Mejia Hospital. Argentina
| | - Ignacio Flores
- Neuroscience Institute, Favaloro Foundation Hospital. Argentina
| | | | | | - Mayra Aldecoa
- Division of Neurology, Ramos Mejia Hospital. Argentina
| | - Leandro Kim
- Division of Neurology, Ramos Mejia Hospital. Argentina
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Byles J, Cavenagh D, Bryant J, Mazza D, Browning C, O'Loughlin S, Sanson-Fisher R. Use of medical services by older Australian women with dementia: a longitudinal cohort study. Aust N Z J Public Health 2021; 45:497-503. [PMID: 34309976 DOI: 10.1111/1753-6405.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the use of Medicare-subsidised health services by women with and without dementia. METHODS Data from women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. RESULTS A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non-emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. CONCLUSIONS The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).
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Affiliation(s)
- Julie Byles
- Centre for Women's Health Research, The University of Newcastle, New South Wales
| | - Dominic Cavenagh
- Centre for Women's Health Research, The University of Newcastle, New South Wales
| | - Jamie Bryant
- Health Behaviour Research Group, The University of Newcastle, New South Wales
| | - Danielle Mazza
- Department of General Practice, Monash University, Victoria
| | | | | | - Rob Sanson-Fisher
- Health Behaviour Research Group, The University of Newcastle, New South Wales
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7
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Lech S, O'Sullivan JL, Wellmann L, Supplieth J, Döpfmer S, Gellert P, Kuhlmey A, Nordheim J. Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators. BMC Med Res Methodol 2021; 21:61. [PMID: 33784967 PMCID: PMC8008594 DOI: 10.1186/s12874-021-01253-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background Recruitment of general practitioners (GPs) and their patients is reported as one of the most challenging steps when undertaking primary care research. The present paper describes the recruitment process of a cluster randomised controlled trial (cRCT) aiming to improve dementia care in the primary care setting. Methods Recruitment data was analysed descriptively using frequency tables to investigate comparisons of recruitment rates and results of different recruitment strategies as well as reasons for participation and non-participation of GPs, patients with dementia (PwD) and their caregivers. Results Over a period of 23 months, N = 28 GPs were successfully included in the cRCT. This represents an overall recruitment rate of 4.6%. The most efficient strategy in terms of high response and low labour-intensity involved the dissemination of calls for participation in a GP research network. Most frequently reported reasons for GP’s participation were Improvement of patient’s well-being (n = 22, 79%) followed by Interest in dementia research (n = 18, 64%). The most common reasons for non-participation were Lack of time (n = 71, 34%) followed by Not interested in participation (n = 63, 30%). On a patient level, N = 102 PwD were successfully recruited. On average, each GP referred about n = 7 PwD (range: 1–17; mdn = 6; IQR = 3.5) and successfully recruited about n = 4 PwD (range: 1–11; mdn = 3; IQR = 3.5). Conclusion First, our findings propose GP research networks as a promising strategy to promote recruitment and participation of GPs and their patients in research. Second, present findings highlight the importance of including GPs and their interests in specific research topics in early stages of research in order to ensure a successful recruitment. Finally, results do not support cold calls as a successful strategy in the recruitment of GPs. Trial registration The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019.
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Affiliation(s)
- Sonia Lech
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julie L O'Sullivan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonard Wellmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Juliana Supplieth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Susanne Döpfmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Adelheid Kuhlmey
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Johanna Nordheim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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The DWQ-EMR Embedded Tool to Enhance the Family Physician-Caregiver Connection: A Pilot Case Study. Geriatrics (Basel) 2021; 6:geriatrics6010029. [PMID: 33801004 PMCID: PMC8006048 DOI: 10.3390/geriatrics6010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
The number of family caregivers to individuals with dementia is increasing. Family physicians are often the first point of access to the health care system for individuals with dementia and their caregivers. Caregivers are at an increased risk of developing negative physical, cognitive and affective health problems themselves. Caregivers also describe having unmet needs to help them sustain care in the community. Family physicians are in a unique position to help support caregivers and individuals with dementia, but often struggle with keeping up with best practice dementia service knowledge. The Dementia Wellness Questionnaire was designed to serve as a starting point for discussions between caregivers and family physicians by empowering caregivers to communicate their needs and concerns and to enhance family physicians' access to specific dementia support information. The DWQ aims to alert physicians of caregiver and patient needs. This pilot study aimed to explore the experiences of physicians and caregivers of people using the Questionnaire in two family medicine clinics in Ontario, Canada. Interviews with physicians and caregivers collected data on their experiences using the DWQ following a 10-month data gathering period. Data was analyzed using content analysis. Results indicated that family physicians may have an improved efficacy in managing dementia by having dementia care case specific guidelines integrated within electronic medical records. By having time-efficient access to tailored supports, family physicians can better address the needs of the caregiver-patient dyad and help support family caregivers in their caregiving role. Caregivers expressed that the Questionnaire helped them remember concerns to bring up with physicians, in order to receive help in a more efficient manner.
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Cheng FY, Chang Y, Cheng SJ, Shaw JS, Lee CY, Chen PH. Do cognitive performance and physical function differ between individuals with motoric cognitive risk syndrome and those with mild cognitive impairment? BMC Geriatr 2021; 21:36. [PMID: 33421996 PMCID: PMC7797100 DOI: 10.1186/s12877-020-01992-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. METHODS A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into 2 groups, MCR (n = 33) and MCI (n = 44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, "pure" MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. RESULTS Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. CONCLUSIONS We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.
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Affiliation(s)
- Fang-Yu Cheng
- Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan
| | - Yuanmay Chang
- Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449 Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Siang Shaw
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chuo-Yu Lee
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449 Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Graduate Institute of Chemistry, Tamkang University, New Taipei City, Taiwan
| | - Pei-Hao Chen
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449 Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
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Geriatric assessment for older adults admitted to the emergency department: A systematic review and meta-analysis. Exp Gerontol 2020; 144:111184. [PMID: 33279664 DOI: 10.1016/j.exger.2020.111184] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/12/2020] [Accepted: 11/28/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older adults are the most frequent users of emergency services. Comprehensive geriatric assessment (CGA) can help identify high-risk older adults at an early stage. We conducted a systematic review and meta-analysis to identify and evaluate CGA tools used in the emergency department (ED), analyze their predictive validity for adverse outcomes and recommend tools for this particular situation. METHODS We systematically searched Medline, Web of Science and CENTRAL for eligible articles published in peer-reviewed journals that observed patients ≥65 years admitted to the ED, used at least one assessment tool and reported adverse outcomes of interest. We performed a descriptive analysis and a bivariate meta-analysis of the diagnostic accuracy and predictive validity of the assessment tools for the chosen adverse outcomes. RESULTS 28 eligible studies were included. The pooled sensitivity (95% CI) of the assessment tools for predicting mortality within short (28-90 days) and long (180-365 days) periods after the first ED visit was 0.77 (0.61-0.89) and 0.79 (0.46-0.96), respectively, with specificity (95% CI) values of 0.45 (0.32-0.59) and 0.37 (0.14-0.65). These findings indicate that the tools used in the included studies had modest predictive accuracy for mortality and were more appropriate for identifying individuals at high risk of readmission in the short term than in the long term. CONCLUSIONS Early use of assessment tools in the ED might improve clinical decision making and reduce negative outcomes for older adults.
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11
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Ng NSQ, Ward SA. Diagnosis of dementia in Australia: a narrative review of services and models of care. AUST HEALTH REV 2020; 43:415-424. [PMID: 30049298 DOI: 10.1071/ah17167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/23/2018] [Indexed: 12/28/2022]
Abstract
Objective There is an impetus for the timely diagnosis of dementia to enable optimal management of patients, carers and government resources. This is of growing importance in the setting of a rising prevalence of dementia in an aging population. The Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referral to comprehensive memory services for dementia diagnosis, but in practice many patients may be diagnosed in other settings. The aim of the present study was to obtain evidence of the roles, effectiveness, limitations and accessibility of current settings and services available for dementia diagnosis in Australia. Methods A literature review was performed by searching Ovid MEDLINE using the terms 'dementia' AND 'diagnosis OR detection'. In addition, articles from pertinent sources, such as Australian government reports and relevant websites (e.g. Dementia Australia) were included in the review. Results Literature was found for dementia diagnosis across general practice, hospitals, memory clinics, specialists, community, care institutions and new models. General practitioners are patients' preferred health professionals when dealing with dementia, but gaps in symptom recognition and initiation of cognitive testing lead to underdiagnosis. Hospitals are opportunistic places for dementia screening, but time constraints and acute medical issues hinder efficient dementia diagnosis. Memory clinics offer access to multidisciplinary skills, demonstrate earlier dementia diagnosis and potential cost-effectiveness, but are disadvantaged by organisational complexities. Specialists have increased confidence in diagnosing dementia than generalists, but drawbacks include long wait lists. Aged care assessment teams (ACAT) are a potential service for dementia diagnosis in the community. A multidisciplinary model for dementia diagnosis in care institutions is potentially beneficial, but is time and cost intensive. New models with technology allow dementia diagnosis in rural regions. Conclusion Memory clinics are most effective for formal dementia diagnosis, but healthcare professionals in other settings play vital roles in recognising patients with dementia and initiating investigations and referrals to appropriate services. What is known about this topic? Delays in dementia diagnosis are common, and it is unclear where majority of patients receive a diagnosis of dementia in Australia. While the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referrals to services such as memory clinics for comprehensive assessment and diagnosis of dementia, such services may have limited capacity and may not be readily accessible to all. What does this paper add? This paper presents an overview of the various settings and services available for dementia diagnosis in Australia including evidence of the roles, accessibility, effectiveness and limitations of each setting. What are the implications for practitioners? This concerns a disease that is highly prevalent and escalating, and highlights the roles for practitioners in various settings including general practices, acute hospitals, specialist clinics, community and nursing homes. In particular, it discusses the potential roles, advantages and challenges of dementia diagnosis in each setting.
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Affiliation(s)
- Natalie Su Quin Ng
- Department of Rehabilitation and Aged Care Services, The Kingston Centre, Monash Health, 400 Warrigal Road, Cheltenham, Vic. 3192, Australia
| | - Stephanie Alison Ward
- Monash Ageing Research Centre (MONARC), Department of Epidemiology and Preventive Medicine, Monash University, The Kingston Centre, 400 Warrigal Rd, Cheltenham, Vic. 3192, Australia
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12
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Sagiadinou M, Plerou A. Brief Cognitive Tests in the Case of Dementia and Alzheimer's Disease Early Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1195:127-135. [PMID: 32468467 DOI: 10.1007/978-3-030-32633-3_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nowadays, Alzheimer's disease (AD) diagnosis is considered to be a crucial and extremely complex process. Nevertheless, psychometric tools, like Mini-Mental State Evaluation (MMSE), are used to address cognitive function assessment and clinical evaluation processes. However, MMSE's sensitivity in the diagnosis of mild cognitive impairment is debatable in terms of education, age, or nationality. Typical psychometric tools with the use of "paper and pencil" methods combined with physiology measurements are proposed in order to enhance validity and effectiveness in the case of Alzheimer's disease cognitive deficits. The objective of this review study is to highlight the effectiveness of brief cognitive tests (BCT) in the case of dementia and Alzheimer's disease screening. Authors' future work will focus on the application of BCT in MCI diagnosis and evaluation.
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Affiliation(s)
| | - Antonia Plerou
- Department of Informatics, Ionian University, Corfu, Greece
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13
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Ng NSQ, Ayton D, Workman B, Ward SA. Understanding diagnostic settings and carer experiences for dementia diagnosis in Australia. Intern Med J 2020; 51:1126-1135. [PMID: 32359111 DOI: 10.1111/imj.14869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/26/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Australian guidelines advocate referral to comprehensive memory services for dementia diagnosis, but many patients may be diagnosed elsewhere. AIMS To determine common settings for dementia diagnosis in Australia and to compare patient and carer experience between settings. METHODS Exploratory cross-sectional study of patients with dementia admitted to a Melbourne sub-acute hospital. Patients who had capacity to participate were included; carers were recruited for patients without capacity. Participants completed an interviewer-administered survey which asked them to recall the diagnostic setting, discussions about diagnosis and management (clinical care) and overall experience of diagnosis. Descriptive statistics were applied and open-ended questions were analysed using inductive and deductive coding approaches. RESULTS From 81 eligible participants, 74 consented to participate (one patient, 74 carers). Participants reported dementia diagnosis occurred a median of 24 months before interview, in the following settings: hospitals (31.3%), private specialist clinics (29.7%), memory clinics (14.9%), general practice (13.5%), community health services (9.5%) and residential care (1.4%). Recall of discussions about dementia-modulating medications was higher in participants diagnosed in memory clinics and private specialist clinics (70%) compared to other settings (15%) (P < 0.001). Discussion about living circumstances was highest in hospitals (87% vs 40%) (P < 0.001). One third of participants reported dissatisfaction with their experience. Reported satisfaction was highest for memory clinics. CONCLUSION Results suggest majority of people with dementia are diagnosed outside memory services. Significant variability exists in experiences between services, with a high proportion of participants expressing dissatisfaction with their experience with dementia diagnosis. Strategies to standardise diagnosis of dementia, measure and improve quality of care across all settings are required.
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Affiliation(s)
- Natalie Su Quin Ng
- Rehabilitation and Aged Care Services, Kingston Centre, Monash Health, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health Services Research Unit, Division of Health Services, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Barbara Workman
- Rehabilitation and Aged Care Services, Kingston Centre, Monash Health, Melbourne, Victoria, Australia.,Monash Ageing Research Centre (MONARC), Monash University, Melbourne, Victoria, Australia
| | - Stephanie Alison Ward
- Monash Ageing Research Centre (MONARC), Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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14
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Akpan A, Tabue-Teguo M, Fougère B. Neurocognitive Disorders: Importance of Early/Timely Detection in Daily Clinical Practice. J Alzheimers Dis 2019; 70:317-322. [PMID: 31177208 DOI: 10.3233/jad-180381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neurocognitive disorders create important challenges for patients, their families, and clinicians who provide their health care. Early/timely detection in daily clinical practice allows for diagnosis and adequate treatment, psychosocial support, education, and engagement in shared decision-making related to health care, life planning, involvement in research, and financial matters. However, neurocognitive disorders, when present, are not detected or not diagnosed and not documented, in more than half of patients seen by primary care physicians. The aim of this paper is to highlight the strategies and the perspectives to improve the early/timely detection of neurocognitive disorders in daily clinical practice.
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Affiliation(s)
- Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Aintree University Hospital NHS FT, Liverpool, UK
| | | | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
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15
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Sekhon H, Launay CP, Chabot J, Allali G, Beauchet O. Motoric Cognitive Risk Syndrome: Could It Be Defined Through Increased Five-Times-Sit-to-Stand Test Time, Rather Than Slow Walking Speed? Front Aging Neurosci 2019; 10:434. [PMID: 30766485 PMCID: PMC6366305 DOI: 10.3389/fnagi.2018.00434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/19/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Slow walking speed, time to perform the five-times-sit-to-stand (FTSS) test and motoric cognitive risk syndrome (MCR; defined as slow gait speed combined with subjective cognitive complaint) have been separately used to screen older individuals at risk of cognitive decline. This study seeks to (1) compare the characteristics of older individuals with MCR, as defined through slow walking speed and/or increased FTSS time; and (2) examine the relationship between MCR and its motor components as well as amnestic (a-MCI) and non-amnestic (na-MCI) Mild Cognitive Impairment. Methods: A total of 633, individuals free of dementia, were selected from the cross-sectional “Gait and Alzheimer Interactions Tracking” study. Slow gait speed and increased FTSS time were used as criteria for the definition of MCR. Participants were separated into five groups, according to MCR status: MCR as defined by (1) slow gait speed exclusively (MCRs); (2) increased FTSS time exclusively (MCRf); (3) slow gait speed and increased FTSS time (MCRsaf); (4) MCR; irrespective of the mobility test used (MCRsof); and (5) the absence of MCR. Cognitive status (i.e., a-MCI, na-MCI, cognitively healthy) was also determined. Results: The prevalence of MCRs was higher, when compared to the prevalence of MCRf (12.0% versus 6.2% with P ≤ 0.001). There existed infrequent overlap (2.4%) between individuals exhibiting MCRs and MCRf, and frequent overlap between individuals exhibiting MCRs and na-MCI (up to 50%). a-MCI and na-MCI were negatively [odd ratios (OR) ≤ 0.17 with P ≤ 0.019] and positively (OR ≥ 2.41 with P ≤ 0.019) related to MCRs, respectively. Conclusion: Individuals with MCRf are distinct from those with MCRs. MCRf status does not relate to MCI status in the same way that MCRs does. MCRs is related negatively to a-MCI and positively to na-MCI. These results suggest that FTTS cannot be used to define MCR when the goal is to predict the risk of cognitive decline, such as future dementia.
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Affiliation(s)
- Harmehr Sekhon
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.,Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Cyrille P Launay
- Geriatric Medicine and Geriatric Rehabilitation Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Julia Chabot
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.,Division of Geriatric Medicine, Department of Medicine, St. Mary's Hospital Center, McGill University, Montreal, QC, Canada
| | - Gilles Allali
- Department of Neurology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Olivier Beauchet
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.,Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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16
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Saxena N, George PP, Teo KW, Tan WS, Ng C, Heng BH, Yeo CYY, Anthony P, Tan C, Low KY, Wu V, Ali NB, Chong MS. Evaluation of an integrated primary care-led dementia shared care program in Singapore: An effectiveness and cost-effectiveness study. Geriatr Gerontol Int 2017; 18:479-486. [PMID: 29193721 DOI: 10.1111/ggi.13196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/21/2017] [Accepted: 08/27/2017] [Indexed: 12/01/2022]
Abstract
AIM With an aging Singapore population, there is an increasing demand for dementia care. The present study aimed to evaluate the effectiveness and cost-effectiveness of the Primary Care Dementia Clinic (PCDC) in comparison with the Memory Clinic (MC; hospital-based) and other polyclinics. METHODS A quasi-experimental design was implemented. Effectiveness of PCDC was assessed through caregiver satisfaction, quality of life (caregiver-rated) and adverse events rates. Quality-of-Life measures using the EuroQol 5 Dimension Questionnaire (EQ-5D) at baseline, 6 months and 12 months was assessed. Costs were calculated from a societal perspective. The incremental cost-effectiveness of the PCDC was compared with MC and other polyclinics. RESULTS The present study showed that quality of life and the rate of adverse events at 12 months were similar between the three groups. Caregiver satisfaction at 12 months was higher in the PCDC group when compared with other polyclinics. There were no observed differences in societal cost between the three groups. At 6-month follow up, direct medical costs for PCDC were significantly lower that of other polyclinics. At 12-month follow up, PCDC patients had higher Quality Adjusted Life Years (QALYs) compared with the MC group. CONCLUSION PCDC provided effective care, similar to care at MC and better than care at other polyclinics. Caregiver satisfaction was higher for the PCDC group, and PCDC patients had lower direct medical costs at 6-month follow up. Given these findings, adopting a PCDC model in other polyclinics in Singapore can be beneficial for optimal right siting of patients. Geriatr Gerontol Int 2018; 18: 479-486.
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Affiliation(s)
- Nakul Saxena
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Pradeep Paul George
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Kelvin Ws Teo
- Formerly from Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Woan Shin Tan
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Charis Ng
- Formerly from Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Bee Hoon Heng
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Cindy Ying Ying Yeo
- Department of Community and Continuing Care, Tan Tock Seng Hospital, Singapore, Singapore
| | - Philomena Anthony
- Department of Nursing (Nurse Clinician), Tan Tock Seng Hospital, Singapore, Singapore
| | - Colin Tan
- Ang Mo Kio Polyclinic, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Kang Yih Low
- Ang Mo Kio Polyclinic, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Valerie Wu
- Operations (Division for Integrative & Community Care), Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Mei Sian Chong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Geriatric Education and Research Institute, Ministry of Health, Singapore, Singapore
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17
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Wübbeler M, Thyrian JR, Michalowsky B, Erdmann P, Hertel J, Holle B, Gräske J, Schäfer-Walkmann S, Hoffmann W. How do people with dementia utilise primary care physicians and specialists within dementia networks? Results of the Dementia Networks in Germany (DemNet-D) study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:285-294. [PMID: 26750619 DOI: 10.1111/hsc.12315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 06/05/2023]
Abstract
Outpatient dementia healthcare is predominantly fragmented, and dementia networks (DNs) represent an integrated care concept to overcome this problem. Little is known about the patients of these networks with regard to utilisation of physicians and associated factors. We interviewed 560 caregivers of people with dementia in 13 different DNs in Germany in 2013 and assessed socio-demographics, clinical data and physician utilisation. Networks were categorised in predominantly medical DNs and community-oriented DNs. Descriptive and multivariate statistical models were used to identify associated factors between DNs and users' data. Overall, the users of networks received high rates of physician care; 93% of the sample stated at least one contact with a primary care physician within the last 6 months, and 74% had been treated by a specialist (neurology/psychiatry physician). Only 5% of the sample had no contact with a physician in the 6 months preceding the interview. Females showed a lower odds for physician specialist consultations (OR = 0.641). Users of medical DNs receive greater specialist consultations overall (OR = 8.370). Compared to the German general population and people with dementia in other settings, users of DNs receive physician care more regularly, especially with regard to the consultations of neurologist/psychiatrists. Therefore, DNs seem to perform a supportive role within the integration of physician healthcare. More research is needed on the appropriate relationship between the needs of the people with dementia and utilisation behaviour.
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Affiliation(s)
- Markus Wübbeler
- German Center for Neurodegenerative Diseases (DZNE), Working Group "Interventional Health Care Research", Site Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Working Group "Interventional Health Care Research", Site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Pia Erdmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Working Group "Care Structures" Site Witten, Witten, Germany
| | - Johannes Gräske
- Department of Human and Health Science, University of Bremen, Bremen, Germany
| | - Susanne Schäfer-Walkmann
- IfaS Zentrum für kooperative Forschung an der DHBW Stuttgart, Fakultät Sozialwesen, Stuttgart, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
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18
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Chan QL, Xu X, Shaik MA, Chong SST, Hui RJY, Chen CLH, Dong Y. Clinical utility of the informant AD8 as a dementia case finding instrument in primary healthcare. J Alzheimers Dis 2016; 49:121-7. [PMID: 26444776 DOI: 10.3233/jad-150390] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The informant AD8 has excellent discriminant ability for dementia case finding in tertiary healthcare settings. However, its clinical utility for dementia case finding at the forefront of dementia management, primary healthcare, is unknown. Therefore, we recruited participants from two primary healthcare centers in Singapore and measured their performance on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a local formal neuropsychological battery, in addition to the AD8. Logistic regression was conducted to examine the associations between demographic factors and dementia. Area under the receiver operating characteristics (ROC) curve analysis was used to establish the optimal cut-off points for dementia case finding. Of the 309 participants recruited, 243 (78.7%) had CDR = 0, 22 (7.1%) CDR = 0.5, and 44 (14.2%) CDR ≥1. Age was strongly associated with dementia, and the optimal age for dementia case finding in primary healthcare settings was ≥75 years. In this age group, the AD8 has excellent dementia case finding capability and was superior to the MMSE and equivalent to the MoCA [AD8 AUC (95% CI): 0.95 (0.91-0.99), cut-off: ≥3, sensitivity: 0.90, specificity: 0.88, PPV: 0.79 and NPV: 0.94; MMSE AUC (95% CI): 0.87 (0.79-0.94), p = 0.04; MoCA AUC (95% CI): 0.88 (0.82-0.95), p = 0.06]. In conclusion, the AD8 is well suited for dementia case finding in primary healthcare settings.
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Affiliation(s)
- Qun Lin Chan
- Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.,Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.,Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Muhammad Amin Shaik
- Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.,Memory Aging and Cognition Centre, National University Health System, Singapore
| | | | | | - Christopher Li-Hsian Chen
- Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.,Memory Aging and Cognition Centre, National University Health System, Singapore
| | - YanHong Dong
- Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.,Memory Aging and Cognition Centre, National University Health System, Singapore.,Centre for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
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19
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Fougère B, Oustric S, Delrieu J, Chicoulaa B, Escourrou E, Rolland Y, Nourhashémi F, Vellas B. Implementing Assessment of Cognitive Function and Frailty Into Primary Care: Data From Frailty and Alzheimer disease prevention into Primary care (FAP) Study Pilot. J Am Med Dir Assoc 2016; 18:47-52. [PMID: 27650669 DOI: 10.1016/j.jamda.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/28/2016] [Accepted: 08/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Aging can be affected by frailty and chronic diseases causing physical, cognitive, sensory, and functional decline evolving gradually to disability. The assessment of older patients is carried out in some geriatric day hospitals (GDHFs). However, it seems difficult to assess all patients in these GDHFs. In this context, a care model, which uses a specialist nurse trained in primary care and geriatric assessment, has been developed. In this article, we describe the organization, details of the evaluation, and provide the main characteristics of the first 200 patients assessed over a 6-month period. METHODS Persons aged 70 years and older were invited to undergo an evaluation at the general practitioner's (GP) office by a nurse if the GP thought that the patient was frail or if the patient had cognitive complaint or for both reasons. RESULTS A total of 200 patients from 14 GP offices were assessed. Overall, the mean age was 81.3 (±5.92) years. More than one-half were female (66%), and 32% of participants lived alone. The average Mini-Mental State Examination score was 25.2 (±4.23); 16.7% had dementia; 12% of mild cognitive impairment were identified; 78% of patients were followed by their GP; and 2.5% were referred to a GDHF, 12% to specialized memory center, and 7.5% to geriatric consultation. CONCLUSIONS This work foreshadows any other ambulatory options for older persons in his/her living area representing an alternative to the GDHF. It seems to meet the needs for this population and demonstrates the feasibility to implement in primary care a nurse trained to assess older patients in a GP office.
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Affiliation(s)
- Bertrand Fougère
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France.
| | - Stéphane Oustric
- Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; Département de médecine générale, Université de Toulouse, Toulouse, France
| | - Julien Delrieu
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bruno Chicoulaa
- Département de médecine générale, Université de Toulouse, Toulouse, France
| | - Emile Escourrou
- Département de médecine générale, Université de Toulouse, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Fati Nourhashémi
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
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20
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Examination of level of knowledge in Italian general practitioners attending an education session on diagnosis and management of the early stage of Alzheimer's disease: pass or fail? Int Psychogeriatr 2016; 28:1111-24. [PMID: 26817511 DOI: 10.1017/s1041610216000041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We detected the general level of knowledge about the early diagnosis of Alzheimer's disease (AD) and subsequent care in general practitioners (GPs) from Southern Italy. We explored also the GP perception about their knowledge and training on diagnosis and management of AD. METHODS On a sample of 131 GPs, we administered two questionnaires: the GP-Knowledge, evaluating GPs' expertise about AD epidemiology, differential diagnosis, and available treatments, and the GP-QUestionnaire on Awareness of Dementia (GP-QUAD), assessing the GPs' attitudes, awareness, and practice regarding early diagnosis of dementia. RESULTS Specific screening tests or protocols to diagnose and manage dementia were not used by 53% of our GPs. The training on the recognition of early AD signs and symptoms was considered inadequate by 55% of the participants. Females were more likely to consider their training insufficient (58%) compared to males (53%). Female GPs were less likely to prescribe antipsychotic drugs to control neuropsychiatric symptoms (NPS) and suggest specialist advice in late stage of cognitive impairment. Multiple Correspondence Analysis (MCA) performed only on GP-QUAD suggested two dimensions explaining 26.1% ("GP attitude") and 20.1% ("GP knowledge") of the inertia for a total of 46.2%, CONCLUSION In our survey on GP clinical practice, several problems in properly recognizing early AD symptoms and subsequently screening patients to be referred to secondary/tertiary care centers for diagnosis confirmation have emerged. In the future, specific training programs and educational projects for GPs should be implemented also in Italy to improve detection rates and management of dementia in primary care.
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21
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Wübbeler M, Wucherer D, Hertel J, Michalowsky B, Heinrich S, Meyer S, Schaefer-Walkmann S, Hoffmann W, Thyrian JR. Antidementia drug treatment in dementia networks in Germany: use rates and factors associated with treatment use. BMC Health Serv Res 2015; 15:205. [PMID: 25998147 PMCID: PMC4460966 DOI: 10.1186/s12913-015-0855-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/05/2015] [Indexed: 01/06/2023] Open
Abstract
Background Dementia networks in Germany constitute a specialised setting for integrated dementia care and have shown benefits on relevant outcomes, including those of drug treatment. National guidelines recommend treatment with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) or the N-Methyl-D-Aspartate antagonist (memantine) to reduce cognitive symptoms. However, prescription rates are lower than 30 % in general practises. This study aims to describe antidementia drug treatment and the factors that are associated with the treatment in different dementia networks across Germany. Methods We have analysed the socio-demographic, clinical and utilisation data from 560 patients with dementia (PWD), as well as data from their caregivers, in 13 selected dementia networks in Germany. The patients and caregivers were interviewed in their homes or in the network facilities. Multiple logistic regression models were fitted to evaluate the socio-demographic and clinical factors associated with the utilisation of antidementia drug treatment in the various networks. Results In all of the networks in the study, 52 % of the participants received an antidementia drug treatment. Factors associated with the utilisation of the antidementia drug treatment were: formal diagnosis (OR = 16.81, p < 0.001), association with a physician in the network (OR = 3.69, p < 0.001), higher number of comorbidities (OR = 0.88, p = 0.039), living alone (OR = 0.51, p = 0.032) and higher age (OR = 2.97, p = 0.002). Conclusion Medical treatment of PWD with antidementia drugs in dementia networks in Germany is more frequent than in primary and nursing home care settings. Our findings also suggest that participants with a formal diagnosis and a physician in the network have increased rates of receiving antidementia drug treatments. These findings suggest that dementia networks focusing on medical treatment should support diagnostic procedures and incorporate physician specialists.
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Affiliation(s)
- Markus Wübbeler
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Interventional Health Care Research", Site Rostock/Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Steffen Heinrich
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Care Structures" Site Witten, Stockumer Str. 12, Witten, D-58453, Germany.
| | - Saskia Meyer
- Department of Human and Health Science, University of Bremen, Grazer Str. 4, Bremen, D-28359, Germany.
| | | | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany. .,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Interventional Health Care Research", Site Rostock/Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
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Dawson A, Bowes A, Kelly F, Velzke K, Ward R. Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach. BMC Geriatr 2015; 15:59. [PMID: 25967742 PMCID: PMC4465454 DOI: 10.1186/s12877-015-0053-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 04/21/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes. METHODS Systematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols. RESULTS Of 131 publications evaluated, 56 were assessed to be of 'high' quality, 62 of 'medium' quality and 13 of 'low' quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions. Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams and other multidisciplinary approaches, use of technology to support community-dwelling people with dementia, and support for people without access to unpaid or informal support. CONCLUSIONS In many areas, policy and practice developments are proceeding on a limited evidence base. Key issues affecting substantial numbers of existing studies include: poorly designed and overly narrowly focused studies; variability and uncertainty in outcome measurement; lack of focus on the perspectives of people with dementia and supporters; and failure to understanding the complexities of living with dementia, and of the kinds of multifactorial interventions needed to provide holistic and effective support. Weaknesses in the evidence base present challenges both to practitioners looking for guidance on how best to design and deliver evidence-based services to support people living with dementia in the community and their carers and to those charged with the inspection of services.
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Affiliation(s)
- Alison Dawson
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Alison Bowes
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Fiona Kelly
- Bournemouth University Dementia Institute (BUDI), Bournemouth University, Bournemouth, BH12, UK.
| | - Kari Velzke
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Richard Ward
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
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Ampadu J, Morley JE. Heart failure and cognitive dysfunction. Int J Cardiol 2015; 178:12-23. [DOI: 10.1016/j.ijcard.2014.10.087] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Meuser TM, Carr DB, Unger EA, Ulfarsson GF. Family reports of medically impaired drivers in Missouri: cognitive concerns and licensing outcomes. ACCIDENT; ANALYSIS AND PREVENTION 2015; 74:17-23. [PMID: 25463940 DOI: 10.1016/j.aap.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
This study investigated reasons why older adults (n=689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimer's disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n=187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness.
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Affiliation(s)
- Thomas M Meuser
- University of Missouri - St. Louis, Gerontology Program, School of Social Work, 133-134 Bellerive Hall, 1 University Blvd., St. Louis, MO 63121, USA.
| | - David B Carr
- Washington University School of Medicine, Department of Medicine and Neurology, 4488 Forest Park Blvd., St. Louis, MO 63108, USA.
| | - Elizabeth A Unger
- University of Iceland, Civil and Environmental Engineering, Hjardarhagi 2-6, IS-107 Reykjavik, Iceland.
| | - Gudmundur F Ulfarsson
- University of Iceland, Civil and Environmental Engineering, Hjardarhagi 2-6, IS-107 Reykjavik, Iceland.
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Ehrensperger MM, Taylor KI, Berres M, Foldi NS, Dellenbach M, Bopp I, Gold G, von Gunten A, Inglin D, Müri R, Rüegger B, Kressig RW, Monsch AU. BrainCheck - a very brief tool to detect incipient cognitive decline: optimized case-finding combining patient- and informant-based data. ALZHEIMERS RESEARCH & THERAPY 2014; 6:69. [PMID: 25422675 PMCID: PMC4241397 DOI: 10.1186/s13195-014-0069-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/29/2014] [Indexed: 12/02/2022]
Abstract
Introduction Optimal identification of subtle cognitive impairment in the primary care setting requires a very brief tool combining (a) patients’ subjective impairments, (b) cognitive testing, and (c) information from informants. The present study developed a new, very quick and easily administered case-finding tool combining these assessments (‘BrainCheck’) and tested the feasibility and validity of this instrument in two independent studies. Methods We developed a case-finding tool comprised of patient-directed (a) questions about memory and depression and (b) clock drawing, and (c) the informant-directed 7-item version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Feasibility study: 52 general practitioners rated the feasibility and acceptance of the patient-directed tool. Validation study: An independent group of 288 Memory Clinic patients (mean ± SD age = 76.6 ± 7.9, education = 12.0 ± 2.6; 53.8% female) with diagnoses of mild cognitive impairment (n = 80), probable Alzheimer's disease (n = 185), or major depression (n = 23) and 126 demographically matched, cognitively healthy volunteer participants (age = 75.2 ± 8.8, education = 12.5 ± 2.7; 40% female) partook. All patient and healthy control participants were administered the patient-directed tool, and informants of 113 patient and 70 healthy control participants completed the very short IQCODE. Results Feasibility study: General practitioners rated the patient-directed tool as highly feasible and acceptable. Validation study: A Classification and Regression Tree analysis generated an algorithm to categorize patient-directed data which resulted in a correct classification rate (CCR) of 81.2% (sensitivity = 83.0%, specificity = 79.4%). Critically, the CCR of the combined patient- and informant-directed instruments (BrainCheck) reached nearly 90% (that is 89.4%; sensitivity = 97.4%, specificity = 81.6%). Conclusion A new and very brief instrument for general practitioners, ‘BrainCheck’, combined three sources of information deemed critical for effective case-finding (that is, patients’ subject impairments, cognitive testing, informant information) and resulted in a nearly 90% CCR. Thus, it provides a very efficient and valid tool to aid general practitioners in deciding whether patients with suspected cognitive impairments should be further evaluated or not (‘watchful waiting’).
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Affiliation(s)
- Michael M Ehrensperger
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter-Spital, Schanzenstrasse 55, 4031 Basel, Switzerland
| | - Kirsten I Taylor
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter-Spital, Schanzenstrasse 55, 4031 Basel, Switzerland ; Centre for Speech, Language and the Brain, Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB UK
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences, Koblenz, Joseph-Rovan-Allee 2, 53424 Remagen, Germany
| | - Nancy S Foldi
- Department of Psychology, Queens College and The Graduate Center of The City University of New York, 65-30 Kissena Blvd., NSB-E318, Flushing, NY 11367 USA
| | - Myriam Dellenbach
- Center for Gerontology, University of Zurich, Sumatrastrasse 30, 8006 Zurich, Switzerland ; Currently: Center for Medical Education, Max-Daetwyler-Platz 2, 3014 Berne, Switzerland
| | - Irene Bopp
- Department of Geriatrics, Town Hospital Waid, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Gabriel Gold
- Department of Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Ch. du Pont-Bochet 3, 1226 Thônex, Switzerland
| | - Armin von Gunten
- Department of Old Age Psychiatry, University of Lausanne, Route du Mont, 1008 Prilly, Switzerland
| | - Daniel Inglin
- Department of Geriatrics, General Hospital, Rorschacher Strasse 94, 9000 St. Gallen, Switzerland
| | - René Müri
- Department of Neurology, University Hospital, Inselspital, 3010 Berne, Switzerland
| | - Brigitte Rüegger
- Department of Geriatrics, Town Hospital Waid, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Reto W Kressig
- University Center for Medicine of Aging Basel, Felix Platter-Spital, Burgfelderstrasse 101, 4055 Basel, Switzerland
| | - Andreas U Monsch
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter-Spital, Schanzenstrasse 55, 4031 Basel, Switzerland
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Hum S, Cohen C, Persaud M, Lee J, Drummond N, Dalziel W, Pimlott N. Role expectations in dementia care among family physicians and specialists. Can Geriatr J 2014; 17:95-102. [PMID: 25232368 PMCID: PMC4164682 DOI: 10.5770/cgj.17.110] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists. METHODS Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis. RESULTS Physicians' clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the "bad cop" to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed. CONCLUSIONS Future research could further explore physicians' and other multi-disciplinary members' perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario.
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Affiliation(s)
- Susan Hum
- Department of Family & Community Medicine, University of Toronto, Women's College Hospital, Toronto, ON
| | - Carole Cohen
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Malini Persaud
- Department of Health, Nursing & Environmental Studies, York University, Toronto, ON
| | - Joyce Lee
- Department of Family & Community Medicine, University of Toronto, North York General Hospital, Toronto, ON
| | - Neil Drummond
- Department of Family Medicine, University of Alberta, Edmonton, AB
| | | | - Nicholas Pimlott
- Department of Family & Community Medicine, University of Toronto, Women's College Hospital, Toronto, ON
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Holzer S, Warner JP, Iliffe S. Diagnosis and management of the patient with suspected dementia in primary care. Drugs Aging 2014; 30:667-76. [PMID: 23775551 DOI: 10.1007/s40266-013-0098-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dementia is a complex progressive syndrome characterised by impairment of cognition (including memory, language, visuospatial skills and executive function), changes in personality and diminished activities of daily living. The impact of dementia is enormous and poses a huge challenge to patients, their carers, society at large and health systems around the world, in terms of the direct cost of medical care, social care and unpaid care provided by family members and others. In this review, we combine evidence and clinical opinion, using guidelines and reviews from 2006, 2009 and 2010 to present a practical guide for primary care physicians to the diagnosis, treatment and ongoing care of patients with suspected or diagnosed dementia. This review summarises the epidemiology of dementia syndrome, and offers detailed evidence-based advice on recognition of dementia (including subtyping) and responses to it and its associated symptoms. The roles of neuroimaging and biomarkers are discussed, as are both non-pharmacological and pharmacological therapies.
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Affiliation(s)
- Stefan Holzer
- Department of Medicine, Imperial College London, London, UK
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Russo MJ, Iturry M, Sraka MA, Bartoloni L, Carnero Pardo C, Allegri RF. Diagnostic accuracy of the Phototest for cognitive impairment and dementia in Argentina. Clin Neuropsychol 2014; 28:826-40. [DOI: 10.1080/13854046.2014.928748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Murphy K, O'Connor DA, Browning CJ, French SD, Michie S, Francis JJ, Russell GM, Workman B, Flicker L, Eccles MP, Green SE. Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework. Implement Sci 2014; 9:31. [PMID: 24581339 PMCID: PMC4015883 DOI: 10.1186/1748-5908-9-31] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/21/2014] [Indexed: 01/22/2023] Open
Abstract
Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs’ reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Methods Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. Results A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of ‘Beliefs about consequences’); discomfort in using validated tools (‘Emotion’), possibly due to limited training and confidence (‘Skills’; ‘Beliefs about capabilities’); limited awareness of the need for, and forgetting to conduct, a depression assessment (‘Knowledge’; ‘Memory, attention and decision processes’). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment (‘Knowledge’); possessing the necessary skills and confidence (‘Skills’; ‘Beliefs about capabilities’); and having adequate time and resources (‘Environmental context and resources’). Conclusions This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs’ uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial.
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Affiliation(s)
| | - Denise A O'Connor
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
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Morley JE. Mild Cognitive Impairment—A Treatable Condition. J Am Med Dir Assoc 2014; 15:1-5. [DOI: 10.1016/j.jamda.2013.11.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 01/24/2023]
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Abstract
PURPOSE OF REVIEW Aging is associated with a decline in cognition. This review examines the available data on the effects of nutrition on cognitive impairment. It also explores the mechanism(s) by which food may enhance memory. RECENT FINDINGS An increasing body of evidence has supported the role of the Mediterranean diet and extra-virgin olive oil in protecting cognition. A number of nutritional formulations to improve deteriorating memory are being studied. Undernutrition is associated with cognitive decline. Hyperglycemia and hypertriglyceridemia cause cognitive impairment. SUMMARY There are increasing data to support the role of nutrition in maintaining cognition.
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Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review. Br J Gen Pract 2013; 63:e88-96. [PMID: 23561676 DOI: 10.3399/bjgp13x663046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Vascular diseases contribute to the causation and progression of clinical dementia. AIM To evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. DESIGN AND SETTING Observational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. METHOD A total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. RESULT Level of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. CONCLUSION The quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.
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Geldmacher DS, Kerwin DR. Practical diagnosis and management of dementia due to Alzheimer's disease in the primary care setting: an evidence-based approach. Prim Care Companion CNS Disord 2013; 15:PCC.12r01474. [PMID: 24392252 PMCID: PMC3869604 DOI: 10.4088/pcc.12r01474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 04/23/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To review evidence-based guidance on the primary care of Alzheimer's disease and clinical research on models of primary care for Alzheimer's disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. DATA SOURCES References were obtained via search using keywords Alzheimer's disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. STUDY SELECTION Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. RESULTS Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer's disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer's disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. CONCLUSIONS Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer's disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer's disease.
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Affiliation(s)
- David S Geldmacher
- Division of Memory Disorders and Behavioral Neurology, University of Alabama, Birmingham (Dr Geldmacher) and Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Kerwin)
| | - Diana R Kerwin
- Division of Memory Disorders and Behavioral Neurology, University of Alabama, Birmingham (Dr Geldmacher) and Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Kerwin)
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Somme D, Gautier A, Pin S, Corvol A. General practitioner's clinical practices, difficulties and educational needs to manage Alzheimer's disease in France: analysis of national telephone-inquiry data. BMC FAMILY PRACTICE 2013; 14:81. [PMID: 23763854 PMCID: PMC3682915 DOI: 10.1186/1471-2296-14-81] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/11/2013] [Indexed: 01/24/2023]
Abstract
Background The literature has emphasized the role of general practitioners (GPs) in caring for Alzheimer’s disease (AD) patients. Within the framework of the French national AD plan, an inquiry was undertaken to identify the clinical practices, difficulties and training needs of GPs managing this pathology. Methods A random sample from a representative national listing of continental French GPs following ≥1 AD patients comprised the study population. Participants completed a standard questionnaire on their clinical practices, difficulties and educational needs for AD management. Feeling insufficiently trained was subjected to univariate and multivariate analyses. Results A minority of the 974 respondents declared using questionnaires in their diagnostic evaluation (15.2%), told the patient the diagnosis (8.2%) and was aware of the national recommendations for AD (41.9%). Behavioral disorders represented the most common (73.5%) problem encountered, while half of the GPs considered management of comorbidities easy roles to fulfill. In comparison, coordination of care and assistance did not seem to be a primary problem. A score was calculated, attributing 1 point to each of the following items: need for further education in terms of communications with the family, with patients, disclosing the diagnosis, and non-drug treatments. The factors linked to feeling insufficiently trained for 3 or 4 of the 4 items were: female sex; not involved in educational programs (for parents/family and patients) and no activity related to training medical students. Conclusions Our study identified gaps in French GP training concerning AD diagnosis practices and diagnosis announcement. GPs seemed aware of their educational needs and described difficulties in managing behavioral disorders. Our findings enabled the definition of policy priorities to provide training and disseminate information.
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Strech D, Mertz M, Knüppel H, Neitzke G, Schmidhuber M. The full spectrum of ethical issues in dementia care: systematic qualitative review. Br J Psychiatry 2013; 202:400-6. [PMID: 23732935 DOI: 10.1192/bjp.bp.112.116335] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Integrating ethical issues in dementia-specific training material, clinical guidelines and national strategy plans requires an unbiased awareness of all the relevant ethical issues. AIMS To determine systematically and transparently the full spectrum of ethical issues in clinical dementia care. METHOD We conducted a systematic review in Medline (restricted to English and German literature published between 2000 and 2011) and Google books (with no restrictions). We applied qualitative text analysis and normative analysis to categorise the spectrum of ethical issues in clinical dementia care. RESULTS The literature review retrieved 92 references that together mentioned a spectrum of 56 ethical issues in clinical dementia care. The spectrum was structured into seven major categories that consist of first- and second-order categories for ethical issues. CONCLUSIONS The systematically derived spectrum of ethical issues in clinical dementia care presented in this paper can be used as training material for healthcare professionals, students and the public for raising awareness and understanding of the complexity of ethical issues in dementia care. It can also be used to identify ethical issues that should be addressed in dementia-specific training programmes, national strategy plans and clinical practice guidelines. Further research should evaluate whether this new genre of systematic reviews can be applied to the identification of ethical issues in other cognitive and somatic diseases. Also, the practical challenges in addressing ethical issues in training material, guidelines and policies need to be evaluated.
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Affiliation(s)
- Daniel Strech
- Hannover Medical School, Institute for History, Ethics and Philosophy in Medicine, CELLS-Centre for Ethics and Law in the Life Sciences, Carl-Neuberg Straße 1, 30625 Hanover, Germany.
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Shah R. The Role of Nutrition and Diet in Alzheimer Disease: A Systematic Review. J Am Med Dir Assoc 2013; 14:398-402. [DOI: 10.1016/j.jamda.2013.01.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/22/2013] [Indexed: 01/16/2023]
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Thyrian JR, Hoffmann W. Dementia care and general physicians--a survey on prevalence, means, attitudes and recommendations. Cent Eur J Public Health 2013; 20:270-5. [PMID: 23441391 DOI: 10.21101/cejph.a3751] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION General physicians (GP) play a key role in providing appropriate care for people with dementia. It is important to understand their workload and opinions regarding areas for improvement. MATERIAL AND METHODS A group of 1,109 GPs working in Mecklenburg-Western Pomerania, Gemany (1.633 million inhabitants), were identified, contacted and asked to participate in a written survey. The survey addressed five main topics: (a) the GP, (b) the GP's practice, (c) the treatment of dementia, (d) personal views, attitudes and specific competences regarding dementia and (e) the GP's recommendations for improving dementia-related health care. RESULTS The survey response rate was 31%. In total, the responding GPs estimated that they provided care to 12,587 patients with dementia every quarter year. The GPs also reported their opinions about screening instruments, treatment and recommendations for better care of dementia patients. Only 10% of them do not use screening instruments, one third felt competent in their care for patients with dementia and 54% opt for transfer of patients to a specialist for further neuropsychological testing. CONCLUSIONS Four conclusions from this study are the following: (a) dementia care is a relevant and prevalent topic for GPs, (b) systematic screening instruments are widely used, but treatment is guided, mostly by clinical experience, (c) attitudes towards caring for people with dementia are positive, and (d) GPs recommend spending a lot more time with patients and caregivers and provision of better support in social participation. A majority of GPs recommend abolishing "Budgetierung", a healthcare budgeting system in the statutory health insurance programmes.
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MacNeil Vroomen J, Bosmans JE, van Hout HPJ, de Rooij SE. Reviewing the definition of crisis in dementia care. BMC Geriatr 2013; 13:10. [PMID: 23374634 PMCID: PMC3579755 DOI: 10.1186/1471-2318-13-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/21/2013] [Indexed: 11/23/2022] Open
Abstract
Background Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice. Methods We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings. Results Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis. If the crisis is not resolved, the cycle continues. Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia. Conclusions This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.
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Affiliation(s)
- Janet MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Somme D, Rousseau C. [Standardized geriatric assessment or comprehensive gerontological assessment: where do we stand?]. Rev Med Interne 2012; 34:114-22. [PMID: 23154109 DOI: 10.1016/j.revmed.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/07/2012] [Indexed: 11/17/2022]
Abstract
The concept of comprehensive gerontological assessment is a foundation of modern geriatrics. Our focus was to try to clarify the underlying concepts, assess the level of evidence and clarify the issues still under debate. The concept implies the definition of an interdisciplinary process for a multidimensional assessment in order to produce a coordinated plan. The central notion is that the systematization of this multidimensionality and interdisciplinarity needs the establishment of dedicated process (meeting tools, clinical information system, etc.). Following dimensions should be covered: health, social, economic, environmental and psychological. Any assessment process that could lead to forgetting one of its dimensions cannot be viewed as a comprehensive gerontological assessment. The level of evidence is higher in hospital acute inpatient unit but it is still low in all other areas of health care but the scattered data in the literature argues for qualitative benefits (improved quality of care or quality of life). The questions that remain are numerous including the choice of strategy for initial evaluation (maximum versus minimum; from the outset by many professionals versus graduated based on the minimum initial evaluation), the choice of tool, the optimal location, the required intensity of monitoring and the ideal target population.
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Affiliation(s)
- D Somme
- Service de gériatrie, centre hospitalier universitaire de Rennes, France.
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Expectations, experiences, and tensions in the memory clinic: the process of diagnosis disclosure of dementia within a triad. Int Psychogeriatr 2012; 24:1756-70. [PMID: 22687191 DOI: 10.1017/s1041610212000841] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Health communication studies emphasize the importance of addressing the needs and expectations of patients and families with the disclosure of grave medical conditions. However, little attention has focused on their expectations and experiences of the clinical encounters in diagnosis disclosure of dementia. METHODS In-depth post-encounter interviews with ten patients and 17 companions from two memory clinics in Israel were analyzed using grounded theory. The analysis focused on identifying their expectations, their experiences, and their perceptions of the process and outcomes. RESULTS Major differences exist between patients' and companions' expectations. Patients' expectations were an expression of the lack of knowledge/understanding of the visit's purpose and of insight into the memory deterioration. Companions had more clear-cut expectations: some desired confirmation of the legitimacy and pertinence of their concerns about their relatives' memory problem, whereas others hoped to allay their concerns. Patients' dissatisfaction stemmed mostly from their perceptions of the process, communication, and outcome. Companions' dissatisfaction stemmed from lack of information or of tailored follow-up processes for implementing recommendations provided by the clinic. CONCLUSIONS Our findings expose two main issues challenging fulfillment of the different and frequently opposing expectations of patients and companions. The first is a consequence of the multi-participant nature of the encounter and the second relates to the character and severity of the disease itself. The discordance between the expectations of the two participants generates conflicts that interfere with meeting their diverse needs within the encounters - with consequent disappointment. The implications of these issues merit consideration in the planning of dementia management.
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Aminzadeh F, Molnar FJ, Dalziel WB, Ayotte D. A review of barriers and enablers to diagnosis and management of persons with dementia in primary care. Can Geriatr J 2012; 15:85-94. [PMID: 23259021 PMCID: PMC3521322 DOI: 10.5770/cgj.15.42] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background With the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention. Purpose To critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care. Methods An interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade. Results The current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care. Conclusions Further progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.
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Affiliation(s)
- Faranak Aminzadeh
- Regional Geriatric Program of Eastern Ontario (RGPEO), Bruyère Research Institute (BRI), and School of Nursing, University of Ottawa, Ottawa, ON
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Quality of care provided to people with dementia: utilisation and quality of the annual dementia review in general practice. Br J Gen Pract 2012; 62:e91-8. [PMID: 22520775 DOI: 10.3399/bjgp12x625148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Primary care services are often the main healthcare service for people with dementia; as such, good-quality care at this level is important. AIM To measure the quality of care provided to people with dementia in general practice using routinely collected data, and to explore associated patient and practice factors. DESIGN AND SETTING Observational, cross-sectional review of medical records from general practices (n = 52) in five primary care trusts. METHOD A total of 994 people with dementia were identified from dementia registers. An unweighted quality-of-care score was constructed using information collected in the annual dementia review, together with pharmacological management of cognitive and non-cognitive symptoms. Multilevel modelling was carried out to identify factors associated with quality-of-care scores. RESULTS In total, 599 out of 745 (80%) patients with dementia had received an annual dementia review; however, a social care review or discussion with carers was evident in just 305 (51%) and 367 (61%) of those 599 cases, respectively. Despite high prevalence of vascular disease, over a quarter (n = 259, 26%) of all patients with dementia were prescribed antipsychotics; only 57% (n = 148) of these had undergone medication review in the previous 6 months. Those with vascular dementia who were registered with single-handed practices received poorer quality of care than those registered with practices that had more than one GP. CONCLUSION Although the number of people with dementia with a record of an annual dementia review is high, the quality of these reviews is suboptimal. The quality score developed in this study could be used as one source of data to identify weaknesses in practice activity that need to be corrected, and so would be of value to commissioners and regulators, as well as practices themselves.
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Russ TC, Calvert L, Morling JR. Attitudes to shared care for patients with dementia: A survey of general practitioners. DEMENTIA 2012; 12:606-18. [DOI: 10.1177/1471301212437781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early diagnosis of dementia is important, but implications for care shared between primary and secondary care remain uncertain. We explored attitudes and expectations of Edinburgh’s general practitioners (GPs) regarding current sharing of care for dementia. Surveys were distributed to all 335 Edinburgh GPs; 79.7% were returned. Attitudes and expectations were examined, specifically whether dementia care was currently appropriately shared. Two-thirds of GPs were sure of their role and a similar number felt that care was appropriately shared. The latter opinion was not associated with individual GP factors, such as gender or length of time since qualification, or local levels of deprivation. However, there was a significant association with sector consultant psychiatrist (F = 2.79, df = 6, p = 0.012) and with the proportion of the practice list diagnosed with dementia (ρ = −0.13, p = 0.038). The endangered relationship between GP and specialist could be a key target to improve shared care and early diagnosis of dementia.
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Affiliation(s)
- Tom C Russ
- Scottish Dementia Clinical Research Network, NHS Scotland, UK
- University of Edinburgh, UK
- University of Edinburgh, UK
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Geriatric Principles: Evidence-Based Medicine at Its Best. J Am Med Dir Assoc 2012; 13:1-2.e1-2. [DOI: 10.1016/j.jamda.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 11/20/2022]
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Morley JE. Dementia-Related Agitation. J Am Med Dir Assoc 2011; 12:611-612.e2. [DOI: 10.1016/j.jamda.2011.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 01/05/2023]
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Oustric S, Rouge-Bugat ME, Vellas B. Primary Care Practitioners on the Front Line of Alzheimer's Disease Care. J Am Med Dir Assoc 2011; 12:545-546.e1. [DOI: 10.1016/j.jamda.2011.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 10/17/2022]
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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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Schoenmakers B, Buntinx F, De Lepeleire J. The primary care physician and Alzheimer’s disease: an international position paper. J Nutr Health Aging 2011; 15:595-6. [PMID: 21919279 DOI: 10.1007/s12603-011-0135-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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