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Wollney EN, Bylund CL, Bedenfield N, Parker ND, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Armstrong MJ. Persons living with dementia and caregivers' communication preferences for receiving a dementia diagnosis. PEC INNOVATION 2024; 4:100253. [PMID: 38298558 PMCID: PMC10828581 DOI: 10.1016/j.pecinn.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
Objective As the number of individuals diagnosed with dementia increases, so does the need to understand the preferences of persons living with dementia (PLWD) and caregivers for how clinicians can deliver a dementia diagnosis effectively, which can be a difficult process. This study describes the diagnostic communication preferences of PLWD and caregivers. Methods We conducted semi-structured individual phone interviews with two groups: PLWD who were diagnosed in the past two years (n = 11) and family caregivers of PLWD (n = 19) living in Florida. PLWD and caregivers were not recruited/enrolled as dyads. Results The groups' communication preferences were largely similar. Data were analyzed thematically into five themes: communicate the diagnosis clearly, meet information needs, discuss PLWD/caregiver resources, prepare for continued care, and communicate to establish and maintain relationships. Conclusion Participants wanted clear communication, information, and support, but differed in some details (e.g. the language used to describe the diagnosis and the amount/type of desired information). Clinicians can apply general principles but will need to tailor them to individual preferences of PLWD and caregivers. Innovation Limited research has elicited PLWD and caregivers' communication preferences for receiving dementia diagnoses, particularly through an individualized data collection method allowing for richer descriptions and deeper understanding.
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Affiliation(s)
- Easton N. Wollney
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Noheli Bedenfield
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Naomi D. Parker
- College of Journalism & Communication, University of Florida, Gainesville, FL, United States of America
| | - Mónica Rosselli
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, United States of America
| | - Rosie E. Curiel Cid
- Department of Psychiatry & Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | | | - Melissa J. Armstrong
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
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Kapeller A, de Boer M. Self-Testing for Dementia: A Phenomenological Analysis of Fear. THE JOURNAL OF MEDICAL HUMANITIES 2024:10.1007/s10912-024-09849-x. [PMID: 38862697 DOI: 10.1007/s10912-024-09849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 06/13/2024]
Abstract
Following the growing economic relevance of mobile health (mHealth) and the increasing global prevalence of dementia, self-testing apps for dementia and mild neurocognitive disorder (MCD) have been developed and advertised. The apps' promise of a quick and easy tool has been criticized in the literature from a variety of angles, but as we argue in this article, the celebratory characterization of self-testing also stands in disbalance to the various kinds of fears that may be connected to taking the test. By drawing on Sara Ahmed's phenomenological theory on emotions and by referring to illustrative experiences from two users with a particular dementia self-testing app, we explore four dimensions of fear derived from phenomenology: performative, ontological, embodied, and temporal dimensions. We argue that fear (1) motivates one to take the self-test and to try to take control over one's health; (2) is shaped by and shapes the ways in which we make sense of ourselves and others as cognitively deficient; (3) constructs and is constructed by our differently embodied presence in the world; and that (4) testing makes a fearful future self as cognitively deficient more tangible. In outlining these different dimensions of fear, this article expands the understanding of the meaning of experiencing self-testing in comparison to the mostly quantitative literature on this topic.
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Affiliation(s)
- Alexandra Kapeller
- Department for Thematic Studies: Technology and Social Change, Linköping University, Temahuset, 58330, Linköping, Sweden.
| | - Marjolein de Boer
- Department of Culture Studies, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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Foxe D, D'Mello M, Cheung SC, Bowen J, Piguet O, Hwang YT. Dementia in Australia: Clinical recommendations post-diagnosis. Australas J Ageing 2024; 43:394-402. [PMID: 38404252 DOI: 10.1111/ajag.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
The delivery of a dementia diagnosis, the information provided, and the practical advice and support arranged can have a long-lasting impact on patients and their families and deserves attention equal to that given to the assessment and investigation process. Patients and their families need a constructive yet sensitive conversation about the nature and cause of their difficulties, communicated in plain language, and tailored to their main concerns and needs. This conversation should lead to the provision of high-quality, easily accessible information. Following this, clinicians may wish to consider broaching the following dementia topics: (1) pharmacological and non-pharmacological interventions, (2) connection and integration with relevant organisations, (3, 4) application for formal support services and engagement with support teams, (5) safety in the home, (6, 7) financial planning, guardianship and legal matters, (8) driving eligibility, (9) support and education resources to family carers and (10) research initiatives and genetic information. Addressing these topics will contribute to improved disease management, which is likely to improve the dementia journey for the patient, their carer(s), and family.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mirelle D'Mello
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sau Chi Cheung
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Neuropsychology Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julane Bowen
- The Australian Frontotemporal Dementia Association, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Yun Tae Hwang
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Central Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Gosford Hospital, Gosford, New South Wales, Australia
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Armstrong MJ, Bedenfield N, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Galvin JE, Lachner C, Grant Smith A, de Los Ángeles Ortega M, Mohiuddin Y, Shatzer J, Marasco D, Willis D, Bylund CL. Best Practices for Communicating a Diagnosis of Dementia: Results of a Multi-Stakeholder Modified Delphi Consensus Process. Neurol Clin Pract 2024; 14:e200223. [PMID: 38152063 PMCID: PMC10750429 DOI: 10.1212/cpj.0000000000200223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/04/2023] [Indexed: 12/29/2023]
Abstract
Background and Objectives Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach. Methods We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus. Results The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B). Discussion Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Noheli Bedenfield
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Monica Rosselli
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Rosie E Curiel Cid
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Marcela Kitaigorodsky
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - James E Galvin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Christian Lachner
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Amanda Grant Smith
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - María de Los Ángeles Ortega
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Yasmin Mohiuddin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Julie Shatzer
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Deann Marasco
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Dianna Willis
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Carma L Bylund
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
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Low LF, Gresham M, Phillipson L, Jeon YH, Hall D, Tan A, Wong N, Brodaty H. Forward with Dementia: process evaluation of an Australian campaign to improve post-diagnostic support. BMC Health Serv Res 2023; 23:1369. [PMID: 38062410 PMCID: PMC10701926 DOI: 10.1186/s12913-023-10347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Forward with Dementia is a co-designed campaign to improve communication of dementia diagnosis and post-diagnostic support. METHODS Webinars, a website, social and traditional media, and promotions through project partners were used to disseminate campaign messages to health and social care professionals (primary audience) and people with dementia and carers (secondary audience). The campaign ran between October 2021 and June 2022, with 3-months follow-up. The RE-AIM framework was used for process evaluation. Measurements included surveys and interviews, a log of activities (e.g. webinars, social media posts) and engagements (e.g. attendees, reactions to posts), and Google Analytics. RESULTS There were 29,053 interactions with campaign activities. More than three-quarters of professionals (n = 63/81) thought webinars were very or extremely helpful. Professionals and people with dementia and carers reported that the website provided appropriate content, an approachable tone, and was easy to use. Following campaign engagement, professionals planned to (n = 77/80) or had modified (n = 29/44) how they communicated the diagnosis and/or provided post-diagnostic information and referrals. Qualitative data suggested that the campaign may have led to benefits for some people with dementia and carers. CONCLUSIONS Forward with Dementia was successful in terms of reach, appropriateness, adoption and maintenance for professionals, however flow-through impacts on people with dementia are not clear. Targeted campaigns can potentially change health professionals' communication and support around chronic diseases such as dementia.
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Affiliation(s)
- Lee-Fay Low
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Danika Hall
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Amy Tan
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nora Wong
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Fox S. "Give me the knowledge, and I can do what I want with it, it's my right and my choice": Triangulated perspectives on the disclosure of young onset dementia. DEMENTIA 2023; 22:1757-1775. [PMID: 37505214 PMCID: PMC10644682 DOI: 10.1177/14713012231191958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Receiving a diagnosis of young onset dementia is particularly distressing; the person under 65 years is often in employment, with financial commitments, young children, and an active social life. Some of the stress experienced by younger people experiencing cognitive changes can be reduced by an early and accurate diagnosis, but this is contingent on the timing of disclosure and a process which is sensitive and appropriate to the person. The study aim was to explore experiences of giving and receiving a diagnosis of young onset dementia, by triangulating the perspectives of the key parties involved. METHODS A qualitative design was employed, using semi-structured interviews. Participants (N = 47) included people with young onset dementia (n = 10), family members (n = 12), and health and social care professionals (n = 25). Thematic analysis and triangulation enabled identification of overall themes across different participant groups. RESULTS All participant groups agreed on key aspects of good disclosure practice, with two overarching themes: The optimal conditions for disclosure, and how best to disclose a diagnosis. Positive experiences of disclosure were prefaced on having the appropriate space and time; having a support person present; clearly labelling the diagnosis; providing appropriate information at the right pace. Other findings include recommendations for longer appointment times, offering additional support for young families, and for carers of people with atypical presentations (e.g. frontotemporal dementia). CONCLUSION Many people with young onset dementia had unsatisfactory disclosure experiences. Health and social care professionals should provide a 'pre-disclosure' appointment, elicit the amount of information the person may want at the point of disclosure of the diagnosis, balance truth and hope, provide contact details for follow-up, and overall be mindful of the individual in front of them. While young onset dementia may be a life-altering diagnosis, a disclosure meeting which is sensitively undertaken can increase the person's agency, coping ability, and ultimately empower them to live well with their diagnosis.
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Affiliation(s)
- Siobhán Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Okamura T, Taga T, Inagaki H, Miyamae F, Ura C, Sugiyama M, Edahiro A, Shirobe M, Motokawa K, Kojima N, Osuka Y, Iwasaki M, Sasai H, Hirano H, Awata S. Barrier to sharing a dementia diagnosis with neighbors in Tokyo. Geriatr Gerontol Int 2023; 23:761-763. [PMID: 37691496 DOI: 10.1111/ggi.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Tsutomu Taga
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Hiroki Inagaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Chiaki Ura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Mika Sugiyama
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Maki Shirobe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
- Division of Preventive Dentistry, Department of Oral Health Science, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute of Gerontology and Geriatrics, Tokyo, Japan
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8
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Wollney EN, Armstrong MJ, Bedenfield N, Rosselli M, Curiel-Cid RE, Kitaigorodsky M, Levy X, Bylund CL. Barriers and Best Practices in Disclosing a Dementia Diagnosis: A Clinician Interview Study. Health Serv Insights 2022; 15:11786329221141829. [PMID: 36506598 PMCID: PMC9729996 DOI: 10.1177/11786329221141829] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
The vast majority of individuals with dementia want to receive a diagnosis. Research suggests, however, that only a fraction of individuals with dementia receive a diagnosis and patients and families often feel the information is poorly explained. We thus aimed to assess clinician-reported barriers to dementia disclosure and recommendations for giving a dementia diagnosis. To accomplish this, we performed telephone interviews with 15 clinicians from different specialties using a semi-structured interview guide. Transcripts were analyzed thematically. Clinician-reported barriers fit 3 categories: patient and caregiver-related barriers, clinician-related barriers, and barriers related to the triadic interaction. Patient and caregiver-related barriers included lack of social support, misunderstanding the diagnosis, and denial. Clinician barriers included difficulty giving bad news, difficulty communicating uncertainty, and lack of time. Triadic interaction barriers included challenges meeting multiple goals or needs and family requests for non-disclosure. Recommendations for best practice included for clinicians to foster relationships, educate patients and family, and take a family-centered approach. Clinicians described recommendations for fostering relationships such as using empathic communication and developing and maintaining connection. Educating patients and families included tailoring communication, explaining how the diagnosis was reached, and following up. Family approaches included meeting with family members prior to delivering the diagnosis and involving the caregiver in the discussion. Findings may inform updated recommendations for best practices when communicating a dementia diagnosis.
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Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA,Easton N Wollney, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, USA.
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Noheli Bedenfield
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Rosie E Curiel-Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ximena Levy
- Clinical Research Unit, Division of Research, Florida Atlantic University, Boca Raton, FL, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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9
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Parker M, Barlow S, Hoe J, Aitken LM. The Bubble of Normalisation: A Qualitative Study of Carers of People With Dementia Who Do Not Seek Help for a Diagnosis. J Geriatr Psychiatry Neurol 2022; 35:717-732. [PMID: 34951319 PMCID: PMC9386763 DOI: 10.1177/08919887211060018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Improving dementia diagnosis rates are a key feature of dementia strategy and policy worldwide. This study aimed to explore the experience of carers of people diagnosed with dementia during or following a hospital admission in order to identify factors that had prevented them from seeking help beforehand. Semi-structured interviews were conducted with 12 informal carers including adults caring for a parent, a friend or a spouse diagnosed with dementia between 2010-2019, following an acute hospital admission for a physical health problem, having not sought help previously. MAIN FINDINGS Carers created a 'bubble of normalisation' around themselves and the person living with dementia (PLWD) to reject the label of dementia and protect the PLWD from a loss of independence, discrimination and prejudice they felt would be the result of a diagnosis. Carers struggled to talk to the PLWD about dementia reinforcing denial and stigma. Post-diagnosis carers felt unsupported and questioned the value of diagnosis. PRINCIPAL CONCLUSIONS Stigma related to images of dementia as a disease that takes away independence and identity prevented discussion about dementia between carers and the PLWD. A lack of open discussion about memory concerns between health care professionals and carers also served to delay diagnosis.
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Affiliation(s)
- Michelle Parker
- Division of Nursing, City University of London, London, UK,Michelle Parker, Division of Nursing, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Sally Barlow
- Division of Nursing, City University of London, London, UK
| | - Juanita Hoe
- Division of Nursing, City University of London, London, UK
| | - Leanne M. Aitken
- School of Health Sciences, City University of London, London, UK,School of Nursing & Midwifery, Griffith University, Australia
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10
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Sullivan KA, Graham K, Parkinson L. Ratings of the reasons for and against the disclosure of an Alzheimer's disease diagnosis: has anything changed in the past 20 years? Aging Ment Health 2022:1-7. [PMID: 35930316 DOI: 10.1080/13607863.2022.2107174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The disclosure of an Alzheimer's disease diagnosis poses challenges for health care professionals, patients, and their families. Past research has shown that people favour disclosure, but it is uncertain if this situation has changed. METHOD We used a cross-sectional online survey to explore disclosure preferences in a sample of young adults (n = 229; 66.7% aged 18 - 25 years, 79.5% Australian born). Factors contributing to preferences were also examined (knowledge, experience, close experience, age, relationship to diagnosis recipient). Established measures were used to assess knowledge (the Alzheimer's Disease Knowledge Test) and preferences (the Reasons for Wanting to Know Questionnaire). RESULTS Most (95%) but not all participants favoured disclosure, whilst recognising as important at least one reason against it. Only age was a significant determinant of preferences (older people were more likely to prefer disclosure). Those against disclosure cited the fear of suicide as a key reason. CONCLUSION The right to know remains a primary reason for preferring disclosure. Health care professionals should use pre-diagnostic interviewing to discuss overall preference and the underpinning reasons both for and against disclosure. Focus should be on developing a person-centred approach that responds to concerns, with further research to evaluate this approach.
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Affiliation(s)
- Karen A Sullivan
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | - Karen Graham
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Lauren Parkinson
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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11
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Chen MC, Lin HR. The experiences of family caregivers in response to a dementia diagnosis disclosure. BMC Psychiatry 2022; 22:475. [PMID: 35840911 PMCID: PMC9287885 DOI: 10.1186/s12888-022-04126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Dementia is a serious disease that can lead to disability because it impacts the individual's memory, cognition, behavior, and capacity to perform activities of daily living. While most people prefer to receive a full diagnostic disclosure, the actual care requirements of family caregivers of persons with dementia are often unknown after a dementia diagnosis is disclosed. The primary aim of this study was to explore the experiences of family caregivers in response to a dementia diagnosis disclosure and analyze the care needs of caregivers. METHODS A qualitative study conducted in accordance with COREQ guidelines. The grounded theory approach was undertaken in 20 family caregivers of persons with dementia, who were selected using purposive sampling. Data were analysed using the constant comparative method. RESULTS The core category of this study was "diagnostic disclosure: Start the long road of care challenges", which was defined as describing the experiences of family caregivers of persons with dementia after first being informed of diagnosis. Five major categories describing the experiences of family caregivers following a dementia diagnosis was developed: 'deciding to seek medical attention,' 'the moment of disclosure,' 'conveying information,' 'maintaining the persons' functioning,' and 'receiving support and living well with dementia.' Subcategories within each major category also emerged. CONCLUSIONS Clear diagnostic disclosure is important for ensuring that positive developments can occur in response to disclosure. Healthcare professionals must develop strategies to prevent disclosure from triggering overreactive emotions from persons with cognitive impairments, assist them in understanding their illness in a tactful manner, and ensure that they understand how to cooperate in any subsequent care plans.
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Affiliation(s)
- Miao-Chuan Chen
- grid.418428.3Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, No.365, Ming Te Rd, Pei Tou, District, Taipei, 11219, Taiwan.
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12
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de Levante Raphael D. The Knowledge and Attitudes of Primary Care and the Barriers to Early Detection and Diagnosis of Alzheimer’s Disease. Medicina (B Aires) 2022; 58:medicina58070906. [PMID: 35888625 PMCID: PMC9320284 DOI: 10.3390/medicina58070906] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Abstract
Primary care physicians play a vital role in the clinical care of their patients, early identification of dementia, and disease advocacy. It is essential to assess the knowledge and attitudes of physicians in the diagnosis of Alzheimer’s disease and other dementias. In primary care, the diagnosis of Alzheimer’s disease is often missed or delayed. With the increased prevalence of Alzheimer’s disease and the growing impact of dementia on health care resources, early detection by primary care physicians (PCP) is essential. Thus, their knowledge and attitudes about early detection and diagnosis are crucial. To examine the knowledge and attitudes of primary care physicians regarding early detection and diagnosis of Alzheimer’s disease and how barriers may contribute to missed and delayed detection and diagnosis. An interpretive scope review was used to synthesize and analyze a body of literature published over the past decade. The study population are physicians in the United States. The current health systems experience challenges in providing early, safe, accurate, and comprehensive Alzheimer’s diagnosis and care by a primary care physician trained or knowledgeable in diagnosing the various forms of dementia. This article identifies several interrelated obstacles to early detection and diagnosis in primary dementia care, including gaps in knowledge, attitudes, skills, and resources for person with dementia (PWD)/caregivers and their primary care providers and systematic and structural barriers that negatively impact dementia care. Research shows that Alzheimer’s disease has gone underdiagnosed and undertreated. Delays in detection, diagnosis, and resource utilization may have social and clinical implications for individuals affected by Alzheimer’s disease and their families, including challenges in obtaining an accurate diagnosis. Until the issues of missed and delayed Alzheimer’s screening become more compelling, efforts to promote early detection and diagnosis should focus on the education of physicians and removing the barriers to diagnosis.
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Affiliation(s)
- Donna de Levante Raphael
- National Memory Screening Department, The Alzheimer's Foundation of America, New York, NY 10001, USA
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13
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Linden I, Hevink M, Wolfs C, Perry M, Dirksen C, Ponds R. Understanding patients' and significant others' preferences on starting a diagnostic trajectory for dementia: An integrative review. Aging Ment Health 2022; 27:862-875. [PMID: 35763442 PMCID: PMC10166060 DOI: 10.1080/13607863.2022.2084505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To explore the preferences of people with memory complaints (PwMC) and their significant others regarding starting a diagnostic trajectory for dementia. METHODS A systematic literature search was conducted in PubMed, PsycINFO, CINAHL, Web of Science, and Embase. Selection of abstracts and papers was performed independently by two researchers. Methodological quality was assessed with the Mixed Method Appraisal Tool. Result sections of the selected papers were thematically synthesized. RESULTS From 2497 citations, seven qualitative studies and two mixed methods studies published between 2010 and 2020 were included. Overall quality of the studies was high to moderate. A thematic synthesis showed that preferences for starting a diagnostic trajectory arose from the feeling of needing to do something about the symptoms, beliefs on the necessity and expected outcomes of starting a diagnostic trajectory. These views were influenced by normalization or validation of symptoms, the support or wishes of the social network, interactions with health care professionals, the health status of the PwMC, and societal factors such as stigma and socioeconomic status. CONCLUSION A variety of considerations with regard to decision-making on starting a diagnostic trajectory for dementia were identified. This emphasizes the need to explore individual preferences to facilitate a timely dementia diagnosis.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Maud Hevink
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Primary and Community care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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14
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Disclosure of a Dementia Diagnosis:. Dela J Public Health 2022; 8:76-77. [PMID: 35692987 PMCID: PMC9162401 DOI: 10.32481/djph.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Maeker É, Roche J, Maeker-Poquet B. [Announcement of the diagnosis of Alzheimer's disease or a related disorder in a geriatric short-stay unit]. SOINS. GERONTOLOGIE 2022; 27:33-37. [PMID: 35738763 DOI: 10.1016/j.sger.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The disclosure of the diagnosis of Alzheimer's disease or a related disorder, or rather the time of the diagnostic disclosure, is a crucial step in the care of people with these neurocognitive diseases. While the disclosure procedures are well defined for practitioners who work in memory consultations, there is a grey area for hospital professionals who work in acute medical units.
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Affiliation(s)
- Éric Maeker
- Unité de court séjour gériatrique, centre hospitalier de Calais, 1601 boulevard des Justes, 62100 Calais, France.
| | - Jean Roche
- Pôle gériatrie, hôpital Fontan 2, 59037 Lille, France
| | - Bérengère Maeker-Poquet
- Unité de court séjour gériatrique, centre hospitalier de Calais, 1601 boulevard des Justes, 62100 Calais, France
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16
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Karagianis JL. Re: Risk Disclosure in Prodromal Parkinson's Disease. Mov Disord 2022; 37:1326. [PMID: 35481903 DOI: 10.1002/mds.29038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- James L Karagianis
- Clinical Associate Professor of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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17
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Clinician approaches to communicating a dementia diagnosis: An interview study. PLoS One 2022; 17:e0267161. [PMID: 35421205 PMCID: PMC9009687 DOI: 10.1371/journal.pone.0267161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Individuals with cognitive impairment and their families place a high value on receiving a dementia diagnosis, but clinician approaches vary. There is a need for research investigating experiences of giving and receiving dementia diagnoses. The current study aimed to investigate clinician approaches to giving dementia diagnoses as part of a larger study investigating patient, caregiver, and clinician experiences during the diagnosis encounter. Method Investigators conducted telephone interviews with Florida-based clinicians who give dementia diagnoses either rarely or commonly. Interviews employed a semi-structured interview guide querying communication practices used by clinicians when giving dementia diagnoses and how clinicians learned to give dementia diagnoses. Investigators used a descriptive qualitative design to conduct a thematic analysis of data. Results Fifteen Florida-based clinicians participated, representing diverse backgrounds related to gender, race/ethnicity, specialty, and practice setting. Participants reported using patient- and family-centered communication practices including checking patient understanding, communicating empathically, and involving family members. Some clinicians explicitly asked patients and/or family members about their preferences regarding diagnosis disclosure; many clinicians tailored their disclosure based on patient and family characteristics or reactions. Some clinicians reported using specific diagnoses, while others used general terms such as “memory disorder.” Clinicians reported positively framing information, including instilling hope, focusing on healthy behaviors, and discussing symptom management. Finally, clinicians provided patient/family education and arranged follow up. Clinicians reported learning approaches to dementia diagnosis disclosure through formal training and self-education. Conclusions Diverse Florida-based clinicians described dementia disclosure practices largely consistent with published guidance, but clinicians varied on approaches relating to soliciting patient disclosure preferences and terminology used. Clinicians caring for diverse populations described that cultural background affects the disclosure process, but more research is needed regarding this finding and best practices for individuals from different backgrounds.
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18
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Wilkins JM, Locascio JJ, Gunther JM, Yap L, Gomez-Isla T, Hyman BT, Blacker D, Forester BP, Okereke OI. Predictors of the importance of everyday preferences for older adults with cognitive impairment. Int Psychogeriatr 2022; 34:287-294. [PMID: 33455605 PMCID: PMC8286271 DOI: 10.1017/s1041610220003956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Among older people with cognitive impairment and mild dementia, relatively little is known about the factors that predict preferences for everyday living activities and experiences and that influence the relative importance of those activities and experiences. DESIGN Cross-sectional study. SETTING Participants were recruited from the Massachusetts Alzheimer's Disease Research Center (MADRC) Clinical Core longitudinal cohort. PARTICIPANTS The sample included 62 community-dwelling older adults with cognitive impairment (Clinical Dementia Rating global score ≥ 0.5). MEASUREMENTS We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle experiences among persons with cognitive impairment. Within-subjects analysis of variance was used to test for significant differences in the mean ratings of importance for four domains of the PELI ("autonomous choice," "social engagement," "personal growth," and "keeping a routine"). Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to importance ratings for each domain. RESULTS Significant differences were noted in the mean importance ratings of the preferences domains: "social engagement" preferences were rated as most important, followed by "autonomous choice," "personal growth," and "keeping a routine." For the "social engagement" preferences domain, female sex was significantly associated with higher importance of "social engagement," while depressive symptoms (Geriatric Depression Scale-15 scores) were significantly associated with lower importance. CONCLUSIONS This study adds novel insight into the everyday preferences of community-dwelling older adults with cognitive impairment and highlights the impact of a number of factors, particularly level of depression, on how important various everyday experiences are perceived.
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Affiliation(s)
- James M. Wilkins
- McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA
| | - Joseph J. Locascio
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
| | - Jeanette M. Gunther
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
| | - Liang Yap
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
| | - Teresa Gomez-Isla
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
| | - Bradley T. Hyman
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
| | - Deborah Blacker
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Olivia I. Okereke
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School; Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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19
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Abstract
Dementia is a progressive, irreversible illness and leading global cause of death defined by cognitive and subsequent functional decline. Current treatments have limited impact on mortality. In this chapter, we discuss the trajectory of dementia and its variability, markers associated with poorer prognosis (such as poor nutrition, pneumonia, comorbid conditions), the impact of hospitalization on prognosis, and current models of end-of-life palliative care/hospice eligibility (with the use of the Functional Assessment Staging tool and other markers). We then discuss strategies to discuss prognosis with patients and their healthcare proxies using a mental model (Ask, Discover, Anticipate, Provide, Track: ADAPT) and specific skills. Because of progression of dementia variability, prognosis is better discussed in terms of function. For patients with dementia, initiating advance care planning earlier in their disease course allows for more patient involvement (such as to identify a surrogate decision maker).
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Affiliation(s)
- Sinthana U Ramsey
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Palliative and Supportive Institute, UPMC Health System, Pittsburgh, PA, United States
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20
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Talking about future decision-making capacity and advance care planning in diagnosis disclosure of dementia. Int Psychogeriatr 2021; 33:1119-1121. [PMID: 33926599 DOI: 10.1017/s1041610221000648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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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22
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Frederiksen KS, Nielsen TR, Winblad B, Schmidt R, Kramberger MG, Jones RW, Hort J, Grimmer T, Georges J, Frölich L, Engelborghs S, Dubois B, Waldemar G. European Academy of Neurology/European Alzheimer's Disease Consortium position statement on diagnostic disclosure, biomarker counseling, and management of patients with mild cognitive impairment. Eur J Neurol 2021; 28:2147-2155. [PMID: 33368924 PMCID: PMC8246881 DOI: 10.1111/ene.14668] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Careful counseling through the diagnostic process and adequate postdiagnostic support in patients with mild cognitive impairment (MCI) is important. Previous studies have indicated heterogeneity in practice and the need for guidance for clinicians. METHODS A joint European Academy of Neurology/European Alzheimer's Disease Consortium panel of dementia specialists was appointed. Through online meetings and emails, positions were developed regarding disclosing a syndrome diagnosis of MCI, pre- and postbiomarker sampling counseling, and postdiagnostic support. RESULTS Prior to diagnostic evaluation, motives and wishes of the patient should be sought. Diagnostic disclosure should be carried out by a dementia specialist taking the ethical principles of "the right to know" versus "the wish not to know" into account. Disclosure should be accompanied by written information and a follow-up plan. It should be made clear that MCI is not dementia. Prebiomarker counseling should always be carried out if biomarker sampling is considered and postbiomarker counseling if sampling is carried out. A dementia specialist knowledgeable about biomarkers should inform about pros and cons, including alternatives, to enable an autonomous and informed decision. Postbiomarker counseling will depend in part on the results of biomarkers. Follow-up should be considered for all patients with MCI and include brain-healthy advice and possibly treatment for specific underlying causes. Advice on advance directives may be relevant. CONCLUSIONS Guidance to clinicians on various aspects of the diagnostic process in patients with MCI is presented here as position statements. Further studies are needed to enable more evidence-based and standardized recommendations in the future.
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Affiliation(s)
| | - T. Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Bengt Winblad
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstituteSolnaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | | | - Milica G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical CentreLjubljanaSlovenia
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People)Royal United HospitalBath and University of BristolBristolUK
| | - Jakub Hort
- Department of NeurologyCognitive CenterSecond Faculty of Medicine and Motol University HospitalCharles UniversityPragueCzech Republic
| | - Timo Grimmer
- Department of Psychiatry and PsychotherapySchool of MedicineRechts der Isar HospitalTechnical University of MunichMunichGermany
| | | | - Lutz Frölich
- Department of Geriatric PsychiatryUniversity of HeidelbergMannheimGermany
| | - Sebastiaan Engelborghs
- Department of Neurology and Center for NeurosciencesUZ Brussel and Free University of Brussels (VUBBrusselsBelgium
- Reference Center for Biological Markers of Dementia (BIODEM)Institute Born‐BungeUniversity of AntwerpAntwerpBelgium
| | - Bruno Dubois
- Department of NeurologyDementia Research CenterSalpêtrière HospitalSorbonne UniversityParisFrance
| | - Gunhild Waldemar
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
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23
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Linden I, Wolfs C, Perry M, Metsemakers J, van der Weijden T, de Vugt M, Verhey FR, Handels R, Olde Rikkert M, Dirksen C, Ponds RWHM. Implementation of a diagnostic decision aid for people with memory complaints and their general practitioners: a protocol of a before and after pilot trial. BMJ Open 2021; 11:e049322. [PMID: 34135053 PMCID: PMC8211080 DOI: 10.1136/bmjopen-2021-049322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Researchers, policy-makers and healthcare professionals often stress the importance of an early dementia diagnosis. Empirical evidence, however, is scarce leading to a lack of consensus on the necessity of diagnosing dementia early. We emphasise the need for a 'timely' diagnosis, that is, one that occurs at the right moment for a person with memory complaints and his/her significant other. As the optimal timing differs between individuals, the implementation of shared decision making (SDM), preferably by the general practitioner (GP), as the start of a diagnostic trajectory, could help to determine this timely moment. SDM, however, is rarely practised with respect to dementia diagnoses. Therefore, in the context of the Shared Decision-Making regarding Dementia Diagnosis project, a patient decision aid (PtDA) for 'timely' dementia diagnosis in general practice will be developed. This protocol will describe the planned before and after evaluation of its implementation. METHODS AND ANALYSIS In a mixed-methods pilot study, we will investigate decision-making processes and experiences regarding a diagnostic trajectory before and after the introduction of a PtDA for people with memory complaints, their significant others and their GPs. The 'before group' will receive diagnostics as usual from their GPs. The 'after group' will use the PtDA. We expect the PtDA to increase the level of SDM and to contribute to a timely and personalised diagnostic trajectory. Data will be collected using semistructured interviews, questionnaires and information retrieved from people with memory complaints' medical records. ETHICS AND DISSEMINATION This study protocol was approved by the Medical Review Ethics Committee of the Maastricht University Medical Centre. The findings will be published in peer-reviewed international journals and presented at conferences. This study was funded by the public funded Dutch Research Institute for Care and Medical Sciences (ZonMw). TRIAL REGISTRATION NUMBER NCT04531956.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands
| | - Job Metsemakers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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24
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McMurray J, Levy A, Holyoke P. Psychometric Evaluation and Workflow Integration Study of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25520. [PMID: 34018966 PMCID: PMC8178737 DOI: 10.2196/25520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/16/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the rapid aging of the global population, experts anticipate a surge in the prevalence of mild cognitive impairment (MCI) and dementia worldwide. It is argued that developing more sensitive, easy to administer, and valid MCI screening tools for use in primary care settings may initiate timely clinical and personal care planning and treatment, enabling early access to programs and services. Including functional competence measures in screening tests makes them more ecologically valid and may help to identify cognitive deficits at an earlier stage. OBJECTIVE We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity, and reliability of the BrainFx Screen (referred to as SCREEN hereafter), a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Quick Mild Cognitive Impairment, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the perceived usefulness and integration of the SCREEN into primary care practice to identify demonstrable impacts on clinical workflow and health care providers' (HCP) perceptions of its success as a screening tool. Patients' perceptions of completing the SCREEN and its impact on their quality of life will also be explored. METHODS This study has a concurrent, mixed methods, prospective, and quasi-experimental design. Participants will be recruited from 5 primary care family health teams (FHTs; defined by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants will include HCPs, patients, care partners, and FHT administrative executives. Patients 55 years and older with no history of diagnoses for MCI, dementia, or Alzheimer disease rostered in one of the FHTs participating in the study will be eligible to participate. Their care partners will help triangulate the qualitative data collected from patients. Participating FHTs will identify an occupational therapist from their site to participate in the study; this HCP will both administer the research protocol and participate in semistructured in-depth interviews and questionnaires. Principal component analysis will be conducted on the SCREEN data to understand the test components better. Tests comparing sensitivity, specificity, and test-retest reliability will assess the validity of SCREEN as a screening tool for MCI. RESULTS This paper describes the study protocol and its activities to date. Data collection was halted early because of COVID-19 restrictions on research activity, and data analysis is currently in progress. CONCLUSIONS At the end of the project, we anticipate having an initial comparative evaluation of the SCREEN as a tool for early detection of MCI in primary care older adult patient populations. Resource constraints on this research study limit our ability to conduct a randomized controlled trial; however, the results will assist developers of the SCREEN in determining whether rigorous controlled testing is warranted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25520.
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25
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Bourque M, Foley T. Improving the Quality of Dementia Care in General Practice: A Qualitative Study. Front Med (Lausanne) 2020; 7:600586. [PMID: 33324664 PMCID: PMC7724029 DOI: 10.3389/fmed.2020.600586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy (INDS). However, there is a paucity of research exploring GPs' views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs. Methods: Semi-structured interviews were conducted with GPs. GPs who completed the “Dementia in Primary Care” CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis. Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings (n = 9) and had nursing home commitments (n = 8). The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness. Conclusion: GPs find dementia care to be a complex and challenging aspect of primary care. While education and training is advocated by GPs, service delivery must be reconfigured. This will necessitate adequate financial resourcing and the restructuring of community-based dementia care services.
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Affiliation(s)
- Meghan Bourque
- Department of General Practice, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
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26
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Mormont E, Bier JC, Bruffaerts R, Cras P, De Deyn P, Deryck O, Engelborghs S, Petrovic M, Picard G, Segers K, Thiery E, Versijpt J, Hanseeuw B. Practices and opinions about disclosure of the diagnosis of Alzheimer's disease to patients with MCI or dementia: a survey among Belgian medical experts in the field of dementia. Acta Neurol Belg 2020; 120:1157-1163. [PMID: 32715405 DOI: 10.1007/s13760-020-01448-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
Previous surveys revealed that only a minority of clinicians routinely disclosed the diagnosis of Alzheimer's disease (AD) to their patients. Many health professionals fear that the disclosure could be harmful to the patient. Recent advances in the development of biomarkers and new diagnostic criteria allow for an earlier diagnosis of AD at the mild cognitive impairment (MCI) stage. The Belgian Dementia Council, a group of Belgian experts in the field of dementia, performed a survey among its 44 members about their opinions and practices regarding disclosure of the diagnosis of AD, including MCI due to AD, and its consequences. Twenty-six respondents declared that they often or always disclose the diagnosis of AD to patients with dementia and to patients with MCI when AD CSF biomarkers are abnormal. The majority observed that the disclosure of AD is rarely or never harmful to the patients. Their patients and their caregivers rarely or never demonstrated animosity towards the clinicians following disclosure of the diagnosis of AD. These results should reassure clinicians about the safety of AD diagnosis disclosure in most cases whether the patient is at the MCI or the dementia stage.
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Affiliation(s)
- Eric Mormont
- Department of Neurology, CHU UCL Namur, UCLouvain, 1 Avenue Dr G. Therasse, 5530, Yvoir, Belgium.
- Institute of NeuroScience, UCLouvain, 1200, Brussels, Belgium.
| | - Jean-Christophe Bier
- Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Neurology Department, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Patrick Cras
- Department of Neurology, Instituut Born Bunge, Antwerp University Hospital, Universiteit Antwerpen, 2650, Edegem, Belgium
| | - Peter De Deyn
- Laboratory of Neurochemistry and Behavior, Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Olivier Deryck
- Department of Neurology, Center for Cognitive Disorders, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Sebastiaan Engelborghs
- Laboratory of Neurochemistry and Behavior, Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology and Center for Neurosciences, UZ Brussel and Vrije Universiteit Brussel (VUB), 1090, Brussels, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Gaëtane Picard
- Department of Neurology, Clinique St Pierre, Ottignies, Belgium
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | - Evert Thiery
- Department of Neurology, University Hospital Ghent, Ghent University, C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Jan Versijpt
- Department of Neurology and Center for Neurosciences, UZ Brussel and Vrije Universiteit Brussel (VUB), 1090, Brussels, Belgium
| | - Bernard Hanseeuw
- Institute of NeuroScience, UCLouvain, 1200, Brussels, Belgium
- Department of Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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27
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Calil V, Elliott E, Borelli WV, Barbosa BJAP, Bram J, Silva FDO, Cardoso LGM, Mariano LI, Dias N, Hornberger M, Caramelli P. Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop. Dement Neuropsychol 2020; 14:201-208. [PMID: 32973973 PMCID: PMC7500814 DOI: 10.1590/1980-57642020dn14-030001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In July 2019, a group of multidisciplinary dementia researchers from Brazil and
the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil,
to discuss and propose solutions to current challenges faced in the diagnosis,
public perception and care of dementia. Here we summarize the outcomes from the
workshop addressing challenges in diagnosis. Brazil faces a major problem in
dementia underdiagnosis, particularly involving the population in an adverse
socioeconomic context. There is poor availability of resources and specialists,
and the knowledge of general practitioners and other healthcare professionals is
far from satisfactory. Low education level is a further obstacle in diagnosing
dementia, as the most commonly used screening tests are not designed to evaluate
this population. Patients and their families must overcome the stigma of a
diagnosis of dementia, which is still prevalent in Brazil and increases the
burden of this condition. Whilst the UK has greater resources, dedicated memory
services and a National Dementia Strategy plan, the National Health Service
(NHS) has limited funding. Therefore, some challenges regarding diagnosis are
common across both countries. The authors suggest possible solutions to confront
these, with the goal of improving assessment and recognition of dementia and
reducing misdiagnosis.
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Affiliation(s)
- Victor Calil
- Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro, RJ, Brazil.,Universidade Federal do Rio de Janeiro - Rio de Janeiro, RJ, Brazil
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow - Glasgow, United Kingdom
| | - Wyllians Vendramini Borelli
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil.,Instituto do Cérebro do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | - Breno José Alencar Pires Barbosa
- Instituto de Medicina Integral Prof. Fernando Figueira - Recife, PE, Brazil.,Departmento de Neurologia, Hospital das Clínicas, Universidade de São Paulo - São Paulo, SP, Brazil
| | - Jessyka Bram
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Natalia Dias
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Michael Hornberger
- Norwich Medical School, University of East Anglia - Norwich, United Kingdom
| | - Paulo Caramelli
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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28
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Bayer A. Next steps after diagnosing dementia: interventions to help patients and families. Pract Neurol 2020; 20:294-303. [PMID: 32444477 DOI: 10.1136/practneurol-2019-002416] [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] [Accepted: 03/04/2020] [Indexed: 11/03/2022]
Abstract
The way that a diagnosis of dementia is delivered to patients, what information is provided and what practical advice and support is arranged has a lasting impact and deserves at least as much attention as the process of assessment and investigation. Individuals and their families require an honest yet sensitive discussion about the nature and cause of their problems, using non-technical language and tailored to their priorities and needs. This should lead on to the provision of good-quality information in an accessible format. Priorities for intervention include medication review, attention to sensory deficits, appropriate pharmacological and nonpharmacological treatment, best use of memory aids and strategies and discussion of driving eligibility, financial entitlement and legal advice. Referral onwards should be made to an appropriate individual or service to provide ongoing emotional and practical support and signposting.
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Affiliation(s)
- Antony Bayer
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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29
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Alpinar-Sencan Z, Schicktanz S. Addressing ethical challenges of disclosure in dementia prediction: limitations of current guidelines and suggestions to proceed. BMC Med Ethics 2020; 21:33. [PMID: 32393330 PMCID: PMC7216419 DOI: 10.1186/s12910-020-00476-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background Biomarker research is gaining increasing attention focusing on the preclinical stages of the disease. Such interest requires special attention for communication and disclosure in clinical contexts. Many countries give dementia a high health policy priority by developing national strategies and by improving guidelines addressing disclosure of a diagnosis; however, risk communication is often neglected. Main text This paper aims to identify the challenges of disclosure in the context of dementia prediction and to find out whether existing clinical guidelines sufficiently address the issues of disclosing a dementia diagnosis and of disclosing the risk of developing dementia in asymptomatic and MCI stage. We will examine clinical guidelines and recommendations of three countries (USA, Canada and Germany) regarding predictive testing and diagnostic disclosure in dementia and Mild Cognitive Impairment (MCI) to show their potentials and limits. This will provide a background to address ethical implications of predictive information and to identify ways how to proceed further. We will start by examining the guidelines and recommendations by focusing on what there is already and what is missing regarding the challenges of disclosing dementia prediction and MCI. Then, we will highlight the novel ethical issues generated by the shift to identify preclinical stages of the disease by biomarkers. We will argue for the need to develop guidelines for disclosing a risk status, which requires different considerations then disclosing a diagnosis of dementia. Finally, we will make some suggestions on how to address the gap and challenges raised by referring to German Stakeholder Conference, which presents us a good starting point to the applicability of involving stakeholders. Conclusions This paper underlines the need to develop empirically based guidelines that address the ethical and social strategies for risk communication of dementia prediction by genetic as well as non-genetic biomarkers. According to our analysis, the guidelines do not address the new developments sufficiently. International efforts should aim for specific guidelines on counseling, communicating risk and disclosing results. We argue that guidelines on (risk) disclosure should be developed by involving various stakeholders and should be informed by socio-empirical studies involving laypersons’ needs and wishes regarding risk communication.
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Affiliation(s)
- Zümrüt Alpinar-Sencan
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
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30
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Gruters AAA, Christie HL, Ramakers IHGB, Verhey FRJ, Kessels RPC, de Vugt ME. Neuropsychological assessment and diagnostic disclosure at a memory clinic: A qualitative study of the experiences of patients and their family members. Clin Neuropsychol 2020; 35:1398-1414. [PMID: 32301377 DOI: 10.1080/13854046.2020.1749936] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to gain insight into the experiences of patients and their family members regarding a neuropsychological assessment (NPA) and the diagnostic disclosure given by the medical specialist (psychiatrist, geriatrician, or their residents) at the memory clinic (MC). METHOD Patients with and without a cognitive impairment and their family members were recruited from three Dutch MCs. Four focus groups with 14 patients and 13 family members were analyzed using both inductive and deductive content analysis. RESULTS Three themes were identified: uncertainty, early diagnostic paradox, and knowledge utilization. High levels of uncertainty were experienced throughout the NPA and diagnostic disclosure. The early diagnostic paradox refers to the coexistence of negative emotions, feeling distressed due to undergoing an NPA that made them aware of their cognitive complaints, and the experience of relief due to insight given by the outcome of the NPA and medical diagnosis. Knowledge utilization refers to a low retention of medical information. CONCLUSION Clinicians can reduce uncertainty by using clear communication, limiting interruptions during an NPA, and paying attention to contextual factors. Low information retention could possibly be improved by involving a family member and using visual aids or written information during the diagnostic disclosure. Finally, participants also appreciated being provided with neuropsychological feedback on the strengths and weaknesses of their cognitive profiles and with guidance on how to manage this diagnosis in their daily lives.
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Affiliation(s)
- Angélique A A Gruters
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Hannah L Christie
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
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31
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Han Y, Jia J, Li X, Lv Y, Sun X, Wang S, Wang Y, Wang Z, Zhang J, Zhou J, Zhou Y. Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China. Neurosci Bull 2019; 36:307-320. [PMID: 31792911 DOI: 10.1007/s12264-019-00444-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.
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Affiliation(s)
| | - Yuliang Han
- The 305 Hospital of People's Liberation Army, Beijing, 100017, China
| | - Jianjun Jia
- The Second Medical Center, People's Liberation Army (PLA) General Hospital, Beijing, 100853, China.
| | - Xia Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, 200030, China
| | - Yang Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 630014, China
| | - Xuan Sun
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Shanshan Wang
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Yongjun Wang
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Zhiwen Wang
- Peking University School of Nursing, Beijing, 100191, China
| | - Jintao Zhang
- The 960th Hospital of People's Liberation Army, Taian, 271000, China
| | - Jiong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuying Zhou
- HuanHu Hospital of Nankai University, Tianjin, 300350, China
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Sinclair C, Gersbach K, Hogan M, Blake M, Bucks R, Auret K, Clayton J, Stewart C, Field S, Radoslovich H, Agar M, Martini A, Gresham M, Williams K, Kurrle S. "A Real Bucket of Worms": Views of People Living with Dementia and Family Members on Supported Decision-Making. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:587-608. [PMID: 31832863 PMCID: PMC6937221 DOI: 10.1007/s11673-019-09945-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six interviews (twenty-one dyadic and fifteen individual) were undertaken with fifty-seven participants (twenty-five people living with dementia and thirty-two family members) across three states in Australia. Interpretative Phenomenological Analysis (IPA) was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants' experiences with decision-making: "the person in relationship over time" and "maintaining involvement." Participant views on the practical issues associated with supported decision-making are addressed under the themes of "facilitating decision-making," "supported decision-making arrangements," "constraints on decision-making," and "safeguarding decision-making." While participants endorsed the principles of supported decision-making as part of their overarching strategy of "maintaining involvement" in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual "constraints on decision-making" also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a "spectrum approach" to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia Albany Centre, 31 Stirling Terrace, Albany, Western Australia, 6330, Australia.
| | - Kate Gersbach
- Brightwater Group, 3/355 Scarborough Beach Road, Osborne Park, Western Australia, 6017, Australia
| | - Michelle Hogan
- Helping Hand Aged Care, 34 Molesworth Street, North Adelaide, South Australia, 5006, Australia
| | - Meredith Blake
- UWA Law School, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Romola Bucks
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia Albany Centre, 31 Stirling Terrace, Albany, Western Australia, 6330, Australia
| | - Josephine Clayton
- HammondCare Centre for Learning & Research in Palliative Care and Northern Clinical, School, Greenwich Hospital, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Cameron Stewart
- University of Sydney Law School, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Sue Field
- UWA Law School, University of Western Australia, Hackett Drive, Crawley, Western Australia, 6009, Australia
| | - Helen Radoslovich
- Helping Hand Aged Care, 34 Molesworth Street, North Adelaide, South Australia, 5006, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, (IMPACCT), University of Technology Sydney, 235 Jones Street, Ultimo, New South Wales, 2007, Australia
| | - Angelita Martini
- Brightwater Group, 3/355 Scarborough Beach Road, Osborne Park, Western Australia, 6017, Australia
| | - Meredith Gresham
- HammondCare Dementia Centre, 97 River Road, Greenwich, New South Wales, 2065, Australia
| | - Kathy Williams
- Dementia Australia Consumer Dementia Network, National Office, 42 MacQuarie Street, Barton, Canberra, Australian Capital Territory, 2600, Australia
| | - Sue Kurrle
- Northern Clinical School, University of Sydney, Sydney, New South Wales, 2006, Australia
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Hersh RG, McCommon B, Golkin EG. Sharing a Diagnosis of Narcissistic Personality: a Challenging Decision with Associated Risks and Benefits. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Day GS, Cruchaga C, Wingo T, Schindler SE, Coble D, Morris JC. Association of Acquired and Heritable Factors With Intergenerational Differences in Age at Symptomatic Onset of Alzheimer Disease Between Offspring and Parents With Dementia. JAMA Netw Open 2019; 2:e1913491. [PMID: 31617930 PMCID: PMC6806434 DOI: 10.1001/jamanetworkopen.2019.13491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Acquired and heritable traits are associated with dementia risk; however, how these traits are associated with age at symptomatic onset (AAO) of Alzheimer disease (AD) is unknown. Identifying the associations of acquired and heritable factors with variability in intergenerational AAO of AD could facilitate diagnosis, assessment, and counseling of the offspring of parents with AD. OBJECTIVE To quantify the associations of acquired and heritable factors with intergenerational differences in AAO of AD. DESIGN, SETTING, AND PARTICIPANTS This nested cohort study used data from the Knight Alzheimer Disease Research Center that included community-dwelling participants with symptomatic AD, parental history of dementia, and available DNA data who were enrolled in prospective studies of memory and aging from September 1, 2005, to August 31, 2016. Clinical, biomarker, and genetic data were extracted on January 17, 2017, and data analyses were conducted from July 1, 2017, to August 20, 2019. MAIN OUTCOMES AND MEASURES The associations of acquired (ie, years of education; body mass index; history of cardiovascular disease, hypertension, hypercholesterolemia, diabetes, active depression within 2 years, traumatic brain injury, tobacco use, and unhealthy alcohol use; and retrospective determination of AAO) and heritable factors (ie, ethnicity/race, paternal or maternal inheritance, parental history of early-onset dementia, APOE ε4 allele status, and AD polygenic risk scores) to intergenerational difference in AAO of AD were quantified using stepwise forward multivariable regression. Missense or frameshift variants within genes associated with AD pathogenesis were screened using whole-exome sequencing. RESULTS There were 164 participants with symptomatic AD, known parental history of dementia, and available DNA data (mean [SD] age, 70.9 [8.3] years; 90 [54.9%] women) included in this study. Offspring were diagnosed with symptomatic AD a mean (SD) 6.1 (10.7) years earlier than their parents (P < .001). The adjusted R2 for measured acquired and heritable factors for intergenerational difference in AAO of AD was 0.29 (F8,155 = 9.13; P < .001). Paternal (β = -9.52 [95% CI, -13.79 to -5.25]) and maternal (β = -6.68 [95% CI, -11.61 to -1.75]) history of dementia, more years of education (β = -0.58 [95% CI -1.08 to -0.09]), and retrospective determination of AAO (β = -3.46 [95% CI, -6.40 to -0.52]) were associated with earlier-than-expected intergenerational difference in AAO of AD. Parental history of early-onset dementia (β = 21.30 [95% CI, 15.01 to 27.59]), presence of 1 APOE ε4 allele (β = 5.00 [95% CI, 2.11 to 7.88]), and history of hypertension (β = 3.81 [95% CI, 0.88 to 6.74]) were associated with later-than-expected intergenerational difference in AAO of AD. Missense or frameshift variants within genes associated with AD pathogenesis were more common in participants with the greatest unexplained variability in intergenerational AAO of AD (19 of 48 participants [39.6%] vs 26 of 116 participants [22.4%]; P = .03). CONCLUSIONS AND RELEVANCE Acquired and heritable factors were associated with a substantial proportion of variability in intergenerational AAO of AD. Variants in genes associated with AD pathogenesis may contribute to unexplained variability, justifying further study.
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Affiliation(s)
- Gregory S. Day
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Carlos Cruchaga
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Thomas Wingo
- Department of Neurology, Emory University, Atlanta, Georgia
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Suzanne E. Schindler
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dean Coble
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Biostatistics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John C. Morris
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
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Abstract
BACKGROUND The apolipoprotein E (APOE) genotype provides information about Alzheimer's disease risk, yet genotype disclosure is discouraged due to concerns about possible distress. This is the first study investigating the psychological and behavioral impacts that genetic susceptibility testing for Alzheimer's disease has in an Asian population. METHODS From March 2016 to November 2017, we ran a prospective cohort study at Duke-National University of Singapore Medical School. 280 healthy Chinese elderly filled in questionnaires that measured psychological symptoms and health behaviors, 1 week before and 6 weeks after APOE genotype disclosure. Responses from ε4-positive subjects (associated with greater Alzheimer's disease risk) were compared to responses from ε4-negative subjects. RESULTS ε4 presence was not significantly associated with anxiety (p = 0.09) or depression (p = 0.25). No associations were found for changes to diet (p = 0.36), dietary supplements consumption (p = 0.90), physical activity (p = 0.15), or cognitive activity (p = 0.18). CONCLUSION There is no evidence to suggest that disclosure of APOE to Asian populations was associated with any short-term adverse psychological or behavioral impacts.
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Gruters AA, Ramakers IH, Kessels RP, Bouwman FH, Olde Rikkert MG, Blom MM, de Vugt ME, Verhey FR. Development of memory clinics in the Netherlands over the last 20 years. Int J Geriatr Psychiatry 2019; 34:1267-1274. [PMID: 31034652 PMCID: PMC6767517 DOI: 10.1002/gps.5132] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Memory clinics (MCs) have been established to improve diagnosis and treatment of cognitive disorders, including dementia. The aim of this study was to determine the characteristics and working methods of MCs in the Netherlands in 2016. More insight into different working methods can be used to improve the quality of care in Dutch MCs. Additionally, the findings will be compared with earlier results to investigate the development of MCs since 1998. METHODS A survey was sent in 1998, 2004, 2009, and 2017 to all operational Dutch MCs with questions about organization, collaboration, patients, and diagnostic procedures. RESULTS From 1998 to 2016, the number of MCs increased substantially from 12 to 91. The capacity increased from 1560 patients to 24,388. In 1998, most patients received a dementia diagnosis (85%), while in 2016, half of the patients were diagnosed with milder cognitive problems. MCs are more often part of regional care chains and are better embedded within regional care organizations. Diagnostic tools, such as blood tests (97%), neuropsychological assessment (NPA) (95%), and neuroimaging (92%), were used in nearly all MCs. The number of patients in whom these tools were used differed greatly between MCs (NPA: 5%-100%, neuroimaging: 10%-100%, and CSF: 0.5%-80%). There was an increase in the use of NPA, while the use of neuroimaging, CSF, and EEG/ECG decreased by 8% to 15% since 2009. CONCLUSIONS Since 1998, MCs have developed substantially and outgrown the primarily research-based university settings. They are now accepted as regular care facilities for people with cognitive problems.
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Affiliation(s)
- Angélique A.A. Gruters
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Inez H.G.B. Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Roy P.C. Kessels
- Donders Institute for Brain, Cognition and BehaviourRadboud University NijmegenNijmegenThe Netherlands,Department of Medical Psychology and Radboudumc Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands
| | - Femke H. Bouwman
- Alzheimer Center and Department of NeurologyVU University Medical Center, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Marcel G.M. Olde Rikkert
- Radboudumc Alzheimer Center and Department of GeriatricsRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
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Abe M, Tsunawaki S, Matsuda M, Cigolle CT, Fetters MD, Inoue M. Perspectives on disclosure of the dementia diagnosis among primary care physicians in Japan: a qualitatively driven mixed methods study. BMC FAMILY PRACTICE 2019; 20:69. [PMID: 31122197 PMCID: PMC6533714 DOI: 10.1186/s12875-019-0964-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/15/2019] [Indexed: 11/21/2022]
Abstract
Background The number of dementia patients in Japan is projected to reach seven million by 2025. While modern ethicists have largely reached the conclusion that full disclosure of dementia serves the best interest of patient, the implications of disclosure of a dementia diagnosis remains an underexplored area of research in Japan. The purpose of this study was to explore primary care physicians’ perspectives relative to the practice of disclosure of the dementia diagnosis. Methods In this qualitatively driven mixed methods project, we conducted semi-structured interviews with 24 primary care physicians using purposeful sampling to identify rural and urban representation. All interview recordings were transcribed verbatim and analyzed thematically. The research team iteratively conducted discussions of the concepts as they emerged until reaching thematic saturation. The summary was distributed to the participants for member checking and we incorporated their feedback into the final analysis. Results Of 24 participants, 12 practice in rural areas and 12 practice in urban/suburban areas. Participants’ attitudes varied in whether or not to disclose dementia diagnosis to the patients, and in the level of clarity of the name and the prognosis of the disease. Participants who were more comfortable in practicing disclosure were communicating collectively to the patients and their family members and those who were less comfortable practicing disclosure were concerned about patients’ feelings and had negative perceptions given the insidious progression of the disease. Conclusion We found substantive individual differences in the approach to disclosure of the diagnosis of dementia and the level of comfort among primary care physicians. More dialogue about this issue and training to equip primary care physicians lacking confidence in their approach may be required. Electronic supplementary material The online version of this article (10.1186/s12875-019-0964-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michiko Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Shinji Tsunawaki
- Kikugawa Family Medicine Center, Kikugawa, Japan.,Shizuoka Family Medicine Program, Hamamatsu, Japan
| | - Masakazu Matsuda
- Kikugawa Family Medicine Center, Kikugawa, Japan.,Shizuoka Family Medicine Program, Hamamatsu, Japan
| | - Christine T Cigolle
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,The School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan. .,Shizuoka Family Medicine Program, Hamamatsu, Japan.
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Patient Stakeholder Versus Physician Preferences Regarding Amyloid PET Testing. Alzheimer Dis Assoc Disord 2019; 33:246-253. [PMID: 31058683 PMCID: PMC6710130 DOI: 10.1097/wad.0000000000000311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. METHODS We surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. Topic importance was rated on a 9-point scale. Patient stakeholder and clinician views were compared using the Mann-Whitney U test. RESULTS Patient representatives (n=107) rated all survey topics as equal to or more important than clinicians (n=114) except 1 item discussing potential harms of false-positive diagnoses. Differences between patient representative and clinician populations were greatest when comparing the competing values of false-positive and false-negative diagnoses and the value of testing asymptomatic individuals. CONCLUSIONS Patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians. This underscores the importance of research investigating the effect of amyloid PET results on asymptomatic individuals and the need for amyloid PET ordering and disclosure standards.
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Hansen A, Hauge S, Hellesø R, Bergland Å. Purchasers' deliberations on psychosocial needs within the process of allocating healthcare services for older home-dwelling persons with dementia: a qualitative study. BMC Health Serv Res 2018; 18:746. [PMID: 30285719 PMCID: PMC6167900 DOI: 10.1186/s12913-018-3550-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Meeting psychosocial needs is a significant component of quality dementia care. To enable persons with dementia to live at home for as long as possible, a community healthcare service offering care where physical, social, psychological, cultural and spiritual needs are met, is recommended. A comprehensive allocation process is required to allocate individually tailored healthcare services. However, the allocation process for older home-dwelling persons with dementia, specifically for services to safeguard psychosocial needs, remains largely unexplored. Accordingly, this study aims to explore purchasers’ deliberations on psychosocial needs during the process of allocating healthcare services to older home-dwelling persons with dementia. Methods The study had a descriptive design with a qualitative approach. The primary data source was focus group interviews with purchasers who assess and allocate healthcare services. The interview data were supplemented by a review of administrative decisions made by the purchasers. Data from the focus group interviews were analysed using a descriptive and interpretive approach. Content analysis of the administrative decisions was conducted. Results The purchasers described the allocation process as challenging. The following four themes reflect the complexity of the allocation process: (i) an unfamiliar and unclear concept; (ii) a hierarchy of needs; (iii) an adjusting allocation process; (iv) a challenging documentation of administrative decisions. Conclusions The purchasers viewed a comprehensive allocation process as important. However, a web of different interplaying aspects prevented the purchasers from conducting a comprehensive need-led allocation process. Insufficient assessment or allocation threatens the adequate safeguarding of the psychosocial needs of persons with dementia. Having varied and sufficient services to allocate is of great importance, but is not sufficient. Psychosocial needs must be better incorporated as a significant element throughout the entire allocation process. Electronic supplementary material The online version of this article (10.1186/s12913-018-3550-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anette Hansen
- Department of Nursing Science, University of Oslo, Faculty of Medicine, Postbox 235, 3603, Kongsberg, Norway. .,Department of Nursing and Health Sciences and Centre for Care Research, University of South-Eastern Norway, Postbox 235, 3603, Kongsberg, Norway.
| | - Solveig Hauge
- Department of Nursing and Health Sciences and Centre for Care Research, University of South-Eastern Norway, Postbox 235, 3603, Kongsberg, Norway
| | - Ragnhild Hellesø
- Institute of Health and Society, Department of Nursing Science, University of Oslo, Faculty of Medicine, Postbox 1130 Blindern,, 0318, OSLO, Norway
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Lovisenberggaten 15b, 0456, Oslo, Norway
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Watson R, Bryant J, Sanson-Fisher R, Mansfield E, Evans TJ. What is a 'timely' diagnosis? Exploring the preferences of Australian health service consumers regarding when a diagnosis of dementia should be disclosed. BMC Health Serv Res 2018; 18:612. [PMID: 30081889 PMCID: PMC6080387 DOI: 10.1186/s12913-018-3409-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently the dementia field has shifted focus away from the early diagnosis debate in favour of 'timely' diagnosis. 'Timely' diagnosis disclosure takes into consideration the preferences and unique circumstances of the individual. Determining when diagnosis disclosure is 'timely' may be particularly complex if there are differing views between the individual, their family, and their health care providers regarding disclosure. This study explores the preferences of consumers regarding when a diagnosis of dementia should be communicated. METHODS A cross-sectional survey was conducted with English-speaking adults attending outpatient clinics at an Australian hospital. Participants were recruited by a research assistant in the clinic waiting room and invited to complete the survey on a web-connected iPad. The survey included questions examining socio-demographics and experience with dementia. Two scenarios were used to explore preferences for timing of diagnosis disclosure. RESULTS Of 446 participants, 92% preferred a diagnosis of dementia to be disclosed as soon as possible. Preferences were not associated with socio-demographics or previous dementia experience. Most participants also preferred disclosure to occur as soon as possible if their spouse or partner was diagnosed with dementia (88%). There was strong correlation between preferences for self and preferences for spouse (0.91). CONCLUSIONS These findings provide guidance to health care providers about preferences for disclosure of a dementia diagnosis, and may help to overcome potential barriers to timely diagnosis. As the prevalence of dementia increases, consumers' preference for diagnosis to occur as soon as possible has important implications for the health system.
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Affiliation(s)
- Rochelle Watson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Tiffany-Jane Evans
- Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
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Abstract
In many countries around the world, owing to the lack of specialists and equipment, delay up to a few years in help-seeking and getting diagnostic examinations for dementia is not uncommon (Sayegh and Knight, 2013), and this situation is considerably more serious in "atypical dementias" due to the challenge they present for differential diagnosis. For instance, a survey in the USA showed that misdiagnosis was common in patients with Lewy body dementia who, on average, saw at least three physicians over a year's time or more before getting the proper diagnosis (Lewy Body Dementia Association, 2010). Furthermore, in multiethnic communities, cultural and language barriers between practitioners and patients may lead to substantial delay as well (Sayegh and Knight, 2013).
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Case-finding in clinical practice: An appropriate strategy for dementia identification? ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:288-296. [PMID: 30090849 PMCID: PMC6077836 DOI: 10.1016/j.trci.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Earlier diagnosis of dementia is increasingly being recognized as a public health priority. As screening is not generally recommended, case-finding in clinical practice is encouraged as an alternative dementia identification strategy. The approaches of screening and case-finding are often confused, with uncertainty about what case-finding should involve and under what circumstances it is appropriate. We propose a formal definition of dementia case-finding with a clear distinction from screening. We critically examine case-finding policy and practice and propose evidence requirements for implementation in clinical practice. Finally, we present a case-finding pathway and discuss the available evidence for best practice at each stage, with recommendations for research and practice. In conclusion, dementia case-finding is a promising strategy but currently not appropriate due to the substantial gaps in the evidence base for several components of this approach. A formal definition of dementia case-finding is proposed. There is currently insufficient evidence to support dementia case-finding. The appropriate criteria for targeting high-risk patient groups are currently unknown.
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Jennings AA, Foley T, Walsh KA, Coffey A, Browne JP, Bradley CP. General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed-methods systematic review. Int J Geriatr Psychiatry 2018; 33:1163-1176. [PMID: 29900592 PMCID: PMC6099359 DOI: 10.1002/gps.4918] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/03/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions. METHODS We conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta-ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings. RESULTS Of the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A "line of argument" was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached. CONCLUSION This systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.
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Affiliation(s)
- Aisling A. Jennings
- Department of General Practice, School of MedicineUniversity College CorkCorkIreland
| | - Tony Foley
- Department of General Practice, School of MedicineUniversity College CorkCorkIreland
| | - Kieran A. Walsh
- School of Public HealthUniversity College CorkCorkIreland
- Pharmaceutical Care Research Group, School of PharmacyUniversity College CorkCorkIreland
- Centre for Gerontology and Rehabilitation, School of MedicineUniversity College CorkCorkIreland
| | - Alice Coffey
- Department of Nursing and MidwiferyUniversity of LimerickLimerickIreland
| | - John P. Browne
- School of Public HealthUniversity College CorkCorkIreland
| | - Colin P. Bradley
- Department of General Practice, School of MedicineUniversity College CorkCorkIreland
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Champlin BE. The informal caregiver's lived experience of being present with a patient who receives a diagnosis of dementia: A phenomenological inquiry. DEMENTIA 2018; 19:375-396. [PMID: 29771140 DOI: 10.1177/1471301218776780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the lived experience of informal caregivers who accompany loved ones as the loved ones receive a diagnosis of dementia. Each of 12 informal caregivers participated in a face-to-face interview that was audiotaped and transcribed. Analysis of the interview text revealed seven constituents as central to the general structure of this experience: (a) having anticipated the diagnosis; (b) feeling relief; (c) feeling the gravitas of the words; (d) grieving the loss; (e) watching for the patient’s reaction; (f) accepting the diagnosis and taking action; and (g) committing to care. Implications for healthcare providers are discussed, with an emphasis on the need to be sensitive to the experience of both patients and informal caregivers when disclosing a diagnosis of dementia.
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Impact of patient involvement on clinical practice guideline development: a parallel group study. Implement Sci 2018; 13:55. [PMID: 29661195 PMCID: PMC5902835 DOI: 10.1186/s13012-018-0745-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/28/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patient and public involvement (PPI) is recognized as a key component of clinical practice guideline development with important implications for guideline implementability. The impact of PPI on guidelines, however, has not been rigorously assessed. Better understanding of the impact of PPI must start with guideline question formation, which drives all subsequent development steps. The aim of this study was to investigate the effect of PPI on guideline question formation and validate a conceptual model of patient and public contributions to guidelines. METHODS For development of a clinical practice guideline on the topic of using amyloid positron emission tomography in the diagnosis of dementia, we convened two parallel guideline development groups, one with and one without patient representatives. Participating physicians were randomized to group assignment. Each group developed Population, Intervention, Comparator, Outcome, Time (PICOT) questions and identified key benefits and harms to incorporate in guideline development. Analysis included a descriptive comparison of proposed PICOT questions, benefits, and harms between groups and a qualitative analysis of discussion themes from audio recordings of the question development retreats. RESULTS Proposed guideline questions, benefits, and harms were largely similar between groups, but only the experimental group proposed outcomes relating to development of cognitive impairment at specific time points and rate of progression. The qualitative analysis of the discussions occurring during guideline question development demonstrated key differences in group conduct and validated the proposed conceptual model of patient and public contributions to guidelines. PPI influenced the conduct of guideline development, scope, inclusion of patient-relevant topics, outcome selection, and planned approaches to recommendation development, implementation, and dissemination with implications for both guideline developers and the guideline development process. CONCLUSIONS Evidence of how PPI impacts guideline development underscores the importance of engaging patient stakeholders in guideline development and highlights developer- and guideline-specific outcomes of PPI, both of which have implications for guideline implementation. It also raises the question of whether guidelines developed without such input are acceptable for use. PPI should be considered an essential element of trustworthy guideline development for purposes of development and funding.
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Low LF, McGrath M, Swaffer K, Brodaty H. Communicating a diagnosis of dementia: A systematic mixed studies review of attitudes and practices of health practitioners. DEMENTIA 2018; 18:2856-2905. [PMID: 29544345 DOI: 10.1177/1471301218761911] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to systematically review practitioners’ practices and attitudes in regards to communicating a diagnosis of dementia. A systematic search was conducted of Scopus, Web of Science and PubMed for English language original empirical papers. A sequential explanatory mixed studies analysis approach was used. Twenty-five quantitative descriptive, two intervention, six mixed methods descriptive and 21 qualitative studies were included. Pooled analysis showed that 34% of GPs and 48% of specialists usually/routinely tell the person with dementia their diagnosis, and 89% of GPs and 97% specialists usually/routinely tell the family the diagnosis. Euphemistic terms such as ‘memory problems’ are more often used to describe dementia than medical terms. Practitioners’ decision to diagnose and communicate the diagnosis of dementia are influenced by (a) their own beliefs regarding dementia and treatment efficacy and their confidence in diagnosis and communication; (b) patient circumstances including level of awareness, level of severity and family support; (c) the health and social care system including access to specialist and diagnostic services, reimbursement for diagnosis/management and availability of services and (d) cultural norms in relation to dementia including stigma, labels, and common clinical practice. The diagnosis and communication of diagnosis of dementia are intertwined processes and should be concurrently addressed in interventions. Multicomponent approaches to address these practices could include guideline development, practitioner education, anti-stigma public health campaigns, offering post-diagnosis treatments and support and sufficient reimbursement for practitioners for time spent managing dementia.
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Jenkins C, Feldman G. Recognition of preclinical signs of dementia: A qualitative study exploring the experiences of family carers and professional care assistants. J Clin Nurs 2018; 27:1931-1940. [PMID: 29495091 DOI: 10.1111/jocn.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To identify preclinical signs of dementia by exploring the experiences of family caregivers and professional care assistants. BACKGROUND Dementia results in disability, emotional strain and financial loss for people with dementia, family members and nations. Informal identification of social and behavioural risk signifiers could facilitate timely interventions with potential to delay onset of serious disability. DESIGN A retrospective qualitative approach using a naturalistic interpretive design was used. Focus groups enabled in-depth understanding of the participants' experiences of life or work with people who subsequently developed dementia. METHODS Purposive sampling was used to recruit family carers and professional carers who had cared for people who later developed dementia. The data from focus groups were fully transcribed and anonymised, and transcripts were analysed by two researchers. These researchers coded and analysed the transcripts independently; subsequently, overlapping and similar themes were identified and consensus reached on final themes. A third researcher was invited to review the analysis and ensure trustworthiness of the study findings. RESULTS Findings revealed that preclinical signs of dementia were identifiable in retrospect Participants' accounts resulted in four themes, "Lowered Threshold of Frustration", "Insight and Coping Strategies," "Early signs of poor memory" and "Alarming Events." CONCLUSIONS Earlier recognition of preclinical signs of dementia would allow affected individuals to follow health promotion advice and plan for the future. Identification of social exclusion prior to diagnosis has implications for antistigma campaigns and development of "dementia-friendly communities." RELEVANCE TO CLINICAL PRACTICE Healthcare professionals could work with those at risk, facilitating lifestyle changes to postpone symptoms and advance planning for improved autonomy. Predementia should be viewed as a disability for which reasonable adjustments can be made at a community level, to enhance and extend emotional well-being and social inclusion.
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Robinson L, Dickinson C, Magklara E, Newton L, Prato L, Bamford C. Proactive approaches to identifying dementia and dementia risk; a qualitative study of public attitudes and preferences. BMJ Open 2018; 8:e018677. [PMID: 29431130 PMCID: PMC5829774 DOI: 10.1136/bmjopen-2017-018677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The aim of this study was to critically explore the views of the public about the acceptability and feasibility of proactive approaches to earlier dementia diagnosis and also identification of people at high risk of dementia. DESIGN Qualitative study using task group methodology and thematic data analysis. SETTING Task groups were held either at the university (n=5) or at a carers' centre (n=1). PARTICIPANTS A convenience sample of 31 of 54 participants identified by local non-statutory agencies took part in a task group. All were aged between 40 years and 80 years, 21 were women and 10men participated. RESULTS Despite the use of task group methodology, participants expressed limited understandings of dementia and confusion between proactive approaches. Nevertheless, they highlighted a range of potential benefits and limitations of proactive approaches and the ethical issues raised. There was a preference to embed risk assessment within routine health checks, which focused on achieving a healthier lifestyle, rather than specifically on dementia. Participants emphasised the need to ensure informed consent prior to use of proactive approaches and to provide appropriate support. They also suggested alternative approaches that could potentially facilitate the early detection of dementia or reduce risk at a population level. CONCLUSIONS As international policy on dementia shifts towards a prevention agenda there is growing interest in identifying those at risk of developing dementia. This study provides useful insights into the acceptability of the use of such proactive approaches among the public. The introduction of proactive approaches to dementia identification raises complex practical and ethical issues, particularly in the context of low public understanding of dementia. The importance of better quality information about dementia (and the likelihood of developing dementia) and provision of psychological support for those undergoing risk assessment were highlighted.
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Affiliation(s)
- Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Dickinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eleni Magklara
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Newton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Prato
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Abstract
BACKGROUND Disclosing the diagnosis of Alzheimer's disease (AD) to a patient is controversial. There is significant stigma associated with a diagnosis of AD or dementia in China, but the attitude of the society toward disclosure of such a diagnosis had not been formally evaluated prior to our study. Therefore, we aimed to evaluate the attitude toward disclosing an AD diagnosis to patients in China with cognitive impairment from their caregivers, and the factors that may affect their attitude. METHODS We designed a 17-item questionnaire and administered this questionnaire to caregivers, who accompanied patients with cognitive impairment or dementia in three major hospitals in Shanghai, China. The caregiver's attitude toward disclosing the diagnosis of AD as evaluated by the questionnaire was compared to that of disclosing the diagnosis of terminal cancer. RESULTS A majority (95.7%) of the 175 interviewed participants (mean 14.2 years of education received) wished to know their own diagnosis if they were diagnosed with AD, and 97.6% preferred the doctor to tell their family members if they were diagnosed with AD. If a family member of the participants suffered from AD, 82.9% preferred to have the diagnosis disclosed to the patient. "Cognitive impairment" was the most accepted term by caregivers to disclose AD diagnosis in Chinese. CONCLUSION This study suggests most of the well-educated individuals in a Chinese urban area favored disclosing the diagnosis when they or their family members were diagnosed with AD.
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Jung JH, Kim MJ, Choi SH, Han NY, Park JE, Park HY, Han JW, Lee DY, Park HY. Do Patients Want to Listen to a Diagnosis of Dementia in Korea? Preferences on Disclosing a Diagnosis of Dementia and Discussing Advance Care Planning in Elderly Patients with Memory Concerns and Their Families. Psychiatry Investig 2017; 14:779-785. [PMID: 29209381 PMCID: PMC5714719 DOI: 10.4306/pi.2017.14.6.779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/14/2017] [Accepted: 07/26/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this study, we aimed to investigate preferences regarding the disclosure of a dementia diagnosis and advance care planning (ACP) in patients with memory complaints and their families. METHODS A total of 98 patients who visited the department of psychiatry at a tertiary hospital with memory complaints and 62 family members completed a structured questionnaire. The questionnaire included preferences on disclosure of dementia and cancer diagnosis, awareness and preferences on ACP. RESULTS In total, 96.9% of patients were willing to know their dementia diagnosis. There were no significant differences in preferences between the diagnosis of cancer and dementia. Only 24.7% of patients and 45.8% of family members have heard of ACP. However, 82.8% of patients agreed on the necessity of ACP under the current condition. Multivariate analysis revealed that younger patients were more likely to agree with necessity for ACP under the current condition. CONCLUSION In Korea, patients with memory complaints and their family members strongly favored a disclosure of dementia diagnosis. The majority of participants also agreed on the necessity of ACP. More active involvement of patients is needed in treatment decisions and care planning in cases of dementia as well as other life-threatening illnesses.
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Affiliation(s)
- Joon Hyung Jung
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Joo Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Na Young Han
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Young Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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