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Jørgensen K, Nielsen TR, Nielsen A, Oxbøll AB, Gerner SD, Waldorff FB, Waldemar G. Diagnostic accuracy of the Brief Assessment of Impaired Cognition case-finding instrument in a general practice setting and comparison with other widely used brief cognitive tests-a cross-validation study. Eur J Neurol 2024; 31:e16418. [PMID: 39045891 DOI: 10.1111/ene.16418] [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: 04/08/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to examine the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in a general practice (GP) setting and compare it with other widely used brief cognitive instruments. METHODS Patients aged ≥70 years were prospectively recruited from 14 Danish GP clinics. Participants were classified as having either normal cognition (n = 154) or cognitive impairment (n = 101) based on neuropsychological test performance, reported instrumental activities of daily living, and concern regarding memory decline. Comparisons involved the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), the Mini-Cog, the 6-item Clock Drawing Test (CDT-6) and the BASIC Questionnaire (BASIC-Q). RESULTS BASIC demonstrated good overall classification accuracy with an area under the receiver operating characteristic curve (AUC) of 0.88 (95% confidence interval [CI] 0.84-0.92), a sensitivity of 0.72 (95% CI 0.62-0.80) and a specificity of 0.86 (95% CI 0.79-0.91). Pairwise comparisons of the AUCs of BASIC, MMSE, MoCA and RUDAS produced non-significant results, but BASIC had significantly higher classification accuracy than Mini-Cog, BASIC-Q and CDT-6. Depending on the pretest probability of cognitive impairment, the positive predictive validity of BASIC varied from 0.83 to 0.36, and the negative predictive validity from 0.97 to 0.76. CONCLUSIONS BASIC demonstrated good discriminative validity in a GP setting. The classification accuracy of BASIC is equivalent to more complex, time-consuming instruments, such as the MMSE, MoCA and RUDAS, and higher than very brief instruments, such as the CDT-6, Mini-Cog and BASIC-Q.
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Affiliation(s)
- Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Anne-Britt Oxbøll
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Sofie D Gerner
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans B Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Garbóczy S, Mohos A, Égerházi A, Szemán-Nagy A, Zsuffa JA, Heim S, Rekenyi V, Kolozsvári LR. Exploration of the Hungarian Version of Test Your Memory in General Practice: A Cross-Sectional Correlational Study of a Convenience Sample of Middle-Aged and Older Adults. Geriatrics (Basel) 2024; 9:74. [PMID: 38920430 PMCID: PMC11202907 DOI: 10.3390/geriatrics9030074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners (GPs) may be the first to notice the cognitive deficit; therefore, it is crucial for them to have access to a screening test that can be administered quickly and efficiently. We explored the Hungarian version of the Test Your Memory self-administered dementia screening test in general practice for the early detection of dementia and cognitive impairment. METHODS In the four Hungarian cities with medical universities, 368 patients over the age of 50 attending GPs filled out the questionnaire within the framework of our cross-sectional study. RESULTS The total scores of the test showed a significant correlation with education and type of occupation and a significant negative correlation with age. The results of this research showed that the clock drawing and recall subtest scores deteriorate at the earliest age. CONCLUSION The test can be filled out in a GP's office easily and two of its subtests can raise the possibility that patients may need further assessment, especially if they have symptoms, at an earlier age than the other subtests.
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Affiliation(s)
- Szabolcs Garbóczy
- Department of Psychiatry, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - András Mohos
- Department of Family Medicine, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Anikó Égerházi
- Department of Psychiatry, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Anita Szemán-Nagy
- Department of Personality and Clinical Psychology, Institute of Psychology, University of Debrecen, 4032 Debrecen, Hungary
| | - János András Zsuffa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, 1145 Budapest, Hungary
| | - Szilvia Heim
- Department of Primary Health Care, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Viktor Rekenyi
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - László Róbert Kolozsvári
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Al-Awad FA, Al-Zahrani MA, Bawazeer AO, Al-Qahtani FS, Al-Jabari SA, Jayaseeli NJ, Alabdulkader AM, Al-Harkan KS, Al-Shammari MO, Mohammedin AS, Rohaiem SN, Al-Muslim NI, Al-Shurem MA, Albakr DM. Physicians' attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia. J Family Community Med 2024; 31:160-167. [PMID: 38800787 PMCID: PMC11114870 DOI: 10.4103/jfcm.jfcm_230_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills. MATERIALS AND METHODS This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables. RESULTS The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding. CONCLUSION Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.
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Affiliation(s)
- Feras A. Al-Awad
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Abdullah O. Bawazeer
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal S. Al-Qahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Nithya J. Jayaseeli
- Research Support Unit, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assim M. Alabdulkader
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid S. Al-Harkan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak O. Al-Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed S. Mohammedin
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaimaa N. Rohaiem
- Department of Geriatrics and Gerontology, Ain Shams University, Cairo, Egypt
| | - Nora I. Al-Muslim
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed A. Al-Shurem
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dalal M. Albakr
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Moniz-Cook E, Mountain G. The memory clinic and psychosocial intervention: Translating past promise into current practices. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1052244. [PMID: 37214129 PMCID: PMC10192709 DOI: 10.3389/fresc.2023.1052244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/16/2023] [Indexed: 05/24/2023]
Abstract
Disproportionate negative effects since the pandemic have amplified the already limited post-diagnostic support for older people with dementia. This paper summarizes an exploratory randomized controlled study of a proactive family-based intervention compared with "usual" post-diagnostic dementia care. Memory clinic practitioners collaborated with the family doctor (GP) to coordinate this. At 12-month follow-up, positive effects on mood, behavior, carer coping and maintenance of care at home were found. Current approaches to deliver post-diagnostic support in primary care may require rethinking since (i) GP workloads have increased with low numbers of GPs per head of population in parts of England; and (ii) unlike many other long-term conditions, ongoing stigma, fear and uncertainty associated with dementia adds to the huge complexity of timely care provision. There is a case for return to a "one-stop facility", with a single pathway of continuing multidisciplinary coordinated care for older people with dementia and families. Future longitudinal research could compare structured post-diagnostic psychosocial intervention coordinated by skilled practitioners in a single locality memory service "hub", against other approaches such support organized mostly within primary care. Dementia-specific instruments for outcome measurement are available for use in routine practice, and should be included in such comparative studies.
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Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
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Perruchoud E, von Gunten A, Ferreira T, Queirós AM, Verloo H. Home-Dwelling Older Adults' Day-to-Day Community Interactions: A Qualitative Study. Geriatrics (Basel) 2022; 7:geriatrics7040082. [PMID: 36005258 PMCID: PMC9408690 DOI: 10.3390/geriatrics7040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Many home-dwelling older adults present abnormal behaviours related to dementia or to non-dementia cognitive impairment (e.g., agitation, anxiety, apathy, etc.). Because many older adults live at home alone or are able to hide any signs of abnormal behaviours from others, the non-healthcare workers who interact with older adults on a daily basis are key actors in detecting those behaviours and orienting older adults towards appropriate support services. To the best of our knowledge, no studies to date have explored the daily interactions experienced between older adults and the various non-healthcare workers whom they regularly encounter in the community. This work aimed to identify the non-healthcare workers who are regularly in direct contact with older adults during their day-to-day activities and then develop specific training for these workers on the subject of abnormal behaviours among the elderly. Methods: This qualitative and ethnographic study asked 21 home-dwelling older adults aged 65 years old or more to answer open-ended questions. Sixteen had no self-reported cognitive impairments, and five had a probable or diagnosed slight cognitive impairment or mild-to-moderate dementia. A thematic analysis of the data was carried out. Results: The non-healthcare workers who spent the most time with older adults with and without reported cognitive impairments were those working in cafés or tea rooms and leisure or activity centres. Conclusions: In view of the significant amounts of contact between home-dwelling older adults and non-healthcare workers, it seems necessary and sensible to increase non-healthcare workers’ knowledge about abnormal behaviours, especially by offering them training. The proactive detection and identification of older adults’ abnormal behaviours by non-healthcare workers will ensure earlier care and reduce avoidable hospitalisations, institutionalisations and costs linked to geriatric healthcare.
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Affiliation(s)
- Elodie Perruchoud
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
- Correspondence:
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
| | - Tiago Ferreira
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
| | - Alcina Matos Queirós
- Department of Health and Social Welfare, CH-1008 Lausanne, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Henk Verloo
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
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Assaf G, El Khoury J, Jawhar S, Rahme D. Mild Cognitive Impairment and modifiable risk factors among Lebanese older adults in primary care. Asian J Psychiatr 2021; 65:102828. [PMID: 34507239 DOI: 10.1016/j.ajp.2021.102828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Mild Cognitive Impairment (MCI) is an intermediate state between normal cognition and dementia. Identification of MCI and associated risk factors is important for early intervention. This study investigated the prevalence of MCI among Lebanese older adults and associated risk factors in primary care. METHODS For this cross-sectional study, 337 adults aged 60 years and older met inclusion criteria and were recruited at a primary care clinic associated with a tertiary medical center in Beirut, Lebanon. The validated Arabic version of the Montreal Cognitive Assessment, the 5-item Geriatric Depression Scale, and the Lawton Instrumental Activities of Daily Living Scale were administered. Data about sociodemographic, behavioral, and clinical characteristics was obtained. RESULTS There was no difference in the mean age between those with normal cognition and those with MCI (mean age 70.38 ± 7.4 and 72.12 ± 7.6 years, respectively). The prevalence of MCI was 14.8% (50 out of 337), 42% were males and 58% were women. Participants having more than 12 years of education (OR = 0.297; CI = 0.112-0.788; P = 0.015) were less likely to have MCI. Participants with history of smoking (OR = 2.599; CI = 1.266-5.339; P = 0.012) or at risk of depression (OR = 2.847; CI = 1.392-5.819; P = 0.004) were more likely to have MCI. CONCLUSION Identification of patients with history of smoking and at risk of depression may serve as an opportunity to offer intensive counseling and targeted treatment to delay the onset or progression of MCI to Alzheimer's disease.
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Affiliation(s)
- Georges Assaf
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamil El Khoury
- School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Sarah Jawhar
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Diana Rahme
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Lee L, Weston WW, Hillier L, Archibald D, Lee J. Improving family medicine resident training in dementia care: An experiential learning opportunity in Primary Care Collaborative Memory Clinics. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:447-462. [PMID: 29927720 DOI: 10.1080/02701960.2018.1484737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.
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Affiliation(s)
- Linda Lee
- The Centre for Family Medicine Family Health Team, Kitchener, Canada
- Department of Family Medicine, McMaster University , Hamilton, Canada
| | - W Wayne Weston
- Schulich School of Medicine & Dentistry, Western University , London, Canada
| | - Loretta Hillier
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton Health Sciences Centre , Hamilton, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Bruyère Research Institute , Ottawa, Canada
| | - Joseph Lee
- Department of Family Medicine, McMaster University , Hamilton, Canada
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Arasanz C, Nylen K. The theory of change of the evaluation support program: Enhancing the role of community organizations in providing an ecology of care for neurological disorders. EVALUATION AND PROGRAM PLANNING 2020; 80:101451. [PMID: 28571607 DOI: 10.1016/j.evalprogplan.2017.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
This paper discusses the Ontario Brain Institute's theory of change for the Evaluation Support Program, a program designed to enhance the role of community organizations in providing care and services for people living with a brain disorder. This is done by helping community organizations build evaluation capacity and foster the use of evidence to inform their activities and services. Helping organizations to build capacities to track the 'key ingredients' of their successes will help ensure that successes are replicated and services can be improved to maximize the benefit that people receive from them. This paper describes the hypothesized outcomes and early impacts of the Evaluation Support Program, as well as how the program will contribute to the field of evaluation capacity building.
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Affiliation(s)
| | - Kirk Nylen
- Ontario Brain Institute, University of Toronto, Department of Pharmacology, Canada
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Kawakita H, Ogawa M, Matsumoto K, Kawakita Y, Hara M, Koyama Y, Fujita Y, Oshita M, Mori T, Toichi M, Takechi H. Clinical characteristics of participants enrolled in an early identification and healthcare management program for dementia based on cluster analysis and the effectiveness of associated support efforts. Int Psychogeriatr 2020; 32:1-11. [PMID: 32063242 DOI: 10.1017/s104161021900125x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although early identification and management services for dementia have become more widespread, their efficacy and the clinical characteristics of service have yet to be fully evaluated. Therefore, the objective of this study is to clarify these issues. MEASUREMENTS The subjects were 164 Japanese users of an early identification and management program for dementia, known as the Initial-phase Intensive Support Team (IPIST), between 2013 and 2015. Nonhierarchical cluster analysis was used to derive subgroups based on cognitive status and ability in activities of daily living (ADL) and behavioral and psychological symptoms of dementia (BPSD). One-way analysis of variance was performed to evaluate differences among the groups derived by the cluster analysis. A paired t test was used to assess how the clinical status of the groups changed between baseline and follow-up. RESULTS Four groups were identified by cluster analysis, i.e. a mild group, a moderate group, a BPSD group with moderate cognitive impairment and severe BPSD, and a severe group with severe cognitive impairment and severe BPSD. Although there were no significant improvements in cognitive impairment or ADL in any group, significant improvements were found in BPSD in the BPSD and severe BPSD groups. Caregiver burden was significantly lessened in all groups. Clinical diagnosis and long-term care insurance service utilization rates were significantly improved overall. CONCLUSION The users of IPIST were classified into four subgroups based on their clinical characteristics. The IPIST program could improve the quality of life of people with dementia and their caregivers.
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Affiliation(s)
- Hitomi Kawakita
- Faculty of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Ogawa
- Faculty of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiko Matsumoto
- The Central Uji Area Comprehensive Support Center, Uji, Kyoto, Japan
| | | | - Mayumi Hara
- Uji City Government Office Health and Welfare Division, Uji, Kyoto, Japan
| | - Yumi Koyama
- Uji City Government Office Health and Welfare Division, Uji, Kyoto, Japan
| | - Yoshinari Fujita
- Uji City Government Office Health and Welfare Division, Uji, Kyoto, Japan
| | - Masanori Oshita
- Uji City Government Office Health and Welfare Division, Uji, Kyoto, Japan
| | - Toshio Mori
- Kyoto Prefectural Rakunan Hospital, Uji, Kyoto, Japan
| | - Motomi Toichi
- Faculty of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health UniversitySchool of Medicine, Toyoake, Aichi, Japan
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McLaughlin K, Laird L. Timely diagnosis and disclosure of dementia for patients and their families: exploring the views of GPs. ACTA ACUST UNITED AC 2019. [DOI: 10.7748/mhp.2019.e1425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Akpan A, Tabue-Teguo M, Fougère B. Neurocognitive Disorders: Importance of Early/Timely Detection in Daily Clinical Practice. J Alzheimers Dis 2019; 70:317-322. [PMID: 31177208 DOI: 10.3233/jad-180381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neurocognitive disorders create important challenges for patients, their families, and clinicians who provide their health care. Early/timely detection in daily clinical practice allows for diagnosis and adequate treatment, psychosocial support, education, and engagement in shared decision-making related to health care, life planning, involvement in research, and financial matters. However, neurocognitive disorders, when present, are not detected or not diagnosed and not documented, in more than half of patients seen by primary care physicians. The aim of this paper is to highlight the strategies and the perspectives to improve the early/timely detection of neurocognitive disorders in daily clinical practice.
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Affiliation(s)
- Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Aintree University Hospital NHS FT, Liverpool, UK
| | | | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
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Giezendanner S, Monsch AU, Kressig RW, Mueller Y, Streit S, Essig S, Zeller A, Bally K. General practitioners' attitudes towards early diagnosis of dementia: a cross-sectional survey. BMC FAMILY PRACTICE 2019; 20:65. [PMID: 31109304 PMCID: PMC6528190 DOI: 10.1186/s12875-019-0956-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/30/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Dementia is often underdiagnosed in general practice, which may be based on general practitioners' (GPs') knowledge and emotional factors as well as external problems. This study aimed to describe GPs' attitudes toward early diagnosis of dementia. METHODS Cross-sectional postal survey in Switzerland in 2017. Members of the Swiss Association of General Practitioners (N = 4460) were asked to participate in the survey. The questionnaire assessed attitudes, enablers and barriers to early dementia diagnosis and post-diagnostic intervention strategies. Exploratory factor analysis and linear regression were used. RESULTS The survey response rate was 21%. 85% of GPs agreed with enablers of early dementia recognition (e.g. "Plan for the future, organize support and care", "Minimize the strain and insecurity of patients and their informal family caregivers"). On the other hand, 15% of respondents perceived barriers towards early dementia recognition (e.g. "Time constraints in carrying out the necessary procedures to diagnose dementia"). GPs who were more likely to agree with barriers would less often counsel family members (β = - 0.05, 95% CI = - 0.09 - -0.02) or test fitness to drive (β = - 0.05, 95% CI = - 0.09 - -0.02), and more often choose a watchful waiting strategy (β = 0.05, 95% CI = 0.02-0.09). CONCLUSIONS The attitude of the majority of GPs is not characterized by diagnostic and therapeutic nihilism. However, negative attitudes were associated with sub-optimal management after the diagnosis. Thus, health systems are required to critically examine the use of available resources allowing GPs to look after patients and their relatives in a holistic way.
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Affiliation(s)
| | - Andreas U. Monsch
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Yolanda Mueller
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Basel, Switzerland
| | - Klaus Bally
- Centre for Primary Health Care, University of Basel, Basel, Basel, Switzerland
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Lee K, Puga F, Pickering CEZ, Masoud SS, White CL. Transitioning into the caregiver role following a diagnosis of Alzheimer's disease or related dementia: A scoping review. Int J Nurs Stud 2019; 96:119-131. [PMID: 30851954 DOI: 10.1016/j.ijnurstu.2019.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify experiences, needs, interventions and outcomes for caregivers of persons with Alzheimer's disease or related dementia as they transition into this new role following diagnosis. DESIGN Scoping review of published literature. DATA SOURCES A search for published articles was conducted in PsycINFO, Scopus, Ovid and Web of Science databases. REVIEW METHODS The Arksey and O'Malley methodological framework guided the review. Studies were screened independently for inclusion by two persons. A total of 955 studies, after duplicates removed, were found by the database search. From these, 127 full-text articles were retained through the screening of titles and abstracts by two reviewers. The two reviewers assessed 46 full-text articles for eligibility. The final 29 studies identified caregiver experiences, needs, and interventions during the period following a diagnosis of Alzheimer's disease or related dementia in the scoping review. RESULTS Twenty-nine studies were organized around three major categories: i) family caregiver experiences on receiving the diagnosis (n = 23), ii) needs during this time of transition (n = 18), and iii) interventions and outcomes to support their transition into the caregiver role (n = 5). While studies may have addressed more than one topic, 16 studies intersected categories of both caregiver experience and needs, and one study intersected categories of needs and interventions. There were several studies that focused more specifically on the caregiver's initial reactions to a diagnosis of Alzheimer's disease or related dementia (n = 9), the emotional responses to the diagnosis (n = 14), changes in personal relationships and responsibilities with a new role (n = 16). Caregiver needs following the diagnosis included knowledge and information (n = 14), emotional and psychological support (n = 11), and assistance with care planning (n = 7). Five papers examined interventions specifically tailored to caregiver needs at this juncture, which support the transition into the caregiver role. CONCLUSIONS The time of receiving a diagnosis of Alzheimer's disease or related dementia is a critical period in the process of transitioning into caregiver role. This period marks a new phase in the process of caring by family caregivers. Thus, it is important to fully understand the experiences and needs of caregivers and effective interventions in order to better support their transition into this new role.
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Affiliation(s)
- Kyungmi Lee
- School of Nursing, University of Texas Health Center San Antonio, United States
| | - Frank Puga
- School of Nursing, University of Texas Health Center San Antonio, United States
| | | | - Sara S Masoud
- School of Nursing, University of Texas Health Center San Antonio, United States
| | - Carole L White
- School of Nursing, University of Texas Health Center San Antonio, United States.
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Woods B, Arosio F, Diaz A, Gove D, Holmerová I, Kinnaird L, Mátlová M, Okkonen E, Possenti M, Roberts J, Salmi A, van den Buuse S, Werkman W, Georges J. Timely diagnosis of dementia? Family carers' experiences in 5 European countries. Int J Geriatr Psychiatry 2019; 34:114-121. [PMID: 30246266 PMCID: PMC6586062 DOI: 10.1002/gps.4997] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Timely diagnosis of dementia is recommended in national strategies. To what extent is it occurring across Europe, what factors are associated with it, and what is the impact on carers emotions of quality of diagnostic disclosure? METHODS/DESIGN Survey of family carers recruited through 5 Alzheimer's associations (Czech Republic, Finland, Italy, the Netherlands, and Scotland). One thousand four hundred and nine carers participated, 84% completing online. Fifty-two percent were adult children, and 37% were spouses, with median age 57. Most (83%) were female. RESULTS Nearly half (47%) of carers reported that an earlier diagnosis would have been preferable. Delaying factors included reluctance of the person with dementia, lack of awareness of dementia, the response of professionals, and delays within health systems. Recent diagnoses were no more likely to be considered timely, although professional responses appeared to be improving. Delayed diagnoses were more often reported by adult child carers and where the diagnosis was made in the later stages of dementia, or another condition had been previously diagnosed. In all countries except Italy, the diagnosis was shared with the person with dementia in the majority of cases. Timely diagnoses and higher quality diagnostic disclosure are associated with better adjustment and less negative emotional impact on carers in the short and medium term. CONCLUSIONS Although the study sample were well educated and likely to be in touch with an Alzheimer organisation, many continued to experience the diagnosis of dementia as coming too late, and further work on public awareness, as well as on professional responses, is needed.
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Affiliation(s)
- Bob Woods
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | | | - Ana Diaz
- Alzheimer EuropeLuxembourgLuxembourg
| | | | | | | | | | - Eila Okkonen
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
| | | | - Jennifer Roberts
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | - Anna Salmi
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
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Lee L, Slonim K, Hillier LM, Lu SK, Lee J. Persons with dementia and care partners’ perspectives on memory clinics in primary care. Neurodegener Dis Manag 2018; 8:385-397. [DOI: 10.2217/nmt-2018-0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: To understand persons with dementia (PWD) and care partners’ experiences with the Primary Care Collaborative Memory Clinic (PCCMC) care model. Methods: Interviews were conducted with a purposeful sample of PWD (n = 12) and care partners (N = 16) to identify their perspectives of care received in the clinic and suggestions for improvement. Results: PWD and care partners were satisfied with care received within the PCCMC, had positive interactions with and perceived a strong sense of support from team members and felt listened to; the necessity of cognitive testing was recognized but disliked. Conclusions: The PCCMC care model can address many existing gaps in dementia care as experienced by PWD and care partners.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6 Ontario, Canada
| | - Karen Slonim
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
| | - Loretta M Hillier
- Geriatric Education & Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, 88 Maplewood Ave, Hamilton, L8M 1W9 Ontario, Canada
| | - Stephanie K Lu
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
| | - Jennifer Lee
- Centre for Family Medicine Family Health Team, McMaster University, 10 B Victoria Street South, Kitchener, N2G 1C5 Ontario, Canada
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Exploring Rural Family Physicians’ Challenges in Providing Dementia Care: A Qualitative Study. Can J Aging 2018; 37:390-399. [DOI: 10.1017/s0714980818000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RÉSUMÉCinq cent soixante-quatre mille Canadiens sont actuellement atteints de démence. Ce nombre continuera de s’accroître avec le vieillissement de la population. Les médecins de famille jouent un rôle important dans le diagnostic et la gestion des patients avec démence. Bien que des recherches aient montré les perspectives des médecins de famille dans les soins liés à la démence en milieu urbain, les connaissances associées aux défis dans les régions rurales sont encore très limitées. Cette étude visait à explorer les expériences des médecins de famille qui dispensent des soins à des patients avec démence dans des régions rurales en Alberta (Canada). Trois groupes de discussion semi-structurés comprenant 16 médecins de famille ont été organisés afin d’évaluer les barrières et les facilitateurs dans la prestation de soins à des personnes avec démence de trois communautés rurales. Les questions des groupes de discussion ont été élaborées selon le modèle duTheoretical Domains Framework(TDF) et ont été analysées selon cette approche-cadre. Les compétences des médecins, leurs opportunités et leur motivation semblent jouer des rôles majeurs dans les soins destinés à ces patients. Ces résultats de recherche pourraient être utilisés pour améliorer la qualité des soins en milieu rural pour les patients atteints de démence.
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Jansen WJ, Handels RLH, Visser PJ, Aalten P, Bouwman F, Claassen J, van Domburg P, Hoff E, Hoogmoed J, Leentjens AFG, Rikkert MO, Oleksik AM, Smid M, Scheltens P, Wolfs C, Verhey F, Ramakers IHGB. The Diagnostic and Prognostic Value of Neuropsychological Assessment in Memory Clinic Patients. J Alzheimers Dis 2018; 55:679-689. [PMID: 27716658 DOI: 10.3233/jad-160126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychological testing has long been embedded in daily clinical practice at memory clinics but the added value of a complete neuropsychological assessment (NPA) to standard clinical evaluation is unknown. OBJECTIVE To evaluate the added diagnostic and prognostic value of NPA to clinical evaluation only in memory clinic patients. METHODS In 221 memory clinic patients of a prospective cohort study, clinical experts diagnosed clinical syndrome (subjective cognitive impairment (SCI), mild cognitive impairment (MCI), or dementia) and etiology (Alzheimer's disease (AD) or no AD), and provided a prognosis of disease course (decline or no decline) before and after results of NPA were made available. The reference standard was a panel consensus based on all clinical information at baseline and up to 2 follow-up assessments. RESULTS With NPA data available, clinicians changed their initial syndromal diagnosis in 22% of patients, and the etiological diagnosis as well as the prognosis in 15%. This led to an increase in correctly classified cases of 18% for syndromal diagnosis, 5% for etiological diagnosis, and 1% for prognosis. NPA data resulted in the largest improvement in patients initially classified as SCI (syndrome: 93.3% (n = 14) correctly reclassified, etiology: net reclassification improvement [NRI] = 0.61, prognosis: NRI = 0.13) or MCI (syndrome: 89.3% (n = 23) correctly reclassified, etiology: NRI = 0.17, prognosis: NRI = 0.14), while there was no improvement in patients with dementia (syndrome: 100% (n = 1) correctly reclassified, etiology: NRI = -0.05, prognosis: NRI = -0.06). Overall, inclusion of NPA in the diagnostic process increased confidence in all diagnoses with 6-7%. CONCLUSION Administration of a complete NPA after standard clinical evaluation has added value for diagnosing cognitive syndrome and its underlying etiology in patients regarded as non-demented based on the first clinical impression.
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Affiliation(s)
- Willemijn J Jansen
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ron L H Handels
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Femke Bouwman
- Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Claassen
- Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter van Domburg
- Department of Neurology, Zuyderland Medical Center, Sittard, The Netherlands
| | - Erik Hoff
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jan Hoogmoed
- Department of Geriatrics, Laurentius Hospital, Roermond, The Netherlands.,Department of Geriatrics, St. Jans Gasthuis, Weert, The Netherlands
| | - Albert F G Leentjens
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ania M Oleksik
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Machiel Smid
- Department of Geriatrics, Zuyderland Medical Center, Sittard, The Netherlands
| | - Philip Scheltens
- Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Tumiran MA, Abdul Rahman NN, Mohd Saat R, Ismail AZ, Ruzali WAW, Bashar NKN, Hasan Adli DS. Senile Dementia from Neuroscientific and Islamic Perspectives. JOURNAL OF RELIGION AND HEALTH 2018; 57:1-11. [PMID: 26160145 DOI: 10.1007/s10943-015-0079-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Diseases involving the nervous system drastically change lives of victims and commonly increase dependency on others. This paper focuses on senile dementia from both the neuroscientific and Islamic perspectives, with special emphasis on the integration of ideas between the two different disciplines. This would enable effective implementation of strategies to address issues involving this disease across different cultures, especially among the world-wide Muslim communities. In addition, certain incongruence ideas on similar issues can be understood better. The former perspective is molded according to conventional modern science, while the latter on the analysis of various texts including the holy Qur'an, sunnah [sayings and actions of the Islamic prophet, Muhammad (pbuh)] and writings of Islamic scholars. Emphasis is particularly given on causes, symptoms, treatments and prevention of dementia.
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Affiliation(s)
- Mohd Amzari Tumiran
- Department of Al-Quran and Al-Hadith, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rohaida Mohd Saat
- Department of Mathematics and Science Education, Faculty of Education, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ahmad Zuhdi Ismail
- Department of Aqidah and Islamic Thought, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Adriyani Wan Ruzali
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurul Kabir Nurul Bashar
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Evaluation of a WeChat-based dementia-specific training program for nurses in primary care settings: A randomized controlled trial. Appl Nurs Res 2017; 38:51-59. [DOI: 10.1016/j.apnr.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/01/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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20
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Indikatoren einer gestiegenen Demenzdiagnoserate in Hausarztpraxen. Z Gerontol Geriatr 2017; 51:517-522. [DOI: 10.1007/s00391-017-1336-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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21
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Lee L, Hillier LM. Family physicians’ perspectives on memory clinics in primary care. Neurodegener Dis Manag 2016; 6:467-478. [DOI: 10.2217/nmt-2016-0031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: To identify family physicians’ perception of the primary care collaborative memory clinic (PCCMC) care model. Methods: Physicians with access to a PCCMC completed a survey to assess their satisfaction with various aspects of PCCMC care delivery (n = 78). Interviews were conducted with a purposeful sample of physicians (n = 20) to gather their opinions on the strengths, gaps in care and benefits associated with the PCCMC model. Results: There was support for this care model in providing timely quality dementia care at a primary care level, making it easier for referring physicians to manage challenging aspects of dementia care. Conclusion: PCCMCs provide a significant opportunity for supporting physicians to manage the care of persons with dementia within primary care practice.
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Affiliation(s)
- Linda Lee
- Department of Family Medicine, Centre for Family Medicine Family Health Team, McMaster University, ON, Canada
| | - Loretta M Hillier
- Specialized Geriatric Services, St Joseph’s Health Care London, Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, ON, Canada
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Shen J, Anderson MC, Arehart KH, Souza PE. Using Cognitive Screening Tests in Audiology. Am J Audiol 2016; 25:319-331. [PMID: 27788277 DOI: 10.1044/2016_aja-16-0032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/03/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The population of the United States is aging. Those older adults are living longer than ever and have an increased desire for social participation. As a result, audiologists are likely to see an increased demand for service by older clients whose communication difficulty is caused by a combination of hearing loss and cognitive impairment. For these individuals, early detection of mild cognitive impairment is critical for providing timely medical intervention and social support. METHOD This tutorial provides information about cognition of older adults, mild cognitive impairment, and cognitive screening tests, with the purpose of assisting audiologists in identifying and appropriately referring potential cases of cognitive impairment. RESULTS Topics addressed also include how to administer cognitive screening tests on individuals with hearing loss, how to use test results in audiology practice, and the potential of using cognitive screening tests for evaluating the benefit of clinical interventions. CONCLUSIONS As health care professionals who serve the aging population, audiologists are likely to encounter cases of undiagnosed cognitive impairment. In order to provide timely referral for medical assistance as well as an optimized individual outcome of audiologic interventions, audiologists should be trained to recognize an abnormality in older clients' cognitive status.
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Affiliation(s)
- Jing Shen
- Northwestern University, Evanston, IL
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23
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Lee L, Weston WW, Hillier LM. Developing memory clinics in primary care: an evidence-based interprofessional program of continuing professional development. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2013; 33:24-32. [PMID: 23512557 DOI: 10.1002/chp.21163] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day mentorship program. METHODS An online survey was completed by participants prior to the training workshop and a similar survey at least 6 months following completion of the program to measure perceived changes related to knowledge, ability, and confidence to assess and manage memory problems, and comfort in speaking to patients and caregivers about concerns regarding dementia. Participants also completed a paper-based reaction survey at the end of the workshop and observership day. RESULTS Twenty-two FHTs, with 124 health professionals, participated in this program. At follow-up there were statistically significant increases in self-reported knowledge of and ability to assess and manage cognitive impairment, confidence, comfort level in speaking to patients about memory problems, and the ability of participants' FHT to manage cognitive impairment independently. Engagement in dementia care practice activities increased following the program. All but one FHT successfully formed a memory clinic. DISCUSSION This training program represents a significant opportunity to bring about evidence-based practice change through a capacity development initiative to support primary care providers to maintain the majority of dementia care within primary care practice. The provision of practical knowledge and resources and incorporating best teaching practices to maximize knowledge transfer contributed to the success of this program.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team Memory Clinic, Kitchener, ON, Canada.
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Perry M, Melis RJF, Teerenstra S, Drasković I, van Achterberg T, van Eijken MIJ, Lucassen P, Rikkert MGMO. An in-home geriatric programme for vulnerable community-dwelling older people improves the detection of dementia in primary care. Int J Geriatr Psychiatry 2008; 23:1312-9. [PMID: 18853470 DOI: 10.1002/gps.2128] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND/OBJECTIVE Dementia is under-diagnosed in primary care. This study investigated whether an in-home geriatric assessment and management programme could improve the identification of patients with dementia in primary care. METHODS A secondary analysis was performed, using data of a randomised controlled trial that studied the effects of an in-home geriatric evaluation and management programme compared with usual care. In this trial, 151 vulnerable community-dwelling patients, aged 70 years and older, participated: 86 in the intervention group and 66 in de control group. The effect of the programme on the dementia detection rate was determined by comparing the number of new dementia diagnoses in both study arms at 6 months follow-up. RESULTS Of all 151 participants, 38 (25%) had a registered dementia diagnosis at baseline. During follow-up, 23 of 113 patients without a registered dementia diagnosis at baseline were identified as suffering from dementia. The difference between the numbers of new dementia diagnoses in the intervention group (19 of 66 patients) and the control group (4 of 47 patients) was significant. (p = 0.02) CONCLUSION An in-home geriatric assessment and management programme for vulnerable older patients improves the detection of dementia and can therefore contribute to overcoming of under-diagnosis of dementia.
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Affiliation(s)
- M Perry
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Mcainey CA, Harvey D, Schulz ME. First Link: Strengthening Primary Care Partnerships for Dementia Support. ACTA ACUST UNITED AC 2008. [DOI: 10.7870/cjcmh-2008-0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While primary care faces many challenges, including an increasing prevalence of older individuals, emerging knowledge about the potential benefits of collaborative partnerships has encouraged the development of new means of providing and supporting primary care. First Link™ is an innovative program involving collaborations among primary care providers, Alzheimer Societies, and other health professionals. The program aims to support persons with Alzheimer's and related diseases after the diagnosis is made and to link them with support services earlier in the disease course. This paper describes the First Link program, provides an overview of a study currently underway to evaluate it, and identifies some of the benefits and challenges associated with this partnership.
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Affiliation(s)
- Carrie A. Mcainey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton Family Health Team, and Geriatric Psychiatry Service, St. Joseph’s Healthcare Hamilton, Ontario
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Cahill S, Clark M, O'Connell H, Lawlor B, Coen RF, Walsh C. The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland. Int J Geriatr Psychiatry 2008; 23:663-9. [PMID: 18229882 DOI: 10.1002/gps.1956] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The diagnosis of dementia poses difficulties for general practitioners (GPs) particularly when access to specialist diagnostic services is delayed. Ireland is soon to witness an increase in numbers of people presenting with dementia, yet little is known about the service needs of GPs when attempting to diagnose dementia. OBJECTIVES To detail the service needs of GPs, especially their training needs, access to diagnostic resources such as CT and MRI brain scans and access to specialist services such as Old Age Psychiatry (OAP), Geriatric Medicine (GM) and Neuropsychology (NP). METHODS The paper is based on survey data collected from a sample of GPs (n = 300) registered with the Irish College of General Practitioners (ICGP) and on qualitative data collected from a Focus Group (n = 7). RESULTS GPs were more likely to blame themselves than either the health care system, their patients or family members for the late presentation of dementia in primary care. Stigma was a major obstacle preventing GPs from being more proactive in this area. Rural GPs felt geographically disadvantaged accessing diagnostic services and both rural and urban GPs experienced considerable time delays accessing specialist diagnostic services. CONCLUSIONS Findings provide compelling evidence that training and access to diagnostic services are only two of several different structural and ideological obstacles that GPs encounter when attempting to diagnose dementia. Future educational supports for GPs need to be developed which concentrate on these areas.
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Affiliation(s)
- S Cahill
- Dementia Services Information and Development Centre, St James's Hospital, Dublin Ireland, Trinity College Dublin, Ireland.
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Kootte M, Steverink N. [Psychologists and openness concerning the diagnosis of dementia to the patient: exploratory research]. Tijdschr Gerontol Geriatr 2008; 39:90-99. [PMID: 18637396 DOI: 10.1007/bf03078134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM To explore the openness about the diagnosis dementia amongst psychologists the following questions were asked. What is their opinion about openness concerning the diagnosis of dementia? What do they actually tell their patients? Why do or don't they mention dementia? METHOD A semistructured questionnaire was given to 17 psychologists working in the North of the Netherlands. They were asked to report on their intention to be open about the diagnosis dementia in general and after neuropsychological examination of 90 patients. These answers were compared to what was actually said to the 90 patients. The collected data have been analyzed mainly qualitatively. RESULTS Essentially psychologists believe that patients need to be informed openly about the diagnosis of dementia. In practice nearly all psychologists also intended to mention the diagnosis of dementia. However, in about a third of the cases, where the results indicated dementia, this was not mentioned openly. Whether or not the diagnosis dementia is discussed openly and in which way, appears to depend on the context and the clarity of the diagnosis, the wishes and reaction of the carer and whether the patient is judged to be able to cope. CONCLUSION Just like physicians, psychologists are not, as a matter of course, open about the diagnosis of dementia to their patients. Circumstances appear to guide them more than their own opinion about what is appropriate.
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Affiliation(s)
- M Kootte
- Universitair Mledisch Centrum Groningen (UMCG) en Rijksuniversiteit Groningen (RUG).
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Argimón Pallàs JM, Riu Subirana S, Lizán Tudela L, Badia Llach X, Martínez Lage JM. [Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA Study]. Aten Primaria 2007; 39:171-7. [PMID: 17428419 PMCID: PMC7664581 DOI: 10.1016/s0212-6567(07)70871-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 05/24/2006] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. DESIGN Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. SETTING A total of 105 primary care centres. PARTICIPANTS The study included 921 patients who attended a clinic. MAIN MEASUREMENTS In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. RESULTS The majority of subjects were female (66.9%) and the mean age was 74.3+/-6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. CONCLUSIONS The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.
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Affiliation(s)
| | | | - Luis Lizán Tudela
- Health Economics and Outcomes Research. IMS Health. Barcelona. España
- Unidad Docente de Medicina de Familia. Castellón. España
| | - Xavier Badia Llach
- Health Economics and Outcomes Research. IMS Health. Barcelona. España
- Departamento de Epidemiología Clínica y Salud Pública. Hospital de la Santa Creu i Sant Pau. Barcelona. España
| | - José Manuel Martínez Lage
- Unidad de Trastornos de Memoria. Departamento de Neurología y Neurocirugía. Clínica Universitaria de la Universidad de Navarra. Pamplona. Navarra. España
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Waldemar G, Phung KTT, Burns A, Georges J, Hansen FR, Iliffe S, Marking C, Rikkert MO, Selmes J, Stoppe G, Sartorius N. Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry 2007; 22:47-54. [PMID: 17044135 DOI: 10.1002/gps.1652] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper reviews and discusses existing barriers to diagnosis and treatment for patients with dementia in Europe as well as approaches to overcome these barriers. The barriers to care are manifold, being present at all levels in each society and between countries in Europe. Multilevel and multifaceted strategies are needed to improve diagnosis and treatments for all patients with cognitive complaints. A multidisciplinary approach based on close collaboration between GPs and specialised memory clinics may be the ideal model for early accurate diagnosis and subsequently early pharmacological and psychosocial interventions. For all healthcare professionals, there should be specialised training in dementia and frequently updated practice guidelines to provide the framework for standards of care. Culture-sensitive strategies to promote public knowledge and destigmatize dementia are essential. Policy makers and authorities should be made aware of the benefits of early access to diagnosis and treatment.
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Affiliation(s)
- Gunhild Waldemar
- Memory Disorder Research Group, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
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Vernooij-Dassen MJFJ, Moniz-Cook ED, Woods RT, De Lepeleire J, Leuschner A, Zanetti O, de Rotrou J, Kenny G, Franco M, Peters V, Iliffe S. Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. Int J Geriatr Psychiatry 2005; 20:377-86. [PMID: 15799080 DOI: 10.1002/gps.1302] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Timely recognition and diagnosis of dementia is the pre-condition for improving dementia care, but diagnosis often occurs late in the disease process. OBJECTIVE To compare facilitators and obstacles to the timely recognition of dementia across eight European Union states, in order to implement established policies for earlier diagnosis. METHODS A modified focus group technique, including a pre and posterior procedure. RESULTS Twenty-three participants from different disciplines, purposively sampled for professional expertise in dementia research and innovative practice, attended two focus groups. Stigma in ageing and dementia, accompanied by a sense that there is little to offer until later on in the disease, underpinned the widespread reluctance of GPs to recognise dementia at an early stage and were major obstacles to the timely diagnosis of dementia across all eight countries. Dementia care services varied widely across Europe. Countries with the greatest development of dementia health care services were characterised by national guidelines, GPs fulfilling a gatekeeper function, multi-disciplinary memory clinics and innovative programmes that stimulated practice and new services. Dementia-related stigma was perceived as being less prominent in these countries. CONCLUSIONS Overcome of delays in the timely diagnosis of dementia needs more than specialist services. They should address the processes associated with stigma, age and dementia, especially where these relate to physician practice and diagnostic disclosure. Stigma is perceived as variable across European States, with a promising finding that its impact is relatively small in countries with the widest range of dementia care services.
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Affiliation(s)
- Myrra J F J Vernooij-Dassen
- Alzheimer Centre/Centre for Quality of Care Research/Vocational training General Practitioners of University Medical Centre Nijmegen, The Netherlands.
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Keady J, Woods B, Hahn S, Hill J. Community mental health nursing and early intervention in dementia: developing practice through a single case history. J Clin Nurs 2004; 13:57-67. [PMID: 15724820 DOI: 10.1111/j.1365-2702.2004.01045.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
People Nursing in association with Journal of Clinical Nursing 13, 6b, 57-67 Community mental health nursing and early intervention in dementia: developing practice through a single case history This paper reports on a single case history taken from the 'Dementia Action Research and Education' project, a 15-month primary care intervention study that was undertaken in North Wales in the early part of 2000. The study sought to address the meaning, context and diversity of early intervention in dementia care and employed a community mental health nurse and a psychiatric social worker to undertake early and psychosocial interventions with older people with dementia (aged 75 years and over) and their families. The workers tape-recorded, documented and analysed their interventions with 27 older people with dementia and their families over the 15-month duration of the study. Clinical supervision was also undertaken during the intervention phase. One case history is presented in this paper to illustrate the work of the community mental health nurse and to identify areas of practice development. Greater role transparency, collaborative working and improvement in educational preparation for practice are called for.
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Affiliation(s)
- John Keady
- Northumbria University, School of Nursing, Midwifery and Health Studies, University of Wales Bangor, Gwynedd, UK.
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2003; 18:1149-56. [PMID: 14870737 DOI: 10.1002/gps.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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