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Zhu Y, Park S, Kolady R, Zha W, Ma Y, Dias A, McGuire K, Hardi A, Lin S, Ismail Z, Adkins‐Jackson PB, Trani J, Babulal GM. A systematic review/meta-analysis of prevalence and incidence rates illustrates systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research. Alzheimers Dement 2024; 20:4315-4330. [PMID: 38708587 PMCID: PMC11180860 DOI: 10.1002/alz.13820] [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: 09/27/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 05/07/2024]
Abstract
We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian-American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random-effects meta-analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian-American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non-Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01-33.8) per 1000 person-years with a range of 75.19-13.59 (12.89-14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. HIGHLIGHTS: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian-Americans. There is limited data on group-specific risk factors for ADRD among Asian-Americans. The average prevalence of (ADRD) among Asian-Americans was found to be 7.4%, with a wide range from 0.5% to 46%.
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Affiliation(s)
- Yiqi Zhu
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | - Soobin Park
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Wenqing Zha
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Ying Ma
- University of Houston56B M.D. Anderson Library HoustonTexasUSA
| | - Amanda Dias
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | | | - Angela Hardi
- Bernard Becker Medical LibraryWashington University School of MedicineSt. LouisMissouriUSA
| | - Sunny Lin
- Division of General Medical SciencesDepartment of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health SciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterDevonUK
| | - Paris B. Adkins‐Jackson
- Departments of Epidemiology and Sociomedical SciencesMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Jean‐Francois Trani
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgCnr Kingsway & University RoadsJohannesburgSouth Africa
- National Conservatory of Arts and CraftsParisFrance
| | - Ganesh M. Babulal
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- National Conservatory of Arts and CraftsParisFrance
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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Browne K, England A, Young R, Moore N, Kjelle E, Owen A, McEntee MF. Radiographers' perceptions of the experiences of patients with dementia attending the radiology department. J Med Imaging Radiat Sci 2024; 55:189-196. [PMID: 38350753 DOI: 10.1016/j.jmir.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Patients with dementia frequently present to the Radiology Department. However, stigmas have been recorded amongst radiographers surrounding imaging persons with dementia (PwD). This study aimed to investigate the impact of PwD attending the Radiology Department for imaging and the resultant effects to all patients, radiographers, and the Department from the perspectives of the examining radiographer. METHODS A paper-based questionnaire of radiographers' perceptions and experiences of individual examinations 'termed an interaction form' was created and made available in a public hospital in Ireland for a period of eight weeks. Radiographers completed the interaction form collecting data regarding individual imaging examinations of PwD. The form comprised sixteen closed and one open-ended question on the radiographers' individual perspectives of PwDs' abilities and distress levels, carers and comforters and their role in the examination, what the radiographer found helpful in the interaction, and any adverse events. Data were analysed using a combination of descriptive analysis and thematic content analysis. RESULTS Thirty-three interaction forms were completed by the participating radiographers. The modality most commonly represented in the survey was general X-ray (58%). Radiographers reported 84% of examinations for PwD required extra time, with 27% of examinations required repeat imaging and 69% of patients appeared distressed. A carer helped facilitate the completion of 77% of examinations. Qualitative data indicated that distractive and communicative techniques were used by radiographers to make the patient feel more comfortable and help with examination success. CONCLUSION PwD often require more time for radiological examinations, they often need repeat imaging and re-scheduling of an examination at a more appropriate time. These factors need to be considered when scheduling and performing radiological examinations. Patient distress was frequently encountered, this area may benefit from further research and dedicated practitioner training which could help drive improvements in patient experience.
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Affiliation(s)
- Katie Browne
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland.
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Elin Kjelle
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | - Andrew Owen
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
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Crombie A, Lingam S, Pascoe A, Disler P, Asaid A, Disler R. Rural general practitioner confidence in diagnosing and managing dementia: A two-stage, mixed methods study of dementia-specific training. Aust J Rural Health 2024; 32:263-274. [PMID: 38268187 DOI: 10.1111/ajr.13082] [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: 05/24/2022] [Revised: 10/16/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Dementias a prevalent chronic healthcare condition affecting 46 million people worldwide and projected to grow in the coming years. Australians living in rural and regional areas often lack access to specialist dementia care, despite greater prevalence relative to metropolitan areas. OBJECTIVE This study aimed to explore general practitioners (GP) understanding, confidence and attitudes towards dementia management in the rural context, and design and pilot a dementia-specific training program. DESIGN A two-stage, mixed methods design, using qualitative and quantitative methods. Sixteen regional GPs from across Victoria participated in scoping semi-structured interviews. Fourteen separate GPs in the St Anthony Family Medical Practice group in the regional Loddon-Mallee area of Victoria completed the pilot training intervention. Pre- and post-training surveys (n = 10), as well as post-training interviews (n = 10), assessed attitude and knowledge changes. FINDINGS Analysis of semi-structured scoping interviews indicated three themes regarding experience of dementia management, including: (1) attitudes to and experiences of dementia; (2) supporting people living with dementia; and (3) knowledge, education and training of dementia. The pilot dementia-specific training was found to improve attitudes (agreement across 24 best-practice indicators improved from 30% to 79%), knowledge (median increase of 2.5/10) and confidence in managing dementia and disclosing dementia diagnoses (median increase 3/10 and 2.75/10, respectively). DISCUSSION General practitioners in this study lacked initial confidence in detecting and managing dementia in a rural primary care setting. A targeted training program showed improvements in these areas. CONCLUSION Accessible, locally delivered, dementia education has the potential to improve confidence in early detection and management of people with dementia and thereby may address gaps in access to care for people living with dementia in rural settings.
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Affiliation(s)
- Angela Crombie
- School of Rural Health, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Bendigo Health, Bendigo, Victoria, Australia
| | - Shivanjali Lingam
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
| | - Amy Pascoe
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
| | - Peter Disler
- School of Rural Health, Monash University, Clayton, Victoria, Australia
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
- St Anthony Memory Service (SAMS), Strathfieldsaye, Bendigo, Victoria, Australia
| | - Adel Asaid
- St Anthony Memory Service (SAMS), Strathfieldsaye, Bendigo, Victoria, Australia
| | - Rebecca Disler
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
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Berghout M, Waller A, Lachapelle N, Noble N, Nair BK, Sanson-Fisher R. Preferred type, timing and format of dementia information: A cross-sectional survey of carers of people living with dementia. Australas J Ageing 2024; 43:131-139. [PMID: 37877350 DOI: 10.1111/ajag.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To clarify the unmet information needs of carers of people living with dementia, including the stage of their care journey at which topics become relevant, and the preferred format and mode of delivery of information. METHODS A cross-sectional survey of carers of people living with dementia was conducted between April 2022 and October 2022. Carers were recruited through public and private geriatric hospital and community clinics, aged care providers, an online research register and community dementia services. Consenting carers completed a survey assessing sociodemographic characteristics, preferred type and timing of information about dementia, accessing services, changes in behaviour/personality, changes in physical/emotional health, managing own health/well-being and preferred information format and mode of delivery. RESULTS A total of 163 carers returned a survey (20% response rate). Most carers (75-98%) reported wanting information across a range of topics. Carers preferred general dementia information at diagnosis, information about accessing services at or within the first year of diagnosis, and information on managing symptoms as they emerged. Carers were most interested in receiving information in-person face-to-face (60% very interested), written information (51% very interested) or via face-to-face group information sessions (42% very interested). CONCLUSIONS Carers of people living with dementia expressed a desire for information on a wide range of topics, which changed as the dementia of the person they cared for progressed. Information needs to be made available in a variety of formats to cater for differing ways in which it is consumed.
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Affiliation(s)
- Mani Berghout
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Amy Waller
- Health Behaviour Research Collaborative, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New South Wales, Newcastle, Australia
| | - Nicole Lachapelle
- Health Behaviour Research Collaborative, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New South Wales, Newcastle, Australia
| | - Natasha Noble
- Health Behaviour Research Collaborative, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New South Wales, Newcastle, Australia
| | - Balakrishnan Kichu Nair
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New South Wales, Newcastle, Australia
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Amano T, Halvorsen CJ, Kim S, Reynolds A, Scher C, Jia Y. An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships. Alzheimers Dement 2024; 20:1614-1626. [PMID: 38053452 PMCID: PMC10984499 DOI: 10.1002/alz.13574] [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: 04/05/2023] [Revised: 09/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity. METHODS Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity. RESULTS A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity. DISCUSSION Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.
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Affiliation(s)
- Takashi Amano
- Department of Social WorkSchool of Arts and SciencesRutgers University NewarkNewarkUSA
| | | | - Seoyoun Kim
- Department of SociologyTexas State UniversitySan MarcosUSA
| | - Addam Reynolds
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesUSA
| | - Clara Scher
- School of Social WorkRutgers UniversityNew BrunswickUSA
| | - Yuane Jia
- Department of Interdisciplinary StudiesSchool of Health ProfessionsRutgers Biomedical and Health SciencesNewarkUSA
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Tolchin B. Improving Communication Around the Diagnosis of Dementia. Neurol Clin Pract 2024; 14:e200237. [PMID: 38144899 PMCID: PMC10741378 DOI: 10.1212/cpj.0000000000200237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Benjamin Tolchin
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine; Yale New Haven Health Center for Clinical Ethics
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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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8
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Pham BD, Kim BG, Esterman A, Brodaty H, Kurrle S, Nguyen TB, Nguyen TH, Roughead E, Hinton L, Dang TH, Nguyen TDH, Tran K, Crotty M, Du D, Nguyen TA. Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam. BMC Health Serv Res 2024; 24:86. [PMID: 38233921 PMCID: PMC10792887 DOI: 10.1186/s12913-023-10460-4] [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: 02/22/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam. METHODS A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam. RESULTS The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management. CONCLUSIONS The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.
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Affiliation(s)
- Bich Diep Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Bao Giang Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
| | - Adrian Esterman
- UniSA: Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Kurrle
- The University of Sydney, Sydney, NSW, Australia
| | | | | | - Elizabeth Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- University of California, Davis, Sacramento, CA, USA
| | - Thu Ha Dang
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Thi Diem Huong Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kham Tran
- National Ageing Research Institute, Melbourne, VIC, Australia
- Flinders University, Adelaide, SA, Australia
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Duc Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuan Anh Nguyen
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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9
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Radcliffe KG, Halim M, Ritchie CS, Maus M, Harrison KL. Care Setting Transitions for People With Dementia: Qualitative Perspectives of Current and Former Care Partners. Am J Hosp Palliat Care 2023; 40:1310-1316. [PMID: 36730920 PMCID: PMC10394111 DOI: 10.1177/10499091231155601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Care partners (CP) of people with dementia (PWD) report that decisions about care setting are aided by the support of healthcare providers. However, providers are often underprepared to offer adequate counseling. This qualitative study aimed to identify what support from providers will assist CPs in making decisions related to care setting throughout the dementia journey. We conducted semi-structured interviews with current CPs of PWD and former CPs of decedents. We utilized the constant comparative method to identify themes regarding preferences around care setting as the PWD progressed from diagnosis to end-of-life. Participants were 31 CPs, including 16 current and 15 former CPs. CPs had a mean age of 67 and were primarily white (n = 23/31), female (n = 21/31), and spouses (n = 24/31). Theme 1: Current CPs discussed overwhelming uncertainty pertaining to care setting, expressing "I don't know when I need to plan on more care," and a desire to understand "what stage we are at." Theme 2: Later in the disease, former CPs wanted guidance from healthcare providers on institutional placement ("I sure would've loved some help finding better places") or support to stay in the home ("a doctor had to come to the house"). CPs want early, specific guidance from healthcare providers related to transitions between home and long-term care. Early in the disease course, counseling geared toward prognosis and expected disease course helps CPs make plans. Later, caregivers want help identifying locations or institutionalization or finding home care resources.
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Affiliation(s)
- Kate G Radcliffe
- UC Berkeley-UCSF Joint Medical Program, University of California at Berkeley, Berkeley, CA, USA
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marlon Maus
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
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10
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Berendzen KM. Understanding social attachment as a window into the neural basis of prosocial behavior. Front Neurol 2023; 14:1247480. [PMID: 37869145 PMCID: PMC10585278 DOI: 10.3389/fneur.2023.1247480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
The representation and demonstration of human values are intimately tied to our status as a social species. Humans are relatively unique in our ability to form enduring social attachments, characterized by the development of a selective bond that persists over time. Such relationships include the bonds between parents and offspring, pair bonds between partners and other affiliative contacts, in addition to group relationships to which we may form direct and symbolic affiliations. Many of the cognitive and behavioral processes thought to be linked to our capacity for social attachment-including consolation, empathy, and social motivation, and the implicated neural circuits mediating these constructs, are shared with those thought to be important for the representation of prosocial values. This perspective piece will examine the hypothesis that our ability to form such long-term bonds may play an essential role in the construction of human values and ethical systems, and that components of prosocial behaviors are shared across species. Humans are one of a few species that form such long-term and exclusive attachments and our understanding of the neurobiology underlying attachment behavior has been advanced by studying behavior in non-human animals. The overlap in behavioral and affective constructs underlying attachment behavior and value representation is discussed, followed by evidence from other species that demonstrate attachment behavior that supports the overlapping neurobiological basis for social bonds and prosocial behavior. The understanding of attachment biology has broad implications for human health as well as for understanding the basis for and variations in prosocial behavior.
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Affiliation(s)
- Kristen M. Berendzen
- Department of Psychiatry and Biological Sciences, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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11
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Bhatt J, Kohl G, Scior K, Charlesworth G, Muller M, Dröes RM. Comparing the stigma experiences and comfort with disclosure in Dutch and English populations of people living with dementia. DEMENTIA 2023; 22:1567-1585. [PMID: 37480343 PMCID: PMC10521157 DOI: 10.1177/14713012231188503] [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: 07/24/2023]
Abstract
OBJECTIVES People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have been validated in languages other than English. We investigated the psychometric properties of Dutch translations of three stigma measures, and explored the stigma experiences of Dutch and English people living with dementia as well as patterns and predictors of comfort with disclosure. METHODS Community-dwelling adults living with dementia in the Netherlands (n = 40) and England (n = 40) completed either the English versions or the Dutch translations of the Comfort with Disclosure scale and three stigma measures (Stigma Impact, Stigma Stress, and Secrecy Scale). We established the psychometric properties of the stigma measures and conducted correlation and regression analyses. RESULTS Internal consistency was good to excellent for all measures in the Dutch sample. Small but significant differences were found between the Dutch and English samples on the total score of the Stigma Impact Scale and its subscale social isolation. Age was negatively associated with comfort disclosing to family, and desire for secrecy was negatively associated with comfort disclosing to both family and friends. CONCLUSIONS The psychometric properties of the Dutch scales were satisfactory. Many people living with dementia would feel comfortable disclosing their diagnosis to family and friends, but stigma experiences can greatly affect this decision. Cross-cultural differences in stigma experiences in persons with dementia require further investigation.
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Affiliation(s)
- Jem Bhatt
- UCL Unit for Stigma Research, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Gianna Kohl
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katrina Scior
- UCL Unit for Stigma Research, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Research and Development, North East London Foundation Trust, London, UK
| | - Majon Muller
- Department of Internal Medicine, Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc/Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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12
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Wangler J, Jansky M. What requirements do primary care physicians have with regard to dementia diagnostics and dementia care? - a survey study among general practitioners in Germany 2022/2023. Arch Public Health 2023; 81:155. [PMID: 37620850 PMCID: PMC10464123 DOI: 10.1186/s13690-023-01174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND General practice offers good conditions to detect and provide care for dementia-related diseases. Nonetheless, the effectiveness of dementia care in general practice is repeatedly criticised. To date, few studies have attempted to form a comprehensive picture of the status quo of dementia care in general practice that focuses on GP perspectives of experience and action. The aim of this study was to identify potential strengths and weaknesses of GP-based dementia care, by means of combined consideration of relevant care and treatment dimensions (construct of 'dementia sensitivity'). METHODS Through an online poll, a total of 4,511 GPs who are active as treatment providers in Baden-Württemberg, Hesse, Rhineland-Palatinate and Saarland were surveyed between September 2022 and January 2023. In addition to the descriptive analysis, a T-test with independent samples was used to identify significant differences between two groups (interval-scaled or metric variables). Pearson's chi-squared test (χ2) was used to analyze the percentage values. Two levels of significance were tested for (mean difference at p < 0.05 and p < 0.001). In the course of the analysis, there were particular differences with regard to the sociodemographic variables 'urban vs. rural doctors' and 'doctors with geriatric training vs. doctors with no geriatric training'. Therefore, a complete listing of these parameters is given in the tables. In addition, the factor analysis method was employed. RESULTS The respondents consider it important for GPs to provide care and support for dementia patients. The doctors express the desire to offer active support to patients and their family caregivers. At the same time, many GPs experience challenges and difficulties when it comes to practical diagnostic steps (in line with guidelines), the (early) identification of dementia and consistent disease management, including the anticipation of care and treatment needs. Moreover, it appears that a significant proportion of the sample has only limited confidence when it comes to review relevant help and support services. One consistent finding is that some doctors in urban practices who also have geriatric training show substantial increases in knowledge and information with regard to dementia care. CONCLUSIONS In the light of the findings, it seems particularly advisable to strengthen the geriatric competence of GPs. Moreover, it seems to be essential to ensure that they are better informed about cooperation and support structures in the area of dementia care and better integrated into these.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
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13
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Zacher M, Brady S, Short S. Geographic Patterns of Dementia in the United States: Variation by Place of Residence, Place of Birth, and Subpopulation. J Gerontol B Psychol Sci Soc Sci 2023; 78:1192-1203. [PMID: 36891976 PMCID: PMC10292838 DOI: 10.1093/geronb/gbad045] [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: 06/21/2022] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES The prevalence of dementia varies geographically in the United States. However, the extent to which this variation reflects contemporary place-based experiences versus embodied exposures from earlier in the life course remains unclear, and little is known regarding the intersection of place and subpopulation. This study, therefore, evaluates whether and how risk for assessed dementia varies by place of residence and birth, overall and by race/ethnicity and education. METHODS We pool data from the 2000 to 2016 waves of the Health and Retirement Study, a nationally representative panel survey of older U.S. adults (n = 96,848 observations). We estimate the standardized prevalence of dementia by Census division of residence and birth. We then fit logistic regression models of dementia on region of residence and birth, adjusting for sociodemographic characteristics, and examine interactions between region and subpopulation. RESULTS The standardized prevalence of dementia ranges from 7.1% to 13.6% by division of residence and from 6.6% to 14.7% by division of birth, with rates highest throughout the South and lowest in the Northeast and Midwest. In models accounting for region of residence, region of birth, and sociodemographic covariates, Southern birth remains significantly associated with dementia. Adverse relationships between Southern residence or birth and dementia are generally largest for Black and less-educated older adults. As a result, sociodemographic disparities in predicted probabilities of dementia are largest for those residing or born in the South. DISCUSSION The sociospatial patterning of dementia suggests its development is a lifelong process involving cumulated and heterogeneous lived experiences embedded in place.
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Affiliation(s)
- Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Samantha Brady
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
- Department of Sociology, Brown University, Providence, Rhode Island, USA
| | - Susan E Short
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
- Department of Sociology, Brown University, Providence, Rhode Island, USA
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14
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Xue B, Luo C, Luo X. Attitudes toward dementia screening and influential factors in older adults in China. Psychogeriatrics 2023; 23:211-221. [PMID: 36457142 DOI: 10.1111/psyg.12918] [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] [Received: 05/05/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Dementia will likely be an ongoing concern for future generations, and according to the World Health Organization, two-thirds of dementia cases are missed diagnoses. We aimed to explore the attitudes of older adults toward dementia screening and the related influencing factors. METHODS A multicentre cross-sectional study was conducted. Data were collected using questionnaires between 2020 December and 2021 June from five provinces in China. The study included older adults aged 60 years or older, living in China. A sociodemographic questionnaire and the Perceptions Regarding Investigational Screening for Memory in Primary Care scale were used to assess attitudes toward and influencing factors of dementia screening. RESULTS A total of 279 participants completed the questionnaires. The results revealed housing status as a positive factor in the acceptance dimension, while high income was the primary positive factor in the benefits of screening dimension. Having religious beliefs, low income, and never participating in social activities were positive factors for the stigma dimension. Widowed marital status and participation in social activities were negative factors for the independence dimension, while having religious beliefs positively influenced the suffering dimension. CONCLUSIONS This study showed that participants held a relatively positive attitude toward dementia screening, although they had concerns about stigma and negative impact on independence. Further studies are required to develop intervention strategies to help older adults improve their attitudes and quality of life, promote cognitive health, and facilitate healthy ageing.
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Affiliation(s)
- Bing Xue
- School of Nursing, Wuhan University, Wuhan, China
| | - Chang Luo
- School of Artificial Intelligence of Jianghan University, Wuhan, China
| | - Xianwu Luo
- School of Nursing, Wuhan University, Wuhan, China
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15
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Coers DO, de Boer ME, Sizoo EM, Smalbrugge M, Leget CJW, Hertogh CMPM. Dealing with requests for euthanasia in incompetent patients with dementia. Qualitative research revealing underexposed aspects of the societal debate. Age Ageing 2023; 52:6969134. [PMID: 36626318 PMCID: PMC9831268 DOI: 10.1093/ageing/afac310] [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: 05/12/2022] [Revised: 10/24/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES In the Netherlands, a case of euthanasia of an incompetent patient with dementia and an advance euthanasia directive (AED) caused great societal unrest and led to a petition signed by more than 450 physicians. In this paper, we investigate these physicians' reasons and underlying motives for supporting the 'no sneaky euthanasia' petition, with the aim of gaining insight into the dilemmas experienced and to map out topics in need of further guidance. METHODS Twelve in-depth interviews were conducted with physicians recruited via the webpage 'no sneaky euthanasia'. General topics discussed were: reasons for signing the petition, the possibilities of euthanasia in incompetent patients and views on good end-of-life care. Data were interpreted using thematic content analysis and the framework method. RESULTS Reasons for supporting the petition are dilemmas concerning 'sneaky euthanasia', the over-simplified societal debate, physicians' personal moral boundaries and the growing pressure on physicians. Analysis revealed three underlying motives: aspects of handling a euthanasia request based on an AED, good end-of-life care and the doctor as a human being. CONCLUSIONS Although one of the main reasons for participants to support the petition was the opposition to 'sneaky euthanasia', our results show a broader scope of reasons. This includes their experience of growing pressure to comply with AEDs, forcing them to cross personal boundaries. The underlying motives are related to moral dilemmas around patient autonomy emerging in cases of decision-making disabilities in advanced dementia. To avoid uncertainty regarding patients' wishes, physicians express their need for reciprocal communication.
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Affiliation(s)
| | - Marike E de Boer
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department Medicine for Older People, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Eefje M Sizoo
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department Medicine for Older People, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department Medicine for Older People, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Carlo J W Leget
- University of Humanistic Studies, Care Ethics, Utrecht, The Netherlands
| | - Cees M P M Hertogh
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department Medicine for Older People, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
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16
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Fortea J, García-Arcelay E, Terrancle Á, Gálvez B, Díez-Carreras V, Rebollo P, Maurino J, Garcia-Ribas G. Attitudes of Neurologists Toward the Use of Biomarkers in the Diagnosis of Early Alzheimer's Disease. J Alzheimers Dis 2023; 93:275-282. [PMID: 36970902 DOI: 10.3233/jad-221160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) biomarkers reflect key elements of pathophysiology and improve the diagnostic process. However, their use in routine clinical practice is still limited. OBJECTIVE We aimed to assess neurologists' barriers and enablers to early AD diagnosis using core AD biomarkers. METHODS We conducted an online study in collaboration with the Spanish Society of Neurology. Neurologists answered a survey exploring their attitudes towards AD diagnosis using biomarkers in mild cognitive impairment (MCI) or mild AD dementia. Multivariate logistic regression analyses were conducted to determine the association between neurologists' characteristics and diagnostic attitudes. RESULTS We included 188 neurologists with a mean age (SD) of 40.6 (11.3) years, 52.7% male. Most participants had access to AD biomarkers, mainly in cerebrospinal fluid (CSF) (89.9%,#x0025;, n = 169). The majority of participants (95.2%,#x0025;, n = 179) considered CSF biomarkers useful for an etiological diagnosis in MCI. However, 85.6% of respondents (n = 161) used them in less than 60% of their MCI patients in routine clinical practice. Facilitating patients and their families to plan for the future was the most frequent enabler for the use of biomarkers. Short consultation time and practicalities associated with the programming of a lumbar puncture were the most common barriers. A younger neurologist age (p = 0.010) and a higher number of patients managed weekly (p = 0.036) were positively associated with the use of biomarkers. CONCLUSION Most neurologists had a favorable attitude to the use of biomarkers, especially in MCI patients. Improvements in resources and consultation time may increase their use in routine clinical practice.
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Affiliation(s)
- Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | | | | | - Blanca Gálvez
- Medical Department, Roche Diagnostics, Barcelona, Spain
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17
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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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18
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Alpinar-Sencan Z, Schicktanz S, Ulitsa N, Shefet D, Werner P. Moral motivation regarding dementia risk testing among affected persons in Germany and Israel. JOURNAL OF MEDICAL ETHICS 2022; 48:861-867. [PMID: 34290115 PMCID: PMC9626915 DOI: 10.1136/medethics-2020-106990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
Recent advances in biomarkers may soon make it possible to identify persons at high risk for late-onset Alzheimer's disease at a presymptomatic (preclinical) stage. Popular demand for testing is increasing despite the lack of cure and effective prevention options and despite uncertainties regarding the predictive value of biomarker tests. This underscores the relevance of the ethical, cultural and social implications of predictive testing and the need to advance the bioethical debate beyond considerations of clinical consequences. Our qualitative study included three groups of affected persons: People with mild neurocognitive disorder, their relatives and family caregivers of people with dementia. We explored their moral motivations regarding predictive, biomarker-based testing and preclinical diagnostics. We interviewed affected individuals in Germany and Israel (N=88; 44 participants in each country). Transcripts of 12 focus groups and 12 semistructured interviews were content analysed with a focus on the moral motivations of affected persons in their justification of why they accept or reject predictive testing and early diagnosis. We grouped the underlying aspects of moral motivation into four ethical categories: beneficence as a form of personal utility focusing on well-being, the ties of responsibility linking families and their individual members, the importance of self-determination by later life planning and notions of a good life. In general, cultural parallels among these motives were very obvious. Cultural variation occurred mainly in openness to suicide, scepticism about test validity and emphasis on personal autonomy. The study underscores the importance of counselling for life-planning issues and of informing test candidates about problems with test validity and about the ambiguity of test results.
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Affiliation(s)
- Zümrüt Alpinar-Sencan
- Department for Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Niedersachsen, Germany
| | - Silke Schicktanz
- Department for Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Niedersachsen, Germany
| | - Natalie Ulitsa
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Daphna Shefet
- Shalvata Mental Health Care Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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19
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Reynolds CF, Jeste DV, Sachdev PS, Blazer DG. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry 2022; 21:336-363. [PMID: 36073714 PMCID: PMC9453913 DOI: 10.1002/wps.20996] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.
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Affiliation(s)
| | - Dilip V. Jeste
- Department of PsychiatryUniversity of California San DiegoLa JollaCAUSA
| | | | - Dan G. Blazer
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNCUSA
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20
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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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21
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Sodri NI, Mohamed-Yassin MS, Mohamad M, Baharudin N. Confidence in Dementia Management and Its Associated Factors among Primary Care Doctors in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169995. [PMID: 36011637 PMCID: PMC9407797 DOI: 10.3390/ijerph19169995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 05/17/2023]
Abstract
Primary care doctors (PCDs) play an important role in the early diagnosis and management of dementia. This study aimed to determine the knowledge, attitude, and confidence in managing dementia among PCDs in Malaysia. It also aimed to determine the factors associated with higher confidence levels in dementia management. An online-based cross-sectional study using Google FormsTM was performed. Sociodemographic and work-related data were collected, and Dementia Knowledge among General Practitioners & General Practitioners Attitude and Confidence Scale for Dementia questionnaires were utilized to assess the knowledge, attitude, and confidence scores. Multiple linear regression was conducted to determine the association between sociodemographic factors, knowledge, and attitude with the confidence in dementia management score. A total of 239 PCDs participated, with the majority being female (72.4%) and Malay (64.4%) and working in public primary care clinics (67.4%). The mean (±SD) score for confidence was 2.96 (±0.76). Among the factors associated with higher confidence levels in managing dementia were higher dementia knowledge scores, higher attitude towards dementia scores, prior dementia education, and the availability of nearby referral services for dementia. Malaysian PCDs' confidence in dementia management was comparable to the PCDs of other countries. Strategies addressing these factors should be implemented to improve the confidence of PCDs in managing dementia.
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Affiliation(s)
- Nurul Izzah Sodri
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Batu Caves 68100, Selangor, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Batu Caves 68100, Selangor, Malaysia
- Correspondence: ; Tel.: +60-3-6126-4655
| | - Mariam Mohamad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Batu Caves 68100, Selangor, Malaysia
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22
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Dufour I, Vedel I, Quesnel-Vallée A. Identification of Major Cognitive Disorders in Self-Reported versus Administrative Health Data: A Cohort Study in Quebec. J Alzheimers Dis 2022; 89:1091-1101. [PMID: 35964188 DOI: 10.3233/jad-220327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls. OBJECTIVE To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data. METHODS This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA. RESULTS The study cohort was composed of 25,125 older adults, of which 784 (3.12%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information. CONCLUSION To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.
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Affiliation(s)
- Isabelle Dufour
- Department of Epidemiology, Biostatistics, andOccupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Faculty of Medicine, McGill University, Montréal, Canada
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23
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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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24
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Birkeland RW, McCarron HR, Nkimberg M, Gaugler JE. Exploring Memory Care Clinics in Minnesota: A Qualitative Analysis. J Geriatr Psychiatry Neurol 2022; 35:601-612. [PMID: 34521279 DOI: 10.1177/08919887211044752] [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: 11/15/2022]
Abstract
OBJECTIVES We explored memory clinic care provision in Minnesota, examining diversity and similarities of services provided and challenges faced. We also considered how well their services and care philosophies aligned with national dementia care practice recommendations. METHODS We created a 53-question interview guide and interviewed 11 memory clinics across Minnesota in late 2019. Interview transcripts were analyzed using Braun and Clarke's thematic analyses in NVivo 12. RESULTS We identified 6 themes regarding financial issues, staffing, appointment logistics, care provision during and after the memory evaluation as well as features of an ideal clinic. CONCLUSIONS Memory evaluation and care provision were very different across clinics, primarily due to team make-up, particularly team size and specialty. However, memory care providers shared a passion for providing patient-centered memory care, emphasizing family and patient education and partnership. Their care was largely aligned with national memory care recommendations. Common challenges, including maintaining financial stability and clinic efficiency, exerted significant influence on clinic functioning and survival.
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Affiliation(s)
- Robyn W Birkeland
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hayley R McCarron
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Manka Nkimberg
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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25
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Wangler J, Jansky M. [Team players or lone fighters? Importance and utilization of practice staff in primary care dementia detection]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:75-83. [PMID: 35190285 DOI: 10.1016/j.zefq.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND General practitioners (GP) face major challenges in everyday practice when it comes to identifying dementia cases as early as possible under the condition of time and resource constraints. The involvement of the practice staff promises decisive advantages in detection and diagnosis. So far, there has been a lack of studies exploring the extent to which non-medical practice employees in general practices are integrated into dementia detection, what experiences they have had and how they assess their own potential to contribute to more efficient dementia detection. METHODS Between August 2020 and August 2021, a total of 64 semi-structured, audio-technically recorded individual / expert interviews were conducted with non-medical practice employees (medical assistants) in general practices in all German federal states (four interviewees per federal state). The interview transcripts were evaluated using a qualitative, structuring content analysis according to Mayring (Software MAXQDA 2020). RESULTS The GP team members show a high degree of willingness and motivation to support the doctor in identifying and diagnosing dementia; situations have been reported where their assistance has led to an earlier identification of people with dementia. Observation and detection of dementia patients are rarely based on systematic criteria. On the whole, only some GPs entrust their staff with tasks like this. A large portion of the interviewees expressed considerable uncertainty regarding the assessment of possible signs of incipient dementia, which corresponds to the fact that only a minority of the interviewees have ever completed further training with a focus on dementia. CONCLUSIONS Practice staff can provide invaluable support when it comes to the timely and consistent detection of incipient dementia in general practice. In addition to sensitizing GPs and optimizing practice management, targeted training with regard to geriatric issues will be instrumental in achieving this. Accordingly, more advanced training formats should be developed that are tailored to the perspective of practice employees and convey important dementia-specific diagnostics, action and communication skills.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland
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26
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Wangler J, Jansky M. Slowing dementia symptoms - a qualitative study on attitudes and experiences of general practitioners in Germany. Eur J Gen Pract 2022; 28:32-39. [PMID: 35249437 PMCID: PMC8903749 DOI: 10.1080/13814788.2022.2037550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is currently no cure for dementia but general practitioners (GPs) have therapeutic options available to counteract the progression of mild cognitive impairment, including drug and non-drug treatment. So far, few studies have investigated treatment strategies preferred by GPs. OBJECTIVES This study aimed to gain an overview of GPs' attitudes towards influencing the progression of dementia, their involvement regarding dementia prevention and perceived effective approaches. It also elucidated the challenges experienced by GPs and desired optimisation measures towards reinforcing secondary prevention. METHODS Between June 2020 and March 2021, 64 semi-standardised interviews amongst GPs were conducted in all federal states of Germany. Thirty interviews were carried out in person and 34 by phone. The data were analysed according to qualitative content analysis. RESULTS Many interviewees see great importance in secondary dementia prevention and believe they could make an effective contribution, some of them using non-drug approaches. GPs play a role in guiding patients and relatives towards support services. Some doctors consider drug treatment as the only option towards influencing the progression of dementia, showing low expectations on self-efficacy. Interdisciplinary collaboration is a frequent challenge, which often conflicts with a coherent treatment strategy. CONCLUSION Many GPs feel confident about influencing the progression of dementia and believe they can intervene effectively, using various (non-drug) treatment measures and referrals to support services. GPs perceive challenges, including obstacles in interdisciplinary collaboration and negative impacts after drug administration. To improve the conditions for GP intervention, it depends on expanding interdisciplinary collaboration and care strategies.
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Affiliation(s)
- Julian Wangler
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Michael Jansky
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
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27
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Merl H, Veronica Doherty K, Alty J, Salmon K. Truth, hope and the disclosure of a dementia diagnosis: A scoping review of the ethical considerations from the perspective of the person, carer and clinician. DEMENTIA 2022; 21:1050-1068. [PMID: 35134305 DOI: 10.1177/14713012211067882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper explores contemporary approaches to balancing truth with the provision of hope during the disclosure of a dementia diagnosis. We discuss the ethical significance of these practices as they relate to each member of the triad - the person, the carer and the clinician - at the point of diagnosis and beyond. The process of disclosing a diagnosis of dementia is complex. It encompasses breaking bad news while balancing hope, with truth about a progressive life-limiting condition. The process of receiving the diagnosis likewise challenges the person who may be unprepared for the diagnosis, while carers seek information and supports. The impact of receiving a diagnosis of dementia can be life-changing and harmful at the personal level - for both the person and carer. This risk of harm becomes a critical consideration for clinicians when deciding on the level of truth: what information should be relayed and to whom? That risk is also balanced against the ethical issue of patient autonomy, which includes the right to know (or not) and make informed decisions about therapeutic interventions. While the consensus is that the autonomy of the person living with dementia must be upheld, controversy exists regarding the extent to which this should occur. For instance, at diagnosis, it is common for clinicians to use euphemisms rather than the word dementia to maintain hope, even though people and carers prefer to know the diagnosis. This practice of therapeutic lying is a pervasive ethical issue in dementia care, made more acceptable by its roots in diagnosis disclosure.
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Affiliation(s)
- Helga Merl
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia
| | | | - Jane Alty
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia.,Neurology department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia
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28
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Kim S, Eccleston C, Klekociuk S, Cook PS, Doherty K. Development and psychometric evaluation of the Dementia Public Stigma Scale. Int J Geriatr Psychiatry 2022; 37. [PMID: 34997624 DOI: 10.1002/gps.5672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/18/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Dementia is a stigmatised condition and dementia-related stigma is associated with low self-esteem, poor psychological wellbeing, social isolation and poor quality of life in people living with dementia and their families. There is, however, a lack of valid measures that accurately quantify dementia-related stigma in the general public. This study reports the initial psychometric evaluation of a new tool designed to measure dementia-related public stigma amongst community dwelling adults. METHODS A sample of 3250 individuals aged 18 and over completed an online survey on their beliefs and feelings regarding dementia and people living with dementia, and their behavioural intentions towards people living with dementia. Exploratory factor analysis (EFA) using Maximum Likelihood with oblique rotation was performed to extract factors. Confirmatory factor analysis (CFA) was used to confirm the factor structure using goodness-of-fit index (GFI), the comparative fit index (CFI), and the root mean square error of approximation (RMSEA) to evaluate the model fit. Internal consistency was measured for the final scale version. RESULTS EFA resulted in a 16-item, 5-factor model (Fear and discomfort, Negative perceptions, Positive perceptions, Burden, and Exclusion) that explained 50.43% of the total variance. The CFA-estimated model demonstrated a good fit; all fit indices were larger than 0.95 (GFI = 0.967, CFI = 0.959) and smaller than 0.05 (RMSEA = 0.048). The final scale showed moderate to high reliability scores ranging from α = 0.738 to 0.805. CONCLUSIONS The Dementia Public Stigma Scale is a tool with reliability, and some demonstrated validity. This scale can be used to measure the public stigma of dementia amongst adults and may be used in the development and evaluation of interventions aimed at dementia-related stigma reduction.
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Affiliation(s)
- Sarang Kim
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Claire Eccleston
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Shannon Klekociuk
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Peta S Cook
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kathleen Doherty
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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29
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Dementia in Media Coverage: A Comparative Analysis of Two Online Newspapers across Time. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910539. [PMID: 34639840 PMCID: PMC8508449 DOI: 10.3390/ijerph181910539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022]
Abstract
The news media, specifically online newspapers, is one of the powerful transmitters of discourse due to its rapid accessibility that contributes to social beliefs and attitudes that often shape our perceptions on dementia and Alzheimer’s disease. The media portrayal of dementia is largely heterogeneous, but there is certainly an association between the influence of online news coverage and the social perceptions of dementia that need to be understood more broadly. In this study, we examined the portrayal of dementia in two online newspapers (The New York Times and The Guardian) that might have an influence on dementia discourse by comparing the content and form of the news coverage on dementia across time. This study was guided by three interconnected theoretical understandings: cultivation theory, agenda-setting theory, and spiral of silence theory. A total of 291 published articles featuring dementia from 2014 to 2019 were included in this study and a content analysis of the articles provided insight into the dementia-related news coverage. Our results showed that both newspapers have a decreasing trend in publishing articles related to dementia over time. In addition, dementia-related (modifiable) risk factors as principal news content was significantly associated with the year of publication. Despite a weak association between story categories and newspapers, the majority of articles reported preventive measures as the main story category. Although both newspapers featured more articles with a less negative tone across time when reporting on dementia, derogative wording, as discourse, was commonly used to address the illness. We have provided some insight into understanding how online newspapers potentially affect subjective representations of dementia as well as perpetuate dementia discourse. Finally, we suggest that future study may benefit from establishing a linkage between the depiction of dementia in online newspapers and the contextualization of dementia within cultures.
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Creavin ST, Haworth J, Fish M, Cullum S, Bayer A, Purdy S, Ben-Shlomo Y. Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study. BJGP Open 2021; 5:BJGPO.2021.0058. [PMID: 34315715 PMCID: PMC8596317 DOI: 10.3399/bjgpo.2021.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs often report using clinical judgment to diagnose dementia. AIM To investigate the accuracy of GPs' clinical judgment for the diagnosis of dementia. DESIGN & SETTING Diagnostic test accuracy study, recruiting from 21 practices around Bristol, UK. METHOD The clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia. RESULTS A total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65-87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION A GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.
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Affiliation(s)
| | - Judy Haworth
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Fish
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sarah Cullum
- Depatment of Psychological Medicine, School of Medicine, The University of Auckland, Grafton, New Zealand
| | | | - Sarah Purdy
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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Breuer E, Freeman E, Alladi S, Breedt M, Govia I, López-Ortega M, Musyimi C, Oliveira D, Pattabiraman M, Sani TP, Schneider M, Swaffer K, Taylor D, Taylor E, Comas-Herrera A. Active inclusion of people living with dementia in planning for dementia care and services in low- and middle-income countries. DEMENTIA 2021; 21:380-395. [PMID: 34468232 DOI: 10.1177/14713012211041426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Involving people living with dementia in service design and planning has become more common in high-income countries. It remains rare in low- and middle-income countries where two-thirds of the world's people with dementia live. In this commentary article, we explore the barriers to inclusion of people living with dementia in planning in low- and middle-income countries and make a case for the inclusion of people living with dementia in care and service planning. We suggest how this can be done at individual, community or national and state level using the following principles: 1) respecting the rights of people living with dementia to self-determination; 2) valuing people living with dementia's unique understanding of dementia; 3) creating a culture of active inclusion which creates a space for people living with dementia to participate and 4) ensuring appropriate accommodations are in place to maximise participation.
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Affiliation(s)
- Erica Breuer
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Emily Freeman
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, London, UK
| | - Suvarna Alladi
- Department of Neurology, 29148National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Marinda Breedt
- STRiDE South Africa National Advisory Group, Cape Town, South Africa
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, 54657The University of the West Indies, Kingston, Jamaica
| | | | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Déborah Oliveira
- Department of Psychiatry, 28105Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | - Tara Puspitarini Sani
- 64732Alzheimer Indonesia and Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, 37716University of Cape Town, Rondebosch, South Africa
| | - Kate Swaffer
- Dementia Alliance International and Faculty of Science, Medicine and Health, 8691University of Wollongong, Wollongong, NSW, Australia
| | - Dubhglas Taylor
- Dementia Alliance International and Dementia Awareness Advocacy Team, Capalaba, QLD, Australia
| | - Eileen Taylor
- Dementia Alliance International and Dementia Awareness Advocacy Team, Brisbane, QLD, Australia
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, London, UK
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32
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Lin X, Wallis K, Ahern S, Brodaty H, Rowe C, Kain B, Lambourne S, McNeil J, Ward SA. Optimising participation of persons with cognitive impairment in a national dementia registry: challenges and solutions. Intern Med J 2021; 51:988-992. [PMID: 34155757 DOI: 10.1111/imj.15357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Clinical quality registries are increasingly utilised to monitor and improve healthcare quality. Opt-out consent is recommended to maximise participation and ensure validity of data, however, presents specific considerations when including persons with impaired decision-making abilities. This paper describes the innovative Australian Dementia Network Registry recruitment framework designed to optimise inclusion of people with dementia and mild cognitive impairment.
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Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara Kain
- Carer representative, Melbourne, Victoria, Australia
| | - Sally Lambourne
- Consumer Engagement, Dementia Australia, Sydney, New South Wales, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
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Abstract
Despite its global importance and the recognition of dementia as an international public health priority, interventions to reduce stigma of dementia are a relatively new and emerging field. The purpose of this review was to synthesize the existing literature and identify key components of interventions to reduce stigma of dementia. We followed Arksey and O'Malley's scoping review process to examine peer-reviewed literature of interventions to reduce dementia-related stigma. A stigma-reduction framework was used for classifying the interventions: education (dispel myths with facts), contact (interact with people with dementia), mixed (education and contact), and protest (challenge negative attitudes). From the initial 732 references, 21 studies were identified for inclusion. We found a variety of education, contact, and mixed interventions ranging from culturally tailored films to intergenerational choirs. Findings from our review can inform the development of interventions to support policies, programs, and practices to reduce stigma and improve the quality of life for people with dementia.
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Oba H, Matsuoka T, Kato Y, Watson R, Mansfield E, Sanson-Fisher R, Narumoto J. Attitude toward dementia and preferences for diagnosis in Japanese health service consumers. BMC Health Serv Res 2021; 21:411. [PMID: 33941184 PMCID: PMC8091787 DOI: 10.1186/s12913-021-06381-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Being diagnosed with dementia is a confronting experience for any individual and their caregiver. However, a diagnosis provides opportunity for future preparation for management of the condition. This study investigated attitudes toward dementia and preferences for diagnosis among a sample of health service consumers in Japan. Methods Participants were patients or accompanying support persons (n = 217) who visited the specialty outpatient clinic of four hospital departments. The survey was conducted using an iPad with answers sent automatically to a secure server. The survey included items about the participants’ most feared diseases and the reasons behind those fears, estimates of dementia prevalence in Japan, and preferences regarding a diagnosis of dementia and the reasons for their preference. Results The most feared disease was cancer (43.8 %), followed by dementia (18 %). Those selecting dementia most commonly reported practical, emotional and social impacts as the reasons why they most feared this condition. Almost all participants preferred to know the diagnosis of dementia as soon as possible for themselves, with significantly fewer preferring their spouse to know as soon as possible if they had dementia (95.9 % for self vs. 67.5 % for partner/spouse, p < 0.001). On average, participants estimated that 18.1 % of Japanese people are diagnosed with dementia by age 65, while they thought that 43.7 % of Japanese people are diagnosed with dementia by age 85. Conclusions The findings highlight a need for community education about the significant impacts of dementia on the lives of individuals and their caregivers. People were more reluctant for their spouse to receive a diagnosis as soon as possible if they had dementia. Physicians should sensitively disclose diagnosis and ensure they involve both the patient and their relatives in discussions about diagnosis disclosure.
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Affiliation(s)
- Hikaru Oba
- Graduate School of Health Sciences, Hirosaki University, 66-1, Hon-cho, Hirosaki-city, 036-8564, Aomori, Japan. .,Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Rochelle Watson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, 2308, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, NSW, 2308, Callaghan, Australia.,Hunter Medical Research Institute, NSW, 2305, New Lambton Heights, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, 2308, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, NSW, 2308, Callaghan, Australia.,Hunter Medical Research Institute, NSW, 2305, New Lambton Heights, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, 2308, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, NSW, 2308, Callaghan, Australia.,Hunter Medical Research Institute, NSW, 2305, New Lambton Heights, Australia
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
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Moe A, Alnes RE, Nordtug B, Blindheim K, Steinsheim G, Malmedal W. Coping with Everyday Life for Home-Dwelling Persons with Dementia: A Qualitative Study. J Multidiscip Healthc 2021; 14:909-918. [PMID: 33935500 PMCID: PMC8079245 DOI: 10.2147/jmdh.s300676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 01/10/2023] Open
Abstract
Aim This study aimed to gain insight into factors that influence everyday coping strategies as described by persons with early to intermediate dementia. Background Living with dementia presents difficulties coping with everyday life. This study focuses on coping with everyday life for persons with mild to moderate dementia in order to facilitate their ability to live at home. Design A qualitative study. Methods Individual interviews with 12 persons with dementia were conducted in their own homes. Findings Coping with everyday life can be influenced by the experience of the diagnostic process and by information about dementia. It can also be affected by stigmatization of persons with dementia, as well as by challenges in everyday life. In addition, challenges in receiving help may include poor continuity of services and healthcare staff with limited competence. By contrast, person-centered care led to positive experiences that supported everyday coping skills. Most of the respondents wanted to participate in day care several days a week. Other positive experiences were making new friends and participating in meaningful activities; such experiences could enhance to coping strategies. Conclusion To strengthen everyday coping for persons with dementia living at home, there is a need for openness about the disease. Follow-up for persons with dementia must be carried out by reputable professionals trained and educated in dementia care. Finally, the municipalities must have contact persons, dementia coordinator/-team, who are available for persons with dementia at the time of diagnosis position and afterwards.
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Affiliation(s)
- Aud Moe
- Centre of Care Research Central Norway, Faculty of Health Science, Nord University, Bodø, Norway
| | - Rigmor Einang Alnes
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Bente Nordtug
- Faculty of Health Science, Nord University, Bodø, Norway
| | - Kari Blindheim
- Centre of Care Research Central Norway, Faculty of Health Science, Nord University, Bodø, Norway.,Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Gunn Steinsheim
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre for Development of Institutional and Home Care Services, Åfjord, Norway
| | - Wenche Malmedal
- Centre of Care Research Central Norway, Faculty of Health Science, Nord University, Bodø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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36
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Wiese LK, Williams CL, Hain D, Newman D, Houston CP, Kaack C, Galvin JE. Detecting dementia among older, ethnically diverse residents of rural subsidized housing. Geriatr Nurs 2021; 42:524-532. [PMID: 33039199 PMCID: PMC8024416 DOI: 10.1016/j.gerinurse.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christine L Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, United States.
| | - Debra Hain
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christina P Houston
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Carolina Kaack
- Louis and Anne Green Memory & Wellness Center, 777 Glades Road, Bldg AZ-79, Boca Raton, FL 33431, United States
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, 5250 University Drive, Coral Gables, FL, United States.
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37
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Ford E, Sheppard J, Oliver S, Rooney P, Banerjee S, Cassell JA. Automated detection of patients with dementia whose symptoms have been identified in primary care but have no formal diagnosis: a retrospective case-control study using electronic primary care records. BMJ Open 2021; 11:e039248. [PMID: 33483436 PMCID: PMC7831719 DOI: 10.1136/bmjopen-2020-039248] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES UK statistics suggest only two-thirds of patients with dementia get a diagnosis recorded in primary care. General practitioners (GPs) report barriers to formally diagnosing dementia, so some patients may be known by GPs to have dementia but may be missing a diagnosis in their patient record. We aimed to produce a method to identify these 'known but unlabelled' patients with dementia using data from primary care patient records. DESIGN Retrospective case-control study using routinely collected primary care patient records from Clinical Practice Research Datalink. SETTING UK general practice. PARTICIPANTS English patients aged >65 years, with a coded diagnosis of dementia recorded in 2000-2012 (cases), matched 1:1 with patients with no diagnosis code for dementia (controls). INTERVENTIONS Eight coded and nine keyword concepts indicating symptoms, screening tests, referrals and care for dementia recorded in the 5 years before diagnosis. We trialled machine learning classifiers to discriminate between cases and controls (logistic regression, naïve Bayes, random forest). PRIMARY AND SECONDARY OUTCOMES The outcome variable was dementia diagnosis code; the accuracy of classifiers was assessed using area under the receiver operating characteristic curve (AUC); the order of features contributing to discrimination was examined. RESULTS 93 426 patients were included; the median age was 83 years (64.8% women). Three classifiers achieved high discrimination and performed very similarly. AUCs were 0.87-0.90 with coded variables, rising to 0.90-0.94 with keywords added. Feature prioritisation was different for each classifier; commonly prioritised features were Alzheimer's prescription, dementia annual review, memory loss and dementia keywords. CONCLUSIONS It is possible to detect patients with dementia who are known to GPs but unlabelled with a diagnostic code, with a high degree of accuracy in electronic primary care record data. Using keywords from clinic notes and letters improves accuracy compared with coded data alone. This approach could improve identification of dementia cases for record-keeping, service planning and delivery of good quality care.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
| | - Joanne Sheppard
- Department of Physics and Astronomy, University of Sussex School of Mathematical and Physical Sciences, Brighton, Brighton and Hove, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Seb Oliver
- Department of Physics and Astronomy, University of Sussex School of Mathematical and Physical Sciences, Brighton, Brighton and Hove, UK
| | - Philip Rooney
- Department of Physics and Astronomy, University of Sussex School of Mathematical and Physical Sciences, Brighton, Brighton and Hove, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Jackie A Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
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Wangler J, Jansky M. Factors influencing general practitioners' perception of and attitude towards dementia diagnostics and care-results of a survey among primary care physicians in Germany. Wien Med Wochenschr 2021; 171:165-173. [PMID: 33443611 PMCID: PMC8057991 DOI: 10.1007/s10354-020-00803-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
Studies have shown that primary care is not always effective when it comes to caring for people with dementia. In addition, general practitioners do not always use diagnostic instruments consistently. The aim of the study was to identify relevant factors that influence general practitioners’ attitudes and willingness with respect to consistent diagnosis and care. For this purpose, resources, viewpoints, and behavioral patterns of general practitioners with regard to dementia diagnostics as well as common challenges in everyday practice were recorded. In the course of a survey, a total of 2266 general practitioners in Hesse and Baden-Württemberg were interviewed between January and March 2020. In addition to the descriptive analysis, a t-test was used to determine significant differences between two groups. A univariate linear regression analysis was carried out to identify possible influencing factors. 81% of the respondents do provide dementia diagnostics; 51% are involved in the treatment. Most of them see the diagnostic work-up (77%), communication and compliance problems (73%), as well as the therapeutic support (71%) as common challenges. In addition, there are interface problems regarding the interdisciplinary cooperation. Some of the respondents express doubts about the value of early detection (41%). The general practitioners’ attitude with respect to dementia diagnostics and care is determined by influencing factors that relate to geriatric competencies, expectations of self-efficacy, the integration of practice staff, as well as the knowledge of and cooperation with counseling and care services. It seems advisable to strengthen the geriatric competence of general practitioners. Moreover, it appears essential to educate general practitioners more about support structures in the field of dementia care and to integrate them accordingly. In addition, practice staff should be more systematically involved in the identification and care of dementia patients.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, Universitätsmedizin Mainz, Am Pulverturm 13, 55131 Mainz, Germany
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, Universitätsmedizin Mainz, Am Pulverturm 13, 55131 Mainz, Germany
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Lazcano-Ponce E, Angeles-Llerenas A, Rodríguez-Valentín R, Salvador-Carulla L, Domínguez-Esponda R, Astudillo-García CI, Madrigal-de León E, Katz G. Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico. BMC Med Ethics 2020; 21:125. [PMID: 33302932 PMCID: PMC7731770 DOI: 10.1186/s12910-020-00566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Angelica Angeles-Llerenas
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico. .,Research Ethics Committee, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Rocío Rodríguez-Valentín
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | | | | | - Eduardo Madrigal-de León
- Hospital Director at the National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Gregorio Katz
- Department of Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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40
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Low LF, Purwaningrum F. Negative stereotypes, fear and social distance: a systematic review of depictions of dementia in popular culture in the context of stigma. BMC Geriatr 2020; 20:477. [PMID: 33203379 PMCID: PMC7670593 DOI: 10.1186/s12877-020-01754-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Literature, film and news media reflect and shape social perceptions of dementia which in turn impact on dementia stigma. The aim of this paper is to systematically review papers on the depiction and frames for dementia in literature, film, mass media and social media in order to better understand cultural stigma related to dementia. METHODS A systematic search of electronic databases was undertaken combining phrases relating to dementia, popular culture and representations, and phrases relating to dementia and stigma. We searched for scientific English language papers which included original analysis on the representation or depiction of dementia in popular culture (i.e. in film and television, literature, news, social media and language). Articles published between 1989-2018 were included. The search was conducted in December 2017 and updated in January 2019. Inductive thematic synthesis was undertaken. RESULTS A total of 60 articles were included from an initial sample of 37022. Dementia was almost always depicted in conjunction with ageing, and often equated with Alzheimer's disease. Common frames for dementia were biomedical - dementia involves the deterioration of the brain for which there is no current cure; natural disaster or epidemic - dementia is a force of nature which will overwhelm mankind; and living dead - people with dementia lose their brains, memories, minds and consequently their personhood and human rights. There were examples of more positive depictions of dementia including expressing love and individual agency and experiencing personal growth. Feelings commonly associated with dementia were fear, shame, compassion and guilt, and depictions often resulted in a sense of social distance. CONCLUSIONS Depictions of dementia in popular culture are associated with negative images and feelings, and social distance between people with dementia and those without. These correspond to dementia stigma in the public and as experienced by people with dementia. Further research is needed into the impact of literature, news and social media on dementia stigma and these cultural mediums might be used to reduce stigma.
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Affiliation(s)
- Lee-Fay Low
- The University of Sydney, Faculty of Health Sciences, Room M3909B, M Block, 75 East Street, Lidcombe, NSW, 2141, Australia
| | - Farah Purwaningrum
- The University of Sydney, Faculty of Arts and Social Sciences, Room 424 Old Teachers College, Manning Road, Lidcombe, Australia.
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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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Portacolone E, Covinsky KE, Johnson JK, Halpern J. Expectations and Concerns of Older Adults With Cognitive Impairment About Their Relationship With Medical Providers: A Call for Therapeutic Alliances. QUALITATIVE HEALTH RESEARCH 2020; 30:1584-1595. [PMID: 32564681 PMCID: PMC7398607 DOI: 10.1177/1049732320925796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We sought to understand the expectations and concerns of older adults with cognitive impairment with regard to their relationship with medical providers. In particular, we observed whether study participants were involved in therapeutic alliances. Medical providers and patients create therapeutic alliances when they agree on the goals of the treatment and share a personal bond. Whereas such alliances have been studied in cancer research, little is known about therapeutic alliances in dementia research. Data were gathered in a qualitative study of 27 older adults with cognitive impairment and analyzed with narrative analysis. We introduce four case studies that illustrate the effects of having or missing a therapeutic alliance. Whereas the participant in the first case benefited from a therapeutic alliance, the other cases are marked by different experiences of abandonment. Findings suggest that interventions should concentrate on ways to enhance the relationship between medical providers and patients with cognitive impairment.
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Affiliation(s)
- Elena Portacolone
- University of California San Francisco, San Francisco, California, USA
| | | | - Julene K. Johnson
- University of California San Francisco, San Francisco, California, USA
| | - Jodi Halpern
- University of California, Berkeley, Berkeley, California, USA
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Hagan RJ. What next? Experiences of social support and signposting after a diagnosis of dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1170-1179. [PMID: 31997478 DOI: 10.1111/hsc.12949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/17/2019] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
The experience of being diagnosed with dementia can be shocking. This may be compounded if individuals feel that there is a lack of signposting onto further avenues of support following diagnosis. This study, then, examines how social support is promoted in the diagnostic process. Using purposive sampling and a grounded theory approach, semi-structured interviews were conducted with 13 members of a dementia empowerment group in Northern Ireland, discussing both their experience of diagnosis and also their subsequent group membership. Respondents reported both positive and negative experiences of diagnosis. Feelings of shock and bewilderment accompanied this process. Only one was able to identify a direct link between a medical professional and referral to the empowerment group, others being referred by other health professionals or dementia navigators. The study indicates that, due to disorienting feelings, one diagnostic consultation is insufficient to explain both the diagnosis and offer follow-up support. Therefore, more explicit links to navigators or other services need to be made at the point of diagnosis to prioritise information regarding opportunities for social engagement for those being diagnosed.
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Affiliation(s)
- Robert J Hagan
- School of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
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Aldus CF, Arthur A, Dennington-Price A, Millac P, Richmond P, Dening T, Fox C, Matthews FE, Robinson L, Stephan BCM, Brayne C, Savva GM. Undiagnosed dementia in primary care: a record linkage study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08200] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background
The number of people living with dementia is greater than the number with a diagnosis of dementia recorded in primary care. This suggests that a significant number are living with dementia that is undiagnosed. Little is known about this group and there is little quantitative evidence regarding the consequences of diagnosis for people with dementia.
Objectives
The aims of this study were to (1) describe the population meeting the criteria for dementia but without diagnosis, (2) identify predictors of being diagnosed and (3) estimate the effect of diagnosis on mortality, move to residential care, social participation and well-being.
Design
A record linkage study of a subsample of participants (n = 598) from the Cognitive Function and Ageing Study II (CFAS II) (n = 7796), an existing cohort study of the population of England aged ≥ 65 years, with standardised validated assessment of dementia and consent to access medical records.
Data sources
Data on dementia diagnoses from each participant’s primary care record and covariate and outcome data from CFAS II.
Setting
A population-representative cohort of people aged ≥ 65 years from three regions of England between 2008 and 2011.
Participants
A total of 598 CFAS II participants, which included all those with dementia who consented to medical record linkage (n = 449) and a stratified sample without dementia (n = 149).
Main outcome measures
The main outcome was presence of a diagnosis of dementia in each participant’s primary care record at the time of their CFAS II assessment(s). Other outcomes were date of death, cognitive performance scores, move to residential care, hospital stays and social participation.
Results
Among people with dementia, the proportion with a diagnosis in primary care was 34% in 2008–11 and 44% in 2011–13. In both periods, a further 21% had a record of a concern or a referral but no diagnosis. The likelihood of having a recorded diagnosis increased with severity of impairment in memory and orientation, but not with other cognitive impairment. In multivariable analysis, those aged ≥ 90 years and those aged < 70 years were less likely to be diagnosed than other age groups; those living with a spouse (odds ratio 2.38, 95% confidence interval 1.04 to 5.41) were more likely to be diagnosed than people living alone. The median time to diagnosis from first meeting the criteria for dementia was 3 years. Diagnosis did not affect survival or the probability of a move to residential care.
Limitations
People with moderate to severe dementia at baseline could not consent to record linkage. The small numbers in some groups limited power to detect effects.
Conclusions
The lack of relationship between severity of non-memory impairment and diagnosis may reflect low awareness of other symptoms of dementia. There remains little objective evidence for benefits of diagnosis for people with dementia.
Future work
Potential benefits of diagnosis can be realised only if effective interventions are accessible to patients and carers. Future work should focus on improving support for people living with cognitive impairment.
Study registration
National Institute for Health Research Clinical Research Network Central Portfolio Management System (CPMS 30655).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 20. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clare F Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Paul Millac
- Alzheimer’s Society Research Network, London, UK
| | - Peter Richmond
- Inspire, Research and Development, The Knowledge Centre, Hellesdon Hospital, Norwich, UK
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Chris Fox
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona E Matthews
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom CM Stephan
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
- Quadram Institute Bioscience, Norwich, UK
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45
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Beck AP, Jacobsohn GC, Hollander M, Gilmore-Bykovskyi A, Werner N, Shah MN. Features of primary care practice influence emergency care-seeking behaviors by caregivers of persons with dementia: A multiple-perspective qualitative study. DEMENTIA 2020; 20:613-632. [PMID: 32050779 DOI: 10.1177/1471301220905233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with dementia use emergency department services at rates greater than other older adults. Despite risks associated with emergency department use, persons with dementia and their caregivers often seek emergency services to address needs and symptoms that could be managed within primary care settings. As emergency departments (EDs) are typically sub-optimal environments for addressing dementia-related health issues, facilitating effective primary care provision is critical to reduce the need for, or decision to seek, emergency services. The aim of this study is to explore how features of primary care practice influence care-seeking decisions by community-dwelling persons with dementia and familial caregivers. METHODS Semi-structured qualitative interviews were conducted with 27 key dementia-care stakeholders (10 primary care/geriatrics providers, 5 caregivers, 4 emergency medicine physicians, 5 aging service providers, and 3 community paramedics) from multiple health systems. Transcripts from audio recordings were analyzed using a thematic analysis framework to iteratively code and develop emergent themes. Features of primary care were also synthesized into lists of tangible factors leading to emergency care-seeking and those that help prevent (or decrease the need for) ED use. FINDINGS Stakeholders identified eight categories of features of primary care encompassing the clinical environment and provision of care. These collapsed into four major themes: (1) clinic and organizational features-including clinic structure and care team staffing; (2) emphasizing proactive approaches to anticipate needs and avoid acute problems-including establishing goals of care, preparing for the future, developing provider-patient/provider-caregiver relationships, and providing caregiver support, education, and resources to help prevent emergencies; (3) health care provider skills and knowledge of dementia-including training and diagnostic capabilities; and (4) engaging appropriate community services/resources to address evolving needs. CONCLUSIONS Features of primary care practice influence decisions to seek emergency department care at the system, organizational/clinic, medical, and interpersonal levels, particularly regarding proactive and reactive approaches to addressing dementia-related needs. Interventions for improving primary care for persons with dementia and their caregivers should consider incorporating features that facilitate proactive family-centered dementia care across the four identified themes, and minimize those leading to caregiver decisions to utilize emergency services.
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Affiliation(s)
| | | | - Matthew Hollander
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Nicole Werner
- College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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46
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Schultz SK, Llorente MD, Sanders AE, Tai WA, Bennett A, Shugarman S, Roca R. Quality improvement in dementia care. Neurology 2020; 94:210-216. [DOI: 10.1212/wnl.0000000000008678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022] Open
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Schultz SK, Llorente MD, Sanders AE, Tai WA, Bennett A, Shugarman S, Roca R. Quality Improvement in Dementia Care: Dementia Management Quality Measurement Set 2018 Implementation Update. Am J Psychiatry 2020; 177:175-181. [PMID: 32008398 DOI: 10.1176/appi.ajp.2019.19121290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Susan K Schultz
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Maria D Llorente
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Amy E Sanders
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Waimei A Tai
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Amy Bennett
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Samantha Shugarman
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Robert Roca
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
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Lazar A, Dixon E. Safe Enough to Share: Setting the Dementia Agenda Online. CSCW : PROCEEDINGS OF THE CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK. CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK 2019; 3:85. [PMID: 32601621 PMCID: PMC7323863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CSCW research is increasingly interested in the ways that people use technology to discuss health and disability online. In addition to studying how people share information and seek and provide emotional support, a growing area of interest is health activism. In this paper, we analyze how a project centered around sharing "real and raw" experiences with dementia provides a safe platform for people to share their authentic experiences. These accounts counter predominant depictions of dementia and push back on tokenistic involvement of people with this condition. In a study involving observations and interviews with members of this project, we find that people with dementia must negotiate several goals which at times compete with each other: sharing a "real and raw" look at dementia, changing attitudes, showcasing a polished presentation, and inhabiting a safe space. The paper concludes with a discussion of future directions for CSCW on configuring a space for dialogue on sensitive topics, health activism, and sharing online with dementia.
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Affiliation(s)
| | - Emma Dixon
- University of Maryland, College Park, USA
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49
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Aufill J, Amjad H, Roter DL, Wolff JL. Discussion of memory during primary care visits of older adults with cognitive impairment and accompanying family. Int J Geriatr Psychiatry 2019; 34:1605-1612. [PMID: 31294474 PMCID: PMC6954826 DOI: 10.1002/gps.5172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Cognitive impairment is underdiagnosed in primary care. Understanding factors that precipitate memory-related discussion could inform strategies to improve diagnosis and counseling. We assessed whether: 1) having a cognitive impairment or dementia diagnosis, 2) ratings of cognition by clinicians, or 3) ratings of cognition by family companions were associated with memory-related discussion during primary care visits. METHODS We examined audio-recorded primary care visits of cognitively impaired patients aged 65 years and older, family companions (n = 93 dyads), and clinicians (n = 14). Cognitive impairment and dementia diagnoses were extracted from the electronic health record. Clinicians and family rated patient cognition on a 10-point scale in postvisit surveys. We measured memory-related discussion using a ratio of memory-related discussion episodes to total visit statements. RESULTS We observed more memory-related discussion during primary care visits of patients with a diagnosis of mild cognitive impairment (+7.8% episodes; P < .001) or dementia (+26.3% episodes; P < .001) than no diagnosis. Clinician and family ratings of cognition varied by diagnosis: among patients with no diagnosis, family rated worse impairment than clinicians (average: 2.4 versus 1.3; P = .004) while for patients with a dementia diagnosis, clinicians rated worse impairment than family (average: 7.1 versus 5.5; P = .006). Each unit increase in clinician-rated severity of cognitive impairment was associated with more memory-related discussion (+2.6% episodes; P < .001); this association was attenuated for family (+0.7% episodes; P = .095). CONCLUSIONS Discussion of cognitive impairment appears largely driven by clinician ratings of cognition and presence of an established diagnosis. Findings suggest potential benefit of engaging family to improve cognitive impairment detection in primary care.
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Affiliation(s)
- Jennifer Aufill
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 690 Baltimore, MD 21205
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Baltimore, MD 21224
| | - Debra L. Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 750, Baltimore, MD 21205
| | - Jennifer L. Wolff
- Eugene & Mildred Lipitz Professor of Health Policy & Management, Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692 Baltimore, MD 21205
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50
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Schuurmans J, Bouwmeester R, Crombach L, van Rijssel T, Wingens L, Georgieva K, O'Shea N, Vos S, Tilburgs B, Engels Y. Euthanasia requests in dementia cases; what are experiences and needs of Dutch physicians? A qualitative interview study. BMC Med Ethics 2019; 20:66. [PMID: 31585541 PMCID: PMC6778363 DOI: 10.1186/s12910-019-0401-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands, in 2002, euthanasia became a legitimate medical act, only allowed when the due care criteria and procedural requirements are met. Legally, an Advanced Euthanasia Directive (AED) can replace direct communication if a patient can no longer express his own wishes. In the past decade, an exponential number of persons with dementia (PWDs) share a euthanasia request with their physician. The impact this on physicians, and the consequent support needs, remained unknown. Our objective was to gain more insight into the experiences and needs of Dutch general practitioners and elderly care physicians when handling a euthanasia request from a person with dementia (PWD). METHODS We performed a qualitative interview study. Participants were recruited via purposive sampling. The interviews were transcribed verbatim, and analyzed using the conventional thematic content analysis. RESULTS Eleven general practitioners (GPs) and elderly care physicians with a variety of experience and different attitudes towards euthanasia for PWD were included. Euthanasia requests appeared to have a major impact on physicians. Difficulties they experienced were related to timing, workload, pressure from and expectations of relatives, society's negative view of dementia in combination with the 'right to die' view, the interpretation of the law and AEDs, ethical considerations, and communication with PWD and relatives. To deal with these difficulties, participants need support from colleagues and other professionals. Although elderly care physicians appreciated moral deliberation and support by chaplains, this was hardly mentioned by GPs. CONCLUSIONS Euthanasia requests in dementia seem to place an ethically and emotionally heavy burden on Dutch GPs and elderly care physicians. The awareness of, and access to, existing and new support mechanisms needs further exploration.
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Affiliation(s)
- Jaap Schuurmans
- General practice Ottenhoff, B. Ottenhoffstraat 18, 6561 CM, Groesbeek, The Netherlands. .,Radboud university medical center, Postbox 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Romy Bouwmeester
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Lamar Crombach
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Tessa van Rijssel
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Lizzy Wingens
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Kristina Georgieva
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Nadine O'Shea
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Stephanie Vos
- Radboud University Honours Academy, Houtlaan 4, 6525, XZ, Nijmegen, The Netherlands
| | - Bram Tilburgs
- Radboud university medical center, Postbox 9101, 6500, HB, Nijmegen, The Netherlands
| | - Yvonne Engels
- Radboud university medical center, Postbox 9101, 6500, HB, Nijmegen, The Netherlands
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