Perspectives of older adults and general practitioners on ageing and cognitive decline in primary care within the context of a decentralised antihypertensive dementia prevention trial

Abstract

AbstractBackgroundBlood pressure (BP) lowering is the most promising strategy for dementia risk reduction.1 However, few clinical trials have been designed to evaluate the impact of BP lowering on dementia as a primary endpoint, and concerns persist over harms associated with this treatment, particularly in older, frailer people.2 Community engagement will guide the design and conduct of such a trial. To gain a better understanding of concerns and potential barriers in this topic, we undertook focus group discussions with memory‐clinic patients without dementia and interviews with general practitioners to gain insights on the topics of cognitive decline, antihypertensive medications, and motivation to participate in a dementia prevention trial.MethodTwo focus groups (N = 7) with memory‐clinic participants (patients [age ≥60yr] with a history of mild cognitive and/or memory complaints without dementia and family carers of a patient with dementia) and 5 individual interviews with practitioners (metropolitan Sydney) were conducted in July 2022. Thematic analysis was used to identify recurring themes .ResultThe most common themes identified by patients included: valuing clear and timely communication from practitioners; valuing accessible options and considerations for computer‐based testing and treatment; and having fears and experience of dismissal from practitioners and peers about their ageing and declining health. Practitioners identified similar priorities of: clear and timely communication and accessibility in the context of a clinical trial; and insights into how cognitive decline is noticed and how individuals are supported, across different community contexts (i.e., social groups with higher levels of social connection and neighbourly bonds corresponded with lower perceived impact of cognitive decline). Importantly, although practitioners expressed concern for their patients, they reported that time restrictions limited the comprehensiveness of their ability to provide diagnostics and care.ConclusionAlthough limited by sample size, this study identified large issues for the conduct of clinical trials and in community dementia care. These concerns need due consideration for future trial designs and primary healthcare guidelines in the areas of dementia prevention, diagnoses, and care.