Abstract
BackgroundThe influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. However, current dementia strategies have not explicitly considered sex and gender differences in the management of dementia to ensure equitable care. The objective of this study was to examine the moderating effect of sex on the quality of care following the implementation of the Quebec Alzheimer Plan (QAP).MethodsWe conducted a secondary analysis of the evaluation of the QAP consisting of a retrospective chart review of 945 independent, randomly-selected patient charts of males and females 75+ years old with dementia and a visit to one of 13 participating Family Medicine Groups before (October 2011–July 2013) and after (October 2014 – July 2015). The quality of dementia care score, based on Canadian and international recommendations and consensus guidelines, consisted of documented assessments in 10 domains. We used a mixed linear regression model to measure the interaction between sex and the implementation of the QAP on the quality of dementia care score, adjusting for age and number of medications.ResultsWe found that improvements in the quality of dementia care following the QAP were larger for men than women (mean difference = 4.97; 95%CI: 0.08, 9.85). We found that men had a larger improvement in four indicators (driving assessments, dementia medication management, Alzheimer Society referrals, and functional status evaluation), while women had a smaller improvement in three (home care needs, behavioural and psychological symptoms of dementia, and weight). Men were prescribed fewer anticholinergics post-QAP, while women were prescribed more. Cognitive testing improved in men but decreased for women following the QAP; the opposite was observed for caregiver needs.ConclusionWhile the overall quality of care improved after the implementation of the QAP, this study reveals differences in dementia management between men and women. While we identified areas of inequalities in the care received, it is unclear whether this represents inequities in access to care and health outcomes. Future research should focus on better understanding sex and gender-specific needs in dementia to bridge this gap and better inform dementia strategies.
Highlights
The influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized
Design and population This study is a secondary analysis of the evaluation of the Quebec Alzheimer Plan (QAP) which consisted of training and funding for primary care clinics in Quebec, Canada’s second largest province accounting for one-quarter of the population [32], to improve the quality of care of persons with dementia
This score consisted of documented assessments in the following 10 domains: cognitive testing, evaluation of functional status, behavioral and psychological symptoms of dementia (BPSD), weight, caregiver needs, driving status, home care needs, community service needs (e.g. Alzheimer Society), absence of anticholinergic medication, and management of dementia medications
Summary
The influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. The importance of integrating sex and gender in health research to prevent inequities in care is increasingly being recognized for sound evidence-based practice and policy [10, 11]. Evidence is emerging on the influence of sex and gender on the risk of dementia, its clinical presentation and progression [13]. Dementia disproportionately affects women, who account for 2 in 3 cases [13] This higher prevalence has been attributed to women living longer on average than men and due to underlying differences in disease and/or sex and gender-related risk factors [13,14,15]. Women, who carry a greater caregiving burden, have twice the risk of developing depression, a major risk factor for dementia, compared to men [16, 17]
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