Survey of physician practices for community-dwelling agitated dementia patients

Abstract

In order to gain a better understanding of physician clinical reasoning and clinical practices for community-dwelling agitated dementia patients, we conducted a small survey of geriatric psychiatrists, primary care physicians and neurologists. The survey asked physician respondents to give a likelihood estimate of how often they would carry out one of 13 different pharmacologic and psychosocial interventions. Intervention by specialty group analyses found that geriatric psychiatrists were more likely to recommend neuroleptic medications and dementia support group activities, but less likely to recommend referral to behavioral specialists than the other physician groups. Neurologists were more likely to recommend dementia support groups than primary care physicians, but they were also more likely to recommend institutional placement than the other physician groups. Primary care physicians were more likely to recommend hydroxyzine than either neurologists or geriatric psychiatrists. Multivariate ordinal logistic regression analysis found that older physicians and primary care physicians expressed a lower likelihood of recommending dementia day care programs and a higher likelihood of recommending hydroxyzine. Women physicians, however, expressed a high likelihood of recommending dementia day care programs. The results of the survey suggest that personal and specialty characteristics of physicians influence the types of treatment recommendations made for agitated dementia patients. The results may help community-based dementia care programs to develop strategies that broaden physician involvement in multidisciplinary team management for these patients.