Dementia In Primary Care Research Articles

Cognitive Diagnostic Tests for Dementia in Primary Care

Cognitive Diagnostic Tests for Dementia in Primary Care

Dementia diagnosis rates and the impact of ethnicity, rurality and deprivation

Objectives NHS England publishes monthly national and regional estimated dementia diagnosis rates (DDR) to assess the healthcare system’s effectiveness in identifying dementia cases. Previous research indicates that sociodemographic factors, such as ethnic minority status, socioeconomic deprivation, and rurality, influence both healthcare quality and dementia risk. This study aimed to examine the association between these sociodemographic factors and DDR, and to estimate an ethnicity-adjusted DDR using available ethnic group data. Method We analysed NHS Digital Primary Care Dementia Data electronic health records for July 2023. We used a linear regression model to determine the association between DDR and ethnicity, deprivation, and rurality factors using local authority region level data. We also adjusted the DDR at the level of sub-integrated care boards based on previously published odds ratios of dementia diagnosis by ethnic group. Results Regression modelling revealed that areas with higher proportions of minority ethnic groups and greater rurality had lower DDRs. Conversely, higher levels of deprivation were linked to higher DDRs. After adjusting for different odds ratios for dementia in minority ethnic groups, the national DDR decreased by 1%, with regional diagnosis rates dropping by up to 5.4%. Conclusion Higher regional proportional ethnic minority population and greater rurality were associated with a lower DDR which might reflect poorer access to diagnostic services. Higher deprivation levels were associated with a higher DDR which might reflect higher rates of dementia in more deprived populations. We discuss measures to improve the accuracy and utility of the DDR, with a specific focus on ethnicity.

Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education

Abstract Background Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. Objective To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. Methods Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. Results The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. Conclusion Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.

Prevalence and Determinants of Diagnosed Dementia: A Registry Linkage Study Linking Diagnosis of Dementia in the Population-Based HUNT Study to Registry Diagnosis of Dementia in Primary Care and Hospitals in Norway.

A timely diagnosis of dementia can be beneficial for providing good support, treatment, and care, but the diagnostic rate remains unknown and is probably low. To determine the dementia diagnostic rate and to describe factors associated with diagnosed dementia. This registry linkage study linked information on research-based study diagnoses of all-cause dementia and subtypes of dementias, Alzheimer's disease, and related dementias, in 1,525 participants from a cross-sectional population-based study (HUNT4 70+) to dementia registry diagnoses in both primary-care and hospital registries. Factors associated with dementia were analyzed with multiple logistic regression. Among those with research-based dementia study diagnoses in HUNT4 70+, 35.6% had a dementia registry diagnosis in the health registries. The diagnostic rate in registry diagnoses was 19.8% among home-dwellers and 66.0% among nursing home residents. Of those with a study diagnosis of Alzheimer's disease, 35.8% (95% confidence interval (CI) 32.6-39.0) had a registry diagnosis; for those with a study diagnosis of vascular dementia, the rate was 25.8% (95% CI 19.2-33.3) and for Lewy body dementias and frontotemporal dementia, the diagnosis rate was 63.0% (95% CI 48.7-75.7) and 60.0% (95% CI 43.3-75.1), respectively. Factors associated with having a registry diagnosis included dementia in the family, not being in the youngest or oldest age group, higher education, more severe cognitive decline, and greater need for help with activities of daily living. Undiagnosed dementia is common, as only one-third of those with dementia are diagnosed. Diagnoses appear to be made at a late stage of dementia.

DemStepCare: Risk-stratified support for primary care-based dementia care - evaluation from general practitioner's view

The innovation fund project DemStepCare aimed to optimize multi-professional care through case management, risk stratification, and crisis outpatient clinic. Here, the evaluation results from the perspective of the general practitioners are presented. A quantitative survey was carried out at three time points regarding acceptance, benefit assessment and sensitivity to dementia of the general practitioners. In addition, qualitative interviews were conducted. Satisfaction with the overall project was high. Added value and relief factors were perceived and more effective and stable dementia care was achieved through collaboration with case management. Physicians reported increased subjective competence in diagnostics and disease management. The results confirm the benefit and effectiveness of DemStepCare from general practitioner's perspective.

Extra/ordinary medicine: Toward an anthropology of primary care

Primary care is at the forefront of healthcare delivery. It is the site of disease prevention and health management and serves as the bridge between communities and the health care system As ethnographers of primary care, in this article we discuss what is gained by situating anthropological inquiry within primary care. We articulate how anthropologists can contribute to a better understanding of the issues that emerge in primary care. We provide a review of anthropological work in primary care and offer empirical data from two ethnographic case studies based in the United States, one focused on social risk screening in primary care and the other examining the diagnosis and care of people with dementia in primary care. Through these cases, we demonstrate how research of and within primary care can open important avenues for the study of the multidimensionality of primary care. This multidimensionality is apparent in the ways the medical field addresses the social and structural experiences of patients, scope of practice and disciplinary boundaries, and the intersection of ordinary and extraordinary medicine that emerge in the care of patients in primary care.

Carers' experiences and perspectives of the use of anticholinergic medications in people living with dementia: Analysis of an online discussion forum.

There is concern about the use of anticholinergic medications in people living with dementia (PLWD). Such medicines may increase cognitive decline and may be associated with higher mortality in PLWD who take these medicines. The aim of this study was to analyse data from an online dementia discussion forum to explore the experiences and perspectives of PLWD and carers about the use of anticholinergic medicines in this population. Following receipt of ethical approval, archived discussions (posts) from Dementia Talking Point, a fully public online forum for anyone affected by dementia, created and maintained by the Alzheimer's Society, were searched from the date of inception to January 2022 using a range of search terms including commonly used anticholinergic medicines. Posts, including any of the search terms, were assessed for relevance and analysed using inductive thematic analysis. Five hundred and fifty unique posts were analysed, all of which had been provided by carers, with no posts attributed to PLWD. The themes that encompassed carers' experiences were (1) motivators of prescribing, (2) perspectives on the process of prescribing and (3) the outcomes of prescribing. The dominant motivator of prescribing was the management of noncognitive symptoms, pre- and postdiagnosis of dementia. Carers' perspectives on the process of prescribing were informed by an assessment of the risk-benefit of starting a medication and shared decision-making between the carer and healthcare professional to a greater or lesser degree. The outcomes of prescribing were observing the effects of the medicines, which in turn influenced whether prescribing was reviewed and continued unchanged, continued but amended, reinitiated if the medicine had been previously stopped or discontinued (the process of deprescribing). This study has provided unique insights into carers' experiences and perspectives about the use of anticholinergic medications in PLWD, highlighting how commonly these medications are prescribed for PLWD and carers' concerns about their use. There is a clear need for carers and PLWD to receive information about these medicines and healthcare professionals to consider how to optimise the use of these medicines to avoid adverse effects. This work was informed by findings from previous research studies focusing on optimising medicine use for people with dementia in primary care, in which interviews were conducted with PLWD, their carers and primary healthcare professionals. Although not strictly patient and public involvement, we utilised the feedback provided by key stakeholders to inform the research questions and aim/objectives of this study.

Identifying individuals at high risk for dementia in primary care: Development and validation of the DemRisk risk prediction model using routinely collected patient data.

Health policy in the UK and globally regarding dementia, emphasises prevention and risk reduction. These goals could be facilitated by automated assessment of dementia risk in primary care using routinely collected patient data. However, existing applicable tools are weak at identifying patients at high risk for dementia. We set out to develop improved risk prediction models deployable in primary care. Electronic health records (EHRs) for patients aged 60-89 from 393 English general practices were extracted from the Clinical Practice Research Datalink (CPRD) GOLD database. 235 and 158 practices respectively were randomly assigned to development and validation cohorts. Separate dementia risk models were developed for patients aged 60-79 (development cohort n = 616,366; validation cohort n = 419,126) and 80-89 (n = 175,131 and n = 118,717). The outcome was incident dementia within 5 years and more than 60 evidence-based risk factors were evaluated. Risk models were developed and validated using multivariable Cox regression. The age 60-79 development cohort included 10,841 incident cases of dementia (6.3 per 1,000 person-years) and the age 80-89 development cohort included 15,994 (40.2 per 1,000 person-years). Discrimination and calibration for the resulting age 60-79 model were good (Harrell's C 0.78 (95% CI: 0.78 to 0.79); Royston's D 1.74 (1.70 to 1.78); calibration slope 0.98 (0.96 to 1.01)), with 37% of patients in the top 1% of risk scores receiving a dementia diagnosis within 5 years. Fit statistics were lower for the age 80-89 model but dementia incidence was higher and 79% of those in the top 1% of risk scores subsequently developed dementia. Our models can identify individuals at higher risk of dementia using routinely collected information from their primary care record, and outperform an existing EHR-based tool. Discriminative ability was greatest for those aged 60-79, but the model for those aged 80-89 may also be clinical useful.

Diagnostic accuracy of a new case‐finding tool for dementia in primary care: The Brief Assessment of Impaired Cognition Questionnaire (BASIC‐Q)

AbstractBackgroundThe aim of the project was to examine the diagnostic accuracy of BASIC‐Q (Brief Assessment of Impaired Cognition Questionnaire), a questionnaire‐based tool for detection of dementia in a community setting. Community health care professionals often see citizens who are older and therefore in risk of developing dementia or having undetected dementia. BASIC‐Q is an easy and quick (≤5 min) conversation‐based tool to be used to support community health care professionals when observing signs of dementia.MethodThe project has been carried out in collaboration with 14 general practices in Denmark in the period October 2021‐October 2022. Patients ≥ 70 years with appointment in the clinic for any given reason, were invited to participate in the study. The general practitioner or the nurse at the clinic administered BASIC‐Q ‐ consisting of four questions about orientation and three questions regarding the participants memory for both the participant and a close relative. Subsequently the participant participated in a structured telephone interview and an extended cognitive testing. Among other, the extended testing consisted of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) that together with an IADL‐evaluation (instrumental activities of daily living) and GDS‐15 (15‐item geriatric depression scale) was used as gold standard for classification of cognitive status when analyzing the sensitivity, specificity, and diagnostic accuracy of BASIC‐Q.ResultThe mean age of the total of 275 participants was 77.7 years, of which 148 were women (52.9%) and 127 were men (46.1%). Of the participants 142 (51.6%) showed no evidence of cognitive impairment, 33 (12%) showed evidence of affective disorder, and 82 (29.8%) showed indications of cognitive impairment. 18 participants (6.5%) could not be classified and were not included in the analyses.ConclusionBASIC‐Q is a quantifiable indicator of cognitive function. BASIC‐Q can be used as an assistive tool when health care professionals observe signs of dementia and need to decide whether to intervene.Preliminary analyses indicate that BASIC‐Q is a reliable tool for the detection of possible dementia in primary health care. The analyses of results are still ongoing and more results regarding the BASIC‐Q’s diagnostic accuracy will follow.

FC23: Dementia and Triadic (Doctor-Patient-Carer) Interactions in Primary Care

Objective:Primary care visits of persons with dementia often bring together triads composed of patients, family carers and general practitioners (GPs), as previously discussed (1). Communication dynamics potentially affect dementia outcomes, not least because primary care is a health setting where these triad encounters often occur naturally. Our aim is to present further data from Portuguese primary care consultations with persons with dementia, their carers and GPs.Methods:We refer to the conclusion of our study ‘Dementia in Primary Care: the Patient, the Carer and the Doctor in the Medical Encounter - Bayer Investigation Grant | NOVAsaúde Ageing 2018’ (1). Fieldwork was interrupted during the COVID-19 pandemic and resumed in 2022. Sixteen consultations with persons with dementia, their carers and GPs (purposive sampling) were audio- recorded and transcribed verbatim. Interactions were thematically analysed using NVIVO® software. The analytical framework combined codes derived from the transcripts with codes from the literature.Results:Dementia-related content took up less than half of consultations’ time, despite their considerable length (as compared to the average in primary care). Most GPs assessments lacked breadth, although efforts towards positive attitudes were present. Themes specifically related to social health in dementia were not (or were poorly) covered. Frequently, carers facilitated GPs’ assessment of dementia consequences, but their own needs were neglected. Patients’ self-expression tended to be limited.Discussion:Our findings suggest that doctor-patient interactions in many GPs’ consultations seemingly compromise patient-centred approaches. There are challenges regarding how to assess the biopsychosocial consequences of dementia in a context of fragmented care (2,3). Given the scarcity of evidence from live-recorded primary care consultations about triadic dynamics, our findings are important to guide further explorations.

Perspectives of General Practitioners on signaling and diagnosing dementia

AbstractBackgroundAlthough a timely diagnosis of dementia is beneficial for patients, their relatives, and society, people with dementia often remain undiagnosed or receive a diagnosis at a relatively late stage (Lang 2017). General practitioners (GPs) have a prominent role in the detection of dementia, yet GPs experience several barriers in diagnosing dementia in primary care (Koch 2010). This study aims to explore the experiences and perspectives of GPs in diagnosing dementia in primary care.MethodA qualitative study was conducted consisting of semi‐structured interviews with 10 Dutch GPs purposively selected using maximum variation sampling. The study was an initiative of Alzheimer Center Groningen as part of ABOARD (A Personalized Medicine Approach for Alzheimer’s Disease). Overall topics included: experiences in signaling dementia; thoughts about the decision to wait in diagnosing dementia, to perform diagnostics, or to refer to a medical specialist for diagnosing dementia; and the needs of GPs in the diagnostic process of dementia. Interview transcripts were analyzed in multiple rounds by a multidisciplinary research team using thematic analysis with a phenomenological approach.ResultOverarching themes were ‘initiation of the diagnostic trajectory’, ‘timing of diagnosis’, ‘relevance of a formal diagnosis’, ‘division of roles and responsibilities, ‘patient denial’, ‘patient‐physician relationship’, ‘crisis’, and ‘arranging care after diagnosis’. Key findings within the ‘initiation of the diagnostic trajectory’ theme were that observations from people around patients (family, community nurse, practice nurse, pharmacist, or medical specialist) were often signals for GPs to start a conversation about dementia and diagnostic possibilities. The diagnostic trajectory rarely started with a request for help from the patient. Patient denial was described as a major obstacle in diagnosing dementia and arranging appropriate care subsequently. A proactive practice policy to detect and monitor cognitive impairment was a key facilitator to achieve a timely diagnosis and prevent crises in dementia. For example, GPs favored regular home visits by a practice nurse and low‐threshold cognitive examination; a long‐term physician‐patient relationship; and successful interdisciplinary collaboration with local care providers, especially consultation of an elderly care physician.ConclusionPatient denial and surrounding people are important barriers and facilitators, respectively, to the diagnostic process of dementia.

Implementation of MIND at Home Program for People Living with Dementia in Primary Care

AbstractBackgroundAs the U.S. population ages, the numbers of people living with dementia (PLWD) continues to grow. One way to improve care for PLWD is to work with their primary care practices to provide patient‐ and care partner‐centered, better quality of care at lower costs for their patients.MethodWe collaboratively implemented the MIND at Home Dementia Care Coordination Program into two large primary care clinics in two states, Iowa and California. The program pilot expanded the skills of existing primary care staff members to the level of Memory Care Coordinators (MCCs), who worked with larger primary care teams on combining the benefits of clinic‐based with home‐based services that support PLWD, their families, and care partners. The program targeted 150 PLWD for a 3‐month program implementation period. Program delivery included one home visit per month, a comprehensive needs assessment, and the subsequent development and implementation of an individualized care plan.ResultWe demonstrated the feasibility of implementing the MIND at Home program into primary care in a racially, ethnically, and geographically diverse population of PLWD to prepare for a larger study and provide qualitative and quantitative data on patient and provider acceptability of the program and early learnings about the program’s impact and barriers to implementation from the primary care practice perspective.ConclusionThis pilot study provides important information by determining the specific needs of patients in community‐based primary care and how creating tailored dementia‐focused care plans might improve communication and collaboration with primary care providers and their teams thereby reducing unnecessary hospitalizations and ER visits, reducing polypharmacy while increasing appropriate medication use, and improving care partners’ ability to provide needed support to PLWD.

Using the RE‐AIM framework to help implement an educational intervention for improving the care of persons with behavioral and psychological symptoms of dementia in primary care

AbstractApproximately 90% of persons living with dementia (PLWD) experience behavioral and psychological symptoms of dementia (BPSD) over the course of their illness, including aggression, psychosis, and depression. With a growing lack of access to specialty geriatric care, most people with BPSD will receive care from their primary care providers. Many primary care practices lack knowledge, self‐efficacy, and established pathways to expert advice for managing these complex behaviors. We have developed a comprehensive educational intervention for primary care providers and clinical staff to help them better address BPSD. The educational intervention combines two complementary approaches: the academic detailing model and the DICE ApproachTM (DICE). In a recent pilot with two primary‐care integrated memory clinic teams, we noted improvements in provider knowledge and clinical staff self‐efficacy and comfort in BPSD and dementia care after 6‐months of participation in academic detailing and DICE training. In our current study, we use the RE‐AIM framework to guide the implementation planning for our educational intervention for primary care providers and clinical staff to help them better address BPSD. The RE‐AIM framework is a widely used tool for evaluating the implementation of health interventions to ensure they are both effective and sustainable. Twenty semi‐structured interviews will be completed among providers practicing in one of two primary care integrated memory clinics who participated in the pilot program (champions) and among their generalist primary care colleagues with no to minimal program experiences (novices), in one urban and one rural healthcare system. The RE‐AIM framework informed the design of our semi‐structured interviews and will help to frame content analysis for identifying potential barriers to implementation, for scale‐up to generalist primary care teams. Five interviews have been completed to date. Qualitative analyses are also underway, and results will be presented. Findings from this study will be used to develop an implementation plan for a future randomized controlled trial to measure the effectiveness of this intervention on health outcomes in PLWD and BPSD.

A Diagnostic Test Accuracy Study Investigating General Practitioner Clinical Impression and Brief Cognitive Assessments for Dementia in Primary Care, Compared to Specialized Assessment.

Many health systems are interested in increasing the number of uncomplicated and typical dementia diagnoses that are made in primary care, but the comparative accuracy of tests is unknown. Calculate diagnostic accuracy of brief cognitive tests in primary care. We did a diagnostic test accuracy study in general practice, in people over 70 years who had consulted their GP with cognitive symptoms but had no prior diagnosis of dementia. The reference standard was specialist assessment, adjudicated for difficult cases, according to ICD-10. We assessed 16 index tests at a research clinic, and additionally analyzed referring GPs clinical judgement. 240 participants had a median age of 80 years, of whom 126 were men and 132 had dementia. Sensitivity of individual tests at the recommended thresholds ranged from 56% for GP judgement (specificity 89%) to 100% for MoCA (specificity 16%). Specificity of individual tests ranged from 4% for Sniffin' sticks (sensitivity 100%) to 91% for Timed Up and Go (sensitivity 23%). The 95% centile of test duration in people with dementia ranged from 3 minutes for 6CIT and Time and Change, to 16 minutes for MoCA. Combining tests with GP judgement increased test specificity and decreased sensitivity: e.g., MoCA with GP Judgement had specificity 87% and sensitivity 55%. Using GP judgement to inform selection of tests was an efficient strategy. Using IQCODE in people who GPs judge as having dementia and 6CIT in people who GPs judge as having no dementia, would be a time-efficient and accurate diagnostic assessment.The original protocol for the study is available at https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0475-2.

DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation.

Care integration is a promising strategy to achieve sustainable health-care systems. WithDementiaNet, a 2-year program, we facilitated collaboration between primary health-care professionals. We studied changes in primary dementia care integration during and after DementiaNet participation. A longitudinal follow-up study was performed. Networks started between 2015 and 2020; follow-up ended in 2021. Quantitative and quantitative data were collected annually to assess quality of care, network collaboration, and number of crisis admissions. Growth modeling was used to identify changes over time. Thirty-five primary care networks participated. Network collaboration and quality of care of newly formed networks increased significantly in the first 2 years (respectively, 0.35/year, P<.001; 0.29/year, P<.001) and thereafter stabilized. Primary care networks improved their collaboration and quality of care during DementiaNet participation, which persisted after the program ended. This indicates that DementiaNet facilitated a sustainable transition toward integrated primary dementia care.

"At least we finally found out what it was": Dementia diagnosis in minoritized populations.

Disparities in diagnosis persist among persons living with dementia (PLWD); most research on delayed diagnosis relies on medical records or administrative claims. This study aimed to identify factors that delay or facilitate dementia diagnoses in racial or ethnic minoritized PLWD and elicit care partner perspectives on timing and effects of diagnosis. Maryland-based participants cared for a PLWD age 60 or older, self-identified as Black/African/African-American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in-depth, semi-structured interviews were conducted and analyzed using conventional qualitative content analysis methods. Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding dementia influenced recognition and discussion of dementia among families and communities. Diagnoses were family-initiated and started in primary care. Care partners were divided in their perceptions of diagnosis timeliness and whether earlier diagnosis would have changed outcomes. Family reactions to dementia diagnoses varied; most participants expressed a strong sentiment of service and duty to care for older family members. Participants overwhelmingly felt the benefits of obtaining a dementia diagnosis outweighed harms. Numerous factors affect dementia diagnosis in racial and ethnic minoritized PLWD. Normalization of brain health discussions and systematic, proactive discussion and detection of dementia in primary care may address multilevel barriers and facilitators to diagnosis. Systems-level and community-led public health interventions may also help address disparities in brain health education and dementia diagnosis.

The clinical decision-making process involved in end of life care for people with dementia in primary care: A protocol paper.

This article is a report of a study protocol designed to explore what factors inform healthcare professionals' clinical decision-making when providing end of life care for people with dementia in primary care. The proposed study will adopt a qualitative study design, utilizing an ethnographic approach. A mixed sample group of registered healthcare professionals, including district nurses, specialist nurses and general practitioners, will be purposively sampled and recruited from one health board in Wales, which will cover three settings in primary care. A multi-method approach will be utilized to provide rich data, including non-participant observation, semi-structured interviews, and review of key documents. Data will be managed using NVivo 12 and analysed thematically. Ethics approval was gained in April 2022. Little is known about the end of life care decision-making process of healthcare professionals caring for people with dementia in primary care settings. This study will therefore address this pertinent gap. The study findings may also be transferable to healthcare professionals working in similar clinical settings across the UK. It is anticipated that this study will inform the subsequent development of an intervention that can be used by healthcare professionals to support decision making and subsequently the provision of quality end of life care in primary care for people with dementia.

Diagnosis and Care Use for People with Young-Onset Dementia in Primary Care in the Netherlands.

Timely diagnosis and adequate care is important for persons with young-onset dementia (YOD) and their caregivers, due to the high impact of the disease. Initiating care can be difficult for the general practitioner (GP) and other healthcare professionals. Provide insight in the care use of persons with YOD and identify factors influencing care use. A primary care register was used for this study. Information on the care use of persons with YOD was extracted from the GPs written notes. Information entailed time until start of care use, reasons and factors influencing the GP's decision, and reasons and factors influencing actual care use were included. Analyses included quantitative explorative descriptive analyses, and qualitative manifest content analyses. 75 persons with YOD were included in this study. The main reason for GPs to refer for diagnosis was concerns of caregivers. After diagnosis, 72% of the persons were assigned a case manager, 42.7% received day care, and 44% were admitted to a long-term care facility. A higher percentage of persons without a case manager was admitted to a long-term care facility (64%) compared to the persons with a case manager (36%). Reasons for not initiating care were reluctancy of the persons with YOD or their caregivers, the person deceased, or because the GP did not refer for care. Care use differed between persons due to different needs and reasons. Although most persons with YOD receive care in the years after diagnosis, there are still factors that could be improved.

NEUROPSYCHIATRIC SYMPTOMS IN PRIMARY CARE PATIENTS WITH DEMENTIA

Abstract Neuropsychiatric Symptoms of dementia are mostly valued within care and burden of formal and informal caregivers and less considered as diagnosis predictors. Diagnosis of dementia in Primary Care Service (PCS) is frequently late and based mostly in general clinic assessment, and patient/family subjective complaints. We study the association of Neuropsychiatric Symptoms (NPI-Q) and existing diagnosis of dementia in PCS. The objectives are to know 1) the prevalence of symptoms identified by familial caregivers in people with a diagnosis of dementia and 2) if there is an association of symptoms with the existence of a diagnosis.Method: we randomly select a community based sample of a pool (N=2734) of primary care users with mental health concerns referred by General Physicians, (N=154), mean age 76 years (sd 7.8), 57% women. Caregivers (N=39) were interviewed and fulfil NPI-Q. Results of descriptive and logistic regression analysis showed that 39% (60) had a formal diagnosis of dementia not differentiating men and women. The neuropsychological symptoms frequency varied between 3.1% (hallucinations) and 16.3% (apathy/indifference), and the symptoms’ mean was 4.5(sd 2.1). The amount of symptoms was not associated with the diagnosis. The symptoms that predict the diagnosis were Apathy/ Indifference OR 5.24(1.25-22.0),p.024 and Motor Disturbance OR 5.70(1.17-27.6), p.031. Qualitative data from caregivers interview show that they are not very comfortable with the terminology of NPI-Q, which may limit the accuracy of assessment. Conclusion some neuropsychological symptoms identified by caregivers seems to be relevant as predictors of diagnosis of dementia in Primary Care.

Integrated [Primary +] Memory Care Clinic.

The Integrated Memory Care Clinic (IMCC) is a model of care for people living with dementia directed by advanced practice registered nurses. The post-diagnosis model incorporates the expertise of nursing, social work and nurse practitioners certified in gerontology, palliative care and/or geriatric psychiatry. The Clinic nurse practitioners provide comprehensive and coordinated primary care for dementia and other stable chronic conditions and episodic care for minor acute illnesses. Care delivery is structured to maximize ongoing dialogue with patients and their caregivers during office visits and by phone and patient portal access. The Clinic provides a number of services to care partners, including an after-hours line, stage-based educational groups, and a monthly support group. The IMCC aims to reduce the overall burden of dementia by partnering with affected individuals and their caregivers in the co-production of care. Now at full capacity, the IMCC serves 525 active patients and their care partners with 1.3 FTE primary care nurse practitioners. The mean age is 78.6 years; most are female (63%); and 42% identify as a racial minority. The majority of patients are moderate (27% early-moderate; 36% late-moderate) stage of dementia clinical syndrome. The mean monthly rate of hospital admissions for ambulatory care sensitive conditions in 2022 is 1.42%. The published rate for this population is 13-15%. Finally, the model is financially neutral in a fee-for-service environment. Open in 2015, the IMCC has combined primary care and dementia care in one clinical practice. The IMCC developed strong rapport and trust with patients and families to achieve outstanding health outcomes. The model is an American Academy of Nursing Emerging Edge Runner, recognized by NCQA as a Patient Centered Medical Home, recognized as a Level 2 Age-Friendly Health System participant, and a Best Practice Exemplar by the Institute for Patient- and Family-Centered Care.