An in‐home geriatric programme for vulnerable community‐dwelling older people improves the detection of dementia in primary care

Abstract

An in-home geriatric assessment and management programme for vulnerable older patients improves the detection of dementia and can therefore contribute to overcoming of under-diagnosis of dementia.

Dementia diagnosis and management: a narrative review of changing practice

“…20 Among interventions that altered the care pathway, the trial of an in-home assessment of patients' mental wellbeing and functional capacity showed a significant improvement in detection rates. 23 Two studies of case management demonstrated improved management either by providing care more adherent to guidelines, increasing referrals to community services, and increasing anti-cholinesterase prescribing, 24 or by reducing hospital use and consultation rates with physicians, and by decreasing feelings of depression or isolation. 25 …”

“…41 The service innovation that produced the most benefits adapted the traditional doctorpatient-caregiver paradigm by introducing a multidisciplinary approach. 23 Another noncontrolled pilot study that tested shared (group) medical appointments for patients with dementia, and that demonstrated benefits by enabling collaboration between patients, caregivers, and clinicians, 42 supports this conclusion. These findings are consistent with the arguments of de Lepeleire et al, 43 who proposed that detection could be improved by employing a stepwise strategy, that improving the referral pathway could be more effective than introducing disease-specific guidelines, and that a strong, multidisciplinary approach enables diagnosis.…”

“…Seven intervention studies of this kind were identified, two with results still pending. 21,22 Of the remaining five, one evaluated a modified care programme, 23 and four evaluated case managers. [24][25][26][27] Of the studies that investigated changing the service pathway, one involved using the EASYcare Dutch Geriatric Intervention Programme, an in-home assessment using the validated EASYcare instrument which assesses function, cognition, mood, and goal setting.…”

“…29 Results showed that dementia diagnosis was significantly improved in the intervention group (29% compared with 9%, P = 0.02). 23 In evaluations of case management, the case manager undertook a range of tasks, including case finding, assessment, care planning, service coordination, and monitoring. One study also evaluated the intervention of a care manager using webbased support software for care planning and coordination.…”

Nursing care in multifunctional small group homes providing day, visiting and overnight services for older people living at home

“…4,5 In the Netherlands, an assessment and management program provided to frail older individuals has successfully improved the detection and management of dementia. 6,7 Nurses are an integral part of these home-based care programs and have contributed greatly to their findings.…”