Caring for Patients with Dementia: How Good Is the Quality of Care? Results from Three Health Systems

Chodosh, Joshua; Mittman, Brian; Connor, Karen I.; Vassar, Stefanie D.; Lee, Martin L.; DeMonte, Robert W.; Ganiats, Théodore G.; Heikoff, Lisa; Rubenstein, Laurence Z.; Penna, Richard Della; Vickrey, Barbara G.

doi:10.1111/j.1532-5415.2007.01249.x

Cited by 73 publications

(85 citation statements)

References 37 publications

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“…48 Previous research comparing people from older age groups, with and without dementia, has shown dementia to be independently associated with poor quality of care. [24][25][26][27] The findings of association between the quality of care and greater number of comorbid medical conditions and medications may be due to increased likelihood of attendance to consultations. 15,24 Comparison with existing literature The deficiencies in the quality of care received by people with dementia are consistent with previous studies demonstrating suboptimal care received by these patients in secondary and private care settings.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…[24][25][26][27] The findings of association between the quality of care and greater number of comorbid medical conditions and medications may be due to increased likelihood of attendance to consultations. 15,24 Comparison with existing literature The deficiencies in the quality of care received by people with dementia are consistent with previous studies demonstrating suboptimal care received by these patients in secondary and private care settings. [24][25][26][27] Although improved performance in care for individual conditions like diabetes has been apparent in recent years -and since the introduction of the QOF in UK general practice 49,50 -this is not necessarily true for all subgroups of patients.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…7 Whether other comorbid conditions are more frequent and underdiagnosed in people with dementia is debated [8][9][10] and not all studies have found comorbid vascular diseases to predict a more rapid progression of dementia, 11 however, there is some evidence that controlling high blood pressure, atrial fibrillation, and angina may slow cognitive decline in dementia. 12 Patient characteristics that have been associated with better quality of care include older age, greater dementia severity, 13 and greater comorbidity, although the latter's relationship with quality of care is not entirely clear. [14][15][16] Compared with people living in the community, those living in care homes receive poorer care for conditions like heart disease and diabetes, and potentially harmful medications (for example, antipsychotics) are overprescribed.…”

Section: Introductionmentioning

confidence: 99%

“…• the detection rates of dementia, and associated behavioural and psychological symptoms of dementia; [22][23][24] • end-of-life care; 25 and…”

Section: Introductionmentioning

confidence: 99%

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Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…• the detection rates of dementia, and associated behavioural and psychological symptoms of dementia; [22][23][24] • end-of-life care; 25 and…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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“…Quality criteria have either been defined as expert standards (Chodosh et al 2007) or the outcome variables of studies of family caregiver interventions (for example reduction of caregiver's burden) are regarded as quality criteria (Mahoney et al 2001). To date, there are no empirical studies of the various characteristics of caregiver counselling regarding their effectiveness, although specific characteristics, such as counselling about the various forms of dementia appear sensible and necessary (Ibach et al 2004).…”

Section: Structural Quality (S): Non-personal Factors (S I); Person-rmentioning

confidence: 99%

Counselling for dementia caregivers—predictors for utilization and expected quality from a family caregiver’s point of view

Gräßel

Luttenberger

Trilling³

et al. 2010

Eur J Ageing

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Caregiver counselling has proved to be effective in reducing the burden of family caregivers of dementia patients. Nevertheless, little is known about the influencing factors for utilization and quality expectations of family caregivers. In this article, we address the following questions on the theoretical base of the Andersen/ Newman model: Which variables of the care situation, the caregivers and their attitudes act as predictors for the utilization of caregiver counselling? What are the views of caregivers about the quality of caregiver counselling? The cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in four regions, both urban and rural, of Germany. Quantitative and qualitative data from 404 family caregivers were analysed using binary logistic regression analysis and qualitative content analysis, respectively. The only significant predictor for utilization is the assessment of how helpful caregiver counselling is for the individual care situation. In the sensitivity analysis 'accessibility of caregiver counselling' was additionally predictive for usage. Family caregivers most frequently expressed a wish for advice about further 'support offers' by qualified counsellors. In order to increase the rate of utilization, family caregivers must be convinced of the relevant advantages of using caregiver counselling. Counselling services should provide information about further support offers and give practical help in filling out application forms.

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Nonpharmacologic Management of Behavioral Symptoms in Dementia

Gitlin

Kales

Lyketsos

2012

JAMA

411

233

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Mr P is a 93-year-old bachelor who has lived in the United States since emigrating from Mexico at age 8. He began to have memory problems 13 years ago such as forgetting why he walked into a room or whether he had taken his medications. Mr P sought treatment in 2004 and scored 29 of 30 points on the Mini-Mental State Examination (MMSE; normal cognition score Ͼ24). His memory impairment, coupled with results from brain computed tomography showing white matter changes and bilateral and frontotemporal atrophy, led to diagnosis of mild cognitive impairment due to brain vascular disease. By 2010, Mr P's score had declined by 8 points (MMSE, 21/30) and his course of illness was considered consistent with mild progressive dementia. Mr P lives with Mr C, a cousin who is also his primary caregiver. Mr P has no children and all other family lives in Mexico. His caregiver is employed full time, which requires that Mr P stay at home alone. Mr P relies on his caregiver to organize and administer his 13 medications and to perform instrumental activities such as shopping and cooking. He dresses and bathes independently.Mr P maintained a positive mood as his disease progressed. He lacked insight into his memory problems. Neuropsychological testing revealed major impairments in executive function, verbal and spatial memory, wordfinding ability, and recall. His other diagnoses included hypertension, type 2 diabetes mellitus, lower extremity peripheral neuropathy, and coronary artery disease. Mr P's dementia progressed, he napped excessively during the day, experienced nighttime restlessness, and frequently awakened Mr C. Additionally, he withdrew from gardening and other previously enjoyed activities and reported feelings of insecurity and loneliness.CME available online at www.jamaarchivescme.com and questions on p 2041.

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Caring for Patients with Dementia: How Good Is the Quality of Care? Results from Three Health Systems

Cited by 73 publications

References 37 publications

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Counselling for dementia caregivers—predictors for utilization and expected quality from a family caregiver’s point of view

Nonpharmacologic Management of Behavioral Symptoms in Dementia

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