Communicating a diagnosis of dementia: A systematic mixed studies review of attitudes and practices of health practitioners

Low, Lee‐Fay; McGrath, Margaret; Swaffer, Kate; Brodaty, Henry

doi:10.1177/1471301218761911

Cited by 71 publications

(89 citation statements)

References 75 publications

(175 reference statements)

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“…22 Even when patients do present to their GPs, GPs' decisions to diagnose and to communicate a diagnosis are influenced by their own beliefs, patient circumstances, health system access and cultural norms. 61 For example, a multicentre randomised controlled trial of an intervention to improve GP diagnosis rates by empowering people from the general population in the south-east of England aged ≥ 70 years to seek help from their GP if they were concerned found that the intervention did not increase diagnosis rate. 62 Evidence suggests that some GPs recognise and manage patients as having dementia without recording them in primary care record systems as having dementia.…”

Section: Inpatient Hospital Visitsmentioning

confidence: 99%

Undiagnosed dementia in primary care: a record linkage study

Aldus

Arthur

Dennington-Price

et al. 2020

Health Serv Deliv Res

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Background The number of people living with dementia is greater than the number with a diagnosis of dementia recorded in primary care. This suggests that a significant number are living with dementia that is undiagnosed. Little is known about this group and there is little quantitative evidence regarding the consequences of diagnosis for people with dementia. Objectives The aims of this study were to (1) describe the population meeting the criteria for dementia but without diagnosis, (2) identify predictors of being diagnosed and (3) estimate the effect of diagnosis on mortality, move to residential care, social participation and well-being. Design A record linkage study of a subsample of participants (n = 598) from the Cognitive Function and Ageing Study II (CFAS II) (n = 7796), an existing cohort study of the population of England aged ≥ 65 years, with standardised validated assessment of dementia and consent to access medical records. Data sources Data on dementia diagnoses from each participant’s primary care record and covariate and outcome data from CFAS II. Setting A population-representative cohort of people aged ≥ 65 years from three regions of England between 2008 and 2011. Participants A total of 598 CFAS II participants, which included all those with dementia who consented to medical record linkage (n = 449) and a stratified sample without dementia (n = 149). Main outcome measures The main outcome was presence of a diagnosis of dementia in each participant’s primary care record at the time of their CFAS II assessment(s). Other outcomes were date of death, cognitive performance scores, move to residential care, hospital stays and social participation. Results Among people with dementia, the proportion with a diagnosis in primary care was 34% in 2008–11 and 44% in 2011–13. In both periods, a further 21% had a record of a concern or a referral but no diagnosis. The likelihood of having a recorded diagnosis increased with severity of impairment in memory and orientation, but not with other cognitive impairment. In multivariable analysis, those aged ≥ 90 years and those aged < 70 years were less likely to be diagnosed than other age groups; those living with a spouse (odds ratio 2.38, 95% confidence interval 1.04 to 5.41) were more likely to be diagnosed than people living alone. The median time to diagnosis from first meeting the criteria for dementia was 3 years. Diagnosis did not affect survival or the probability of a move to residential care. Limitations People with moderate to severe dementia at baseline could not consent to record linkage. The small numbers in some groups limited power to detect effects. Conclusions The lack of relationship between severity of non-memory impairment and diagnosis may reflect low awareness of other symptoms of dementia. There remains little objective evidence for benefits of diagnosis for people with dementia. Future work Potential benefits of diagnosis can be realised only if effective interventions are accessible to patients and carers. Future work should focus on improving support for people living with cognitive impairment. Study registration National Institute for Health Research Clinical Research Network Central Portfolio Management System (CPMS 30655). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 20. See the NIHR Journals Library website for further project information.

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Section: Inpatient Hospital Visitsmentioning

confidence: 99%

Undiagnosed dementia in primary care: a record linkage study

Aldus

Arthur

Dennington-Price

et al. 2020

Health Serv Deliv Res

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“…The importance of our findings rest within the context of broader evidence that patients prefer early initiation of conversations about memory and would like conversations with clinicians to be more thorough, encompassing disease progression, counseling, and planning for the future. 6,31,32 Interestingly, primary care clinicians are more likely to disclose dementia diagnoses to family members than patients, 33 suggesting a need to better align patient, family and clinician perspectives concerning presence of cognitive impairment when moving toward detection and diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Discussion of memory during primary care visits of older adults with cognitive impairment and accompanying family

Aufill

Amjad

Roter

et al. 2019

Int J Geriat Psychiatry

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Objectives Cognitive impairment is underdiagnosed in primary care. Understanding factors that precipitate memory‐related discussion could inform strategies to improve diagnosis and counseling. We assessed whether: 1) having a cognitive impairment or dementia diagnosis, 2) ratings of cognition by clinicians, or 3) ratings of cognition by family companions were associated with memory‐related discussion during primary care visits. Methods We examined audio‐recorded primary care visits of cognitively impaired patients aged 65 years and older, family companions (n = 93 dyads), and clinicians (n = 14). Cognitive impairment and dementia diagnoses were extracted from the electronic health record. Clinicians and family rated patient cognition on a 10‐point scale in postvisit surveys. We measured memory‐related discussion using a ratio of memory‐related discussion episodes to total visit statements. Results We observed more memory‐related discussion during primary care visits of patients with a diagnosis of mild cognitive impairment (+7.8% episodes; P < .001) or dementia (+26.3% episodes; P < .001) than no diagnosis. Clinician and family ratings of cognition varied by diagnosis: among patients with no diagnosis, family rated worse impairment than clinicians (average: 2.4 versus 1.3; P = .004) while for patients with a dementia diagnosis, clinicians rated worse impairment than family (average: 7.1 versus 5.5; P = .006). Each unit increase in clinician‐rated severity of cognitive impairment was associated with more memory‐related discussion (+2.6% episodes; P < .001); this association was attenuated for family (+0.7% episodes; P = .095). Conclusions Discussion of cognitive impairment appears largely driven by clinician ratings of cognition and presence of an established diagnosis. Findings suggest potential benefit of engaging family to improve cognitive impairment detection in primary care.

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“…El contar con un diagnóstico certero favorece la confianza de los profesionales de la salud para comunicarlo y discutirlo, ya sea con el paciente o con los padres de los pacientes. [19][20][21][22]…”

Section: Variables Independientesunclassified

Comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual

et al. 2020

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Objetivo. Estimar los factores asociados con la comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual y otros trastornos del neurodesarrollo. Material y métodos. Encuesta transversal en 759 profesionales de la salud mental. Se estimó la asociación entre el patrón de comunicación abierto y los atributos de la comunicación a través de un modelo logístico, ordinal y multivariado. Resultados. La prevalencia del patrón de comunicación abierta en profesionales de la salud mental fue de 30.6% (IC95% 27.4-34.0). Los factores asociados fueron menor edad (RM=2.42, IC95% 1.57-3.75), especialidad (RM=1.56, IC95% 1.09-2.23), alto valor a la verdad (RM=4.95, IC95% 3.21-7.65), bajo paternalismo (RM=10.93, IC95% 7.22-16.52) y cursos de bioética (RM=1.45, IC95% 1.01-2.09), ajustando por variables confusoras. Conclusión. Los profesionales de la salud mental reportaron bajos niveles de comunicación abierta con los padres de personas con trastornos del neurodesarrollo, por lo que priorizar el valor a la verdad, promover un menor paternalismo y el respeto a la autonomía de los pacientes puede contribuir a cambiar estos patrones de comunicación en la práctica clínica en México.

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Communicating a diagnosis of dementia: A systematic mixed studies review of attitudes and practices of health practitioners

Cited by 71 publications

References 75 publications

Undiagnosed dementia in primary care: a record linkage study

Undiagnosed dementia in primary care: a record linkage study

Discussion of memory during primary care visits of older adults with cognitive impairment and accompanying family

Comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual

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