Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Borson, Soo; Scanlan, James M.; Hummel, Jeffrey W.; Gibbs, Kathy; Lessig, Mary; Zuhr, Elizabeth

doi:10.1007/s11606-007-0242-0

Cited by 33 publications

(50 citation statements)

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“…A previous study in Seattle (US) found comparable prevalence rates among primary care patients aged 65 years or older (18%) [27]. In a population-based study sample of older adults in Leipzig (Germany) aged 75 or older, the prevalence of dementia according to the ICD-10 criteria was 12.4% [28].…”

Section: Limitations and Generalizability Of Resultsmentioning

confidence: 93%

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Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

Eichler

Hoffmann

Hertel

et al. 2016

JAD

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Abstract. Background:Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. Objectives: To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. Methods: DelpHi-MV (Dementia: Life-and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9). Results: N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drugrelated problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings. Conclusion: Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning.

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Section: Limitations and Generalizability Of Resultsmentioning

confidence: 93%

“…Twenty-three percent of the primary care patients who had screened positive (DemTect-score <9) were not categorized as cognitively impaired according to their MMSE-score (27)(28)(29)(30); assessed at baseline). A certain proportion of these patients might have been screened falsepositive.…”

Section: Limitations and Generalizability Of Resultsmentioning

confidence: 99%

Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

Eichler

Hoffmann

Hertel

et al. 2016

JAD

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“…28 Pre-visit questionnaires take advantage of this heuristic, because using a pre-visit questionnaire allows data-gathering to occur simultaneously with the clinician's activities in caring for other patients, rather than having to be sequenced into the clinician's activities once the patient is in the examination room. Other redesign heuristics include automating tasks where possible (e.g., using digital pen and paper to automatically import paper-based questionnaire answers into electronic format), empowering staff to complete tasks previously performed by clinicians (e.g., memory testing on patients with possible cognitive impairment), 29 or designing specific workflows to have available for particular cases (e.g., condition-specific progress note templates). 28 Because patients and caregivers often initiate workflow for a primary care practice, they are an extended part of the primary care team; electronic patient-clinician communication that automatically routes patient queries to the appropriate destination (be it clinician, staff, or pharmacy) may thus represent an enhancement to a practice's work processes.…”

Section: Workflow Managementmentioning

confidence: 99%

Key Elements of High-Quality Primary Care for Vulnerable Elders

Ganz

Fung²,

Sinsky

et al. 2008

J GEN INTERN MED

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With the impending surge in the number of older adults, primary care clinicians will increasingly need to manage the care of vulnerable elders. Caring for vulnerable elders is complex because of their wide range of health goals and the interdependence of medical care and community supports needed to achieve those goals. In this article, we identify ways a primary care practice can reorganize to improve the care of vulnerable elders. We begin by identifying important outcomes for vulnerable elders and three key processes of care (communication, developing a personal care plan for each patient, and care coordination) needed to achieve these outcomes. We then describe two delivery models of primary care for vulnerable elders -co-management, and augmented primary care. Finally, we discuss how the physical plant, people, workflow management, and community linkages in a primary care practice can be restructured to better serve these patients.KEY WORDS: primary care; practice redesign; quality of care; quality improvement; older adults.

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“…Both have psychometric properties superior to the MMSE; as such, they are clinically and psychometrically robust and, it has been argued, are more appropriate for routine use in primary care. 27,46 Step 3: Assessment of Daily Functioning An assessment of daily function is vital to determine the extent of the patient's disability and dependence on the caregiver, the results of which help to enable planning to maximize patients' independence. 47 Basic ADLs, such as feeding and toileting, can be assessed with an interview or by using a tool such as the ADL Scale.…”

Section: Informant-based Screening Toolsmentioning

confidence: 99%

Practical Guidelines for the Recognition and Diagnosis of Dementia

Galvin

Sadowsky²

2012

The Journal of the American Board of Family Medicine

149

120

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To date, user-friendly, practical guidelines for dementia have not been available for busy family physicians. However, the growing number of patients with dementia means that primary care physicians will have an increasingly important role in the diagnosis and subsequent management of dementia. This article provides practical guidance for the recognition and diagnosis of dementia and is aimed at family physicians, who are usually the first clinicians to whom patients present with dementia symptoms. Because Alzheimer disease (AD) is the most common form of dementia, this condition is the main focus of this article. We review the pathophysiology of AD and discuss recommended diagnostic protocols and the importance of early diagnosis. An AD diagnostic algorithm is provided, with clearly defined steps for screening and diagnosing AD and assessing daily functioning, behavioral symptoms, and caregiver sta- Dementia: an OverviewAlzheimer disease (AD) is the most common form of dementia, accounting for approximately 60% of all cases, 1,2 and it is therefore the main focus of this article. AD destroys brain cells, causing problems with memory, thinking, and behavior severe enough to affect work, family, and social relationships and, eventually, the most basic activities of daily living (ADLs). AD and related disorders are a growing public health problem in the United States, with a prevalence ranging from 3% to 11% among people aged 65 years and older and from 25% to 47% among those aged older than 85 years. 3,4 There are an estimated 5.3 million cases of dementia in the United States, 5 and this number is expected to increase to 18.5 million by 2050. 6 The number of those afflicted is increasing annually as a result of the aging population. Dementia leads to a high burden of suffering for patients, families, and society, with an annual estimated cost of $172 billion. 5 People with dementia usually present first to their family physician, although an estimated 39% present to specialist clinics (neurologists, psychiatrists and geriatricians). 7 The primary care physician (PCP) is often the first physician to observe patients with possible dementia and often the only physician involved in making the diagnosis. 8 Because of the key role that PCPs play in the longterm management of elderly individuals with chronic disease, the growing number of patients with dementia will have a significant impact on these health professionals. 9 The rising number of patients with dementia means that family physicians will have an increasingly important role in recognizing early signs and symptoms of disease, ordering appropriate tests, formally diagnosing, and, finally, treating these patients. However, at present, diagnosing AD can be Funding: none. Conflict of interest:Dr Sadowsky has served as a consultant to Novartis Pharmaceuticals Corporation, has served as a speaker for Novartis Pharmaceuticals Corporation and Forest Pharmaceuticals and Accera, and has received honoraria from these companies. James E Galvin is a paid consultant for ...

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Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Cited by 33 publications

References 0 publications

Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

Key Elements of High-Quality Primary Care for Vulnerable Elders

Practical Guidelines for the Recognition and Diagnosis of Dementia

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