Physicians' Perspectives on Caring for Cognitively Impaired Elders

Adams, Wendy L.; McIlvain, Helen E.; Geske, Jenenne; Porter, Judy

doi:10.1093/geront/45.2.231

Cited by 37 publications

(37 citation statements)

References 18 publications

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“…Dementia creates acute and intensive demands because of its behavioral complexity, chronicity, the patients' growing dependence on and involvement of informal helpers and family members, and the presence of comorbid health problems that compete for the attention of providers. Our findings are consistent with prior work on physician views of issues in early diagnosis and management 23,32 and 1 study examining longer term issues in dementia care 27 . Dementia often starts as a problem with cognition, but it almost always evolves into a problem with behavior.…”

Section: Discussionsupporting

confidence: 89%

“…25,26 Health care systems issues, particularly insufficient time, are often mentioned as barriers to diagnosis or management. 23,25 Whereas most studies focus on the initial assessment and management, Adams and colleagues 27 describe challenges primary care physicians face in the ongoing care of persons with dementia, including a shift from curing to caring, increasing reliance on the family, and ethical dilemmas. In discussing their findings, they note that dementia does not "fit well" within many physician's practice settings.…”

Section: Introductionmentioning

confidence: 99%

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Practice Constraints, Behavioral Problems, and Dementia Care: Primary Care Physicians’ Perspectives

Hinton

Franz

Reddy³

et al. 2007

J GEN INTERN MED

199

238

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OBJECTIVES:To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care. DESIGN:Cross-sectional qualitative interview study of primary care physicians. SETTING: Physicians' offices.PARTICIPANTS: Forty primary care physicians in Northern California. MEASUREMENTS:Open-ended interviews lasted 30-60 minutes and were structured by an interview guide covering clinician background and practice setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews were transcribed and themes reflecting constraints of practice were identified through a systematic coding process. RESULTS:Recurring themes (i.e., those present in ≥25% of physician interviews) included insufficient time, difficulty in accessing and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems, "reactive" as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial approaches. CONCLUSION:Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall short.KEY WORDS: dementia; quality of care; barriers; qualitative.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Practice Constraints, Behavioral Problems, and Dementia Care: Primary Care Physicians’ Perspectives

Hinton

Franz

Reddy³

et al. 2007

J GEN INTERN MED

199

238

View full text Add to dashboard Cite

show abstract

“…27 Research indicates that other dilemmas related to disclosure arise for GPs: anxieties about how persons may cope coming to terms with a progressive disability; 2 and ethical issues as medical decisions move from the patient to someone else. 28 The literature supports these GP concerns for patient wellbeing. While Pinner and Bouman's clinic sample had no major incidents following disclosure to patients, after 1 year 6% required antidepressant treatment.…”

Section: Resultsmentioning

confidence: 99%

Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice

Phillips

Pond²,

Paterson³

et al. 2012

Br J Gen Pract

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“…Although several studies have shown that mild to moderately impaired patients with dementia can provide reliable self-report information about their health and well-being (6, 9-11), family members are frequently viewed as the primary source of patient status information (12). Unfortunately, agreement between patient and caregiver reports of patient status is low to moderate at best (6, 7, 9-11, 13), raising questions about the usefulness of family proxy reports as guides to patient treatment.…”

Section: Introductionmentioning

confidence: 99%

Magnitude and Causes of Bias Among Family Caregivers Rating Alzheimer Disease Patients

Schulz

Cook

Beach

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Family caregivers generally underestimate the health and well-being of Alzheimer’s disease (AD) patients when compared to patient self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias. Methods 105 patients with AD and their family caregivers were assessed twice by trained interviewers one year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver-patient discrepancies. Results Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver-patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy. Conclusions Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers’ ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver’s own well-being is compromised.

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Physicians' Perspectives on Caring for Cognitively Impaired Elders

Abstract: Profound changes occur in the process of care with cognitively impaired patients. The increased complexity mandates an expanded model of care that addresses the prominent psychosocial and ethical aspects of care as well as the medical ones.

Cited by 37 publications

References 18 publications

Practice Constraints, Behavioral Problems, and Dementia Care: Primary Care Physicians’ Perspectives

Practice Constraints, Behavioral Problems, and Dementia Care: Primary Care Physicians’ Perspectives

Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice

Magnitude and Causes of Bias Among Family Caregivers Rating Alzheimer Disease Patients

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