Reported practices of primary care physicians in the diagnosis and management of dementia

Abstract

The shortage of geriatric specialists in the US may require that primary care physicians (PCPs) receive more education on diagnosing and managing dementia since the number of older Americans with dementia will increase from about five million in 2010 to up to 14 million in 2050. Thus, we administered a brief, anonymous questionnaire to determine PCPs' diagnostic, referral, and management practices to a convenience sample of 142 PCPs in Arkansas. We reworded a Scottish survey to conform to terminology used in the US and added items on referral practices. The PCPs who reported difficulty establishing the diagnosis of dementia had more difficulty telling the diagnosis (O.R = 3.59, p < 0.004). The PCPs were less likely (p < 0.001) to tell the patient if they suspected dementia (73%) than if they were sure the patient had dementia (88%). In both cases, they were more likely to tell the family (92% & 100%, respectively), although this difference was not statistically significant. The PCPs discussed disease progression and driving risks with patients and families, but few referred them to social workers or community agencies. Findings support training PCPs in the diagnosis and management of persons with dementia and providing tools to improve care.

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

“…18,19 Sensitively disclosing a dementia diagnosis reflected the well-recognised stigma implicated in delays in dementia diagnosis. 2,4,23,24,30 In accordance with findings of Cody et al 17 and Downs et al, 21 GPs in this study often couched disclosure using terms other than dementia, and the importance of giving hope in the disclosure process was also raised. 21 Sensitively delivering the diagnosis suggests some GPs may use a more patient-centred approach to disclosure, an approach that is gaining attention in the literature.…”

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

“…Greater likelihood of telling the diagnosis was associated with the practitioner being male (Somme et al, 2013, Cody et al, 2002 and younger (Somme et al, 2013, Tarek et al, 2009, Downs et al, 2002, or working in a practice with two or more practitioners (Van Hout et al, 2006). Two studies reported contradictory findings on how severity of dementia related to whether the diagnosis was told.…”

“…Two studies used a combination of representative and convenience sampling (Cody et al, 2002, Kaduszkiewicz et al, 2008a, one study used a 'market research' sample but how this was sourced was not clear (Jones et al, 2010). Participation rates ranged from 15% to 100%.…”

Diagnosis of Dementia in Primary Care: A Representative Survey of Family Physicians and Neuropsychiatrists in Germany

“…Other investigators showed that low knowledge as well as dementia-related 'nihilistic' attitudes affect detection rates and case management [16,[36][37][38] . However, diagnostic assessment and disclosure of the results both need skills on the part of the physicians.…”