Family carers' accounts of general practice contacts for their                 relatives with early signs of dementia

Downs, Murna; Ariss, Steven; Grant, Eryk; Keady, John; Turner, Stephen; Bryans, M; Wilcock, Jane; Levin, Enid; O’Carroll, Ronan E.; Iliffe, Steve

doi:10.1177/1471301206067111

Cited by 16 publications

(16 citation statements)

References 34 publications

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“…The second delay occurred after the first health professional was consulted. Some carers reported that the first health professional did not act on symptoms or perform a memory test, and, as in other studies, 5 , 12 , 13 some carers reported that their concerns were dismissed or referral was delayed. In some cases, health professionals might not have considered dementia a likely diagnosis, may have been hesitant to suggest dementia as a possible diagnosis because of uncertainty or the stigma associated with the disease, 9 or may have believed tests would not change patient management 14 .…”

Section: Discussionmentioning

confidence: 53%

The pathway to dementia diagnosis

Speechly

Bridges‐Webb

Passmore

2008

Medical Journal of Australia

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Objective: To describe the steps taken by health professionals to diagnose dementia and the timeframes for these steps, as reported by carers. Design, setting and participants: A cross‐sectional, anonymous survey was mailed or distributed by Alzheimer's Australia New South Wales, six Sydney residential aged care facilities and 13 Sydney general practitioners to 415 carers or family members of patients with dementia between May and August 2007. Main outcome measures: First symptoms noticed and actions taken; time to first health professional consultation and diagnosis; reported actions of first health professional; satisfaction with first consultation; and use of dementia and chronic illness resources. Results: 209 surveys were returned. Family members noticed the first symptoms of dementia at a mean of 1.9 years before the first health professional consultation about dementia, and 3.1 years before a firm diagnosis. Resource use first occurred 2.8 years after the first symptoms. Most carers (72%) were satisfied with the first consultation, which was usually with a GP (84%). Two‐thirds of carers (64%) reported that the first health professional had performed a memory test. Conclusions: Delays in presentation, diagnosis and resource use may have clinical and social implications for people with dementia and their families, in addition to the challenges of the process of obtaining a firm diagnosis.

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Section: Discussionmentioning

confidence: 53%

The pathway to dementia diagnosis

Speechly

Bridges‐Webb

Passmore

2008

Medical Journal of Australia

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“…(56,80,81) CPG can be a useful tool in enhancing the knowledge and confidence of PCP in the diagnosis and management of PWD. (22,82,83) However, many PCP remain unaware of the existing CPG, are unfamiliar with the specific content, and question the credibility, applicability, and feasibility of the recommendations. (16,34,82,83) …”

Section: Resultsmentioning

confidence: 99%

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

et al. 2012

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BackgroundWith the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention.PurposeTo critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care.MethodsAn interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade.ResultsThe current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care.ConclusionsFurther progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.

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“…Recent research has found that family carers observed significant levels of agitated behaviour, behaviour that they felt unprepared for as they were unaware that agitation could occur as part of dementia . Carers value a proactive approach to dementia care from GPs . Therefore, a more proactive initial discussion with family care‐givers on BPSD, combined with regular screening questions as part of dementia reviews in general practice, could help to address how unprepared carers feel when faced with managing BPSD at home.…”

Section: Discussionmentioning

confidence: 99%

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

Jennings

Foley

Walsh

et al. 2018

Int J Geriat Psychiatry

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ObjectivesTo synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions.MethodsWe conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta‐ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings.ResultsOf the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A “line of argument” was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached.ConclusionThis systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.

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Family carers' accounts of general practice contacts for their relatives with early signs of dementia

Cited by 16 publications

References 34 publications

The pathway to dementia diagnosis

The pathway to dementia diagnosis

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

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