Practice Patterns, Beliefs, and Perceived Barriers to Care Regarding Dementia: A Report from the American Academy of Family Physicians (AAFP) National Research Network

Abstract

Purpose: Given the increasing age of the US population, understanding how primary care is delivered surrounding dementia and physicians' perceived barriers and needs associated with this care is essential.Methods: A 29-item questionnaire was developed by project investigators and family physician consultants and mailed to a random sample of 1500 US members of the American Academy of Family Physicians in 2008; 2 follow-up mailings were sent to nonrespondents. Physicians were queried about sociodemographic characteristics, practice patterns, and beliefs (including challenges, barriers, and needs) about care processes focusing on dementia among older patients.Results: The response rate was 60%, with respondents statistically comparable (P > .05) to the American Academy of Family Physicians physician population. Among physicians, 93% screen and/or conduct diagnostic evaluations for dementia in older patients, whereas 91% provide ongoing primary care for patients with dementia whether or not they screen for or diagnose dementia. Forty percent of physicians refer some patients with suspected dementia to other providers (primarily neurologists) to verify diagnosis, for comanagement, or both. Factors affecting the diagnosis of dementia and the delivery of dementia care included patient behavior challenges (aggressiveness, restlessness, paranoia, wandering); comorbidities (falls, delirium, adverse medication reactions, urinary incontinence); caregiver challenges (fatigue, planning for patient's institutional placement, anger); and structural barriers (clinician time, time required for screening, limited treatment options). Tools needed to provide enhanced dementia care included better assessment tools, community resources, and diagnostic and screening tools. Dementia is a general term describing a serious loss of at least 2 cognitive functions, such as memory, attention, thinking, or language, caused by a number of brain disorders. Alzheimer's disease (AD), which accounts for 60% to 80% of all dementia cases, is the most common cause.1 About 13.9% of This article was externally peer reviewed.

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

“…Whether successful management of incontinence is able to reduce either this associated burden or alter decisions to institutionalize these people is unknown; evidence is limited to case reports and anecdotal evidence. Family physicians identify dealing with incontinence in dementia as a significant challenge [28]. Likewise there is the concern regarding the influence of antimuscarinic medications on cognition, where there is increasing evidence of cognitive impairment and higher rates of incident dementia diagnosis associated with high antimuscarinic load and long exposure in older adults in epidemiological studies [29,30], although data in those with pre-existing dementia are less consistent [31].…”

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

“…National strategies developed to address the increased prevalence of dementia have emphasised the role of GPs in successful implementation but dementia care in the community can be challenging . In common with their hospital‐based colleagues, General practitioners find the management of the behavioural and psychological symptoms of dementia (BPSD) particularly difficult …”

“…8,9 In common with their hospital-based colleagues, 10 General practitioners find the management of the behavioural and psychological symptoms of dementia (BPSD) particularly difficult. [11][12][13][14] Behavioural and psychological symptoms of dementia encompass behaviours such as aggression, wandering, sexual disinhibition, agitation, and symptoms such as anxiety, depression, and delusions. Most people with dementia will experience BPSD at some time during their illness.…”

Investigating Patient-Centered Care

“…Sadly, many questions relate to patient cost and insurance coverage, in addition to a variety of other issues. Stewart et al 13 reinforce the large contribution of family physicians to dementia care: Almost all family physicians are involved in the assessment and routine care of those with suspected or diagnosed dementia. This issue also includes a clinical review of hepatitis C 14 and brief consideration of a case of split peroneus brevis tendon.…”