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

被引：133
作者：
Aminzadeh, Faranak [1 ,2 ]
Molnar, Frank J. [3 ,4 ]
Dalziel, William B. [4 ,5 ]
Ayotte, Debbie [6 ]
机构：
[1] Univ Ottawa, Bruyere Res Inst BRI, Reg Geriatr Program Eastern Ontario RGPEO, Ottawa, ON, Canada
[2] Univ Ottawa, Sch Nursing, Ottawa, ON, Canada
[3] Univ Ottawa, Ottawa Hosp, Res Inst, RGPEO,BRI, Ottawa, ON, Canada
[4] Univ Ottawa, Fac Med, Ottawa, ON, Canada
[5] Ottawa Hosp, Geriatr Day Hosp, Civ Campus, Ottawa, ON, Canada
[6] Reg Geriatr Program Eastern Ontario RGPEO, Ottawa, ON, Canada
来源：
CANADIAN GERIATRICS JOURNAL | 2012年 / 15卷 / 03期
关键词：
dementia; primary care; health-care utilization; diagnosis and management; intervention studies;
D O I：
10.5770/cgj.15.42
中图分类号：
R592 [老年病学]; C [社会科学总论];
学科分类号：
03 ; 0303 ; 100203 ;
摘要：
Background With 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. Purpose To critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care. Methods An interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade. Results The 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. Conclusions Further 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.
引用
收藏
页码：85 / 94
页数：10
相关论文
共 119 条
[1]  
Rising Tide: The Impact of Dementia On Canadian Society, (2010)
[2]  
Bronskill S.E., Camacho X., Gruneir A., Et al., Health System Use by Frail Ontario Seniors: An In-depth Examination of Four Vulnerable Cohorts, (2011)
[3]  
Analysis in Brief: Taking Health Information Further, Alternative Level of Care in Canada, (2011)
[4]  
Pedone C., Ercolani S., Catani M., Et al., Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA study, J Gerontol A Biol Sci Med Sci, 60, 12, pp. 1576-1580, (2005)
[5]  
Rudolph J.L., Zanin N.M., Jones R.N., Et al., Hospitalization in community-dwelling persons with Alzheimer's Disease: Frequency and causes, J Am Geriatr Soc, 58, 8, pp. 1542-1548, (2010)
[6]  
Zilken R.R., Spilsbury K., Bruce D.G., Et al., Clinical epidemiology and in-patient hospital use in the last year of life (1990-2005) of 29,884 Western Australians with dementia, J Alzheimers Dis, 17, 2, pp. 399-407, (2009)
[7]  
Callahan C.M., Boustani M., Sachs G.A., Et al., Integrating care for older adults with cognitive impairment, Curr Alzheimer Res, 6, 4, pp. 368-374, (2009)
[8]  
Feldman H.H., Jacova C., Robillard A., Et al., Diagnosis and treatment of dementia: 2. Diagnosis, CMAJ, 178, 7, pp. 825-836, (2008)
[9]  
Hogan D.B., Bailey P., Black S., Et al., Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia, CMAJ, 179, 8, pp. 787-793, (2008)
[10]  
Iliffe S., Jain P., Wong G., Et al., Dementia diagnosis in primary care: Thinking outside the educational box, Aging Health, 5, 1, pp. 51-59, (2009)
12345678910