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Yondjo J, Siette J. "VR is the future": perspectives of healthcare professionals on virtual reality as a diagnostic tool for dementia status in primary care. BMC Med Inform Decis Mak 2024; 24:9. [PMID: 38178165 PMCID: PMC10765843 DOI: 10.1186/s12911-023-02413-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Healthcare professionals (HPs) hold critical perspectives on the barriers and facilitating factors for the implementation of virtual reality (VR) dementia diagnosis tools in the clinical setting. This study aims to explore HP perspectives regarding the clinical implementation of dementia diagnosis tools using VR platforms. METHODS An exploratory qualitative interview study was carried out between July and September 2022. In-depth semi-structured interviews were conducted with HPs (n = 7) with clinical expertise in dementia diagnoses drawn from medicine, nursing and allied health practices. A hermeneutic phenomenological approach was used to frame the interview data across the dementia diagnosis pathway and application of new technology. RESULTS HPs were on average 36.29 years old (SD = 11.56) with 11.85 years of experience (SD = 12.80, range:4-42). Analyses identified three main themes related to the contemporary methods of dementia diagnosis, dementia diagnosis and the medical landscape and HP perspectives on the usefulness and barriers of VR implementation. VR was considered an innovative prospect, with improved ecological validity compared to commonplace, current cognitive assessments. Concerns of time commitments, monetary costs and the validity of the new technology were identified as key barriers to implementation. Overall, implementation of a new diagnostic tool was considered a complex process. CONCLUSIONS Our insight into general practice and nursing clinics can be supported to embed and integrate virtual reality platforms in primary care settings. Primary healthcare organizations require more funding and time related resources to produce a context in which VR tools could be implemented in a beneficial manner.
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Affiliation(s)
- Joshua Yondjo
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia.
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2
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Bergman H, Borson S, Jessen F, Krolak-Salmon P, Pirani A, Rasmussen J, Rodrigo J, Taddeo D. Dementia and comorbidities in primary care: a scoping review. BMC PRIMARY CARE 2023; 24:277. [PMID: 38097969 PMCID: PMC10720181 DOI: 10.1186/s12875-023-02229-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND People with dementia (PwD) are known to have more chronic conditions compared to those without dementia, which can impact the clinical presentation of dementia, complicate clinical management and reduce overall quality of life. While primary care providers (PCPs) are integral to dementia care, it is currently unclear how PCPs adapt dementia care practices to account for comorbidities. This scoping review maps recent literature that describes the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities, identifies critical knowledge gaps and proposes potential avenues for future research. METHODS We searched for peer-reviewed literature published between 2017-2022 in MEDLINE, Cochrane Library, and Scopus using key terms related to dementia, primary care, and comorbidity. The literature was screened for relevance by title-abstract screening and subsequent full-text screening. The prioritized papers were categorized as either 'Risk Assessment and Prevention', 'Screening, Detection, and Diagnosis' or 'Management' and were further labelled as either 'Tools and Technologies', 'Recommendations for Clinical Practice' or 'Programs and Initiatives'. RESULTS We identified 1,058 unique records in our search and respectively excluded 800 and 230 publications during title-abstract and full-text screening. Twenty-eight articles were included in our review, where ~ 50% describe the development and testing of tools and technologies that use pre-existing conditions to assess dementia risk. Only one publication provides official dementia screening guidelines for PCPs in people with pre-existing conditions. About 30% of the articles discuss managing the care of PwD, where most were anchored around models of multidisciplinary care and mitigating potentially inappropriate prescribing. CONCLUSION To our knowledge, this is the first scoping review that examines the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities. Given our findings, we recommend that future studies: 1) further validate tools for risk assessment, timely detection and diagnosis that incorporate other health conditions; 2) provide additional guidance into how comorbidities could impact dementia care (including prescribing medication) in primary care settings; 3) incorporate comorbidities into primary care quality indicators for dementia; and 4) explore how to best incorporate dementia and comorbidities into models/frameworks of holistic, person-centred care.
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Affiliation(s)
- Howard Bergman
- Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada.
| | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | | | | | | | - Jesus Rodrigo
- Spanish Alzheimer's Confederation (Confederación Española de Alzheimer), Pamplona, Spain
| | - Daiana Taddeo
- Italian College of General Practitioners and Primary Care (SIMG - Società Italiana Di Medicina Genrale E Cure Primarie), Florence, Italy
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3
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Ford E, Milne R, Curlewis K. Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia. WILEY INTERDISCIPLINARY REVIEWS. DATA MINING AND KNOWLEDGE DISCOVERY 2023; 13:e1492. [PMID: 38439952 PMCID: PMC10909482 DOI: 10.1002/widm.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/06/2024]
Abstract
Dementia poses a growing challenge for health services but remains stigmatized and under-recognized. Digital technologies to aid the earlier detection of dementia are approaching market. These include traditional cognitive screening tools presented on mobile devices, smartphone native applications, passive data collection from wearable, in-home and in-car sensors, as well as machine learning techniques applied to clinic and imaging data. It has been suggested that earlier detection and diagnosis may help patients plan for their future, achieve a better quality of life, and access clinical trials and possible future disease modifying treatments. In this review, we explore whether digital tools for the early detection of dementia can or should be deployed, by assessing them against the principles of ethical screening programs. We conclude that while the importance of dementia as a health problem is unquestionable, significant challenges remain. There is no available treatment which improves the prognosis of diagnosed disease. Progression from early-stage disease to dementia is neither given nor currently predictable. Available technologies are generally not both minimally invasive and highly accurate. Digital deployment risks exacerbating health inequalities due to biased training data and inequity in digital access. Finally, the acceptability of early dementia detection is not established, and resources would be needed to ensure follow-up and support for those flagged by any new system. We conclude that early dementia detection deployed at scale via digital technologies does not meet standards for a screening program and we offer recommendations for moving toward an ethical mode of implementation. This article is categorized under:Application Areas > Health CareCommercial, Legal, and Ethical Issues > Ethical ConsiderationsTechnologies > Artificial Intelligence.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public HealthBrighton and Sussex Medical SchoolBrightonUK
| | - Richard Milne
- Kavli Centre for Ethics, Science and the PublicUniversity of CambridgeCambridgeUK
- Engagement and SocietyWellcome Connecting ScienceCambridgeUK
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Low LF, Gresham M, Phillipson L. Further development needed: models of post-diagnostic support for people with dementia. Curr Opin Psychiatry 2023; 36:104-111. [PMID: 36705009 DOI: 10.1097/yco.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW There is increasing recognition of a service gap immediately after diagnosis for people with dementia and carers. This narrative review of models of post-diagnostic support focuses on recent developments and offers suggestions for future development. We present the current evidence for these models and consider the service components they provide against the recommendations of clinical guidelines and principles underpinning ideal post-diagnostic support. RECENT FINDINGS Models of post-diagnostic support include a short-term support worker, ongoing support worker, centre-based support, primary care management, and specialist dementia clinics. Of these, specialist dementia clinics that include ongoing support workers provide most components of an ideal and timely post-diagnostic support framework, but may be more costly to implement universally. The greatest research evidence is for the benefits of long-term support models, specifically case management, though this does not necessarily include medical care or nonpharmacological interventions. There is sparce evidence for the benefits of short-term support worker models such as dementia advisers for people with dementia and carers. SUMMARY Further development is needed to create whole-system models of dementia support which meet the needs of people with dementia and their carers, are timely, accessible and equitable, and can be implemented universally.
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Affiliation(s)
- Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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Johar H, Schaefer A, Su TT. Depressive symptoms mediate the longitudinal association between diabetes and subjective cognitive decline. Findings from a semirural multi-ethnic older population in Malaysia. Prev Med 2023; 167:107390. [PMID: 36528114 DOI: 10.1016/j.ypmed.2022.107390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/15/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
The potential role of psychological distress as the pathway linking diabetes and subjective cognitive decline (SCD) is still unclear. This study aims to investigate whether depressive symptoms mediate the relationship between diabetes and SCD in older adults. Baseline data from 3428 adults (55-94 years) of the South East Asia Community Observatory (SEACO), Malaysia were utilized. Subjective cognitive complaints (SCC) were recorded at baseline and five years later. Mediation analyses with non-parametric bootstrapping methods were employed. A proportion of 20% of participants without SCC at baseline reported a decline in SCC after 5 years of follow-up. Known diabetes (β = -0.13, SE = 0.05, p = 0.02) and depressive symptoms (ß = -0.18, SE = 0.05, p = 0.001) were independently associated with SCD. Previously diagnosed diabetes was associated with depressive symptoms at baseline (ß = 0.04, SE = 0.02, p = 0.01), and greater SCD at follow-up (β = -0.19, SE = 0.06, p = 0.001). Mediation analyses revealed that 9% of the association between diabetes and SCD was attributable to an indirect effect through depressive symptoms (ß = -0.01, 95% CI 0.02-0.001, p < 0.0001). This study provides further evidence of the detrimental effects of diabetes and depression on subjective cognitive decline. Our findings also suggest that depression is an important pathway linking previously diagnosed diabetes with subjective cognitive decline in older adulthood.
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Affiliation(s)
- Hamimatunnisa Johar
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia; Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Giessen, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, München, Germany.
| | - Alexandre Schaefer
- School of Medical and Life Sciences, Department of Psychology, Sunway University, Malaysia; Ageing, Health and Well-being Research Centre, Sunway University, Malaysia
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia; South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
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Lee SI, Cooper J, Fenton A, Subramanian A, Taverner T, Gokhale KM, Phillips K, Patel M, Harper L, Thomas GN, Nirantharakumar K. Decreased renal function is associated with incident dementia: An IMRD-THIN retrospective cohort study in the UK. Alzheimers Dement 2022; 18:1943-1956. [PMID: 34978143 DOI: 10.1002/alz.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Decreased renal function is a potential risk factor for dementia. METHODS This retrospective cohort study of 2.8 million adults aged ≥50 years used the IMRD-THIN database, representative of UK primary care, from January 1, 1995 to February 24, 2020. The associations between estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) with incident all-cause dementia were analyzed using Cox regression. RESULTS In the eGFR cohort (n = 2,797,384), worsening renal dysfunction was associated with increased hazard of all-cause dementia, with greatest hazard at eGFR 15-30 ml/min/1.73min2 (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19-1.33). In the ACR cohort (n = 641,912), the hazard of dementia increased from ACR 3-30 mg/mmol (HR 1.13, 95% CI 1.10-1.15) to ACR > 30 mg/mmol (HR 1.25, 95% CI 1.18-1.33). DISCUSSION Worsening eGFR and albuminuria have graded associations with the risk of dementia, which may have significant implications for the care of patients with kidney disease.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Cooper
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Fenton
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | | | - Tom Taverner
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Mitesh Patel
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Lorraine Harper
- Institute of Clinical Sciences, Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
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Longstreth M, McKibbin C, Steinman B, Slosser Worth A, Carrico C. Exploring Information and Referral Needs of Individuals with Dementias and Informal Caregivers in Rural and Remote Areas. Clin Gerontol 2022; 45:808-820. [PMID: 31920164 DOI: 10.1080/07317115.2019.1710735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: The provision of information and referral (I&R) and connection to support services is crucial for individuals with Alzheimer's disease and related dementias (ADRD) and their informal caregivers, especially in rural and remote regions where care and support resources may be limited. The purpose of this study was to develop a deeper understanding of needs for I&R from community stakeholders across a rural and remote state.Methods: A series of town hall meetings were conducted across ten communities in a frontier state.Results: Participants were 175 adults with a mean age of approximately 60 years (SD = 15 years); a majority were non-Hispanic white, female, and self-identified as informal caregivers. Three themes emerged as primary areas of need: (1) to address stigma related to ADRD; (2) to improve the availability of dementia-related I&R; and (3) to efficiently disseminate dementia-related I&R.Conclusions: Findings suggest the importance of a single point of access for I&R with presence in local communities as well as initial and ongoing assessment and provision of appropriate I&R throughout the course of ADRDs.Clinical Implications: Existing community resources and funding support should be leveraged for multiple points and means of access to reliable I&R.
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Affiliation(s)
- Morgan Longstreth
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | | | - Bernard Steinman
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, Wyoming, USA
| | | | - Catherine Carrico
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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8
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Creavin ST, Haworth J, Fish M, Cullum S, Bayer A, Purdy S, Ben-Shlomo Y. Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study. BJGP Open 2021; 5:BJGPO.2021.0058. [PMID: 34315715 PMCID: PMC8596317 DOI: 10.3399/bjgpo.2021.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs often report using clinical judgment to diagnose dementia. AIM To investigate the accuracy of GPs' clinical judgment for the diagnosis of dementia. DESIGN & SETTING Diagnostic test accuracy study, recruiting from 21 practices around Bristol, UK. METHOD The clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia. RESULTS A total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65-87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION A GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.
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Affiliation(s)
| | - Judy Haworth
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Fish
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sarah Cullum
- Depatment of Psychological Medicine, School of Medicine, The University of Auckland, Grafton, New Zealand
| | | | - Sarah Purdy
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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Hallam B, Rees J, Petersen I, Cooper C, Avgerinou C, Walters K. How are people with mild cognitive impairment or subjective memory complaints managed in primary care? A systematic review. Fam Pract 2021; 38:669-683. [PMID: 33907811 PMCID: PMC8604277 DOI: 10.1093/fampra/cmab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary care is typically the first point of contact in the health care system for people raising concerns about their memory. However, there is still a lack of high-quality evidence and understanding about how primary care professionals (PCPs) currently manage people at higher risk of developing dementia. OBJECTIVES To systematically review management strategies provided by PCPs to reduce cognitive decline in people with mild cognitive impairment and subjective memory complaints. METHOD A systematic search for studies was conducted in December 2019 across five databases (EMBASE, Medline, PsycInfo, CINAHL and Web of Science). Methodological quality of included studies was independently assessed by two authors using the Mixed Methods Appraisal Tool. RESULTS An initial 11 719 were found, 7250 were screened and 9 studies were included in the review. Most studies were self-reported behaviour surveys. For non-pharmacological strategies, the most frequent advice PCPs provided was to increase physical activity, cognitive stimulation, diet and social stimulation. For pharmacological strategies, PCPs would most frequently not prescribe any treatment. If PCPs did prescribe, the most frequent prescriptions targeted vascular risk factors to reduce the risk of further cognitive decline. CONCLUSION PCPs reported that they are much more likely to provide non-pharmacological strategies than pharmacological strategies in line with guidelines on preventing the onset of dementia. However, the quality of evidence within the included studies is low and relies on subjective self-reported behaviours. Observational research is needed to provide an accurate reflection of how people with memory problems are managed in primary care.
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Affiliation(s)
- Brendan Hallam
- UCL Research Department of Primary Care and Population Health, London, UK
| | - Jessica Rees
- Division of Psychiatry, University College London, London, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | | | - Kate Walters
- UCL Research Department of Primary Care and Population Health, London, UK
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10
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Griffiths AW, Ashley L, Kelley R, Cowdell F, Collinson M, Mason E, Inman H, Henry A, Farrin A, Surr C. Balancing the needs of individuals and services in cancer treatment for people with dementia: A focused ethnographic study. Int J Nurs Stud 2021; 121:104006. [PMID: 34271462 PMCID: PMC8404043 DOI: 10.1016/j.ijnurstu.2021.104006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Managing multiple conditions is difficult for patients and their families, increasing complexity in care. Two of the most common long-term conditions, cancer and dementia, both disproportionately affect older adults. However, little is known about the needs and experiences of those living with both conditions, which could inform practice in the area. OBJECTIVES This focused ethnographic study sought to understand how oncology services balance the unique and complex needs of these patients with those of the service more widely. DESIGN Focused ethnography. SETTING Two National Health Service hospital trusts. PARTICIPANTS Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated. METHODS Participant observation, informal conversations, semi-structured interviews, and medical notes review. RESULTS Improved satisfaction and outcomes of care were reported when staff were delivering person-centred care. Staff tried to balance the need for personalised and flexible support for individuals with dementia with managing targets and processes of cancer care and treatment. The importance of continuity of people, places, and processes was consistently highlighted. CONCLUSION Navigating and managing the delicate balance between the needs of the individual and the needs of services more widely was difficult for both staff and patients. Improved awareness, identification and documentation of dementia would help to ensure that staff are aware of any specific patient needs. Consistency in staffing and appointment locations should develop familiarity and routine for people with dementia.
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Affiliation(s)
| | | | | | - Fiona Cowdell
- Birmingham City University, Birmingham, United Kingdom
| | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Ellen Mason
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Hayley Inman
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Claire Surr
- Leeds Beckett University, Leeds, United Kingdom
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11
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Luck KE, Doucet S. A rapid review exploring nurse-led memory clinics. Nurs Open 2021; 8:1538-1549. [PMID: 34102023 PMCID: PMC8186716 DOI: 10.1002/nop2.688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS To systematically explore the structures, functions, outcomes, roles and nursing credentials of memory clinics where nurses autonomously lead diagnosis and postdiagnostic care. DESIGN A systematic rapid review was conducted. DATA SOURCES MEDLINE (Ovid), CINAHL Full-Text (EBSCO) and EMBASE were systematically searched in December 2019 with no timeframe limitations imposed. REVIEW METHODS The modified PRISMA checklist was used as a guide to facilitate the review. Articles identified were screened and assessed for inclusion criteria, and screening of reference lists of included studies was also completed. RESULTS Six articles, published between 2011-2019, including two case studies, two descriptive reports, one qualitative study and one programme evaluation were included in the review. Nurse-led memory clinics were situated in community centres, on university campuses, hospitals and in general practitioners' offices. The services offered included assessment, diagnosis and treatment/postdiagnostic care. Nurse credentials included advanced practice nurses and a community psychiatric nurse who was a non-medical prescriber. Overall, there was low quantity and quality of evidence to evaluate outcomes.
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Affiliation(s)
| | - Shelley Doucet
- University of New BrunswickSaint JohnNBCanada
- Dalhousie Medicine New BrunswickSaint JohnNBCanada
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12
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Lam J, Mattke S. Memory care approaches to better leverage capacity of dementia specialists: a narrative synthesis. Neurodegener Dis Manag 2021; 11:239-250. [PMID: 33966489 DOI: 10.2217/nmt-2020-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prior research suggests that a scarcity of dementia specialists could hamper access to disease-modifying Alzheimer's treatments. We describe alternative approaches on how to leverage specialist time for memory care in this narrative synthesis based on 17 semi-structured interviews and a targeted literature review on memory care approaches that leverage specialist time. We identified four types of approaches: community primary care practices empowered with better tools and training; primary care memory clinics; specialty memory clinics and; specialty memory centers. Several approaches to use specialist time efficiently have been implemented and some but not all evaluated. The optimal approach may depend on the local context.
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Affiliation(s)
- Jenny Lam
- Department of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA 90089-3333, USA.,Leonard D Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA 90089-3333, USA
| | - Soeren Mattke
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089-3333, USA
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13
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Williams A, Cottingham M, Patel E. A brief look at diagnosing neurocognitive disorders in a VA primary care setting: Understanding the practices of our physician partners and the future of integration. Clin Neuropsychol 2020; 36:1372-1383. [PMID: 32945227 DOI: 10.1080/13854046.2020.1822445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The population aged 65 and over is growing rapidly and with it are increased demands for integrative care and management of cognitive health issues. Such care models often do not include neuropsychologists or other psychology specialties. METHODS In this study, 72 medical charts of VA patients diagnosed with neurocognitive disorders were reviewed using best practice guidelines for diagnosing and managing neurocognitive disorders, adapted from Downs et al. (2006). RESULTS Results indicated that physicians typically used clinical judgment through review of medications, blood work within the past year, and a history of symptoms to make diagnostic conclusions. Cognitive assessment and consideration of other reversible causes of cognitive decline (e.g., depression) were less commonly considered. CONCLUSIONS The results are discussed in terms of potential implications for neuropsychologists and the integration of neuropsychology and primary care.
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Abstract
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.
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Affiliation(s)
- Brian Draper
- a School of Psychiatry , University of NSW , Sydney , NSW , Australia
| | - Lee-Fay Low
- b Faculty of Health Sciences , University of Sydney , Sydney , NSW , Australia
| | - Henry Brodaty
- c Centre for Healthy Brain Ageing , University of NSW Sydney , Sydney , NSW , Australia
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