Primary care system must change how it approaches dementia
Caring for Dementia Patients
In an editorial in the November issue of the Journal of General Internal Medicine, geriatrics researchers from the Indiana University School of Medicine, the Indiana University Center for Aging Research and the Regenstrief Institute, Inc. say that primary care doctors, the physicians seen by most older adults, cannot meet the needs of the growing number of older adults with dementia without changing how the primary care system approaches dementia.
"We have a dilemma in our healthcare system. The majority of people with dementia don't see specialists. These patients receive their healthcare within the primary care system from general internal medicine and family medicine physicians. Neither the primary care system nor primary physicians have the time or resources to meet the biopsychosocial needs of individuals with dementia," said co-author Malaz Boustani, M.D., M.P.H. Biopsychosocial issues resulting from dementia include cognitive disability, daily living difficulty, behavioral and psychological deficits, decision-making problems, and future planning concerns.
The editorial provides a possible solution to this dilemma - collaborative dementia care, which extends the dementia care setting beyond the primary care doctor's office into the homes and communities of patients and their caregivers.
"This model, which we have studied, can be adjusted to enable the delivery of the right doses and the right combination of critical components of dementia care to the right dementia patient and the right caregiver at the right time," said Dr. Boustani.
Patients with dementia extensively use the health care system. They typically suffer from many chronic medical conditions, receive multiple prescriptions including psychotropic drugs, and display a wide range of behavioral and psychological symptoms. More than 20% of patients with dementia are exposed to at least one inappropriate dementia medication and less than 10% are prescribed appropriate drugs for their dementing disorder according to previous research conducted by the IU Geriatrics group
Moreover, individuals with dementia are not the only ones presenting challenges to the healthcare system. Nearly 25% of their caregivers go to an emergency department or are hospitalized in a given year. The stress of caregiving is partially responsible for this frequent use of acute care services.
"Primary care needs much greater support and integration with community services and access to dementia support teams if primary care is to succeed in caring for the growing population of older adults with dementia," the editorial concludes.