Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.

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Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors.

Zakljucno, potrebno je i nadalje svakodnevno raditi na prevenciji demencije, osiguravati resurse i osmisljavati strategije borbe protiv demencije, jer ce broj osoba s demencijom i u Hrvatskoj u buducnosti biti veci. No, s obzirom da se u svijetu ulažu znatna sredstva u podrucju istraživanja demencije, za ocekivati je pozitivnih pomaka, kako na podrucju terapije, rane dijagnostike, tako i na podrucju rehabilitacije osoba s demencijom. Stoga - vrijeme je na nasoj strani!

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Dementia: a public health priority

The term person-centred care has become all-pervasive on the UK dementia care scene. It has been suggested that it has become synonymous with good quality care. It seems that any new approach in dementia care has to claim to be pc (person-centred) in order to be P.C. (politically correct). The term is used frequently in the aims and objectives for dementia care services and provision in the UK and the US, although what lies behind the rhetoric in terms of practice may be questionable.

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What is Person-Centred Care in Dementia?

Pain is a common and major problem among nursing home residents. The prevalence of pain in elderly nursing home people is 40–80%, showing that they are at great risk of experiencing pain. Since assessment of pain is an important step towards the treatment of pain, there is a need for manageable, valid and reliable tools to assess pain in elderly people with dementia. This systematic review identifies pain assessment scales for elderly people with severe dementia and evaluates the psychometric properties and clinical utility of these instruments. Relevant publications in English, German, French or Dutch, from 1988 to 2005, were identified by means of an extensive search strategy in Medline, Psychinfo and CINAHL, supplemented by screening citations and references. Quality judgement criteria were formulated and used to evaluate the psychometric aspects of the scales. Twenty-nine publications reporting on behavioural pain assessment instruments were selected for this review. Twelve observational pain assessment scales (DOLOPLUS2; ECPA; ECS; Observational Pain Behavior Tool; CNPI; PACSLAC; PAINAD; PADE; RaPID; Abbey Pain Scale; NOPPAIN; Pain assessment scale for use with cognitively impaired adults) were identified. Findings indicate that most observational scales are under development and show moderate psychometric qualities. Based on the psychometric qualities and criteria regarding sensitivity and clinical utility, we conclude that PACSLAC and DOLOPLUS2 are the most appropriate scales currently available. Further research should focus on improving these scales by further testing their validity, reliability and clinical utility.

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Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools

Despite a strong intuitive and theoretical tradition linking autobiographical memory and sense of self, there are few coherent, testable models that exemplify how these constructs relate. Without any clear theoretical starting point, research efforts have been fragmented, with many different fields of psychology operating in relative isolation, using different methodological approaches and a confusing array of self-related terminology. We attempt to bridge the widening gap between theory and research by proposing a novel framework for sense of self and memory. This simple model delineates sense of self along 2 dimensions: the subjective versus objective and the present versus temporally extended aspects of sense of self. The 4 resulting components of sense of self are argued to relate to autobiographical memory in important, but very different, ways. Subjective sense of self provides a crucial precondition for episodic memory, which in turn is a prerequisite for phenomenological continuity. Autobiographical memory, and particularly its semanticized forms, are important for the formation and maintenance of a mental representation of the objective self in the present moment and across time. This model does not represent a new theoretical direction for the study of sense of self and memory; to the contrary, it is deeply grounded in the theoretical work of the past few decades. Its novelty is that it translates this theoretical groundwork into a form that is readily accessible for researchers. We review evidence for our model and suggest ways that it may provide a roadmap for future research efforts.

https://psycnet.apa.org/journals/bul/139/4/815.pdf

Autobiographical memory and sense of self.

The purpose of this review is to identify and explore the emerging attention being paid to the individual in dementia research. Following a brief introduction, the review will examine literature which recognises three aspects of the person with dementia: the individual's sense of self; the person's rights; and the value to be gained from a concern with the perspectives of people with dementia. To date the medical model has dominated dementia research. This model tends to reduce the person with dementia to his/her neurobiology or neuropsychology (Cotrell and Schulz 1993). The experience and manifestation of dementia has been attributed solely to the disease process, with a consequent neglect of the psychosocial context surrounding the individual (Lyman 1989). Research on the psychosocial aspects of dementia has concentrated on family carers. Keady (1996) provides a useful categorisation of this research into the following topics: gender and coping style; marital relationships and the impact of dementia; access to information and services; participation in and effectiveness of support groups; adjustment and circumstances surrounding admission into care; and perception of own health needs. No literature focuses on people with dementia.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X9700665X

The emergence of the person in dementia research.

Dementia studies are currently dominated by biomedical and psychological models that focus on the individual without regard to their socio-cultural context (Bond 1992, 1999; Lyman 1989; Harding and Palfry 1997; Whitehouse et al. 2000). There is now a growing interest in how socio-cultural factors may mediate the experience of, and response to, dementia (Holstein 1998). The purpose of this review is to examine this growing interest in the socio-cultural context of dementia with reference to earlier developments in disability studies (Oliver 1990; Thomas 1999) and ageing research in general (Estes et al. 1984). The implications of placing dementia in a socio-cultural context for research, policy and practice will be discussed.Most of the theoretical work on dementia has been devoted to pointing out the inadequacies of biomedical and psychological models in which problems are attributed solely to an individual's neuropathology with a simultaneous neglect of socio-cultural factors (Binney and Swan 1991; Lyman 1989; Harding and Palfry 1998; Kitwood 1998). The study of dementia, it is argued, has been limited by the broader ‘biomedicalisation of ageing’ whereby problems of ageing have been attributed to the ‘tragedy’ of the individual's pathology rather than as a function of an inadequate societal response. Robertson (1991) describes how people so labelled are referred to as ‘victims’ or ‘sufferers’. All difficulties in the person's life are attributed to their underlying disease with a consequent neglect of social and environmental factors that may ameliorate or prevent such ‘symptoms’.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X99007758

Dementia in a socio-cultural context: an idea whose time has come

General practitioners (GPs) and the primary care team are uniquely situated to play a central role both in the diagnosis and ongoing care of dementia. Anecdotal reports and empirical work suggest that GPs face several challenges in fulfilling this role. This paper describes the various roles GPs and the primary care team could play in diagnosis and ongoing management. It then discusses the legitimate anxieties and difficulties faced in fulfilling these roles. The paper concludes with suggestions for how GPs and the primary care team might be supported to maximize their role in dementia diagnosis and management.

The role of general practice and the primary care team in dementia diagnosis and management

This review presents evidence of the undertreatment of pain for people with cognitive impairment and explores reasons for this, emphasizing inadequate detection due to lack of suitable pain assessment protocols. Implications for practice and suggestions for further research are made.

Assessing the pain of people with cognitive impairment.

While general practitioners (GPs) have a central role to play in the effective primary care response to people with dementia and their families, concern has been raised as to the adequacy with whic

Murna G. Downs

Papers

The emergence of the person in dementia research.

Dementia in a socio-cultural context: an idea whose time has come

The role of general practice and the primary care team in dementia diagnosis and management

Assessing the pain of people with cognitive impairment.

Caring for patients with dementia: The GP perspective