Who refuses the diagnostic assessment for dementia in primary care?

被引:69
作者
Boustani, Malaz
Perkins, Anthony J.
Fox, Chris
Unverzagt, Fred
Austrom, Mary Guerriero
Fultz, Bridget
Hui, Siu
Callahan, Christopher M.
Hendrie, Hugh C.
机构
[1] Regenstrief Inst Inc, Indianapolis, IN 46202 USA
[2] Indiana Univ, Ctr Aging Res, Indianapolis, IN 46204 USA
[3] Indiana Univ, Sch Med, Dept Med, Indianapolis, IN 46204 USA
[4] Univ Kent, Kent Inst Med & Hlth Sci, Canterbury CT2 7NZ, Kent, England
[5] Indiana Univ, Sch Med, Dept Psychiat, Indianapolis, IN 46204 USA
关键词
dementia; screening; diagnosis; attitudes; primary care;
D O I
10.1002/gps.1524
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
Objective Early screening and detection of dementia in primary care remains controversial. At least half of the patients identified as cognitively impaired by screening instruments do not meet criteria for dementia and some patients refuse further evaluation following a positive screen. The aim of this study was to identify the characteristics of patients who refuse a clinical diagnostic assessment for dementia after screening. Design Cross sectional study. Setting Seven primary care practice centers in Indianapolis. Participants Four hundred and thirty-four individuals aged 65 and older who screened positive for dementia with a mean age of 74.6, 67% women, and 68% African-American. Main outcome measure Patients' acceptance of undergoing a dementia diagnostic assessment that included neuropsychological testing, caregiver interview, and medical chart review. Results Among patients with positive screening results for dementia, approximately half (47.7%) refused further assessment to confirm their screening results. In a bivariate analysis, possible factors associated with a higher probability of refusing dementia assessment were older age and better screening score. In a multiple logistic regression model, performing well on the temporal orientation of the screening instrument was associated with a higher probability of refusing diagnostic assessment for dementia (OR = 1,37; p = 0.001). Also, African-American patients aged 80 and older were more likely to refuse the diagnostic assessment than African-Americans less than 80 years of age (OR = 3.1, p < 0.001), while there was no significant age association for white patients (OR = 0.9, p = 0.728). Conclusions Older primary care patients who perceived themselves as having no cognitive symptoms refused dementia diagnostic assessment despite their positive screening results. We must improve our understanding of the decision-making process driving patients' beliefs and behaviors about the benefits and risks of dementia screening and diagnosis before implementing any broad-based screening initiatives for dementia. Copyright (c) 2006 John Wiley & Sons, Ltd.
引用
收藏
页码:556 / 563
页数:8
相关论文
共 34 条
[1]   Suicide amongst Alzheimer's disease patients: A 10-year survey [J].
Barak, Y ;
Aizenberg, D .
DEMENTIA AND GERIATRIC COGNITIVE DISORDERS, 2002, 14 (02) :101-103
[2]   Screening for dementia: Recommendation and rationale [J].
Berg, AO ;
Allan, JD ;
Frame, P ;
Homer, CJ ;
Johnson, MS ;
Klein, JD ;
Lieu, TA ;
Mulrow, CD ;
Orleans, CT ;
Peipert, JF ;
Pender, NJ ;
Siu, AL ;
Teutsch, SM ;
Westhoff, C ;
Woolf, SH .
ANNALS OF INTERNAL MEDICINE, 2003, 138 (11) :925-926
[3]   Diagnosing dementia: Perspectives of primary care physicians [J].
Boise, L ;
Camicioli, R ;
Morgan, DL ;
Rose, JH ;
Congleton, L .
GERONTOLOGIST, 1999, 39 (04) :457-464
[4]   Implementing a screening and diagnosis program for dementia in primary care [J].
Boustani, M ;
Callahan, CM ;
Unverzagt, FW ;
Austrom, MG ;
Perkins, AJ ;
Fultz, BA ;
Hui, SL ;
Hendrie, HC .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2005, 20 (07) :572-577
[5]   Acceptance of dementia screening in continuous care retirement communities: a mailed survey [J].
Boustani, M ;
Watson, L ;
Fultz, B ;
Perkins, AJ ;
Druckenbrod, R .
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 2003, 18 (09) :780-786
[6]   Screening for dementia in primary care: A summary of the evidence for the US Preventive Services Task Force [J].
Boustani, M ;
Peterson, B ;
Hanson, L ;
Harris, R ;
Lohr, KN .
ANNALS OF INTERNAL MEDICINE, 2003, 138 (11) :927-937
[7]  
Boustani M., 2003, SCREENING DEMENTIA S
[8]   Six-item screener to identify cognitive impairment among potential subjects for clinical research [J].
Callahan, CM ;
Unverzagt, FW ;
Hui, SL ;
Perkins, AJ ;
Hendrie, HC .
MEDICAL CARE, 2002, 40 (09) :771-781
[9]   A CHRONIC DISEASE SCORE WITH EMPIRICALLY DERIVED WEIGHTS [J].
CLARK, DO ;
VONKORFF, M ;
SAUNDERS, K ;
BALUCH, WM ;
SIMON, GE .
MEDICAL CARE, 1995, 33 (08) :783-795
[10]   Caregivers' attitudes toward their family members' participation in Alzheimer disease research: Implications for recruitment and retention [J].
Connell, CM ;
Shaw, BA ;
Holmes, SB ;
Foster, NL .
ALZHEIMER DISEASE & ASSOCIATED DISORDERS, 2001, 15 (03) :137-145