Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling
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Displaying One Session
TOWARDS BETTER-TAILORED DIAGNOSTICS IN PATIENTS WITH MEMORY COMPLAINTS
Background and purpose
Dementia is a diagnosis that can be made by a general practitioner. However, 60% of patients with memory complaints are diagnosed in a memory clinic. In the past few years, research in the field of dementia has focused on advanced and extensive diagnostic testing to determine a diagnosis as early as possible. It is unknown whether patients and informal caregivers benefit from extensive diagnostic testing in memory clinics, and what motives general practitioners have when referring such patients to secondary care. This study aims to explore general practitioners’ considerations regarding referral of patients with memory complaints.
Between October 2020 and December 2020, Dutch general practitioners participated in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and thematically analysed using MaxQDA software.
Interviews with 11 general practitioners revealed multiple clusters of considerations: patient and caregiver related, healthcare system or organisational related, perspective of the general practitioner, diagnostic instruments, and care related considerations. Participants highlighted the importance of local agreements regarding diagnostic work-up and subsequent care in primary care. The local differences in agreements and the general practitioners’ attitude towards the topic were amplifying factors that influenced their decision on referral. Furthermore, treatment and care after diagnosis were mentioned as important factors to consider.
General practitioners described a range of considerations and exposed a great heterogeneity in the implementation of the diagnostic and referral process in patients with memory complaints in primary care throughout the Netherlands.
NEEDS AND VIEWS OF CHINESE OLDER ADULTS ON HEALTHY LIFESTYLES FOR THE PREVENTION OF DEMENTIA: A QUALITATIVE STUDY.
Background and purpose China is expected to face an enormous increase of people with dementia. Approximately 40% of all dementia cases might be attributable to potentially modifiable risk factors, suggesting the potential to delay or prevent dementia when targeting these risk factors. In this qualitative study, we aim to explore the experiences, needs and views of older Chinese adults regarding healthy lifestyles for the prevention of dementia, facilitating development of a coach-supported mobile health (mHealth) platform in the Prevention of Dementia using Mobile Phone Applications (PRODEMOS)-study.
Methods Eligibility criteria were an age >55, increased dementia risk without a diagnosis of dementia, and possession of a smartphone. Semi-structured interviews were performed by nine Chinese researchers. Data were analysed through thematic analysis.
Results We performed 26 interviews with participants from Beijing and Tai’an, aged 55-86 years. We identified three main themes: ‘valuing a healthy lifestyle’, ‘sociocultural expectations’, and ‘need for guidance’. First, a healthy lifestyle was deemed important. Participants had tried to change their behaviour using both generic and specific Chinese approaches. Second, an important motive to stay healthy was to limit the burden put on family members. Paradoxically, time-consuming family and other social obligations could also impede healthy behaviours. Finally, participants expressed a need for reliable and personalised lifestyle support from a health professional.
Conclusions In spite of their clear appreciation of healthy lifestyles, Chinese older adults express a need for personalised lifestyle support. The PRODEMOS mHealth platform was adapted to meet these needs. Efficacy and implementation will be tested in a trial that is currently ongoing.
DELIVERING PERSONALISED CARE TO PEOPLE LIVING WITH DEMENTIA AND THEIR FAMILIES: A NEW INTERVENTION FOR PRIMARY CARE
Background and purpose
Despite national and international emphasis on dementia strategies and guidelines, post-diagnostic support for people living with dementia in the UK remains highly variable. The aim of the PriDem project is to develop and test a new intervention for people with dementia and their families informed by existing literature and examples of good practice in England.
We reviewed existing literature, interviewed commissioners and service managers, and conducted case studies of six services providing unique approaches to post-diagnostic support for dementia. Findings suggested that there was no single model which addressed all aspects of post-diagnostic support. Ideas for intervention were iteratively developed using the theory of change with our programme management group and our mixed stakeholder panel (the Dementia Care Community). A series of eight virtual task groups, involving all stakeholders, then critically reviewed the intervention and advised on implementation.
Our complex intervention will focus on three main areas: developing systems, delivering tailored support and building capacity. Delivery of the intervention will be led/facilitated by a clinical dementia expert based in a primary care network. Resources to support implementation include a detailed list of components of post-diagnostic support (and examples of how these have been delivered successfully); example templates for annual review and care planning; and strategies for addressing potential barriers to implementation.
Delivering personalised post-diagnostic support for people living with dementia and their families requires a multifaceted and comprehensive approach. The intervention will now be tested to explore its feasibility and acceptability.
WHAT CIRCUMSTANCES CONTRIBUTE TO OR HAMPER LIVING AT HOME UNTIL THE END OF LIFE WITH SEVERE DEMENTIA?
Background and purpose: Although people with dementia often prefer to live at home until the end of life, they often die in a nursing home. The aim our study was to obtain insight into circumstances that contribute to or hamper living at home until the end of life with advanced dementia.
Methods: Qualitative interviews were done with family caregivers, general practitioners (GPs) and case managers. The interviewees were involved in cases of persons with severe dementia that preferred to live at home until the end of life. We included both cases in which it was realized to remain at home and cases in which the person with dementia eventually moved to a nursing home.
Results: The interviews indicate that cases in which a person with dementia lived at home until the end of life are characterized by a committed family caregiver as well as the involvement of a case manager or a GP. The interviewees expressed that support from other family members or friends, neighbors, volunteers and respite care contribute to maintaining care at home. However, dropout of the primary family caregiver and a strong physical or mental decline of the person with dementia were mentioned as reasons for admission in a nursing home.
Conclusions: Available support of a family caregiver, of the broader social network and of professionals contributes to remaining at home until the end of life. When any of these three types of support are not available, remaining at home until death is complex to achieve.