Improving dementia care in health systems requires estimates of need in the population served. We explored whether dementia-specific service needs and gaps for patients and caregivers could be predicted by simple information readily captured in routine care settings.
Primary family caregivers (n = 215) rated their own current stress, challenging patient behaviors, and prior-year needs and gaps in 16 medical and psychosocial services. These were evaluated with other patient and caregiver characteristics in multivariate regressions to identify unique predictors of service needs and gaps.
Caregiver stress and patient behavior problems together accounted for an average of 24% of the whole-sample variance in total needs and gaps. All other variables combined (comorbid chronic disease, dementia severity, age, caregiver relationship, and residence) accounted for a mean of 3%, with none yielding more than 4% in any equation. We combined stress and behavior problem indicators into a simple screen. In early/mild dementia dyads (n = 111) typical in primary care settings, the screen identified gaps in total (84%) and psychosocial (77%) care services for high stress/high behavior problem dyads vs. 25% and 23%, respectively, of low stress/low behavior problem dyads. Medical care gaps were dramatically higher in high stress/high behavior problem dyads (66%) than all others (12%).
The Dementia Services Mini-Screen is a simple tool that could help clinicians and health systems rapidly identify dyads needing enhanced dementia care, track key patient and caregiver outcomes of interventions, and estimate population needs for new service development.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Geriatric Psychiatry
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Alzheimer disease in the United States (2010–2050) estimated using the 2010 census.Neurology. 2013; 80: 1778-1783
- Monetary costs of dementia in the United States.N Engl J Med. 2013; 368: 1326-1334
- Caring for patients with dementia: how good is the quality of care? Results from three health systems.J Am Geriatr Soc. 2007; 55: 1260-1268
- Association of incident dementia with hospitalizations.JAMA. 2012; 307: 165-172
- Quality improvement in neurology: Dementia Management Quality Measures.Neurology. 2013; 81: 1545-1549
- Discussing dementia-related behaviors during medical visits for people with Alzheimer's disease.Am J Alz Dis Oth Dement. 2010; 25: 248-254
- Redesigning health care for dementia: from wish through policy to practice.Am J Geriatr Psychiatry. 2013; 21: 30
- Primary care providers' views of challenges and rewards of dementia care relative to other conditions.J Am Geriatr Soc. 2009; 57: 2209-2216
- Primary care physicians' dementia care practices: evidence of geographic variation.Gerontologist. 2010; 50: 179-191
- Family physicians and dementia in Canada: Part 1. Clinical practice guidelines: awareness, attitudes, and opinions.Can Fam Physician. 2009; 55: 506-507
- Diagnosing dementia: perspectives of primary care physicians.Gerontologist. 1999; 39: 457-464
- Treating nondementia illnesses in patients with dementia.JAMA. 2000; 283: 3230-3235
- Health care triads and dementia care: integrative framework and future directions.Aging Ment Health. 2001; 5: S35-S48
- Primary care and dementia: 2. Long-term care at home: psychosocial interventions, information provision, carer support and case management.Int J Geriatr Psychiatry. 2010; 25: 657-664
- A dementia care management intervention: which components improve quality?.Am J Manag Care. 2012; 18: 85-94
- Insight into dementia care management using social-behavioral theory and mixed methods.Nurs Res. 2009; 58: 348-358
National Plan to Address Alzheimer's Disease. 2012. Washington, DC, US Department of Health and Human Services. Available at: http://aspe.hhs.gov/daltcp/napa/NatlPlan.pdf
- Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial.JAMA. 2006; 295: 2148-2157
- The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial.Ann Intern Med. 2006; 145: 713-726
- Cooperative dementia care clinics: a new model for managing cognitively impaired patients.J Am Geriatr Soc. 2006; 54: 1937-1942
- Adaptation of a group visit dementia care model to a community setting.J Psychiatry Clin Neurosci. 2013;
- What do community-dwelling people with dementia need? A survey of those who are known to care and welfare services.Int Psychogeriatr. 2009; 21: 949-965
- Use of health and human services by community-residing people with dementia.Soc Work. 1999; 44: 535-548
- Predictors of health and human services use by persons with dementia and their family caregivers.Soc Sci Med. 2002; 55: 1255-1266
- Measuring dementia carers' unmet need for services—an exploratory mixed method study.BMC Health Serv Res. 2010; 10: 122-132
- Evaluation of an assessment battery for estimating dementia caregiver needs for health and social care services.Am J Alzheim Dis Other Demen. 2010; 25: 446-454
- Consortium to Establish a Registry for Alzheimer's Disease (CERAD): the first twenty years.Alzheim Dement. 2008; 4: 96-109
- Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type.Int Psychogeriatr. 1997; 9 (discussion 177–178): 173-176
- Improving identification of cognitive impairment in primary care.Int J Geriatr Soc. 2006; 21: 349-355
- The Clock Drawing Test: utility for dementia detection in multiethnic elders.J Gerontol Biol Sci Med Sci. 1999; 54A: M534-M540
- Comorbidity in aging and dementia: scales differ, and the difference matters.Am J Geriatr Psychiatry. 2010; 18: 999-1006
- Prevalence and impact of medical comorbidity in Alzheimer's disease.J Gerontol Biol Sci Med Sci. 2002; 57A: M173-M177
- Needs assessment in dementia.Int J Geriatr Psychiatry. 2005; 20: 322-329
- Integrating care for older adults with cognitive impairment.Curr Alzheim Res. 2009; 6: 368-374
- Measurement of psychological distress in patients with intracranial tumours: the NCCN distress thermometer.J Neurooncol. 2011; 104: 357-364
- Management of mild to moderate Alzheimer's disease and dementia.Alzheim Dement. 2007; 3: 355-384
- Assessing care of vulnerable elders—Alzheimer's disease: a pilot study of a practice redesign intervention to improve the quality of dementia care.J Am Geriatr Soc. 2010; 58: 324-329
Published online: November 14, 2013
Accepted: November 6, 2013
Received in revised form: November 1, 2013
Received: October 10, 2012
© 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.