Academic journal article Central European Journal of Public Health

Dementia Care and General Physicians - a Survey on Prevalence, Means, Attitudes and Recommendations

Academic journal article Central European Journal of Public Health

Dementia Care and General Physicians - a Survey on Prevalence, Means, Attitudes and Recommendations

Article excerpt

SUMMARY

Introduction: General physicians (GP) play a key role in providing appropriate care for people with dementia. It is important to understand their workload and opinions regarding areas for improvement.

Material and Methods: A group of 1,109 GPs working in Mecklenburg-Western Pomerania, Gemany (1.633 million inhabitants), were identified, contacted and asked to participate in a written survey. The survey addressed five main topics: (a) the GP, (b) the GP's practice, (c) the treatment of dementia, (d) personal views, attitudes and specific competences regarding dementia and (e) the GP's recommendations for improving dementia-related health care.

Results: The survey response rate was 31%. In total, the responding GPs estimated that they provided care to 12,587 patients with dementia every quarter year. The GPs also reported their opinions about screening instruments, treatment and recommendations for better care of dementia patients. Only 10% of them do not use screening instruments, one third felt competent in their care for patients with dementia and 54% opt for transfer of patients to a specialist for further neuropsychological testing.

Conclusions: Four conclusions from this study are the following: (a) dementia care is a relevant and prevalent topic for GPs, (b) systematic screening instruments are widely used, but treatment is guided mostly by clinical experience, (c) attitudes towards caring for people with dementia are positive, and (d) GPs recommend spending a lot more time with patients and caregivers and provision of better support in social participation. A majority of GPs recommend abolishing "Budgetierung", a healthcare budgeting system in the statutory health insurance programmes.

Key words: general physician, dementia

INTRODUCTION

Providing care for patients with dementia in addition to tailored support for their relatives is a challenge to the existing health care system, and its significance will increase further in the near future. Due to massive demographic changes, the health care system faces more elderly people (1,2) and thus an increase in patients with age-associated illnesses. Dementia is one of the most rapidly growing age-associated conditions. This trend is likely to add to the imminent undersupply of professional caregivers, especially as the utilisation of medical care increases (1). The federal state of Western Pomerania Mecklenburg (Mecklenburg- Vorpommern, MV), Germany, is experiencing this trend at an accelerated rate due to the growing population 65 years and older and the simultaneous decrease in total population. The demographic change in MV is expected to occur faster than in any other state (3).

It is estimated that 6-9% of people 65 years and older in industrialised countries suffer from dementia. In Germany, it is estimated that 1.07 million people above the age of 60 have mild to severe dementia. The prevalence increases with age: from 0.6-0.8% for 60-64 year-olds, to 30-43% for 100+ year-olds (4). There are annually 250,000 incident cases of dementia (5). A prognosis for MV from 2005 indicated that there were approximately 19,400 people with dementia and that this number would increase by 80-9 1 % until 2020. Although these are the most current statistics for Germany, there are limitations to the data. Some data stem from meta-analyses that combine studies with different assessment methods, sample sizes or target samples (6, 7). The most recent study by Ziegler & Doblhammer (8) is based on the ICD-10 diagnosis of dementia in 2002 for members of one statutory health insurance company. However, it is known from prospective population-based studies that the proportion of false negatives for dementia exceeds 60% (9, 1 0). The general physician (GP) plays a key part in providing appropriate care for people with dementia. According to the Federal Bureau of Statistics, 83% of the people 60 years and older consult their GP at least once in a quarter of year (11) and the majority of the caregivers regard the GP as the key person in managing care for dementia patients (12). …

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