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Preparing for Baby Boomer Dementia Epidemic Spurs
Study
June 23, 2005 - How can the U.S. health-care system
and more specifically, primary care doctors - the physicians from whom
older adults receive most of their care - prepare for the huge wave of
dementia patients expected to engulf us in 2010, the year the baby
boomers begin to reach 65? Is it a daunting task?
Researchers from the Indiana University School of
Medicine, the Regenstrief Institute, Inc. and the Indiana University
Center for Aging Research begin to answer this difficult question in a
study published in the July issue of the Journal of General Internal
Medicine, now available online.
The researchers conducted a dementia screening
program on 3,340 older adults attending primary care clinics. They used
the CSID, a highly regarded, culturally sensitive screening test.
Screening results indicated that 434 were possibly or potentially
suffering from dementia.
"Dementia is common and unrecognized in primary
care," said Malaz Boustani, M.D., M.P.H., the first author of the study
and an assistant professor of medicine. "Since screening instruments
alone have insufficient specificity to establish a valid diagnosis of
dementia, all 434 were invited back for a diagnostic assessment."
Unfortunately 50 percent of those in the study who
screened positive for dementia did not return to evaluate their
screening results. Such evaluation would have ruled-in or ruled-out the
presence of dementia.
"That's similar to half of female patients whose
mammograms show possible cancers not returning for biopsies to determine
whether they have a malignancy. Screening tools require confirmation and
the primary care doctor who screens must be prepared to follow up with
confirmatory testing," said Dr. Boustani.
Of the 227 who did return for diagnostic
assessment, only one-half received a diagnosis of dementia. Slightly
less than one-third had mild cognitive impairment not severe enough to
cause dementia. One-fifth did not have any type of cognitive problem.
Early diagnosis of dementia may allow individuals
to plan for their future while they still have the mental capacity to
make important care and end-of-life decisions. There are medications
which may improve symptoms of dementia in some people.
The negative impact of unrecognized dementia on the
management of other medical conditions is significant, noted Dr.
Boustani.
"Physicians typically are treating older adults for
multiple chronic diseases such as hypertension, diabetes and high
cholesterol and unless the patient presents with symptoms of dementia,
the physician assumes the patient has the mental capacity to take
medications appropriately and follow other directions. If we don't
detect and help older adults with asymptomatic dementia, they
potentially will not benefit from the medical management of their other
health problems and thus, become big users of health-care dollars, he
said."
Additionally, dementia puts both the patient and
others at risk. Individuals with advanced dementia are better off not
living alone or driving.
The cost to society for care of individuals with
unrecognized dementia is substantial. The cost of screening and, if
indicated, diagnosing each older adult who participated in the study was
$130. If the total cost of the program is divided by the number of cases
of dementia detected during the study, each confirmed dementia case
would cost $4,000.
The authors found the disparity between the number
of patients screened and those that returned for diagnostic assessment
disturbing.
"Our team thinks this may reflect the societal
stigma of dementia," said Dr. Boustani. "Patients may be scared that
they will be discriminated against in the workplace or that they will be
placed in a nursing home against their will."
Co-authors of the study are Christopher Callahan,
M.D.; Frederick Unverzagt, Ph.D.; Mary Guerriero Austrom, Ph.D.; Anthony
Perkins, M.S.; Bridget Fultz, M.A.; Siu Hui, Ph.D.; and Hugh Hendrie,
MB, ChB, DSc. The study was funded by a grant from the Agency for
Healthcare Research and Quality.
The IU and Regenstrief researchers currently are
conducting a collaborative study, the PRISM - US vs. UK, with British
researchers from the University of Kent at Canterbury to learn whether
such a stigma exists and, if so, its variation between the U.S. and the
United Kingdom health-care systems.
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