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Journal of General Internal Medicine

, Volume 22, Issue 11, pp 1625–1627 | Cite as

Can Primary Care Meet the Biopsychosocial Needs of Older Adults with Dementia?

  • Malaz BoustaniEmail author
  • Greg Sachs
  • Christopher M. Callahan
Editorial

In an urban health care system that is responsible for delivering care to approximately 90,000 adult patients, a typical primary care provider delivers care to a panel of about 2,000 patients1, 2. Among the 300 patients aged 65 years and older in this typical primary care provider panel, 150 of these older adults suffer from at least three chronic conditions, 195 patients report musculoskeletal pain, 93 patients report feeling anxious, and 63 patients are hospitalized every year1, 2, 3, 4. Applying relevant management guidelines for each chronic disease that is affecting the average older patient would lead to the prescription of approximately 12 medications with a cost of $400 per patient per month, numerous complex non-pharmacological regimens, and attention to conflicting recommendations and drug interaction across disease-specific guidelines5. In addition to managing acute illnesses, this primary care provider needs an estimated 10 hours per working day to deliver all of the...

KEY WORDS

primary care biopsychosocial needs dementia 

Notes

Acknowledgement

Dr. Boustani is supported by NIA Paul B. Beeson K23 Career Development Award # 1-K23-AG026770-01. Dr. Sachs is supported by Alzheimer’s Association grant IIRG-07-60105. Dr. Callahan is supported by NIA awards K24-AG026770-01 and P30AG024967.

References

  1. 1.
    Boustani M, Callahan CM, Unverzagt FW, et al. Implementing a screening and diagnosis program for dementia in primary care. J Gen Inter Med. 2005;20:572–7.CrossRefGoogle Scholar
  2. 2.
    Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. J Am Med Assoc. 2006;295:2148–57.CrossRefGoogle Scholar
  3. 3.
    Sha MC, Callahan CM, Counsell SR, et al. Physical symptoms as a predictor of health care use and mortality among older adults. Am J Med. 2005;118(3):301–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Schubert CC, Boustani M, Callahan CM, et al. Comorbidity profile of dementia patients in primary care: are they sicker? J Am Geriatr Soc. 2006;54:104–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Ostbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3(3):209–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Boustani M, Peterson B, Hanson L, et al. Screening for Dementia. Systematic Evidence Review. Available at www.ahrq.gov/clinic/uspstfix.htm. Agency for Healthcare Research and Quality, Rockville, MD; 2003a.
  8. 8.
    Boustani M, Peterson B, Hanson L, et al. Screening for dementia in primary care: a summary of the evidence for the U.S. Preventative Services Task Force. Ann Intern Med. 2003b;138:927–37.PubMedGoogle Scholar
  9. 9.
    Bodenheimer T. Primary care in the United States. Innovations in primary care in the United States. BMJ. 2003;326(7393):796–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Counsell SR, Callahan CM, Buttar AB, et al. Geriatric Resources for Assessment and Care of Elders (GRACE): a new model of primary care for low-income seniors. J Am Geriatr Soc. 2006;54(7):1136–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Tanner CE, Eckstrom E, Desai SS, et al. Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers. J Gen Intern Med. 2006;21(1):51–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Hinton L, Franz CE, Reddy G, et al. Practice constraints, behavioral problems, and dementia care: Primary care physicians’ perspectives. J Gen Intern Med 2007 (this issue).Google Scholar
  13. 13.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA. 2003;290:2015–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Fox P, Newcomer R, Yordi C, Arnsberger P. Lessons learned from the Medicare Alzheimer Disease Demonstration. Alzheimer Dis Assoc Disord. 2000;14:87–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Belle SH, Burgio L, Burns R, et al. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups. A randomized, controlled trial. Ann Intern Med. 2006;145:727–38.PubMedGoogle Scholar
  17. 17.
    Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006;145:713–26.PubMedGoogle Scholar
  18. 18.
    Sachs GA, Shega JW, Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med 2004;19:1057–63.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Malaz Boustani
    • 1
    • 2
    • 3
    Email author
  • Greg Sachs
    • 1
    • 2
    • 3
  • Christopher M. Callahan
    • 1
    • 2
    • 3
  1. 1.Indiana University Center for Aging ResearchIndianapolisUSA
  2. 2.Regenstrief Institute, Inc.IndianapolisUSA
  3. 3.Department of Medicine, Division of General Internal Medicine and GeriatricsIndiana UniversityIndianapolisUSA

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