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Putting dementia awareness into general practice

The CADIF approach

Frühwahrnehmung von Demenzen in der Hausarztpraxis

Der CADIF-Ansatz

Zeitschrift für Gerontologie und Geriatrie volume 50, pages 44–47 (2017)Cite this article

Abstract

Background

International studies show that dementia is often recognized at later stages in general practice. Pure knowledge-sharing interventions could not change this in a sustainable manner. Concepts for changing attitudes of general practitioners (GPs) are required.

Objectives

What barriers affect GPs’ recognition of and diagnostic approach to dementia? What recommendations for a GP-specific diagnostic procedure can be derived from this?

Methods

Metasynthesis of qualitative studies with GPs on barriers to dementia recognition, explication of the “frailty” concept and the diagnostic approach described therein and the development of an approach in cases of suspected cognitive decline in a multiprofessional team.

Results

A metasynthesis of qualitative studies revealed a lack of a general practice framework in the diagnostic approach of GPs, characterized by poor patient-centeredness and confusion of early detection, diagnostics and disclosure. The embedding of cognitive decline into the geriatric triad is intended to promote the focus on everyday function and quality of life, i.e. on caring instead of curing. The proposed concept for a transfer into practice emphasizes increased awareness for cognitive warning signs among practice personnel, a geriatric and personal approach to the patient, as well as follow-up assessment and monitoring.

Conclusion

In contrast to early recognition, awareness initially does not imply an active search for cognitive deficits with questions and tests but a vigilance for red flags. The described scheme is a component of a complex intervention for attitude change among GPs towards dementia.

Zusammenfassung

Hintergrund

Internationale Studien weisen darauf hin, dass Demenzerkrankungen in der Hausarztpraxis oft erst spät erkannt werden. Rein wissensvermittelnde Interventionen konnten daran nicht nachhaltig etwas ändern; gefordert sind Konzepte der Einstellungsänderung bei Hausärzten/innen.

Fragestellung

Welche Barrieren wirken auf die hausärztliche Erkennung und diagnostische Herangehensweise bei Demenz? Welche Empfehlungen für ein hausärztlich-diagnostisches Vorgehen lassen sich daraus ableiten?

Methoden

Metasynthese qualitativer Studien mit Hausärzten/-ärztinnen zu Barrieren der Demenzerkennung; Explikation des „Frailty“-Konzepts und der darin beschriebenen diagnostischen Herangehensweise; multiprofessionelles Team zur Entwicklung einer Vorgehensempfehlung bei Verdacht auf abnehmende kognitive Leistung.

Ergebnisse

Die Metasynthese der qualitativen Studien zeigt einen fehlenden allgemeinmedizinischen Rahmen in der diagnostischen Herangehensweise von Hausärzten/-ärztinnen, geprägt von mangelnder Patientenzentrierung und einer Vermengung von Früherkennung, Diagnostik und Aufklärung. Die Einbettung von „cognitive decline“ in die geriatrische Trias soll den Fokus auf Alltagsfunktion und Lebensqualität, auf „caring“ statt „curing“ lenken. Das vorgeschlagene Konzept für die praktische Ausgestaltung betont die frühe Wahrnehmung im Sinne erhöhter Sensibilität für kognitive Warnsignale im Praxisteam, eine geriatrisch orientierte direkte Ansprache des/der Patienten/Patientin sowie Verlaufsbeobachtung und Begleitung.

Diskussion

Im Gegensatz zu „Früherkennung“ impliziert „Frühwahrnehmung“ initial kein aktives Suchen nach kognitiven Defiziten über Fragen und Testverfahren, sondern eine Wachsamkeit für „red flags“. Das beschriebene Schema ist ein Bestandteil einer komplexen Intervention zur Einstellungsänderung bei Hausärzten/-ärztinnen zur Demenz.

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Funding

The CADIF study is part of the German Research Network on Degenerative Dementia (KNDD) and was funded by the German Federal Ministry of Education and Research (grant 01GI1011).

Author information

Affiliations

  1. Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

    Michael Pentzek Dipl.-Psych.,  Stefan Wilm & Verena Leve M.Sc.

  2. Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany

    Horst Christian Vollmar MPH

  3. Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany

    Horst Christian Vollmar MPH

Authors
  1. Michael Pentzek Dipl.-Psych.
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  2. Horst Christian Vollmar MPH
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  3. Stefan Wilm
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  4. Verena Leve M.Sc.
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Corresponding author

Correspondence to Michael Pentzek Dipl.-Psych..

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Conflict of interests

M. Pentzek, H.C. Vollmar, S. Wilm and V. Leve declare that they have no competing interests.

This article does not contain any studies with patients or animals performed by any of the authors.

The supplement containing this article is not sponsored by industry.

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Pentzek, M., Vollmar, H.C., Wilm, S. et al. Putting dementia awareness into general practice. Z Gerontol Geriat 50, 44–47 (2017). https://doi.org/10.1007/s00391-017-1206-6

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  • DOI: https://doi.org/10.1007/s00391-017-1206-6

Keywords

  • Dementia
  • Cognition
  • Health services research
  • Attitudes of health personnel
  • Diagnosis

Schlüsselwörter

  • Demenz
  • Kognition
  • Versorgungsforschung
  • Einstellungen
  • Diagnose