This article addresses the importance of language, speech, and communication accommodations between the physician and the patient with dementia. Following a brief summary of common profiles of speech, language, and communication in several different types of dementia, the authors discuss key elements based on a comprehensive model of communication enhancement for individuals with dementia. The primary emphasis of this article is that physicians must select individually tailored communication strategies drawn from a sound knowledge of patients' skills. More importantly, the article stresses that communication is not just the exchange of information, but communication includes components that help establish mutual respect and maintain patients' self-identity and autonomy.
Although a large number of people are diagnosed with dementia each year, the syndrome is still perceived as a sensitive and tabooed topic. Communication about dementia to those living with the syndrome and their relatives is often experienced as challenging by health professionals. Failure to communicate clearly may threaten assessment and allocation of appropriate, effective healthcare services. Accordingly, the aim of this study was to explore how purchasers, assessing and allocating healthcare services to home-dwelling older people with dementia, described challenges in communicating about dementia with those with the syndrome and their relatives. Furthermore, the study aimed to explore the purchasers' justifications for their choice of words.
A qualitative study was conducted to investigate two data sources: focus group interviews with purchasers assessing need for healthcare services, and a review of administrative decisions written by those allocating services. Focus group data were explored using an interpretive approach and qualitative content analysis was carried out with the administrative decisions.
The purchasers found it challenging to talk and write about dementia to those with the syndrome and their relatives when assessing and allocating services. The purchasers were flexible in their communication and aimed to be open when talking and writing about dementia. However, euphemisms and omission were used extensively. Four justifications for the chosen verbal and written language were identified: avoiding disclosure; protecting the person with dementia; protecting the relatives/avoiding conflict; and last, taboo and stigma.
Despite purchasers experiencing difficulties in communicating about dementia to those with the syndrome and their relatives, they did manage to communicate in a conscious and flexible way. The purchasers had several justifications for their language choice. However, extensive use of euphemisms and omission might threaten appropriate identification of needs and provision of high quality healthcare services. The challenges experienced by the purchasers demonstrate the need to focus on appropriate and flexible strategies for individually-tailored communication about dementia with people living with the syndrome.
We investigate a user-driven collaborative knowledge engineering and interaction design process. The outcome is a knowledge-based support application tailored to physicians in the local dementia care community. The activity is organized as a part of a collaborative effort between different organizations to develop their local clinical practice. Six local practitioners used the generic decision-support prototype system DMSS-R developed for the dementia domain during a period and participated in evaluations and re-design. Additional two local domain experts and a domain expert external to the local community modeled the content and design of DMSS-R by using the modeling system ACKTUS. Obstacles and success factors occurring when enabling the end-users to design their own tools are detected and interpreted using a proposed framework for improving care through the use of clinical guidelines. The results are discussed.
An account is given of the first year's experience in providing psychogeriatric service to a large urban community. Patients were attended in their homes, in nursing homes and in Homes for the Aged. There was a tendency for the consultant's help to be sought mainly in cases of "disposal" of difficult patients rather than for treatment of the many who could be expected to benefit from it. However, the advantage has been demonstrated of continuity of service in the variety of settings and, as a result, the more proper placement of patients. Acceptance of the help the psychogeriatrician can contribute will inevitably increase, but demands the provision of improved day-care and day-hospital facilities.
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In dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life.
The aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers' educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities.
The mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals' educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care.
The mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.
Two dementia quality registries have been developed in Denmark and Sweden with the aim to assess quality of dementia care based on adherence to national guidelines.
To compare patient characteristics, diagnostics, treatment, and quality indicators of dementia care among patients referred to specialist units in Sweden and Denmark.
Data from the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry were merged. Newly diagnosed dementia cases referred to memory clinics during 2007-2012 were included (19,629 Swedish and 6,576 Danish patients).
The median duration between initial assessment and confirmed diagnosis was 56 and 57 days in Sweden and Denmark, respectively. Brain imaging using MRI was twice as common in Sweden. A diagnosis of dementia was established at an average MMSE of 21. An etiological diagnosis was concluded in 89.6% of the Swedish and 87.3% of the Danish cases. Alzheimer's disease (AD) was the most common disorder (47.7% in Denmark and 36.6% in Sweden); however, more cases were diagnosed as mixed AD in Sweden (24.7% versus 10.6% ). More than 80% of patients with AD, dementia with Lewy bodies, and Parkinson's disease with dementia were treated with anti-dementia drugs.
The targets of several quality indicators in both registries were met, such that structural brain imaging and MMSE were performed in >90% and an etiological diagnosis was concluded in >80% of the patients. However, there were also results of concern. The diagnosis of dementia was established at a mean MMSE of 21, which is already late in the course of most dementia disorders. A higher chance of vascular findings following the higher rate of MRI in Sweden may have resulted in more mixed AD diagnosis, which could be one explanation for diagnostic differences but also highlights the need to harmonize diagnostic criteria.
OBJECTIVE: The aim of the present study was to find reasons for the low detection rate of dementia in primary care. Another aim was to investigate the attitudes and knowledge on dementia among Swedish general practitioners (GPs). DESIGN: Two-hundred-and-twenty-eight postal questionnaires were distributed to GPs in the county of Ostergötland. SETTING: Primary care in Sweden. MAIN OUTCOME MEASURES: The opinions of GPs on dementia management in primary care. RESULTS: The response rate was 67%. GPs showed a good knowledge of dementia diseases but underestimated the occurrence of dementia. They presented a positive attitude towards managing patients with dementia and considered that existing drug therapy justified an active search for patients with dementia in primary care, but they believed the efficacy of the drugs to be limited. Assessing the social environment of patients and organising social support were regarded as the most difficult tasks in the management of demented patients. CONCLUSION: The study indicates that the main obstacles are a lack of resources and a sceptical attitude to the benefits of drug treatment. Co-operation between the community services, specialist clinics and the primary care team should be improved.