Putting dementia awareness into general practice : The CADIF approach

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.

Keywords: Attitudes of health personnel; Cognition; Dementia; Diagnosis; Health services research.