scholarly journals SCREENING FOR MILD COGNITIVE IMPAIRMENT: THERE IS THE WILL BUT IS THERE A WAY?

2020 ◽  
pp. 1-2
Author(s):  
J.E. Galvin
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Burden Of Illness ◽  
Financial Burden ◽  
Fold Increase ◽  
Primary Care Providers ◽  
Care Providers ◽  
Eligibility Determination ◽  
The Will

Alzheimer’s disease (AD) currently affect over 5.8 million Americans and over 35 million people worldwide (1). The number of AD cases is expected to increase as the number of people over age 65 grow by 62% and the number over age 85 is expected to grow by 84% (1, 2). More than one in eight adults over age 65 has dementia, and current projections indicate a three-fold increase by 2050. Thus, the prevalence, incidence, morbidity, and mortality for AD (3) and its prodromal state of Mild Cognitive Impairment due to AD (MCI-AD) (4) will increase dramatically and the societal financial burden of illness and dependency will expand exponentially. Primary care providers are often responsible for the detection, diagnosis, and treatment of AD as the number of dementia specialists (neurologists, psychiatrists, and geriatricians) and specialty centers is not sufficient to meet the growing demands (2, 5). The inability to detect MCI and ADRD may affect eligibility determination for care and services and impede case ascertainment and recruitment in clinical research.

scholarly journals Health Variables Are Informative in Screening for Mild Cognitive Impairment Among Elderly African Americans

2017 ◽  
Vol 38 (10) ◽  
pp. 1421-1444 ◽  
Author(s):  
Siny Tsang ◽  
Scott A. Sperling ◽  
Moon-Ho Park ◽  
Ira M. Helenius ◽  
Ishan C. Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
African Americans ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cognitive Difficulties ◽  
Increased Risk ◽  
State Examination

To aid primary care providers in identifying people at increased risk for cognitive decline, we explored the relative importance of health and demographic variables in detecting potential cognitive impairment using the Mini-Mental State Examination (MMSE). Participants were 94 older African Americans coming to see their primary care physicians for reasons other than cognitive complaints. Education was strongly associated with cognitive functioning. Among those with at least 9 years of education, patients with more vascular risk factors were at greater risk for mild cognitive impairment. For patients with fewer than 9 years of education, those with fewer prescribed medications were at increased risk for dementia. These results suggest that in addition to the MMSE, primary care physicians can make use of patients’ health information to improve identification of patients at increased risk for cognitive impairment. With improved identification, physicians can implement strategies to mitigate the progression and impact of cognitive difficulties.

scholarly journals Promoting Conversations About Cognitive Decline Between Older Adults and Primary Care Providers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 157-158
Author(s):  
Benjamin Olivari ◽  
Christopher Taylor ◽  
Nia Reed ◽  
Lisa McGuire
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Chronic Conditions ◽  
Memory Loss ◽  
Primary Care Providers ◽  
Subjective Cognitive Decline ◽  
Care Providers

Abstract Alzheimer’s disease and related dementias often begin with symptoms of mild memory loss, eventually leading to more severe cognitive impairment, functional impairment, and ultimately, death. Data from the Behavioral Risk Factor Surveillance System core questions related to chronic diseases and from the cognitive decline optional module on subjective cognitive decline (SCD) from the years 2015-2018 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among U.S. adults aged 65 years and older, only 39.8% (95%CI=37.6-42.1) of those experiencing SCD reported discussing their SCD symptoms with a healthcare provider. The prevalence of discussing SCD symptoms with a provider was higher among those with at least one chronic condition than among those with no chronic conditions. 30.7% (28.6-32.8) of those aged 65 years and older reported that their SCD led to functional limitations and 28.8% (26.5-31.2) needed assistance with day-to-day activities. For patients aged 65 years and older, Welcome to Medicare visits and Medicare Annual Wellness Visits are critically underutilized primary care access points. Primary care providers can manage chronic conditions, cognitive health, and initiate referrals for testing. Efforts to promote the use of toolkits and diagnostic codes that are available to primary care providers to initiate conversations about memory loss with patients may be utilized to improve detection, diagnosis, and planning for memory problems. Discussions may lead to earlier detection and diagnosis of cognitive impairment, such as Alzheimer’s disease, or other treatable conditions such as delirium or pressure in the brain and avoid costly hospitalizations.

Living Alone With Cognitive Impairment

2016 ◽  
Vol 32 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Allison K. Gibson ◽  
Virginia E. Richardson
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Primary Care Providers ◽  
Study Data ◽  
Living Alone ◽  
Cognitive Screening ◽  
Care Providers ◽  
Data Set ◽  
Increased Risk ◽  
Study Participants

Although most individuals experiencing cognitive impairment (CI) reside with a caregiver, an estimated 800,000 live alone. Such individuals may have an increased risk for injury to self or others through self-neglect as a result of the CI symptoms. While persons living alone with CI have been identified as an important area for needed research, few studies have been able to examine this population due to the challenges of identifying and recruiting study participants. By using the National Health & Aging Trends Study data set, the researchers explored the characteristics to describe this population. The results of this study indicated that the majority of persons living with CI were older, widowed females who were not diagnosed with Alzheimer’s or dementia but tested positive on cognitive screening measures. Further, the majority of persons living alone with CI relied on adult children and paid professionals as the primary care providers.

scholarly journals Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cati G. Brown-Johnson ◽  
Nadia Safaeinili ◽  
Juliana Baratta ◽  
Latha Palaniappan ◽  
Megan Mahoney ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Financial Burden ◽  
Primary Care Providers ◽  
Health Coaching ◽  
High Tech ◽  
Care Providers ◽  
Care Clinic ◽  
Implementation Outcomes ◽  
Precision Health

Abstract Background Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs. Methods We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes. Results Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability. Conclusion This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.

scholarly journals Integrating the GSA KAER Toolkit Into Practical Training for Primary Care Clinics

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 346-347
Author(s):  
Jaqueline Raetz ◽  
Basia Belza ◽  
Monica Zigman Suchsland ◽  
Judit Illes ◽  
Benjamin Olivari ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Deep Understanding ◽  
Primary Care Providers ◽  
Care Practice ◽  
Practical Training ◽  
Core Knowledge ◽  
Care Providers ◽  
Team Members ◽  
Primary Care Clinics

Abstract Education is central to driving change in clinical practice. First, primary care providers and their clinic team members need to understand why detecting cognitive impairment is important, how it can be done efficiently, and what the next steps in referral and management are. To engage primary care clinics in this change process, we developed a continuing education intervention, based on the KAER Model, using a live video format. Four evidence-based, 45-minute training modules presented core knowledge skills, including how to have difficult conversations, which are essential to diagnosing cognitive impairment. To overcome the obstacles to doing so in primary care, our team relied on a deep understanding of busy primary care practice. With a combined 35 years of direct experience in primary care, our collaborative interdisciplinary team was able to use the KAER Model to develop a highly acceptable intervention for primary care.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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