Caring or forwarding? Challenges in the diagnosis and management of patients with dementia in Primary Health Care

Authors

DOI:

https://doi.org/10.33448/rsd-v11i7.29398

Keywords:

Dementia Syndromes; Primary Health Care; Care practices; Differential diagnosis; Health education.

Abstract

Introduction: With population aging, we have an increase in neurodegenerative conditions, including dementia syndromes. It is essential that health services are able to receive this demand, especially in Primary Health Care, for better monitoring of the elderly. Objective: to know the difficulties faced by doctors of the Family Health Strategy in the city of São Caetano do Sul in the care of patients with dementia. Method: this is a cross-sectional, quantitative, descriptive, exploratory approach, with a convenience sample, not probabilistic. The Brazilian version, validated for physicians, of the instrument “Atenció Sanitària de Les Demències: la visió de L'Atenció Primarià” was used. Results: 100% of the doctors of the Family Health Strategy in the municipality of São Caetano do Sul were evaluated. Regarding the care provided in Primary Health Care, 82.6% of the physicians evaluated reported that more than 25% of the patients seen were elderly. Most participants (64.3%) indicated that the greatest difficulty in identifying a case of dementia was the differentiation of signs and symptoms of dementia from geriatric depression. Another challenge observed by 46.4% of physicians was the differentiation of signs and symptoms of dementia from the physiological process of aging, senescence. Among the main signs and symptoms that lead to suspect the diagnosis of dementia, 46.4% of physicians pointed to cognitive impairment with memory alterations, 28.6% reported that the impairment of the ability to perform activities of daily living would be the first signs and symptoms and 21.4% reported that the presence of psychological and behavioral symptoms is what would most lead to suspicion of the diagnosis. Final Considerations: It was observed that physicians had difficulty in evaluating patients with cognitive complaints in relation to screening for reversible dementias and investigating differential diagnoses with common aging and mood disorders, for example. It is essential to train the studied group to improve the quality of care for the elderly.

References

American Psychiatric Association. (2014). Manual diagnóstico e estatístico dos transtornos mentais: DSM-5. (5a ed.). Artmed.

Bottino, C. M. C. et. al. (2008). Estimate of Dementia Prevalence in a Community Sample from São Paulo, Brazil. Dement Geriatr Cogn Disord, 26(4), 291-299. https://doi.org/10.1159/000161053

Brasil. (2012). Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Brasileiro de 2010. https://www.ibge.gov.br/estatisticas/sociais/saude/9662-censo-demografico-2010.html?edicao=9673&t=sobre

Brucki, S. M. D. (2013). Epidemiology of mild cognitive impairment in Brazil. Dement Neuropsychol, 7(4), 363-366. https://doi.org/10.1590/S1980-57642013DN74000002

Costa, G. D. (2014). Adaptação transcultural do instrumento Atenció Sanitária de Les Demències: la visió de L 'Atenció Primarià. 2014. Dissertação (Mestrado) Escola de Enfermagem da Universidade de São Paulo, São Paulo. https://doi.org/10.11606/D.7.2014.tde-12122014-110114

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. (2020). The Lancet, 396(10258), 1204-1222. https://doi.org/10.1016/S0140-6736(20)30925-9

Gusso, G. & Lopes, J. M. C. (2012). Tratado de medicina de família e comunidade: princípios, formação e prática. Artmed.

Koche, J. C. (2011). Fundamentos de metodologia científica. Vozes.

Livingston, G. et al. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6

Luchesi, B. M., et al. (2021). Prevalence of risk factors for dementia in middle- and older- aged people registered in Primary Health Care. Dement Neuropsychol, 15(2), 239-247. https://doi.org/10.1590/1980-57642021dn15-020012

Pelegrini, L. N. C. et al. (2019). Diagnosing dementia and cognitive dysfunction in the elderly in primary health care: a systematic review. Dement Neuropsychol, 13(2), 144-153. https://doi.org/10.1590/1980-57642018dn13-020002

Suemoto, C. K. et al. (2017). Neuropathological diagnoses and clinical correlates in older adults in Brazil: a cross-sectional study. PLOS Medicine, 14(3). https://doi.org/10.1371/journal.pmed.1002267

Ramos, C. C. F., & Garcia, R. R. (2012). How is the care provided by physicians to patients with dementia in Primary Care? Research, Society and Development, 11(1), e24211124723. https://doi.org/10.33448/rsd-v11i1.24723.

Rayanne, P., Veras, L., & Leitão, J. M. S. de R. (2021). Pharmaceutical care in Alzheimer’s Disease. Research, Society and Development, 10(13), e385101321247. https://doi.org/10.33448/rsd-v10i13.21247

Silveira, A. G., & Silva, D. A. da. (2020). Burden of family members in caring for senile dementia patients: an integrative review. Research, Society and Development, 9(6), e179963671. https://doi.org/10.33448/rsd-v9i6.3671

Tuero, G. C. et al. (2011). Percepción, actitudes y necesidades de los profesionales de atención primaria con relación al paciente con demencia. Aten Primaria, 43(11), 585-594. https://doi.org/10.1016/j.aprim.2010.11.015

Unwin, B. K., Loskutova, N., Knicely, P. & Wood, C. D. (2019). Tools for Better Dementia Care. Fam Pract Manag, 26(1), 11-16. https://pubmed.ncbi.nlm.nih.gov/30645088/

US Preventive Services Task Force et al. (2020). Screening for Cognitive Impairment in Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 323(8), 757-763. https://doi.org/10.1001/jama.2020.0435

Published

01/06/2022

How to Cite

RAMOS, C. C. F. .; GARCIA , R. R. .; JOÃO , M. V. M. . Caring or forwarding? Challenges in the diagnosis and management of patients with dementia in Primary Health Care. Research, Society and Development, [S. l.], v. 11, n. 7, p. e48311729398, 2022. DOI: 10.33448/rsd-v11i7.29398. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/29398. Acesso em: 4 jul. 2022.

Issue

Section

Health Sciences