Article Figures & Data
Figures
- Figure 1.
Study sample selection
CC—community care, GAT—geriatric assessment team, PCN—primary care network.
*Meeting inclusion criteria of having a diagnosis of dementia or mild cognitive impairment (made by the GAT physician).
†Randomly selected from the 267 charts.
‡All CC patients had corresponding PCN charts.
- Figure 2.
Reasons for referral to the GAT: Referrals total more than 100% because there could be multiple reasons for referral.
GAT—geriatric assessment team.
Tables
The following are considered indicative of high-quality dementia care: Documented diagnosis of dementia and its severity
Cognitive testing (Mini-Mental State Examination,26 clock-drawing test, the Montreal Cognitive Assessment,27 or other)
Inquiry into basic activities of daily living28 and instrumental activities of daily living29
Laboratory testing (including complete blood count and measurement of electrolyte, thyroid-stimulating hormone, blood glucose, and calcium levels)
Identification of behavioural and psychological issues of dementia
Identification of caregiver burden
Identification of safety issues (eg, wandering and driving status)
Identification of medicolegal issues (eg, personal directives, enduring power of attorney, capacity assessment)
Interventions (eg, referral to community care)
Data from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.30
VARIABLE GAT (N = 100) PCN (N = 81) CC (N = 73) Age, y • Mean (SD) 80.9 (7.43) 81.2 (7.35) 82.2 (6.55) • Range 56–96 56–96 65–96 Sex, % • Female 55 57 62 Marital status, % • Married, common-law 52 51 43 • Widowed 40 41 51 • Separated, divorced, never married 8 9 7 Living arrangements, % • With spouse or family member 57 57 49 • Alone 39 42 45 • Other 4 3 6 Residence, % • House or apartment 72 72 62 • Assisted living 27 27 37 • Long-term care 1 1 1 Family physician, % • Yes 100 100 100 Home care involvement, % • Yes 67 65 NA CC—community care, GAT—geriatric assessment team, NA—not applicable, PCN—primary care network.
- Table 2.
Comparison of family physician and GAT data on selected indices of dementia assessment and care
VARIABLE PCN, % (N = 81) GAT, % (N = 81) P VALUE Diagnosis of dementia documented • On referral to GAT 52 37 .02 Cognitive testing • Any cognitive testing performed 44 100 < .001 Cognitive tests used* • MMSE 44 100 < .001 • MoCA 7 32 < .001 • CDT 12 88 < .001 • Other 3 15 .01 ADLs • Assessment of BADLs28 17 100 < .001 • Assessment of IADLs29 17 100 < .001 Safety • Driving status explored 30 99 < .001 • Wandering explored 17 88 < .001 Medicolegal • Personal directive explored 6 99 < .001 • EPOA explored 10 99 < .001 • DMC assessment explored 5 39 < .001 • DMC assessment provided 4 36 < .001 • Elder abuse explored 1 26 < .001 BPSD • Identification of BPSD 46 100 < .001 Caregiver stress • Caregiver coping or stress explored 20 53 < .001 CC services • Referral to CC services 16 57 < .001 ADLs—activities of daily living, BADLs—basic activities of daily living, BPSD—behavioural and psychological symptoms of dementia, CC—community care, CDT—clock-drawing test, DMC—decision-making capacity, EPOA—enduring power of attorney, GAT—geriatric assessment team, IADLs—instrumental activities of daily living, MMSE—Mini-Mental State Examination, MoCA—Montreal Cognitive Assessment, PCN—primary care network.
↵* Out of those for whom cognitive testing was performed.
- Table 3.
Comparison of CC and GAT data on selected indices of dementia assessment and care
VARIABLE CC, % (N = 73) GAT, % (N = 73) P VALUE Diagnosis of dementia documented • On referral to GAT 45 44 > .999 Cognitive testing • Any cognitive testing performed 79 100 < .001 Cognitive tests used* • MMSE 77 100 < .001 • MoCA 6 32 < .001 • CDT 47 88 < .001 • Other 7 15 .39 Number of cognitive tests used* • 1 38 9 • 2 55 54 • 3 34 31 • 4 2 6 ADLs • Assessment of BADLs28 93 100 .06 • Assessment of IADLs29 89 100 .01 Safety • Driving status explored 70 99 <.001 • Wandering explored 73 88 .04 Medicolegal • Personal directive explored 73 99 <.001 • EPOA explored 64 99 <.001 • DMC assessment explored NA† 36 NA • DMC assessment provided NA† 33 NA • Elder abuse explored 14 30 .03 BPSD • Identification of BPSD 88 100 .004 Caregiver stress • Caregiver coping or stress explored 55 52 0.832 CC services • Referral to CC services NA‡ 59 NA ADLs—activities of daily living, BADLs—basic activities of daily living, BPSD—behavioural and psychological symptoms of dementia, CC—community care, CDT—clock-drawing test, DMC—decision-making capacity, EPOA—enduring power of attorney, GAT—geriatric assessment team, IADLs—instrumental activities of daily living, MMSE—Mini-Mental State Examination, MoCA—Montreal Cognitive Assessment, NA—not applicable.
↵* Out of those for whom cognitive testing was performed.
↵† CC does not conduct capacity assessments.
↵‡ CC cannot refer to itself.
- Table 4.
Contingency table of dementia diagnosis: Sensitivity = 0.59; specificity = 0.92; PPV = 0.98; NPV = 0.28.
GAT (CRITERION STANDARD) YES NO TOTALS PCN YES 41 1 42 NO 28 11 39 TOTALS 69 12 81 GAT—geriatric assessment team, NPV—negative predictive value, PCN—primary care network, PPV—positive predictive value.
- Table 5.
Contingency table of MCi diagnosis: Sensitivity = 0; specificity = 0.99; PPV = 0; NPV = 0.85.
GAT (CRITERION STANDARD) YES NO TOTALS PCN YES 0 1 1 NO 12 68 80 TOTALS 12 69 81 GAT—geriatric assessment team, MCI—mild cognitive impairment, NPV—negative predictive value, PCN—primary care network, PPV—positive predictive value.
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