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
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Cognitive testing (Mini-Mental State Examination,26 clock-drawing test, the Montreal Cognitive Assessment,27 or other)
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Inquiry into basic activities of daily living28 and instrumental activities of daily living29
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Laboratory testing (including complete blood count and measurement of electrolyte, thyroid-stimulating hormone, blood glucose, and calcium levels)
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Identification of behavioural and psychological issues of dementia
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Identification of caregiver burden
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Identification of safety issues (eg, wandering and driving status)
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Identification of medicolegal issues (eg, personal directives, enduring power of attorney, capacity assessment)
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Interventions (eg, referral to community care)
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Data from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.30
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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.
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- 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.
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↵* Out of those for whom cognitive testing was performed.
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- 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.
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↵* Out of those for whom cognitive testing was performed.
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↵† CC does not conduct capacity assessments.
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↵‡ CC cannot refer to itself.
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- 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.
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- 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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