Dementia presents a challenge for primary care and the advent of new therapeutic options has highlighted the need to improve its detection so that early decisions about medication use can be made. Efforts at earlier diagnosis should be targeted at primary care as the gateway to specialist health and social services. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice throughout the world. This article reviews the obstacles to early recognition of dementia and the factors causing sub-optimal management in the community, and discusses educational approaches to enhancing professional skills in the recognition of and response to dementia. Three educational interventions with different characteristics and methods of delivery are described.
Bair, B.
(1998). Frequently missed diagnosis in geriatric psychiatry. The Psychiatric Clinics of North America, 21, 941–972.
4.
Briggs, R.
(1993). Comment: Alzheimer’s disease – your views. Geriatric Medicine, 23(1), 40–41.
5.
Brookfield, S.D.
(1986). Understanding and facilitating adult learning. Buckingham: Open University Press.
6.
Cervero, R.M.
(1988). Effective continuing education for professionals. San Francisco: Jossey Bass.
7.
De Lepeleire, J.
, & Heyman, J. (1999). Diagnosis and management of dementia in primary care at an early stage:The need for a new concept and an adapted structure. Theoretical Medicine & Bioethics, 20, 215–228.
8.
De Lepeleire, J.
, Heyman, J., Baro, B., Buntinx, F., & Lausy, C. (1994). How do general practitioners diagnose dementia?Family Practice, 11, 148–152.
9.
De Lepeleire, J.
, Heyman, J., & Buntinx, F. (1998).The early diagnosis of dementia: Triggers, early signs and luxating events. Family Practice, 15, 431–436.
10.
Downs, M.
(1996).The role of general practice and the primary care team in dementia diagnosis and management. International Journal of Geriatric Psychiatry, 11, 937–942.
11.
Durno, D.
, & Gill, M. (1974). Survey of general practitioners’ views on postgraduate education in north east Scotland. Journal of the Royal College of General Practitioners, 24, 648–654.
12.
Eastley, R.
, Haworth, J.,Wilcock, G., & Sharp, D. (1999). Guideline should cover differential diagnosis. British Medical Journal, 318, 731-731.
13.
Eccles, M.
, Clarke, J., Livingston, M., Freemantle, N., & Mason, J. (1998). North of England evidence based guidelines development project: Guideline for the primary care management of dementia. British Medical Journal, 317, 802–808.
14.
Eefsting, J.A.
, Boersma F.,Van den Brink, W., & Van Tilburg, W. (1996). Differences in the prevalence of dementia based on community survey and general practitioner recognition. Psychological Medicine, 26,1223–1230.
15.
Eraut, M.
(2000). Developing professional knowledge and competence. London: Falmer.
16.
Feltovitch, P.J.
, & Barrow, H.S. (1984). Issues of generality in medical problem solving. In H.G. Schmidt & M.L. De Volder (Eds.), Tutorials in problem-based learning (pp. 128–142). Assen:Van Gorcum.
17.
Gillam, S.
, Eversley, J., Snell, J., & Wallace, P. (1999). Building bridges:The future of GP education – developing partnerships with the service. London: Kings Fund.
18.
Grant, J.
, & Stanton, F. (2000). The effectiveness of continuing professional development. Edinburgh:The Association for the Study of Medical Education.
19.
Grant, J.
, Stanton, F., Flood, S., Mack, J., & Waring, C. (1998). An evaluation of educational needs and provision for doctors within three years of completion of training. London: Joint Centre for Education in Medicine.
20.
Haines, A.
, & Donald, A. (1998). Making better use of research findings.British Medical Journal, 317, 72–75.
Iliffe, S.
, Booroff, A., Gallivan, S., Goldenberg, E., Morgan, P., & Haines, A. (1990). Screening for cognitive impairment in the elderly using the mini-mental state examination. British Journal of General Practice, 40 (336), 277–279.
23.
Iliffe, S.
, Eden, A., Downs, M., & Rae, C. (1999).The diagnosis and management of dementia in primary care: Development, implementation and evaluation of a national training programme. Aging & Mental Health, 3(2), 129–135.
24.
Iliffe, S.
, Mitchley, S., Gould, M., & Haines, A. (1994). Evaluation of the use of brief screening instruments for dementia, depression and problem drinking among elderly people in general practice. British Journal of General Practice, 44, 503–507.
25.
Iliffe, S.
,Walters, K., & Rait, G. (2000). Shortcomings in the diagnosis and management of dementia in primary care:Towards an educational strategy. Aging and Mental Health, 4(4), 286–291.
26.
Kitson, A.
, Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: A conceptual framework. Quality in Health Care, 7, 149–158.
27.
Knowles, M.S.
(1980). The modern practice of adult education:From pedagogy to andragogy (2nd ed.). New York: Cambridge Books.
28.
Kolb, D.A.
(1984). Experiential learning:Experience as the source of learning and development. Englewood Cliffs: Prentice Hall.
29.
Levin, E.
, Sinclair, I., & Gorbach, P. (1989) Families, Confusion & Old Age. Aldershot: Gower.
30.
Matthews, H.
,Wilkinson, D., & Holmes, C. (1999). Some recommendations given are not directly based on evidence cited. British Medical Journal, 318, 802–808.
31.
NHS Centre for Reviews & Dissemination
(1999). Effective health care:Getting evidence into practice. Volume 5(1).York: York University.
32.
Nowlem, P.M.
(1988). A new approach to continuing education for business and the professions.New York: Macmillan.
33.
O’Connor, D.W.
, Pollitt, C.P., Brook, C.P.B., & Reiss, B.B. (1989).The validity of informant studies histories in a community study of dementia. International Journal of Geriatric Psychiatry, 4, 203–208.
34.
O’Connor, D.W.
, Pollitt, C.P., Hyde, J., Reiss, B., & Roth, M. (1988). Do general practitioners miss dementia in elderly patients?British Medical Journal, 297, 1107–1110.
35.
Pollitt, C.P.
(1996). Dementia in old age: An anthropological perspective. Psychological Medicine, 26, 1061–1074.
36.
Pond, C.
, Mant, W., Kehoe, L., Hewitt, & Brodaty, H. (1994). General practitioner diagnosis of depression and dementia in the elderly: Can academic detailing make a difference. Family Practice, 11, 141–147.
37.
Reedy, B.
(1979). General Practitioners and postgraduate education in the northern region: Occasional paper 9. Monograph of the Royal College of General Practitioners.
38.
Schon, D.
(1987). Educating the reflective practitioner. San Francisco: Jossey Bass.
39.
Scottish Intercollegiate Guidelines Network
(1998). Interventions in the management of behavioural and psychological aspects of dementia:A national clinical guideline recommended for use in Scotland by the Scottish Intercollegiate Guidelines Network, February.
40.
Spencer, J.A.
, &, Jordan, R.K. (1999). Learner centred approaches in medical education. British Medical Journal, 318, 1280–1283.
41.
Toner, H.
(1992).What do we mean by assessment? In D. Haxby (Ed.) Dementia: diagnosis and assessment. Stirling: Dementia Services Development Centre.
42.
Van den Broucke, J.P.
(1999). Case reports in an evidence based world. Journal of the Royal Society of Medicine: 92 (4), 159–163.
43.
Wilcock, J.
, Iliffe, S.,Walters, K., Rait, G.,Turner, S., Downs, D., Carroll, R., & Keady, J. (2001) Development of a dementia training curriculum. Manuscript in preparation.
44.
Willis, S.L.
, & Dubin, S.S. (Eds.) (1990). Maintaining professional competence. San Francisco: Jossey Bass.
45.
Yeo, G.T.
, Deburgh, S.P.H, Letton, T., Shaw, J., Donnelly, N., Swinburn, M.E., Phillips, S., Bridgeswebb, C., & Mant, A. (1994). Educational visiting and hypnosedative prescribing in general-practice. Family Practice, 11(1), 57–61.
