Title | Effect of Early Referral to Specialist in Dementia on Institutionalization and Functional Decline: Findings from a Population-Based Study. |
Publication Type | Journal Article |
Year of Publication | 2016 |
Authors | Pimouguet, C, Le-Goff, M, Rizzuto, D, Berr, C, Leffondré, K, Pérès, K, Dartigues, JFrançois, Helmer, C |
Journal | J Alzheimers Dis |
Volume | 49 |
Issue | 3 |
Pagination | 819-28 |
Date Published | 2016 |
ISSN | 1875-8908 |
Keywords | Activities of Daily Living, Cognition Disorders, Community Health Planning, Dementia, Disability Evaluation, Female, Finland, Follow-Up Studies, Humans, Institutionalization, Male, Psychiatric Status Rating Scales, Referral and Consultation, Specialization |
Abstract | BACKGROUND: Although early diagnosis has been hypothesized to benefit both patients and caregivers, until now studies evaluating the effect of early dementia diagnosis are lacking. OBJECTIVE: To investigate the influence of early specialist referral for dementia on the risk of institutionalization and functional decline in Activity of Daily Living (ADL). METHODS: Incident dementia cases were screened in a prospective population-based cohort, the Three-City Study, and initial specialist consultation for cognitive complaint was assessed at dementia diagnosis. Proportional hazard regression and illness-death models were used to test the association between specialist referral and, respectively, institutionalization and functional decline. RESULTS: Only one third of the incident individuals with dementia had consulted a specialist for cognitive problems early (36%). After adjustment on potential confounders (including cognitive and functional decline) and competing risk of death, participants who had consulted a specialist early in the disease course presented a higher rate of being institutionalized than those who did not (Hazard Ratio = 2.00, 95% Confidence Interval (CI): 1.09- 3.64). But early specialist referral was not associated with further functional decline (HR = 1.09, 95% CI: 0.71- 1.67). CONCLUSIONS: Early specialist referral in dementia is associated with increased risk of institutionalization but not with functional decline in ADL. These findings suggest that early care referral in dementia may be a marker of concern for patients and/or caregivers; subsequent medical and social care could be suboptimal or inappropriate to allow patients to stay longer at home. |
DOI | 10.3233/JAD-150574 |
Alternate Journal | J. Alzheimers Dis. |
PubMed ID | 26484926 |