Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility.

Autor: Harris DP; Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA., Ortiz F, Adler FM, Yu K, Maines ML, Barba D, Viggiani SI, Wolf SM, Fitten LJ, Chodosh J, Vickrey BG
Jazyk: angličtina
Zdroj: International journal of geriatric psychiatry [Int J Geriatr Psychiatry] 2011 Mar; Vol. 26 (3), pp. 268-76. Date of Electronic Publication: 2010 Jul 14.
DOI: 10.1002/gps.2524
Abstrakt: Objective: Implement a memory impairment screening procedure for elderly Hispanic primary care patients, and analyze its yield and challenges to further triage and diagnostic evaluation.
Methods: Three hundred twenty nine Hispanic patients aged ≥60 years or proxy informants were enrolled from outpatient primary care clinics at an urban safety-net medical center. Patients were screened for memory impairment using the WHO-UCLA AVLT; for those without consent capacity, proxies were given the IQCODE. Bilingual research assistants conducted in-person or telephone screening. Age, gender, education, comorbidities, acculturation, overall health, access to care, and memory concerns were assessed as potential predictors of memory impairment. Based on identified implementation challenges, a multi-disciplinary stakeholder committee proposed revised approaches to increase diagnostic evaluation and sustainability.
Results: Of 677 eligible patients approached, 329 (49%) were screened, and 77 (23%) met criteria for memory impairment using the WHO-UCLA AVLT (N=60) or the IQCODE (N=17). Only male gender and higher comorbidity uniquely predicted memory impairment (ps<0.05). Few screen-positive patients declined further triage and evaluation, but a substantial proportion could not be subsequently contacted. Challenges to implementing a memory screening program included staff time and adequate clinic space for in-person screening; challenges to follow-up of positive screening results included inability to contact patients and lack of primary care continuity to facilitate further triage and referral.
Conclusions: Nearly one-fourth of primary care Hispanic elders screened as memory-impaired, but few factors predicted positive screening. Stakeholder-guided adaptations are needed-particularly in resource-constrained settings-to overcome challenges to further diagnostic evaluation and referral.
(Copyright © 2010 John Wiley & Sons, Ltd.)
Databáze: MEDLINE
Externí odkaz: