Who Is Providing the Predominant Care for Older Adults With Dementia?
Open accessAbstract
Objectives To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.Design Cross-sectional analysis.Participants Fee-for-service Medicare beneficiaries aged ≥65 years with dementia.Measurements Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits.Results Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001).Conclusion It is unknown whether specialists are aware of their central role for many dementia patients' care needs. In LTC, NPs play the lead role as PPCs.
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PCPs are responsible for managing treatment for people living with dementia as well as screening and diagnosing.
“As well as screening for and diagnosing dementia, PCPs are responsible for managing treatment for people living with dementia.639”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [639]
The Discussion (page not provided) says primary care clinicians provide most predominant care for beneficiaries with dementia and play a critical role in their management. It does not establish that PCPs are responsible for screening and diagnosis; instead, it notes that many prefer specialist referral because they are uncertain about diagnosing dementia. The study identifies the provider with the most ambulatory visits, not who manages dementia-specific treatment. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPCPs are responsible for managing treatment for people living with dementia.
“As well as screening for, detecting and diagnosing dementia, PCPs are responsible for managing treatment for people living with dementia.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [733]
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2023 Alzheimer's disease facts and figures
(2023) · Alzheimer's & Dementia · doi:10.1002/alz.13016 · Cited by 3,212 · see citing works
2024 Alzheimer's disease facts and figures
(2024) · Alzheimer's & Dementia · doi:10.1002/alz.13809 · Cited by 2,536 · see citing works
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- Authors
- Yang, M., Chang, C.-H., Carmichael, D., Oh, E. S., & Bynum, J. P. W.
- Affiliations
- Johns Hopkins University (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Corresponding author
- Bynum, Julie P.W.
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 17
- Issue
- 9
- Pages
- 802-806
- ISSN
- 1525-8610 (ISSN-L)
- PMC
- PMC5045870
- OpenAlex
- W2416552113
- Cited by
- 36
- References
- 8
- Citations by year
- 2025: 6 · 2024: 6 · 2023: 6 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 2 · 2017: 2
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Donald W. Reynolds Foundation (1K23AG043504-01)
- National Institutes of Health (P50 AG005146)
- National Institute on Aging (P01 AG19783)
- John A. Hartford Foundation
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- dementia, primary care, long-term care, community-dwelling older adults, Medicare beneficiaries, nurse practitioners, elderly care, neurology, outpatient visits, care coordination
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Dementia, Female, Medicare, Humans, Long-Term Care, Male, Nursing Homes, Primary Health Care, Specialization, United States
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