Sex differences in the management of persons with dementia following a subnational primary care policy intervention
Open accessAbstract
BACKGROUND: The influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. However, current dementia strategies have not explicitly considered sex and gender differences in the management of dementia to ensure equitable care. The objective of this study was to examine the moderating effect of sex on the quality of care following the implementation of the Quebec Alzheimer Plan (QAP). METHODS: We conducted a secondary analysis of the evaluation of the QAP consisting of a retrospective chart review of 945 independent, randomly-selected patient charts of males and females 75+ years old with dementia and a visit to one of 13 participating Family Medicine Groups before (October 2011-July 2013) and after (October 2014 - July 2015). The quality of dementia care score, based on Canadian and international recommendations and consensus guidelines, consisted of documented assessments in 10 domains. We used a mixed linear regression model to measure the interaction between sex and the implementation of the QAP on the quality of dementia care score, adjusting for age and number of medications. RESULTS: We found that improvements in the quality of dementia care following the QAP were larger for men than women (mean difference = 4.97; 95%CI: 0.08, 9.85). We found that men had a larger improvement in four indicators (driving assessments, dementia medication management, Alzheimer Society referrals, and functional status evaluation), while women had a smaller improvement in three (home care needs, behavioural and psychological symptoms of dementia, and weight). Men were prescribed fewer anticholinergics post-QAP, while women were prescribed more. Cognitive testing improved in men but decreased for women following the QAP; the opposite was observed for caregiver needs. CONCLUSION: While the overall quality of care improved after the implementation of the QAP, this study reveals differences in dementia management between men and women. While we identified areas of inequalities in the care received, it is unclear whether this represents inequities in access to care and health outcomes. Future research should focus on better understanding sex and gender-specific needs in dementia to bridge this gap and better inform dementia strategies.
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Sex, rurality, and neighborhood income quintile have been previously tied to inequalities in access to care that could be exacerbated by the COVID-19 pandemic.
“Sex, rurality, and income quintile were chosen as strata as they have been previously tied to inequalities in access to care that could be exacerbated by the pandemic.13 , 14”
From Impact of the COVID-19 pandemic on home care services among community-dwelling adults with dementia (2021) · cites this paper as [13]
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- Authors
- Sourial, N., Arsenault-Lapierre, G., Margo-Dermer, E., Henein, M., & Vedel, I.
- Affiliations
- Centre Hospitalier de l’Université de Montréal (CA)
- McGill University (CA)
- Jewish General Hospital (CA)
- Corresponding author
- Sourial, Nadia
- Venue
- International Journal for Equity in Health
- Published
- 2020-10-06
- Volume
- 19
- Issue
- 1
- Pages
- 175-175
- ISSN
- 1475-9276 (ISSN-L)
- PMC
- PMC7539425
- OpenAlex
- W3091909259
- Cited by
- 17
- References
- 36
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 2
- FWCI
- 1.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal for Equity in Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- The Canadian Consortium on Neurodegeneration in Aging
- Fonds de Recherche du Québec - Santé
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- dementia care, sex differences, gender differences, primary care policy, quality of care, health equity, older adults, behavioral and psychological symptoms of dementia, caregiver needs, cognitive assessment, home care needs
- MeSH terms
- Aged, Dementia, Female, Health Policy, Humans, Male, Primary Health Care, Quebec, Retrospective Studies, Sex Factors
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