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Background Management of neuropsychiatric symptoms is a challenging task in primary care. Aims To assess self-reported confidence and knowledge of general practitioners (GPs) regarding the identification and management of behavioural and psychological symptoms of dementia (BPSD).Methods A self-designed two-page paper questionnaire was sent to a random sample of 160 GPs practising in north Dublin. They were asked to evaluate their confidence and knowledge on several aspects of diagnosis and management of BPSD.Results Completed questionnaires were returned from 109 GPs (response rate = 68%), of which 106 were usable. In general, GPs were somewhat critical of their self-reported skills in diagnosing (76.4%) and managing (77.4%) BPSD, as well as in discriminating BPSD from other behavioural disturbances (71.7%). Many of them (67.9%) also encountered difficulty accessing specialist services. There was no correlation between demographic characteristics of GPs or patient caseload with respect to their responses to questionnaire items. Although many GPs (92.5%) highly valued the important role of non-pharmacological interventions in BPSD, none of them reported recommending these in their daily practice.Conclusions Despite the fact that GPs have a wealth of knowledge about BPSD, they are largely critical of their knowledge and management skills of these symptoms. Efforts should be focused on supporting GPs by means of educational interventions that consider all aspects of dementia, but additionally highlight the more challenging neuropsychiatric components of the illness. Health services need to be structured in a way that promotes collaboration between GPs and mental health professionals for a seamless delivery of care.
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OBJECTIVES: To examine the quality of end-of-life care received by patients with and without dementia on acute medical wards during their final hospitalization. METHODS: A retrospective clinical case note review of patients aged over 65 who had died on acute medical wards within a 6-month period in a general hospital in Dublin was conducted. Seventy-five multidisciplinary clinical notes were available for scrutiny in order to identify cognitive status, measure the frequency of invasive procedures undertaken and examine the quality of palliative care as benchmarked with the Liverpool Care Pathway for the Dying Patient (LCP) program. Comparison between patients with and without dementia was made. RESULTS: Eighteen (24.0%) subjects had dementia, 32 (42.7%) subjects were described as "cognitively intact" and 25 subjects did not have reference to cognitive status. Of the 50 patients with known cognitive status, 27 (54.0%) had had a Mini Mental State Examination (MMSE) conducted (10 dementia vs. 17 nondementia). Patients were equally subjected to invasive interventions regardless of their cognitive status. However, dementia patients were significantly less likely to be referred to palliative care interventions (P=.007), to be prescribed palliative drugs (P=.017) and to have carers involved in decision making (P=.006). CONCLUSION: Individuals with dementia may be receiving different end-of-life care from those without. The effective delivery of robust multidisciplinary frameworks for the palliation of symptoms of hospitalized dementia patients remains an important clinical goal.
