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One of the biggest hurdles in assessing patients with dementia is that they are often unable to provide a reliable history.
Symptoms can be subtle and easily overlooked, especially in early stages.
In aged care settings, clinical assessments are often difficult due to multiple factors, including patient cooperation, cognitive limitations, and the availability of resources.
Physical examinations can be challenging and, in some cases, limited due to the patient’s frailty, communication barriers, and coexisting comorbidities.
Access to imaging and diagnostic tests is not as readily available in aged care settings, and decisions around investigations are often influenced by factors such as the ceiling of care and patient/family preferences.
The difficulties faced in assessing dementia patients are not unique to aged care facilities—they are universal, whether the patient is managed by a GP in aged care or by a specialist in a hospital setting.
Even in hospital settings, clinicians face similar challenges, particularly in differentiating acute medical issues from pre-existing cognitive decline.
The key takeaway here is that regardless of the setting, medical teams need to develop strategies to navigate these challenges effectively.
Given the limitations in diagnostic resources, especially in aged care, it is essential to depend more on clinical skills rather than extensive investigations.
A structured clinical approach, focusing on history-taking, bedside assessments, and pattern recognition, is often the most beneficial strategy in managing these patients.
Since patients with dementia often cannot provide a reliable account, obtaining a collateral history from nursing staff, caregivers, or family members becomes crucial.
The key aspects to assess include:
Narrowing down to only address acute issues helps in focusing on treatment plans without overcomplicating management.
Whether in aged care or hospital settings, the focus should be on identifying and addressing acute issues rather than trying to treat every chronic condition at once.
Tailoring interventions based on patient goals, frailty, and ceiling of care is essential to avoid overmedicalisation and ensure patient-centred care.
With the increasing number of aged care homes and a rising population of residents, the healthcare system needs to be better equipped to handle these challenges.
One of the most effective strategies would be enhancing the training of nursing and aged care staff.
Developing clear and practical protocols for common geriatric conditions can empower nursing staff to identify early signs of medical deterioration and seek timely medical intervention.
Strengthening collaboration between GPs, specialists, and aged care staff will also play a key role in ensuring better continuity of care and improving outcomes for patients with dementia.
The integration of telemedicine and remote medical support may further aid in bridging some of the current gaps in timely geriatric assessments.
Authored by:
Dr. Prajwal K. Das, General Practitioner, Lake Orr Family Medical Practice
Dr R Bansal, Consultant Psychiatrist and Psychogeriatrician
Date: March 26, 2025
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