" Falling through the cracks "; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention
" Falling through the cracks "; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention
复制标题
“从裂缝中跌落”；
DOI：
10.1002/gps.5373
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发表时间：
2020
影响因子：
4
通讯作者：
Poppe M
中科院分区：
文献类型：
--
作者：
Poppe M
许多人都意识到轻微的认知变化会增加他们患痴呆症的风险。先前的作者描述了这种介于认知健康和痴呆症之间的阈值状态的不确定性，在这种状态下，“处于危险之中”本身就是一种疾病。我们询问服务机构如何应对目前有记忆问题的人，以及未来如何为有记忆问题的人构建有效和包容的痴呆症预防干预措施。方法/设计对18名有主观或客观记忆问题的60岁以上老年人、6名家庭成员、10名卫生和社会护理专业人员以及11名第三部门工作人员进行定性访谈。访谈录音，转录和分析使用归纳主题方法。结果确定了三个主要主题：(1)承认阈限状态，与当前不协调的卫生服务反应相结合：医学记忆问题，同时将其管理责任定位于患者和家属；(2)在身体和认知脆弱以及脱离社会的挑战性环境中实现变革；(3)建立在现有价值观、文化和惯例的基础上。结论有效的痴呆症预防必须使个人能够在具有挑战性的环境中改变生活方式。规划必须以证据为基础，但又要有足够的灵活性，使新的活动能够适应人们目前的生活；并注意将记忆问题病态化的风险。目前大多数记忆服务机构既没有委托，也没有财政或临床资源来支持有记忆问题但没有痴呆症的人。有效、大规模的痴呆症预防需要广泛的社会反应。
ObjectivesMany people live with an awareness of mild cognitive changes that increase their dementia risk. Previous authors describe the uncertainties of this liminal state, between cognitive health and dementia, where being “at risk” can itself be an illness. We ask how services respond to people with memory concerns currently, and how a future, effective and inclusive dementia prevention intervention might be structured for people with memory concerns.Methods/DesignWe conducted qualitative interviews with 18 people aged 60+ years with subjective or objective memory problems, six family members, 10 health and social care professionals and 11 third sector workers. Interviews were audio‐recorded, transcribed and analysed using an inductive thematic approach.ResultsThree main themes were identified: (1) acknowledging the liminal state, compounded by current, discordant health service responses: medicalising memory concerns yet situating responsibilities for their management with patients and families; (2) enabling change in challenging contexts of physical and cognitive frailty and social disengagement and (3) building on existing values, cultures and routines.ConclusionsEffective dementia prevention must empower individuals to make lifestyle changes within challenging contexts. Programmes must be evidence based yet sufficiently flexible to allow new activities to be fitted into people's current lives; and mindful of the risks of pathologising memory concerns. Most current memory services are neither commissioned, financially or clinically resourced to support people with memory concerns without dementia. Effective, large scale dementia prevention will require a broad societal response.