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Care for persons suffering from Alzheimer’s disease in general medicine
Stéphanie Pin Le Corre, sociologist1, and Dominique Somme2, geriatrician and doctor in
public health
1
French National Institute for Health Education and Prevention
2
Paris hospitals, GeorgesPompidouEuropeanHospital
Essential points in figures (4,300 signs)
In 2008, 92% of GPs surveyed (n=1058) claimed to have seen at least one patient with
Alzheimer’s disease over the previous 12 months, and 31% claimed to have cared for more
than ten. Male doctors in the highest age category, those practising social security rates,
declaring 20 or more medical procedures per day, spending five to seven days in their
practice, only occasionally or never practising under a special status, always or often
implementing educational activities are more likely to have monitored at least one patient
with Alzheimer’s disease over the past year.
Of the doctors whose patients include Alzheimer’s sufferers, four out of five doctors (81%)
feel that they have sufficient training to communicate with the family, 67% to communicate
with the patients, 60% to announce the diagnosis and 51% in non-medicinal treatments for the
disease. The age, gender and number of Alzheimer patients seen yearly significantly influence
the doctors' perception of their training level. 41% of doctors claim to be familiar with the
French national authority for health (HAS) guidelines on the diagnosis and management of
Alzheimer patients. The training level perceived and familiarity with the guidelines
significantly influence how doctors announce the diagnosis and whether they refer their
patients to specialists or paramedical or community health services.
1
Among these practitioners, 71% say that they always announce the diagnosis to the patient’s
family and 8% to their patients; 32% say that they never announce the diagnosis to their
patient. The youngest doctors and those who believe they have sufficient training in the
different aspects of care for Alzheimer’s disease are more likely to announce the diagnosis to
their patients.
Four out of five GPs (81%) say that they always refer their Alzheimer patients to a specialist,
56% steer them towards a home care and home help service and 40% towards a local centre
for gerontological information and coordination. The two latter practices are very much
interlinked.
One in five doctors (22%) having monitored Alzheimer’s patients over the past year feels
uncomfortable with these patients. Almost seven out of ten GPs (68%) find it easy to manage
comorbidities, 55% find it easy to give information on the social support available, 52% find
it easy to coordinate care and help and 26% find it easy to manage comorbidities.
2
Introduction
In France, the number of people suffering from Alzheimer's disease is estimated to be
between 400,000 and 800,000. This degenerative condition, progressing over several years,
requires endless adjustments on the part of the patient, friends and family and healthcare
professionals, not only to changes in the disease-related disorders, but also to changes in the
family and environmental situation [1]. The GP is considered as the primary contact for
patients and their families, although treatment is initiated solely by specialists and specialised
centres (memory consults, resource and research memory centre) [2]. However, certain
specificities of Alzheimer’s disease make the relationship between healthcare professionals
and Alzheimer sufferers difficult [3,4]: anosognosia, where the patient seems unaware of his
or her disease and memory loss appear to hinder the patient’s ability to implement care plans,
even when devised conjointly with the doctor; the behavioural problems associated with the
condition and the absence of a cure favour non-medicinal assistance and the use of social and
community health services, which require healthcare professionals to be very familiar with
local resources to guide patients and their loved ones [5]. In more advanced stages,
communication problems limit discussions during the consultation or the patient’s
participation in group education sessions [3,6]. Furthermore, more so than with other chronic
diseases, healthcare professionals insist on the importance of the family carer’s role in helping
Alzheimer sufferers [7,8,9], and as the disease progresses, this carer indeed becomes the
doctor's primary contact. Often perceived as “incapable”, due to their cognitive deficiencies,
of being protagonists in their own healthcare, those living with a neurodegenerative disease
often feel left out of the care relationship, which tends to privilege the primary carer, even in
the early stages of the disease [4,10].
In addition to the objective problems linked to the manifestations of Alzheimer’s disease, the
patients, their loved ones and healthcare professionals all share the very heavy burden of
social stigma related to the disease. Associated with mental deterioration, the loss of identity
and dependency, Alzheimer’s disease is one of the conditions most feared in France [11] and
for some even the symbol of an “ungraceful” and “inhumane” end to life [12,13]. These
stigmata begin to form as soon as the diagnosis is disclosed, which is one of the major
problems noticed by doctors and families when asked about the management of the disease
[9, 12-15].
In order to overcome these hurdles, the Alzheimer Plan 2008-2012 [17] included the
introduction of good practice guidelines on the management of Alzheimer patients and a
3
system to disclose diagnosis and provide assistance, in order to help healthcare professionals
in the management of Alzheimer patients (Insert). In order to apprehend certain aspects of
care for Alzheimer patients in general medicine, a series of questions on the disease was
included for the first time in the general practitioners’ barometer survey. This module is part
of a wider Alzheimer’s disease opinion poll system (DEOMA) [11] which aims to ascertain
how the disease is perceived in France and what practices are in place among the
professionals concerned, by way of a series of qualitative studies and surveys.
The first part of this chapter will deal with the characteristics of GPs caring for persons
suffering from Alzheimer’s disease. We will then look at the different aspects of care for
patients in general medicine, particularly the disclosure of the diagnosis and patient referral,
to compare them with HAS guidelines. The last part will describe how the doctors surveyed
perceive their role in care for Alzheimer patients.
Insert - Management of Alzheimer's disease and similar diseases, HAS guidelines
(March 2008)
In March 2008, the French national authority for health (HAS) devised good practice
guidelines to standardise practices relating to the diagnosis and management of
patients suffering from Alzheimer's disease or a similar condition. These guidelines
deal with: the diagnosis of Alzheimer’s disease and the most common forms of
dementia, early diagnosis and disclosing diagnosis, the handling the behavioural and
psychological symptoms of dementia and non-medicinal care.
Extracts:
- “It is advisable to diagnose Alzheimer's disease as soon as the first symptoms
appear. The diagnosis must involve a detailed cognitive assessment, preferably
carried out in the context of a specialised memory consultation.”
- “It is advisable to disclose the diagnosis to the patient. (…) The diagnosis can also
be disclosed to the patient's family or anyone they choose with their consent. (…) The
diagnosis should be disclosed taking into account the patient's background, his or her
attitude towards the condition and fears. Practitioners may need to consult the
patient's regular doctor and relatives to prepare the ground. The diagnosis should be
disclosed by the doctor who diagnosed the disease. Coordination of disclosure is
necessary between the specialist and the patient's regular doctor who will be
4
responsible for drawing up a care protocol under the terms of the long-term
conditions programme.”
“Diagnosis must be part of a care and support plan, involving the following elements
depending on the stage of the disease:
-
medication and other forms of treatment;
-
coordinated medico-socio-psychological care for the patient and his/her family
and friends;
-
legal steps where necessary.”
- “It is recommended that multidisciplinary follow-up be offered, organised by the
patient's regular doctor in consultation with a neurologist, a geriatrician or a
psychiatrist. Its precise details will depend on the local context and what resources
are available, but the measures proposed should be available to all patients.”
- “It is vital that the patient's regular doctor sees him or her at least once every three
months, and more often if necessary depending on the situation. The doctor may need
the help of a paramedical coordinator.
Each appointment should investigate:
·
the patient's weight, nutritional status and constant parameters (pulse, blood
pressure);
·
all comorbidities closely;
·
compliance with pharmacological and non-pharmacological interventions and
their efficacy and safety.” [18]
5
Results
A. General practitioners monitoring persons suffering from Alzheimer’s disease
In 2009, 92% of GPs surveyed (n=1058) claimed to have monitored at least one patient with
Alzheimer’s disease over the previous 12 months: just over one-third of doctors surveyed
(35.7%) said they had monitored one to four patients and 30.7% claimed to have cared for
more than ten over the previous year. More male doctors saw Alzheimer patients than female
doctors over the previous year (Figure 1). In a multivariate analysis, GPs who claimed to see
Alzheimer patients are more likely to be aged 51 or over (OR = 3.0; Confidence Interval
95%= 1.5-6.1); they tend to be those practising social security rates (OR =1.9; CI 95%=1.03.7), declare 20 medical procedures a day or more (OR=3.2; CI 95% = 1.9-5.5), and spend
five to seven days a week in their practice (OR = 2.3; CI 95% = 1.4-3.9). These doctors only
practise occasionally (OR=2.4; CI 95% = 1.3-4.4) or never (OR = 3.5; CI 95% = 1.8-6.8)
under a special status, but claim to always or often inform and advise their patients with
chronic diseases (OR = 2.9; CI 95% = 1.2-6.9).
6
Excluding age, the same factors are associated with the monitoring of 10 Alzheimer patients
or more: male doctors, those declaring over 21 medical procedures daily, and who never or
occasionally practise under a special status are more likely to have seen 10 or more patients
over the past year (Table 1). Doctors with a higher than average ratio of Alzheimer patients
also tend to be members of a geriatric network and less than 2% of their patients benefit from
universal health coverage.
Tableau I – Factors associated with follow-up of 10 patients or more1(n =925)
Odds ratio ajustés
Intervalle de confiance à
95%
Sexe
Female
Male
1,0
1,8***
1,3-2,6
1,0
1,0
1,1
0,6-1,6
0,7-1,7
1,0
0,8
0,7
0,7*
0,7
0,5-1,2
0,4-1,1
0,4-1,0
0,4-1,2
1,0
1,7***
1,3-2,4
1,0
1,1
0,8-1,7
1,0
1,5*
2,1***
1,0-2,3
1,4-3,1
1,0
0,8
0,9
0,6*
0,5-1,2
0,6-1,4
0,4-0,9
1,0
2,0*
1,1-3, 6
Age
40 years and less
41 - 50 years
51 years et over
Town size
less 2 000 inhabitants
2 000 - 20 000 inhabitants
20 000 - 100 000 inhabitants
over 100 000 inhabitants
Paris area
Number of acts per days
1 - 20 acts
21 acts and over
Number of days per weeks at the
doctor
1 – 4 days
5 – 7 days
Practice of a particular mode of
exercise
Systématic or regular
Occasionnal
Never
Part of patient with CMU
<2%
Between 2 and 4%
Between 5 and 9%
10% and over
Participation in a network of geriatric
Yes
No
1
Ont été introduit dans le modèle les variables significativement associés au seuil de 5% lors des analyses
bivariées, ainsi que l’âge.
7
NB. *= p≤0,05 ; ** = p≤0,01 ; ***=p≤0,001
B. Aspects of care for Alzheimer’s sufferers in general medicine
Among those GPs seeing Alzheimer patients (N=974), four out of ten (41.3%) claim to be
familiar with HAS guidelines on the diagnosis and management of Alzheimer patients. After
verification by age group, male doctors (OR = 1.4; CI 95% =1.0-1.9), doctors who are
members of a healthcare network (OR=1.5; CI 95% = 1.2-2.0), those who work as supervising
teachers or trainers (OR = 1.4; CI 95% = 1.0-2.0), who claim to always or often implement
educational activities (OR =1.5; CI 95% = 1.1-2.0) and who feel that they work sufficiently in
conjunction with welfare professionals (OR =1.6; CI 95% = 1.1-2.2) tend to be more familiar
with these guidelines. Knowledge of the work conducted by the HAS in this area results in
different attitudes and perceptions (Figure 2), particularly a greater propensity to disclose the
diagnosis and a more positive view of the different aspects of care for these patients.
As far as Alzheimer’s disease is concerned, one of the aspects most widely studied in the role
of GPs is their attitude in identifying the disease, disclosing the diagnosis and referring them
8
to specialists who, in France, are responsible for initiating specific medicinal treatment, where
applicable. Although there were no questions on the detection of cognitive disorders, the GPs
were asked about the use of preestablished tests or questionnaires. Of those GPs caring for
Alzheimer patients, 15.2% (n=147) say they use preestablished questionnaires to assess the
patient’s memory or cognitive disorders.
Almost three-quarters (70.8%) of doctors who saw at least one Alzheimer patient over the
previous year always disclose the diagnosis to the patient’s family, while only 8.3% always
disclose the diagnosis to the patient (Figure 3). One-third of doctors say that they never
disclose the diagnosis to the patient. Apart from age (the eldest are less inclined to disclose
the diagnosis to the patients than those under 40), it is the level of training that appears to
determine doctors’ primary attitude towards disclosing diagnosis: working as a supervising
teacher or trainer, feeling sufficiently trained to disclose diagnosis and being familiar with
HAS guidelines are variables closely associated with the decision to disclose the diagnosis to
Alzheimer’s patients (Table 2).
9
Tableau II - Factors associated with failure to announce the diagnosis to the patient2 (n
=951)
OR
IC à 95%
1,0
1,0
0,7-1,4
Sexe
Female
Male
Age
40 years and less
1,0
41 - 50 years
1,4
51 years et over
2,6***
Activities supervisor or
trainer
Yes
1,0
No
1,7**
Diagnosis announced to the
family
Sometimes or never
1,0
Always or often
0,5***
Feel adequately trained in
the diagnosis
No
1,0
Yes
0,6***
Know les RBP of HAS
No
1,0
Yes
0,7*
NB. *= p≤0,05 ; ** = p≤0,01 ; ***=p≤0,001
0,8-2,3
1,6-4,2
1,2-2,5
0,4-0,7
0,4-0,8
0,5-0,9
Of those doctors caring for Alzheimer patients, eight out of ten GPs say they always refer
them to a specialist. This is much more often the case3 among doctors who do not work as
supervising teachers or trainers (OR = 1.7; CI 95% = 1.2-2.5) and who feel they work
sufficiently in conjunction with other medical professionals (OR =1.6; CI 95% = 1.1-2.3).
This tendency also varies according to the type of educational activity the doctor practises: it
is more likely among those who, for this type of activity, refer their patients (OR =1.6: CI
95% = 1.1-2.3), but also among those who inform and advise their patients (OR = 2.3; CI
95% = 1.1-4.8). Always referring Alzheimer patients to a specialist is very much associated
2
Ont été introduit dans le modèle les variables significativement associés au seuil de 5% lors des analyses
bivariées, ainsi que l’âge et le sexe.
3
Results of a multivariate logistic regression model where the dependent variable is the systematic referral to a
specialist and independent variables are as follows: age, gender, working as a trainer or supervising teacher,
steering patients towards educational activities, informing and advising patients on educational activities,
considering that they work sufficiently in conjunction with other medical professionals, seeing more than ten
patients, announcing the diagnosis to the patient and always announcing the diagnosis to friends and family. All
these variables are associated in a bivariate analysis with the dependent variable with a threshold of 5%.
10
with disclosing the diagnosis to loved ones (OR =1.6; CI 95% = 1.1-2.4; it is correlated to the
fact that the doctor sees fewer than ten patients a year (OR = 1.8; CI 95% = 1.3-2.6).
Two other forms of referral were also explored, more concerning paramedical care and
welfare services, and which are less systematic (Figure 4): 76.3% of GPs caring for
Alzheimer patients say that they always or often steer them towards home help or home care
services and 39.5% towards a local centre for gerontological information and coordination.
The two latter practices are very much interlinked, including when the effect of other
variables are taken into account (p<0.001). It is more common4 for doctors to steer patients
towards a care or support service when they also refer them to other professionals for health
education activities (OR = 1.6; CI 95% = 1.1-2.2); the probability of doing this is higher when
doctors find it easy to handle the different aspects of care (OR =1.2; CI 95% = 1.0-1.3).
Doctors steer patients towards a local centre for gerontological information and coordination
much more often5 when they are female (OR =2.2; CI 95% = 1.6-3.0), in the higher age
category (OR =1.6; CI 95% = 1.0-2.5), when they are a member of a healthcare network (OR
= 1.4; CI 95% = 1.0-1.8) and a prevention association (OR = 1.6; CI 95% = 1.1-2.4).
4
Results of a multivariate logistic regression model where the dependent variable is always or often steering
towards a care and support service and independent variables are as follows: age, gender, steering patients
towards educational activities, considering that they work sufficiently in conjunction with welfare professionals,
always announcing the diagnosis to friends and family, always or often steering Alzheimer patients towards a
local centre for gerontological information and coordination and the score on ease of care perceived. All these
variables are associated in a bivariate analysis with the dependent variable with a threshold of 5%.
5
Results of a multivariate logistic regression model where the dependent variable is always or often steering the
patients towards a local centre for gerontological information and coordination and independent variables are as
follows: age, gender, the number of days spent in the practice per week, being a member of a healthcare network,
being a member of prevention associations, steering patients towards educational activities and always or often
steering them towards a care or support service. All these variables are associated in a bivariate analysis with the
dependent variable with a threshold of 5%.
11
C. Difficulties and level of training perceived
Of those GPs whose patients include Alzheimer’s sufferers, over three-quarters say they are
totally (19.7%) or fairly (58.0%) comfortable with their patients. Doctors tending to feel
“uncomfortable” are prone to work more in conjunction with other professionals: in
multivariate analyses, this is therefore less common among GPs who are members of a
healthcare network, who work as supervising teachers, who use educational activities and
who feel that they work sufficiently in conjunction with welfare professionals (Table 3).
Relations with Alzheimer patients are also perceived negatively by doctors who see fewer
than ten a year and by those who feel they have insufficient training.
Tableau III – Factors related to a sense of unease in the relationship to Alzheimer's
disease patients 6(n=903)
OR
IC à 95%
1,0
1,2
0,8-1,8
Sexe
Female
Male
6
Ont été introduit dans le modèle les variables significativement associés au seuil de 5% lors des analyses
bivariées, ainsi que l’âge et le sexe.
12
Age
40 years and less
41 - 50 years
51 years et over
Participation in a health network
Yes
No
Activities supervisor or trainer
Yes
No
Implement educational activities
Always/often
Sometimes/never
Feel they have enough collaboration in social
Yes
No
Over 10 Alzheimer’s disease patients
Yes
No
Diagnosis announced to the family
Always/often
Sometimes/never
Perceived level of training (0 - poor, 4 sufficient)
NB. *= p≤0,05 ; ** = p≤0,01 ; ***=p≤0,001
1,0
1,5
2,5***
0,8-2,8
1,4-4,5
1,0
1,5*
1,0-2,1
1,0
1,8*
1,1-2,9
1,0
1,6*
1,1-2,3
1,0
2,3**
1,4-3,8
1,0
3,0***
1,9-4,7
1,0
1,8**
0,7***
1,3-2,7
0,6-0,8
When asked about how difficult it is to manage certain aspects of care for Alzheimer patients,
almost seven out of ten GPs (68.4%) say that it is extremely or fairly easy to deal with
comorbidities; they are divided over the coordination of care and support (52.2% find this
extremely or fairly easy) and information on the social support available (55.5%). 74.7% of
doctors feel that behavioural disorders are difficult to manage (Figure 5).
In all aspects considered, a positive assessment is correlated to a training level perceived as
high and a positive view of their relationship with Alzheimer patients. Excluding these
similarities, doctors’ profiles vary according to the aspects of care. For example, doctors
satisfied with how they exercise their profession (OR =1.5; CI 95% = 1.0-2.1), who steer their
patients towards educational activities (OR =1.4; CI 95% =1.1-1.9), and who feel they work
sufficiently in conjunction with welfare professionals (OR = 2.4; CI 95% =1.7-3.5) tend to
find it easy to coordinate care and support; these doctors are more prone to always disclose
the diagnosis to the patients’ friends and family (OR =1.7; CI 95% = 1.2-2.3), to not always
refer their Alzheimer patients to a specialist (OR =1.8; CI 95% =1.3-2.6), but are more
inclined to steer them towards a home care or home help service (OR =1.5; CI 95% = 1.1-
13
2.1)7. In specific multivariate analyses8, working sufficiently in conjunction with welfare
professionals and steering patients towards a home care or home help service are also
correlated to a positive view of their management of comorbidities and to the fact that they
inform patients of the social support available.
Eight out of ten doctors (80.7%) feel that they have sufficient training to communicate with
the family, 67.9% to communicate with the patients, 60.8% to announce the diagnosis and
7
Results of a multivariate logistic regression model where the dependent variable is the ease with which doctors
coordinate care and support and independent variables are as follows: age, gender, size of town, satisfaction with
profession, informing and advising patients on educational activities, steering patients towards educational
activities, always announcing the diagnosis to friends and family, always referring Alzheimer patients to a
specialist, always or often steering them towards a care or support service, feeling uncomfortable with Alzheimer
patients and the training level perceived. All these variables are associated in a bivariate analysis with the
dependent variable with a threshold of 5%.
8
Results of two multivariate logistic regression models. In the first, the dependent variable is the ease with
which doctors manage comorbidities and the independent variables are age, gender, considering that they work
sufficiently in conjunction with welfare professionals, always or often steering Alzheimer patients towards a care
or support service, feeling uncomfortable with Alzheimer patients, the training level perceived and being
familiar with HAS guidelines. In the second, the dependent variable is the ease with which doctors provide
information on social support available and the independent variables are the same as in the first model, plus
membership of a healthcare network. All these variables are associated in a bivariate analysis with the dependent
variable with a threshold of 5%.
14
51.8% in non-medicinal treatments for Alzheimer’s disease. Based on these four items, it is
possible to compile a score to ascertain the training level perceived by GPs; this score varies
between 0 (training perceived as insufficient in all aspects) to 4 (training perceived as
sufficient in all aspects); Cronbach’s alpha is 0.7. The mean score is 2.6 (standard deviation:
1.4). Over one-third of the doctors surveyed (36.5%) feel they have sufficient training in the
four aspects considered and 26.6% in three aspects. Approximately one in ten doctors (13.1%)
claims to have insufficient training in all aspects.
Proportionately to their female colleagues, male doctors tend more to feel they have sufficient
training to announce the diagnosis (OR =1.5; CI 95% =1.0-2.0) and communicate with
patients (OR =1.5; CI 95% = 1.1-2.1). Age influences the doctors’ perception of their training
level as far as announcing the diagnosis and non-medicinal treatments are concerned: the
older the doctors are, the more they tend to feel they have sufficient training in these aspects.
The number of Alzheimer patients seen yearly also improves the doctor’s subjective view of
his or her training level: doctors with ten Alzheimer’s patients or more tend to feel they have
sufficient training in all aspects considered9 (Figure 6).
9
These results are based on four multivariate logistic regression models where the dependent variables are
considering that they have sufficient training to announce the diagnosis (1), to communicate with the patients
(2), to communicate with their loved ones (3) and in non-medicinal treatments (4). The models always include
age, gender, seeing ten or more Alzheimer patients a year and feeling uncomfortable with Alzheimer patients.
For model (1), the following were added: always announcing the diagnosis to friends and family, announcing the
diagnosis to the patient and being familiar with HAS guidelines; for model (2), implementing educational
activities with the patients, working sufficiently in conjunction with other medical professionalsand working
sufficiently in conjunction with welfare professionals; for model (3), working sufficiently in conjunction with
other medical professionals, working sufficiently in conjunction with welfare professionals, always announcing
the diagnosis to friends and family and being familiar with HAS guidelines; for model (4), being a member of a
prevention association, working sufficiently in conjunction with other medical professionals, with psychology
and welfare professionals, always announcing the diagnosis to friends and family and being familiar with HAS
guidelines. All associated variables were introduced into these models under a bivariate analysis with a threshold
of 5%.
15
Discussion
In France, general practitioners have a key role in the care of Alzheimer’s patients and their
loved ones. As the survey results show, the majority of practitioners saw at least one
Alzheimer patient over the previous year. The form of management, however, is not always
the same; certain doctors are more inclined to offer specialised but also community health
support while others are less comfortable in their relationship with Alzheimer’s patients and
in the medical or community health aspects of care. These differences are mainly due to the
different practices, the doctors’ experience and knowledge of the disease; the same
differences are found in other surveys: compared to GPs, specialists have greater faith in their
diagnostic and support capabilities [19]; certain socio-demographic criteria, such as age or
gender, also influence doctors’ attitude towards diagnosis or treatment [19-21].
One of the aspects most widely studied regarding care for patients suffering from dementia in
general medicine concerns how the diagnosis is announced, which forces doctors to face a
series of moral and practical dilemmas [13]. Experts called upon by the HAS recommend
disclosing the diagnosis to the patient, adopting a segmental approach that respects the
attitudes and wishes of the patient and his or her friends and family [18]. The survey does not
assess how well this approach has been implemented by GPs nor does it tell us which terms
doctors use with their patients to talk about the disease. It confirms the divergence in
practices, according to whether the doctor addresses the patient’s loved ones or the actual
16
patients themselves, which has been revealed in other surveys in France and abroad
[13,14,21]. In a recent survey conducted by the Médéric Alzheimer foundation (FMA) among
1,406 GPs in Auvergne, the Loire valley and Poitou-Charentes, one-third of doctors feel that
announcing the diagnosis raises problems [22], which is akin to the mixed feelings over
training in this area revealed in our survey.
One stumbling block concerns non-medicinal treatments, for which one half of doctors feel
they have insufficient training. In the FMA survey, behavioural disorders are a common cause
of difficulty for 75% of doctors, ahead of hygiene (69%) and admission into institutions
(69%). Here, once again, information and training appear to be important: general
practitioners who are familiar with the HAS guidelines feel better equipped to deal with this
aspect.
Coordination of care and support does not appear to be a problem for the GPs involved in the
barometer survey. These patients are almost always referred to specialists; however, only one
half of GPs steer them towards care and support services and four out of ten towards a local
centre for gerontological information and coordination. Do doctors feel that their patients do
not need this support? Are they unfamiliar with these services or organisations? According to
the FMA survey [21], two-thirds of doctors are familiar with the support systems available in
their region, but there are huge divergences between different regions and the types of system.
The same proportion feels able to coordinate their Alzheimer patients’ care effectively.
This survey was conducted before the Alzheimer Plan’s diagnosis disclosure and support
system was put in place [17], before the Alzheimer patient integration and care home
experiment and before the existence of case managers to facilitate coordination of care and
simplify the patient’s care by the different healthcare and community health structures. These
different measures, experimental or otherwise, will no doubt have consequences on the
perceptions and knowledge of doctors regarding their role and practices. Renewing the survey
at the end of the Alzheimer Plan will enable us to ascertain how the situation has changed and
what impact the government’s actions have had.
17
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