Primary care plays a critical role in managing the complex health needs of people living with mild cognitive impairment or dementia. This care involves both their general health care needs and their needs related to cognitive impairment or dementia, as well as their caregivers’ health care needs.
More than 90% of community-dwelling seniors with dementia in Ontario have two or more coexisting chronic medical conditions, whose courses are often complicated by dementia. As dementia progresses, people experience challenges with memory, symptom awareness, decision-making, and expressive language, which can make it difficult for them to manage their general health and coexisting chronic conditions. It can be hard to adhere to medication regimens and to monitor themselves and perform the self-care required to effectively manage conditions such as diabetes, heart failure, and chronic obstructive pulmonary disease. Chronic conditions can become de-stabilized and exacerbated when a person has dementia, potentially resulting in visits to the emergency department, hospitalizations, deconditioning (muscle loss owing to inactivity) and earlier institutionalization.
To address these challenges, people living with dementia or mild cognitive impairment and their caregivers need timely access to primary care that:
- Is person-centred (rather than disease-focused)
- Is continuous and comprehensive for most health needs
- Is coordinated and links to other health care professionals and resources across the health care system, as needed
- Addresses individual needs and aligns with the person’s goals of care
Primary care also provides a critical link to specialist care and specialty programs, such as specialty dementia care and specialized geriatric services. To address complex medical and behavioural issues, functional complexity, and certain stages of illness, it is important for primary care clinicians to collaborate with, and get support from, specialists in dementia care, such as geriatricians, geriatric psychiatrists, and cognitive neurologists, as well with community support agencies.