Physicians' Perspectives on Caring for Cognitively Impaired Elders

Purpose: This study aims to develop an in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. Design and Methods: In-depth interviews were conducted with 20 primary care physicians. Text coded as “cognitive impairment” was retrieve...

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Bibliographic Details
Published in:The Gerontologist 2005-04, Vol.45 (2), p.231-239
Main Authors: Adams, Wendy L., McIlvain, Helen E., Geske, Jenenne A., Porter, Judy L.
Format: Article
Language:English
Subjects:
Adult
Aged
Attitude of Health Personnel
Cognition Disorders - therapy
Cognitive Functioning
Cognitive impairment
Elder care
Elderly
Ethics
Female
Geriatrics
Humans
Interviews as Topic
Male
Medical Education
Mental disorders
Middle Aged
Patients
Physicians
Practitioner Patient Relationship
Primary care
Primary Health Care
Quality of Life
United States
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Description
Summary:Purpose: This study aims to develop an in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. Design and Methods: In-depth interviews were conducted with 20 primary care physicians. Text coded as “cognitive impairment” was retrieved and analyzed by use of grounded theory analysis techniques. Results: A patient's impaired ability to provide an accurate history and to participate in self-care hindered the usual process of care, often resulting in greater medical uncertainty and feelings of inadequacy and frustration for the physician. Shifting the goal of care from “curing” the patient's illness to “caring” for the patient's quality of life was also problematic. The doctor–patient relationship changed dramatically as others became involved in care, often with attendant ethical dilemmas related to patient autonomy and the locus of decision making. Many physicians described a deep sense of loss and grief as the personhood of patients faded. The increased complexity and prominent social and emotional issues were difficult to manage in the context of the current model of practice. Implications: Profound changes occur in the process of care with cognitively impaired patients. The increased complexity mandates an expanded model of care that addresses the prominent psychosocial and ethical aspects of care as well as the medical ones.
ISSN:0016-9013
1758-5341
DOI:10.1093/geront/45.2.231