Low Lee-Fay, Gresham Meredith, Phillipson Lyn
Faculty of Medicine and Health, University of Sydney.
Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney.
Curr Opin Psychiatry. 2023 Mar 1;36(2):104-111. doi: 10.1097/YCO.0000000000000848. Epub 2022 Dec 30.
There is increasing recognition of a service gap immediately after diagnosis for people with dementia and carers. This narrative review of models of post-diagnostic support focuses on recent developments and offers suggestions for future development. We present the current evidence for these models and consider the service components they provide against the recommendations of clinical guidelines and principles underpinning ideal post-diagnostic support.
Models of post-diagnostic support include a short-term support worker, ongoing support worker, centre-based support, primary care management, and specialist dementia clinics. Of these, specialist dementia clinics that include ongoing support workers provide most components of an ideal and timely post-diagnostic support framework, but may be more costly to implement universally. The greatest research evidence is for the benefits of long-term support models, specifically case management, though this does not necessarily include medical care or nonpharmacological interventions. There is sparce evidence for the benefits of short-term support worker models such as dementia advisers for people with dementia and carers.
Further development is needed to create whole-system models of dementia support which meet the needs of people with dementia and their carers, are timely, accessible and equitable, and can be implemented universally.
痴呆症患者及其照料者在确诊后存在的服务差距日益受到关注。本叙述性综述聚焦于诊断后支持模式的最新进展,并为未来发展提供建议。我们展示了这些模式的现有证据,并对照临床指南的建议以及理想诊断后支持的基本原则,考量它们所提供的服务内容。
诊断后支持模式包括短期支持工作者、持续支持工作者、基于中心的支持、初级保健管理以及专科痴呆症诊所。其中,包含持续支持工作者的专科痴呆症诊所提供了理想且及时的诊断后支持框架的大部分内容,但普遍实施可能成本更高。关于长期支持模式,尤其是病例管理的益处,有最充分的研究证据,不过这不一定包括医疗护理或非药物干预。对于短期支持工作者模式,如为痴呆症患者及其照料者配备痴呆症顾问,其益处的证据较少。
需要进一步发展以创建满足痴呆症患者及其照料者需求、及时、可及且公平、能够普遍实施的全系统痴呆症支持模式。