White Jennifer, Norton Grace, Pond Dimity, Khaing Kay, Dolja-Gore Xenia, Byles Julie, Carey Mariko
Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
J Adv Nurs. 2025 Mar;81(3):1505-1516. doi: 10.1111/jan.16354. Epub 2024 Jul 29.
The uptake of the health assessment for persons aged 75 years and older (75 + HA) remains low. Repeat assessments provide an opportunity to identify areas of change in cognitive function which may mark the onset of dementia. We aimed to explore general practitioner (GP) and practice nurse experiences of implementing the 75 + HA with a focus on clinical considerations for dementia care.
An interpretative qualitative study involving interviews with 15 GPs (female = 11, male = 4) and 5 practice nurses (all female). Data were analysed using an inductive thematic approach.
The majority of GPs (n = 11) worked in metropolitan settings and four GPs worked in regional settings across NSW. All participants worked in separate clinics, except for two GPs and one practice nurse who worked within the same metropolitan clinic. Distinct themes emerged regarding participants experiences of implementing the 75 + HA for patients with dementia: (1) negotiating aged care is complex and facilitated by a comprehensive assessment; (2) implementing work practices that support the 75 + HA in patients with cognitive decline; and (3) variations in follow up of findings and implications for care.
The 75 + HA provides an opportunity for monitoring and acting on emergent physical and cognitive health changes. Increased engagement and support towards implementing the 75 + HA, particularly in the context of dementia, may facilitate the instigation of interventions. While some participants in this study were confident with identifying and managing cognitive decline, the majority relied on geriatricians to confirm dementia diagnosis and refer to community support services. We suggest the need for greater initiatives and clinical guidelines to assist GPs in the identification and management of cognitive decline.
From a nursing perspective, this study highlights the valuable role of nurses towards assessment and management of issues raised in the health assessment for persons aged 75 years and older. However, more resources are needed to enable nurse time for adequate follow-up care.
75岁及以上人群健康评估（75 + HA）的接受率仍然很低。重复评估为识别认知功能的变化领域提供了机会，这些变化可能标志着痴呆症的 onset。我们旨在探讨全科医生（GP）和执业护士在实施75 + HA方面的经验，重点关注痴呆症护理的临床考虑因素。
一项解释性定性研究，包括对15名全科医生（女性 = 11名，男性 = 4名）和5名执业护士（均为女性）进行访谈。使用归纳主题方法分析数据。
大多数全科医生（n = 11）在大都市地区工作，4名全科医生在新南威尔士州的地区工作。除了两名全科医生和一名执业护士在同一大都市诊所工作外，所有参与者都在不同的诊所工作。关于参与者为痴呆症患者实施75 + HA的经验出现了不同的主题：（1）协商老年护理很复杂，需要全面评估来促进；（2）实施支持认知功能下降患者进行75 + HA的工作实践；（3）检查结果的后续跟进以及护理影响方面存在差异。
75 + HA为监测突发的身体和认知健康变化并采取行动提供了机会。增加对实施75 + HA的参与和支持，特别是在痴呆症背景下，可能有助于推动干预措施的实施。虽然本研究中的一些参与者对识别和管理认知功能下降有信心，但大多数人依赖老年病专家来确认痴呆症诊断并转介到社区支持服务。我们建议需要更多举措和临床指南来协助全科医生识别和管理认知功能下降。
从护理角度来看，本研究强调了护士在评估和管理75岁及以上人群健康评估中提出的问题方面的宝贵作用。然而，需要更多资源来使护士有时间进行充分的后续护理。
