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Discrepancies in Information Provided to Primary Care Physicians by Patients With and Without Dementia: The Steel Valley Seniors Survey

From the Departments of Psychiatry (MG, YD, BHM, KAM, JVB), Medicine (EGR), and Pharmaceutical Sciences (GPS), University of Pittsburgh School of Medicine; the Department of Epidemiology (MG, HHD), University of Pittsburgh Graduate School of Public Health; and the Center for Addiction and Mental Health and Department of Psychiatry (BHM), University of Toronto, Ontario, Canada.

Objective: The objective of this study was to examine associations between discrepancies in health information provided to primary care providers and severity of impairment in older patients with and without dementia.

Methods: This study included brief assessment and medical record review of 1,107 patients with a mean (standard deviation) age of 76.3 (6.6) years (range: 65–100 years) in seven small–town primary care practices. In 358 patients, detailed in-home assessment included demographics; dementia by Clinical Dementia Rating (CDR) scale; and frequencies of memory complaints, falls, and inadvertent medication nonadherence determined from medical records and standardized in-home research assessments. Main outcome variables were trends in discrepancies between chart reviews and research assessments. Main explanatory variable was CDR box total scores.

Results: Proportions of patients reporting memory complaints and falls, and evidence of inadvertent nonadherence, in the charts and by research assessment increased with CDR. Discrepancies between medical record and research assessment, were also associated with CDR, showing linear trends for memory complaints and inadvertent nonadherence and a quadratic trend for falls.

Conclusion: Memory complaints, falls, and inadvertent medication nonadherence increase with dementia severity. The levels of discrepancy between information patients provided to their physicians and information they provided in response to detailed, standardized assessments, also varied with dementia severity. Physicians should be alert to the possibility of receiving unreliable health information from even mildly demented patients, whether or not dementia has been detected.

Key Words: Memory • falls • medication adherence • under-reporting • cognition

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				J. E. Galvin, C. M. Roe, M. A. Coats, and J. C. Morris Patient's Rating of Cognitive Ability: Using the AD8, a Brief Informant Interview, as a Self-rating Tool to Detect Dementia Arch Neurol, May 1, 2007; 64(5): 725 - 730. [Abstract] [Full Text] [PDF]