A FAMILY-CENTERED APPROACH TO PRIMARY CARE FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT

Abstract

Cognitive impairment (e.g., dementia) presents challenges for individuals, their families, and healthcare professionals alike. It disproportionately impacts minoritized communities and often goes unassessed or undiagnosed, leaving missed opportunities for treatment and the use of supportive services for family caregivers. The primary care setting presents a unique opportunity to care for older adults living with cognitive impairment, who present with complex care needs that may benefit from a family-centered approach. An in-depth systemic review revealed that family-centered care and family engagement yields promising results including improved health outcomes, quality care, the patient experience, and caregiver satisfaction. Furthermore, it promotes and advances the core values of medical family therapy: agency and communion. An original quantitative study surveying 45 PCPs was conducted to better understand the influence of family engagement, race, and gender on primary care providers' (PCPs) diagnostic management and decision-making practices with older adults exhibiting cognitive impairment. Utilizing a vignette-based methodology, results revealed three main findings: (a) family engagement provides an opportunity for more efficient and accurate identification and diagnostic process for cognitive impairment, (b) family engagement allows for a clearer picture of patient symptoms and may present opportunities for PCPs to refer to specialists for diagnosis and treatment earlier, and (c) family engagement provides an opportunity to reduce health inequities by reducing variations in PCP perceptions of symptoms influenced by implicit bias. Recommendations for clinical care, training, and policies in primary care settings are provided using CJ Peek's Three World View. This dissertation further advances the knowledge of family-centered primary care, and influence of provider bias, when designing systems of care for older adults with cognitive impairment and their families.