A review of barriers and enablers to diagnosis and management of persons with dementia in primary care

Can Geriatr J. 2012 Sep;15(3):85-94. doi: 10.5770/cgj.15.42. Epub 2012 Sep 20.


Background: With the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention.

Purpose: To critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care.

Methods: An interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade.

Results: The current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care.

Conclusions: Further progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.

Keywords: dementia; diagnosis and management; health-care utilization; intervention studies; primary care.