Development of Care Services for Older People with Dementia in a Primary Care Setting

Abstract

                  This technical collaborative action research aimed to develop dementia care services for older people in a primary care setting, in central Thailand. Participants included primary care providers, community health volunteers, older people, and caregivers. Data were collected during April 2016 to February 2017 using in-depth interviews, focus group discussions, observations, and document reviews. Qualitative data were analyzed by content analysis, and quantitative data were analyzed by descriptive statistics.

                 Results: Phase 1 Situational Analysis. The dementia services provided depended on knowledge and understanding of dementia among clients and providers. Clients perceived dementia as an aging process. There was no need for diagnosis and specific care. Providers recognized severe dementia and referred clients to psychiatric hospital; Phase 2 Development. The primary care providers and community health volunteers were educated and trained regarding dementia and screening. Among 319 older people, there were nine with dementia and three with mild cognitive impairment, and those with dementia were referred for proper diagnosis and treatment. Coordination and consultation services were provided on demand and a cognitive stimulation program and home care were provided by nurses. Phase 3 Synthesis. A dementia care service pathway was developed consisting of six services: 1) awareness raising and capacity building; 2) dementia screening; 3) referral for diagnosis and treatment; 4) coordination/consultation services; 5) cognitive stimulation; and 6) home care. We conclude that nurses in Thailand need to be educated and trained to provide better dementia care and the six dementia care services based on the pathway of primary care setting proved be an important strategy to achieve this.