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Dementia diagnosis in the Veteran's Administration: What does it mean?

Frank L, Cody M. Dementia diagnosis in the Veteran's Administration: What does it mean? Presented at: VA HSR&D National Meeting; 1999 Sep 15; Washington, DC.

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RESEARCH OBJECTIVE(S): Diagnosing and treating dementia is an increasingly important activity within the Veteran's Administration (VA), as the population served by the VA ages. Guidelines for disease detection exist and the value of early diagnosis to the avoidance of some disease-related burden are documented. This study evaluates the process of dementia diagnoses within a regional VA system including the range of diagnosis sites and diagnostic testing completed. STUDY DESIGN: The sample was composed of all Arkansas veterans over age 60 with an initial diagnosis of dementia in the VA computerized database in 1994, with continuous records available for the prior and subsequent 18 months (N = 134). Chart review of each subject's record was completed to verify diagnosis information, clarify diagnosis process, and identify sources of diagnostic information. PRINCIPAL FINDINGS: No clear patterns of referral for comprehensive or definitive testing were evident. Only 4% of subjects had a mental status exam of any sort noted in the record; only 3% had a psychiatric assessment. Site of initial diagnosis varied widely, with half the subjects diagnosed on a medical/surgical unit. Chart review revealed that dementia diagnosis was ruled out, not found, or changed in 15% of subjects, with questionable diagnosis noted in an additional 11% of subjects. CONCLUSIONS: Considerable variation in diagnosis process exists within the VA examined. Despite guidelines for diagnosis, few subjects obtained comprehensive dementia evaluation within the VA and validity of diagnoses was therefore difficult to determine. Chart review is desirable wherever feasible to overcome limitations of computerized data. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The validity of a dementia diagnosis has implications for patient care, resource use, and research on care provision. Stricter attention to dementia diagnosis guidelines could improve dementia detection and treatment for this population. (Abstract by: Author)

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