Physicians' perspectives on caring for cognitively impaired elders.
OBJECTIVE
This study aims to develop an in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders.


METHODS
In-depth interviews were conducted with 20 primary care physicians. Text coded as "cognitive impairment" was retrieved and analyzed by use of grounded theory analysis techniques.


RESULTS
A patient's impaired ability to provide an accurate history and to participate in self-care hindered the usual process of care, often resulting in greater medical uncertainty and feelings of inadequacy and frustration for the physician. Shifting the goal of care from "curing" the patient's illness to "caring" for the patient's quality of life was also problematic. The doctor-patient relationship changed dramatically as others became involved in care, often with attendant ethical dilemmas related to patient autonomy and the locus of decision making. Many physicians described a deep sense of loss and grief as the personhood of patients faded. The increased complexity and prominent social and emotional issues were difficult to manage in the context of the current model of practice.


CONCLUSIONS
Profound changes occur in the process of care with cognitively impaired patients. The increased complexity mandates an expanded model of care that addresses the prominent psychosocial and ethical aspects of care as well as the medical ones.
Adams
Wendy L
WL
Departmentof Geriatrics, Dean East Clinic, Madison, WI, USA.
McIlvain
Helen E
HE
Geske
Jenenne A
JA
Porter
Judy L
JL
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003072:Cognition Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011320:Primary Health Care; D014481:United States