SCREENING FOR COGNITIVE IMPAIRMENT IN THE ELDERLY

OBJECTIVE To evaluate the extent and type of screening for cognitive i mpairment primary care physicians use for their elderly patients, to i dentify perceived barriers to screening, and to explore whether physic ians would be willing to use the clock drawing test as a cognitive scr eening tool. DESIGN Mailed questionnaire. SETTING Primary care practic es in the Ottawa-Carleton region. PARTICIPANTS Family physicians and g eneral practitioners culled from the Yellow Pages and Canadian Medical Directory, 368 of 568 questionnaires were returned for a response rat e of 70%. Six respondents had fewer than 30 patients weekly and two re sponded too late to be included in the analysis; 360 cases were includ ed in the analysis. MAIN OUTCOME MEASURES Responses to 10 questions on cognitive screening and five on demographics and the nature of respon dents' practices. RESULTS About 80% of respondents reported doing at l east one mental status examination during the past year. Only 24% rout inely screened patients, although 82% believed screening was needed. M ajor barriers to cognitive screening were lack of time, risk of offend ing patients, and possible negative consequences of follow up. Clock d rawing was perceived as an acceptable method of screening, if it were proven effective. CONCLUSIONS Most primary care physicians believe cog nitive screening is needed, but few routinely screen their elderly pat ients. Lack of time is the most important perceived barrier to screeni ng. Primary care physicians are receptive to using the clock drawing t est, and, because it is not time-consuming, are less likely to conside r lack of time a barrier to testing. The clock test might help bridge the gap between perceived need for screening and actual screening.