Health care triads and dementia care: integrative framework and future directions

Physicians are usually the first contact in the health care system for pers ons with dementia and their family caregivers. This paper provides a synops is of research findings and knowledge gaps regarding interactions among the se participants in the health care triad-primary care physicians, family ca regivers, and persons with dementia. Research traditions that inform knowle dge about health care triads and dementia care include: older patient-physi cian relationships; the stress-coping social-support health model that domi nates family caregiver research; the social learning-self-efficacy model; a nd literature on the quality of medical care. An integrative framework is p resented to illustrate how the quality of interaction in dementia care enco unters may be influenced by specific characteristics of members of the heal th care triad. Domains of dementia care interaction include symptom diagnos is, symptom management, medication management, support service linkage, and emotional support. The integrative framework also links the quality of int eraction in these domains with health-related outcomes relevant to each of the health care triad members. Most empirical research in this area has fou nd that family caregivers are dissatisfied with many aspects of physicians' dementia care, but measurement techniques vary widely and little is known about how the quality of physician care is associated with health-related o utcomes. Physician surveys have shown that they are least certain about the quality of support service linkage advice they provide. Virtually no resea rch has examined how the person with dementia experiences medical care enco unters with physicians and their family members. Much remains to be learned about the longitudinal experience of each member of the health care triad, and how the quality of dementia care encounters changes over the course of the disease process. In this era of rapidly expanding educational and supp ort service interventions for persons with dementia and their family caregi vers, as well as computer-based information about dementia care, the influe nce of these external factors on health care triad interactions and outcome s also remains to be studied.