Diagnostic, therapeutic, ethic and legal issues in caring for dementia: The viewpoint of medical representative in Modena (Italy)

The clinical outcomes of dementia are characterized by several ethic, diagnostic and therapeutic dilemmas. To evaluate the viewpoint and believes on the diagnostic, therapeutic, ethic and legal issues arising in the management of demented elderly, a 47 item questionnaire was designed and mailed to 898 physicians working in the field of dementia. Our sample consisted of geriatricians, neurologists, psychiatrists and primary care physicians in the Province of Modena. The physicians older than 50 years have a lower average know-ledge about the most recent therapeutic guidelines on dementia. Differences were found in the management of severe dementia according to the setting. There is agreement that the diagnosis should be communicated by family physicians with no differences across speciality. Decision making was the most doubtful field: 15 % of participants considered demented patients capable of informed consent, 46 % questioned it, 27 % was very uncertain and 12 % disagreed. Determining a person's legal status by a proper legal process is an uncommon practice. The majority of the responders agree on giving a support to the carers, but heavy skepticism emerges on its presumed efficacy. There is no homogeneity in physicians' attitude toward demented patients; the clinical setting seems to influence some choices more than the physician's speciality. Ethic issues are often given up or faced with paternalistic attitude. Information and educational processes about diagnostic, ethic and therapeutic options are required to improve the care of demented patients.