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The Rural Older Adult Memory (ROAM) Study: A Practice-based Intervention to Improve Dementia Screening and Diagnosis

Layton Aging and Alzheimer's Disease Center (LB), Oregon Health and Science University, Portland
Department of Internal Medicine (EE), Oregon Health and Science University, Portland
Oregon Rural Practice-based Research Network (LF, AK, MG, DIB, CM), Oregon Health and Science University, Portland
Department of Family Medicine (LF, DIB), Oregon Health and Science University, Portland
Department of Medical Informatics and Clinical Epidemiology (AK, DIB, CM), Oregon Health and Science University, Portland
the Oregon Clinical and Translational Research Institute (LF, AK, CM), Oregon Health and Science University, Portland

Correspondence: Corresponding author: Linda Boise, PhD, MPH, Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Road (CR131), Portland, OR 97239 (E-mail: boisel{at}ohsu.edu)

Introduction: The aim of the Rural Older Adult Memory (ROAM) pilot study was to evaluate the feasibility of screening and diagnosing dementia in patients aged 75 years or older in 6 rural primary care practices in a practice-based research network.

Methods: Clinicians and medical assistants were trained in dementia screening using the ROAM protocol via distance learning methods. Medical assistants screened patients aged 75 years of age and older. For patients who screened positive, the clinician was alerted to the need for a dementia work-up. Outcomes included change in the proportion of patients who were screened and diagnosed with dementia or mild cognitive impairment, clinician confidence in diagnosing and managing dementia, and response to the intervention.

Results: Results included a substantial increase in screening for dementia, a modest increase in the proportion of patients who were diagnosed with dementia or mild cognitive impairment, and improved clinician confidence in diagnosing dementia. Although clinicians and medical assistants found the ROAM protocol easy to implement, there was substantial variability in adherence to the protocol among the 6 practices.

Conclusion: This study demonstrated the complex issues that must be addressed in implementing a dementia screening process in rural primary care. Further study is needed to develop effective strategies for overcoming the factors that impeded the full uptake of the protocol, including the logistic challenges in implementing practice change and clinicians’ attitudes toward dementia screening and diagnosis.

Key Words: Practice-based Research • PBRN • Dementia • Rural Health • Primary Health Care

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