This week in Family Medicine

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Welcome to This Week in Family Medicine. This week we're covering 8 notable papers spanning ageing and cognition in general practice, health inequity and hard-to-reach patients, and the relationships and everyday activities that shape how patients feel about their health. Let's dive in.

Our first theme is the older patient, and how general practice might better recognise cognitive and functional decline. In the Scandinavian Journal of Primary Health Care, Kjær and colleagues set out the case for a general practice-centred model of Alzheimer's diagnosis in Denmark [1]. This is a position paper rather than a trial. The authors acknowledge that current disease-modifying therapies offer only modest benefit, but argue that scalable blood-based biomarkers will make earlier diagnosis more accessible. They propose three steps for primary care: structured clinical and cognitive assessment, exclusion of secondary causes including structural neuroimaging, and, once feasible, biomarkers to support diagnosis and guide referral. They are clear that organisational, educational and ethical groundwork has to come first. A qualitative study in the British Journal of General Practice by Nimmons and colleagues explains why recognition in this group is hard [2]. Interviews with 56 people with dementia, carers and primary care professionals in England found that anxiety and depressive symptoms overlap with cognitive impairment, and that this overlap can delay a dementia diagnosis. Professionals and carers often put emotional symptoms down to dementia itself, even though other comorbidities may contribute. Stigma, cultural influences, denial and masking of symptoms all shaped help-seeking. As qualitative work, it describes the problem rather than testing a fix, but it suggests that changes in behaviour over time, comorbidity, culture and personality all bear on recognition. A broader functional lens comes from Norway, again in the Scandinavian Journal of Primary Health Care. Sebjørnsen and colleagues surveyed about 2,150 patients aged 65 and over in general practice waiting rooms using a modified version of the World Health Organization's ICOPE screening tool [3]. Six in ten respondents showed decline in at least one domain of intrinsic capacity. Hearing loss was the most common problem, affecting close to a third of respondents, followed by limited mobility and malnutrition. Decline was linked to older age and financial difficulty. Patients with decline in any domain were roughly four and a half times as likely to rate their health as poor, and that likelihood climbed with each additional domain affected. Depressive symptoms and limited mobility had the strongest independent links. The data are cross-sectional and come from patients already attending the surgery, and the authors say plainly that whether ICOPE can be built into routine primary care still needs study.

Our second theme is inequity, and patients whom standard care tends to miss. Carlsson and colleagues, in the Scandinavian Journal of Primary Health Care, followed 1.4 million Stockholm residents with no prior stroke or transient ischaemic attack for 12 years [4]. Stroke was more common in low-income neighbourhoods, and the gap was widest before age 65, with no significant difference at 80 and older. The pattern for transient ischaemic attack ran the other way, with higher recorded rates in affluent neighbourhoods, especially among men. The authors read this as likely underdiagnosis and low awareness in deprived areas rather than true protection. That interpretation is reasonable but untested in this registry design. Even so, it points to missed warning events in exactly the populations with more strokes. What might engaging these patients look like? In the same journal, van Bommel and colleagues interviewed 18 patients, 2 general practitioners and 12 practice nurses in the Netherlands who used a co-created, person-centred integrated care approach for patients with chronic conditions and low socioeconomic status [5]. The approach combined stepwise consultations, a visual tool and clinician training. Clinicians reported greater job satisfaction and felt the tool built trust and surfaced social needs. Patients liked being seen as individuals but noticed limited changes in their actual care. That gap between how clinicians and patients experienced the approach is worth noting, and the sample is small. A systematic review in the British Journal of General Practice by Bryant and colleagues brings a similar lens to severe mental illness [6]. It pooled eight qualitative studies from five countries, covering 375 patients, carers and providers, to understand low uptake of annual physical health checks. Barriers arose at individual, relational and service levels. They included unclear understanding of what the check is for, the quality of the clinical encounter, and limited support for behaviour change afterwards. The authors conclude that coordinated redesign shaped by lived experience is needed, though the evidence base remains thin.

Our final theme is about continuity and the wider life of the patient. In BMC Primary Care, Garpenhag and colleagues surveyed Swedish patients one to two years and five to six years after breast, prostate, lung or colorectal cancer [7]. Nearly all respondents had used primary care since diagnosis, and most had done so for cancer-related reasons at some point. Yet among patients who had finished treatment, few recalled being actively handed over to primary care. Around half of respondents rated their primary care contacts as satisfactory and 8 percent as unsatisfactory. Satisfaction was higher in patients with a regular physician and an active handover, and lower with more comorbidities or problem-driven cancer contacts. The study is cross-sectional, so the direction of these links is uncertain, but it lines up with the long-standing continuity argument. Finally, Jansåker and colleagues, in the Scandinavian Journal of Primary Health Care, followed about 3,300 Swedish adults across three waves spanning roughly 17 years [8]. They found a graded association: people with low cultural participation, such as visits to cinema, theatre, concerts, museums or religious services, had nearly double the odds of impaired self-reported health compared with high participators, after adjusting for confounders. Reverse causation and residual confounding remain plausible, so this supports interest in social prescribing rather than proving that it works.

If you only have time for one paper this week, make it the Norwegian intrinsic capacity survey from Sebjørnsen and colleagues [3]. It suggests that functional decline, especially hearing, mobility and mood, is the norm rather than the exception among older patients sitting in the waiting room. It also reopens the question of whether structured function screening belongs in routine general practice.

Here is what this week's evidence adds up to in Family Medicine. First, decline in function and mood among older patients is common and closely tied to self-rated health, but whether screening tools like ICOPE improve outcomes in primary care has not been tested. Second, anxiety and depression in dementia are easily attributed to the dementia itself, according to qualitative evidence from England, and the push for primary care-led Alzheimer's diagnosis rests on biomarkers that are not yet routinely available. Third, Swedish registry data show stroke concentrated in deprived neighbourhoods, while transient ischaemic attack appears under-recorded there, a signal of possible missed diagnosis that needs confirming. Fourth, tailored approaches for low-income and severely mentally ill patients are well received by clinicians, but the evidence is largely qualitative and patient-perceived change remains modest. Fifth, observational data link continuity, active handover after cancer and cultural engagement with better patient-reported experience and health, though none of these studies establishes cause.

That's your roundup for This Week in Family Medicine. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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