Beyond "worried well": health care professionals' perspectives on improving subjective cognitive decline care.

Abstract

Background and objectives: Subjective cognitive decline (SCD) is an early indicator of cognitive impairment and dementia risk, yet its clinical management remains inconsistent. Health care professionals play a critical role in identifying and addressing SCD, but their perspectives on barriers and facilitators to care are understudied. This study explored health care professionals' insights for improving SCD care.

Research design and methods: We conducted five qualitative focus groups (n = 26) with multidisciplinary health care professionals providing care for older adults with SCD. Participants were recruited from diverse clinical settings within an academic medical center. Transcripts were analyzed using a hybrid deductive-inductive thematic analysis. We proposed strategies to overcome barriers to SCD care using the Expert Recommendations for Implementing Change framework.

Results: Four major themes emerged: (a) Terminology, Identification, and Diagnosis-barriers related to inconsistent terminology, overlap with normal aging, and limited standardized guidelines; (b) Psychosocial Factors-stigma surrounding SCD, variability in patient motivation for interventions, and caregiver roles; (c) Access and Equity-disparities in culturally and linguistically concordant care, financial barriers, and exclusion from research; and (d) Health Care Systems-time constraints, referral delays, and clinic variability impacting the quality of care.

Discussion and implications: Findings highlight systemic and psychosocial barriers to SCD care, as well as potential facilitators, including interdisciplinary collaboration and patient-centered strategies. Addressing these challenges requires targeted interventions to standardize terminology, improve provider education, enhance access, and promote equitable care. Future research should evaluate implementation strategies to optimize SCD management and reduce disparities in early dementia prevention efforts.