Beyond "Worried Well": Healthcare Professionals' Perspectives on Improving Subjective Cognitive Decline Care

Ryan A Mace; Mason J Stewart-McLellan; Makenna E Law; Dumichel Harley; Christine Ritchie; Stephen Bartels; Olivia I Okereke; Bettina B Hoeppner; Judson Brewer; Rebecca E Amariglio; Ana-Maria Vranceanu

doi:10.1093/geront/gnaf159

Beyond "Worried Well": Healthcare Professionals' Perspectives on Improving Subjective Cognitive Decline Care

Gerontologist. 2025 Jun 17:gnaf159. doi: 10.1093/geront/gnaf159. Online ahead of print.

Authors

Ryan A Mace^{1

2}, Mason J Stewart-McLellan³, Makenna E Law¹, Dumichel Harley¹, Christine Ritchie^{4

5}, Stephen Bartels^{4

5}, Olivia I Okereke^{5

6}, Bettina B Hoeppner^{2

7}, Judson Brewer^{8

9}, Rebecca E Amariglio^{2

10}, Ana-Maria Vranceanu^{1

2}

Affiliations

¹ Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
² Harvard Medical School, Boston, MA, USA.
³ Department of Clinical Psychology, Midwestern University, Glendale, AZ, USA.
⁴ The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
⁵ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Psychiatry, Health through Flourishing Research Program, Massachusetts General Hospital, Boston, MA, USA.
⁸ Mindfulness Center, Brown University School of Public Health, Providence, RI, USA.
⁹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹⁰ Department of Neurology, Mass General Brigham, Boston, MA, 02115.

PMID: 40574661
DOI: 10.1093/geront/gnaf159

Abstract

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

Research design and methods: We conducted five qualitative focus groups (N = 26) with multidisciplinary healthcare 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 (ERIC) framework.

Results: Four major themes emerged: (1) Terminology, Identification, and Diagnosis-barriers related to inconsistent terminology, overlap with normal aging, and limited standardized guidelines; (2) Psychosocial Factors-stigma surrounding SCD, variability in patient motivation for interventions, and caregiver roles; (3) Access and Equity-disparities in culturally and linguistically concordant care, financial barriers, and exclusion from research; and (4) Healthcare 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.

Keywords: Qualitative; dementia prevention; multidisciplinary; psychosocial; quality of care.

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