Are patients with dementia treated as well as patients without dementia for hypertension, diabetes, and hyperlipidaemia?

Müther, Johannes; Abholz, Heinz-Harald; Wiese, Birgitt; Fuchs, Ângela; Wollny, Anja; Pentzek, Michael

doi:10.3399/bjgp10x515395

Cited by 17 publications

(34 citation statements)

References 14 publications

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“… Reported differences in care/treatment Connolly [92]UKDM, StrokeCross sectional700 PWD (compared to people without dementia on QOF register)Monitoring and treatmentYesPWD -significantly lower on 73% of QOF indicators; including peripheral pulses check, neuropathy testing, cholesterol measures for stroke.Curtis [33]USAVI (AMD)Retrospective cohort284380TreatmentYesPWD significantly less likely to receive anti-VEGF RR 0.88 (95% CI 0.88 to 0.89)Guijarro [45]SpainVI, generalCohort40482TreatmentYesPWD had some procedures less frequently than those without dementia. For example,cataract surgery ( P <0.001), hernia repair, orthopaedic surgeryKeenan [11]UKVI (AMD)Cohort65894 (AMD cohort, 168092 dementia cohort)TreatmentYesPWD significant decrease in likelihood of hospital admission for AMD P <0.001Löppönen [55]FinlandVI, generalCross sectional (survey)1260 older people (112 PWD)Diagnosis and treatmentYesPWD -more undiagnosed diseases compared to those without dementia ( P =0.041) , less likely to be diagnosed with glaucoma ( P =0.022)Müther [60]GermanyDM, hypertensionRetrospective matched control216 PWD, 216 matched controlsTreatmentNoNo significant differences in treatment for those with and without dementia. PWD more likely not to receive medication for hypertension or be treated with low-priced medications (not significant)Saposnik [66]CanadaStrokeCohort877 with pre-existing dementiaTreatmentYesPatients with pre-existing dementia less likely to receive intravenous thrombolysis.877 controls (no pre-existing dementia)Sloan [69]USAAcute MICross sectional5851 admitted for AMI with dementia, 123241 admitted for AMI without dementiaTreatmentYesPWD less likely to have a range of invasive procedures compared to those without a history of dementiaThorpe [74]USADM, VICohort288805 (44717 PWD)MonitoringYesPWD less likely to receive HbA1c tests (73% ver...…”

Section: Resultsmentioning

confidence: 99%

Comorbidity and dementia: a scoping review of the literature

Bunn

Burn

Goodman

et al. 2014

BMC Med

336

223

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BackgroundEvidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient’s ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity.MethodsWe undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014).ResultsWe included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia.ConclusionsThe prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0192-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Comorbidity and dementia: a scoping review of the literature

Bunn

Burn

Goodman

et al. 2014

BMC Med

336

223

View full text Add to dashboard Cite

show abstract

“…Eleven studies 98,110,117,118,123,129,136,139,145,155,161 compared access to treatment or receipt of services in groups with and without dementia. Ten 98,110,117,118,129,136,139,145,155,161 of the 11 studies found some evidence that people with dementia were less likely to receive the same quality of care or access to services as those without dementia.…”

Section: Comprehensiveness and Equitymentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…23 Quality indicators -even bundled indicators that emphasise the importance of individual specific review -cannot reflect or assess the complexities of primary health care and the uniqueness of individual patients 24,25 but, rather, involve making and assessing generalisations about individual patients. The quality of a dementia review will also depend on the continuity of care, interpersonal care, and trust between health professional, patient and, where appropriate, carer.…”

Section: Strengths and Limitationsmentioning

confidence: 99%