Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study

Abstract

BackgroundThe majority of people with dementia have other long-term diseases, the presence of which may affect the progression and management of dementia. This study aimed to identify subgroups with higher healthcare needs, by analysing how primary care consultations, number of prescriptions and hospital admissions by people with dementia varies with having additional long-term diseases (comorbidity).MethodsA retrospective cohort study based on health data from the Clinical Practice Research Datalink (CPRD) was conducted. Incident cases of dementia diagnosed in the year starting 1/3/2008 were selected and followed for up to 5 years. The number of comorbidities was obtained from a set of 34 chronic health conditions. Service usage (primary care consultations, hospitalisations and prescriptions) and time-to-death were determined during follow-up. Multilevel negative binomial regression and Cox regression, adjusted for age and gender, were used to model differences in service usage and death between differing numbers of comorbidities.ResultsData from 4999 people (14 866 person-years of follow-up) were analysed. Overall, 91.7% of people had 1 or more additional comorbidities. Compared with those with 2 or 3 comorbidities, people with ≥6 comorbidities had higher rates of primary care consultations (rate ratio (RR) 1.31, 95% CI 1.25 to 1.36), prescriptions (RR 1.68, 95% CI 1.57 to 1.81), and hospitalisation (RR 1.62, 95% CI 1.44 to 1.83), and higher risk of death (HR 1.56, 95% CI 1.37 to 1.78).DiscussionIn the UK, people with dementia with higher numbers of comorbidities die earlier and have considerably higher health service usage in terms of primary care consultations, hospital admissions and prescribing. This study provides strong evidence that comorbidity is a key factor that should be considered when allocating resources and planning care for people with dementia.

Cardiovascular and metabolic comorbidities in patients with Alzheimer's disease and vascular dementia compared to a psychiatric control cohort

“…Recent studies have focused on the number of comorbidities and hospitalization rates in the UK and Canada. These studies showed that an increased number of comorbid disorders led to a higher frequency of hospitalization, although neither study differentiated between psychiatric or somatic departments …”

“…[33][34][35][36][37] Some studies have focused on a higher use of psychiatric and medical inpatient treatment among dementia patients with further psychiatric comorbidities, 37 but little research has been conducted on the effect of cardiovascular and metabolic comorbidities. 33 Recent studies have focused on the number of comorbidities and hospitalization rates in the UK and Canada. These studies showed that an increased number of comorbid disorders led to a higher frequency of hospitalization, although neither study differentiated between psychiatric or somatic departments.…”

“…These studies showed that an increased number of comorbid disorders led to a higher frequency of hospitalization, although neither study differentiated between psychiatric or somatic departments. 33,35 Strengths and limitations of the study Firstly, the present study is based on the VIPP database, which is one of the largest and most extensive databases on in-hospital treatment of patients with psychiatric disorders in Germany. Altogether, 85 hospitals from all over the country contributed to the database, which includes more than 600 000 patients.…”

Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: A systematic review

“…10 Some people with dementia may also be prescribed medication for comorbid health conditions such asType 2 Diabetes Mellitus or high blood pressure. 11 Unsurprisingly, given their cognitive problems, managing medication is complex for people with dementia which can result in "medication errors, medication related hospital admissions, and dependence on others to assist with medication management tasks". 12 Although non-adherence to medication is a widespread problem across conditions, ages, and other demographics, and can be intentional or unintentional, 13 cognitive impairment and dementia have been shown to specifically impact on medication adherence.…”

“…Although there is currently no cure for dementia, medicines play a key role in the lives of people with dementia, primarily to manage symptoms . Some people with dementia may also be prescribed medication for comorbid health conditions such as Type 2 Diabetes Mellitus or high blood pressure . Unsurprisingly, given their cognitive problems, managing medication is complex for people with dementia which can result in “medication errors, medication related hospital admissions, and dependence on others to assist with medication management tasks” .…”