Comorbidity Profile of Dementia Patients in Primary Care: Are They Sicker?

Schubert, Cathy C.; Boustani, Malaz; Callahan, Christopher M.; Perkins, Anthony J.; Carney, Caroline P.; Fox, Chris; Unverzagt, Frederick W.; Hui, Siu L.; Hendrie, Hugh C.

doi:10.1111/j.1532-5415.2005.00543.x

Cited by 245 publications

(278 citation statements)

References 37 publications

Supporting

Mentioning

252

Contrasting

Unclassified

Order By: Relevance

“…Ten studies 2,12,14,91,118,119,121,127,142,143 reported the prevalence of stroke in people with dementia and two studies 101,134 reported the prevalence of stroke in people with cognitive impairment. Prevalence rates varied from 3% in hospitalised older people in the UK 12 to 34% in a sample of urban and rural community-dwelling people with cognitive impairment in the USA (Figure 4).…”

Section: Strokementioning

confidence: 99%

“…Thirteen studies reported the prevalence of diabetes in populations of people with dementia 2,12,14,91,118,119,121,127,128,142,143 or MCI. 101,134 Prevalence rates varied from 6% to 39%.…”

Section: Diabetesmentioning

confidence: 99%

“…We included 86 papers, 76 of which were classified as primary references 1,2,12,14,20,21,69,72, and 10 of which were classified as associated papers. 4,73,74,[156][157][158][159][160][161][162] An overview of the selection process can be seen in Figure 2.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Data were collected from medical records in seven studies, 12,14,91,127,137,142,144 from clinical examination or interviews in six studies 1,101,118,119,128,134 and from a mixture of medical records and clinical examination in three studies. 2,121,143 The presence of dementia and comorbid medical conditions was assessed using a variety of measures (see Appendix 4, Table 14). …”

Section: Description Of Studiesmentioning

confidence: 99%

“…1,2 As the population ages and the proportion of people with both dementia and multimorbidity increases, the delivery of health care becomes increasingly complex and challenging. 3 Despite this, health-care systems and research often treat dementia as an isolated condition with little understanding of how other complex health needs might impact on patient and carer experiences or service use and provision.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Strokementioning

confidence: 99%

“…Thirteen studies reported the prevalence of diabetes in populations of people with dementia 2,12,14,91,118,119,121,127,128,142,143 or MCI. 101,134 Prevalence rates varied from 6% to 39%.…”

Section: Diabetesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

Comparison of the Quality of Chronic Disease Management Between Adults With and Without Dementia

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Adults with dementia may experience poorer quality of chronic disease management because of the difficulty in reporting symptoms and engaging in shared decision-making associated with cognitive impairment. OBJECTIVE To compare the quality of chronic disease management received by adults with and without dementia. DESIGN, SETTING, AND PARTICIPANTS For this cross-sectional study, nationally representative data from noninstitutionalized patients 65 years or older were obtained from the 2002-2015 Medical Expenditure Panel Survey. The control group comprised adults of similarly limited life expectancy without dementia comprised . Data analysis was performed in June 2020. EXPOSURES Dementia diagnosis. MAIN OUTCOMES AND MEASURES Quality of chronic disease management based on 14 individual quality indicators. The association between dementia status and the quality of chronic disease management (3 composite categories: preventive care, diabetes care, and medication treatment) was examined using multivariable linear regression models. Survey weights, sampling strata, and primary sampling unit variables were used to produce national estimates adjusted for nonresponse. RESULTS This study included 2506 adults (mean [SD] age, 81.4 [4.7] years; 1259 [49.3%] female;1243 [50.7%] male), of whom 1335 (53.3%) had a diagnosis of dementia and 1171 (46.7%) did not have a diagnosis of dementia. After adjusting for potential confounders, adults with dementia received lower-quality preventive care compared with adults of similar life expectancy without dementia (adjusted absolute difference [aAD], −6.1 percentage points [pp]; 95% CI, −9.7 to −2.5 pp; P = .001). We found no evidence that the quality of care differed in diabetes care (aAD, 1.7 pp; 95% CI, −4.5 to 7.9 pp; P = .59) and medication treatment (aAD, 1.0 pp; 95% CI, −5.0 to 7.0 pp; P = .75). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, the quality of chronic disease management for adults with dementia was not substantially different from that for those without dementia despite potential barriers. Future studies are warranted to gain a better understanding of the underlying mechanism of these findings for preventive care.

show abstract

COVID‐19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US

Wang

Davis

Gurney

et al. 2021

Alzheimer's & Dementia

207

222

View full text Add to dashboard Cite

Introduction At present, there is limited data on the risks, disparity, and outcomes for COVID‐19 in patients with dementia in the United States. Methods This is a retrospective case‐control analysis of patient electronic health records (EHRs) of 61.9 million adult and senior patients (age ≥ 18 years) in the United States up to August 21, 2020. Results Patients with dementia were at increased risk for COVID‐19 compared to patients without dementia (adjusted odds ratio [AOR]: 2.00 [95% confidence interval (CI), 1.94–2.06], P < .001), with the strongest effect for vascular dementia (AOR: 3.17 [95% CI, 2.97–3.37], P < .001), followed by presenile dementia (AOR: 2.62 [95% CI, 2.28–3.00], P < .001), Alzheimer's disease (AOR: 1.86 [95% CI, 1.77–1.96], P < .001), senile dementia (AOR: 1.99 [95% CI, 1.86–2.13], P < .001) and post‐traumatic dementia (AOR: 1.67 [95% CI, 1.51–1.86] P < .001). Blacks with dementia had higher risk of COVID‐19 than Whites (AOR: 2.86 [95% CI, 2.67–3.06], P < .001). The 6‐month mortality and hospitalization risks in patients with dementia and COVID‐19 were 20.99% and 59.26%, respectively. Discussion These findings highlight the need to protect patients with dementia as part of the strategy to control the COVID‐19 pandemic.

show abstract

Comorbidity Profile of Dementia Patients in Primary Care: Are They Sicker?

Cited by 245 publications

References 37 publications

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

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

Comparison of the Quality of Chronic Disease Management Between Adults With and Without Dementia

COVID‐19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US

Contact Info

Product

Resources

About