Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly, A.; Campbell, Stephen; Gaehl, Ella; Iliffe, Steve; Drake, Richard; Morris, Julie; Martin, Helen; Purandare, Nitin

doi:10.3399/bjgp13x663046

Cited by 13 publications

(14 citation statements)

References 52 publications

(64 reference statements)

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“…Within the group who had dementia the most disadvantaged appeared to be women, individuals living in care homes and those with fewer comorbid physical conditions and medications (Connolly et al . ).…”

Section: The Role Of Social Class In Diagnosis and Treatmentmentioning

confidence: 99%

Social class, dementia and the fourth age

Jones

2017

Sociology Health & Illness

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Research addressing social class and dementia has largely focused on measures of socioeconomic status as causal risk factors for dementia and in observed differences in diagnosis, treatment and care. This large body of work has produced important insights but also contains numerous problems and weaknesses. Research needs to take account of the ways in which ageing and social class have been transformed in tandem with the economic, social and cultural coordinates of late modernity. These changes have particular consequences for individual identities and social relations. With this in mind this article adopts a critical gaze on research that considers interactions between dementia and social class in three key areas: (i) epidemiological approaches to inequalities in risk (ii) the role of social class in diagnosis and treatment and (iii) class in the framing of care and access to care. Following this, the article considers studies of dementia and social class that focus on lay understandings and biographical accounts. Sociological insights in this field come from the view that dementia and social class are embedded in social relations. Thus, forms of distinction based on class relations may still play an important role in the lived experience of dementia.

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Section: The Role Of Social Class In Diagnosis and Treatmentmentioning

confidence: 99%

Social class, dementia and the fourth age

Jones

2017

Sociology Health & Illness

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“…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. For instance, studies found that people with dementia were less likely to receive monitoring for diabetes-related problems 97,136 and had reduced access to treatment such as intravenous thrombolysis for stroke, 129 surgery for cataracts, 110 treatment for age-related macular degeneration (AMD) 98,117 or services for diabetes.…”

Section: Comprehensiveness and Equitymentioning

confidence: 99%

“…Although heterogeneity in the populations and differences in the way that conditions were ascertained make comparisons across studies difficult, the data do suggest that the rate of diabetes in people with dementia may be between 13% and 20% and the rate of stroke may be between 16% and 29%. Of the 11 studies 98,110,117,118,123,129,136,139,145,155,161 that compared access to treatment or receipt of services in groups with and without dementia, 10 98,110,117,118,129,136,139,145,155,161 found some evidence that people with dementia were less likely to receive the same quality of care or access to services than those without dementia.…”

Section: Scoping Reviewmentioning

confidence: 99%

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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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“…We included 74 papers, 65 of which were classified as primary references [2,5,11,13, and nine as associated papers [84][85][86][87][88][89][90][91][92]. Study characteristics are summarised in the list below and details of individual studies, including the links between primary and associated papers, in Additional file 1.…”

Section: Description Of Studiesmentioning

confidence: 99%

Comorbidity and dementia: a scoping review of the literature

et al. 2014

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Background: Evidence 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. Methods: We 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).

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Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Cited by 13 publications

References 52 publications

Social class, dementia and the fourth age

Social class, dementia and the fourth age

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

Comorbidity and dementia: a scoping review of the literature

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