Undiagnosed Diseases in Patients with Dementia – A Potential Target Group for Intervention

Löppönen, Minna; Isoaho, Raimo; Räihä, Ismo; Vahlberg, Tero; Loikas, Saila; Takala, Timo I.; Puolijoki, Hannu; Irjala, Kerttu; Kivelä, Sirkka‐Liisa

doi:10.1159/000080126

Cited by 54 publications

(67 citation statements)

References 74 publications

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“…Table 13). 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%

“…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%

“…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%

“…A large primary care cohort study in the UK found a lower incidence rate for cataracts in people with Alzheimer's disease than in control subjects 144 but a smaller population-based study in Finland reported no difference in the rates of cataracts. 118 A cross-sectional study in Spain found that the prevalence of cataracts was 7% and that of glaucoma was 4%. 14 Prevalence of dementia in people with stroke, diabetes and vision impairment…”

Section: Vision Impairmentmentioning

confidence: 99%

“…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%

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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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Section: Description Of Studiesmentioning

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: Strokementioning

confidence: 99%

Section: Vision Impairmentmentioning

confidence: 99%

Section: Comprehensiveness and Equitymentioning

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

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A Biobehavioral Home-Based Intervention and the Well-being of Patients With Dementia and Their Caregivers

Gitlin¹,

Winter²,

Dennis³

et al. 2010

JAMA

309

342

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Impact of dementia and drug compliance on patients with acute myocardial infarction

Lee,

Kang,

Kim

et al. 2023

Clinical Cardiology

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BackgroundIn South Korea, the number of people with dementia is rising at a worrisome rate, and many of them also have acute myocardial infarction (AMI), a disease with a high mortality rate.HypothesisWe speculated that dementia and drug compliance have significant impact on the mortality of patients with AMI.MethodsThe study derived data from the National Health Insurance Service‐Senior for a retrospective cohort study. The total number of patients diagnosed with AMI for the first time between 2007 and 2013 was 16 835, among whom 2021 had dementia. Medication possession ratio (MPR) was used to assess medication adherence.ResultsAMI patients with dementia had unfavorable baseline characteristics; they had significantly higher risk of all‐cause mortality (hazard ratio [HR]: 2.49; 95% confidence interval [CI]: 2.34−2.66; p < .001) and lower MPR (aspirin: 21.9% vs. 42.8%; p < .001). AMI patients were stratified by presence of dementia and medication adherence, and the survival rate was the highest among those with no dementia and good adherence, followed by those with no dementia and poor adherence, those with dementia and good adherence, and those with dementia and poor adherence. The multivariable analysis revealed that dementia (HR: 1.64; 95% CI: 1.53−1.75; p < .001) and poor adherence to medication (HR: 1.60; 95% CI: 1.49−1.71; p < .001) had a significant association with all‐cause mortality in AMI patients.ConclusionsAMI patients with dementia have a higher mortality rate. Their prognosis is negatively affected by their poorer medication adherence than patients without dementia.

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Undiagnosed Diseases in Patients with Dementia – A Potential Target Group for Intervention

Cited by 54 publications

References 74 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)

A Biobehavioral Home-Based Intervention and the Well-being of Patients With Dementia and Their Caregivers

Impact of dementia and drug compliance on patients with acute myocardial infarction

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