A multi-institutional team of British researchers has determined that evidence suggests a high prevalence of comorbid medical conditions and related complaints among people with dementia, and that 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 investigate the extent, range, and nature of research activity around dementia and comorbidity.
The researchers have reported their findings in an Open Source research article published in the journal BMC Medicine entitled “Comorbidity And Dementia: A Scoping Review Of The Literature“ (BMC Medicine 2014, 12:192 doi:10.1186/s12916-014-0192-4), coauthored by Frances Bunn and Anne-Marie Burn of the Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK; Greta Rait of the Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK; Sam Norton of the Department of Psychology, Institute of Psychiatry, King’s College London,UK; Louise Robinson of the Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK; Johan Schoeman of the South Essex Partnership Trust, Luton, UK; and Carol Brayne of the Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
The team conducted a review encompassing all types of research relating to prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and caregiver experiences; and the experiences and attitudes of service providers. They 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), examining 54 primary studies, eight reviews and three guidelines.
The coauthors note that much of the available literature relates to prevalence of comorbidities in people with dementia, or issues around quality of care, but less is known about service organisation and delivery, or the views and experiences of people with dementia and their family caregivers. They observe that 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.
The researchers conclude that prevalence of comorbid conditions such as diabetes or stroke in people with dementia is high, and while current evidence suggests that people with dementia may have poorer access to services, the reasons for that are not clear. They contend that there is a need for more research looking at ways in which having dementia impacts clinical care for other conditions, and how the process of care and different services are adapting to needs of people with dementia and comorbidity. The coauthors also recommend that people with dementia be included in the debate about management of comorbidities in older populations, and say there needs to be greater consideration given to including such persons in studies that focus on age-related health care issues.
The researchers say their review suggests significant numbers of people with dementia have a comorbid health condition, and this has serious implications for the way specialist services for conditions such as diabetes are delivered for people with dementia. Despite these high levels of comorbidity in people with dementia there was evidence that they 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. They say there are a variety of factors contributory to this finding; for example, people with dementia are perhaps less likely to attend regular appointments or to notice or report relevant symptoms, and they may be more reliant on caregivers to manage and facilitate appointments, or clinicians might be more reluctant to investigate and treat patients with dementia either because of the difficulties involved in securing patient cooperation, or because treatments are considered inappropriate for older patients with multi morbidity.
Moreover, they acknowledge that family caregivers of people who have dementia and other health conditions face great challenges in managing both conditions and dealing with the impact of accompanying behavioral and psychological symptoms of dementia on care routines, but despite this, little is known about how family caregivers can best be supported, or how health care services should adapt to address the particular needs of this population, ande ven less about healthcare providers’ experiences managing people living with dementia and comorbid health conditions and how the presence of dementia influences the care they receive for their comorbidity.
In addition, the researchers identify a need for more detailed epidemiological work on the prevalence of comorbidities in people with dementia and the appropriateness of treatment and referral for this group, and a need for more research into ways in which having dementia impacts clinical care for other conditions, how process of care and different services can adapt to the needs of people with dementia and comorbidity, and what interventions might improve access to services and the physical health of people with dementia.