BackgroundEvidence 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.MethodsWe 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).ResultsWe included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. 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.ConclusionsThe prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0192-4) contains supplementary material, which is available to authorized users.

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.

ObjectivesPeople living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population.DesignQualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care.SettingPrimary and secondary care in the South and North East of England.ParticipantsPLWD who had 1 of the following comorbidities—diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions.ResultsWe recruited 28 community-dwelling PLWD, 33 family carers and 56 HCPs. Analysis resulted in 3 overarching themes: (1) family carers facilitate access to care and continuity of care, (2) the impact of the severity and presentation of dementia on management of comorbid conditions, (3) communication and collaboration across specialities and services is not dementia aware. We found examples of good practice, but 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.ConclusionsThis study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient's diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity.

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).

The EU-supported TeDUB (Technical Drawings Understanding for the Blind) project is developing a software system that aims to make technical diagrams accessible to blind and visually impaired people. It consists of two separate modules: one that analyses drawings either semi-automatically or automatically, and one that presents the results of this analysis to blind people and allows them to interact with it. The system is capable of analysing and presenting diagrams from a number of formally defined domains. A diagram enters the system as one of two types: first, diagrams contained in bitmap images, which do not explicitly contain the semantic structure of their content and thus have to be interpreted by the system, and second, diagrams obtained in a semantically enriched format that already yields this structure. The TeDUB system provides blind users with an interface to navigate and annotate these diagrams using a number of input and output devices. Extensive user evaluations have been carried out and an overall positive response from the participants has shown the effectiveness of the approach

Many people with dementia have other complex health needs, including comorbidity and frailty. Most models of care focus on single diseases and do not take into account the needs of those with comorbidities and dementia. Integration, continuity of care and personalisation are particularly important for this vulnerable group. It is also important to recognise potential barriers to accessing care so that these can be addressed. Issues around providing health care for people with dementia and complex health needs are considered in this article, including management and organisation of care, access to care, models of care, role of the family carer, and prevention of dementia, frailty and long-term conditions.

One in eight children aged 5–19 years in the UK suffer from a psychiatric disorder, while fewer than 35% are identified and only 25% of children access mental health services. Whilst government policy states that primary schools are well-placed to spot the early warning signs of mental health issues in children, the implementation of early identification methods in schools remains under-researched. This study aims to increase understanding of the acceptability and feasibility of different early identification methods in this setting. Four primary schools in the East of England in the UK participated in a qualitative exploration of views about different methods that might enhance the early identification of mental health difficulties (MHDs). Twenty-seven staff and 20 parents took part in semi-structured interviews to explore current and future strategies for identifying pupils at risk of experiencing MHDs. We presented participants with four examples of identification methods selected from a systematic review of the literature: a curriculum-based approach delivered to pupils, staff training, universal screening, and selective screening. We used NVivo to thematically code and analyse the data, examining which models were perceived as acceptable and feasible as well as participants’ explanations for their beliefs. Three main themes were identified; benefits and facilitators; barriers and harms, and the need for a tailored approach to implementation. Parents and staff perceived staff training as the most acceptable and feasible approach to systematic identification, followed by a curriculum-based approach. Universal and selective screening garnered mixed responses. Findings suggest that a systematic and tailored approach to early identification would be most acceptable and feasible, taking into consideration school context. Teacher training should be a core component in all schools.

ObjectivesIn 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.DesignQualitative study involving interviews, focus groups and thematic content analysis.SettingPrimary care and secondary care across six counties in the East of England.ParticipantsHospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.ResultsWe recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.ConclusionsThe study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.