Comorbidity and dementia: a scoping review of the literature

Bunn, Frances; Burn, Anne–Marie; Goodman, Claire; Rait, Greta; Norton, Sam; Robinson, Louise; Schoeman, Johan; Brayne, Carol

doi:10.1186/preaccept-1961031831372106

Cited by 78 publications

(116 citation statements)

References 57 publications

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“…Given the increasing awareness and use of health services for dementia, it also seems likely that the costs of medical services will increase more rapidly in the coming decades than by 5% annually, that is, by the rate we used in our sensitivity analysis. Third, as people with dementia often suffer from other chronic health conditions, 50 , 51 comorbidities might reduce the accuracy of our estimates of dementia costs. Fourth, data on the proportion of patients with dementia seeking professional care were very limited.…”

Section: Discussionmentioning

confidence: 99%

The economic burden of dementia in China, 1990–2030: implications for health policy

Wang

Wimo

et al. 2016

Bull. World Health Organ.

160

138

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ObjectiveTo quantify and predict the economic burden of dementia in China for the periods 1990–2010 and 2020–2030, respectively, and discuss the potential implications for national public health policy.MethodsUsing a societal, prevalence-based, gross cost-of-illness approach and data from multiple sources, we estimated or predicted total annual economic costs of dementia in China. We included direct medical costs in outpatient and inpatient settings, direct non-medical costs – e.g. the costs of transportation – and indirect costs due to loss of productivity. We excluded comorbidity-related costs.FindingsThe estimated total annual costs of dementia in China increased from 0.9 billion United States dollars (US$) in 1990 to US$ 47.2 billion in 2010 and were predicted to reach US$ 69.0 billion in 2020 and US$ 114.2 billion in 2030. The costs of informal care accounted for 94.4%, 92.9% and 81.3% of the total estimated costs in 1990, 2000 and 2010, respectively. In China, population ageing and the increasing prevalence of dementia were the main drivers for the increasing predicted costs of dementia between 2010 and 2020, and population ageing was the major factor contributing to the growth of dementia costs between 2020 and 2030.ConclusionIn China, demographic and epidemiological transitions have driven the growth observed in the economic costs of dementia since the 1990s. If the future costs of dementia are to be reduced, China needs a nationwide dementia action plan to develop an integrated health and social care system and to promote primary and secondary prevention.

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Section: Discussionmentioning

confidence: 99%

The economic burden of dementia in China, 1990–2030: implications for health policy

Wang

Wimo

et al. 2016

Bull. World Health Organ.

160

138

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“…In the light of the lack of previous research in this area,8 we took an exploratory qualitative approach involving in-depth semistructured interviews and focus groups. The purpose was the identification and development of appropriate theory to support the development of interventions for PLWD and comorbidity and their family carers 13…”

Section: Methodsmentioning

confidence: 99%

“…They were informed by a scoping review8 and consultation with service user representatives, and were tailored to the type of participant and the comorbidity involved. The majority of interviews with patients involved patient–carer dyads and took place in the participants' own home, with one interview taking place in a participating memory clinic.…”

Section: Methodsmentioning

confidence: 99%

“…For example, there is evidence that cognitive decline may be accelerated in older people with conditions such as type 2 diabetes or cardiovascular disease 5–7. Moreover, the presence of dementia may undermine a patient's abilities to access routine care, self-manage chronic conditions and engage in health maintenance activities 8. Despite this, healthcare systems often treat dementia as an isolated condition with little understanding of how the presence of other complex health needs might impact on processes of care, health outcomes or how this population prioritise the uptake of health services 3…”

Section: Introductionmentioning

confidence: 99%

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Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals

et al. 2017

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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.

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“…For example, certain conditions, such as stroke [3] and diabetes [4], have been linked to accelerated cognitive decline. Dementia-related impairments can also hinder a patient’s ability to self-manage concurrent diseases, adhere to therapies, or effectively communicate the signs and symptoms of complications to care providers, which may lead to adverse outcomes [5]. Therefore, common goals for dementia care are to manage coexisting conditions and, where possible, to prevent potentially avoidable care transitions, including hospitalization and institutionalization [6].…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort

et al. 2017

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BackgroundFor community-dwelling older persons with dementia, the presence of multimorbidity can create complex clinical challenges for both individuals and their physicians, and can contribute to poor outcomes. We quantified the associations between level of multimorbidity (chronic disease burden) and risk of hospitalization and risk of emergency department (ED) visit in a home care cohort with dementia and explored the role of continuity of physician care (COC) in modifying these relationships.Methods and findingsA retrospective cohort study using linked administrative and clinical data from Ontario, Canada, was conducted among 30,112 long-stay home care clients (mean age 83.0 ± 7.7 y) with dementia in 2012. Multivariable Fine–Gray regression models were used to determine associations between level of multimorbidity and 1-y risk of hospitalization and 1-y risk of ED visit, accounting for multiple competing risks (death and long-term care placement). Interaction terms were used to assess potential effect modification by COC.Multimorbidity was highly prevalent, with 35% (n = 10,568) of the cohort having five or more chronic conditions. In multivariable analyses, risk of hospitalization and risk of ED visit increased monotonically with level of multimorbidity: sub-hazards were 88% greater (sub-hazard ratio [sHR] = 1.88, 95% CI: 1.72–2.05, p < 0.001) and 63% greater (sHR = 1.63; 95% CI: 1.51–1.77, p < 0.001), respectively, among those with five or more conditions, relative to those with dementia alone or with dementia and one other condition. Low (versus high) COC was associated with an increased risk of both hospitalization and ED visit in age- and sex-adjusted analyses only (sHR = 1.11, 95% CI: 1.07–1.16, p < 0.001, for hospitalization; sHR = 1.07, 95% CI: 1.03–1.11, p = 0.001, for ED visit) but did not modify associations between multimorbidity and outcomes (Wald test for interaction, p = 0.566 for hospitalization and p = 0.637 for ED visit). The main limitations of this study include use of fixed (versus time-varying) covariates and focus on all-cause rather than cause-specific hospitalizations and ED visits, which could potentially inform interventions.ConclusionsOlder adults with dementia and multimorbidity pose a particular challenge for health systems. Findings from this study highlight the need to reshape models of care for this complex population, and to further investigate health system and other factors that may modify patients’ risk of health outcomes.

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Comorbidity and dementia: a scoping review of the literature

Cited by 78 publications

References 57 publications

The economic burden of dementia in China, 1990–2030: implications for health policy

The economic burden of dementia in China, 1990–2030: implications for health policy

Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals

Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort

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