Impact of dementia on caring for patients’ diabetes

Feil, Denise; Lukman, Revana; Simón, Barbara; Walston, Amy; Vickrey, Barbara G.

doi:10.1080/13607863.2011.569485

Cited by 31 publications

(81 citation statements)

References 34 publications

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“…72,158 A qualitative study involving the views of 21 caregivers of people with dementia and type 2 diabetes found that behavioural and psychological symptoms of dementia disrupted diabetes care. 102 In addition, carers felt that they received inadequate support in planning their relatives' care, that their contribution to managing their relatives' care was not always recognised and that they were often excluded from decision-making. A systematic review 153 investigating the role of informal caregivers of PLWD found that family carers are often expected to manage medication regimens, the complexity of which are increasing.…”

Section: Views and Experiencesmentioning

confidence: 99%

“…23,242 Family caregivers of people who have dementia and other health conditions face additional challenges in managing both conditions and dealing with the impact of the accompanying behavioural and psychological symptoms of dementia on care routines. 102 Our study suggests that care pathways need to recognise the contribution of family members and, when available, incorporate their contribution in the care of PLWD. Pathways should include appropriate support for carers that addresses the possibility that carers do not want or cannot absorb the extra responsibilities of caring for someone with a condition such as diabetes.…”

Section: Carer Inclusion and Supportmentioning

confidence: 99%

“…Seven 72,92,102,125,132,148,162 were qualitative studies, one 107 was a mixed study including a review and a qualitative study, three 93,99,153 were reviews and two 20,94 were questionnaire studies. Three studies 20,94,102 focused on people with dementia and diabetes, two 72,93 focused on those with dementia and VI, one 89 looked at those with dementia and deafness, one 92 focused on those with dementia and cancer, two 148,153 looked at family carers' views on medication management and four 99,107,125,132 looked at the needs of people with dementia in general hospitals. Literature on the experiences of older people with dementia in acute general hospitals has highlighted shortcomings in the care provided, the attitudes and training of staff, and the physical environment and problems with care cultures.…”

Section: Views and Experiencesmentioning

confidence: 99%

“…For example, people with dementia and diabetes had problems understanding their condition, managing medication and monitoring their blood glucose. 20,21,94,102,103 A review published in 2013 88 identified 16 guidelines/position statements or standards (from the UK, USA and Australia) for the care of PLWD but these generally focused on standards for providing optimal care for older people with cognitive impairment in acute hospitals or on specific issues such as hydration, nutrition or wandering. They did not cover issues relating to the care of people with dementia and specific medical conditions (such as stroke).…”

Section: Guidelines and Care Pathwaysmentioning

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: Views and Experiencesmentioning

confidence: 99%

Section: Carer Inclusion and Supportmentioning

confidence: 99%

Section: Views and Experiencesmentioning

confidence: 99%

Section: Guidelines and Care Pathwaysmentioning

confidence: 99%

See 2 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

View full text Add to dashboard Cite

show abstract

“…25,28,30,37,39,42,43,45,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] These comprised 79 research papers and 10 guidelines or discussion pieces. Other papers cited in this chapter are for background information and did not undergo full data extraction.…”

Section: Description Of Studiesmentioning

confidence: 99%

Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

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BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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Medication use to manage comorbidities for people with dementia: a systematic review

Page

Etherton‐Beer

Seubert

et al. 2018

Pharmacy Practice and Res

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Aim: People with dementia commonly live with multiple comorbidities. This review aimed to review medications to manage chronic conditions in people who also have a diagnosis of dementia. The secondary aim was to determine whether drug utilisation for other conditions change as a result of dementia diagnosis. Methods: Data source: We included experimental and observational studies where participants with dementia were diagnosed and treated for one or more comorbid conditions that reported health outcomes or drug utilisation. Study selection: MedLine and Embase databases were searched from inception to March 2016 (updated September 2016). Three researchers screened titles, abstracts and full-text articles, then extracted data using a data extraction sheet. Results: Six studies met inclusion criteria with 51 696 participants (mean age 81.1 AE 2.0 years, 78% female). One experimental study compared bisphosphonate use with placebo in people with mid-stage dementia and found reduced risk of non-vertebral fractures (OR = 0.27, 95% CI 0.12-0.61) in the bisphosphonate group. Five observational studies reported drug utilisation for people with dementia to treat comorbidities, namely depression, osteoporosis, diabetes and cardiovascular disease. Drug utilisation was found to be similar for depression, diabetes and cardiovascular disease for people with and without dementia, although bisphosphonate use was significantly reduced. Conclusion: Evidence on medication use for comorbidities in people with dementia is currently limited to drug utilisation patterns and treatment of one comorbidity: osteoporosis. Comorbidities for people with dementia appear to be managed pharmacologically until the late stages of disease without considering time to benefit or that it is a life-limiting condition. 1.13 (0.93-1.38) CHADS = congestive heart failure, hypertension, age >75, diabetic, history of stroke.

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Impact of dementia on caring for patients’ diabetes

Cited by 31 publications

References 34 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)

Managing diabetes in people with dementia: a realist review

Medication use to manage comorbidities for people with dementia: a systematic review

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