Management of long-term conditions and dementia: The role of the Admiral Nurse

As life expectancy increases so people often develop a range of conditions and disabilities in the years before death | British Journal of Community Nursing

Multimorbidity represents the most common ‘disease pattern’ found among the elderly and is characterised by complex interactions of co-existing diseases where a medical approach focused on a single disease does not suffice. People with dementia who also have other comorbidities do not always have their comorbid conditions managed as those without dementia which often lead to a high number of hospital admissions with longer lengths of stay and greater treatment costs. This case study presents the case management approach taken by Admiral Nursing in managing the complexities where there is comorbidity of a long-term condition and a diagnosis of dementia. By empowering the person and their carer with information and choices and through good case management and communication, people can be supported to live well and avoid inappropriate hospital admissions.

Full reference: Knight, C. & Harrison Dening, K. (2017) Management of long-term conditions and dementia: The role of the Admiral Nurse. British Journal of Community Nursing. Vol. 22 (no. 6)

Integrated Care Pathways and Care Bundles for Dementia in Acute Care

Caring for people with dementia in acute settings is challenging and confounded by multiple comorbidities and difficulties transitioning between community and acute care | American Journal of Alzheimer’s Disease & Other Dementias

path-2177251_960_720.jpg

Recently, there has been an increase in the development and use of integrated care pathways (ICPs) and care bundles for defined illnesses and medical procedures, and these are now being promoted for use in dementia care in acute settings. We present a review of the literature on ICPs and/or care bundles for dementia care in the acute sector. This includes a literature overview including “gray literature” such as relevant websites, reports, and government publications.

Taken together, there is clearly a growing interest in and clinical use of ICPs and care bundles for dementia. However, there is currently insufficient evidence to support the effectiveness of ICPs for dementia care in acute settings and limited evidence for care bundles for dementia in this setting.

Full reference:  Sullivan, D.O. et al. (2017) Integrated Care Pathways and Care Bundles for Dementia in Acute Care: Concept Versus Evidence. American Journal of Alzheimer’s Disease & Other Dementias. 32(4) pp. 189 – 193

Association of comorbidity and health service usage among patients with dementia in the UK

Browne, J. et al. (2017) BMJ Open. 7:e012546

Social Care Photography, DH

Background: The majority of people with dementia have other long-term diseases, the presence of which may affect the progression and management of dementia. This study aimed to identify subgroups with higher healthcare needs, by analysing how primary care consultations, number of prescriptions and hospital admissions by people with dementia varies with having additional long-term diseases (comorbidity).

Discussion: In the UK, people with dementia with higher numbers of comorbidities die earlier and have considerably higher health service usage in terms of primary care consultations, hospital admissions and prescribing. This study provides strong evidence that comorbidity is a key factor that should be considered when allocating resources and planning care for people with dementia.

Read the full article here

Developing dementia-friendly care and support for people with a learning disability

A report from several voluntary sector organisations calls for an improvement in the way that the needs of people with learning disabilities and dementia are addressed | VODG

thought-leadership
Image source: VODG

This paper explores how best to develop support, services and treatments for the growing number of people with a learning disability and dementia. It builds on earlier work, across the voluntary sector strategic partnership which focuses on dementia support within the context of the protected characteristics defined under the Equality Act 2010.

Read the full report here

Healthcare organisation and delivery for people with dementia and comorbidity

Bunn, F. et al. BMJ Open. Published online 18 January 2017

network-1989133_960_720.jpg

Objectives: People 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.

 

Conclusions: This 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.

Read the full article here

New horizons: the management of hypertension in people with dementia

Harrisson, J.K. et al. (2016) Age Ageing. 45(6). pp. 740-746

heart-1222517_960_720.jpg

The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful.

Read the full abstract here

Risk of dementia and death in community-dwelling older men with bipolar disorder

Almeida, O.P. et al. The British Journal of Psychiatry .Aug 2016. 209 (2). pp. 121-126;

https://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=22&_IXSR_=mdb5QI1Fs9J&_IXSS_=_IXFPFX_%3dtemplates%252ft%26_IXMAXHITS_%3d250%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26_IXFIRST_%3d1%26%252asform%3dwellcome%252dimages%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26%3d%26_IXrescount%3d96%26_IXINITSR_%3dy%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26_IXshc%3dy%26%2524%253ds%3ddementia&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: Susan Lockhart – Wellcome Images // CC BY-NC-ND 4.0

Background: Bipolar disorder has been associated with cognitive decline, but confirmatory evidence from a community-derived sample of older people is lacking.

Aims: To investigate the 13-year risk of dementia and death in older adults with bipolar disorder.

Method: Cohort study of 37 768 men aged 65–85 years. Dementia (primary) and death (secondary), as recorded by electronic record linkage, were the outcomes of interest.

Results: Bipolar disorder was associated with increased adjusted hazard ratio (HR) of dementia (HR = 2.30, 95% CI 1.80–2.94). The risk of dementia was greatest among those with <5 years of history of bipolar disorder or who had had illness onset after 70 years of age. Bipolar disorder was also associated with increased mortality (HR = 1.51, 95% CI 1.28–1.77). Competing risk regression showed that bipolar disorder was associated with increased hazard of death by suicide, accidents, pneumonia or influenza, and diseases of the liver and digestive system.

Conclusions: Bipolar disorder in later life is associated with increased risk of dementia and premature death.

Read the abstract here