Analysis of primary care data relating to other health conditions that patients with dementia live with in England | Public Health England
NHS England has published a data briefing on the analysis of a sample of primary care records of patients with dementia, relating to their other health conditions (comorbidities).
It examines whether:
patients with dementia are more likely to have comorbidities
patients with dementia are more likely to have multiple comorbidities
different subtypes of dementias lead to different patterns of comorbidities
The comorbidities considered in this study are conditions that:
can increase the risk of dementia such as hypertension, coronary heart disease (CHD) and diabetes
are associated with dementia such as stroke or transient ischaemic attack (stroke or TIA), depression, Parkinsonism, epilepsy, severe mental illness or psychosis (SMI)
are physical conditions not directly associated with dementia – such as asthma and chronic obstructive pulmonary disease (COPD)
The briefing asks commissioners and health and care providers to consider the plans they have in place to diagnose and treat the other conditions that people living with dementia experience, particularly those living with more severe dementias.
They should also consider how multiple morbidities can be successfully managed in a comprehensive personal care plan, as outlined in the NHS Long Term Plan, to improve health outcomes and provide better support – with an active focus on supporting people in the community.
This report was undertaken to summarise the existing research evidence about the burden, determinants, prevention, and treatment of multimorbidity | The Academy of Medical Sciences
The term multimorbidity refers to the existence of multiple medical conditions in a single individual. For many regions of the world, there is evidence that a substantial, and likely growing, proportion of the adult population is affected by more than one chronic condition.
Health conditions that frequently group together include heart disease, high blood pressure, diabetes, cancer, depression, anxiety, chronic obstructive pulmonary disease (COPD) and chronic kidney disease. Why this happens is poorly understood, making it difficult to predict which patients may be most in need of preventive or increased care.
The report also highlights how physical conditions, such as type 2 diabetes, can affect mental health, and vice versa. But the division between health services treating mental and physical health often means that patients with physical and mental conditions are at particular risk of poor care.
Findings suggest that dementia is associated with poorer cancer outcomes
Objectives: A comorbid diagnosis of cancer and dementia (cancer–dementia) may have unique implications for patient cancer-related experience. The objectives were to estimate prevalence of cancer–dementia and related experiences of people with dementia, their carers and cancer clinicians including cancer screening, diagnosis, treatment and palliative care.
Method: Databases were searched using key terms such as dementia, cancer and experience. Inclusion criteria were as follows: (a) English language, (b) published any time until early 2016, (c) diagnosis of cancer–dementia and (d) original articles that assessed prevalence and/or cancer-related experiences including screening, cancer treatment and survival. Due to variations in study design and outcomes, study data were synthesised narratively.
Results: Forty-seven studies were included in the review with a mix of quantitative (n = 44) and qualitative (n = 3) methodologies. Thirty-four studies reported varied cancer–dementia prevalence rates (range 0.2%–45.6%); the others reported reduced likelihood of receiving: cancer screening, cancer staging information, cancer treatment with curative intent and pain management, compared to those with cancer only. The findings indicate poorer cancer-related clinical outcomes including late diagnosis and higher mortality rates in those with cancer–dementia despite greater health service use.
Conclusions: There is a dearth of good-quality evidence investigating the cancer–dementia prevalence and its implications for successful cancer treatment. Findings suggest that dementia is associated with poorer cancer outcomes although the reasons for this are not yet clear. Further research is needed to better understand the impact of cancer–dementia and enable patients, carers and clinicians to make informed cancer-related decisions.