In addition, we employed extensive lateral search techniques, such as checking reference lists, performing key word searches in Google Scholar and using the ‘cited by’ option in PubMed. An example of the search query for PubMed is given in Table 1. The electronic search strategy was developed by an experienced information scientist with input from the project team. Studies were identified by computerised searches of AMED, Cochrane Library (including CENTRAL, CDSR, DARE, HTA), CINAHL (EBSCO Publishing) (1980 to 2012), PubMed (1950 to 2013), NHS Evidence (searched September 2012) and Scopus (1966 to 2012). We included published and unpublished literature with no date restrictions. We searched for a representative range of material which provided an overview of current knowledge and that identified some key examples of developments in the organisation and delivery of care for people with dementia and comorbid conditions.
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We excluded studies disseminated in languages other than English. In addition, we included non-research items, such as clinical guidelines. We included all study types including systematic reviews, randomised controlled trials (RCTs), controlled studies, observational studies and qualitative studies using any recognisable qualitative methodology. We looked for studies relating to the prevalence of comorbidities in people with dementia or cognitive impairment 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 focused on community dwelling participants and excluded studies in long term care settings. Moreover, they may exacerbate or influence the progression of dementia and management of these conditions in particular, self-management is likely to be complicated by the presence of dementia. These three conditions were chosen because they are common in older people, generally involve some form of external monitoring and require collaboration between primary and secondary care. Although we included all types of comorbidities there was a particular focus on three exemplar comorbid medical conditions diabetes, stroke and visual impairment.
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We included studies involving people with dementia who had an additional comorbid health condition. The aim of this review was to identify the extent, range and nature of research activity relating to dementia and comorbidity, in particular the prevalence of co-morbidity amongst people with dementia, systems and structures that currently exist for the care of people with dementia who have comorbid medical conditions, and the experiences of people with dementia who have comorbid medical conditions and their family carers. There is also a lack of research on patients’ views on the ways in which multiple conditions affect their health, well-being and clinical care. Ī review of qualitative research on the experience of diagnosis and treatment of dementia found very little evidence relating to the experiences of people diagnosed with dementia who have an accompanying comorbid condition. Despite this, little is known about the effects of comorbidity on processes and quality of care, patient experience, or how services are adapting to address the particular needs of this population.
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It may also undermine patients’ abilities to self-manage chronic conditions and engage in health maintenance activities. Moreover, the presence of dementia may adversely affect and complicate the clinical care of other conditions and be a key factor in how patients’ needs are anticipated and specialist and emergency services are used. For example, cognitive decline may be accelerated in older people with type 2 diabetes. Certain comorbid medical conditions may exacerbate the progression of dementia.
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Ĭomorbidity amongst people with dementia presents particular challenges for primary and secondary care. In addition, there is evidence to support an association between the dementia syndrome including Alzheimer’s disease and cardiovascular risk factors, such as hypertension and hypercholesterolaemia. Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. Dementia is primarily a disease of old age and it often coexists with other conditions of old age. By 2050 it has been estimated that this number will rise to more than 115 million. World-wide there are an estimated 35.6 million people with dementia.