Dementia and comorbidities: Ensuring parity of care

This report published by the International Longevity Centre demonstrates that a failure to prevent, diagnose, and treat depression, diabetes and urinary tract infections in people with dementia could be costing the UK’s health and social care system up to nearly £1 billion per year.

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The report shows that people with dementia are less likely to have cases of depression, diabetes or urinary tract infections diagnosed, and those that do are less likely to receive the same help to manage and treat these comorbidities.

The report also finds that the failure to prevent, diagnose, and treat comorbidities in people with dementia is leading to this group having a reduced quality of life and an earlier death than people who have the same medical conditions, but do not have dementia.

The report highlights how hospital in-patients with dementia are over three times more likely to die during their first admission to hospital for an acute medical condition than those without dementia. It also reveals that four of the five most common comorbidities people with dementia are admitted to hospital for in the UK are preventable conditions – a fall, broken/fractured hip or hip replacement, urine infection and chest infection.

The report identifies six key areas which appear to be leading to the discrepancy in health outcomes for people with dementia and comorbidities:

1. Atypical symptoms. People with dementia often present atypical symptoms which may lead to carers and medical professionals interpreting these problems as worsening dementia and neglecting other conditions as a potential cause.
2. Communication difficulties between medical professionals/carers and people with dementia, and between medical professional themselves, leading to lower standards of care.
3. A failure by the health system to recognise the individual as a whole, instead focussing on the person as a patient with a given diagnosis, leading to the optimisation of care for dementia while the individual continues to deteriorate because of poor management of a comorbid condition or vice versa.
4. A knowledge gap of hospital staff and carers in caring for people with dementia and comorbidities.
5. Poor medication management relating to how people with dementia’s medications are prescribed, monitored, administered and/or dispensed.
6. A lack of support to aid self-management and poor 

The report sets out the following recommendations to ensure that parity occurs:

1. The National Institute for Health and Care Excellence (NICE) must update its condition specific guidelines to take into account the needs of a people with dementia in order to ensure this group receive the same level of care as the rest of the population.
2. Care homes should modify the care plans of residents with dementia to include checklists covering the symptoms of common comorbidities (such as UTIs) to help ensure early diagnosis and treatment.
3. Health professionals must involve people with dementia, their carers and families in every decision about their care to improve both the diagnosis and management of comorbidities.
4. Health Education England should consider broadening its tier one dementia awareness training to include how dementia may affect care for both short and long term conditions.
5. Health trusts should develop comprehensive catheter action plans, based around staff education and training, to reduce the incidence of UTIs in people with dementia through unnecessary catheter usage.
6. The Care Quality Commission (CQC) should consider making it mandatory for care homes to undertake annual check-ups for residents with dementia and diabetes where their blood glucose levels, cholesterol levels and vision are monitored.
7. Clinical Commissioning Groups (CCGs) should commission a wide range of psychological therapies at a suitable capacity to ensure that GPs are not reliant on drugs to treat depression in dementia patients.