People living with dementia usually have one or more other diseases, which can mean they are complex to treat and which may accelerate the progression of their dementia.  A new study, from Dr Duncan Edwards and colleagues at the Primary Care Unit and Universidad Católica, Chile, shows how the use of health care services by people with dementia varies with having additional long-term diseases (comorbidity). The study shows that comorbidity is a key factor that should be considered when allocating resources and planning care for people with dementia.

Using electronic health records from Clinical Practice Research Datalink (CPRD), this study identified 4,999 people recently diagnosed with dementia in the UK and followed them for up to five years. Those with six or more long-term diseases had 31% more primary care consultation, 68% more prescriptions, and 62% more admissions to hospitals compared with those living with only two or three additional diseases.

The study also suggests that almost half (45%) of people diagnosed with dementia in the UK have at least four additional long term diseases, the most common of which were high blood pressure, a chronic painful condition such as arthritis, depression, hearing loss and heart disease.

To our knowledge, this is the first UK based study that informs the degree in which other diseases affects service utilisation among those living with dementia. It provides updated evidence to suggest that the number of comorbidities could be used to inform resource allocation for care services and guide decision-making relating to the type (e.g. palliative care or normal care) and place of dementia care. . The findings of this study should be used to increase awareness of comorbidity in dementia care and to encourage adaptation of services accordingly

– Dr Duncan Edwards

The differences in service utilisation rates identified in this study have significant implications in terms of health service funding, particularly given the increasing prevalence of dementia, which is the second leading cause of mortality in the UK, accounting for 10.3% of deaths in 2014²¹. For example, in females aged 80 to 85 years, those with at least six additional comorbidities had, on average, 18.8 more primary consultations, 134.9 more prescriptions, and 2.1 more hospitalisations during a three year period than those with two or three additional comorbidities. Based on average costs in 2013 for a GP consultation (£45)²², non-elective inpatient stay (£1,489)²³ and net ingredient cost per prescription item (£8.37)²⁴, this excess service utilisation would have represented a estimated cost difference of £5,100 per person over three years.

Notes

Read the paper: Browne et al. Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study. BMJ Open, DOI: 10.1136/bmjopen-2016-012546

Clinical Practice Research Datalink (CPRD) provides anonymous data from electronic health records of 674 primary care practices in the UK and is generally representative of the population as a whole. Dr Duncan Edwards leads CPRD at Cambridge – a multidisciplinary team based in the Primary Care Unit that aims to increase the quantity and quality of CPRD-based research across the university.

Media queries: Lucy Lloyd