Principles of action on comorbidity Principle Actions Key partners 1 Promotion of health, wellbeing and prevention However, it can lead to comorbid conditions being under-diagnosed and thus health needs of patients remaining unmet. The fast-changing research literature is summarised in this document in order to aid understanding of the possible mechanisms, symptoms, behaviours and other possible consequences of comorbid and underlying medical conditions in autism, thus enabling improved health care and enhanced quality of life for people with autism. It will take only 2 minutes to fill in. Conversely, the proportion of patients in the dementia group with 3 or more comorbidities increases with age to 23% for the 75 to 79 year olds, but then decreases for the older groups to 15% for those aged 90 years and older. The findings of the activity suggest that for the conditions of interest in this study, the calculated rates from the THIN dataset are either comparable with the QOF data or have known reasons for the variation. Not surprisingly vascular dementia is associated with the cardiovascular conditions, but surprisingly also more associated with respiratory conditions than the other forms of dementia. The prevalence of both asthma and depression are also higher in the THIN dataset because both conditions can be marked as resolved within the records. In determining how to effectively meet the needs of those with multiple and complex health conditions consideration of the specific needs of people living with dementia is appropriate. The data shows that about 70% of in-patient personality disorder cases in the UK are diagnosed in females and 30% in males. Technical Briefing 3: Commonly used public health statistics and their confidence intervals 2008 (viewed August 2019), Scrutton JB. This section looks at the difference in comorbidities by type of dementia diagnosis. Technology Reference data Update Distribution (viewed August 2019) ↩, Madhusoodanan S. Managing psychosis in patients with Alzheimer disease Psychiatric Times 2014 volume 31 (viewed August 2019) ↩, NHS Digital. A diagnosis of stroke or TIA is at least twice as likely in patients with vascular dementia (35%) than in all other forms of dementia. Alzheimer’s Society. Figure 4 below shows that the pattern in prevalence rates of comorbidities across age bands varies considerably for each condition investigated in the study. The rate distribution across age bands for patients with dementia is very similar to the all patient group. This study includes additional neurological conditions (Parkinsonism and epilepsy) and mental health conditions - severe mental illness or psychosis (SMI) - that have a known association with dementia [footnote 5],[footnote 8]. The process for the selection of comorbidities considered in this study was informed by the APPG report, conditions managed in primary care and the availability of data and definitions published through QOF. This study investigated this hypothesis by … Hypertension is diagnosed in more than half of patients. This is important for this work as this group make up the bulk of the population with a recorded dementia diagnosis. The term ‘patients with dementia’ is used throughout this briefing as the analysis is of activity of people with dementia associated with health care provision. This classification is not included in reference material produced by Alzheimer’s society [footnote 9], but is a common occurrence in operational datasets, when insufficient detail is recorded in communication exchanges between practitioners. The Adult Psychiatric Morbidity Survey (APMS) series provides data on the prevalence of psychiatric disorder in the English adult population. Also includes an index of state-level and county-level mortality data available for download. Patients with dementia are more likely to have multiple health conditions. THIN is a registered trademark of Cegedim SA in the United Kingdom and other countries. stream 22% of patients with dementia have 3 or more comorbidities and 8% have 4 or more, compared to 11% and 3% respectively in the all patient group. endobj Read Codes (viewed August 2019) ↩, NHS Digital. The coverage for England is around 2% of practices and 2% of registered patients. More than 15 million people - 30% of the UK population - live with one or more long-term conditions, and more than 4 million of these people will also have a mental health problem. The page included the latest comorbidity data as early as May 8, at that time reporting that 7% of deaths had COVID-19 listed as the sole cause of death ( here ). Dementia rarely travels alone: living with dementia and other conditions 2016 (viewed August 2019) ↩ ↩2, Vision. The findings of this study show that patients with dementia are more likely to have multiple health conditions and thus more likely to have complex health needs when compared to the all patient group. The consequence of this is that by dementia subtype, the proportions found in this study may differ from other published sources. The prevalence for both groups being higher than the respective all patient group (9% versus 7%). A total of 22% with 3 or more comorbidities and 8% with 4 or more comorbidities, compared to 11% and 3% respectively in the all patient group. Implications of comorbidity for primary care costs in the UK. The list of ICD 10 codes above was mapped to the equivalent Read codes using cross mapping files [footnote 7] and reviewed by clinicians to ensure appropriateness of approach. Asthma is more common in females with dementia than males with dementia (9% versus 7%). Quality and Outcomes Framework, Achievement, prevalence and exceptions data (viewed August 2019) ↩ ↩2 ↩3, Prince, M. and others: Dementia UK: Update. {�K��w�����������or��������|��yWk[������!���u�kM�>�5 �}��� �%������f`��`��r��C���9���@��u��L* ��[�sl��V��AOY���׾W�{Kyn����2��r�gɵ�8 �K�ǘת]���؊����e�n�%�`uܧ&X� ��`P7��# ����Y��Y+�8�����P��w#-Gh;h��= d��&L Furthermore, it shows that 22% have 3 or more comorbidities and 2% are living with 5 or more comorbidities considered in the study. Figure 6 shows the comorbidity prevalence rates by dementia type. Tabulated data on provisional COVID-19 deaths by age, sex, race and Hispanic origin, and comorbidities. Scotland, Wales and Northern Ireland all report their own data, which we collect. *5�9��K�n�L.�cC���l����@Q��e�7(i��(�8�`MdIeg� ��>ls�O��MH��a��.�z�]���r���� �t���Od�8����.8��&4>�lxI@��܂����?˂�|��n�m��P ��k���Y5���tL^_��w�� x��W�o�6~/����20+�,�p8 m�� �]�'vc��9>t��G��%N�N(�Z6��I��g��������ϟ�vz�/Ol��F7�ԑ� �?D�F1��u���J��V�����h3����I�� .�� �b�v�1�F���HƪG���6E|��PƓ�-�٪e�I�f�m��b%S q��d0�A� Data presented in figures 5 and 7 related to proportion aggregated from the data source. Therefore, it can be assumed that the analysis for the dementia cohort is reasonably reliable given the data collection caveats around the accurate recording of patient health conditions in primary care health systems. For the 7 remaining health conditions the prevalence in patients with dementia is higher than the all patient group. Dementia rarely travels alone: living with dementia and other conditions 2016 (viewed August 2019), World Health Organisation. Lack of comorbidities. Source: The Health Improvement Network (THIN), NHS Digital. Anxiety: 75.8% comorbidity rate; Attention-Deficit Hyperactivity Disorder: 18.8% comorbidity rate; Depression: 40.7% comorbidity rate; Bipolar Disorder: 23.4% comorbidity rate; Suicide is an important topic to discuss in relation to any mental health disorder. In this analysis patient dementia type has been determined by the most recent diagnosis code on their patient record. Each countries data is calculated from a different source. The epilepsy definition has been amended to include all those with a recorded diagnosis of epilepsy regardless of current treatment status. Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk of … The dataset is based on extracts from GP systems that are taken every 4 months. We’ll send you a link to a feedback form. Figure 1 above shows that 77% of patients with dementia also have a diagnosis for at least one of the comorbidities included in the study. Comorbidities 5 Table 1. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Depression Symptoms Sadness (or irritability, par cularly in children) Hopelessness Lack of interest in school or social ac vi es The THIN dataset contains anonymised records for 21,917 patients aged 65 years and older who have a diagnosis of some form of dementia. A second issue relates to quality of diagnosis. There is a decreasing pattern of prevalence rates across age groups for depression in patients with dementia which is similar to the pattern for the all patient group. Research from Prince [footnote 12] found that male patients are one third more likely to have a diagnosis for vascular dementia than female patients (20% versus 15%). However, there are increases in the proportions identified with hypertension, CHD and stroke or TIA, as age increases. Table 1 below includes the health conditions of interest in this study with the calculated rates and confidence intervals from the THIN dataset. You can change your cookie settings at any time. International Longevity Centre UK 2016 (viewed August 2019), Coronavirus (COVID-19): guidance and support, Transparency and freedom of information releases, stroke or transient ischaemic attack (stroke or. For all conditions except asthma, depression and epilepsy, the THIN calculated rates are very similar to the QOF. For COPD the prevalence in patients with dementia aged the under 80 years is fairly constant and then decreases by age. The APPG report identifies 5 conditions that people with dementia commonly live with that can increase the risk of developing dementia (hypertension, CHD and diabetes) and are associated with dementia (stroke or TIA, depression). Females with dementia have a higher prevalence of depression than that of males with dementia (20% versus 15%), with again the 2 groups having higher rates than their respective all patient groups (9% and 6% respectively). ܓ`��T}ʆC� �,���4�C =��f`88�/%�8y��&�WW�[�ϠŮ��\���=. This analysis is based on data extracted during August 2016. To help us improve GOV.UK, we’d like to know more about your visit today. The second group relates to dementia in other diseases and other degenerative diseases of the nervous system. International Longevity Centre UK 2016 (viewed August 2019) ↩. 11% have a diagnosis of Parkinsonism, 5% have epilepsy and 4% have SMI. We also use cookies set by other sites to help us deliver content from their services. This study found that the proportions of patients with dementia and a diagnosis of SMI, depression, Parkinsonism or epilepsy decreases as age increases. These include conditions which are linked to an increased risk of dementia as well as others which have a known association with dementia, including heart disease, stroke/TIA, and diabetes. are patients with dementia more likely to also have other health conditions than the all patient group? Therefore, in conclusion, the findings of this study support the view that patients with dementia are more likely to have a diagnosis for other health conditions, as considered in this study, when compared with the all patient group. The Charlson comorbidity index predicts the one-year mortality for a patient who may have a range of comorbid conditions, such as heart disease, AIDS, or cancer (a total of 22 conditions). Hypertension (44%) is the most prevalent condition for patients with dementia, which is more than twice as common as diagnoses for diabetes (20%), stroke/TIA (18%), CHD (18%) and depression (17%). The THIN dataset contained anonymised records for 536,738 individuals aged 65 years and older. Also included are the corresponding rates and confidence intervals for England, published through the QOF for comparison. This may lead to the underdiagnoses of some conditions that people living with dementia experience. %PDF-1.5 We aimed to study the association between ethnicity and risk of COVID-19 and adjust it by deprivation and previous comorbidity. Comorbidity means more than one disease or condition is present in the same person at the same time. Source: Bunn F et al (2016). Commissioners and health and care providers may wish to consider the mechanisms they have in place to diagnose, manage and treat the comorbid conditions that people living with dementia experience, particularly those living with more severe dementia. 1 0 obj This briefing shows findings from the analysis of a sample of anonymised primary care records in relation to the prevalence of diagnosed comorbid conditions of patients with a diagnosis of dementia. Cancer related health conditions were also excluded . This is more noticeable amongst females. The target audiences for this briefing are health commissioners and providers of primary care and community services supporting patients with dementia. Patients with vascular dementia are also most likely to have a diagnosis of COPD (13%) and asthma (9%) than those of other dementia types. 5 0 obj The complexity of the support needed by the individual is increased further when the dementia diagnosis itself is included as part of the health care need. In terms of current comorbidity, mood (26.0%) and anxiety (24.5%) were most common. Diabetes (all types) is estimated to affect 1 in 11 adults aged 20 to 79 years, or 415 million adults globally [ 1 ]. The prevalence of stroke or TIA increases with age, although the increase varies less in patients with dementia than the all patient group, due to higher rates in the dementia group. For CHD the peak age is 80 to 84 years with a rate of 21% and for diabetes the peak rate of 22% is in the 75 to 79 years band. Publications related to Coronavirus (COVID-19) Statistical bulletins. 17% of people living with dementia in the UK had diabetes, 18% had experienced a stroke and 17% had a visual impairment. Both groups being higher than the corresponding all patient groups (Figure 3). A total of 77% of patients with dementia also have at least one of the specific health conditions considered in this study. These findings may support the view that comorbid condition diagnosis is more difficult to achieve as severity of dementia increases, in particular when age is a proxy for increased severity. Beyond this age, the proportions with 2 or more comorbidities decreases. 1 in 3 people born in the UK this year will develop dementia in their lifetime. The type of dementia that a patient has does influence the comorbidities they also have diagnoses for. For the remaining 3 conditions, the THIN rates are around 1.5 times larger. Charlson index. International Statistical Classification of Diseases and Related Health Problems 10th Revision 2015 (viewed August 2019) ↩ ↩2, NHS Digital. This is reflected in the findings of the study that the largest disparity in prevalence rates for comorbidities between male patients and female patients are for CHD, diabetes and stroke/TIA. ‘Children with autism spectrum disorders: The importance of medical investigations.’ “Treatment of comorbid medical Page 7 (viewed November 2019), All Party Parliamentary Group on Dementia. BRGP 2013 Apr; 63(609):e274-82 . Patients in age groups 15 to 19 and 35 to 39 are slightly under represented in THIN, whereas those age groups between 45 years to 69 years are slightly over represented. The first group being the dementia types that are Alzheimer’s disease, mixed dementias and unspecified dementia, characterised with 15% to 20% of patients having a diagnosis of diabetes, depression or CHD.