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Table 4 Impact of dementia and medical comorbidities on quality of care and access to treatment

From: Comorbidity and dementia: a scoping review of the literature

Study ID Country Comorbidity Study type Number of participants Aspect of quality of care Evidence that care is different? Reported differences in care/treatment
Connolly [92] UK DM, Stroke Cross sectional 700 PWD (compared to people without dementia on QOF register) Monitoring and treatment Yes PWD -significantly lower on 73% of QOF indicators; including peripheral pulses check, neuropathy testing, cholesterol measures for stroke.
Curtis [33] USA VI (AMD) Retrospective cohort 284380 Treatment Yes PWD significantly less likely to receive anti-VEGF RR 0.88 (95% CI 0.88 to 0.89)
Guijarro [45] Spain VI, general Cohort 40482 Treatment Yes PWD had some procedures less frequently than those without dementia. For example,cataract surgery (P <0.001), hernia repair, orthopaedic surgery
Keenan [11] UK VI (AMD) Cohort 65894 (AMD cohort, 168092 dementia cohort) Treatment Yes PWD significant decrease in likelihood of hospital admission for AMD P <0.001
Löppönen [55] Finland VI, general Cross sectional (survey) 1260 older people (112 PWD) Diagnosis and treatment Yes PWD -more undiagnosed diseases compared to those without dementia (P =0.041) , less likely to be diagnosed with glaucoma (P =0.022)
Müther [60] Germany DM, hypertension Retrospective matched control 216 PWD, 216 matched controls Treatment No No significant differences in treatment for those with and without dementia. PWD more likely not to receive medication for hypertension or be treated with low-priced medications (not significant)
Saposnik [66] Canada Stroke Cohort 877 with pre-existing dementia Treatment Yes Patients with pre-existing dementia less likely to receive intravenous thrombolysis.
877 controls (no pre-existing dementia)
Sloan [69] USA Acute MI Cross sectional 5851 admitted for AMI with dementia, 123241 admitted for AMI without dementia Treatment Yes PWD less likely to have a range of invasive procedures compared to those without a history of dementia
Thorpe [74] USA DM, VI Cohort 288805 (44717 PWD) Monitoring Yes PWD less likely to receive HbA1c tests (73% versus 81%), LDL-C tests (61% versus 79%), and eye examinations (52% versus 63%).
Vitry [77] Australia DM Cohort 20134 veterans with diabetes (includes people with dementia/CI but numbers not clear) Treatment Yes Presence of dementia associated with decreased likelihood of treatment intensification (for example, addition of antidiabetic medicine or switch to insulin/different medication)
Zhang [83] Australia DM, VI Cohort 17095 veterans with and without diabetes (4.4% on dementia medication) Treatment, access to services Yes Patients receiving medications prescribed for dementia less likely to use diabetic and optometry/ophthalmology services.
  1. AMD, age-related macular degeneration; AMI, acute myocardial infarction; CI, cognitive impairment; DM, diabetes mellitus; HbA1c, glycosylated hemoglobin; LDL-C, low-density lipoprotein cholesterol PWD, people with dementia; QOF, quality of life; VEGF, vascular endothelial growth factor; VI, visual impairment.