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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.