Conclusion: Individuals with OA are more likely to have other chronic conditions. Also includes an index of state-level and county-level mortality data available for download. Mixed dementia with features of more than one type, is now considered to be the commonest type of dementia, especially in older adults [footnote 9]. The figure below also shows that the proportions of patients with dementia with 2 or more comorbidities increases with age for those aged under 85 years of age. Patients with dementia are nearly twice as likely to have 3 or more other specific health conditions and 4 times more likely to have 5 other specific health conditions than the all patient group. Comorbidity also means that interactions between these two disorders can worsen the course of both. Quality and Outcomes Framework (QOF), enhanced services and core contract extraction specifications (business rules) version 34 (viewed March 2017) ↩, Public Health England Neurology Intelligence Network. 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. Parkinsonism is most common in patients with dementia in other diseases and other degenerative disease category. There are many different causes and types of dementia. In 2016, it was the seventh leading cause of death worldwide with an estimated 1.6 million deaths directly caused by diabetes [ 2 ]. Conditions described as comorbidities are often chronic or long-term conditions. However, hypertension has a higher prevalence in the all patient group. Statistics relating to the impact of coronavirus on education, travel and the wider community. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk. Furthermore, when including dementia, 8% of patients with dementia have a diagnosis for 5 or more conditions, over 11 times greater than the all patient group (0.7%). The All Party Parliamentary group (APPG) report from 2016 [footnote 2] suggested almost 7 in 10 people with dementia also have one or more other health condition. Over 77% of patients with dementia are living with at least one further health condition, while 22% are living with at least 3 further conditions. 1 0 obj Methods: Prospective cohort. Diagnoses for depression are equally likely in all forms of dementia (15% to 21%), similar to the prevalence for diabetes (16% to 20%), except in vascular dementia where the prevalence rate is 28%. Technical Briefing 3: Commonly used public health statistics and their confidence intervals 2008 (viewed August 2019), Scrutton JB. In QOF a patient with a resolved code entered on their record later than a diagnosis code would no longer be considered to have the condition, whereas in this THIN analysis, they are included. Wittenberg. This publication is available at https://www.gov.uk/government/publications/dementia-comorbidities-in-patients/dementia-comorbidities-in-patients-data-briefing. 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. The risk of COVID-19 mortality was generally higher for a comorbidity for patients under age 70 than it was for the same comorbidity for patients of all age groups. h�KDk�� vL���et����������8z[�m����k�P��7�^�hi#�J�H�S�̜UA�\U+��Ie�qW����bY�e[���*%8j�Nx�cť���Ҙ71����v�y���o�|%�5�=?MY�U��Z���g/Ł����������O;�0�e^z��EVZ�f(�R�Eg4[�'T+��l�G-�"|@}}H�;�3F��ͼS�=Dh$�.� ‰Sl�SW"�"v%�Z! A second issue relates to quality of diagnosis. Panel 1: Comorbidity: when a person has two or more disorders at the same time or one after the other.This occurs frequently with substance use and mental disorders. Males with dementia have a higher prevalence of COPD than females (11% versus 8%), again with both groups being higher than their respective all patient group (8% and 7% respectively). The definition of Parkinsonism uses a list of ICD10 codes published by PHEs Neurology Intelligence Network (NIN)[footnote 11] and then mapped to Read codes. 5 0 obj 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%). endstream This survey is the fourth in a series and was conducted by NatCen Social Research, in collaboration with the University of Leicester, for NHS Digital. Projections of Older People with Dementia and Costs of Dementia Care in the United Kingdom 2019-2040; Care Policy and Evaluation Centre at London School of Economics and Political Science 2019. The epilepsy definition has been amended to include all those with a recorded diagnosis of epilepsy regardless of current treatment status. Figure 6 shows the comorbidity prevalence rates by dementia type. Technical Briefing 3: Commonly used public health statistics and their confidence intervals 2008 (viewed August 2019) ↩, Scrutton JB. Data presented in figures 5 and 7 related to proportion aggregated from the data source. Background: Accurate prevalence rates of the neurodevelopmental disorders (ND) and comorbid conditions in child and adolescent mental health services (CAMHS) are essential for treatment planning and organization of health care. These health conditions, known as comorbidities, include: The APPG asked that Public Health England (PHE) “do more to provide health and social care commissioners with data on dementia and common comorbidities”. Borderline and Histrionic Personality Disorders are more commonly diagnosed among females while Antisocial, and Obsessive Compulsive Personality Disorder are more commonly diagnosed among males. This dataset was chosen because it is a sample dataset of primary care records that the Dementia Intelligence team at PHE currently have access to. Coronavirus and its social impacts survey, Great Britain Coronavirus and anxiety, 3 … Lack of comorbidities. The pattern in prevalence rates by age for Parkinsonism, epilepsy and SMI in patients with dementia decreases with age. The study investigates 10 specific physical health, mental health and neurological comorbid conditions and compares their rate of prevalence with the all patient group in the dataset. In section 4.4 of this briefing, the representative nature of THIN dataset compared to the England registered patient population in terms of age and sex is discussed. The report notes that "The Joint Mission acknowledges the known challenges and biases of reporting crude CFR early in an epidemic" 2. This study found that the proportions of patients with dementia and a diagnosis of SMI, depression, Parkinsonism or epilepsy decreases as age increases. 4 0 obj However, it can lead to comorbid conditions being under-diagnosed and thus health needs of patients remaining unmet. The THIN dataset contains anonymised records for 21,917 patients aged 65 years and older who have a diagnosis of some form of dementia. <> For the comorbidities that can increase the risk of dementia, the prevalence rates peak before the oldest age group. For the 2 physical conditions (respiratory conditions) considered in the study it was found that patients with dementia have a higher prevalence of COPD. Dementia and comorbidities: ensuring parity of care. Source: The Health Improvement Network (THIN), NHS Digital. This compares to 68% in the all patient group for the same list of health conditions (excluding dementia). dementia in other diseases (F02) such as Parkinson’s disease or Pick disease, other degenerative diseases of the nervous system (G31). 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. are patients with dementia more likely to also have other health conditions than the all patient group? 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 suggests that the proportion is close to 8 in 10, rather than the 7 in 10 quoted in the APPG report. For this study, a statistic is considered significantly different from its comparator if the corresponding CIs are not overlapping. The proportions in the older 2 age groups increase again, with 23% of the 90 years and older having no other recorded comorbid condition. International Statistical Classification of Diseases and Related Health Problems 10th Revision 2015 (viewed August 2019) ↩, World Health Organisation. Hypertension is diagnosed in more than half of patients. <>>> However, no assessment has been made in relation to the ethnicity of patients or the level of social deprivation in which the patient resides. This study shows that the prevalence rates for the individual specific health conditions are generally higher among patients with dementia than the all patient group in the THIN dataset (Figure 2). A diagnosis of Alzheimer’s disease accounts for 38% of those patients with dementia, with 25% having a diagnosis of vascular dementia, 3% have mixed dementias, while 29% of the cohort have an unspecified type of dementia recorded in the primary care record. Background: Recent data suggest higher COVID-19 rates and severity in Black, Asian, and minority ethnic (BAME) communities. They are nearly twice as likely to have 3 or more other specific health conditions and 4 times more likely to have 5 other specific health conditions than the all patient group. The pattern in the all patient group is different as it increases to a peak in the 75 to 79 years age band and then decreases with age. The prevalence of hypertension of females with dementia is lower than that of the all patient group. Comorbid conditions may be markers for underlying pathophysiology and request a more varied treatment approach.” Isaksen et al 2012. Lifetime-wise, mood (54.2%), anxiety (37.1%), and substance use (24.8%) disorders were most common. The THIN dataset contained anonymised records for 536,738 individuals aged 65 years and older. International Statistical Classification of Diseases and Related Health Problems 10th Revision 2015 (viewed August 2019), NHS Digital. comorbidity, difficulties with diagnosis including diagnostic overshadowing, and the lack of a good theoretical model of the association between severe mental illness and substance misuse, mean that it is still unclear how many people in the UK have a severe mental illness and comorbid … The prevalence rate in the England population is 4.3% for the comparable period [footnote 12]. Quality and Outcomes Framework, Achievement, prevalence and exceptions data (viewed August 2019), Prince, M. and others: Dementia UK: Update. 7 Brilleman et al. 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. Lifetime comorbidities were found to be comparable to those found in the ECA. The prevalence rates are calculated using the standardised counts of those with a diagnosis of a specific condition recorded in the data source for both the patients with dementia and the all patient group and then divided by the corresponding standardised cohort count. A hypothesis of the network perspective on psychopathology is that comorbidity arises due to the interplay of symptoms shared by both disorders, with overlapping symptoms acting as so-called bridges, funneling symptom activation between symptom clusters of each disorder. 2 0 obj 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. For more information, please contact MHDNIN@phe.gov.uk. For all other conditions in this group there was no difference between the rates for males and females and the dementia groups have higher rates than their respective all patient groups. This study found that hypertension was the most common other comorbidity that patients with dementia have a diagnosis for (44%). Comorbidities 5 Table 1. Overall patients with any type of dementia have high prevalence rates of hypertension, with rates ranging from 34% in those with dementia in other diseases, to 55% in those with vascular dementia. 3 0 obj The third group is vascular dementia. Aim To provide an overview of frequent disease combinations of one and two additional chronic diseases and groups among patients with cardiovascular disease (CVD) in general practice. The findings of this study 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. {�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 International Statistical Classification of Diseases and Related Health Problems 10th Revision 2015 (viewed August 2019) ↩ ↩2, NHS Digital. The prevalence of type 2 diabetes (T2DM) is increasing in the UK and internationally. For COPD the prevalence in patients with dementia aged the under 80 years is fairly constant and then decreases by age. This type of dementia has a unique pattern of comorbidities with high prevalence rates in excess of 25% for the cardiovascular conditions of stroke/TIA, diabetes and CHD. In a study of 2447 children and adolescents (aged 5–17 years) with ≥1 psychiatric disorder(s), 650 (27%) were diagnosed only with ADHD and 401 (16%) only with another psychiatric disorder, while 1396 (57%) had ≥2 psychiatric disorders (1269 [66%] also had ADHD).7 In a cross-sectional study of ADHD prevalence amongst 1986 adult psychiatric outpatients across Europe, the overall prevalence of Diagnostic and Statistical Manual o… %���� However, the proportion of patients with dementia remains higher than the all patient group, with the difference in the proportion increasing as the number of comorbidities increases. In addition to the comorbidities analysed in this study, the patients included in the dementia group are also living with dementia. This compares with 68% in the all patient group, for the same list of health conditions (Figure 1). The target audiences for this briefing are health commissioners and providers of primary care and community services supporting patients with dementia. However, valid and reliable prevalence estimates from Nordic CAMHS populations are scarce, and the published findings vary. Dementia rarely travels alone: living with dementia and other conditions 2016 (viewed August 2019) ↩ ↩2, Vision. 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. These findings are available and presented at a national level with the intention that they are then interpreted to inform a local assessment of the needs of patients with dementia and the provision of health and care services. The key comorbidities associated with OA were stroke (PR 2.61 [95% CI 2.13-3.21]), peptic ulcer (PR 2.36 [95% CI 1.71-3.27]), and metabolic syndrome (PR 1.94 [95% CI 1.21-3.12]). The health conditions investigated in this study are dementia specific comorbidities categorised into 2 groups. The coverage for England is around 2% of practices and 2% of registered patients. Historically speaking, OCD has been considered low for suicide risk. 1 People with long-term physical conditions are more likely to have lower wellbeing scores than those without. Although hypertension is the most common comorbidity for patients with dementia, the age standardised rate is greater in the all patients group (44% versus 47%). Source: Bunn F et al (2016). 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. In the patient with dementia group, 65% are female and 35% are males, 88% are aged 75 years and older and 12% are between 65 years and 74 years of age. The number of people living with dementia in the UK is estimated to be around 850,000 and set to increase, with figures anticipated to reach over one million by 2025 [footnote 1]. Other sources have indicated that mixed dementias are more common for those in older age groups [footnote 9]. 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. For hypertension the rates peak in the age band of 85 to 89 years, at 55%. As stated earlier, in this study 38% of the patients with dementia have a recorded diagnosis of Alzheimer’s disease, 25% have a diagnosis of vascular dementia, 3% have mixed dementias, while 29% of the cohort have an unspecified type of dementia recorded in the primary care record. 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. For 5 of the study comorbidities the rates calculated from the THIN dataset are above the corresponding QOF values and for 5 other conditions, they are below the rate. We’d like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. Read Codes (viewed August 2019) ↩, NHS Digital. are patients with dementia more likely to have multiple health conditions than the all patient group? 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. Patients with dementia are more likely to have multiple health conditions. However, for rates of hypertension, there is no difference between males and females with dementia, and there is no difference between the 2 male groups. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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). endobj Among those with a 12 month diagnosis of any substance use disorder, 36% had at least one anxiety disorder whilst … Overall, 23% of patients in the dementia group do not have any other health condition considered in this study. For the 7 remaining health conditions the prevalence in patients with dementia is higher than the all patient group. Page 35 (viewed August 2019), APHO. The NHS Health Check can detect early signs of these conditions and also can reduce the risk of these conditions developing for those aged 40 to 74 years of age. Diabetes (all types) is estimated to affect 1 in 11 adults aged 20 to 79 years, or 415 million adults globally [ 1 ]. The findings of this study support the APPG conclusion that a large proportion of patients with dementia live with other health conditions. It asks: The study cohort (patients with dementia) are those patients who have primary care records in THIN dataset, aged 65 years and older and that have a diagnosis for the following forms of dementia recorded (including International Classification of Diseases ICD 2010 codes [footnote 4]): Primary care record systems use Read codes [footnote 6] to record patient activity. The dataset is based on extracts from GP systems that are taken every 4 months. 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. This may lead to the underdiagnoses of some conditions that people living with dementia experience. Alzheimer’s Society. International Longevity Centre UK 2016 (viewed August 2019) ↩. It is not always possible to determine the true diagnosis of dementia or dementias for an individual without an autopsy of brain tissue. Comorbidity between depressive and anxiety disorders is common. 2 <> Each countries data is calculated from a different source. This analysis is based on data extracted during August 2016. 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. 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. 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. Cancer related health conditions were also excluded . 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. With the comorbidities associated with dementia, there are 2 very different patterns associated with age. The proportion of patients aged 85 years and older with 2 or more other health conditions recorded in the primary care notes is lower than the proportion in age groups under 85 years. The data shows that about 70% of in-patient personality disorder cases in the UK are diagnosed in females and 30% in males. In conclusion, the differing types of dementia do lead to different patterns of comorbidities being diagnosed. 1 in 3 people born in the UK this year will develop dementia in their lifetime. %PDF-1.5 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. The findings in this study are dependent on how data on patient activity is recorded on primary care systems. These findings are available and presented at a national level with the intention that they are then interpreted to inform a local assessment of the need… 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%). stream 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. We also use cookies set by other sites to help us deliver content from their services. It is not easily possible to validate the findings of this study in terms of the prevalence rates of comorbidities in patients with dementia. For all the above conditions, except for Parkinsonism, definitions are available from the Quality and Outcomes Framework (QOF) business rules [footnote 10]. There are two sources that provide age, sex, and comorbidity statistics: 1. In terms of current comorbidity, mood (26.0%) and anxiety (24.5%) were most common. It will take only 2 minutes to fill in. Patients with dementia are also more likely to have COPD (9%) than the all patient group (8%). Primary dementias include: dementia due to Alzheimer’s disease, vascular dementia, dementia with Lewy bodies and frontotemporal dementia (9). By age group, the largest proportion of patients with no other health condition, are aged under 74 years of age, with the proportion decreasing to 20% for the 80 to 84 year olds. This study used the THIN dataset to investigate the issues raised by the APPG. Implications of comorbidity for primary care costs in the UK. 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. ܓ`��T}ʆC� �,���4�C =��f`88�/%�8y��&�WW�[�ϠŮ��\���=. For the remaining 3 conditions, the THIN rates are around 1.5 times larger. In mental health, one of the more common comorbidities is that of depression and anxiety . This group is characterised by a high prevalence of Parkinsonism (above 40%) in addition to the high prevalence of hypertension. Depression Symptoms Sadness (or irritability, par cularly in children) Hopelessness Lack of interest in school or social ac vi es 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. The type of dementia that a patient has does influence the comorbidities they also have diagnoses for. However, there are increases in the proportions identified with hypertension, CHD and stroke or TIA, as age increases. Beyond this age, the proportions with 2 or more comorbidities decreases. The prevalence of any current (12 month) diagnosis was 29.5% ( Kessler et al., 1994 ). The prevalence rate for dementia in the THIN dataset is between 4% and 4.1%. Respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) are also part of the study as general physical health comparators. People living with dementia are more likely to have complex health needs. REPORT: Over 95% of UK “Covid19” deaths had “pre-existing condition” Latest statistics show vast majority of fatalities had at least one other disease Editor Over 95% of “COVID Deaths” recorded in England and Wales had potentially serious comorbidities, according to statistics released by … However, the proportion decreases with age for those aged 85 years and older. Projections of Older People with Dementia and Costs of Dementia Care in the United Kingdom 2019-2040; Care Policy and Evaluation Centre at London School of Economics and Political Science 2019. *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�� However, it is possible to benchmark the calculated prevalence rates for the individual comorbid conditions from the THIN all patient group with the Quality Outcomes Framework. We aimed to study the association between ethnicity and risk of COVID-19 and adjust it by deprivation and previous comorbidity. The study found that the proportion of patients with multiple health conditions increases with age for patients with dementia under the age of 85 years. ADHD and Comorbid Condi ons ADHD and Comorbid Condi ons More than two‐thirds of individuals with ADHD have at least one other coexis ng condi on. This study was focussed on the analysis and interpretation of the sample primary care dataset (THIN). comorbidity definition: 1. the fact that people who have a disease or condition also have one or more other diseases or…. 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). THIN is a registered trademark of Cegedim SA in the United Kingdom and other countries. stream For epilepsy and SMI the prevalence rate across all ages remains constant, while for Parkinsonism the prevalence rate peaks at 80 to 84 years. Comorbidity means more than one disease or condition is present in the same person at the same time. 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. A paper by the Chinese CCDC released on Feb. 17, which is based on72,314 confirmed, suspected, and asymptomatic cases of COVID-19 in China as of Feb. 11, and was … Defining adult neurological conditions 2016 (viewed August 2019) ↩, NHS Digital. endobj 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.
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