... with people who are managing multiple health conditions in work. Evidence from the existing literature found a higher risk of comorbidity for specific groups, such as older workers, those from low socio-economic backgrounds and for women. Analysis of data from the Health Survey found that people with two or more long-term health conditions are: less likely to be in employment; are more likely to be doing
(Edited publisher abstract)
This report examines the effect of multiple long term conditions on employment and looks at ‘what works’ in terms of managing and supporting people to remain, and to be productive, in work. The report draws evidence from the literature, analysis of data from the Health Survey for England 2013 which covered people of working age with at least two long-term health conditions, and interviews with people who are managing multiple health conditions in work. Evidence from the existing literature found a higher risk of comorbidity for specific groups, such as older workers, those from low socio-economic backgrounds and for women. Analysis of data from the Health Survey found that people with two or more long-term health conditions are: less likely to be in employment; are more likely to be doing unskilled work; and likely to have lower levels of job satisfaction. Musculoskeletal disorders and mental health problems were also found to have a substantial impact on employment outcomes. In terms of support, the report found that adjustments by employers, such as changes in working hours or break patterns; support provided by GPs and Occupational Health Services were found to be helpful for staff retention. The report makes recommendations focused on improving the prevention, recognition and management of multiple long term conditions during working age, and particularly in the working population. These include recommendations for individuals, employers, the health sector and government.
(Edited publisher abstract)
Subject terms:
comorbidity, employment, health needs, long term conditions, mental health problems, physical illness, intervention;
Aging and Mental Health, 20(11), 2016, pp.131-1138.
Publisher:
Taylor and Francis
... with a higher GAI score.
Conclusion: Anxiety is common in geriatric psychiatric patients, regardless of the primary diagnosis. The findings suggest that anxiety is often a hidden comorbidity in various psychiatric disorders. A high score on the GAI was associated with the severity of depression, female gender and the use of antipsychotic and anxiolytic drugs.
(Edited publisher abstract)
Objectives: The authors' aims were to explore prevalence of anxiety among patients admitted to departments of geriatric psychiatry for treatment of various diagnoses and to examine how often anxiety was registered as a previous or ongoing diagnosis.
Method: In all, 473 patients admitted to one of five departments of geriatric psychiatry were included in a quality register and examined according to a standardised protocol. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety during the first week after admission. Diagnoses were made at discharge.
Results: Using a cutoff on the GAI of 8/9, the prevalence of anxiety for the following diagnostic groups was depression 65.3%, psychosis 28%, dementia 38.8% and mania 33.3%. Of 24 patients with a primary diagnosis of anxiety, 66.7% scored above 8 on the GAI. Of 236 patients with a GAI score above 8, only 22 (9.3%) were reported to have a comorbid anxiety disorder by the treating psychiatrist. In a multiple regression analysis, we found that the severity of depression (beta 0.585, p < 0.001), being female (beta 0.096, p 0.028) and the use of antipsychotic drugs (beta 0.129, p 0.006) and anxiolytic drugs (beta 0.129, p 0.005) were associated with a higher GAI score.
Conclusion: Anxiety is common in geriatric psychiatric patients, regardless of the primary diagnosis. The findings suggest that anxiety is often a hidden comorbidity in various psychiatric disorders. A high score on the GAI was associated with the severity of depression, female gender and the use of antipsychotic and anxiolytic drugs.
(Edited publisher abstract)
Subject terms:
anxiety, older people, psychiatry, mental health problems, comorbidity, depression;
DEMENTIA INTELLIGENCE NETWORK, NATIONAL END OF LIFE CARE INTELLIGENCE NETWORK
Publisher:
Public Health England
Publication year:
2016
Pagination:
12
Place of publication:
London
Briefing paper which draws on national data to illustrate key information related to people who died with dementia in 2012-14. It focusses on the setting and circumstances of death, and presents figures on the relationship between deprivation and age for dementia deaths, place of death, and comorbidities for people who have died with dementia. It also provides recommendations to help deliver high-quality palliative care to people with end-of-life dementia, which include focusing on dementia specific palliative services, improving the adoption and quality of advanced care planning and advocating GP led holistic reviews for more co-ordinated care. It reports an increase in mortality rate for deaths with a mention of dementia from 2001 to 2014 and found that over half of dementia deaths for people aged 65 years and above occurred in care homes, compared with a quarter of the general population.
(Edited publisher abstract)
Briefing paper which draws on national data to illustrate key information related to people who died with dementia in 2012-14. It focusses on the setting and circumstances of death, and presents figures on the relationship between deprivation and age for dementia deaths, place of death, and comorbidities for people who have died with dementia. It also provides recommendations to help deliver high-quality palliative care to people with end-of-life dementia, which include focusing on dementia specific palliative services, improving the adoption and quality of advanced care planning and advocating GP led holistic reviews for more co-ordinated care. It reports an increase in mortality rate for deaths with a mention of dementia from 2001 to 2014 and found that over half of dementia deaths for people aged 65 years and above occurred in care homes, compared with a quarter of the general population.
(Edited publisher abstract)
Subject terms:
dementia, death, poverty, comorbidity, end of life care, dying;
DEMENTIA INTELLIGENCE NETWORK, NATIONAL END OF LIFE CARE INTELLIGENCE NETWORK
Publisher:
Public Health England
Publication year:
2016
Pagination:
34
Place of publication:
London
Drawing on an analysis of national data, this report provides information on people who have died with a recorded mention of dementia in England. It covers how trends have changed over time, the geographical distribution of deaths with a mention of dementia, demographics of people who have died with dementia, the place of death and the comorbidities recorded on the death certificate. The report is aimed at health and social care commissioners involved in end of life care services to help improve the quality of end-of-life care for people with dementia. The findings suggest that people who live in more deprived areas die with dementia at a younger age than those with dementia who live in more affluent areas. The also data shows that people with dementia are more likely to die in hospitals and care homes and less likely to die at home or in end of life care settings such as hospices. Limitations of the data are also noted, as the analysis is restricted to deaths where dementia was recorded a significant contributory factor, so likely to be an underestimate.
(Edited publisher abstract)
Drawing on an analysis of national data, this report provides information on people who have died with a recorded mention of dementia in England. It covers how trends have changed over time, the geographical distribution of deaths with a mention of dementia, demographics of people who have died with dementia, the place of death and the comorbidities recorded on the death certificate. The report is aimed at health and social care commissioners involved in end of life care services to help improve the quality of end-of-life care for people with dementia. The findings suggest that people who live in more deprived areas die with dementia at a younger age than those with dementia who live in more affluent areas. The also data shows that people with dementia are more likely to die in hospitals and care homes and less likely to die at home or in end of life care settings such as hospices. Limitations of the data are also noted, as the analysis is restricted to deaths where dementia was recorded a significant contributory factor, so likely to be an underestimate.
(Edited publisher abstract)
Subject terms:
death, dying, dementia, end of life care, poverty, comorbidity;
Final report of the Westminster Commission on Autism into the access to health care for people with autism which was chaired by Barry Sheerman MP. The report aims to highlight what good quality, person centred healthcare, tailored to the needs of those on the autistic spectrum, can achieve and calls for equal access to quality healthcare for all on the autistic spectrum. The report follows a seven-month inquiry and a consultation of over 900 people. The Commission collected evidence through four oral evidence sessions in the Houses of Parliament and through written submissions, telephone interviews, and 863 survey response from autistic people and parent-advocates. The inquiry identified seven main obstacles that people with autism encounter when accessing health care. These were: lack of understanding; autism and co-occurring conditions; co-occurring mental health issues; diagnostic overshadowing; sensory processing and communication; isolation, avoidance and neglect; and leadership. It also highlights the need for improvement in training and commissioning. The report makes six key recommendations to help improve access, these cover: training, inspection, data collection, annual health checks, leadership and the development of resources to help people with autism access health care services.
(Edited publisher abstract)
Final report of the Westminster Commission on Autism into the access to health care for people with autism which was chaired by Barry Sheerman MP. The report aims to highlight what good quality, person centred healthcare, tailored to the needs of those on the autistic spectrum, can achieve and calls for equal access to quality healthcare for all on the autistic spectrum. The report follows a seven-month inquiry and a consultation of over 900 people. The Commission collected evidence through four oral evidence sessions in the Houses of Parliament and through written submissions, telephone interviews, and 863 survey response from autistic people and parent-advocates. The inquiry identified seven main obstacles that people with autism encounter when accessing health care. These were: lack of understanding; autism and co-occurring conditions; co-occurring mental health issues; diagnostic overshadowing; sensory processing and communication; isolation, avoidance and neglect; and leadership. It also highlights the need for improvement in training and commissioning. The report makes six key recommendations to help improve access, these cover: training, inspection, data collection, annual health checks, leadership and the development of resources to help people with autism access health care services.
(Edited publisher abstract)
Subject terms:
health care, access to services, autistic spectrum conditions, autism, comorbidity, user views, consultation;
Report of the All Party Parliamentary Group on Dementia which looks at the challenges facing people living with dementia and other conditions, the prevalence of co-morbidities, and the changes that are needed across the health and social care system to help mitigate these difficulties. The report draws on 30 evidence submissions received from a range of organisations, including voluntary organisations, the Royal colleges, practitioners, and service providers and two focus groups held by the Alzheimer’s with people with dementia and carers. The report found that despite significant progress to deliver integrated care services and support, the health and social system frequently treats conditions in isolation so that people with dementia and other health conditions receive disjointed, substandard care and treatment. It makes a number of recommendations grouped into the following themes: improved risk reduction, GP-led holistic annual reviews, new guidance for medication management, better data for joint commissioning, and regulation of care pathways as well as providers.
(Edited publisher abstract)
Report of the All Party Parliamentary Group on Dementia which looks at the challenges facing people living with dementia and other conditions, the prevalence of co-morbidities, and the changes that are needed across the health and social care system to help mitigate these difficulties. The report draws on 30 evidence submissions received from a range of organisations, including voluntary organisations, the Royal colleges, practitioners, and service providers and two focus groups held by the Alzheimer’s with people with dementia and carers. The report found that despite significant progress to deliver integrated care services and support, the health and social system frequently treats conditions in isolation so that people with dementia and other health conditions receive disjointed, substandard care and treatment. It makes a number of recommendations grouped into the following themes: improved risk reduction, GP-led holistic annual reviews, new guidance for medication management, better data for joint commissioning, and regulation of care pathways as well as providers.
(Edited publisher abstract)
Subject terms:
dementia, comorbidity, long term conditions, integrated care, joint commissioning, health care;
London School of Economics and Political Science. Personal Social Services Research Unit
Publication year:
2016
Pagination:
20
Place of publication:
London
Summarises evidence on the likely impact that an ageing population will have on end of life care costs and how this could influence future health and social care costs within the UK. Key findings from the review include: population ageing is likely to increase acute care expenditures moderately, and more strongly increase expenditures in long-term and social care; multi-morbidity and dementia are highly associated with increased health expenditure at end of life, and that prioritising medical innovations that improve quality of life and functioning at end of life, and assisting individuals to remain living at home, have the greatest potential to lead to cost savings. Following the evidence review, three end of life interventions are described which have the potential to reduce health expenditures and some of the rising costs of an ageing population. These are palliative care teams, advance care planning, and care integration for individuals with multi-morbidity. It concludes that the cost of population ageing at end of life would be a greater concern if the health and social care system failed to adapt to the needs of an older and more complex patient cohort.
(Edited publisher abstract)
Summarises evidence on the likely impact that an ageing population will have on end of life care costs and how this could influence future health and social care costs within the UK. Key findings from the review include: population ageing is likely to increase acute care expenditures moderately, and more strongly increase expenditures in long-term and social care; multi-morbidity and dementia are highly associated with increased health expenditure at end of life, and that prioritising medical innovations that improve quality of life and functioning at end of life, and assisting individuals to remain living at home, have the greatest potential to lead to cost savings. Following the evidence review, three end of life interventions are described which have the potential to reduce health expenditures and some of the rising costs of an ageing population. These are palliative care teams, advance care planning, and care integration for individuals with multi-morbidity. It concludes that the cost of population ageing at end of life would be a greater concern if the health and social care system failed to adapt to the needs of an older and more complex patient cohort.
(Edited publisher abstract)
Subject terms:
literature reviews, ageing, end of life care, costs, comorbidity, complex needs, older people, public expenditure;
Health and Social Care Delivery Research, 4(8), 2016, Online only
Publisher:
National Institute for Health Research
Place of publication:
London
Objectives: This study aims to explore the impact of dementia on access to non-dementia health care services and identify ways of improving the integration of services for this population.
Design: The study involved a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. The qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.
(Edited publisher abstract)
Objectives: This study aims to explore the impact of dementia on access to non-dementia health care services and identify ways of improving the integration of services for this population.
Design: The study involved a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). It focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.
Participants: The study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.
Results: The scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. The qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Examples of good practice tended to be about the behaviour of individual practitioners rather than system-based approaches. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.
Conclusions: Significant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.
(Edited publisher abstract)
Subject terms:
comorbidity, dementia, health needs, access to services, health care, carers, health professionals, integrated care, user views, continuity of care;
This report, supported by Pfizer, highlights the disparities in care and health outcomes that are associated with people living with dementia who also have comorbid illnesses. Informed by a systematic review of both academic and grey literature the report looks at how a diagnosis of dementia can affect the prevention, diagnosis, treatment and management of co-existing conditions. It also looks at the reasons for the differences in healthcare outcomes for people with dementia. The report finds that this lack of parity in care results in an increased risk of early mortality for people with dementia, increased costs of health care, and comorbid conditions only being detected once they become severe. It identifies six key areas which lead to the discrepancy in health outcomes for people with dementia and comorbidities: atypical symptoms, communication difficulties, a failure by the health system to recognise the individual as a whole, a knowledge gap of hospital staff and carers in caring for people with dementia and comorbidities, poor medical management, a lack of support to aid self-management and poor monitoring of comorbidities by health professionals. The final section of the report looks at how having dementia may affect the prevention, diagnosis, treatment and management of specific three conditions: depression, diabetes, and urinary tract infections. Illustrative ‘good’ care stories for each. It sets out seven recommendations to help ensure the parity of care for people with dementia and comorbidities.
(Edited publisher abstract)
This report, supported by Pfizer, highlights the disparities in care and health outcomes that are associated with people living with dementia who also have comorbid illnesses. Informed by a systematic review of both academic and grey literature the report looks at how a diagnosis of dementia can affect the prevention, diagnosis, treatment and management of co-existing conditions. It also looks at the reasons for the differences in healthcare outcomes for people with dementia. The report finds that this lack of parity in care results in an increased risk of early mortality for people with dementia, increased costs of health care, and comorbid conditions only being detected once they become severe. It identifies six key areas which lead to the discrepancy in health outcomes for people with dementia and comorbidities: atypical symptoms, communication difficulties, a failure by the health system to recognise the individual as a whole, a knowledge gap of hospital staff and carers in caring for people with dementia and comorbidities, poor medical management, a lack of support to aid self-management and poor monitoring of comorbidities by health professionals. The final section of the report looks at how having dementia may affect the prevention, diagnosis, treatment and management of specific three conditions: depression, diabetes, and urinary tract infections. Illustrative ‘good’ care stories for each. It sets out seven recommendations to help ensure the parity of care for people with dementia and comorbidities.
(Edited publisher abstract)
Subject terms:
dementia, comorbidity, long term conditions, health inequalities, health care, depression, costs, diabetes, diagnosis;
... and self-harm, and comorbidity in mental and physical illness. Trends identified include: an increase in the numbers of women with common mental health disorders, with numbers in men remaining largely stable; young women emerging as a high-risk group, with high rates of common mental health disorders and self-harm. Most mental disorders were also more common in people living alone, people with poor physical
(Edited publisher abstract)
The fourth survey of the mental health of adults living in private households in England, which are carried out every seven years using a large representative sample of 7,500 people, including those who do not access services. The report presents estimates on prevalence and trends in mental health conditions and contains information on age, sex, ethnicity, employment and benefit status, region, household composition, and the level and nature of mental health treatment and service use. Chapters cover common mental health disorders, mental health treatment and service users, post-traumatic stress disorder, psychotic disorder, autistic spectrum disorder, personality disorder, attention-deficit/hyperactivity disorder, bipolar disorder, alcohol dependence, drug use and dependence, suicide attempts and self-harm, and comorbidity in mental and physical illness. Trends identified include: an increase in the numbers of women with common mental health disorders, with numbers in men remaining largely stable; young women emerging as a high-risk group, with high rates of common mental health disorders and self-harm. Most mental disorders were also more common in people living alone, people with poor physical health, and the unemployed.
(Edited publisher abstract)
Subject terms:
surveys, mental health problems, comorbidity, self-harm, substance misuse, bipolar disorder, post traumatic stress disorder, autistic spectrum conditions, attempted suicide, personality disorders, mental health services, service uptake, health inequalities;