This report demonstrates that a failure to prevent, diagnose, and treat depression, diabetes and urinary tract infections in people with dementia could be costing the UK’s health and social care system up to nearly £1 billion per year.

‘Dementia and Comorbidities: Ensuring parity of care’, kindly supported by Pfizer, shows that people with dementia are less likely to have cases of depression, diabetes or urinary tract infections diagnosed, and those that do are less likely to receive the same help to manage and treat these comorbidities.

This lack of parity can lead to people’s dementia worsening more quickly leading to greater health and social care costs. ILC-UK demonstrate an annual total net loss of up to approximately £994.4 million for just three conditions:

• £501.7 million for people with dementia and depression
• £377 million for people with dementia and diabetes
• £115.7 million for people with dementia and urinary tract infections

The report also finds that the failure to prevent, diagnose, and treat comorbidities in people with dementia is leading to this group having a reduced quality of life and an earlier death than people who have the same medical conditions, but do not have dementia. It highlights how:

• Hospital in-patients with dementia are over three times more likely to die during their first admission to hospital for an acute medical condition than those without dementia.
• Four of the five most common comorbidities people with dementia are admitted to hospital for in the UK are preventable conditions – a fall, broken/fractured hip or hip replacement, urine infection and chest infection.

The ILC-UK identifies six key areas which appear to be leading to the discrepancy in health outcomes for people with dementia and comorbidities:

1. Atypical symptoms. People with dementia often present atypical symptoms which may lead to carers and medical professionals interpreting these problems as worsening dementia and neglecting other conditions as a potential cause.
2. Communication difficulties between medical professionals/carers and people with dementia, and between medical professional themselves, leading to lower standards of care.
3. A failure by the health system to recognise the individual as a whole, instead focussing on the person as a patient with a given diagnosis, leading to the optimisation of care for dementia while the individual continues to deteriorate because of poor management of a comorbid condition or vice versa.
4. A knowledge gap of hospital staff and carers in caring for people with dementia and comorbidities.
5. Poor medication management relating to how people with dementia’s medications are prescribed, monitored, administered and/or dispensed.
6. A lack of support to aid self-management and poor monitoring of comorbidities by health professionals.

The ILC-UK have set out seven recommendations which will help to ensure that parity occurs:

1. The National Institute for Health and Care Excellence (NICE) must update its condition specific guidelines to take into account the needs of a people with dementia in order to ensure this group receive the same level of care as the rest of the population.
2. Care homes should modify the care plans of residents with dementia to include checklists covering the symptoms of common comorbidities (such as UTIs) to help ensure early diagnosis and treatment.
3. Health professionals must involve people with dementia, their carers and families in every decision about their care to improve both the diagnosis and management of comorbidities.
4. Health Education England should consider broadening its tier one dementia awareness training to include how dementia may affect care for both short and long term conditions.
5. Health trusts should develop comprehensive catheter action plans, based around staff education and training, to reduce the incidence of UTIs in people with dementia through unnecessary catheter usage.
6. The Care Quality Commission (CQC) should consider making it mandatory for care homes to undertake annual check-ups for residents with dementia and diabetes where their blood glucose levels, cholesterol levels and vision are monitored.
7. Clinical Commissioning Groups (CCGs) should commission a wide range of psychological therapies at a suitable capacity to ensure that GPs are not reliant on drugs to treat depression in dementia patients.

Baroness Sally Greengross, Chief Executive of the ILC-UK said:

“It is an absolute scandal that Doctors, nurses and healthcare workers are too often failing to see people living with dementia as more than simply this disease. As such our health system is too often failing to prevent, diagnose, and treat comorbidities among people with dementia. This failure has a devastating impact on quality of life, and results in earlier deaths. A failure to prevent adds avoidable financial pressures to our cash strapped health service.”

Jeremy Hughes, Chief Executive of Alzheimer’s Society, said:

“The reality for many people with dementia is that they have to contend with other long-term conditions, all of which greatly impact their quality of life. As this report highlights, to view dementia in isolation not only makes poor economic sense, but can cause unnecessary suffering. While initiatives to integrate health and social care services are a step in the right direction, it is clear government plans need to go much further to truly meet the needs of people with dementia and other health conditions.”

“Alzheimer’s Society is working with the All Party Parliamentary Group on Dementia to better understand the experiences of people living with dementia and other conditions. Our report is due later this month.”

Roz Schneider, MD Global Patient Affairs Lead at Pfizer said:

“This report clearly highlights disparities in care and health outcomes that are associated with people living with dementia who also have comorbid illnesses. Patients and their caregivers, as well as others in their support community, can provide subtle yet critical insights about medical changes that affect these patient’s lives.  Such a collaborative approach could lessen or avoid the progression of some comorbid conditions. That is why this expanded care community stand ready to partner with healthcare teams in order to advance these important healthcare conversations and care decisions.”

Authors: Jonathan Scrutton and Cesira Urzi Brancati