Ulster University

Academic Institute

Economic and Social Research Council

Yes

251

In the United Kingdom, among people aged 65 years and over, the prevalence of dementia is 7.1% and with an ageing population, it has been estimated that there will be over 1 million people living with dementia in the United Kingdom by 2025 (Dementia UK: Update, 2014). In people with dementia, multimorbidity, commonly defined as the presence of two or more chronic conditions, is associated with an accelerated decline in daily function (Melis et al., 2013). Comorbid conditions and polypharmacy (multiple medication use) are common in people with dementia (Browne et al., 2017; Clague et al., 2017). There is some evidence to suggest that people with dementia and other comorbidities have increased health service use. For example, a retrospective cohort study using data on people with dementia from the Clinical Practice Research Datalink (CPRD) (n=4,999) in the United Kingdom found that 91.7% had one or more additional comorbidities (Browne et al., 2017). Furthermore, people (with dementia) with six or more comorbidities had higher rates of primary care consultations, prescriptions, hospitalisations and a higher risk of death (than people (with dementia) with two or three comorbidities) (Browne et al., 2017). Additionally, concerns have been raised by clincians and families about the efficacy of anti-depressant and anti-psychotic medication for the treatment of mood and agitation, respectively, in this population. However, evidence in these areas is limited. The proposed study will contribute to this area of research by investigating patterns in multimorbidity, trends/prevalence of medications and any trends in mortality in people with dementia in Northern Ireland.

This area of research is of importance to Health and Social Care research due to the ageing population and prevalence of dementia. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing and, consequently, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and potentially inappropriate prescribing in this patient cohort. As part of this study, we will examine medications, comorbidities and mortality in people with dementia. There is a lack of evidence-based information on the effect of multiple drugs on such clinically relevant outcomes as functional and cognitive decline, quality of life, adverse events, and mortality. Most research still adopt a disease-oriented approach, which does not take account of the complexity and overlapping health and social problems of elderly patients with dementia. In NI the dementia learning and development framework is provided as a source of information on knowledge and skills for health and social care staff caring for people with dementia (HSC Board, 2016). Part of the knowledge identified in the framework is for the awareness of the needs of people with dementia and other comorbidities (HSC Board, 2016). Furthermore, a section refers to the holistic approach in the management of dementia care including medication use (e.g. polypharmacy, main classes of medication used in dementia care) (HSC Board, 2016). Another section refers to the knowledge and skills needed to support people with dementia, and their families and/or carers, in relation to palliative care and end of life care (HSC Board, 2016). The National Institute for Health and Care Excellence (NICE) guidelines considers comorbidities in dementia. In the NICE guidelines “Dementia: assessment, management and support for people living with dementia and their carers” (NICE Guideline [NG97], June 2018), Section 1.8 is “assessing and managing other long-term conditions in people living with dementia”. Within these guidelines, recommendations are to “ensure that people living with dementia have equivalent access to diagnosis, treatment and care services for comorbidities to people who do not have dementia” (section 1.8.1) (NICE Guideline [NG97], 2018).

21/11/2019

TRE