Blog posts

Dementia, Comorbidity and ICTs
Published on 18 February 2022
Impact of dementia

Dementia figures are alarming. As the WHO warned in September 2021, "more than 55 million people suffer from dementia worldwide, yet only one out of four countries has care plans for them or their families". Moreover, it has been estimated that this figure will reach 78 million in the next ten years. Europe faces a major challenge regarding these patients and their families, as about half of the countries affected by this scenario are European. Healthcare plans, policies and strategies targeted to these patients have become a top priority. In 2019, it was estimated that 1.3 trillion dollars will be spent on the care of these people. The impact of a diagnosis of dementia on the family environment is devastating from an emotional point of view. Added to this emotional burden are the care and expenses associated with disability and dependency. There is a lack of professional advice on self-care strategies, while poor communication and coordination of care services is often the norm. In addition, there is a lack of information about services such as care pathways and support services (1).

Dementia and other health problems

The management of multimorbidity in older adults is complex, and when dementia is added, it becomes even more complicated. Older adults with multimorbidity face a range of physical, social and psychological challenges, with unmet care needs, requiring attention and support in three main areas: social activities and relationships, psychological health, and activities related to mobility, self-care and home life. On average, in dementia patients 4.6 additional chronic diseases are present. Cardiovascular diseases such as hypertension or heart failure, diabetes, chronic kidney disease, or chronic obstructive pulmonary disease, are very frequent in patients with cognitive impairment. The increasing number of older adults with dementia and multimorbidity, the specific challenges of these patients, the association of these conditions with adverse outcomes such as increased mortality (2), disability and frailty (3), hospitalisation with longer hospital stays (4), multiple health care appointments (5), poorer quality of life (6), polypharmacy with increased risk of drug interactions and adverse drug effects (7), and increased healthcare costs and long-term care (8), make research into new integrated healthcare systems essential.

Management of patients with dementia and multimorbidity

Given this scenario, it is urgent to develop strategies that take into account all the needs of these patients and their families. In this sense, information and communication technologies (ICT) may play an outstanding role, with a view to improving the quality of life and autonomy of patients, with the main objective of ensuring that the person remains at home for as long as possible. An example of this is the monitoring of people through ICT in their homes by means of sensors, home automation, locators, etc., which alert and inform about the person's condition as well as adverse events such as falls or other domestic accidents. Moreover, the monitoring of these patients through telemedicine means savings in visits to the health system with cost reductions, improvements in the management of patient information, and improvements in the communication between professionals. All these together, produce a reduction in direct and indirect costs to the healthcare system, and increase the patient's quality of life. The application and use of ICT, as a whole, will enhance the patient-centered care approach based in 4P personalized medicine (predictive, personalized, preventive, and participatory), increasing the quality of healthcare services. When applied to people with dementia and multimorbidity, all these benefits are to be multiplied.

Reference:
  1. Abdi S, Spann A, Borilovic J, et al. Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatr. 2019; 19: 195. doi: 10.1186/s12877-019-1189-9.
  2. Nunes BP, Flores TR, Mielke GI, et al. Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2016; 67: 130-8. doi: 10.1016/j.archger.2016.07.008.
  3. Pivetta NRS, Marincolo JCS, Neri AL, et al. Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship. Arch Gerontol Geriatr. 2020; 86: 103931. doi: 10.1016/j.archger.2019.103931.
  4. Nunes BP, Soares MU, Wachs LS, et al. Hospitalization in older adults: association with multimorbidity, primary health care and private health plan. Rev Saude Publica. 2017; 51: 43. doi: 10.1590/S1518-8787.2017051006646.
  5. Quinaz Romana G, Kislaya I, Cunha Gonçalves S, et al. Healthcare use in patients with multimorbidity. Eur J Public Health. 2020; 30: 16-22. doi: 10.1093/eurpub/ckz118.
  6. 6. Makovski TT, Schmitz S, Zeegers MP, et al. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019; 53: 100903. doi: 10.1016/j.arr.2019.04.005.
  7. 7. Muth C, Blom JW, Smith SM, et al. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med. 2019; 285: 272-88. doi: 10.1111/joim.12842.