Comorbidity Profile of Dementia Patients in Primary Care: Are They Sicker?
Cathy C. Schubert MD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorMalaz Boustani MD, MPH
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorChristopher M. Callahan MD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorAnthony J. Perkins MS
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorCaroline P. Carney MD, MSc
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorChristopher Fox MBBS, BSc
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorFrederick Unverzagt PhD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorSiu Hui PhD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorHugh C. Hendrie MB, ChB, DSc
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorCathy C. Schubert MD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorMalaz Boustani MD, MPH
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorChristopher M. Callahan MD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorAnthony J. Perkins MS
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorCaroline P. Carney MD, MSc
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorChristopher Fox MBBS, BSc
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorFrederick Unverzagt PhD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorSiu Hui PhD
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorHugh C. Hendrie MB, ChB, DSc
From the Departments of * Medicine † Psychiatry, ‡ Indiana University Center for Aging Research, and § Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Indiana ∥ Kent Institute of Medicine, University of Kent, Canterbury, United Kingdom
Search for more papers by this authorSupported by Grant R01HS10884-01 from the Agency for Healthcare Research and Quality.
Abstract
OBJECTIVES: To compare the medical comorbidity of older patients with and without dementia in primary care.
DESIGN: Cross-sectional study.
SETTING: Wishard Health Services, which includes a university-affiliated, urban public hospital and seven community-based primary care practice centers in Indianapolis.
PARTICIPANTS: Three thousand thirteen patients aged 65 and older attending seven primary care centers in Indianapolis, Indiana.
MEASUREMENTS: An expert panel diagnosed dementia using International Classification of Diseases, 10th Revision, criteria. Comorbidity was assessed using 10 physician-diagnosed chronic comorbid conditions and the Chronic Disease Score (CDS).
RESULTS: Patients with dementia attending primary care have on average 2.4 chronic conditions and receive 5.1 medications. Approximately 50% of dementia patients in this setting are exposed to at least one anticholinergic medication, and 20% are prescribed at least one psychotropic medication. After adjusting for patients' age, race, and sex, patients with and without dementia have a similar level of comorbidity (mean number of chronic medical conditions, 2.4 vs 2.3, P=.66; average CDS, 5.8 vs 6.2, P=.83).
CONCLUSION: Multiple medical comorbid conditions are common in older adults with and without dementia in primary care. Despite their cholinergic deficit, a substantial proportion of patients with dementia are exposed to anticholinergic medications. Models of care that incorporate this medical complexity are needed to improve the treatment of dementia in primary care.
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