Comorbidity profile of dementia patients in primary care: are they sicker?
OBJECTIVE
To compare the medical comorbidity of older patients with and without dementia in primary care.


METHODS
Cross-sectional study.


METHODS
Wishard Health Services, which includes a university-affiliated, urban public hospital and seven community-based primary care practice centers in Indianapolis.


METHODS
Three thousand thirteen patients aged 65 and older attending seven primary care centers in Indianapolis, Indiana.


METHODS
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).


CONCLUSIONS
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.
Schubert
Cathy C
CC
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Boustani
Malaz
M
Callahan
Christopher M
CM
Perkins
Anthony J
AJ
Carney
Caroline P
CP
Fox
Christopher
C
Unverzagt
Frederick
F
Hui
Siu
S
Hendrie
Hugh C
HC
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D019338:Polypharmacy; D011320:Primary Health Care
D018680:Cholinergic Antagonists