Quality of dementia clinical guidelines and relevance to the care of older people with comorbidity: evidence from the literature

Purpose: The aim of this paper was to explore the applicability of dementia clinical guidelines (CGs) to older patients, to patients with one or several comorbidities, and to both targets in order to evaluate if an association between the applicability and quality of the CGs exists. Materials and methods: A systematic search strategy conducted on electronic databases identified CGs on diagnosis and treatment of dementia published from 2000 to 2013. In addition, websites of organizations devoted to the treatment and awareness of dementia were searched. The quality of evidence was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Two investigators independently scored the relevance of the CGs by means of a specific tool. Descriptive and inferential analyses were performed (Mann–Whitney test, 0.05 α-level). Results: Twenty-two CGs met our inclusion criteria. On average, the quality of the CGs was higher than 70% in three of six domains measured by the AGREE tool. The domains with lower mean scores (less than 50%) were “Applicability” and “Editorial independence”. Considering applicability to older patients, 20 CGs (91%) addressed issues of treatment for older patients, five of them (23%) classified older patients by age, and 13 CGs (60%) addressed issues of comorbidity. Only seven (32%) discussed the quality of evidence for patients with multiple comorbid conditions. Thirteen CGs (60%) reported recommendations for patients with at least one comorbid condition, while seven of them (32%) reported on several comorbid conditions. No statistically significant association between CG quality and relevance to care of older people with or without comorbidity was found (P>0.05). Conclusion: This study showed that dementia CGs poorly address treatment for older patients with comorbidities, regardless of their quality. Therefore, they scarcely satisfy the need of modern clinical practice

Dementia clinical guidelines and quality of care for older patients with multiple comorbid disease. A comparison between Europe and North America

Background Dementia affects 5.4% of the over 65s and its prevalence further increases with age, expecially without effective preven- tion and treatment. Clinical Guidelines (CG) could be used as a tool to improve the quality of care. There is evidence suggesting that CG should be modified for the patient with comorbidities. The aim of this study was to evaluate the applicability of CG for Dementia to the care of older individuals with several comorbid diseases between different international contexts. Methods CG on diagnosis and treatment of dementia published between 2005 and 2012 in Europe (EU) and North America (NA) were identified through searches in the electronic databases. Additionally, dementia organizational websites were searched. Quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Two investi- gators independently assessed the relevance of the CG on the care of older people with comorbidity by means of a specific instrument developed by Boyd et al. Descriptive and inferential analyses were performed (chi-square test at the 0.05 signifi- cance level). Results Twenty-one CG were included in the study. Quality of the evaluated CG was on average higher than 70% in three out of the six domains measured by AGREE instrument. The domains with lower mean scores (less than 50%) were Applicability and Editorial Indipendence. The 8 (38.10%) of the selected CG were published in EU, while 13 (61.90%) were from NA (23.81% from Canada, 38.10% from USA). Quality of evidence for older patients with comorbid conditions was considered in 9 (57.14%)CG. In 12 to 22 CG there are specific recommendations for patients with one comorbid condition, while only 6 to 22 considering several comorbid condition. No differences between NA and EU were found on the analysis of quality of evidence for older patient. While the quality of evidence is discussed for older patients with comorbid conditions more in Europe than in North America (p < 0.02). Also the attention to specific recommendations for patients with at least one comorbid condition is higher in EU (p < 0.04). Conclusion Our findings show that the attention to comorbidity in diagnosis and treatment of dementia is a matter to delve more deeply at the international level