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A new study underlines the importance of continuity of care for people with dementia. Marko Geber/Getty Images
  • Recent research shows that people with dementia who have a high continuity of care receive care of a better quality than people who see different doctors.
  • The results showed that people who received follow-up care with the same doctor over time had fewer adverse health outcomes than those who did not.
  • Compared with people who saw multiple doctors over time, those in the high continuity of care group experienced fewer emergency hospitalizations, fewer adverse side effects of medication, and reduced incidence of delirium.

Lead author Dr. João Delgado and his team recently published the results of their study on dementia care in the British Journal of General Practice.

The researchers analyzed data from 9,324 people with dementia in a retrospective year-long follow-up study.

The aim was to determine whether a higher continuity of care resulted in better health outcomes and fewer cases of “potentially inappropriate prescribing.”

Potentially inappropriate prescribing can be defined as “prescriptions that introduce a significant risk of an adverse drug-related event when there is evidence for an equally or more effective alternative medication.”

People with dementia often have additional health problems, called “comorbidities,” that can complicate their care and require more complex treatment plans.

According to the authors of the new study, high continuity of care typically results in good relationships between doctors and the people they treat. This fosters good care, more accountability, and an increased sense of responsibility in the doctor.

Conversely, as the authors explain, “Lower continuity of care is associated with poorer medication management and worse health outcomes, including increased mortality.”

However, to date, there has been limited research into the effects of continuity of care for people with dementia. The current study goes some way toward filling that gap.

Having comorbidities increases the risk of adverse health outcomes caused by multiple drug interactions.

The participants in the study had, on average, 14.5 consultations with a doctor in 1 year.

The authors found that participants with a high continuity of care were less likely to face “extreme polypharmacy” — 10 or more prescriptions. They were also less likely to receive medications that could interfere with other drugs or otherwise worsen their symptoms.

For example, in the high continuity group, doctors were less likely to prescribe benzodiazepines, a class of drug that causes drowsiness, to people at risk of falling. This group was also less likely to receive drugs that cause constipation — a health issue that increases the risk of delirium in older adults.

As another example, participants in the high continuity group with urinary incontinence and high blood pressure were less likely to receive loop diuretics as a high blood pressure treatment. As the authors note, these diuretics “can exacerbate incontinence symptoms.”

Beyond the crucial importance of quality patient care, improving care for people with dementia would have significant financial benefits.

Conditions such as delirium and episodes of severe confusion are common in people with dementia and require additional hospital resources.

Overall, the study showed that people in the highest quartile — those who had the highest continuity of care — were 34.8% less likely to develop delirium, 57.9% less likely to experience incontinence, and 9.7% less likely to require emergency hospitalization than people in the lowest quartile of continuity of care.

Other measures of continuity, such as the dispersion of doctors seen and the number of sequential consultations with the same doctor, led to similar benefits. But the researchers did not observe the escalation of effect with each successive quartile that they did with their the main measure of continuity.

Dr. Delgado explains some of the study’s limitations:

“The observational nature of this study provides data on statistical associations but cannot indicate causation. This study has, nonetheless, produced robust analyses, including adjustment for 14 chronic comorbidities, frailty, and use of health services.”

“Finally, the number of [potentially inappropriate prescribing] criteria available means associations with continuity of care may be affected by false discovery rates, and additional studies are required to reproduce these findings,” he added.

MNT also spoke with the director of clinical services at Dementia UK, Paul Edwards, who explained:

“[Doctors] are undoubtedly facing undeniable pressure as they and other primary care services continue to be overstretched in the wake of COVID-19. [Doctors] often have limited time to treat and diagnose dementia as well as attend to other health issues families may be facing. This means families with dementia miss out on the care and support they urgently need.”

“It is refreshing to see a study provide objective evidence to support the well-recognized benefits of continuity of care,” Dr. Ian Neel, an associate clinical professor of medicine at the University of California, San Diego, who was not involved in the study, told MNT.

“As people age and develop increasing burden of disease, they [unwittingly] place themselves at risk of increasingly fragmented care delivered by subspecialists looking at individual problems rather than the person as a whole,” Dr. Neel continued, adding, “This can lead to suboptimal prescribing patterns and place the person at risk of harm.”

“This article adds strength to the argument that having a primary care provider who knows the patient’s values and complexities can lessen their risk of harm.”

– Dr. Ian Neel

“The number of people with dementia has been rising steadily, and it is now one of the leading causes of death in the [United Kingdom],” Dr. Delgado, a research fellow at the University of Exeter Medical School, explains.

“In the absence of a cure, long-term care is particularly important. Treating people with dementia can be complex because it often occurs together with other common diseases.”

“Our research shows that seeing the same [doctor] consistently over time is associated with improved safe prescribing and improved health outcomes. This could have important healthcare impacts, including reduced treatment costs and care needs,” he concluded.