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Conceptualising comorbidity and multimorbidity in dementia: A scoping review and syndemic framework

Dunn, Rosie; Clayton, Eleanor; Wolverson, Emma; Hilton, Andrea


Eleanor Clayton

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Dr Emma Wolverson
Reader in Ageing and Dementia. Research Lead for Dementia UK.

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Dr Andrea Hilton
Reader and Programme director, Non-Medical Prescribing


Older people and people with dementia experience a high prevalence of multiple health conditions. The terms ‘comorbidity’ and ‘multimorbidity’ are often used interchangeably to describe this, however there are key conceptual differences between these terms and their definitions. This has led to issues in the validity and comparability of research findings, potentially inappropriate intervention development and differences in quality of health care.
To review how the terms ‘comorbidity’ and ‘multimorbidity’ are defined within peer-reviewed dementia research and propose an operational framework.
A scoping review of definitions within dementia research was carried out. Searches took place across five databases: Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES and PsycINFO. PRISMA-ScR guidelines were followed.
Content analysis revealed five key themes, showing significant overlap and inconsistencies from both within, and between, the comorbidity and multimorbidity definitions; 1. Number of conditions; 2. Type of health conditions; 3. The co-occurrence of conditions; 4. The inclusion of an index disease (or not); 5. Use of medical language. The analysis also revealed gaps in how the underlying concepts of the definitions relate to people with dementia living with multiple health conditions.
This scoping review found that current definitions of comorbidity and multimorbidity are heterogeneous, reductionist and disease-focussed. Recommendations are made on the design of research studies including transparency and consistency of any terms and definitions used. A syndemic framework could be a useful tool for researchers, clinicians and policy makers to consider a more holistic picture of a person with dementia’s health and wellbeing.


Dunn, R., Clayton, E., Wolverson, E., & Hilton, A. (2022). Conceptualising comorbidity and multimorbidity in dementia: A scoping review and syndemic framework. Journal of Multimorbidity and Comorbidity, 12,

Journal Article Type Article
Acceptance Date Sep 27, 2022
Online Publication Date Sep 27, 2022
Publication Date Sep 27, 2022
Deposit Date Oct 3, 2022
Publicly Available Date Oct 3, 2022
Journal Journal of Multimorbidity and Comorbidity
Print ISSN 2633-5565
Electronic ISSN 2633-5565
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 12
Keywords Multimorbidity; Comorbidity; Dementia; Syndemic; Scoping review
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Copyright Statement
© The Author(s) 2022.
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

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