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

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

Abstract

Background
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.
Objective
To review how the terms ‘comorbidity’ and ‘multimorbidity’ are defined within peer-reviewed dementia research and propose an operational framework.
Design
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.
Results
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.
Conclusion
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.

Citation

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, https://doi.org/10.1177/26335565221128432

• 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
• DOI: https://doi.org/10.1177/26335565221128432
• Keywords: Multimorbidity; Comorbidity; Dementia; Syndemic; Scoping review
• Public URL: https://hull-repository.worktribe.com/output/4086975