Abstract
BackgroundDementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD.MethodsThis is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders — user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers — took part in interviews, and 24 participated in a consensus conference.ResultsWe included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement.ConclusionsEvidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs.Trial registrationPROSPERO, CRD42015020625. Registered on 18 May 2015.
Highlights
Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people
Ten papers focused on people living with dementia and diabetes (PLWDD), and the rest were concerned with diabetes (n = 32), dementia (n = 31) or other groups, such as those with chronic illness or frailty
We recognise that perceptions of ‘good’ are situation-specific, differ for PLWDD and for family carers and will change over time
Summary
Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. Rates of diabetes in people living with dementia (PLWD) are between 13% and 20% [1]. In PLWD the likelihood of diabetes-related complications, such as hypoglycaemic episodes, cardiovascular conditions and amputations may be increased [3, 4]. This happens because dementia has an impact on an individual’s ability to administer medication, regulate eating habits and recognise and treat hypoglycaemia [5,6,7]. The impact on health and social care economies and on patients and their families is considerable [10]
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