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.