This article is shared from the NIHR Evidence website – review this and more articles, and subscribe to alters at https://evidence.nihr.ac.uk/ 
People with memory loss, confusion or difficulty concentrating (cognitive impairment) are far less likely than others to visit a dentist or have their eyesight checked, according to new research. It suggests they need more support to access preventive health services.
Cognitive impairment can be mild, or may worsen over time and develop into dementia. The number of people with cognitive impairment and dementia is increasing as our population ages and people live longer. They may be confused, have difficulty concentrating, and struggle to carry out everyday tasks.
Despite increased recognition of dementia, including the development of national dementia plans and specific NICE guidelines, many people seem to be falling through the gaps. A new study explored concerns that people with cognitive impairment (including those with dementia) are not receiving adequate medical help and social support.
The researchers suggest that this group may need extra help to access sight tests and dental examinations. The tests themselves could be better adapted to the needs of people with cognitive impairment.
What’s the issue?
The UK has an ageing population. But people are living for longer in poor health; there is no increase in years of healthy life.
Dementia is a major driver of poor health in older people. In the UK, the number of people with the condition is predicted to rise from 850,000 in 2015 to one million by 2025. Up to one in five people aged over 65 have mild cognitive impairment . This can involve memory loss, mood changes, and difficulty concentrating.
Services exist to preserve the health of people with cognitive impairment, to improve their well-being and quality of life. However, there are long-standing concerns that people with cognitive impairment, including dementia, do not seek the help and services they need.
Extensive reform of health and social care is likely in the next few years . To help plan effective services, this study aimed to map the way older people use health and social care services. It looked in particular at the impact of cognitive impairment on service use.
This study took place in Wales using data from the Cognitive Function and Ageing Study Wales (CFAS Wales). It included 3,593 adults living in the community and in care homes. They were all aged 65 and above.
Researchers asked about their health and lifestyle and assessed their physical and emotional health. They tested cognitive abilities (memory, thinking and reasoning). One in four participants had a cognitive impairment and either had dementia or were at high risk of developing it. The researchers were then able to look at service use among those with cognitive impairment compared to others in the study.
Most of the original group took part in a follow-up interview two years later. They were asked what services they had used in the previous four weeks, including social care help at home, a visit to their GP or an allied health professional (such as a physiotherapist, hearing specialist or dentist). They were also asked if they had received respite care (been looked after by someone else to allow their carer a break) or been treated in hospital in the previous year.
As expected, those with poorer health and disabilities were more likely to access health and social care services.
The standout finding, however, was that people with cognitive impairment were far less likely to use allied health services than others. The authors discovered that people with cognitive impairment were:
- far less likely to have their sight checked or visit a dentist
- more likely to use social care services
- no more likely to visit hospital, see a GP or use nursing services.
Why is this important?
These results suggest that people with cognitive impairment are missing out on essential preventative services, including sight checks and dental visits. This is despite increased recognition of dementia, including the development of national dementia plans and specific NICE guidelines .
Missing preventive health checks may have knock-on effects on health and well-being. Eyesight checks detect conditions such as cataracts (the lens in the eye becomes cloudy) which blurs vision and can lead to falls. They also pick up other health conditions such as diabetes and high blood pressure. Dental check-ups identify poor oral health, which increases the risk of health conditions such as stroke, heart disease and, again, diabetes.
Early detection of illnesses increases the chances of successful treatment for patients. It is also more cost-effective for the NHS.
The data did not explain why people with cognitive impairment have fewer dental and eye checks than other groups. Older people generally may put off accessing services because they expect ill health and reduced wellbeing as they age. The researchers are keen to understand why service use is even lower among people with cognitive impairment than others.
One possibility could be that this group tends to focus on the present rather than the future and may consider preventive services less important. It might also be difficult for people with cognitive impairment to travel to dentists and opticians; and they might find that sight tests and dental examinations are not adapted to take cognitive impairment into account.
The researchers would like service providers to look at how accessible their services are, and to see if they are dementia and cognitive impairment friendly. They suggest that service providers could consider offering older people with cognitive impairment extra help to access and use services. Longer term, increased use of prevention services could reduce demand for more expensive intensive care later on.
This study included few people with severe cognitive impairment, or from ethnic minority backgrounds. More work is needed to look at what use these groups make of prevention services.
You may be interested to read
This NIHR Alert is based on: MacLeod CA, and others. Cognitive impairment negatively impacts allied health service uptake: Investigating the association between health and service use . SSM – Population Health 2021;13:100720
Finding an NHS dentist : guidance for people with dementia from the Alzheimer’s Society.
Having an eye examination at home : advice on getting NHS eye tests at home from the Royal National Institute of Blind People.
Sources of support and advice : general support and advice for people with dementia from Dementia UK.