Professor Claudia Cooper is Professor of Psychological Medicine and Deputy Vice Principal for Research Culture and Innovation at Queen Mary University London and Deputy Director of the Wolfson Institute of Population Health. A consultant old age psychiatrist in East London NHS Foundation Trust memory services, she led the Alzheimer’s Society Centre of Excellence for Independence at home (2018-24) and will lead the Alzheimer’s Society Centre for Inequalities (2026-30). She co-directs the NIHR Dementia and Neurodegenerative diseases Policy Research Unit based at QMUL (DENPRU-QM), and is a member of the UK Cabinet Office Evaluation Task Force Advice Panel and NIHR Senior Investigator. @ClaudiaACooper1 @DeNPRU_QM
Professor Sube Banerjee, Pro-Vice Chancellor and Professor of Dementia at the Faculty of Medicine and Health Sciences, University of Nottingham, is an old age psychiatrist and clinical researcher working on improving quality of life and quality of care for people with dementia. He is the director of Time for Dementia, which seeks to improve dementia attitudes and skills in the workforce, and of DETERMIND, an ESRC/NIHR programme of research into inequalities and inequities in dementia care and outcomes. He also co-directs DENPRU-QM with Professor Cooper.
Claudia, Sube and colleagues recently published their research paper: Association of comorbidities and socioeconomic deprivation among people who died from dementia in England between 2013 and 2023: analysis of death certificates in Age and Ageing journal.
Looking at the profile of illnesses experienced by those who have died with dementia can help us understand the care needs of those living with dementia. Our Age and Ageing article shows that 85% of people who died with dementia in England between 2013 and 2023 also had at least one other long-term condition (and up to ten) recorded on their death certificate. The chances of this multimorbidity with dementia, and therefore having more complex care needs in life, were higher in more deprived areas.
Some of this morbidity is expected in end-stage dementia. But our findings also speak to the strong association of deprivation with dementia and other disorders.
The Ten Year Health Plan for England has a clear focus on reducing the stark geographical inequalities that are linked to deprivation. If it succeeds in delivering more integrated, community-based care closer to home, people living with multimorbidity stand to be major beneficiaries.
Truly integrated care would account for the dynamic interaction between cognitive, physical, and mental conditions, and between risk factors such as people’s behaviour and socioeconomic status. If we are to compress morbidity—decreasing the period of life spent with illness or disability and so increasing time spent illness free—for people with multiple long-term conditions (multimorbidity), health and care systems must shift from disease-specific to person-centred, integrated care models.
This should start with prevention. We recently reported that APPLE-Tree, a low-cost lifestyle and wellbeing intervention for people at risk of dementia, improved healthy diet and cognition. Healthier diets also reduce the risks of cancer, cardiovascular morbidity, and overall mortality. What works in a trial may not do so within complex, real-world systems, but if interventions like APPLE-Tree (which can be delivered by people without clinical training and so has the potential for rapid scaling up and widespread delivery) are made available to underserved communities, then broad health benefits can be unlocked.
Dementia transfigures almost every aspect of care for comorbid illnesses, such as cancer or diabetes, both of which were recorded in a tenth of those who died with dementia in the past decade. This includes how diagnoses and treatment plans are made, communicated, and delivered. Patients with dementia receiving treatment for comorbid disorders may need longer appointment slots, and dementia friendly care environments. Unfortunately, despite this, they often receive less, not more, health care, relative to people without dementia.
Almost all health professionals treat people with dementia, so need the skills and competencies to deliver care that meets their needs. These are greater than the sum of those for treating either illness alone. For example, diabetes increases the risk of dementia by half, so many people live (and die) with both conditions. Well-controlled diabetes maximises cognitive function, so can be critical to reducing morbidity; however, people with diabetes and dementia and their families will require additional support around self-management as part of good quality, integrated care. Unfortunately, current services are rarely set up to enable this. When condition-specific advice doesn’t fit the needs of people with dementia, carers are often left feeling alone, to meet the health needs of the care recipient as best they can. They can be made to feel that they have failed, rather than the truth, that the system has failed them.
Death certificates provide a useful - albeit imperfect - window into the population’s health. While almost all cases of dementia recorded on death certificates in one study were corroborated by medical records, they did not record around one in ten known dementia diagnoses. Taken together with other data, however, this study provides clear evidence that deploying good quality preventive strategies and care models for people with multiple long-term conditions including dementia could be an important step to reducing inequities in morbidity and mortality.