By Micha Shalev
Dementia is a mental state used to denote severe cognitive impairment which impacts daily activities and life. Alzheimer’s disease is one of the most common forms of dementia and vascular dementia is the other. Contrary to common belief, the mental decline seen in Alzheimer’s disease and other dementias is beyond memory failure but encompasses a range of cognitive functions including awareness, reasoning, perception, creativity, language and communication. Some diseases and conditions which can be of infectious, metabolic or neurological origin, or traumatic brain injury, can also lead to dementia.
Dementia is becoming a global emergency of epidemic proportions affecting millions of people worldwide. In 2016, 47 million people lived with dementia. By 2050 there will be over 131 million, worldwide, with projections of a 116 percent increase in dementia prevalence in developed countries, and double by comparison to 227 percent for transitional countries and 264 percent for developing countries (Alzheimer’s Disease International 2015; 2016; The Lancet 2015). In research studies there is a tendency to focus on Alzheimer’s disease data, which is expected as it’s the most common form of dementia. As a consequence, data on other forms of dementia are not usually addressed or measured.
Among the ageing population, dementia is the leading chronic disorder and contributor to disability and need for care. An expanding ageing population means that even if the prevalence of dementia remains constant, the number of people with dementia will continue to grow. Any treatment approach that delays the onset and improves the symptoms of dementia will have significant societal and economic benefits.
A new report from Alzheimer’s Disease International, authored by researchers at King’s College London and the London School of Economics and Political Science (LSE), reveals that most people with dementia have yet to receive a diagnosis, let alone comprehensive and continuing healthcare.
The World Alzheimer Report 2016 notes that improving healthcare for people living with dementia, calls for concerted action to increase the coverage of healthcare for people with dementia worldwide.
Dementia affects 47 million people worldwide and this number will treble by 2050. Currently, only around half of those in high income countries, and one in ten or less in low and middle income countries have received a diagnosis. Expanding coverage of services for increasing numbers of people with dementia can only be achieved – and a crisis averted – by boosting capacity, and the efficiency with which care is delivered.
The report highlights that dementia care being provided mainly by specialist doctors is a key barrier to progress. Greater involvement of non-specialist primary care staff can unlock capacity to meet increasing demand for dementia care, and could make the cost of care per person up to 40 percent cheaper. Primary care services will need to be strengthened and supported to take on this role, through specialists providing guidance and support. Affordability of new treatments is critical to ensuring equity and social justice for the two-thirds of people with dementia living in low-resourced countries.
Clear care pathways would define roles and responsibilities within the care system, and establish standards to be monitored and met. Care pathways, a structured and organized approach to the coordination, resourcing and delivery of continuing care, are now a common component of chronic disease care for other conditions including diabetes, hypertension, and cancer care. Case management supports coordination and integration of care and can help ensure that services are both person-centered and efficient.
The report calls for a radical change in the way healthcare is delivered to people living with dementia, with a rebalancing toward non-specialist primary care, and planned and coordinated inputs from all levels of the health and social care sectors. It emphasizes that care must be holistic, continuous and integrated, with a focus on quality of life for people living with dementia and their caregivers, and explicit monitoring of processes and outcomes.
More research is needed into; the cost-effectiveness of case management; the potential for unnecessary hospital admissions to be averted or abbreviated, and the outcomes of hospital admission to be improved; the benefits and harms of advanced care planning, and a palliative care approach; and trials to establish which elements of care can be safely transferred to non-specialist services.
Micha Shalev MHA CDP CDCM CADDCT is the owner of Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 Randolph Road in Worcester. He is a graduate of the National Council of Certified Dementia Practitioners program, and well known speaker covering Alzheimer’s and Dementia training topics. The programs at Dodge Park Rest Home specialized in providing care for individuals with dementia and Alzheimer’s disease. The facility is holding a free monthly support group meeting on the 2nd Tuesday of each month for spouses and children of individuals with dementia and/or Alzheimer’s disease. He can be reached at 508-853-8180 or by e-mail at m.shalev@dodgepark.com or view more information online at www.dodgepark.com.
