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), found that the vast majority of persons with dementia
have yet to receive a diagnosis and calls for a global transformation in
healthcare.
It also claims that strategies need to be developed that will focus on
prevention and risk assessment, while rebalancing non-specialist primary care.
The report, Improving healthcare for people living with dementia, rings the
alarm about the rapid rise in dementia cases worldwide, which are projected to
triple by 2050. A particular aspect of concern is the low levels of dementia
diagnosis that prevent dementia patients from having access to care and
treatment.
The researchers noted that around half of persons with dementia (40-50%)
in high-income countries, and one in ten or less (5-10%) in low and
middle-income countries have received a diagnosis.
In high-income countries, the costs of healthcare are higher for those
suffering from dementia than age-matched controls, with a substantial
proportion of costs arising from hospitalisation.
Gilles Pargneaux, a French Socialist MEP, recently told EurActiv that
dementia costs Europe €123 billion per year, in terms of medical expenditures
and social care.
According to the report, a radical change in the way healthcare is
delivered to individuals living with dementia should be made, focusing more on
non-specialist primary care.
“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% cheaper,” the report reads.
Primary care staff are non-specialist doctors and nurses based in the
community who are typically the first point of contact with the healthcare
system.
Primary care
Martin Prince, the lead author of the report at King’s College London, told
EurActiv that current specialist models of dementia care (where geriatricians,
neurologists, and psychiatrists are providing dementia care) were unlikely to
be able to scale up to care for the growing number of individuals affected by
dementia – especially in low and middle-income countries.
“There is evidence that when primary care doctors take responsibility
for dementia care they can achieve similar outcomes to specialists. Nurses can
be case managers, and perform diagnostic assessments and reviews,” he said.
Prince explained that training was crucial if primary care doctors
are to take on an increased role in treating dementia patients. This, he said,
can be achieved by defining a ‘pathway’ for dementia care with clearly defined
roles for primary care doctors, specialists and others to work collaboratively.
“Specialists will need to take on a prominent role in training and
supervising non-specialists in more general tasks,” Prince said. “In
low-resource countries, a greater commitment is needed to strengthen primary
healthcare. These are elements that should be contained in a National Plan on Dementia,
with allocated funding, in every country,” he added, emphasising that more
effort is needed to integrate dementia in primary healthcare.
Professor Craig Ritchie, who is the director of the University of Edinburgh Centre for Dementia Prevention, told EurActiv
that primary or non-specialist care has two main roles: one linked to diagnosis
and another related to prevention.
“There are still a lot of people in the world who have not been
diagnosed with dementia who are living with this condition; I think there is a
particular role for primary care to play in making this diagnosis,” he said.
“For instance, we need to see who does best during the whole evolution
of the disease. Early disease possibly requires more specialist assessment
in making a diagnosis but later in the disease primary care certainly will have
a very prominent if not leading role,” he noted.
Regarding prevention, he emphasised that although efforts have rightly
focused on developing new drugs, there are probably a lot of things to do in
risk mitigation, like the promotion of a better diet, exercise, and
healthier lifestyle.
“Clearly, there is a role for the general practitioners in this as there
is in other chronic conditions like diabetes or heart disease. So the general
practitioners not only have a role in making diagnoses but also a very critical
role in terms of prevention and maintenance of brain health.”
What can the family do?
For Ritchie, families and close relatives have a critical role to
play. Living with someone affected by dementia has a major impact on the
wellbeing of family members who may need to sacrifice
their professional lives to care for the patient, on top of the
challenges of seeing a loved one’s illness progress.
The family could also help identify the early symptoms, Ritchie said.
“So family members have to be encouraged and given the opportunity to seek
assistance if they are worried about a loved one’s memory,” he pointed out,
saying the first point of contact is often the general practitioner.
Family members should also be involved in the therapy process,
which helps optimise treatment, Ritchie said. But families cannot bear the
entire burden, he warned. “Good care must also reflect and manage the needs of
family members who may have developed their own physical and mental health
needs in their caring role,” he remarked.
Raising awareness in the EU
The latest survey regarding the state of dementia
care in the EU showed that half the carers spent at least 10 hours a day
looking after their loved one and only 17% of them consider that the level of
care for the elderly in their country is good.
They also noted that the information they received at diagnosis was
“inadequate”, and called for more information on drug treatments.
Four out of five said they wanted more information on help and support
services and just two out of five were informed about the existence of an
Alzheimer’s association.
“Perhaps of greatest concern is that more than half have no access to
services such as home care, day care or residential/nursing home care, and when
these services are available, many carers have to pay themselves,” the report
reads.
Another report, Mapping dementia-friendly communities across Europe, commissioned
by the European Foundations’ Initiative on Dementia (EFID) and carried out in
2014-2015 by the Mental Health Foundation (a UK non-governmental organisation),
specified the need for dementia-friendly communities across Europe.
The report aimed at providing practical information to support good
practice around sustainable, inclusive and supportive environments for persons
living with dementia and their carers.
Among the findings, researchers suggested that dementia sufferers should
be actively included and involved in the communities they live in. Raising
awareness about dementia was also highlighted by the researchers, who
warned that “unclear information can be misleading and inadvertently risk
adding to stigma”.
SOURCE: Sarantis Michalopoulous
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