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Dementia healthcare must adapt to tackle global dementia crisis
London, 20 September 2016
World Alzheimer Report 2016 calls for global transformation in healthcare for people with dementia
Most people with dementia have yet to receive a diagnosis, let alone treatment and care
- Balancing tasks between primary and specialist care could increase capacity and reduce costs
- Clear, evidence-based dementia care pathways should be established in all health systems, and monitored for progress towards universal coverage
- Lack of research on the effectiveness of key components of dementia healthcare is striking, and should be considered an urgent priority
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: 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% 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 organised 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-centred and efficient.
Increased coverage of comprehensive healthcare services is affordable, amounting to approximately 0.5% of total healthcare expenditure by 2030. However, political will is required to establish the necessary changes.
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 emphasises that care must be holistic, continuous and integrated, with a focus on quality of life for people living with dementia and their carers, 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.
Glenn Rees, Chair of ADI, said, “The goal of both improving rates of diagnosis and making the global health system more efficient was critically important to the report, including a clear recommendation that we monitor the outcomes of dementia care so that people with dementia and their care partners can be better informed about the quality of care available.”
Professor Martin Prince, lead author, from King’s College London, said: “This landmark report highlights the need to redesign and repurpose dementia care services for the challenges of the 21st Century. We have just 10-15 years to get this right, planning and implementing a realistic and robust platform for delivering dementia healthcare for all, in advance of any new and more effective treatments becoming available.”
The report is released ahead of World Alzheimer’s Day, 21 September, the focal point of the global World Alzheimer’s Month campaign led by Alzheimer associations around the world to increase awareness of dementia. The report includes an analysis of existing care models in Canada, China, Indonesia, Mexico, South Africa, South Korea and Switzerland. A ‘Zero Draft’ Global Action Plan on Dementia is currently being developed by the World Health Organisation in response to advocacy by ADI and others to address the growing issue of dementia globally.
The World Alzheimer Report 2016 was researched and written by the Global Observatory for Ageing and Dementia Care at King’s College London in collaboration with the Personal Social Services Research Unit at the London School of Economics and Political Sciences (LSE).
Notes to editors
The report will be launched in London, 20 September 2016 and co-launched during the ADI African Regional Conference in Ibadan, Nigeria on World Alzheimer’s Day, 21 September.
The full report is available at: www.alz.co.uk/worldreport2016
About Alzheimer’s Disease International
ADI is the international federation of 85 Alzheimer associations around the world, in official relations with the World Health Organization. ADI's vision is an improved quality of life for people with dementia and their families throughout the world. ADI believes that the key to winning the fight against dementia lies in a unique combination of global solutions and local knowledge. As such, it works locally, by empowering Alzheimer associations to promote and offer care and support for persons with dementia and their carers, while working globally to focus attention on dementia and campaign for policy change from governments. For more information, please visit www.alz.co.uk.
About King’s College London
King's College London is one of the top 25 universities in the world (2016/17 QS World University Rankings) and among the oldest in England. King's has more than 26,500 students (of whom nearly 10,400 are graduate students) from some 150 countries worldwide, and nearly 6,900 staff. The university is in the second phase of a £1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for world-class teaching and cutting-edge research. In the 2014 Research Excellence Framework (REF) King’s was ranked 6th nationally in the ‘power’ ranking, which takes into account both the quality and quantity of research activity, and 7th for quality according to Times Higher Education rankings. Eighty-four per cent of research at King’s was deemed ‘world-leading’ or ‘internationally excellent’ (3* and 4*). The university is in the top seven UK universities for research earnings and has an overall annual income of more than £600 million.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners.
King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org
About London School of Economics and Political Science (LSE)
LSE is a specialist university with an international intake and global reach. Founded in 1895, the School has an outstanding reputation for academic excellence spanning the full breadth of the social sciences, from economics to sociology. LSE has 16 Nobel Prize winners and 34 past or present world leaders have studied or taught at LSE. In 2014 LSE’s outstanding success in the national Research Excellence Framework Exercise confirmed it as a world leading research university, where it ranked first in the UK for its research in the social policy field.
The Personal Social Services Research Unit (PSSRU) is the foremost social care and mental health economics research group in the UK and one of the leading such groups internationally. Its mission is to conduct high-quality policy analysis, evaluation and research to inform policy, practice and theory in health and social care, and is regularly commended for its 'exceptional track record in adult social care research' and 'significant contribution to strengthening the evidence-base for policymaking in key areas'. Since 2004 alone, PSSRU has had number of research awards totalling over £38 million, and produced over 600 peer-review journal papers, books and reports.