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Summary

Adults :: Dementia :: Summary

Dementia is a global term used to describe a range of neurological disorders characterised by a decline in intellectual and other mental functions. It can affect people of any age, but is most common in older people and age is the greatest risk factor for dementia.

Dementia affects one in fourteen people over the age of 65 and one in six over the age of 80. However, dementia is not restricted to elderly people: there are 15,000 people under the age of 65 with dementia in the UK, although this figure is likely to be an underestimate[1].

Dementia costs the UK economy 23 billion pounds per year. This is more than cancer and heart disease combined. The average care costs per person are £29,000 per year[2].

In the Medway local authority area in 2012, there were estimated to be 2,587 people living with dementia with 2,523 being over 65 years old. The number estimated for the registered population for Medway CCG is 2,783. Data from the Quality and Outcomes Framework primary care dementia registers in 2012/13 have only identified 1,332 patients in Medway as having dementia. The diagnosis rate of dementia for Medway CCG population is 47.87%, which is higher than the Kent and Medway average of 42.94% and the South of England average of 45.65%.

Key issues and gaps

  1. Between 2012 and 2037, the number of older people living in Medway with Dementia is expected to increase from approximately 2,500 to 5,600. This is driven by projected changes in the age structure of the population. This will represent a huge challenge as current services will have to nearly double in capacity if in their present form or different approaches will need to be found. 45% of these will be likely to have moderate to severe dementia.
  2. Development of a clearly described integrated care pathway for dementia would assist both people living with the condition and professionals supporting people to access services without increasing the stresses and anxieties already likely to be present in people's lives.
  3. Current under-reporting in primary care (which is an issue nationally) and variation in primary care in quality of dementia care needs to be addressed to improve early diagnosis and intervention.
  4. Improving professional understanding and appropriate management of dementia is an ongoing need. This is the case for all health and social care professionals, including doctors, care staff and acute hospital staff.
  5. There is still stigma associated with dementia which means that people may be reluctant to seek help for themselves or their loved ones. Further campaigns (e.g. Dementia Friends) to change public perception and reinforce the importance of early diagnosis need to be supported locally.
  6. 24/7 practical support to carers needs to be further developed to ensure that people living with dementia are supported to remain in their own homes for as long as possible and for any admissions to acute settings can be as short as possible.
  7. Local stakeholder events have indicated that some support services are working well but there is a need for more support to carers, better information, earlier diagnosis but with additional support, clear pathways to services and better integration and coverage of what is available to ensure equality of opportunity across Medway. The absence of services for people with a learning disability who also develop a dementia illness was highlighted as a significant issue.

Recommendations for Commissioning


• The aims of the Dementia Strategy are being developed to take into account the growing needs within the Medway population and in recognition of changing priorities within health and social care. The Dementia Strategy when complete should inform commissioning activity on behalf of both Adult Social Care and the CCG.
• Public awareness about dementia and its effect on people's lives should be the focus of attention within the community of Medway and the creation and support of a local Dementia Action Alliance is seen as the most effective was of becoming a dementia friendly community.
• The role of the GP is central to meeting people's needs and there should be a continued development of understanding for the importance of early diagnosis, treatment through medication, and the care and support that is available through social care services including those provided by the independent sector.
• The role and importance of the carer should be incorporated into the Strategy and supported by the commissioning options selected for implementation. A focus of attention will need to be given to ensuring that services are available to avoid and manage crises that might lead to avoidable hospital or care home admissions.
• The Dementia Strategy should set out in the form of clear pathways the journey that people with a developing dementia disease are expected to take. Together with clear pathways there is a need to develop ways that information, guidance and support can be understood and available in easy to understand formats. Options being considered for practitioner and patient signposting should continue to be explored.
• Achieving a dementia friendly community is one where people living with dementia can do so in a way that promotes a sense of value and ability to make a continued meaningful contribution to the community. The strategy will need to be developed from an understanding of the needs and aspirations heard from listening carefully to people living with dementia, both the person with the condition and their carers.
• To ensure services provide quality at each point on a person's dementia journey, support and development will be necessary within the care home sector.


References

[1]   Emiliano DA, Banerjee PS, Dhanasiri S, et al. Dementia UK: The Full Report 2007; Alzheimer's Society. http://alzheimers.org.uk/site/scripts/download.php?fileID=2 .
[2]   Health Economics Research Centre UoO. Dementia 2010: The economic burden of dementia and associated funding in the UK 2010; Alzheimers Research Trust. http://www.herc.ox.ac.uk/pubs/downloads/dementiafullreport .