Alzheimer’s Disease: A Chronic Illness
The Alzheimer’s Disease Plan: England
Speaker: Sube Banerjee, MD, MSc, FRCPsych, Co-lead, Development of a National Dementia Strategy; Senior Professional Advisor, Older People’s Mental Health, Department of Health, England; Professor of Mental Health and Ageing, The Institute of Psychiatry, King’s College London.
Providing dementia care in the United Kingdom currently costs £17 billion annually and is rising. Given that Alzheimer’s disease is predicted to double in prevalence within the next 30 years, affecting approximately 1.4 million people, Dr. Banerjee stated that the need for an improved national dementia strategy in England is inarguable.
Dr. Banerjee, co-lead for the development of a National Dementia Strategy for England, observed that the costs for dementia—which are projected to reach £51 billion when the prevalence doubles — are already higher than the combined costs for cancer, cardiovascular disease, and diabetes. The majority of the money is spent on care placement, serving only one-third of those with dementia. A National Audit Office study found that money is being spent poorly, spent late, and spent on uncoordinated services.
The strategy, (published in full in February 2009), encompasses four main themes, Dr. Banerjee explained: improved awareness, early and better diagnosis, improved quality of care, and strategy implementation to improve patients’ quality of life.
Dr. Banerjee stated that the stigma preventing people from disclosing symptoms to professionals also manifests among healthcare providers themselves. The consequence is undertreatment at early stages: clearly, a diagnosis must be in place so that services can be accessed. False beliefs he described as pervasive include, one, the sense that dementia and memory problems are part of growing older and need not be addressed by a GP, and two, since disease process-modifying drugs are not yet available, nothing can be done to alleviate dementia’s effects. These beliefs persist despite abundant study data showing the benefits that accrue with psychosocial and educational interventions.
The aim for earlier diagnosis meets a formidable obstacle: only one-third of people ever receive a formal diagnosis and often only when it is too late for them to partake in decision-making.
The Department of Health has funded a pilot of a model of service provision in early intervention, the Croydon Memory Service Model. It represents an “evolution” of the memory clinic, according to Dr. Banerjee. Its services are aimed at early/moderate dementia. The service, which is designed to be reproducible, features clinical teams trained in generic assessment, uses referrals from GPs and social services, home assessment, manualized assessment with standardized tools, diagnosis and management planning, provisions for social care packages, psychological care, medication, continuity of care, and case review. He described the virtue of the model as enhancing the capacity to make the diagnosis well, deliver it well, and follow up with immediate individualized care and support. Follow-up detected significant quality of life improvements as well as drops in behavioural disturbances.
Improving quality of care involves advancing the message that services can enable people to live a good life with dementia. Modifying dementia services in general hospitals, providing intermediate and respite care, improving home care as well as care homes, and bettering registration can all improve quality of life for dementia patients.
The report’s final theme focused on delivering the strategy and calls for local implementation, regional support, and national coordination in the dissemination of information, research, and support for implementation. While the cost investment is significant, he notes that care homes cost approximately £7 billion per year. If only 10% of referrals to long-term care were delayed, the cost investment in the new strategy would break even, according to Dr. Banerjee.
He concluded that quality improvement in dementia care requires vision, system change, ambition in scale, investment, commitment over time, and leadership. The developing national strategy offers a simpler, more effective care pathway.
