Dementia

Introduction

The term ‘dementia’ is used to describe the symptoms that occur when the brain is affected by specific conditions, including Alzheimer’s disease, stroke, and many other rarer conditions.  Dementia is increasingly becoming one of the most important causes of disability in older people.  In terms of Global Burden of Disease, it contributes 11.2% of all years lived with disability.  This figure is higher than stroke, musculoskeletal disorders, heart disease and cancer.

“Dementia results in a progressive decline in multiple areas of function, including memory, reasoning, communication skills, and those skills needed to carry out daily activities.  Alongside this decline, individuals may develop behavioural and psychological symptoms such as depression psychosis, aggression and wandering, which complicate care.”  (National Dementia Strategy 2010)

What are the big issues?

  • The prevalence of dementia increases with age, at present, 1 in 14 people aged over 65, and 1 in 6 people aged over 85 have some form of dementia.
  • Combined with the projected increase in older people in Warwickshire, as a result of people living longer, there is likely to be an increase in demand for services to support people with dementia as well as their carers and families.
  • Between 2010 and 2030, it is estimated that the number of older people with dementia in Warwickshire will double, to more than 13,000.  The majority of these will be aged 75 and over.
  • Dementia diagnosis is low; according to the Alzheimer’s Society only 38% of dementia cases in the West Midlands are diagnosed.  In 2008, less than 50% of the predicted number of people with dementia were recorded by their GP as having dementia.
  • Currently, in the UK, around two thirds of people with dementia live in private households.
  • It is not currently known how many people with dementia are funding their own care either in residential care or in their own home.
  • In 2010 – 2011, Adult Social Care supported 863 people with dementia in Warwickshire.  Of those 500 (58%) were in residential or nursing care.  863 customers represent 10% of the Adult Social Care customers aged over 65.  It is likely that more people with dementia received adult social care support in 2010-2011 but customers are not recorded as dementia unless they have a diagnosis from a health professional.
  • The provision of carer replacement services for people with Dementia in Warwickshire is small.  Community based carer support is provided by Carers Short Break services, however, these contracts are not dementia specific.

What do people say?

Adult social care customers and carers in Warwickshire were asked to prioritise the dementia strategy delivery plan based on the three key objectives: Awareness and Understanding, Early Diagnosis & Support, and Living Well with Dementia.  They prioritised as follows:

  • Awareness and Understanding: 30% said information and advice was most important, 28% dementia awareness training and 26% public awareness.
  • Early Diagnosis and Support: Improved referrals to memory clinics was the top priority from 27% of those asked.  Defined care pathways and less use of anti-psychotic drugs were both the top priority for 25% of those questioned.
  • Living Well with Dementia: 24% said accessing personal and health budgets should be the top priority.  On a separate question, 31% said that more extra care housing should be a priority rather than specialist residential care and housing related support.

Consultation with professionals tells us that not all services are available to all people with dementia in Warwickshire.  There is a particular issue with delivery of care and support in rural areas.

What do we need to do?

  • Awareness and Understanding: A key part of understanding mental ill health is to promote positive mental health and also the awareness of dementia and the services to enable individuals to live well.  A lack of understanding of dementia can lead to a number of problems including symptoms not being recognised early enough leading to poor access to services and poor outcomes.
  • Early Diagnosis and Support: Early diagnosis is key to providing the right support to both service users and carers in a timely manner.
  • Living Well with Dementia: Users and carers highlight that once diagnosed with dementia they require a range of services that fully meet changing needs.  Whilst there are already a number of services in Warwickshire that offer both support and services to people living with dementia, it is recognised that there is more to be done to make sure the highest quality support and services are available to people with dementia and their carers.
  • Making the Change: Service users and carers in Warwickshire have told us that the National Dementia Strategy recommendations for an informed and effective workforce are key to improving services.
  • Transform health care for people with dementia and their families.

Who needs to know?

  • GPs and other health professionals
  • NHS Warwickshire
  • Third sector organisations supporting vulnerable older people
  • Warwickshire County Council
  • Warwickshire GPs and Clinical Commissioning Groups

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