1. Improvements needed in the care of people living with Dementia

2. What is Dementia Term used to describe a collection of symptoms, including a decline in –Memory –Reasoning and communication skills –Gradual loss of skills needed to carry out daily activities

3. These symptoms are caused by structural and chemical changes in the brain as a result of physical disease such as Alzheimer’s disease Dementia can affect people of any age, but is most common in older people One in five people over 80 has a form of dementia and one in twenty over 65

4. Current dementia figures 683,597 people in UK with dementia 416,967 people in UK with Alzheimer’s disease (61%) Vascular dementia and mixed (vascular and Alzheimer’s) together account for 184,571 (27%) Estimated 940,110 by 2021 (37% increase) and 1,735,087 people with dementia by 2051 (153% increase)

5. Risk factors Main risk factor for most forms of dementia is advanced age, with prevalence roughly doubling every five years over the age of 65 Recent research suggests that vascular disease and vascular risk factors predispose to Alzheimer’s disease as well as to vascular dementia (Hofman et al 1997)

6. Smoking seems to increase the risk for Alzheimer’s disease as well as vacular dementia (Ott et al 1998) Long term follow-up studies show that high blood pressure (Skoog et al 1996, Kivipelto et al 2001) and high cholesterol levels (Kivipelto et al 2001) in middle age increase the risk of going on to develop Alzheimer’s disease in later life

7. Early diagnosis No simple test to make a diagnosis Helpful so that person with dementia and any carers can be better equipped to deal with disease and to know what to expect Dementia shortens the lives of those who develop the condition –Estimated median survival with Alzheimer’s at 7.1 years –Estimated median survival with vascular dementia at 3.9 years

8. Current difficulties People with severe and complex disorders, and high levels of risk and comorbidity will find their way to community mental health teams People with early and uncomplicated disorder are less likely to access care but with greatest possibility of early intervention and therefore the greatest possibility of prevention of future harm, risk and cost to patient, carer and services (Gaugler et al, 2005)

9. Service provision failing to meet needs of the majority of people with dementia with only 15-20% ever having contact with specialist services (Holmes et al, 1995) Great deal of evidence that mental health remains one of the most prevalent of unmet needs for older people (e.g. DoH 2001, Girling et al 1995; Holmes et al 1995; SSI 1997; MRC-CFAS 1999)

10. Recognition of mental health needs of older people from BME groups may be lower than in white population (Lloyd 1993, Abas 1996, Livingstone et al 2002) ‘the organisational division between mental health services for adults of working age and older people has resulted in the development of an unfair system…’ Living Well in Later Life, the HC/CSCI/AC 2006 review of older people’s services.

11. Dementia has too low a priority Dementia is one of the main causes of disability in later life - according to 2003 World Health Report Global Burden of Disease estimates, dementia contributed 11.2% of all years lived with a disability among people aged 60 and over; more than stroke (9.5%), musculoskeletal disorders (8.9%), cardiovascular disease (5%) and all forms of cancer (2.4%)

12. Carers Using data from General Household Survey (1998/99), Pickard et al (2001) estimated that 53% of people aged 65 or over with ‘dependency problems’ were supported by unpaid carers only 34% received both informal and formal care 9% received formal care only 3% unsupported Audit Commission (2004) estimated 4 million carers in England, 1 million providing more than 50 hours per week of care

13. Areas of concern Audit Commission identified a number of ‘failings’ –Poor early identification of carers –Failure to refer them to social services or voluntary sector –Unsystematic approaches to provision of information and advice –Lack of clear point of contact for carers in need of urgent help or advice –Limited availability of appropriate support at crucial times (night or weekends)

14. Impact on Carer’s health Poor carer health particularly associated with supporting older people with cognitive impairment (Morris et al 1998; Moise et al 2004) ‘High level of burden and mental distress in spouse carers for people with Alzheimer’s disease’ Schneider et al (1999) High prevalence of depression among carers of older people with depression, dementia or physical disability living in community. Livingston et al (1996)

15. Future of informal care Particular concern is that the pool of potential family caregivers is being affected by changing demographic patterns, shifts in family composition, labour force participation and increased geographical mobility (Moise et al 2004, Comas et al 2007)

16. The challenge ahead At present it may be the case that less than a quarter of people with dementia come into contact with old age psychiatry services at any time in their illness (Holmes et al 1997) Services are not available for a large majority of the population to deliver the memory assessment and care services that are stipulated in Everybody’s Business

17. With the publication of definitive statements on the content and value of good quality care, such as the NICE Clinical Guideline, and positive changes in public attitudes and understanding of dementia, demand can be predicted to grow. The expected aging of the population will mean larger numbers of people with dementia. For example (GAD 2005) figures for England for period 2002-2041 suggest and increase of 190% in number of people aged 85 and over