Dementia Diagnosis: Why should we bother? Dr. Sridhar Vaitheswaran 30 th October 2013

The Problem Growing numbers Barriers to diagnosis Treatment gap Cost to the society

The Problem Growing numbers Barriers to diagnosis Treatment gap Cost to the society

World population 60 & above

Population pyramid for Scotland -1981

Population pyramid for Scotland

Population pyramid for Scotland

Population pyramid for Scotland

Population pyramid for Scotland

Population pyramid for Scotland

SCOTLAND [percentage -total population]

Population of very elderly in Scotland 17% increase in % increase in 100+ General Register Office for Scotland Year , ,190820

Projected Age Change in Change% Aberdeen City Aberdeenshire

Projected Age Change in Change% Aberdeen City32,105 Aberdeenshire

Projected Age Change in Change% Aberdeen City32,105 Aberdeenshire40,022

Projected Age Change in Change% Aberdeen City32,10551,81719, % Aberdeenshire40,022

Projected Age Change in Change% Aberdeen City32,10551,81719, % Aberdeenshire40,02278,47438, %

The Problem Growing numbers Barriers to diagnosis Treatment gap Cost to the society

Barriers to diagnosis Stigma Dementia falsely regarded as aspect of normal ageing Therapeutic nihilism Co-ordinated service provision

The Problem Growing numbers Barriers to diagnosis Treatment gap Cost to the society

Treatment Gap Diagnosis - access to pathway for care, support & treatment Treatments effective in ameliorating symptoms & reduce strain among carers Carer interventions – facilitate care at home, delay institutionalisation

Treatment Gap Persons with dementia to participate in treatment & care planning When diagnosis is delivered in a supportive manner this facilitates reassurance & empowerment Timely diagnosis facilitates planning with right advice & support Most people would like to know their diagnosis

The Problem Growing numbers Barriers to diagnosis Treatment gap Cost to the society

Costs to the society Average annual societal costs are US$32,865 (£20,493) per person with dementia One-off costs of a high quality dementia diagnosis are around US$5,000 (£3,118) per person

World Alzheimer Report 2011 Lack of detection is a significant barrier Improving the likelihood of earlier diagnosis can be enhanced through – medical practice based educational programs in primary care – the introduction of accessible diagnostic and early stage dementia care services – promoting effective interaction between different components of the health system Early therapeutic interventions can be effective – improving cognitive function – treating depression – improving caregiver mood – delaying institutionalisation

Timeline of disease progression

How do we facilitate timely diagnosis?

Over 75 screening; ? Re-instate Use of anticipatory care planning Screen patients who recently had delirium Specialist clinics in GP surgeries to reduce stigma Improve awareness of benefits of diagnosis among public Specialist nurse resource in primary care

References World Alzheimer Report Report2011.pdf 2010-based Population Projections, Aberdeen City and Shire, Briefing paper 2012/01 veasdialog.asp?lID=45250&sID=3365