SPECIAL REPORT: Dementia in Ireland - Condition could bankrupt us
THE magnitude and challenge of dementia cannot be over-estimated.
Across the world, every four seconds, a new case of dementia occurs and over the next 35 years, in the absence of a cure, dementia prevalence rates are set to triple globally and to reach 135m by 2050.
Like in other countries, the prevalence of dementia will rise in Ireland in the foreseeable future, from current estimates of 48,000 to circa 150,000 by 2051.
Dementia is a chronic, progressive, and often devastating illness, since it not only affects the individual but also significant others, including close family members, colleagues, communities, and society at large.
Although age is by far the single strongest risk factor for dementia, there are about 4,000 Irish men and women with younger-onset dementia. These are an exceptionally vulnerable group of people who do not fit easily into service systems and structures generally established for older people.
In 2010, the economic cost of Alzheimer’s disease (AD) was estimated to be €500bn globally. In Ireland, the figure was €1.69bn.
Economic costs are significant given the illness trajectory and the fact that those diagnosed will often experience other chronic and progressive age-related illnesses and/or sensory impairments, which may further complicate dementia, adding to spiraling health and social care costs.
It has recently been argued that unless governments take global action to combat AD and the related dementias, the illness will, in time, bankrupt economies. Although a commitment to finding a cure for dementia by 2025 was pledged at the G8 summit in 2013, research on dementia lags significantly behind other epidemiological and disease-specific research.
In the UK, the numbers of dementia researchers is disproportionately low to the cost of dementia and low compared to the numbers of scientists assigned to researching cancer, coronary heart disease and stroke where the collective costs of these illnesses are significantly less than the cost of dementia.
Against this backdrop, the Government launched its first Irish National Dementia Strategy in December 2014.
This strategy was underpinned by an extensive research review, funded by the Atlantic Philanthropies and undertaken by Trinity College Dublin and NUI Galway. It involved public consultations with stakeholder organisations, briefing papers, and workshops with family caregivers and with people with dementia, and the establishment by the minister of a national dementia advisory group, which met regularly to advise the Government.
Although the strategy sets out recommendations regarding several core policy areas, the three priority areas identified are:
- Intensive home care packages;
- Timely diagnosis of dementia;
- Better public awareness and understanding.
Since most people with dementia (circa 63%) live at home in the community, it is not surprising that the main bulk of funding ring-fenced for dementia services (two thirds) has been assigned to intensive home care packages.
Eight geographical areas have been targeted under this programme, which aims to extend intensive home care packages to 500 families over a three-year period. The areas identified include Dublin North, South West, South East, Cork, Waterford, Limerick, and Galway.
A second, new, and much-needed service initiative is in the area of training GPs. A needs analysis of GPs vis-a-vis dementia assessment and diagnosis will be undertaken followed by a bespoke educational programme led by Tony Foley and designed by University College Cork, the Irish College of General Practitioners, and Dublin City University. Resource materials will include the installation of IT support systems. A number of GPs will be recruited as champions to deliver the programme.
The third area identified for immediate action in this five-year government plan is public education and training on dementia. Led by the HSE Health and Wellbeing Directorate and its public communications department, the aim here will be to raise public awareness, address stigma and promote the social inclusion and involvement in society of all those with dementia.
This campaign will build on the excellent work of the Alzheimer Society of Ireland and lead to online and printed support resources designed to upskill the public.
What is exciting and encouraging about this particular national strategy is that a huge emphasis has been placed on its implemention.
In my view, for this strategy to work will require strong political leadership, collaboration across service sectors, the involvement of all key stakeholders and funding.
For the moment, no funding has been ring-fenced to reform the residential care sector where about one third of all people with dementia live, sometimes in environments far from ideal and not in keeping with best practice.
However on a more positive note, this new national strategy is a fresh start for Ireland and provides real opportunity for many peoples’ lives to be transformed by our government’s investment in the area of dementia and by it taking action to address the immediate challenge of this very complex condition.
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