Report suggests joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients | RAND Corporation
The burden of Alzheimer’s disease in high-income countries is expected to approximately double between 2015 and 2050. Recent clinical trial results give hope that a disease-modifying therapy might become available in the near future. The therapy is expected to treat early-stage patients to prevent or delay the progression to dementia.
This preventive treatment paradigm implies the need to screen, diagnose, and treat a large population of patients with mild cognitive impairment. There would be many undiagnosed prevalent cases that would need to be addressed initially, and then the longer-term capacity to address incident cases would not need to be as high.
Researchers used a simulation model to assess the preparedness of the health care system infrastructure in six European countries — France, Germany, Italy, Spain, Sweden, and the United Kingdom — to evaluate, diagnose, and treat the expected number of patients.
Projected peak wait times range from five months for treatment in Germany to 19 months for evaluation in France. The first year without wait times would be 2030 in Germany and 2033 in France, and 2042 in the United Kingdom and 2044 in Spain. Specialist capacity is the rate-limiting factor in France, the United Kingdom, and Spain, and treatment delivery capacity is an issue in most of the countries.
If a disease-modifying therapy becomes available in 2020, we estimate the projected capacity constraints could result in over 1 million patients with mild cognitive impairment progressing to Alzheimer’s dementia while on wait lists between 2020 and 2050 in these six countries.
In addition to increasing specialist and infusion capacity in each individual country, joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients.
A combination of reimbursement, regulatory, and workforce planning policies, as well as innovation in diagnosis and treatment delivery, is needed to expand capacity and to ensure that available capacity is leveraged optimally to treat patients with early-stage Alzheimer’s disease.
The Telegraph | October 2018 | Nursing home builds real-life 1950s memory lane to help dementia patients
Starting this week (3 October) residents at the Five Rise Nursing Home in Bingley can take a stroll down an artificial street designed to resemble how the West Yorkshire town looked in the 1950s.
The new-build home which cost £6m, is an innovation from twin brothers Danny and Damien Holt.
Damien, a psychiatric nurse, said: “People with advanced dementia can have very complex needs and we know how vital it is to provide plenty of mental stimulation in a safe, modern environment.
“Many of our residents have lived around Bingley for years.
“They remember it as it was.
“The purpose of our memory lane is to provide an attractive and interesting destination for the people we care for, offering reminiscence therapy to improve the psychological well being and quality of life for our residents.”( Source: The Telegraph)
OnMedica | October 2018 | One in two women and one in three men will develop neurological disease
A research team from the Netherlands studied lifetime risk of dementia, stroke and parkinsonism, in over 12,102 individuals (just over half of them women) who at baseline were aged at least 45 years (median 62.2 years), and free from these diseases, for 26 years, between the years 1990 and 2016 in a prospective population- based study.
Within this period over 1400 individuals were diagnosed with dementia, 1,285 with stroke and more than 250 with parkinsonism; and of these 438 people (14.6%) were diagnosed with multiple diseases. The researchers found that women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. Females over 45 years of age had a significantly higher lifetime risk of developing dementia and stroke than men (31.4% compared with 18.6% in men; and 21.6% compared with 19.3% in men, respectively); whereas lifetime risk of parkinsonism (4.3% in women and 4.9% in men) was not significantly different. They also saw similar patterns in sex-specific occurrence for Alzheimer’s disease and vascular dementia, ischaemic, haemorrhagic and unspecified stroke and Parkinson’s disease (Source: OnMedica)
Objective To quantify the burden of common neurological disease in older adults in terms of lifetime risks, including their co-occurrence and preventive potential, within a competing risk framework.
Methods Within the prospective population-based Rotterdam Study, we studied lifetime risk of dementia, stroke and parkinsonism between 1990 and 2016. Among 12 102 individuals (57.7% women) aged more than or equal to 45 years free from these diseases at baseline, we studied co-occurrence, and quantified the combined, and disease-specific remaining lifetime risk of these diseases at various ages for men and women separately. We also projected effects on lifetime risk of hypothetical preventive strategies that delay disease onset by 1, 2 and 3 years, respectively.
Results During follow-up of up to 26 years (156 088 person-years of follow-up), 1489 individuals were diagnosed with dementia, 1285 with stroke and 263 with parkinsonism. Of these individuals, 438 (14.6%) were diagnosed with multiple diseases. Women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. The lifetime risk for any of these diseases at age 45 was 48.2% in women and 36.2% in men. This difference was driven by a higher risk of dementia as the first manifesting disease in women than in men, while this was similar for stroke and parkinsonism. Preventive strategies that delay disease onset with 1 to 3 years could theoretically reduce lifetime risk for developing any of these diseases by 20%–50%.
Conclusion One in two women and one in three men will develop dementia, stroke or parkinsonism during their life. These findings strengthen the call for prioritising the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the ageing population.
Today, 21 September 2018, is World Alzheimer’s Day. Coinciding with this, Alzheimer’s Disease International have released the World Alzheimer Report 2018: The State of the art of dementia research: New frontiers.
This report is written to be of appeal to a broad audience including governments and policymakers, academics and researchers and the general public with an interest in dementia.
Essentially the report is an overview of where we are currently: the hopes and frustrations, the barriers, the enablers and the ground-breaking work being undertaken.
The report’s key calls-to-action:
Improving the sharing, using and disseminating of data and using registries in the best possible way.
A minimum 1% of the societal cost of dementia to be devoted to funding research in: basic science, care improvements, prevention and risk reduction, drug development and public health.
Attracting researchers and skill to the sector
Increasing the scale of new research with the global ratio of publications on neurodegenerative disorders versus cancer at just 1:12
Involvement of people in low- and middle-income countries (LMICs) in the research process.
Encouraging innovation, the use of technology and entrepreneurship.
To support the 2018 World Alzheimer’s Month campaign, Alzheimer’s Disease International (ADI) in partnership with ITN Productions have released the documentary film below ‘Every 3 seconds’ to help raise awareness of global impact of dementia:
University College London | September 2018 | Dementia patients “suffering in silence”
A new study from University College London (UCL) reports that one-third of patients with dementia who may also experience delirium (a state of acute confusion) are frequently unable to express that they are in pain. The study has originality, as it is the first of its kind in a hospital context. It has been funded by the Alzheimer’s Society and Bupa Foundation, and supported by the terminal illness charity Marie Curie. The research was conducted in two acute hospitals in the UK and followed more than 200 patients over the age of 70 (via UCL).
At the outset the researchers asked patients if they were in pain. If the patient was then unable to communicate, researchers assessed people for signs of pain in their facial expression and body language. They recorded the number of people who were unable to communicate that they were in pain, and measured delirium with a standard confusion assessment method.
The researchers found that almost half (49%) of the participants experienced pain at rest, while a quarter (25%) experienced pain during activity. A little over a third (35%) of participants who were delirious and unable to self-report pain, of these patients 33% experienced pain at rest, and 56% experienced pain during activity.
The odds of being delirious were 3.26 times higher in participants experiencing pain at rest.
Senior Author Dr Liz Samson from the Marie Curie Palliative Care Research Department, UCL Psychiatry says, ” In the UK, almost half of people admitted to hospital over the age of 70 will have dementia. We know that they are a high-risk group for delirium and yet delirium is often under treated.” She elaborated, “It’s deeply troubling to think that this vulnerable group of patients are suffering in silence, unable to tell healthcare professionals that they are in pain.” (Source: UCL)
Health Education England, Skills for Health & Skills for Care, | July 2018 |Dementia Training Standards Framework
Health Education England (HEE) have released the Dementia Training Standards Framework, the resource was previously known as Dementia Core Skills Education and Training Framework, its recent update and review include a number of additions regarding food, drink and oral health.
The framework is an extraordinarily useful resource which details the essential skills and knowledge necessary across the health and social care spectrum. Three tiers are described:
Awareness, which everyone should have;
Basic skills which are relevant to all staff in settings where people with dementia are likely to appear and;
This framework will help ensure quality and consistency in dementia education and training if you are an organisation or an individual working in health, social care or housing.
The framework will allow the differentiation of high quality services, ensure personalised care and support for people living with dementia, and support organisations and individuals to meet requirements of regulators (source: HEE).
Alzheimer’s Society | July 2018 | Ten minutes of social interaction improves wellbeing in dementia care
Spending ten minutes interacting with people with dementia in care homes can benefit their wellbeing. The Wellbeing and Health for people with Dementia (WHELD) programme trained care home staff to increase social interaction from two minutes a day to ten, combined with a programme of personalised care. Carers were encouraged to discuss the patient’s interests and involve them in decisions about their care. The Improving Staff Attitudes and Care for People with Dementia e-Learning (tEACH) study, conducted by the University of Exeter Medical School and King’s College London in partnership with the Social Care Institute for Excellence (SCIE), was presented at the recent Alzheimer’s Association International Conference 2018. The study involved 280 residents and care staff in 24 care homes over a nine- month period.
Carers participated in an e-learning programme, carers who participated via Skype continued to deliver improved resident wellbeing four months after the trial was completed. Although boh treatment arms improving resident wellbeing and staff attitudes to person-centred care.
Dr Doug Brown, Chief Policy and Research Officer at Alzheimer’s Society, said:
‘It’s unacceptable that people in care homes only get ten minutes of social interaction each day. What we need is a person-centred approach to care, that takes into account each individual’s unique qualities, abilities, interests, preferences and needs.
‘This study supports what we know from our own research – training is crucial in order to provide this type of individualised care, activities and social interactions, which can have a significant impact of the well-being of people living with dementia in care homes (Source: The Alzheimer’s Society).