Dementia is now a major healthcare challenge -Burke

The HSE estimates the number of people in Ireland suffering from dementia will increase from its present level of 40,000 plus to over 100,000 by the year 2036. Improved healthcare, better nutrition, better working conditions, reduction in poverty have all contributed to people living longer and generally healthier lives.   However, one of the unforeseen consequences of this is a very significant increase in dementia, particularly Alzheimer’s, which should not be allowed to be seen as a normal part of ageing but which is a reality for many.

As defined by the World Health Organisation [WHO] dementia is a syndrome, usually of a chronic or progressive nature, caused by a variety of brain illnesses that affect memory, thinking, behaviour and ability to perform everyday activities. 60-70% of dementia patients have Alzheimer’s. Symptoms vary from the mild to the very extreme and the prognosis can vary considerably from person to person.   A recent New England Journal of Medicine estimates that the prevalence of dementia in the over 70s is of the order of 14.7%.

The challenges of dementia are not limited to the Irish health system and society they are increasingly global in nature. The US National Institute of Ageing estimates that more than 5 million people now suffer from dementia in the US and the figure will rapidly increase in the years ahead.

The 2012 report by the WHO on dementia estimates that 36 million people world wide now live with dementia.   Each year there are 7.7 million new cases. The total number of people suffering from dementia is expected to reach 66 million by 2030 and 115 million by 2050.   Barry Greenberg, Director of Strategy, Toronto Dementia research Alliance writing about dementia has said the following “The scope of the looming medical-care crisis is beyond comparison with anything that has been faced during the entire history of humanity”

The HSE estimate of more than 100,000 dementia cases by 2036 may seem large but Ireland’s population of elderly is already rapidly increasing and the trend is set to continue. CSO population projections indicate that the number of people over the age of 65 will rise from its current level of 550,000 to 1.3 million or more by 2041.   During the same period the number of people aged 80 or over is projected to increase from around 71,000 to 257,000.   International studies indicate that the number of people with Alzheimer’s doubles for every 5 year interval past the age of 65.

Dementia is a deep personal affliction for those who suffer from the syndrome and huge emotional, psychological and financial stress is often placed on their family. According to HSE figures 40% of people with dementia are in residential care while just over 40% are cared for by family members. In addition at any one time 18% of acute hospital beds are occupied by people with dementia. This latter figure is an indication that there are gaps in the care provisions for these patients. The WHO report also draws attention to the need to have a legislative framework for people with dementia in order that their personal dignity and rights are protected.

In that context it is important to note that the programme for government clearly states the following, “we will develop a national Alzheimer’s and other dementias strategy by 2013 to increase awareness, ensure early diagnosis and intervention, and development of enhanced community based services. This strategy will be implemented over five years”.

The HSE is already doing very good work in the area of training and community support. It is imperative however that the government move decisively to develop the promised strategy on dementia. Several organisations including the Alzheimer’s Society of Ireland have made excellent submissions. There needs to be a broad consultation process. As the WHO points out people with dementia and their caregivers often have unique insights to their condition and life. They should be involved in formulating the policies, health plans, laws and services that relate to them. The strategy needs to focus on prevention, early detection, patient care, treatment protocols and research.

There is some research evidence to suggest that obesity, smoking, abuse of alcohol and other drugs are risks factors for dementia. There is also evidence to suggest that an active physical, mental and social life can delay the onset of dementia and lessen it impact. It also appears that a high level of sensory stimulation may help in prevention.

All this evidence has implications for the location of nursing homes for the elderly and care within them. Putting elderly people into low stimulation environments is not a sensible policy. We can learn from best treatment practice elsewhere in the world whether that is in more traditional societies or more developed ones.   The Netherlands for instance has developed a pilot project where dementia patients are cared for in a safe, secure village style environment, and have a high level of personal autonomy.     

Ireland should also begin to take a lead in the medical treatment of dementia and research into its causes and new drug treatments.

I believe the time has come for the government to establish a National Institute for Dementia modelled on the various institutes under the umbrella US organisation, the National Institute for Health [NIH]. This Institute should be part funded by the State. Additional funding could be sourced from the EU Horizon 2020 research programme. Indeed a specific portion of the research budget will be devoted to health, demographic change and well being. There are many wealthy individuals in Ireland who could also be persuaded to support such an Institute.

Dementia is an international health issue growing in magnitude. The WHO estimates that caring for people with dementia currently costs the world more than €450 billion per annum. An Irish institute devoted exclusively to this major health issue could soon become a centre of excellence, attracting international funding and expertise.  

There is still some residual stigma attached to dementia which we need to get rid of.   As the number with dementia grows resources will be stretched.   We must not ignore the challenge; it is not going to go away. We need to face it with determination and resolve and above all with compassion for those directly affected and for those caring for them. Now is the time for the Department of Health to show strong leadership on this issue of national concern.