Is Dementia A Worldwide Problem

A Call For Action Was Adopted Today By The Participants Of The First Who Ministerial Conference On Global Action Against Dementia

The participants included 80 Member States, 80 philanthropic foundations, 45 NGOs and 4 UN Agencies

We, the participants of this Conference, note the following:

1. Dementia currently affects more than 47 million people worldwide, with more than 75 million people estimated to be living with dementia by 2030. The number is expected to triple by 2050. It is one of the major health challenges for our generation. Often hidden, misunderstood and underreported, dementia impacts individuals, families and communities and is a growing cause of disability.

2. Contrary to popular belief, dementia is not a natural or inevitable consequence of ageing. It is a condition that impairs the cognitive brain functions of memory, language, perception and thought and which interferes significantly with the ability to maintain the activities of daily living. The most common types of dementia are Alzheimers disease and vascular dementia. Evidence suggests that the risk of certain types of dementia may be lowered by reducing cardiovascular risk factors, as applicable.

4. Nearly 60% of people with dementia live in low- and middle-income countries, and this proportion is expected to increase rapidly during the next decade, which may contribute to increasing inequalities between countries and populations.

6. The following overarching principles and approaches are integral to global efforts:

These Are The 2 Blood Values To Keep Under Control To Prevent Vascular Dementia

The 2015 World Alzheimers Report reports that 46.8 million people worldwide suffer from a form of dementia. Precisely every year 9.9 million new cases of dementia are detected.

Alzheimers is the most common form of dementia and it is a disease that, unfortunately, is progressing very fast in the world. This is a much studied but not yet fully known topic.

For this reason, it is difficult to say how the problem can be prevented. What is known, however, is that there are some behaviors that can help us improve this condition.

We are talking, in particular, about the importance of exercising regularly, not smoking, training your mind and following a correct diet. In this regard, in fact, we have already pointed out that these are the foods that would ward off Alzheimers and senile dementia.

Still with regard to nutrition, a really interesting discovery concerns a drink that would have beneficial effects on these pathologies. In fact, few people know that this drink could be useful in combating Alzheimers and memory loss.

After Alzheimers, vascular dementia is the second most common cause of dementia.

Overview Of Alzheimer’s Disease

Alzheimer’s disease is a type of brain disease, just as coronary artery disease is a type of heart disease. It is also a degenerative disease, meaning that it becomes worse with time. Alzheimer’s disease is thought to begin 20 years or more before symptoms arise,- with changes in the brain that are unnoticeable to the person affected. Only after years of brain changes do individuals experience noticeable symptoms such as memory loss and language problems. Symptoms occur because nerve cells in parts of the brain involved in thinking, learning and memory have been damaged or destroyed. As the disease progresses, neurons in other parts of the brain are damaged or destroyed. Eventually, nerve cells in parts of the brain that enable a person to carry out basic bodily functions, such as walking and swallowing, are affected. Individuals become bed-bound and require around-the-clock care. Alzheimer’s disease is ultimately fatal.

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Greater Risks Of Alzheimers And Dementia For Blacks And Latinos

• 18.6% of Blacks and 14% of Hispanics age 65 and older have Alzheimers compared with 10% of White older adults .

• Other prevalence studies also indicate that older Blacks are about twiceas likely to have Alzheimers or other dementias as older Whites.

The Role Of Secondary Care

Primary care is increasingly taking on a greater role in both the assessment and the long term care of people with dementia one multicentre randomised controlled trial found no evidence that specialist memory clinics were more effective than general practice services in providing post-diagnostic support.21 Secondary services have an important role in defining the dementia subtype, dealing with more complex cases, and stratifying which patients with mild cognitive impairment are at greatest risk of developing dementia and most in need of follow-up.

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Is A Breakthrough On The Horizon

There is no cure for dementia, though some medications help slow the progression of the disease if started early. New drugs are in the pipeline, however, and a researcher in the U.K. has grabbed headlines by hailing a breakthrough in the next five years.

Matthew Baumgart, Senior Director of Public Policy for the U.S.-based Alzheimers Association, said he hopes that prediction holds true but believes it is optimistic.

Five trials of Alzheimers prevention drugs are set to begin soon in the U.S., he said. Each will take about two to three years, and require replication. Actually getting a product to market in five years could be difficult.

Laura Phipps, a representative of Alzheimers Research UK, said that her charity is investing in new drug discovery work to speed up clinical trials. In the next five years, if we dont have a treatment from current trials, we will have more potential new treatments coming through towards the clinic, she told Healthline.

Specific Information In This Report

Alzheimer’s Disease Facts and Figures

• Brain changes that occur with Alzheimer’s disease.
• Risk factors for Alzheimer’s dementia.
• Number of Americans with Alzheimer’s dementia nationally and for each state.
• Lifetime risk for developing Alzheimer’s dementia.
• Proportion of women and men with Alzheimer’s and other dementias.
• Number of deaths due to Alzheimer’s disease nationally and for each state, and death rates by age.
• Number of family caregivers, hours of care provided, and economic value of unpaid care nationally and for each state.
• The impact of caregiving on caregivers.
• National cost of care for individuals with Alzheimer’s or other dementias, including costs paid by Medicare and Medicaid and costs paid out of pocket.
• Medicare payments for people with dementia compared with people without dementia.
• Number of geriatricians needed by state in 2050.

The Appendices detail sources and methods used to derive statistics in this report.

When possible, specific information about Alzheimer’s disease is provided in other cases, the reference may be a more general one of âAlzheimer’s or other dementias.â

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High Costs And Effects Of Caregiving

• The estimated number of caregivers for people with Alzheimers and other dementias in 2020 is 11.2 million.
• Caregivers provided 15.3 billion hours of unpaid care in 2020, valued at almost $257 billion, to people living with Alzheimers and other dementias.
• Two-thirds of dementia caregivers are women.
• The prevalence of depression is higher among dementia caregivers than other caregivers, such as those who provide help to individuals with schizophrenia or stroke .

Social Aspects Of Dementia: From Caregivers To Related Costs

There are two main social aspects of dementia: The first point concerns the evidence that the Alzheimer’s disease prevalence is likely to increase . A second aspect pertains to people professionally involved in the assistance of the patients and the workload and costs that this assistance imposes to the family members . For example, developed countries face increasing health expenses, both in absolute terms and as a percentage of the gross domestic product . Since neurological and psychiatric diseases in Europe afflict more than 14% of the population, representing about 20% of health expenditure, this implies a segment of considerable public spending .

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Growing Numbers Of People With Alzheimers In The Us

About 6.2 million people in the United States are living with Alzheimers disease. Of the total U.S. population, more than 1 in 9 people age 65 and older has Alzheimers. The percentage of people with Alzheimers increases with age: 5.3% of people ages 65 to 74, 13.8% of people ages 75 to 84, and 34.6% of people 85 and older.

Social Aspects Of Dementia Prevention From A Worldwide To National Perspective: A Review On The International Situation And The Example Of Italy

Giovanna Ricci

1School of Law, University of Camerino, Camerino, Italy

Abstract

At the moment, dementia is affecting around 47 million people worldwide, with a forecast amount of 135 million affected people in 2050. Dementia is a growing health concern worldwide with no treatment currently available, but only symptomatic medication. Effective interventions in the prevention and management of dementia are urgently needed to contain direct and indirect costs of this disease. Indeed, the economic impact of dementia is a vast and continually growing figure, but it is still difficult to quantify. Due to an increase in both the disease spreading and its direct and indirect costs, national and international action plans have to be implemented. As a virtuous example, the Italian national plan for dementia has been summarized. Faced with an increasingly less sustainable disease impact at national and international levels, the plan suggests that it is certainly the entire welfare model that should be rethought, strengthening the network of services and providing interventions to support affected people and their caregivers. Alongside this synergistic approach, scientific research could play a crucial role for pharmacological and nonpharmacological treatments capable of delaying the state of loss of self-sufficiency of the patient, with a significant impact on social and health costs.

1. Introduction

1.1. Epidemiology

1.3. Effects of Potentially Modifiable Risk Factors on the Brain

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Use And Costs Of Health Care And Long

Among Medicare beneficiaries with Alzheimer’s or other dementias, black/African Americans had the highest Medicare payments per person per year, while whites had the lowest payments . The largest difference in payments was for hospital care, with black/African Americans incurring 1.7 times as much in hospital care costs as whites .

• Created from unpublished data from the National 5% Sample Medicare Fee-for-Service Beneficiaries for 2014.

In a study of Medicaid beneficiaries with a diagnosis of Alzheimer’s dementia that included both Medicaid and Medicare claims data, researchers found significant differences in the costs of care by race/ethnicity. These results demonstrated that black/African Americans had significantly higher costs of care than whites or Hispanics/Latinos, primarily due to more inpatient care and more comorbidities. These differences may be attributable to later-stage diagnosis, which may lead to higher levels of disability while receiving care delays in accessing timely primary care lack of care coordination duplication of services across providers or inequities in access to care. However, more research is needed to understand the reasons for this health care disparity.

Racial And Ethnic Differences In The Prevalence Of Alzheimer’s And Other Dementias

Although there are more non-Hispanic whites living with Alzheimer’s and other dementias than any other racial or ethnic group in the United States , older black/African Americans and Hispanics/Latinos are disproportionately more likely than older whites to have Alzheimer’s or other dementias., , – Most studies indicate that older black/African Americans are about twice as likely to have Alzheimer’s or other dementias as older whites., , Some studies indicate older Hispanics/Latinos are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites.,, , However, Hispanics/Latinos comprise a very diverse group in terms of cultural history, genetic ancestry and health profiles, and there is evidence that prevalence may differ from one specific Hispanic/Latino ethnic group to another .,

There is evidence that missed diagnoses of Alzheimer’s and other dementias are more common among older black/African Americans and Hispanics/Latinos than among older whites., Based on data for Medicare beneficiaries age 65 and older, it has been estimated that Alzheimer’s or another dementia had been diagnosed in 10.3% of whites, 12.2% of Hispanics/Latinos and 13.8% of black/African Americans. Although rates of diagnosis were higher among black/African Americans than among whites, according to prevalence studies that detect all people who have dementia irrespective of their use of the health care system, the rates should be even higher for black/African Americans.

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Caregiver Interventions And Family Engagement In Dementia

The term caregiver is used more in the United States, Canada, and China, while carer or caretaker is more common in the United Kingdom .

In any case, we can consider the following:

A management strategy is required to assess the cost/benefit ratio of treatments, and the expansion of the number of patients with dementia disease requires an acceleration of efforts in these fields. This explains why international research has developed considerably on this point. Chronic diseases have led to financial difficulties in public health systems. Hence, the role of informal caregivers is also important in evaluating economic and health analyses .

During preclinical dementia, when the disease appears and develops until its terminal phase, the patient poses complex health issues to social workers and family caregivers, who cannot always find the correct answer from the health and welfare services. These services, however, have not always reached a widespread and effective organizational model that can take into account the complexity of needs of the elderly .

There are also a few European experiences about neighbourhoods inhabited by patients and caregivers.

Trends In Dementia Caregiving

There is some indication that families are now better at managing the care they provide to relatives with dementia than in the past. From 1999 to 2015, dementia caregivers were significantly less likely to report physical difficulties and financial difficulties related to care provision. In addition, use of respite care by dementia caregivers increased substantially . However, as noted earlier, more work is needed to ensure that interventions for dementia caregivers are available and accessible to those who need them. A 2016 study of the Older Americans Act’s National Family Caregiver Support Program found that over half of Area Agencies on Aging did not offer evidence-based family caregiver interventions.

FIGURE 11

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Effects Of Dementia On Caregivers

Caregivers face many obstacles as they balance caregiving with other demands, including child rearing, career, and relationships. They are at increased risk for burden, stress, depression, and a variety of other health complications. The effects on caregivers are diverse and complex, and there are many other factors that may exacerbate or ameliorate how caregivers react and feel as a result of their role. Numerous studies report that caring for a person with dementia is more stressful than caring for a person with a physical disability.,,

Two models of factors leading to caregiver stress are useful. In the Poulshock and Deimling model, dementia leads to a burden of care which can manifest as strain in a number of ways that can be exacerbated or ameliorated Pearlin and colleagues’ model of caregiver stress outlines four main areas that contribute to caregiver stress: the background context , the primary stressors of the illness , secondary role strains , and intrapsychic strains such as personality, competence, and role captivity of the caregiver ., In Campbell and colleagues’ review of the model, the strongest predictors of caregiver burden were sense of role captivity , caregiver overload , adverse life events outside of the caregiving role and relationship quality.

It Requires More Research Better Provision For Long

OF ALL THE troubles facing the world, the rising prevalence of dementia might seem among the less pressing. The reason behind itlonger lifespansis to be cheered it does not advance at the speed of a viral infection but with the ponderous inevitability of demographic change and its full effects will not be felt until far into the future. But the reality is very different. As our special report this week makes clear, dementia is already a global emergency. Even now, more people live with it than can be looked after humanely. No cure is in the offing. And no society has devised a sustainable way to provide and pay for the care that people with it will need.

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The problems these numbers will bring everywhere have already been felt in countries where people are older, and especially acutely during lockdownswitness the difficulty of looking after people with dementia in their own homes, and the large numbers in overstretched care homes who receive little individual attention. As families shrink, single children and grandchildren will struggle to cope with their old folk. Already, dementia care has had a knock-on effect on general health care. Before the pandemic as many as a quarter of beds in British hospitals were occupied by people with dementia. There was nowhere else for them to go.

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How Much Does It Cost

Two thirds of the cost of dementia is paid by people with dementia and their families.

Unpaid carers supporting someone with dementia save the UK economy £13.9 billion a year.

The total cost of care for people with dementia in the UK is £34.7billion. This is set to rise sharply over the next two decades, to £94.1billion by 2040.

The cost of social care for people with dementia is set to nearly treble by 2040, increasing from £15.7billion to £45.4billion.

Dementia is one of the main causes of disability later in life, ahead of cancer, cardiovascular disease and stroke. As a country we spend much less on dementia than on these other conditions.

New Initiative To Better Coordinate Dementia Research

A series of unsuccessful clinical trials for treatments for dementia, combined with the high costs of research and development, led to declining interest in new efforts. There has, however, been a recent increase in dementia research funding, mainly in high-income countries such as Canada, the United Kingdom and the United States of America. The latter increased its annual investment in Alzheimers disease research from US$ 631 million in 2015 to an estimated US$ 2.8 billion in 2020.

“To have a better chance of success, dementia research efforts need to have a clear direction and be better coordinated, said Dr Tarun Dua, Head of the Brain Health Unit at WHO. This is why WHO is developing the Dementia Research Blueprint, a global coordination mechanism to provide structure to research efforts and stimulate new initiatives. An important focus of future research efforts should be the inclusion of people with dementia and their carers and families. Currently two-thirds of countries reporting to the Global Dementia Observatory involve people with dementia rarely or not at all.

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