dementia diagnosis: why should we bother? dr. sridhar vaitheswaran 30 th october 2013
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Dementia Diagnosis: Why should we bother?
Dr. Sridhar Vaitheswaran30th 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 -1981Population Pyramids of Scotland, 1981-2035
60000 40000 20000 0 20000 40000 60000
0
10
20
30
40
50
60
70
80
90+
Age
PersonsMale Female
1981
Data for 2011 to 2035 is from the 2010-based National Population Projections. Data prior to this is from the NRS mid-year population estimates.
Population Pyramids of Scotland, 1981-2035
60000 40000 20000 0 20000 40000 60000
0
10
20
30
40
50
60
70
80
90+
Age
PersonsMale Female
1991
Data for 2011 to 2035 is from the 2010-based National Population Projections. Data prior to this is f rom the NRS mid-year population estimates.
Population pyramid for Scotland - 1991
Population Pyramids of Scotland, 1981-2035
60000 40000 20000 0 20000 40000 60000
0
10
20
30
40
50
60
70
80
90+
Age
PersonsMale Female
2001
Data for 2011 to 2035 is from the 2010-based National Population Projections. Data prior to this is from the NRS mid-year population estimates.
Population pyramid for Scotland - 2001
Population Pyramids of Scotland, 1981-2035
60000 40000 20000 0 20000 40000 60000
0
10
20
30
40
50
60
70
80
90+
Age
PersonsMale Female
2011
Data for 2011 to 2035 is from the 2010-based National Population Projections. Data prior to this is from the NRS mid-year population estimates.
Population pyramid for Scotland - 2011
Population Pyramids of Scotland, 1981-2035
60000 40000 20000 0 20000 40000 60000
0
10
20
30
40
50
60
70
80
90+
Age
PersonsMale Female
2021
Data for 2011 to 2035 is from the 2010-based National Population Projections. Data prior to this is from the NRS mid-year population estimates.
Population pyramid for Scotland - 2021
Population Pyramids of Scotland, 1981-2035
60000 40000 20000 0 20000 40000 60000
0
10
20
30
40
50
60
70
80
90+
Age
PersonsMale Female
2031
Data for 2011 to 2035 is from the 2010-based National Population Projections. Data prior to this is from the NRS mid-year population estimates.
Population pyramid for Scotland - 2031
SCOTLAND[percentage -total population]
0
5
10
15
20
25
30
85+75-8465-74
Population of very elderly in Scotland
• 17% increase in 90+• 44% increase in 100+
General Register Office for Scotland
Year 90+ 100+
2002 29,970
570
2010 35,190
820
Projected Age Change in 65+2010 2035 Change %
Aberdeen City
Aberdeenshire
Projected Age Change in 65+2010 2035 Change %
Aberdeen City 32,105
Aberdeenshire
Projected Age Change in 65+2010 2035 Change %
Aberdeen City 32,105
Aberdeenshire 40,022
Projected Age Change in 65+2010 2035 Change %
Aberdeen City 32,105 51,817 19,712 61.4%
Aberdeenshire 40,022
Projected Age Change in 65+2010 2035 Change %
Aberdeen City 32,105 51,817 19,712 61.4%
Aberdeenshire 40,022 78,474 38,452 96.1%
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?
References
• World Alzheimer Report 2011http://www.alz.co.uk/research/WorldAlzheimerReport2011.pdf• 2010-based Population Projections, Aberdeen
City and Shire, Briefing paper 2012/01http
://www.aberdeencity.gov.uk/nmsruntime/saveasdialog.asp?lID=45250&sID=3365
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