Dementia stats down however postcode lottery drives uneven care

Dementia has been described as a ticking time bomb, with the variety of these affected predicted to double within the subsequent twenty years. However a brand new examine means that the prevalence of individuals with dementia within the UK has really fallen over the previous 20 years.

With no treatment but on the horizon, why does the prevalence of the illness look like falling? And is it counterproductive for advocacy teams to boost fears by describing it as a dementia “disaster”?

What the figures say

The findings, primarily based on knowledge from members aged over 65 and dwelling in Cambridgeshire, Newcastle and Nottingham, seems to be consistent with a a lot bigger Europe-wide examine printed by Alzheimer Co-operative Valuation in Europe (Alcove).

The researchers in England checked out 7,000 individuals randomly chosen between 1989 and 1994 and requested them about their life-style, well being and socio-economic standing. Almost 8,000 extra have been recruited once more between 2008 and 2011. Round 1,500 have been examined for dementia.

Primarily based on the estimated prevalence of dementia 20 years in the past, the researchers then estimated that some 880,000 throughout the UK can be anticipated to have dementia by now (about 8% of individuals aged over 65). However this native examine suggests a nationwide prevalence of round 670,000 individuals (6.5% of the over 65 inhabitants). General, this can be a fall of almost 1 / 4 within the variety of individuals anticipated to have dementia.

Dementia prevalence nonetheless stays larger in girls. In care houses it has elevated, from over a half of residents 20 years in the past. A current Scottish examine in 2011 discovered 90%.

Maintaining the funding

There are two attainable causes for the general fall in prevalence: research could also be getting extra rigorous and extra correct, or we’ve considerably improved our well being over the past 20 years which has led to much less of us getting dementia. Extra work can be wanted to tease this out.

Richard Horton, Editor-in-Chief of the Lancet, mentioned he hoped that the findings didn’t result in a discount in much-needed funding for dementia care and analysis. “Dementia stays a considerable problem for these affected, their households, the NHS, and the Treasury,” he mentioned.

Researchers all the time fear about this, and it’s significantly awkward to ask for cash for an issue that might be even remotely perceived as going away.

Nonetheless, maybe extra importantly than the numbers is how we successfully diagnose and deal with individuals with the situation.

A dementia map of the UK

Final yr David Cameron launched the dementia problem and a doubling of funding for dementia analysis to £66m by 2015.

Besides funding for dementia analysis within the UK remains to be solely a fraction of what’s spent on most cancers analysis. That is ironic when dementia prices society some £23bn a yr – greater than most cancers, coronary heart illness and stroke put collectively.

However as Horton additionally mentioned: “We have to perceive higher why the prevalence of dementia has fallen and what which means for prevention and remedy providers.”

The researchers counsel that coverage makers are working with inaccurate or deceptive statistics. This means that insurance policies are extra primarily based on proof than on sentiment created by lobbying and political opportunism. I don’t imagine that is the case and right here’s the laboratory to check it.

The statistics about dementia are arguably the identical all throughout the UK, and we are able to evaluate how 4 units of coverage makers have responded in England, Scotland, Wales and Northern Eire. Every of the 4 well being departments has a distinct coverage. However let’s have a look at one final result: are you able to get a analysis and subsequently entry to treatment and different accessible help?

Primarily based on the identical statistics on prevalence of dementia, every nation made a distinct coverage at a distinct time and bought vastly totally different outcomes. In Northern Eire, for instance, you could have a 63% probability of being recognized by the well being system, however in England it’s 42%.

This postcode lottery is a scandal however averaging out the determine for England, Wales and Northern Eire simply buries such variations.

Hope over hype

The discount in dementia prevalence is purpose to have fun. A lot of the response to dementia is pricey and silly – for instance admitting individuals with dementia into hospital when it’s not the very best place for them to be – so the thought of a discount within the variety of potential victims of the well being and social care system is sensible.

However how dementia is framed within the media and by advocacy teams is important. Internationally it’s represented as an enemy that needs to be fought. It’s a “disaster”, a “rising tide” or “an epidemic” – or certainly the ticking time bomb. However in whose curiosity is it to signify it as a disaster?

There’s a perverse incentive for fundraisers and lobbyists to have it introduced in a destructive mild. The hazard of that form of language is that it makes individuals very nervous with out really enhancing care or accelerating change. We’ve had Baroness Mary Warnock advocating for suicide for individuals with dementia and creator Terry Pratchet has spoken out in favour of euthanasia. Higher lifeless than demented, apparently. However there may be nonetheless a lot extra that may be finished to enhance care and fight the situation.

Life-style adjustments, akin to stopping smoking, diet and higher administration of situations akin to diabetes, can delay the onset of dementia signs, or cut back the chance of contracting underlying ailments that trigger signs together with Alzheimer’s and vascular illness.

Cambridge’s Professor Carol Brayne, who led the Lancet examine, says that the good points produced from the autumn in prevalence and, whether or not this continues into the longer term, “rely on whether or not additional enhancements in major prevention and efficient healthcare for situations which enhance dementia threat might be achieved.”

She’s proper. It’s not simply the numbers however what we do with them that issues.