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Dementia

Dementia Strategy MKB Care:  2013/14

Dementia describes a group of symptoms caused by the gradual death of brain cells, leading to progressive decline of functions such as memory, orientation, understanding, judgement, calculation, learning, language and thinking, (ICD10 found in Dementia 2010 ;Oxford University).  Each person who suffers the illness is unique.  Progression depends upon many pre-existing factors, some being personality, previous intellectual ability and the presence of other illnesses (co-morbidities). Causes are seen to be genetic in some cases (Gene 21 is thought to influence Alzheimer’s disease) vascular in others (Vascular Dementia, with possible cardio-vascular disease as co-morbidity), and other cerebral changes resulting from as yet unknown origin cause, e.g. Lewy Body/fronto-temporal lobe dementia.

The onset and progression of dementia in older people is different for the different types found.  In older people Alzheimer’s disease is the most common may take 10 to 15 years to develop into an intrusive condition, whilst vascular dementia may take much less time.  The illness trajectory remains different for different types. Alzheimer’s disease shows a slow but predictable decline in cognition and self care ability, whilst vascular dementia shows a step wise process, associated with numerous or significant vascular events (eg stroke or multiple trans-ischemic attacks).  Lewy body dementia shows wild swings in ability and is difficult to predict.  This said some people suffer a mixed dementia which may include any or all of the above.

It is clear that people who suffer moderate to severe dementia may have very individual and challenging needs in care and in their medical management.  Although some types of dementia do have pharmacological treatment plans, these are short term, and there is no medical pathway for all.  The care for people with dementia needs to be geared to supporting the complex change and loss processes the person is undergoing, and managing long and short term co-morbidities.

The prevalence of dementia in Buckinghamshire and Milton Keynes is identified through statistical analysis.  Figures supplied by collaborative studies propose in the age cohort 30-59yrs 0.125% of the population have dementia, in the 60-79 yrs cohort there are 3.06% with dementia and in the 80yrs plus cohort there are 24.8% of the population with dementia. (Hofman et al, 1990; Alzheimer’s Europe, 2009)

Buckinghamshire has a population of 494700 (2009) with a lower than national average older (65yrs +) population of 96100.  In the period 2001 to 2009 the population aged 65 years plus increased by 14500 (17.8%).  The life expectancy in Buckinghamshire continues to rise and in January 2011 showed men to have a life expectancy of 80.3 years and women 83.9 years (BELP Technical Paper 2, Buckinghamshire’s Demography, January 2011).  The path is showing a predicted increase in old age of 44.4% by 2026, (3.17% per annum).  The population of Milton Keynes is 236700 with a projected increase to 323146 by 2026 (ONS 2006).  There are a low stated number of older people in Milton Keynes with the majority of the population in 30-54 demographic bands. However, the statistics show 40630 people aged 60 years plus including 8040 aged 80 years plus. (MK Population Bulletin 2011/12)

Working on a figure of 9000 people in Buckinghamshire and 8000 people in Milton Keynes aged 80 yrs plus, we may currently expect to find 4216 (24.8% pop) people suffer dementia, in this age cohort. Given the most frequent onset of dementia is 10-15years prior to care need and there are currently 27800 people aged 70-74 years (Bucks + MK), we may expect another 850 sufferers (3.06% pop) by 2027; the time they reach 80 years of age.  This gives an annual increase of 56.7 people requiring dementia care on top of current demand.   

This strategy needs to consider the support for people with dementia who are both currently and in the near future likely to receive care from domiciliary and/or residential care teams. The National Dementia Strategy (NDS) identifies the need for early diagnoses, carer recognition and support, improved quality of care in general hospitals, improved quality of care in care homes, an informed and effective workforce and a joint commissioning strategy (DH, Feb 2009). 

Key areas of the NDS need to be incorporated into the MKBCare strategy but the focus needs to be upon:

• promoting an integrated model of learning and personal development for carers (ADASS Sept 2008)

• identifying key indicators of best practice

• disseminating best practice (National Care Forum 2007)

• providing a monitoring and review system to support commissioning for dementia care across Buckinghamshire and Milton Keynes.

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