03 Sep 2012
The current prevalence of dementia and its associated economic and social burden presents a challenge for the configuration of dementia care services at present and it is clear that this challenge will become ever more urgent as a consequence of population ageing. IPH supports the development of a Dementia Strategy in Ireland that is comprehensive and holistic. We recommend that the strategy encompasses aspects of prevention as well as optimal management at all stages of the disease. IPH considers that a social determinants of health approach that focuses on the prevention of disease and disability could form an important strand of the strategy. Key points from IPH response IPH would emphasise the following key priorities for inclusion in the Dementia Strategy.
Adoption of a public health approach as set out by WHO (2011)
and the development of an implementation plan and structures to support
- A co-ordinated, multi-sector approach to dementia care that identifies synergies with existing public health strategies relevant to health and wellbeing in later life.
- Development of a monitoring and evaluation framework on the number of people living with dementia, severity of the disease and placement patterns, as well as quality of life and quality of care policy indicators.
- Guidance on ethics and legal aspects of dementia and patient rights in Ireland
- Establishment of a Ministerial Taskforce to oversee the implementation of the new Dementia Strategy within a clear timeframe
A commitment to primary, secondary and tertiary prevention of dementia.
- Enhanced awareness in the general population and at all levels of health and social care services to increase understanding about the risk factors and signs and symptoms of dementia
- A focus on addressing risk factors for vascular disease, including diabetes, hypertension, obesity, smoking and physical activity across the life course and enhancing the effectiveness of current strategies and programmes relating to prevention and optimal management of these disorders or health behaviours.
- Clarifying the specific roles of key health care workers in terms of the diagnosis, management and care of persons with dementia and their families
- Specifying standards in the domains of assessment, review and care outcomes
- Ensuring equity of access (and outcomes where possible) for designated vulnerable dementia patients and their families, for example including those living in disadvantaged communities, ethnic minorities, adults with learning disability, those with existing mental health or physical disabilities etc
- Workforce planning and designated pathways for professional development for relevant health and social care service providers involved in the diagnosis and care of those with dementia and their carers, with an emphasis on primary care and integration with the primary care programme.
- Ongoing development and evaluation of the case management model of integrated care for dementia guided by a HSE Clinical Programme
- Appropriate planning, delivery and evaluation of a range of options for end of life care.
Resourcing of a programme of research to support primary,
secondary and tertiary prevention of dementia to ensure a systematic
approach to generate an evidence-base and disseminate pertinent findings
in the Irish context. Emphasis should be placed on high quality
research specifically to:enhance information systems on dementia at a
- enhance information systems on dementia at a national level
- provide an evidence base on the risk factors/causes of dementia;
- identify those most at risk of developing dementia in the community at an early stage; and
- provide an evidence-base on interventions that delay the onset and course of dementia.
A life course approach to tackle the social determinants of dementia and ill-health in later life.
- IPH recommends the adoption of a ‘brain health’ approach in broader public health campaigns and the widespread adoption of interventions to promote childhood resilience and protective factors for brain health throughout life.
- Broader public health interventions are required to tackle the social determinants of dementia, specifically education and deprivation in line with recommendations from other national strategies including the forthcoming Public Health Strategic Framework and Positive Ageing Strategy.
Supporting carers for people with dementia
- Promoting community capacity to maintain people with dementia living a meaningful life in their homes for as long as possible.
- Resourcing carers through training, effective information provision and formal support for their caring commitments