Appendix 5 - World Alzheimer Report

World Alzheimer report 2016 Improving healthcare for people living with dementia.

Summary of review findings: Models of healthcare delivery

Healthcare is at the core of the system of treatment and support for people with dementia and their carers. Healthcare professionals, and services have important roles to play across the course of the condition; promoting brain health; providing a timely diagnosis with post-diagnostic information and support; signposting community support services; initiating treatments where appropriate; optimising physical health and managing comorbidities; assessing and managing behavioural and psychological symptoms.

Dementia is not just another diagnosis on the lengthening list of comorbidities that most of us face as we age. It changes everything, not least future expectations of life, and independence. It impairs one’s ability to recognise and report new symptoms, seek help, and manage one’s own health conditions. Therefore, it has profound implications for the management of all health issues for the person with dementia, and the way that healthcare needs to be planned and delivered for people with dementia in general.

Healthcare for people with dementia needs to be

  • continuous; treatment options, care plans and needs for support need to be monitored and reviewed as the condition evolves and progresses
  • holistic; treating the whole person, not single conditions, organs or systems, mindful of that person’s unique context, values and preferences
  • integrated; across providers, levels of care, and health and social care systems

Currently, healthcare systems struggle to provide adequate coverage of diagnostic services, and care is too often fragmented, uncoordinated, and unresponsive to the needs of people with dementia and their families at the time when they arise. In high income countries, dementia healthcare systems tend to be highly specialised, from diagnosis onwards, with very little formal recognition of the role of primary care services, or allocation of tasks to this sector.

This is probably also true for low and middle income countries, where diagnostic coverage is low, but such services as are available are provided by a very limited number of specialists.

As the numbers of people affected and the demand for services increase, it is unlikely that full coverage of dementia healthcare services can be attained or afforded using the current specialist care model. There are other limitations too. Seamless and continuing carries beyond the capacity and reach of specialist services working in isolation. The specialist model of dementia care does not facilitate holistic management of or care-coordination for, complex multimorbidities. These are core functions of primary healthcare.

Task-shifting and task-sharing, including but not limited to increasing the role and competencies of primary healthcare services within the system, will be the core strategies for increasing the coverage of diagnosis and continuing care. Collaborative or shared-care models distribute tasks between primary and secondary care services in a structured and organised fashion. Case management may be an important strategy for increasing treatment coverage, and improving integration and coordination of care. More research is needed to clarify the best ways of delivering this promising intervention. Evidence to date suggests that case management needs to be adequately resourced by skilled staff with manageable caseloads, and implemented such that case managers have the authority to work with all stakeholders and providers.

The introduction of evidence-based care pathways, linked to process and outcome indicators, should help to improve adherence to healthcare quality standards, and allow transparent monitoring of treatment coverage and effective treatment coverage.

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