Care Needed

OECD

• Éditeur: OECD
• Année: 2018
• ISBN:
  9789264303683
• Sujet: Ciencias sociales
• Sous-sujet: Sociología

Chapter 1. Key findings and conclusion

This chapter summarises the main findings of the report and explains the methodology used. It provides an overview of the state of dementia in OECD countries. In discussing the impact of dementia in OECD countries today and in the years to come, it makes the case for why greater attention to the condition and more concerted policy efforts are needed.

The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.

Nearly 19 million people across the OECD are living with dementia. Many more are affected by the disease: millions of family members and friends provide care or otherwise support their loved ones throughout their lives. Receiving a dementia diagnosis remains a shattering experience. Until a cure or disease-modifying treatment for dementia is developed, the progress of the disease cannot be slowed or stopped. Nevertheless, the quality of life and level of impairment that people experience can be improved. OECD countries already offer a range of treatments and services that can improve the lives of people with dementia, even in the absence of a cure. Medications, psychosocial interventions, dementia-friendly community initiatives and high-quality health and long-term care services can help people with dementia live more independently and maintain a higher level of wellbeing.

However, significant barriers to access remain and many people with dementia simply do not get the care they need to improve their lives or the lives of those close to them. Furthermore, many millions of cases of dementia go undiagnosed or are diagnosed late. Even when people receive services, these may fail to fully address their needs, and outcomes can be poor.

This report presents the state of the art in comparing dementia treatment and care, sets out estimates of the burden of dementia – diagnosed and undiagnosed – across OECD countries, reports on the state of dementia care across the OECD, and identifies the policies and practices that have been put in place to improve the quality of life for individuals living with dementia and their families. It builds on previous OECD work on dementia care, in particular Addressing Dementia: the OECD Response, which gave an overview of the evidence around dementia care and identified ten key objectives that all countries should consider when setting dementia policy (OECD, 2015a). This report deepens the analysis by comparing how these objectives are being addressed in different countries, both in terms of the policies that are being implemented and the outcomes that are being achieved. This report compares dementia care in OECD countries, and explores how better comparisons can be made in the future.

The report shows that countries have enhanced their efforts to provide high-quality dementia care during diagnosis, early and advanced dementia, but improving measurement is necessary for enhancements in care quality and outcomes for people with dementia. Chapter 2 presents an overview of recent efforts in countries to diagnose dementia and document and track people with dementia in the health system. It highlights in particular that diagnosis rates for dementia are low and efforts to expand diagnosis are often aimed at physicians underprepared to handle the job. Chapter 3 finds that while there is a growing body of good practice for community-based care, care co-ordination, dementia-friendly initiatives and support for informal carers must be further developed and more regularly measured to further progress. Finally, the research in Chapter 4 reveals that quality of care for advanced dementia remains poor, including high rates of antipsychotic prescribing which remain widespread despite the fact that such approaches are widely discouraged across the OECD.

1.1. Dementia will have a growing human and financial cost to society

1.1.1. Population ageing means dementia prevalence will continue to rise

Encompassing a range of health conditions, dementia refers to symptoms of memory and cognitive difficulties that can eventually interfere with the everyday life and activities of people living with dementia. While Alzheimer’s disease is the most common form of dementia, other diseases exhibit similar symptoms, including vascular dementia, dementia with Lewy bodies, and Parkinson’s disease.

Despite significant research efforts, much about dementia remains unknown. While it is clear that dementia does not represent a necessary outcome of ageing, dementia prevalence rises rapidly with age: while just over 2% of people between 65-69 years live with dementia, prevalence rises to over 40% for those aged over 90 (Figure 1.1).

Figure 1.1. Prevalence of dementia across all OECD countries, by age group

Source: OECD Health Statistics 2017, http://dx.doi.org/10.1787/health-data-en.

StatLink http://dx.doi.org/10.1787/888933735025

This makes the rapid ageing of the population in many OECD countries particularly relevant for dementia. The share of the population aged over 65 in OECD countries has risen quickly in recent years, and will continue to grow in the coming decades. On average, the proportion of the population aged over 65 rose from less than 10% in 1960 to 17% in 2015, and is projected to reach 28% by 2050 (OECD, 2017a). Many of these people are living with dementia. In Canada, for example, dementia prevalence in the population 65 and over reached 7.1% in 2013 (Public Health Agency of Canada, 2017). Moreover, the share of the population over 80 in the OECD is projected to increase from nearly 5% in 2015 to more than 10% by 2050 (OECD, 2017a) (Figure 1.2). As populations continue to age, the prevalence of dementia in OECD countries is also expected to rise, from an estimated 18.7 million people in 2017 to 40.9 million by 2050. The pace of population ageing has been slower in non-OECD countries, although it is expected to accelerate. In large partner countries including Brazil and China, less than 2% of the population was 80 years and over in 2015, though this share is expected to reach close to 7% in Brazil and more than 8% in China by 2050.

Figure 1.2. Trends in the share of the population aged over 80 years, 1990-2050

Note: Partner countries include Brazil, China, Colombia, India, Indonesia, Lithuania, Russia, Costa Rica and South Africa.

Source: OECD Historical Population Data and Projections Database, 2017.

StatLink http://dx.doi.org/10.1787/888933735044

The personal and financial costs of dementia are immense. Globally, dementia represents one of the leading causes of disability for elderly adults. It is estimated that the health and social costs of dementia reached over USD 1 trillion per year in 2018 (Alzheimer’s Disease International, ...