Sir William Beveridge Foundation
Working on Health & Social Care; Women Empowerment; Training & Education; Research & Dementia Friendly Care Village
In 2010, the total estimated worldwide costs of dementia were $604 billion (US dollars). This figure placed it as the 18th largest in the world economies. The costs included informal care (provided by family and others); direct costs of social care (provided by community care professionals and in residential home settings) and the direct costs of medical care (the costs of treating dementia and other conditions on primary and secondary care).
In 2010 there were an estimated 35.6 million people living with dementia worldwide; this is set to increase to 65.7 million by 2030 and 115.4 million by 2050 (figures from Alzheimer’s Disease International). In South Asia, this figure currently stands at around 4.5 million and is expected to increase by 108 per cent to 9.3 million in 2030.
The World Alzheimer’s Report 2013 says that globally, 13% of people aged 60 or over require long-term care. Between 2010 – 2050, the total number of people with care needs will nearly treble from 101 million to 277 million. Long term care is mainly about care for people with dementia; around half of all older people with care needs have dementia and 80% of older people living in care homes are living with dementia. The worldwide cost of dementia care is currently over $US600 billion or around 1% of global GDP.
What is dementia?
It is often referred to as a syndrome that can be caused by a number of progressive disorders affecting memory, thinking, behaviour and the ability to perform everyday tasks.
There are four main types:
– Alzheimer’s disease
– vascular dementia
– dementia with Lewy bodies
– frontotemporal dementia.
There are over 100 variations of the condition under these four main types. Dementia mainly affects older people but there is growing awareness of cases that start before the age of 65 – for instance, there are cases of people developing the condition in their forties.
Professor Martin Prince, co-author of the World Alzheimer Report 2010, believes that there are ways of tackling this situation:
“Empowering older people; promoting lifelong physical health; social protection and age-appropriate health care are all important,” he says. “There are opportunities for prevention in early life by good nutrition and neurodevelopment; in mid-life by cutting the risks of developing cardiovascular (heart) disease and other conditions by tackling smoking and diabetes; in later life by tackling under-nutrition that is linked to poverty and older people and can lead to anaemia, yet another risk factor for developing dementia.” Professor Prince says that cigarette smoking in early life is a significant factor in developing dementia in later life.
Alzheimer’s Disease International has put forward a number of recommendations that include a non-means tested universal social pension; access to disability benefits for people with dementia; caregiver benefits; incentivised family care; provision of basic information, training and support for care givers in the community.
There is a call for governments across the world to wake up to the costs that they are incurring in trying to deal with the effects of dementia – costs that are set to rise significantly as the number of sufferers increases.
Around 70 per cent of the total costs of dementia occur in Western Europe and North America. The majority of dementia care provided in these parts of the world come through informal care by family members and others and care homes. But any notion by governments that families can continue to provide the necessary care “needs to be disabused” says Professor Prince because the projected increase in numbers of dementia sufferers will make this untenable – families just won’t be able to cope. And this doesn’t take account of people who don’t have children or other family members to provide such care, or whose children may have moved away or have their own health problems making them unable to perform an informal caring role.
Governments across the world are also reminded of their obligations under the UN Convention on the Rights of People with Disabilities and the Madrid International Plan for Action on Ageing to ensure access to healthcare. Also for governments to fund and expand the implementation of the World Health Organisation’s Mental Health Gap Action Plan, including the packages of care for dementia as one of the seven core disorders identified in the plan.
Groundbreaking Action By The Foundation
With the world’s population increasingly living further into old age, diseases such as dementia are set to become more prevalent. The appropriate care of people with this distressing condition across the world is patchy; even getting an accurate diagnosis is very difficult never mind receiving appropriate treatment and care. Yet it is a condition that can place great strain on health and social care systems particularly hospitals where most people with the condition will be sent, as there are no other alternatives. The Foundation’s work on dementia care in Bangladesh is groundbreaking and as well as raising awareness of the condition, the aim is to establish a necessary knowledge base and extend care and treatments across the country. The vision is to establish a number of dementia clinics over the coming years in different areas to help deal with the diagnosis and care of people with this very distressing condition. These clinics would then act as a platform for spreading this approach into other countries.
The World Factbook 2011 (published by the US Central Intelligence Agency) states that health expenditure in Bangladesh stands at 3.4 per cent of GDP (2009). The density of physicians stands at 0.295 per 1,000 head of population and the density of hospital beds is 0.4 per 1,000 head of population. Around 40 per cent of the population live below the poverty line and there are over 7 million people over the age of 65.
The figures quoted above indicate that structures in Bangladesh are not equipped to deal with the health needs of the general population and particularly the special needs of vulnerable elderly people. There are currently no reliable figures as to how many people in Bangladesh may be suffering from dementia but it is likely to run into hundreds of thousands at least and when multiplied with the number of family members who are very likely caring for someone with the condition then it runs into millions – it remains a hidden problem with very little knowledge of it and its treatment.
The World Alzheimer Report 2011 majors on the importance of early diagnosis of dementia and that this is achieved, it says, through “access to information, advice and support and access to a pathway of effective treatment and care from the time of diagnosis to end of life care.” It is precisely this desire that the Foundation is seeking to address with this proposed dementia project in Bangladesh and views it as an extension of the care that it is already providing to people through to the end of their lives.
'Dementia Bangladesh' special unit
The initial activity has centred on providing dementia care training for key staff in the Foundation that was provided by Alzheimer’s Associations in Australia as well as by their experienced tutors in Bangladesh. Following this training and after receiving funding from an international body, earlier this year the Foundation established a special unit to operate a three year project under its auspices. The unit is called ‘Dementia Bangladesh’ and is managed by a Medical Director appointed in early 2013 and a team comprising a Head of Dementia and a lead admin officer plus a number of senior professional healthcare advisors. The Foundation is proud to have held its first International conference in February 2014, click here for further information.
Dementia Volunteer Group : Forging a countrywide network
By linking in with over 8,000 Union Information Centers operated by the government in Bangladesh, the Beveridge Foundation hopes to further expand its volunteer programme across the country in the next few years. Over the coming months, the intention is to secure at least one volunteer in each of the 64 districts and then, over the coming years, to spread this to over 460 sub-districts utilising the Centres to help with this.
“The first batch of 18 volunteers have already been trained, equipped with information in the form of leaflets and newsletters and deployed in a number of districts,” said SWBF Medical Director in Bangladesh. “These volunteers are made up of men and women representing major ethnic communities and will also include those from minority groups as the volunteer programme expands.
“The first volunteers include people who are already familiar with the Beveridge Foundation’s work in Bangladesh and were recommended by the Foundation’s staff. They come from a variety of backgrounds and professions and are aged from 22 to 65 years old. This first batch have completed a training programme covering subjects such as raising their awareness of our activities in Bangladesh; what dementia is, how it manifests itself, treatments and care; the objectives of the Dementia Bangladesh Unit and how to devise and develop dementia awareness raising activities in their areas. I am confident it will turn out to be a very rewarding and much-needed enterprise.”