Seminar on Dementia: Mission Possible

Transcription

1 Seminar on Dementia: Mission Possible Stirring Ripples Making Waves Dr David Dai Consultant Geriatrician Prince of Wales Hospital 30 th November, 2009

2 Chief Executive s Policy Address The ageing population is another challenge we must address. The number of people aged 65 or above is expected to increase to 2.17 million by 2033, or 2.5 times the present figure. By then, 1 in 4 persons in HK will be in this group. Individuals, families and society should have the responsibility for taking care of our elderly people.

3 Hong Kong Bycensus 2006 > 65 yrs 1996: 10.1% (630,000) 2006: 12.4(853,000) 2033: 27% Median age(yrs) 1996: : 39 Ageing of the Aged

4 Alzheimer s disease and related dementia: an Age Dependent Condition ( ) Department of Health(2006): >70yrs nearing 10% 90% undiagnosed Doubles every 5 yrs Vulnerability of the Brain in Old Age

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6 Alzheimer s Disease 1907, mbereine eigenartige Erkankung der Hirnrinde On an Unusual Illness of the Cerebral Cortex

7 Alzheimer s Mixed Others Non- Alzheimer s Vascular Types of Dementia Pres5702(zip)

8 Symptom progression pattern in patients with Alzheimer s disease Adapted from: Reisberg et al. Am J Psychiatry 1982; 139:

9 No standard Too long Waiting time A Community Model for Dementia Care 2009 Inadequate places Too long waiting time Inadequate input Suboptimal care Screening >75 yrs At risk: Long standing HT, DM Head injury Strong family Hx Opportunistic case finding in clinics - primary - specialist Public education Special groups - residential - estates for seniors - social center for elders - Down s syndrome - Housing estates Further Evaluation Dementia Centre In depth functional and neuropsychological assessment Psychosocial needs Counseling Multidiscipliciary input Primary care Medical assessment and Ix Need training Support Services and monitoring Dementia/Social centre Supportive Carer support Cognitive/skill training General health Health Care planning Advanced care planning Legal/Ethical concerns Primary care Initiate medical Px Specialist Medical Evaluation Geriatric (multiple commodities) Neurologist: (early onset dementia, neurological disease) Psychogeriatric -(difficult BPSD) Ix Neuroimaging Admission for optimization Long term care BPSP Supportive RT Skin Palliative Ethical concerns End of life care Hospitalization Acute illness Appropriate Ix and Mx Delirium on dementia Feeding/ restraining issues Death & dying Grief reaction Mx Inadequate networking Carer Training Formal / Informal Respite Care Home Care integrated with Day care Too little support Inadequate places Inadequate places Life Course Approach to Brain Health

10 The issues of today The cumulates of yesterday

11 The Next Generation of Elders Healthier Better educated Better informed Higher expectations Better prepared? Heightened anxiety?

12 The Humane lives long lives Pursuit of Learning and Happiness AD 770

13 China Possibilities Hong Kong Models

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15 Policy Address 2009: Elderly Services 96. There is no place like home 97. Continuous care in residential care 99. Quality of residential homes 100. District-based Scheme on Carer Training; improve home care; social enterprises 101. Elder Academy and continuous learning

16 1. The World Health Organization (WHO) should declare dementia a world health priority. 2. National governments should declare dementia a health priority and develop national strategies to provide services and support for people with dementia and their families. 3. Low and medium income countries should create dementia strategies based first on enhancing primary healthcare and other community services 4. High income countries should develop national dementia action plans with designated resource allocations. 5. Develop services that reflect the progressive nature of dementia

17 6. Distribute services with the core principle of maximising coverage and ensuring equity of access, to benefit people with dementia regardless of age, gender wealth, disability, and rural or urban residence. 7. Create collaboration between governments, people with dementia, their carers and their Alzheimer associations, and other relevant Non-Governmental Organizations and professional healthcare bodies. 8. More research needs to be funded and conducted into the causes of Alzheimer s disease and other dementias, pharmacological and psychosocial treatments, the prevalence and impact of dementia, and the prevention of dementia.

18 Each time a man stands up for an ideal, Or acts to improve the lot of others, Or strikes out against injustice, He sends forth a tiny ripple of hope, And crossing each other from a million Different centres of energy and daring, Those ripples build a current that can Sweep down the mightiest walls of Oppression and resistance. Robert Kennedy, 1996