No silver bullet solution

By Yasmin Noone

There is no simple way of addressing the very complex situation created by the ageing population and the unprecedented number of older people who will be living with dementia in the near future, a UK dementia expert has warned.

Head of the Centre for Innovation and Evaluation in Mental Health at London’s King’s College, Professor Sube Banerjee, has encouraged Australia to get behind a national approach to dementia care, do the hard yards now and reap the potential benefits later.

“Now is the right time to focus on doing positive work to improve the quality of care for people living with dementia,” Prof Sube Banerjee said.

“We have a fantastic opportunity to do this now.

“…You can’t get away from the fact that these are complex problems and there are no easy solutions. You have to find complex solutions and set up structures [that will work] over time to solve them.

“You need leadership and the ability to develop and change services; commitment over time; and a bit of creativity. And simple, clear messages that every one can share.”

Prof Banerjee, who also led the development of the UK’s National Dementia Strategy, briefed officials from the Department of Health and Ageing on what worked well in the UK during a meeting yesterday, arranged by Alzheimer’s Australia.

“I am not seeking to tell Australia what to do but just to let officials in Australia know what we are doing and [hear] what they think…Sometimes it’s useful to not reinvent the wheel and see what others are doing.”

He advised that the three main aims of intervention for an Australian national strategy should be: to improve public and professional understanding of dementia; to enable early diagnosis and intervention; and to improve the quality of care for people with dementia, from diagnosis to the end of their life.

“Early diagnosis is the key to enabling people with dementia to live well. If people don’t know what they’ve got, it’s hard to access and offer services to them…If they don’t know they’ve got dementia it makes everything more difficult.”

He said that research has shown that early intervention is cost-effective and improves quality of life for people with dementia and their families.

But, he said, early intervention needs to be done properly by “making a diagnosis well, breaking the diagnosis well and providing the immediate care and support that people need”.

“You can improve quality of life of people with dementia and their carers by improving the quality of care they receive. If you try and do it on the cheap, then you end up creating more problems. It’s not expensive to do it and do it well.  In the long-term you spend to save.”

Prof Banerjee believes that investing in early identification and intervention dementia services can not only save providers money but make them much-needed dollars.

“That’s the argument that the UK National Audit Office advocated. There’s a strong case that can be made about the financial benefits of early intervention, but you need to see it through. You will save money but in four to seven years.

“To start putting money back into the system, there needs to be a modest increase in average quality of life of people with dementia, plus a 10 per cent diversion of people with dementia from residential care. The net increase in public expenditure would then, be justified by the expected benefits.”

Prof Banerjee also spoke of the over prescription of anti-psychotic drugs to older people with dementia.

“What’s interesting is that we know that problems like this have persisted over a long period of time and the simple things that people have tried to do to fix the problems haven’t worked.

“The problems we have here are a symptom of the overall failings of the system of care for people with dementia. Without changing the system to be more positive for those living with dementia, this problematic prescribing will continue.
 
“So we should act now to improve the quality of care for dementia and the other things will start to fall into place.”