Why is it an issue?
Dementia describes a set of symptoms which include memory loss, changes in mood and behaviour, problems with communication, reasoning and the ability to carry out daily activities (Alzheimer’s Society 2012, DoH 2009). Patients may also develop depression, psychosis, aggression and wandering (DoH 2009).
The causes of dementia are not well understood (DoH 2009) but the symptoms occur when the brain is damaged by certain diseases causing structural and chemical changes, including Alzheimer’s disease and damage caused by a series of small strokes (Alzheimer’s Society 2012). There is no cure for dementia, it is a progressive disease; the symptoms will gradually get worse. How fast dementia progresses will depends on the type of dementia. However, people with dementia can often have a good quality of life for a number of years.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- Under the current Quality and Outcomes Framework (QOF), as part of the GP contract, GPs keep registers of the numbers of people with dementia on their patient lists. It is possible to take these numbers and compare them to estimated numbers of people with dementia in a PCT area. The 2011/12 QOF registers suggest that within the registered population aged 30 plus there is a prevalence rate of 0.9% for dementia.
- Locally-modelled estimates from SystmOne can describe the age distribution. Those estimates suggest that diagnosed dementia rates becomes higher after the age of 65, rising steeply after the age of 75. However, two concepts are important. One, this is a reflection of diagnosis; and two, there are smaller numbers of people in younger age bands who have also been diagnosed.
- Studying the numbers of patients treated either in the community or as an inpatient by SWYPFT during 2011/12 (2318 patients), this prevalence could be more like 1% of the population aged 30 years plus. However if we use the estimated rates per 100,000 that were formulated as a result of research by YHIP (2009) the estimated prevalence of dementia could be 1.8% , double the prevalence suggested by the Wakefield QOF registers (see Appendix 4 of full report for full prevalence and population data).
- The diagnosis gap is an area of concern nationally. The national percentage of people with a dementia diagnosis in 2011 was 41.1% and the regional figure for Yorkshire and the Humber SHA was 45%. (Mapping Dementia Gap, 2011, Alzheimer’s Society 2012). Wakefield’s percentage of people with a dementia diagnosis at this time matched the regional figure of 45% which was slightly lower than some neighbouring PCT areas such as Bradford and Airedale (51.7%), Leeds at (47.1%) and Kirklees (47.2%) yet higher than Calderdale (42.3%), Barnsley (41.8%) and Hull (39.9%).
- Over time Wakefield has seen an improvement in recognition rates, in 2010 Wakefield’s percentage of people with a dementia diagnosis was 43.7% and in 2011 was 45%. The recent figures (appendix 4) suggest the figure is now 49%. However there is still an under diagnosis by around 50% supporting the development of a Wakefield approach to increasing awareness of dementia amongst the public and professionals.
- Early on-set dementia accounts for 2.2% of all people living with dementia in the UK (Living with Dementia Strategy, 2009) with the prevalence data for Wakefield at 2.3% for under 65. The number of patents treated by SWYPFT with an assumed diagnosis for dementia is 7%(Figure 3). The prevalence data is based on resident population (the number of people living in a given area) and the data from SWYPFT is based on a registered population (the number of patients registered with a GP practice in a given area) which may explain the difference in percentage. However the data also suggests that in Wakefield were not under diagnosing in the under 65 age group but in the over 65’s age group.
- Dementia mainly affects older people. The longer a person lives the higher the risk of developing a type of dementia. Females have a higher life expectancy which may explain why more females are being treated for dementia. The higher number of females being treated is in line with expected prevalence data
What’s the trend and what can we predict?
- Applying their Dementia UK’s prevalence rates to ONS projections suggests that the number of people in the district over the age of 65 with dementia will rise from 3700 to 6900 by 2030 (POPPI, 2010).
- Using the YHIP estimated rates, a similar estimate is found, with dementia prevalence looks set to increase to 1.9% (4240 patients) by 2015 and to 2.7% (6787 patients) by 2030.