9 October 2014

Aged Care Reviews

On September 17th, a group of world experts on Alzheimers, led by Professor Martin Prince, from King’s College London, released the 2014 World Alzheimer Day 2014 report entitled, ‘Dementia and Risk Reduction: An analysis of protective and modifiable factors’. It’s a lengthy article directed at health care providers. But this technical article has important lessons for the community at large. In this article, we dissect the central messages and examine ways to incorporate these learnings into everyday practice.

In addition to the recommendations for clinical practice and prevention strategies, this report called for dementia to be integrated into the global and national public health programmes in the same way that other major non communicable diseases are.

There were three central themes in the report:
1.    Diabetes can increase the risk of dementia by 50%. Keeping active and healthy is of the utmost importance at all stages of life.
2.    Healthy brain exercises can reduce the impact of dementia on intellectual and cognitive functioning.
3.    Most people are unclear about the causes of dementia, nor do they understand what actions they can take to reduce their risk later in life.

Diabetes can increase the risk of dementia
The report explains that controlling diabetes, and reducing other cardiovascular risk factors like high blood pressure, obesity, physical inactivity and cigarette smoking can decrease the chance of developing dementia, even later in life. Specifically, the report indicated that diabetes can increase the risk of dementia by 50%.

Quitting smoking is highlighted in the report as a way to reduce the risk of dementia. Studies of the number of cases of dementia in individuals 65 years and older indicate that ex-smokers and lifetime non-smokers have a similar risk of dementia. Conversely, there were many more cases of dementia in smokers.

A healthy brain can reduce the impact of dementia on intellectual and cognitive functioning
The study noted that those who have greater educational opportunities are at a lower risk of having the brain changes that happen with dementia affect their intellectual functioning. This means that though their brains may show similar physiological changes, they do not have the same effect on someone with a healthy brain’s ability to function in late-life. For the elderly with healthier brains, this means being more likely to have a longer, more independent and contented life.

Understand the causes of dementia and what you can do to prevent it
Brain health is important beginning in middle-aged individuals, since this is when the brain begins to change though symptoms are not yet likely to appear for another few decades. The report recommended that non-communicable disease programmes address the diseases that most affect older people, like dementia. The group’s message was that ‘it never too late to make a change’.

A key comment in this report comes from Professor Graham Stokes, Global Director of Dementia Care, Bupa, who says: “While age and genetics are part of the disease’s risk factors, not smoking, eating more healthily, getting some exercise, and having a good education, coupled with challenging your brain to ensure it is kept active, can all play a part in minimising your chances of developing dementia. People who already have dementia, or signs of it, can also do these things, which may help to slow the progression of the disease.”

Professor Stokes’ organization, Bupa, released data indicating that many individuals don’t understand the causes of dementia, nor do they know the actions they can take to lower their risk of developing the condition:
●    Only 17% of people surveyed realised that socializing with friends and family could reduce their risk.
●    Only 25% could identify obesity as a risk factor for the condition.
●    Only 23% identified physical activity as a way to reduce their risk of dementia
●    However, 68% of those surveyed worry about developing dementia later in life.

Marc Wortmann, Executive Director, Alzheimer’s Disease International, says: “By 2050, we estimate that 71% of people living with dementia will live in these regions, so implementing effective public health campaigns may help to reduce the global risk.”

The author of the report, Dr. Martin Prince comments: “There is already evidence from several studies that the incidence of dementia may be falling in high income countries, linked to improvements in education and cardiovascular health. We need to do all we can to accentuate these trends. With a global cost of over US$ 600 billion, the stakes could hardly be higher.”

The report emphasizes that globally and nationally dementia is an epidemic. While public health bodies, governments and medical practitioners continue to develop programs and research around dementia prevention and control, on an individual level, there are things we can do to reduce our risk. The most important are:
●    Eating a healthy diet;
●    Increasing the amount of physical activity we do;
●    Quitting smoking; and,
●    Maintaining social connections.

The full report is available here: http://www.alz.co.uk/worldreport2014