Dementia: A Growing Health Problem in Australia

Abstract

Calculations for which diseases and health problems cause the most burdens to society are complex due to the many factors involved. Two factors commonly quantified are the amount of healthy life lost to disability or premature death and how much money a disease costs to treat. While these factors are clearly important, they do not take into account the toll that some diseases take on family and the informal care providers involved with individuals suffering from prolonged illness. Measurements of health care cost and loss of life would suggest that dementia is the third greatest health care problem facing Australia, however, I argue that dementia is the greatest health care problem facing Australia when the cost of informal health care and the impact to families are factored into the burden equation.

Introduction

The Australian government (Australian Institute of Health and Welfare, 2012) reports that in 2011 there were approximately 298,000 Australians suffering from dementia. A little over half were women and nearly three quarters were over the age of 75. Dementia is reported to have a high financial burden with $4.9 billion dollars being spent currently on health and aged care expenditures. This number is likely to grow substantially based on projections of population growth and ageing, the number of individuals with dementia will reach 400,000 by 2020 and 900,000 by 2050. This burden will take the form of an increasing need for high quality health services, support for the careers of patients with dementia (Etters, Goodall, & Harrison, 2008), a greater need for training of health care experts in dementia, and the added cost of research into new therapies and prevention strategies.

To understand the personal and family burdens that arise from dementia, we must examine the nature of the disease. Four common forms are recognized (ADI 2009, Draper, 2011, Seeher et al, 2011). First, Alzheimer disease is the most common form of dementia and accounts for between 50% and 75% of all cases of dementia. Most people are aware of Alzheimer disease due to its frequency; it is characterized by loss of short-term memory, apathy, and depression in the earliest stages. Alzheimer disease progresses gradually and can last for as long as 5-20 years. Vascular dementia is the second most common form of dementia, accounting for 20-30% of cases. This type is caused by vascular disease that affects the brain, for example, stroke. Mood changes are more pronounced, and the memory loss is not as significant as that seen in Alzheimer disease. Progression is not predictable and declines in function may occur suddenly and without warning. The third most common form is Frontotemporal dementia (5-10% of cases), which occurs more frequently in males and usually with a younger onset. There may be personality and mood swings, problems with language and disinhibition. Finally, Dementia with Lewy bodies accounts for ~5% of cases. This form is caused by the development of abnormal structures in the brain. Patients may suffer from hallucinations, changes in cognition, and tremors and rigidity that resemble Parkinson disease. There are other minor forms dementias and some individuals may suffer from more than one form. For example, a patient with Alzheimer disease may suffer a stroke and consequently also suffer from Vascular dementia. The latter may be referred to as mixed dementia, but there is no consensus on the diagnostic criteria for this form (Seeher et al., 2011). Due to loss of cognitive ability in each form of dementia, patients may require significant help with all aspects of daily functioning, which can be a tremendous burden to family members and friends in addition to the direct costs to the health care system.

Carers, such as family and friends, who provide unpaid informal care, play a critical role in helping individuals with dementia. Such care can improve quality of life and may delay the need for an elderly person with dementia to require residential aged care services (Drame et al., 2012). Although the number of carers is not certain, estimates range from ~50,000 to 250,000 (Australian Institute of Health and Welfare, 2012). Another cost that is often overlooked is the time invested by these carers. This time is often at the expense of time at work or other community activities. In addition to the emotional toll dementia extracts from friends and family, the loss of work time can be a financially burden and reduced free time prevents an individual from contributing to other productive activities in the local community. Such emotional and time investments by family members and friends can be particularly difficult with dementia, compared to other diseases, as the patients may require a high level of daily assistance and the disease can last for many years.

Conclusion

By straightforward measures, such as money spent on health care and mortality rates, dementia is ranked in the top three disease burdens on Australians. Projections conclude that this burden will grow significantly as the average Australian life span is extended. However, this alone is not the whole story. Due to the nature of Dementia and its debilitation of the mind rather than the body, it extracts a greater toll on the families and friends that provide informal care to these patients than many other diseases. It takes away time that could be spent at work, developing careers, participation in community service, and other productive activities. In summary, based on the current health care costs, and the hard to quantify costs of informal health care and emotional costs to family and friends, dementia may be considered the leading health care problem today, and for the foreseeable future, in Australia.

References

Australian Institute of Health and Welfare. (2012). Dementia in Australia. Cat. No. AGE 70. Canberra: AIHW.

ADI (Alzheimer’s Disease International). (2009). World Alzheimer Report 2009. London: ADI.

Drame, M., Lang, P., Jolly, D., & Narbey, D. (2012). Nursing home admission in elderly subjects with dementia: Predictive factors and future challenges. JAMDA, 13, e17-83.

Draper, B. (2011). Understanding Alzheimer’s & other dementias. Sydney: Longueville Books.

Etters, L., Goodall, D., & Harrison, B.E. (2008). Caregiver burden among dementia patient caregivers: A review of the literature. J. Am. Acad. Nurse Pract., 20, 423-428.

Seeher, K., Withall, A., & Brodaty, H. (Eds) (2011). The dementia research mapping project, the 2010 update: final report. Sydney: Dementia Collaborative Research Centre, University of New South Wales.