AADDRESSING THE Office for National Statistics, depression was the leading cause of death in England and Wales last year, accounting for 65,967 deaths, or 11.4% of the total, up from 10.4% in 2021. The Service National Health estimates that 940,000 people in Britain are living with the condition. Many need care, either in their own homes or in residential facilities. Graham Stokes, director of dementia care at HC-One, a care home provider, says 75% of its beds are filled with people with dementia. But despite the frustration of many, it seems that the issue has slipped down the list of government priorities.
He may feel that the problem is not as severe as previously feared. New drugs offer hope to those with Alzheimer’s, the most common cause of dementia, that the progression of the incurable disease can at least be slowed. Evidence is mounting that the risk of developing dementia can be greatly reduced by lifestyle changes that are at least encouraged – giving up smoking and excessive drinking, exercising, eating and sleep well, and so on.
International evidence indicates that the incidence of age-related dementia has been falling rapidly. A study published in 2020, for example, of 50,000 people in America and Europe between 1988 and 2015 found that the risk of developing dementia had decreased on average by about 13% per decade. It went from about a one in four chance for a 75-year-old man in 1995 to less than one in five by 2015.
But optimism about Britain’s ability to cope with rising numbers of people with dementia was scarce at two recent gatherings of professionals and charities. Dementia conference in London in October and on 17th UK Dementia Congress in Birmingham in November, organized by the Journal of Dementia Careare increasingly animated by a sense of beleaguerment – a sense that Britain’s care sector is undervalued and, in the words of Mr Stokes, “dementia has lost its place in the sun”.
This is one rare corner where David Cameron’s term as prime minister is remembered as a golden era. In 2012 he launched a dementia “challenge”, building on a “national dementia strategy” from 2009. Scotland still has one, but England has declined, including with cancer and diseases another, in a “Key Contracts Strategy” published in August. Suzanne Mumford, head of nursing at Care UK, another residential care provider, laments the change: “It’s a big deal because it doesn’t bring the right kind of focus. ” Dementia, she says, is unusual in that people can live with it for decades. Care homes, she says, have become specialized centers for dealing with it.
Meanwhile, a recent study has cast doubt on the idea that dementia rates in Britain are actually declining in the long term. Published in Lancet Public Health, found that its incidence, allowing for age and gender, fell significantly in 2002-08, in line with what had been happening in other rich countries, such as America, France and the Netherlands. But the trend suddenly reversed in England and Wales in 2008-16, with a 25% increase in the prevalence of dementia in that period. If that rate continued, the number of people with dementia in Britain would rise to 1.7m by 2040; the figure would be 1.3m if the long-term trend was there and 1m if the development continued in 2002-08.
That’s a huge range of products. But they all mean a level of demand for care services that will be difficult to meet. It depends on the ongoing efforts of unpaid care workers, charities and, to a large extent, unpaid carers, usually family members, usually women. One promising idea that has spread from the Netherlands is for dementia “meeting centers”, of which 70-odd, each serving a few dozen people, have opened in Britain so far. They offer just that – a place where people with dementia can meet regularly and get support while living at home. It is an inexpensive intervention that is very effective in slowing cognitive decline. However, says Shirley Evans, director of the Society for Dementia Research at the University of Worcester, who is leading the campaign, it is not supported by central government. That seems a shame. ■
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