Prevalence and costs

Up-to-date estimates of the current and future prevalence of dementia and of the costs of dementia are needed for policymaking and planning and these are available for both NI and ROI. Estimates of the numbers of people with dementia are made by applying dementia prevalence rates (the proportion of people affected) to the numbers of people in a given population. Dementia prevalence rates are obtained from population-based epidemiological surveys. Meta-analysed figures were applied in both jurisdictions and the reports summarised below explain the methodology used. The Dementia UK Update (2014) also includes updated costs of dementia in the UK, but could not estimate costs separately for the different regions of the UK since the requisite disaggregated data were not available for each country. 

An Irish National Survey of Dementia in Long-Term Residential Care

Cahill, S., O'Nolan, C., O' Caheny, D. and Bobersky, A.
Dementia Services Information and Development Centre.
This is a national survey undertaken by the Dementia Services and Information Development Centre (DSIDC) to gather information on the number and location of Specialist Care Units providing care to people with dementia in long-stay residential care settings in Ireland.
A survey developed for self-administration by nursing home staff was completed by 469 nursing homes, the majority of which were privately operated. Of the 469 nursing homes, 54 self-identified as a SCU. These 54 SCUs accommodated 1, 034 people with dementia, and had a total of 66 respite beds. The survey found considerable geographical differences regarding the location of SCUs and waiting times for admission to SCUs also varied substantially. The average number of residents in the SCUs was 19. The majority of SCUs were privately operated, and in these SCUs residents were more likely to have a private room and bathrooms. Almost 20% of SCUs surveyed provided no opportunities to residents to enable them participate in household activities. Just over one-half had an open door visiting policy. All nursing and health care assistants had received dementia care training in about one-half of the 54 SCUs. The report discusses these findings in the context of Ireland’s funding model for nursing home care, international best practice on dementia specific SCUs, national standards in Ireland on residential care settings for older people, and best practice in end of life care for people with dementia.

An Economic Analysis of Home Care Services for People with Dementia

Alzheimer Society Ireland
This expert paper commissioned by the Alzheimer Society of Ireland addresses a range of questions raised in relation to home care for people with dementia including when is care required for people with dementia; who provides the care to people with dementia and what type of home care is currently p
rovided to people with dementia. In considering how care is best provided to people with dementia, the report suggests a number of approaches including a case management approach; monitoring of care to ensure that the required care is provided; and making use of available information. It then considers the economic argument for home care, and suggests that home care makes economic sense as the costs are lower than residential care, but that there is a need to consider the dynamic relationship between providing care for people with dementia and how this is balanced the competing priorities elsewhere in society.

An Economic Analysis of a Community-Based Model for Dementia Care in Ireland: A Balance of Care Approach

O'Shea, E. and Monaghan, C
This study provides an economic analysis of the cost of care for people with dementia who are receiving supports within the HSE & Genio Dementia Programme and who are on the boundary of care between home care and residential care.
In the study, those people at a significant risk of admission to residential care were identified using two criteria, the Institutional Risk Trigger and the Institutional Probability Scale. The costs of a range of formal and informal supports that these people are receiving from the state, the additional supports they availed of through the HSE & Genio Dementia Programme and informal care provided to them were estimated, along with personal consumption and housing costs. A total of 181 were estimated to be on the boundary of care. The results of the economic analysis suggest that significant numbers of people with dementia could potentially be supported to live at home for longer as a result of the HSE & Genio Dementia Programme, resulting in exchequer savings when comparisons are made between public expenditure in the community and in residential care. When personal consumption and housing costs are added, there is a reduction in the overall cost advantage associated with community-based personalised care. Placing a monetary valuation on informal care further increases the cost of community care, making it slightly more costly than residential care, based on an opportunity cost methodology.

Dementia UK Update

Prince, M, Knapp, M, Guerchet, M, McCrone, P, Prina, M, Comas-Herrera, A, Wittenberg, R, Adelaja, B, Hu, B, King, D, Rehill, A, Salimkumar, D.
Alzheimer’s Society (UK)

This report published by the Alzheimer’s Society (UK) provides an update to the figures provided on the prevalence and costs of dementia in the UK in the 2007 report of the same name.

An Expert Delphi Consensus approach was taken to update dementia prevalence rates for Western Europe, which were then applied to UK population data. Health, social and unpaid care costs were calculated using a new version of a model of the costs and outcomes of dementia that builds on previous versions of the Personal Social Services Research Unit (PSSRU) aggregate long-term care model (Wittenberg et al., 1998, 2001) and of the PSSRU dementia care model (Comas-Herrera et al., 2007). The report estimated that the total number of people with dementia in the UK in 2015 is 850,000 and is forecast to increase to 1 million by 2025. The total cost of dementia in the UK is estimated at £26.3 billion, with an average cost of £32,250 per person, comprising £4.3 billion spent on healthcare costs, £10.3 billion spent on social care (publicly and privately funded) and £11.6 billion contributed by the work of informal carers of people with dementia.

Dementia prevalence estimates for NI for the years 2010-2013 and 2021 are readily available on the Alzheimer’s Society (UK) website.    

Prevalence and Projections of Dementia in Ireland

PIERCE, M., CAHILL, S., O’Shea, E.

Providing estimates of dementia prevalence and projects was a key objective of the research review of dementia in ROI (Cahill et al., 2011a). However, the estimates reported in the review were based on the 2006 Census of Population.

Hence, a new Census of Population was conducted in 2011 and the 2006 estimates were updated in a new report for ROI. Applying the EuroCoDe dementia prevalence rates, it estimated that there were almost 48,000 people with dementia in 2011 and based on the most recent population projections, there could be as many as 90,000 people with dementia in ROI by 2031. Unlike the prevalence estimates for NI, this report provides an estimate of the number of women and men with dementia in ROI and points to the need for a gendered analysis to be taken to dementia.  

Dementia 2010: The Economic Burden of Dementia and Associated Research Funding in the UK

Alzheimer Research Trust
Alzheimer Research Trust

The Alzheimer Research Trust in the UK commissioned the Health Economics Research Centre at the University of Oxford to undertake this cost of illness study to evaluate using a societal perspective the combined costs of dementia and Alzheimer’s disease (AD).

Overall, the study estimated the cost of dementia in 2008 to be £23 billion in terms of health and social care, informal care and productivity losses in 2008. Of these costs, 5% were attributed to healthcare, 40% to social care and 55% to informal care, with productivity losses accounting for less than 1% of total costs. The study also estimated the costs of cancer and compared the costs of dementia and cancer, dementia and coronary heart disease (CHD) and stroke. It estimated the costs of dementia to be the highest, followed by cancer, CHD and stroke, with the costs of dementia greater than the combined costs of cancer and CHD.  In addition, the study investigated the allocation of research funds by governmental organisations and charities in the UK. It found that despite the high economic cost of dementia, research funding is highly dominated by cancer followed a considerable way behind by CHD and offers some suggestions to explain the underfunding for dementia research.