ISE10/16-17
| Subject: | health services, mental health |
- Dementia is a syndrome, usually of a chronic or progressive nature, affecting brain functions including memory, thinking, comprehension, learning and judgment. It is caused by a variety of diseases and injuries that affect the brain, such as Alzheimer's disease and stroke. However, there is currently no treatment available to cure dementia. Dementia generally occurs among people aged over 65 and the risk of dementia increases significantly with age. According to the World Health Organization ("WHO"), dementia is one of the major causes of disability and dependency among older people worldwide and poses significant burden on caregivers, families and societies. As such, WHO has suggested that health authorities should consider dementia as part of the public health agenda.1Legend symbol denoting See World Health Organization (2012 and 2016).
- According to the Hospital Authority, the prevalence rates of dementia in Hong Kong is estimated to be at 5%-8% among persons aged over 65, and at 20%-30% among those aged over 80.2Legend symbol denoting See Hospital Authority (2017). While the Government does not keep track of the total number of persons with dementia in Hong Kong,3Legend symbol denoting The Government has only compiled statistics on the number of dementia patients receiving psychiatric specialist services provided by the Hospital Authority and the number of elderly persons with dementia who have benefitted from the allocation of dementia supplement to eligible residential care homes for the elderly and day care centres to facilitate the provision of care services for elderly persons with dementia. an academic study published in 2012 estimated that among persons aged 60 and above, around 333 000 or 11% would be suffering from dementia in 2039. These are considerably higher than the corresponding figures of 103 000 or 8.4% in 2009.4Legend symbol denoting See Yu, R. et al (2012).
- Amid the above trend, Hong Kong has not set out any dementia care strategy specifically for the planning and provision of support services for persons with dementia. Nevertheless, the Government has conducted reviews on the medical and long-term care services for persons with dementia through the Review Committee on Mental Health5Legend symbol denoting The Food and Health Bureau set up the Review Committee on Mental Health in May 2013 to review the existing mental health policy and consider measures to strengthen the provision of mental health services in Hong Kong. An expert group on dementia was set up under the Review Committee to review the care services for dementia patients. and the Elderly Services Programme Plan respectively.6Legend symbol denoting In his 2014 Policy Address, the Chief Executive has tasked the Elderly Commission to formulate the Elderly Services Programme Plan in two years. Service provision for elderly persons with dementia is among one of the issues considered in the programme formulation process. The reports of both reviews have yet to be published.
- In contrast with Hong Kong, overseas places such as England of the United Kingdom ("UK") and Japan have formulated their respective comprehensive national dementia strategy to cope with the challenges posed by a growing population of elderly persons with dementia. Their strategies feature a wide range of areas including public education, early identification and intervention, medical and social care services, building dementia-friendly communities, support for carers and research. This issue of Essentials highlights the issues and concerns about the existing care services provided for elderly persons with dementia in Hong Kong, and the key features of the national dementia strategies adopted in England and Japan which Hong Kong might draw reference from.
Provision of care services for elderly persons with dementia in Hong Kong
- In Hong Kong, the Hospital Authority provides medical services including in-patient, out-patient, day rehabilitation training and community support services for elderly persons with dementia. In 2015-2016, about 12 000 dementia patients received psychiatric specialist services provided by the Hospital Authority. With regard to social care services, the Social Welfare Department provides a range of support services including residential care, day care, community care, and carer support services for elderly persons with dementia and their carers through the subsidized residential care homes for the elderly ("RCHEs"), day care centres/units for the elderly ("DEs/DCUs")7Legend symbol denoting The Social Welfare Department provides subsidized residential care and community care services for frail elderly persons with proven needs as assessed under the Standardised Care Need Assessment Mechanism for Elderly Services. and elderly centres. The demand for subsidized medical and social care services has been keen as reflected by the long waiting time for services. As at 31 December 2015, the median waiting time of new cases at the psychogeriatric specialist out-patient clinics in the Hospital Authority was 11 weeks. As at 31 December 2016, the average waiting time for admission to subvented/contract RCHEs and subsidized DEs/DCUs were 36 months and 10 months respectively.8Legend symbol denoting The median waiting time of new cases at the psychogeriatric specialist out-patient clinics in the Hospital Authority increased from 7 weeks in 2012-2013 to 11 weeks in 2015-2016 (as at December 2015). The average waiting time for admission to subvented/contract RCHEs slightly increased from 35 months in 2012-2013 to 36 months in 2016-2017 (as at December 2016) and that for subsidized DEs/DCUs also slightly increased from 9 to 10 months during the same period.
- In order to enhance community care services for demented patients with a view to reducing the waiting time for the Hospital Authority's assessment and specialist services, the Hospital Authority and the Social Welfare Department have planned to launch a two-year pilot scheme in early 2017 to provide services for elderly persons with mild to moderate dementia through medical-social collaboration at district elderly community centres. Under the scheme, patients and their carers will be provided with training and support such as day rehabilitation service according to an individual care plan formulated by the Hospital Authority to delay their cognitive and functional decline.
Issues and concerns
- Against the above, there have been concerns about the inadequate provision of medical and social care services for elderly persons with dementia in the light of the long waiting time for services. Besides, stakeholders have called for the Government to put more efforts on public education, early diagnosis and intervention, and providing support for carers.
- Some academics have suggested that capabilities of the health care professionals in early diagnosis of dementia should be developed and cognitive function should be included as a regular feature of health assessment for the elderly in primary care.9Legend symbol denoting See Yu, R. et al (2010) and Yu, R. et al (2012). Besides, raising public awareness and understanding of dementia is imperative to reduce the stigma of dementia and barriers to receiving diagnosis and care among patients. As carers play an important role in the long-term care of persons with dementia who are living in the community, some stakeholders have also suggested enhancing support for carers to promote their caring skills, and physical and psychological health.
- Looking ahead, the population of persons aged 65 and above in Hong Kong will increase from 1.17 million in mid-2016 to 2.45 million in mid-2039. Amid ageing of the population, there will be a possible increase in the number of elderly persons with dementia and an increase in economic and social burden on the society in the coming decades. A study published in 2010 estimated that the cost of institutional care for persons aged 60 and above with dementia would increase from HK$1.6 billion in 2010 to HK$4.2 billion in 2036. The cost of informal care would also increase from HK$10.4 billion in 2010 to HK$27 billion in 2036.10Legend symbol denoting See Yu, R. et al (2010). As such, stakeholders are of the view that the Government should start the estimate on the future number of demented elderly persons in Hong Kong and formulate a long-term dementia care strategy and service provision plan accordingly.11Legend symbol denoting See Legislative Council Secretariat (2014 and 2016) and University of Hong Kong (2015).
National dementia strategies in England and Japan
- In the UK, the number of persons with dementia was estimated at about 816 000 in 2013, of which 84% were living in England. The prevalence rate of dementia among persons aged 65 and above was estimated to be 7.1%.12Legend symbol denoting See Alzheimer's Society (2014). It was also estimated that dementia cost the economy £23 billion (HK$219.4 billion) a year, more than the costs of cancer or heart disease. The number of demented persons is expected to double by 2040 and the predicted costs would treble accordingly.13Legend symbol denoting See House of Commons Library (2016).
- The UK government introduced the first national dementia strategy in 2009 and subsequently updated the strategy in 2012 and 2015. In the latest strategy, the government has set out more than 50 commitments and the related action plans across four core themes of risk reduction, health and care, awareness and social action, and research with the objective to make England the world-leader in dementia care, research and awareness by 2020. Since 2009, England has made significant progress in improving the diagnosis rate of persons with dementia (from 42% in 2010 to about 60% in 2015), enhancing the health and social care services for persons with dementia and carers, creating dementia-friendly communities, and boosting dementia research.
- In Japan, the number of persons with dementia was estimated at 4.6 million in 2012. The prevalence rate of dementia among persons aged 65 and above was estimated to be 15%. The number of demented persons is forecast to reach 7 million in 2025. In order to improve the care services for and quality of life of persons with dementia, the Ministry of Health, Labour and Welfare ("MHLW") inplemented a national dementia strategy - "the Orange Plan" in 2013. MHLW updated the strategy in 2015 and was allocated with a budget of ¥16.1 billion (HK$1.03 billion) for the implementation of the strategy. The New Orange Plan covers measures to support persons with dementia on areas such as public education, medical and social care services, community support, carer support, and research and development.
- Both England and Japan have formulated a comprehensive national dementia strategy covering prevention or risk reduction of dementia, and provision of quality care and treatment for persons with dementia. Both places have also emphasized the building up of dementia-friendly communities to enable persons with dementia to live well in the community. The common key features of the national dementia strategies of the two places are highlighted in the ensuing paragraphs.
Public education
- England and Japan have both implemented a "dementia friends/ supporters" programme as a major initiative to raise public awareness and understanding of dementia. Under the programme, volunteers are recruited and trained on the symptoms and treatment of dementia, and ways to support persons with dementia and carers to live well in the community. As at 2015, over 1 million and 5.5 million dementia friends/supporters were recruited in England and Japan respectively. England and Japan have also supported education programmes about dementia at schools for nurturing a dementia-friendly generation.
Risk reduction, early identification and intervention
- England has introduced risk reduction measures such as educating people about the risks of developing dementia and ways to reduce those risks through the National Health Service Health Check programme,14Legend symbol denoting Under the National Health Service Health Check programme, residents aged between 40 and 74 who have not suffered from stroke, kidney disease, heart disease, diabetes and dementia are invited to take part in a free health check-up provided by the National Health Service every five years. and providing risk assessment tools for the public to identify personal risk of cognitive decline. The Japanese government has also implemented risk reduction measures such as promoting healthy lifestyle and diet among the public.
- Both places have engaged general practitioners in identifying and coordinating care for patients at the primary care level. The Japanese government has also set up medical centres for dementia and outreach support teams for conducting assessments and providing information about care services to persons identified to have dementia to enable them to receive the appropriate intervention after diagnosis.
Provision of integrated medical and social care services
- England and Japan are committed to providing personalized, continuous and integrated medical and social care to persons with dementia at different stages of their illness under their national dementia strategies. Both places have developed an evidence-based dementia care pathway and improved the coordination of care along the pathway. Relevant training has also been provided to the dementia care workforce, including health care and social care workers to enhance their awareness of dementia and capability to provide quality care to patients.
Support for carers
- In England and Japan, carers are provided with support services such as respite, training and emotional support to help them cope with their caring responsibilities. Besides, the Japanese government has supported the setting up of "dementia cafés"15Legend symbol denoting "Dementia cafés" are restaurants, cafés or public facilities in local communities where seminars about dementia, discussion sessions and social activities are held. Persons with dementia and their carers can obtain information about dementia and support services in a casual and friendly manner. in the local communities to enable persons with dementia and their carers to obtain information and advice on dementia care and socialize with peers in a comfortable and familiar environment.
Building dementia-friendly communities
- Under the national dementia strategies of England and Japan, persons with dementia are encouraged to live in the community and lead an independent living as long as they can. As such, both places have provided relevant community care services, built up networks of "dementia friends/supporters" to support persons with dementia to live in the community, and promoted the development and use of assistive technology. The Japanese government has also introduced measures to promote the social engagement of persons with dementia and ensure the physical environment such as the road system is safe and easy to navigate.
Research and development
- Both England and Japan have committed resources on research relating to the prevention, diagnosis and treatment of dementia, and development of assistive technologies for the rehabilitation and care of persons with dementia so as to enable them to live well in the community. In England, funding from the public and private sectors for research on dementia has doubled since 2009 to over £66 million (HK$782 million) in 2015. In Japan, over ¥6.5 billion (HK$416 million) was allocated for funding the related research programmes in 2015.
Observations
- The ageing population and the projected increase in number of elderly persons with dementia in the coming decades will pose immense pressure on the medical and social care systems which have already been overstretched. The UK and Japanese governments have been committed to developing and implementing a comprehensive national dementia strategy to cope with the rising population of elderly persons with dementia. Under their respective strategies, multi-pronged measures have been adopted to enhance early identification and intervention of persons with dementia, strengthen medical, social care and carer support services, and build dementia-friendly communities for persons with dementia to live in so that institutionalization of persons with dementia can be minimized.
Prepared by Ivy CHENG
Research Office
Information Services Division
Legislative Council Secretariat
21 February 2017
Endnotes:
References:
| Hong Kong
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| 1. | Census and Statistics Department (2017).
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| 2. | Food and Health Bureau. (2016) Replies to initial written questions raised by Finance Committee Members in examining the Estimates of Expenditure 2016-17.
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| 3. | GovHK. (2015) Press Releases: LCQ 16 - Dementia.
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| 4. | Hong Kong Alzheimer's Disease Association. (undated) Supportive Environment for Elderly with Dementia - Needs & Challenges in Caring of Elderly with Dementia.
|
| 5. | Hospital Authority. (2016) Pilot Scheme on Dementia Community Support Services for the Elderly.
|
| 6. | Hospital Authority. (2017) Dementia.
|
| 7. | Labour and Welfare Bureau. (2016) Replies to initial written questions raised by Finance Committee Members in examining the Estimates of Expenditure 2016-17.
|
| 8. | Labour and Welfare Bureau et al. (2016) Provision of Services for Elderly Persons with Special Needs.
|
| 9. | Legislative Council Secretariat. (2014) Report of Joint Subcommittee on Long-term Care Policy. LC Paper No. CB(2)2154/13-14(01) Annex I.
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| 10. | Legislative Council Secretariat. (2016) Provision of services for elderly persons with special needs. LC Paper No. CB(2)1336/15-16(02).
|
| 11. | Social Welfare Department (2017).
|
| 12. | University of Hong Kong. (2015) Elderly Services Programme Plan - Report on Scoping Stage.
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| 13. | Yu, R. et al. (2010) Dementia Trends: Impact of the Ageing Population and Societal Implications for Hong Kong.
|
| 14. | Yu, R. et al. (2012) Trends in Prevalence and Mortality of Dementia in Elderly Hong Kong Population: Projections, Disease Burden, and Implications for Long-Term Care. International Journal of Alzheimer's Disease, vol. 2012, pp. 1-6.
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| Others
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| 15. | Alzheimer's Society. (2014) Dementia UK Update.
|
| 16. | Department of Health. (2016a) Prime Minister's Challenge on Dementia 2020 - Implementation Plan.
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| 17. | Department of Health. (2016b) Prime Minister's Challenge on Dementia 2020 - Implementation Plan Annex 2: Roadmaps to 2020 Delivery.
|
| 18. | Gov.UK. (2015) 2010 to 2015 government policy: dementia.
|
| 19. | Hotta, S. (2015) National and Local Dementia Strategy in Japan: Living with Dementia in the Community.
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| 20. | House of Commons Library. (2016) Dementia: policy, services and statistics.
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| 21. | Ministry of Health, Labour and Welfare of Japan. (2014) Global Dementia Legacy Event Japan.
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| 22. | Nakanishi, M. & Nakashima, T. (2014) Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems? Alzheimer's & Dementia, vol. 10, no. 4, pp. 468-476.
|
| 23. | The Japan Times. (2015) New dementia strategy to cope with projected rise in cases.
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| 24. | World Health Organization. (2012) Dementia - A Public Health Priority.
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| 25. | World Health Organization. (2016) Dementia - Fact sheet.
|
| 26. | 厚生労働省：《認知症施策推進総合戦略 - 認知症高齢者等にやさしい地域づくりに向けて（新オレンジプラン）について》，2015年。 |