Cost of dementia in Switzerland

From Research to Policy: Unveiling Dementia Prevention Efforts in Switzerland

Recent research has challenged the notion that dementia is an inevitable outcome of age-related cognitive decline, highlighting the possibility of preventing or delaying onset by addressing specific risk factors. This paradigm shift suggests that prevention through lifestyle modifications and early interventions is possible, potentially averting millions of cases worldwide. This study explores the translation of scientific evidence on dementia prevention into public health policy in Switzerland. Combining the analysis of official policy documents and qualitative interviews with stakeholders, the study explores potential barriers and challenges to implementing preventive intervenions or programs, as well as opportunities for improvement. Results indicate a significant gap in incorporating emerging scientific evidence on dementia prevention into health policies and disseminating information to the public in Switzerland. This study underscores the need for a collaborative and coordinated approach to address these barriers and effectively translate scientific findings into preventive policies and campaigns. These insights can inform policy and targeted programs in Switzerland both at the federal and the cantonal level, eventually serving as a model for other countries seeking to translate evidence-based dementia prevention strategies into public health policies. By bridging the gap between research and policy, significant progress can be made in preventing or delaying the onset of dementia, providing significant benefits to individuals, families, and society.

Development of the Dardashna Checklist for Identifying Triggers of Behavioral Change in Individuals With Dementia: A Qualitative Study

The purpose of the current qualitative study was to describe the development of the Dardashna Checklist to clinically identify behavior change triggers in individuals with dementia. Semi-structured, in-depth, face-to-face interviews were conducted with four physicians and four experienced caregivers involved in the care of individuals with dementia. From analysis of participants' interviews, themes extracted included Triggers of Behavioral Change in Individuals With Dementia and Types of Behavioral Changes, using the checklist structure as a guide. The information gathered by this checklist conveys important messages to experienced physicians or caregivers who want to help less experienced caregivers or individuals with dementia. In this case, physicians' prescriptions and the responses of other experienced caregivers will be more targeted and useful. This checklist will help facilitate clinical care decisions, improve quality of life, reduce expenses and side effects of medications, and improve communication among persons with dementia, their caregivers, and health care providers. [Journal of Gerontological Nursing, 50(1), 37-46.].

Clinical reasoning of occupational therapists in selecting activities together with older adults with dementia to postpone further development of cognitive decline

BACKGROUND

Research suggests that participation in activities has the potential to prevent or delay the development of later-life cognitive decline and dementia. This area is unexplored within occupational therapy.

AIM

To explore and describe the clinical reasoning of occupational therapists in selecting activities together with older adults with dementia to participate in, with the goal to postpone further development of cognitive decline in a sample from the German part of Switzerland.

METHODS

A constructivist grounded theory approach was used. Six in-depth, semi-structured interviews with occupational therapists working in geriatric units in the German part of Switzerland were conducted.

RESULTS

Three main categories were identified: (i) from the discovery of 'who the older adult is' to the discovery of 'meaningful activities', (ii) reflecting on occupational therapists' individuality, and (iii) matching the activity to older adults' skills. A core category was developed: Pursuing active participation through meaningful and chosen activities.

CONCLUSIONS

The study suggests that to pursue enabling active participation in activities among older adults with dementia, and promoting the quality of participation, occupational therapists must consider the identified elements that are important in selecting the activities which might be used to postpone cognitive decline in each individual.

The economic value of long-term family caregiving. The situation of caregivers of persons with spinal cord injury in Switzerland

Health systems rely on the unpaid work of family caregivers. Nevertheless, demographic changes suggest a shortage of caregivers in the near future, which can constrain the long-term care policy in many countries. In order to find ways to support family caregivers, a primary effort would be to estimate how much their work is worth. This paper estimates the economic value of long-term family caregivers and how these costs would be shared by the health system, the social insurances and the cared-for person in the absence of informal caregivers. We use data of 717 family caregivers of persons with spinal cord injury (SCI) in Switzerland. We implemented the proxy-good method and estimated the market value of their work if performed by professional caregivers. Our results show that family caregivers in the sample spent an average of 27 hr per week caring for a relative for almost 12 years. This work, if undertaken by professional home care, has a market value of CHF 62,732 (EUR 56,455) per year. In the absence of family caregivers, these costs should be financed by the health insurances (47%), by the cared-for person (24%) and by the social insurances (29%). It is in the best interest of the cared-for person and of the healthcare and social systems to keep a sustained supply of family caregivers. One option is finding ways to recognise and compensate them for their work and make it less cumbersome.

Health-economic burden of dementia in South Korea

Background

This population-based study estimated the health-economic costs of dementia from a societal perspective using nationally representative data from 2015 to 2019 and analysed recent trends in Korea.

Methods

The prevalence of and mortality due to dementia were calculated using the National Health Insurance claims data and population census. The health-economic burden due to dementia was estimated using a prevalence-based approach, including the number of dementia patients and the number of deaths resulting from dementia during 2015–2019. The health-economic burden was presented separately as the national burden and the burden per capita by summing the direct and indirect costs.

Results

Between 2015 and 2019, the prevalence of dementia among the elderly aged 65 years or older based on clinical diagnosis increased from 5.9 to 7.3%, with approximately 588000 elderly dementia patients in Korea. The total health-economic cost of dementia increased by about 1.5 times in the last 5 years and was estimated to be about USD 4218 million. Direct costs were 52.0% in 2019, and the proportion has been steadily increasing over the past 5 years; indirect costs accounted for 48.0% of the total burden, mainly from family members and caregivers. The health-economic cost per capita due to dementia was approximately USD 6957.

Conclusions

The burden of dementia in Korea is expected to considerably increase alongside the elderly population in the future. Health policies addressing the prevention and management of dementia should be prioritised.

Essential oil therapy for the short-term treatment of behavioral and psychological symptoms of dementia: a monocentric randomized pilot study

BACKGROUND

The behavioral and psychological symptoms of dementia (BPSD) can be severely distressing for both patients and caregivers.

AIMS

This study assessed the efficacy of environmental diffusion essential oil therapy (EOT) combined with psychotropic drug therapy (group A) in BPSD management, compared with psychotropic drug therapy alone (group B). The stress responses of attending caregivers were also assessed.

METHODS

Thirty-two patients with dementia and BPSD were enrolled. The presence and severity of BPSD were assessed using the Italian version of the NPI-NH scale, which also measures the stress felt by professional caregivers. Global geriatric evaluations were performed to rule out acute diseases that could contribute to delirium and worsen patients' mental status.

RESULTS

Following treatment, the average NPI-NH value was significantly reduced in group A compared with group B (p < 0.001). Caregiver distress was also significantly reduced in group A (p < 0.01).

DISCUSSION

This pilot study showed that BPSD were better treated using EOT combined with standard pharmacological treatment, compared with standard pharmacological treatment alone. No adverse effects of EOT were observed. Reductions in caregiver distress could be due either to reductions in BPSD severity and frequency resulting in decreased caregiver burden, and/or the emotional benefit for caregivers of exposure to essential oils.

CONCLUSIONS

This study supports the combined use of EOT and psychotropic drugs in the treatment of BPSD. Essential oils may improve the wellbeing of both patients and caregivers, without adverse effects. Additionally, EOT is easy to administer by environmental diffusion.

Synergistic influence of education and marriage on the risk for cognition loss among the older people in China

Aim

The study aimed to prove that both rationality and emotion are indispensable for older people to maintain their ability to live independently during the twilight of their lives. The resilience of older people to dementia were investigated by considering the interactions between educational levels and marriage status.

Design

A quantitative study was conducted using questionnaires.

Methods

Four sociodemographic variables (age, sex, educational level and marital status) were collected from 1,177 older Chinese participants, whose mini‐mental state examination scores (MMSE scores) were measured.

Results

A lower educational level coupled with being widowed caused a greater risk for severe cognitive impairment (relative risk [RR] 1.48; 95% confidence interval [CI] 1.20–1.82; p < .001) for high‐aged older participants (age range: ≥80) than for their low‐aged counterparts (age range: ≥60 and <80). In contrast, a higher educational level coupled with being married levelled this age‐related risk for cognitive loss (RR 0.91; 95% CI 0.65–1.27; p = .62).

Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City

Background: Dementia is one of the public health priorities in China. This study aimed to examine the hospitalization costs of patients with dementia and analyzed the factors associated with their inpatient costs. Methods: This was a prevalence-based, observational study using claims data derived from two urban insurance schemes during the period from 2008 through 2013 in Guangzhou. The extended estimating equations model was performed to identify the main drivers of total inpatient costs. Results: We identified 5747 dementia patients with an average age of 77.4. The average length of stay (LOS) was 24.2 days. The average hospitalization costs per inpatient was Chinese Yuan (CNY) 9169.0 (CNY 9169.0 = US$1479.8 in 2013). The mean inpatient costs for dementia patients with the Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY 9425.0 = US$1521.1) were higher than those for patients with the Urban Resident-based Basic Medical Insurance scheme (CNY 7420.5 = US$1197.6) (p < 0.001). Having UEBMI coverage, dementia subtypes, having hypertension, being admitted in larger hospitals, and longer LOS were significantly associated with hospitalization costs of dementia. Conclusions: The costs of hospitalization for dementia were high and differed by types of insurance schemes. Dementia was associated with substantial hospitalization costs, mainly driven by insurance type and long LOS. These findings provided economic evidence for evaluating the burden of dementia in China.

Best practice in the management of behavioural and psychological symptoms of dementia

Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The causes and risk factors for BPSD are multiple and include biological, psychological and environmental variables. Frequently, their combination, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Thus, a sound etiopathogenetic investigation including the patient and the family or care team is essential. The aim is to develop an individualized treatment plan using a therapeutic decision tree modified by the individual and environmental risk profile. Still, treatment may be difficult and challenging. Clinical empiricism often steps in where evidence from controlled studies is lacking. Psychosocial treatment approaches are pivotal for successful treatment of BPSD. Often a combination of different non-pharmacological approaches precedes drug treatment (most of which is off-label). Regular assessments of the treatment plan and any prescriptions must be carried out to detect signs of relapse and to stop any medicines that may have become inappropriate. Even with optimal management, BPSD will not disappear completely in some cases and will remain challenging for all involved parties. This article is a narrative review based closely on the interprofessional Swiss recommendations for the treatment of BPSD. To establish the recommendations, a thorough research of the literature has been carried out. Evidence-based data were provided through searches of Medline, Embase, ISI and Cochrane-Database research. Evidence categories of the World Federation of Biological Societies were used. Additionally, the clinical experience of Swiss medical experts was considered.

Development and validation of clinical profiles of patients hospitalized due to behavioral and psychological symptoms of dementia

BACKGROUND

Patients hospitalized on acute psychogeriatric wards are a heterogeneous population. Cluster analysis is a useful statistical method for partitioning a sample of patients into well separated groups of patients who present common characteristics. Several patient profile studies exist, but they are not adapted to acutely hospitalized psychogeriatric patients with cognitive impairment. The present study aims to partition patients hospitalized due to behavioral and psychological symptoms of dementia into profiles based on a global evaluation of mental health using cluster analysis.

METHODS

Using nine of the 13 items from the Health of the Nation Outcome Scales for elderly people (HoNOS65+), data were collected from a sample of 542 inpatients with dementia who were hospitalized between 2011 and 2014 in acute psychogeriatric wards of a Swiss university hospital. An optimal clustering solution was generated to represent various profiles, by using a mixed approach combining hierarchical and non-hierarchical (k-means) cluster analyses associated with a split-sample cross-validation. The quality of the clustering solution was evaluated based on a cross-validation, on a k-means method with 100 random initial seeds, on validation indexes, and on clinical interpretation.

RESULTS

The final solution consisted of four clinically distinct and homogeneous profiles labeled (1) BPSD-affective, (2) BPSD-functional, (3) BPSD-somatic and (4) BPSD-psychotic according to their predominant clinical features. The four profiles differed in cognitive status, length of hospital stay, and legal admission status.

CONCLUSION

In the present study, clustering methods allowed us to identify four profiles with distinctive characteristics. This clustering solution may be developed into a classification system that may allow clinicians to differentiate patient needs in order to promptly identify tailored interventions and promote better allocation of available resources.

Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru

Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries.

A web-based non-intrusive ambient system to measure and classify activities of daily living

Background

The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer’s disease and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients to stay in their home environment. Despite doctors’ and caregivers’ awareness of the patient’s cognitive status, they are often uncertain about its consequences on activities of daily living (ADL). To provide effective care, they need to know how patients cope with ADL, in particular, the estimation of risks associated with the cognitive decline. The occurrence, performance, and duration of different ADL are important indicators of functional ability. The patient’s ability to cope with these activities is traditionally assessed with questionnaires, which has disadvantages (eg, lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify these activities in the patient’s home. Combined with Web technology, these systems can inform caregivers about their patients in real-time (eg, via smartphone).

Objective

We hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging, and microphone recordings would be better suited for use in dementia patients. Since it does not require patient’s attention and compliance, such a system might be well accepted by patients. We present a passive, Web-based, non-intrusive, assistive technology system that recognizes and classifies ADL.

Methods

The components of this novel assistive technology system were wireless sensors distributed in every room of the participant’s home and a central computer unit (CCU). The environmental data were acquired for 20 days (per participant) and then stored and processed on the CCU. In consultation with medical experts, eight ADL were classified.

Results

In this study, 10 healthy participants (6 women, 4 men; mean age 48.8 years; SD 20.0 years; age range 28-79 years) were included. For explorative purposes, one female Alzheimer patient (Montreal Cognitive Assessment score=23, Timed Up and Go=19.8 seconds, Trail Making Test A=84.3 seconds, Trail Making Test B=146 seconds) was measured in parallel with the healthy subjects. In total, 1317 ADL were performed by the participants, 1211 ADL were classified correctly, and 106 ADL were missed. This led to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed an average of 134.8 ADL (SD 75).

Conclusions

The non-intrusive wireless sensor system can acquire environmental data essential for the classification of activities of daily living. By analyzing retrieved data, it is possible to distinguish and assign data patterns to subjects' specific activities and to identify eight different activities in daily living. The Web-based technology allows the system to improve care and provides valuable information about the patient in real-time.

The Burden of Care in Instances of Chronic Non-communicable Disease

Objetivo: analizar los diferentes enfoques para abordar la carga del cuidado en la enfermedad crónica no transmisible (ECNT). Materiales y métodos: con base en una revisión de literatura en las bases de datos: CINAHL, Ovid, Scielo, Medline y Psychoinfo, bajo los descriptores carga, impacto, costos, en combinación con enfermedad crónica y cuidado, con su respectiva traducción al inglés, se identificaron y analizaron los elementos estudiados como carga del cuidado de la ECNT. Resultados: la carga del cuidado en la ECNT es un constructo multidimensional que incluye la perspectiva epidemiológica (relación con la frecuencia y valoración de consecuencias en años de vida y pérdidas funcionales), la económica (impacto sobre consumo, ahorro, oferta de mano de obra, productividad y acumulación de capital humano) y la social (factores de desgaste, estrés, impacto familiar, limitación social y aspectos positivos de la experiencia), con múltiples interrelaciones entre sí. Conclusión: se requiere una mirada integral para examinar la carga del cuidado en la ECNT que incluya los actores sociales afectados: pacientes, cuidadores familiares, familias, profesionales e instituciones de salud.