Now is the time to take action

Gill Livingston is professor of psychiatry of older people in the Division of Psychiatry, UCL Faculty of Brain Sciences.

Worldwide around 50 million people live with dementia, and this number is projected to increase to 152 million by 2050. Dementia affects individuals, their families, and the economy, with global costs estimated at about US$1 trillion annually.
It is one of the biggest global health problems facing societies today.

The last 20 years has seen significant advances in our understanding of the human brain and the biology of dementia and other neurodegenerative diseases. However, despite this progress, there remains a lack of societal understanding of dementia and implementation of our knowledge about how to treat it effectively.

Acting now on dementia prevention, intervention, and care will vastly improve the living and dying experience for people with the condition – and their families, and thus society (Livingston et al 2017, 2020). Wellbeing should be the goal of dementia care, with an individualised approach to each patient diagnosed.

Those with dementia often have a number of complex symptoms and issues, and time and care should be taken by health-care practitioners to ensure that interventions are developed on an individual basis. It is important to consider the patient in their entirety. This means taking into account the patient, their culture, environment and the care they receive from their family as well.

There is increasing evidence that in the near term, at least, psychosocial interventions that are adapted to an individual patient’s symptoms and needs can help to manage neuropsychiatric symptoms. Such evidence-based interventions can help to reduce agitation and distress. They can also benefit society by being cost effective in the longer-term.

Physical health is key and ensuring that this is maximised plays an important role in cognitive health. Those diagnosed with dementia tend to have more physical illness than those without dementia of the same age. But we know that it is often the case that people with dementia will receive less health care in the community – as well as finding it complex to seek help, report their symptoms and follow a treatment plan, including taking medication.

We also know that older people with dementia account for more admissions to hospital than those without. Some of the illnesses precipitating these admissions could probably have been managed at home, if the individuals concerned were receiving an appropriate level of care. This would have been less distressing for them, especially when, as is common, they find new environments difficult.

Such experiences would have been even more common during the pandemic, with staff wearing masks and visiting restricted. Dementia patients have died disproportionately.

People with dementia are particularly susceptible to delirium and this can exacerbate cognitive decline. I would urge health care professionals to consider dementia as a possibility in older people without known dementia who have frequent admissions or who develop delirium.

Once admitted to hospital, care should include appropriate sensory stimulation, ensuring hydration levels are kept up with regular fluid intake and significant efforts to avoid infections. These interventions can help reduce the occurrence of delirium episodes.

Recent research has supported our understanding of some preventable causes of dementia – and UCL is playing a key role in this.  The university is creating an exciting future for dementia research in the UK and globally by providing the next generation of dementia academics through our Master’s in dementia course. Many people then go on to do a PhD and we are fuelling the next generation of dementia academics.

Now the progress in dementia research needs be matched by the implementation of the findings. This is the time for action and change.

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Livingston G, Sommerlad A, Orgeta V, Costafreda SG et al (2017) Dementia prevention, intervention, and care. The Lancet 390(10113) 2673-2734.

Livingston G, Huntley J, Sommerlad A, Ames D et al (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet 396(10248) 413-446.