Social Policy in Ontario

TheGlobeandMail.com – Life/Health
Published Tuesday, Sep. 21, 2010. Last updated Thursday, Sep. 23, 2010.   André Picard — public health reporter

Dementia is fast becoming one of the world’s biggest health challenges, with the soaring number of cases packing a financial wallop in both established and emerging economies.

If countries rich and poor hope to attenuate the coming financial and social crisis, they need to develop sweeping policies that bring relief to caregivers, rejig health systems to respond to debilitating brain disease, and invest in research to find a cure.

That is the stark, urgent message underlined in a report being released on Tuesday that places the annual global cost of dementia at $604-billion (U.S.) − the equivalent of the revenues of the mega-corporations Wal-Mart and Exxon Mobilcombined – and warns that it will increase at an “alarming rate” for at least 40 more years unless firm action is taken.

In its report, Alzheimer’s Disease International, a London-based consumer group, says 35.6 million people worldwide are living with dementia.

The cost of caring for them includes $96-billion in direct medical care, $255-billion for residential care such as nursing homes, and $253-billion in unpaid labour by family caregivers.

By 2030, the number of people with dementia will almost double to 65.7-million and total costs will surpass $1.1-trillion annually, according to the estimates.

“The figures are cause for great concern, and we hope that this report will act as a call to action for governments and policy-makers across the world,” said Marc Wortmann, executive director of Alzheimer’s Disease International.

“It is vital that they recognize that the cost of dementia will continue to increase at an alarming rate and we must work to improve care and support services,” he said.

According to their calculations, the costs of dementia are the equivalent of 1 per cent of the gross domestic product globally.

“If dementia were a country, it would be the world’s 18th largest economy, ranking between Turkey and Indonesia,” the authors write in the new report.

The report, prepared by Anders Wimo of the Alzheimer’s Disease Research Centre of the Karolinska Institutet in Stockholm and Martin Prince of the Centre for Public Mental Health at King’s College in London, notes that rates of dementia and the costs of care vary markedly around the world.

For example, the average cost of caring for a person with dementia is $32,865 annually in a high-income country like Canada. By contrast, in a low-income country like Bangladesh, the average cost is $868.

Low-income countries, which account for 14 per cent of dementia cases, account for only 1 per cent of costs; middle-income countries account for 40 per cent of cases and 10 per cent of costs, while 46 per cent of cases are in high-income countries, although they account for 89 per cent of costs.

The principal difference is that, in poor countries, the burden of care-giving falls almost exclusively on families.

In high-income countries, as many as 50 per cent of people with dementia live in nursing homes and long-term care facilities, while in low- and middle-income countries, it is fewer than 6 per cent.

The report notes that, while much has been written about the rising tide of dementia in developed countries, the projected increase is far greater in the developing world.

For example, while the number of people living with dementia is expected to increase by about 63 per cent in North America in the next 20 years, it is expected to soar 117 per cent in East Asia and 146 per cent in Latin America.

A report published earlier this year by the Alzheimer Society of Canada found that dementia costs the Canadian economy about $15-billion a year, and estimated that figure will soar to $153-billion annually by 2038.

In that same time frame, the number of Canadians living with dementia is expected to jump to 1.1 million from 500,000 today.

Both the Canadian and the international reports make similar recommendations. These include:

• Develop national strategies to deal with the disease;

• Create policies that explicitly focus on supporting family caregivers so that people with dementia can remain at home as long as possible;

• Reorganize health systems so that, instead of the current emphasis on acute, episodic care, they better meet the needs of patients with chronic conditions like dementia;

• Dramatically increase research funding to help develop new treatments.

“The societal cost of dementia is already enormous,” the authors write. “Dementia is already significantly affecting every health system in the world, and the economic impact on families is insufficiently appreciated.”

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