Read Advisory Board's take: Why providers must prepare for a rise in dementia patients
The World Health Organization (WHO) on Tuesday released new guidelines that include eight recommendations for reducing the risk of developing dementia.
Dementia: A growing global health concern
WHO defines dementia as a "deterioration in cognitive function beyond what might be expected from normal aging." According to WHO, dementia stems from several diseases or injuries, such as Alzheimer's disease and stroke. And while age contributes to dementia risk, "dementia is not a natural or inevitable consequence of aging," WHO said.
Dementia can affect memory, thinking, comprehension, learning capacity, language, calculation, and judgment. It is a major cause of disability and dependence for older people, and there's not yet a cure, WHO said.
Currently, about 50 million people worldwide suffer from dementia, according to WHO, and the number of dementia patients is expected to grow threefold over the next three decades.
8 dementia-fighting tips
With these challenges in mind, WHO compiled a list of 8 recommendations to reduce the risk of developing dementia. While the Associated Press reports that most of the recommendation are "common sense," some may not be as well known. For example, WHO recommends:
- Avoiding harmful alcohol use;
- Controlling blood pressure;
- Controlling blood sugar;
- Controlling cholesterol;
- Eating a healthy diet, possibly following a Mediterranean diet;
- Exercising regularly;
- Maintaining health weight; and
- Not smoking.
Further, the guidelines warn against using vitamin B pills, vitamin E pills, fish oil supplements, or multi-complex supplements that are advertised as helping brain health, as there is a lack of strong evidence that they work.
In addition, WHO did not endorse activities and games designed to bolster thinking skills. While people with mild impairment or normal capacities can do these activities, there's not much evidence they afford a benefit, WHO said.
WHO said health care providers should discuss the guidelines with patients. In addition, WHO said the guidelines also intended to help governments and policymakers develop programs to promote healthy lifestyles.
Comments
Experts characterized the recommendations as comprehensive and sensible, according to CNN, but some also challenged the strength of the evidence used to make the guidelines.
Robert Howard, a professor of old age psychiatry at University College London, said, "Keep on doing the things that we know benefit overall physical and mental health, but understand that the evidence that these steps will reduce dementia risk is not strong."
Nonetheless, Maria Carrillo, chief science officer of the Alzheimer's Association, which has published similar advice to the WHO guidelines, noted that many cases of dementia are preventable. "It's never too late or too early to incorporate healthy habits," she said.
Meanwhile, Tom Dening, director of the Centre for Old Age and Dementia, Institute of Mental Health at the University of Nottingham, praised the recommendation against supplements. "The negative recommendation, advocating that people do not use vitamin or dietary supplements (unless they are needed for a clinical problem) is welcome, and it is to be hoped that it saves lots of people from wasting their money" (WHO release, 5/14; Marchione, AP/ABC News, 5/14; Hunt, CNN, 5/14).
Advisory Board's take
Anna Yakovenko, Practice Manager, and Emily Heuser, Senior Consultant, Market Innovation Center
Hopefully providers can use these new WHO guidelines to help their patients stave off dementia—a task that is becoming increasingly important with the demographic situation in the U.S. today. As life expectancy increases and the baby boomer generation reaches Medicare age, the number of Americans diagnosed with dementia—particularly Alzheimer's disease—is projected to skyrocket. Currently, 5.7 million Americans have Alzheimer's—a figure expected to rise to 14 million by 2050.
Providers need to make sure they are prepared to address this rise and meet the unique needs of patients with dementia. Here are 5 ways they can begin to prepare:
- Educating the community about the condition
Providers can play a valuable role in the community by providing patients and their caregivers with information about early detection of dementia. This education is pivotal for encouraging early detection and decreasing the cost burden of dementia care—as a patient with mild symptoms costs $18,400 to treat annually, whereas a patient with severe symptoms costs up to $36,132 on average.
Our research on baby boomers indicates that they are highly apprehensive about developing the condition—in one survey 87% of boomers said they were 'extremely' or 'very concerned' about staying mentally sharp in the future—and are highly receptive to education about early detection. Therefore, this education is not only appreciated, but can also brand your hospital as a go-to dementia provider.
- Strengthening staff skills
Dementia patients require unique skills among care staff, who can best excel in providing high-level care when they fully understand the condition and its progression. Your organization can encourage staff to exceed state requirements for dementia training by becoming a Certified Dementia Practitioner or taking other Alzheimer's and dementia trainings offered through the National Council of Certified Dementia Practitioners.
- Creating cross-service line dementia care teams
Cross-service line care teams can help to improve care coordination for dementia patients and make their hospital experience less overwhelming and stressful. For instance, at New York-Presbyterian Hospital, dementia patients receive care from a multidisciplinary team of healthcare professionals including neurologists, neuropsychologists, social workers, nurse practitioners, and rehabilitation specialists. In addition to screening and treatment services, this team provides neuropsychological assessments, patient and caregiver education, and assistance in managing patient care.
- Promoting treatment in outpatient settings
Work with PCPs to encourage dementia patients to seek care at outpatient centers. Although patients can still feel disoriented and confused in outpatient clinics, these sites of care tend to be less overwhelming and upsetting to dementia patients than inpatient settings.
When possible, you can structure consultations or tests to be conducted in outpatient facilities before inpatient admission. Learn more about outpatient geriatric assessment centers and geriatric emergency departments if you're interested in alternative options for better accommodating dementia patients.
- Demystifying the discharge process
Create easily-understandable, printed discharge materials about planning for future care for dementia patients and their caregivers. A JAMA study found that even elderly patients without dementia struggle to understand normal discharge directions. Materials written at an accessible reading level and accompanied by pictures can help patients and their caregivers understand post-treatment procedures and how to prevent complications.
To learn the best practices in creating a dementia program, download our research report on Building a Financially Sustainable Alzheimer's Disease & Memory Disorders Program. Then, for a quick overview about developing your geriatrics program, download our Geriatrics Cheat Sheet.