Ageing and dementia care in Finland - current discussions and challenges
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Transcript of Ageing and dementia care in Finland - current discussions and challenges
www.helsinki.fi/yliopisto
Ageing and dementia in Finland – current discussions and challenges
Ulla Eloniemi-Sulkava
Adjunct Professor, PhD, RN
10.9.2013 1 [email protected]
www.helsinki.fi/yliopisto
Population aged 75+ years in Finland
Age v.2000 v. 2010 v. 2020 v. 2030
v. 2040
75+ 340 409
7 %
411 864
8 %
518 312
10 %
748 144
14 %
826 351
15 %
10.9.2013 2 [email protected]
www.helsinki.fi/yliopisto
Life expectancy in Finland
• Male
– 75 yrs: 11 yrs
– 80 yrs: 8 yrs
– 85 yrs: 6 yrs
– 90 yrs: 4 yrs
– 95 yrs: 3 yrs
– 100 yrs: 2 yrs
• Female
– 75 yrs: 13 yrs
– 80 yrs: 11 yrs
– 85 yrs: 7 yrs
– 90 v: 5 yrs
– 95 v: 4 yrs
– 100 v: 2.5 yrs
10.9.2013 [email protected] 3
www.helsinki.fi/yliopisto
Dementia in different age groups in Finland (%)
0,26
4,20
10,70
35
0
5
10
15
20
25
30
35
30-64v 65-74v 75-84v 85- v
10.9.2013 4 [email protected]
www.helsinki.fi/yliopisto
Prevalence of dementia in a population aged 75+ years and
older (Kuopio 75+ Study)
Prevalence of dementia 22.7%
Alzheimer’s disease (AD) 46.7%
Vascular dementia 23.4%
Dementia with Lewy bodies + AD 21.9%
Other 8.0%
10.9.2013 5 [email protected]
www.helsinki.fi/yliopisto
Number of people with dementia in Finland (2013)
• Total 130 000
• Moderate to severe dementia 95 000
• Mild dementia 35 000
• Patients aged 65 years and less 7 000
• Patients aged 80 years and over 60 000
• New cases every year 14 000
10.9.2013 6 [email protected]
www.helsinki.fi/yliopisto
Costs of community and long term institutional care in people with dementia
in Finland, million euros (Sulkava 2006)
2005 2010 2015
• Community 893 980 1 105
• Institutional 2 231 2 449 2 760
• All 3 124 3 429 3 865
10.9.2013 7 [email protected]
Year
www.helsinki.fi/yliopisto
Dementia in Finland
• Only one half of people with memory disorders are properly diagnosed and accordingly treated
• Three out of four aged people receiving 24-hour care have dementia
• 60 % of people with dementia are in community care, 60 % of them living alone (no informal caregiver)
• There are increased needs for services with aging population, therefore it is needed – to promote brain health – to prevent memory disorders – to detect memory problems as early as possible – to have an effective and seamless clinical pathway for
treatment, rehabilitation and support
10.9.2013 [email protected] 8
www.helsinki.fi/yliopisto 10.9.2013 [email protected] 9
Even a minor change in the efficacy of treatment or care can significantly decrease costs and improve quality of life of people with dementia.
www.helsinki.fi/yliopisto
National Memory Programme 2012–2020.
Creating a "memory-friendly" Finland
Four pilars:
1. Promoting brain health
2. Fostering a more open attitude towards brain health, treatment of dementia disease and rehabilitation
3. Ensuring a good quality of life for people with dementia and their families through timely support, treatment, rehabilitation and services
4. Increasing research and education
http://www.stm.fi/c/document_library/get_file?folderId=6511574&name=DLFE-26234.pdf
10.9.2013
www.helsinki.fi/yliopisto 10.9.2013 [email protected] 11
There is a friction
between the service system and
caregiving families
www.helsinki.fi/yliopisto
We studied dementia caregiving families
(Raivio et al 2007)
• In what terms spouse caregivers do their every day work?
• How do spouse caregivers adjust to their situation?
• What are the subjective needs of these spouse caregivers from our service system?
• How our services meet the needs of dementia caregiving families?
10.9.2013 12 [email protected]
www.helsinki.fi/yliopisto
• Cross-sectional postal survey to spouse caregivers of people with Alzheimer’s disease (AD) in Finland
• A random sample of Alzheimer drug users’ register (N= 1989)
Methods
HELSINKI
TAMPERE
LAPLAND
NORTH CARELIA
MIDDLE FINLAND
10.9.2013 13 [email protected]
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Demographics
• 75% returned the questionnaire
• 1214 spouses acknowledged themselves as the main caregiver of the spouse with AD
• 63% of the caregivers were women
• Mean age of caregivers: 78 years
• Mean age of spouses with AD: 80 years
• Mean years in marriage: 52 years
• A third of caregivers had a poor subjective health
10.9.2013 14 [email protected]
www.helsinki.fi/yliopisto
Behavioral and psychological symptoms of spouses with dementia (n=1214)
0
10
20
30
40
50
60
70
80
Need for
constant
supervision
Depressed Agitated Cooperation
difficulties
Hallucinations Incontinence
10.9.2013 15 [email protected]
www.helsinki.fi/yliopisto
Physical impairments of spouses with dementia (n=1214)
0
10
20
30
40
50
60
70
80
Poor
functioning
Needs
spouse's aid
when walking
Rigidity Dizziness Muscle
weakness
Pain
10.9.2013 16 [email protected]
www.helsinki.fi/yliopisto
Adjustment to caregiving situation
• Caregiving limits social life 63.5%
• Well or quite well adapted to the spouse’s Alzheimer’s disease 92.2%
• Satisfied with their marriage 63%
10.9.2013 17 [email protected]
www.helsinki.fi/yliopisto
Psychological well-being of spouses (n=1214)
0
10
20
30
40
50
60
70
80
90
100
Satisfied with life Feeling needed Zest for life Constantly
depressed
Lonely
10.9.2013 18 [email protected]
www.helsinki.fi/yliopisto
Official services most often offered for AD caregiving families
• Financial support to caregiver 36% (”caregiving salary”)
• Various aids and devices (e.g. walking aid) 33%
• Physiotherapy 32%, of which 86% was rehabilitation to II world war veterans based on law
• A respite care in an institutional setting 31%
10.9.2013 19 [email protected]
www.helsinki.fi/yliopisto
Services wished and received by spouse caregivers
0
10
20
30
40
50
60
70
Physiotherapy Society's financial
support
House cleaning Home respite
Wished services
Received services
10.9.2013 20 [email protected]
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Satisfaction to the services in the families
• Only 39% of the families were satisfied with the services they received.
• Only 29% found it was easy to get information about available services.
• Only 31% felt they could have any influence on what services they received.
10.9.2013 21 [email protected]
www.helsinki.fi/yliopisto
Key messages
• Spouse caregivers of the spouses with AD were old and many in poor health.
• People with AD have high rate of behavioral and psychological symptoms and need for continuous help.
• Caregivers have adjusted well to their life situation, often satisfied with their marriage and have quite good psychological well-being.
• Services meet poorly needs of these families.
10.9.2013 22 [email protected]
www.helsinki.fi/yliopisto
In complexity of the service system a coordinator is needed to work in cooperation with people with dementia and their families
FAMILY
PRIMARY -
CARE -
PHYSICIAN
SPECIALIST -
DOCTOR
DEMENTIA -
NURSE
HOME CARE -
NURSE -
NUTRITIONIST -
MEALS ON -
WHEALS
FOOT -
CARE
DENTIST -
PHARMACY
PHARMACIST
TAXI -
SERVICES
INVALID PARKING
-
(POLIS)
DEVICES -
OCCUPATIONAL THERAPIST
-
- DIPERS
II WORLD WAR -
VETERANS’ -
REHABILITATION -
SERVICES
II World war
VETARNANS’ -
SERVICES
Third sector services
various private services
- domestic help
- caregiver groups
- Alzheimer clubs
- doctors, etc
- l
OFFICIAL
ECONOMICAL
CAREGIVER SUPPORT
SOCIAL -
CARE
WORKER - RESPITE
- CARE -
VARIOUS
DAY Ä
CARE
DEMENTIA -
COUNCELER
PHYSIO -
TERAPY -
SOCIAL SERVICE OFFICE: - l SUBSTITUTIONS FOR DRUGS, LIVING ARRANGEMENTS, REHABILITATION,
-
-
-
-
TAX OFFICERS -
NURSE -
SOCIETAL: LEGAL ISSUES
BANK
- legal issues
- lawyers
DOMESTIC SERVICES -
- SHOPPING CLEANING
-
-
NURSING HOMES
SPEECH THERAPY
10.9.2013 23 [email protected]
www.helsinki.fi/yliopisto
Two randomized controlled trials with the main element of a dementia care
coordinator
10.9.2013 [email protected] 24
Kuopio Dementia
Study
(Eloniemi-Sulkava et al
2001)
Family care as
collaboration
(Eloniemi-Sulkava et al
2009)
www.helsinki.fi/yliopisto
Aika, kuukautta
0 2 4 6 8 10 12 14 16 18 20 22 24
Laitostu
min
en, %
0
5
10
15
20
25
30
35
40
45
50
Kontrolliryhmä
Hoitoryhmä
During the follow-up
time p = 0.27
Time in community care (Eloniemi-Sulkava et al 2009, in line with the survival curve in 2001)
At 1.6 yr, 11% of
people with dementia
in intervention group
vs 24% of those in
control group were
in permanent
institutional care
(p=0.027) 10.9.2013 25 [email protected]
www.helsinki.fi/yliopisto
Cost of services (Eloniemi-Sulkava et al 2009)
• Mean cost of municipal social and health care services/ couple/ year: in intervention group 15 568 € vs control group 23 553 €
• Mean savings/couple/ year 7 985 euros in municipal social and health care services (p=0.03)
• Mean cost of intervention/ couple/ year was
2 923 €
10.9.2013 26 [email protected]
www.helsinki.fi/yliopisto 10.9.2013 [email protected] 27
The panel of experts:
Finnish recommendations for best practices in the treatment of progressive memory disorders (Suhonen J, Alhainen K, Eloniemi-Sulkava U et al, 2008)
www.helsinki.fi/yliopisto
Main points of the recommendation
• Prevention of dementia • Early diagnoses • Good medical care including AT medication • Diagnostics, effective treatment, family support
and guidance by memory clinics • Comprehensive assessment and care planning • Continuous chain of care and services throughout
disease process • Support of community care is arranged by
dementia care coordinator
10.9.2013 [email protected] 28
www.helsinki.fi/yliopisto
Guidelines for medical treatment
• Current Care Guideline for Memory Disorders (The Finnish Medical Society Duodecim
2010)
10.9.2013 [email protected] 29
www.helsinki.fi/yliopisto 10.9.2013 [email protected] 30
Guidelines for the competences of multiprofessional team (Eloniemi-Sulkava et al 2010)
www.helsinki.fi/yliopisto 10.9.2013 [email protected] 31
Increasing interests in: • a person with dementia as a human being • interaction and communication issues •Environmental issues • quality of life and wellbeing issues • effective psychosocial interventions
www.helsinki.fi/yliopisto
• Disease-orientated approach: – behavioural and psychological symptoms of dementia
(BPSD) – behavioural problems – neuropsychiatric symptoms
• Nurse-orientated approach: – challenging behaviour
• Person-orientated approach: – Unmet needs behaviour – Need-Driven Dementia-Compromised Behaviours
10.9.2013 32 [email protected]
Behavioral symptoms or needs of a person with memory disorder?
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Recent Finnish RCT’s with positive results
• Supporting staff towards person-centeredness, and to identify and meet unmet needs of people with dementia decreased challenging behaviours and increased quality of life in people living in long term care settings. (Eloniemi-Sulkava and Savikko 2011)
• Tailored nutrition guidance and care has beneficial effects on nutrition and health related quality of life in home-dwelling people with AD. (Suominen et al 2013)
• An intensive and long-term exercise program had beneficial effects on the physical functioning of people with AD without increasing the total costs of health and social services or causing any significant adverse effects. (Pitkälä et al 2013)
10.9.2013 [email protected] 33
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For past 20 years : • We have gained much knowledge. • We have conducted high level RTC’s. •We have national recommendations and guidelines from diagnoses to death. •We even have guidelines to professional competences.
www.helsinki.fi/yliopisto 10.9.2013 [email protected] 35
How to implement evidence based practices in real life?
1. High quality multidisciplinary reseach team
2. Funding
We need to study
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Lights of the day (Päivänvaloja, artist Nanna Susi)
10.9.2013 [email protected] 36