The “National Policy for Primary Care” is responsible for the first contact with the population and for referring people to more specialised services in order to receive proper diagnosis (Brazilian Ministry of Health, 2012). We had previously estimated that dementia is underdiagnosed, and we believe that those diagnosed are in general at more advanced stages of the disease. In practice, patients suspected to have dementia by primary care professionals should be referred to a specialist (usually a geriatrician, psychiatrist, or a neurologist), who will follow through each case and will prescribe anti-cholinesterase drugs or other medication routinely. The post-diagnostic support is generally provided through primary care services in which people living with dementia would receive a similar type of support like other older people with chronic conditions. The care itself is not provided by public services and there are no dementia-specific mainstream post-diagnostic services for people living with dementia and their carers. A few initiatives can be found locally through University hospitals where support groups are provided, or through private services.

References:

Brazilian Ministry of Health. (2012). Política Nacional de Atenção Básica. http://189.28.128.100/dab/docs/publicacoes/geral/pnab.pdf

The Mental Health Review Report (MHRR) reveals that there is inadequate expertise and capacity in early diagnosis and post-diagnostic support of dementia in primary care setting (Food and Health Bureau, 2017a, p. 161). The report proposes five recommendations on promoting timely diagnosis, intervention, and best practices in managing different stages of dementia.

• “Recommendation 3 – A common reference should be developed to support primary care professionals on the diagnosis and management of dementia” (Food and Health Bureau, 2017a, p. 186).
• “Recommendation 4 – The role of primary care in the provision of dementia care should be enhanced through capacity building” (Food and Health Bureau, 2017a, p. 186).
• “Recommendation 5 – The capacity of specialist services in HA should be strengthened to facilitate timely intervention of dementia cases through the implementation of a refined intervention model, while reducing the waiting times of specialist services” (Food and Health Bureau, 2017a, p. 187).
• “Recommendation 8 – It is necessary to enhance medical-social collaboration and further integrate the delivery of healthcare and social care interventions to provide patient-centred support” (Food and Health Bureau, 2017a, p. 188).
• “Recommendation 9 – End-of-life care and palliative care in the community setting should be promoted to minimise unnecessary and repeated hospitalisations” (Food and Health Bureau, 2017a, p. 189).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The fourth action step focuses on early diagnosis and management. However, post-diagnostic support outlined second action step appears to be more focused on caregivers and provides little information about post-diagnostic support and care for people living with dementia (Ministry of Health Republic of Indonesia, 2015b).

References:

Ministry of Health Republic of Indonesia. (2015b). National Strategy: Management of Alzheimer and Other Dementia Diseases: Towards Healthy and Productive Older Persons. Ministry of Health Republic of Indonesia.

Not applicable.

It points out the need for timely diagnosis and treatment, as well as for strengthening care at the community and family level, with a comprehensive outpatient, non-hospital vision for the long-term care of patients with dementia, through specific rehabilitation programs.

NZ Dementia framework:

The second key element of the dementia framework centres around assessment, diagnosis, early intervention, and ongoing support. It addresses each of the aspects in turn.

Assessment:

The aim is to “empower anyone who recognises changes in their own or someone else’s memory or cognitive abilities to seek an assessment and have timely access to an assessment”. The framework outlines good practice points for health services to follow. These include specific recommendations for:

• Assessment in primary care, when to refer to specialist services and what specialist services should have available (such as access to CT scans and formal neuropsychological testing),
• Diagnosis.

Diagnosis:

The aim is to “provide earlier diagnosis for people with dementia. An earlier diagnosis will allow the person and provide them with information to promote self-management and rehabilitation, thus ensuring that they are able to live with a sense of wellbeing for as long as possible.”

Recommendations include considerations for when making the diagnosis of dementia as well as how to approach other underlying or co-morbid diagnoses (such as MCI, depression, and substance use).

Early intervention and ongoing support:

The aim is to “encourage people with a recent diagnosis of dementia to participate in ongoing, culturally appropriate support that is tailored to meet their needs and maximise their abilities and independence…[and] is also to help the person with dementia and their family and whānau navigate through the health and social support system”. 

Good practice points are provided for the management of the person with dementia, meeting the needs of family and whānau, and expectations of health navigators (a named first point of contact with a good knowledge of dementia as well as health and social services which can help the person and their whānau understand the diagnosis and assist with navigation through the system).

Dementia Action Plan:

The dementia plan outlines a priority action of supporting people living with dementia and their family/whānau care partners/supporters to live their best possible lives.

Action areas include recommendations to:

• implement options to improve the provision of timely and accurate diagnosis and comprehensive management planning in primary care;
• align core features of DHB Cognitive Impairment Pathways to reinforce a national approach, including investigating health technology options for cognitive testing to arrive at a recommendation for national adoption;
• coordinate and support access to needed services including emergency support;
• include information, education, support, and flexible, available and accessible respite services;
• start working with specific populations (such as Pasifika/those living alone) to identify unique needs and develop solutions for each.