DESK REVIEWS | 04.04. Areas for action included in policies and plans for dementia

DESK REVIEW | 04.04. Areas for action included in policies and plans for dementia

All areas are generally fulfilled.

As stated previously, there is no dementia-specific policy or plan for South Africa and therefore the questions for this section are not applicable.

The Ministry of Health tries to conduct dementia awareness campaigns in the whole country, every year in September. Actions carried out by dementia associations also greatly contribute to increase dementia awareness, stigma reduction, and the development of dementia-friendly communities. These types of action are supported by the Older People’s Statute as they contribute to increase attention and protection of older people (Presidency of Republic of Brazil, 2003).

References:

Presidency of Republic of Brazil. (2003). Estatuto do Idoso. Presidency of Republic of Brazil; National Congress of Brazil’s Information System. http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm

 

The Kerala State Initiative on Dementia (KSID) (Social Justice Department and ARDSI, 2014) addresses dementia awareness and dementia friendly initiatives (through campaigns, pledges, and sensitisation events) at a subnational level.

References:

Social Justice Department and ARDSI (2014). Kerala State Initiative on Dementia. Alzheimer’s Disease International.

Raising awareness of dementia through dementia awareness campaigns was set as the first action point of the policy. These campaigns are supposed to be held by revising older programmes and creating new programmes that promote healthy lifestyles, as well as raise awareness of risk factors and protective factors. The campaigns are set to be distributed through schools, families, and society. However, the policy does not provide information about their anticipated content or whether it aims to reduce stigma and/or support the creation of dementia-friendly communities (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.

It raises the need to consider dementia as a public health problem, integrating civil society, private institutions, and industry in the fight against dementia, against discrimination, and to promote mobilisation.

The “Technical Guidelines for Implementing a Healthcare Pathway for Integral Health for Older People” mentions about potentially modifiable risk factors such as physical inactivity, smoking, low cognitive activity etc. (Brazilian Ministry of Health, 2018e). In addition, primary healthcare policies, such as the Family Health Strategy, carry an important role in the reduction of risk factors for dementia, even though this policy has not been developed specifically for dementia, but for cardiovascular disease and diabetes mainly. The primary healthcare policies, among other things, promote preventive actions towards hypertension, diabetes, promotion of healthier lifestyles etc. which may contribute to the risk reduction of dementia.

References:

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

Risk reduction and prevention for dementia is addressed in part through the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) (MoHFW, 2017b). While the NPCDCS does not specifically mention dementia, it addresses risk factors and co-morbid conditions in persons with dementia. This could involve screening for risk factors and promoting healthy behaviours to reduce risk of dementia.

References:

Ministry of Health and Family Welfare. (2017b). National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS).

The third action step focuses on dementia prevention and risk. It emphasises the accessibility of information on healthcare services which comply with the minimum standard for older people. This is consistent with the health promotion emphasised in the first action step, which focuses on the promotion of a healthy lifestyle (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.

It points to the need to strengthen prevention campaigns against diabetes, obesity, hypertension, and physical inactivity, in order to reduce risk factors associated with dementia.

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 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.

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.

The government has been investing in training their workforce so they can recognize signs of cognitive impairment (informal source, 2019). In São José dos Campos (state of São Paulo) there is a dementia training for doctors, nurses, and dentists. This programme is based on discussions of dementia clinical cases together with a multidisciplinary team (informal source, 2019). As stated above, Brazil comprises 5,570 municipalities, thus other unknown strategies might exist. The Law Project 4364/2020 supports the health professionals training in dementia.

There are courses to improve awareness and knowledge about dementia among the workforce. The Cognitive Neurology subdivision of the Indian Academy of Neurologists conducts teaching courses in cognitive neurology in neurology and psychiatry annually (IAN, n.d.). In addition, geriatric care training was provided by the National Institute of Social Defence (NISD) under the Ministry of Social Justice and Empowerment (National Institute of Social Defence, [NISD], n.d.). This training programme included a module on dementia care (NISD, n.d.). However, this programme is not being continued. The NISD also had a bedside assistants programme (NISD, n.d.), which has also been discontinued.

More recently, the Department of Health and Family Welfare, Government of Karnataka, NITI-Aayog and the National Institute of Mental Health and Neurosciences (NIMHANS) have come together to launch the Karnataka Brain Health Initiative (KBHI). KBHI aims to develop a comprehensive strategy to address burden associated with common neurological disorders including dementia in the community (Karnataka Brain Health Initiative (KBHI), 2022). As a part of this initiative, a pilot project to train public primary health care physicians on diagnosing and treating neurological conditions including dementia has been initiated by specialists at NIMHANS in Karnataka (Alladi, 2022).

References:

Alladi. S (2022). Primary Health Care doctors training by neurologists. Twitter. Available from: https://twitter.com/alladi_suvarna/status/1502244487191416833?cxt=HHwWgsCqjdzZhdkpAAAA

Indian Academy of Neurology. (n.d.). Cognitive Neurology. Available from: https://www.ianindia.org/cognitive-neurology.php

Karnataka Brain Health Initiative (2022). Forum for Karnataka Brain Health Initiative. National Institute of Mental Health and Neurosciences. Available from: https://brainhealthnimhans.in/#

National Institute of Social Defence. (n.d). Courses. Ministry of Social Justice and Empowerment. Available from: http://www.nisd.gov.in/old_age_training.html

The fifth action step mentioned the inclusion of dementia in the training curriculum for doctors and nurses (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.

It points out the need for qualified and specialised personnel, organised in multidisciplinary teams with the participation of specialists, rehabilitators, caregivers, and family members.

The Law Project 4364/2020, states support for family carers. However, there is no detailed information on how this would be done. Currently, there are no areas for action in this category. This is left to the families themselves and to the primary care units.

Support for carers is outlined under both, the second action step, indicated by the description of a support group for caregivers and the fourth action step, indicated through a guideline and training for caregivers (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.

It emphasises that the recognition and support to professional and family caregivers is vital to maintain quality care of patients.

The Law Project 4364/2020 (if approved) currently states that all people with dementia should be confidentially registered in an information system from SUS.

The presence of a monitoring/surveillance system is mentioned as one of the indicators for the seventh action step (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.

It mentions the need to develop new sources of information for the construction of a permanent epidemiological surveillance system to monitor dementia cases in Mexico as well as the generation of evaluation tools to measure the impact of the implemented actions.

The Law Project 4364/2020 (if approved) will prioritise dementia research in Brazil. So far, the Brazilian research institutions have been investing in research on dementia. Between 2002 and April 2019, a total of US$5,397,116.92 were invested in 66 research projects on dementia by the Department of Science and Technology through the Ministry of Health (Brazilian Ministry of Health, 2019g). At local level, agencies have been financing a number of studies. For example, the agency FAPESP (São Paulo Research Foundation) has allocated 421 scholarships and research funds for dementia research, and when it comes to Alzheimer’s disease, this number rises to 884 (however, we cannot distinguish whether these 884 research funds focus on Alzheimer’s disease only or cover Alzheimer’s and other types of dementia) (FAPESP, 2019).

References:

Brazilian Ministry of Health. (2019g). Pesquisa Saúde. https://pesquisasaude.saude.gov.br/

FAPESP. (2019). FAPESP :: Fundação de Amparo à Pesquisa do Estado de São Paulo. http://www.fapesp.br/

 

The seventh action step focuses on research on cognitive function and 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.

Encouraging national research (basic, clinical, epidemiological, and social) on this disease is essential to generate new knowledge to promote better management of the disease to optimise the quality of life of family members and people with dementia.