• There is need of good trainings on dementia for the health and long-term care workforce. Other than health and long-term care workforce, there are members of the public that do not receive training/education on dementia, but should receive it given their professions, such as: police and fire services, first responders/paramedics, community/city workers (public transport staff, librarians), bankers, financial service staff, retail, and hospitality staff (restaurants, grocery store).
• There is neither coordinated planning (in terms of service delivery) nor resourcing of care specifically for people living with dementia.
• There is no typical path for people to get diagnostic assessment for dementia. In the same way, there is no information on the proportion of people who receive a diagnostic assessment neither on differences in diagnostic regarding geographical region, socioeconomic status, etc.
• No clear links between primary care services, specialist care services, and community/institutional care services exist to support people living with dementia.
• There is lack of co-ordinated care for people living with dementia, particularly across health and long-term care.
• Family and other unpaid carers are not recognised/registered as part of dementia diagnostic services.
• Social media and technology are still very incipient in caring for people living with dementia in Brazil.

Prevention, early detection, diagnostic service by primary care, case management, care co-ordination in community, flexible/ tailored respite service, training of formal care workforce, informal carer training, and public education of end-of-life care and related legal matters are the major service provision gaps in Hong Kong.

The treatment gap for dementia is estimated to be greater than 90% in the majority of India (Dias and Patel, 2009). Low levels of awareness and lack of adequate services to diagnose and manage dementia contribute to this treatment gap. After receiving a diagnosis, families have limited access to post-diagnostic support services. Service centres that provide long-term care support such as day care centres and residential care facilities are very few for persons with dementia in the country (Alzheimer’s and Related Disorders Society of India (ARDSI), 2010). Family remains the main provider of long-term care for dementia in India (ARDSI, 2010).

References:

Alzheimer’s and Related Disorders Society of India. (2010). THE DEMENTIA INDIA REPORT 2010: Prevalence, impact, cost and services for dementia. New Dehli. Retrieved from https://ardsi.org/pdf/annual%20report.pdf

Dias, A., & Patel, V. (2009). Closing the treatment gap for dementia in India. Indian Journal of Psychiatry, 51 Suppl 1, S93-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21416026

Direct service provision for dementia in the public sector appears to be limited to one weekly dementia clinic at the University Hospital of the West Indies, in the country’s capital of Kingston. Based on the limited data gleaned for this desk review, it appears that there is no clear care pathway enacted for dementia in the public sector. This has implications for timely diagnosis; adequate treatment, social support and the ability of families to manage care; considering the lack of a public long-term care system.

Prevention, early detection, and treatment of dementia using evidence-based and task-sharing approaches (using health care workers and/or community health providers such as community health workers, traditional and faith healers) to increase the capacity of the workforce is the road to a dementia free country or a significant reduction of the dementia treatment gap in Kenya.

There is no national system of care. No specific public dementia-care services are in place at national level. Few specialised memory clinics and only few third level hospitals that have specialists that are trained to diagnose and offer treatment/management for dementia, are in place. There is no specific support for carers (training, respite services, income benefits). There is also lack of coordination among services and stewardship.

Based on the desk review above, the following have emerged as service provision gaps in South Africa:

• Care pathways and diagnostic services for dementia: Differential diagnostics (types of dementia, co-morbidities influencing symptoms for example dehydration, urinary tract infection, etc.);
• Training of primary healthcare workers to recognise and respond to dementia-care needs;
• Specialist training: (1) Re-institutionalisation of specialist training curricula for geriatric nursing by the South African Nursing Council (SANC) that includes a special focus on dementia treatment, care, and support (nurses are the backbone of the country’s PHC system); and (2) Geriatricians and Psychogeriatricians in both the public and private sector;
• Dementia pharmacological treatments for public service users;
• Non-pharmacological approaches to dementia care: Home-based/community-based dementia-care services (i.e., for public service users that are dementia-specific in terms of care, treatment and support for persons living with dementia and their families). For example, home-based nursing care, respite care, training and support of family carers.