Logo of qualhcLink to Publisher's site
Qual Health Care. 1997 Sep; 6(3): 146–152.
PMCID: PMC1055476

Alzheimer's disease in the United Kingdom: developing patient and carer support strategies to encourage care in the community.

Abstract

Alzheimer's disease is a growing challenge for care providers and purchasers. With the shift away from the provision of long term institutional care in most developed countries, there is a growing tendency for patients with Alzheimer's disease to be cared for at home. In the United Kingdom, this change of direction contrasts with the policies of the 1980s and 90s which focused more attention on controlling costs than on assessment of the needs of the patient and carer and patient management. In recent years, the resources available for management of Alzheimer's disease have focused on institutional care, coupled with drug treatment to control difficult behaviour as the disease progresses. For these reasons, the current system has led to crisis management rather than preventive support--that is, long term care for a few rather than assistance in the home before the crises occur and institutional care is needed. Despite recent innovations in the care of patients with Alzheimer's disease, the nature of the support that patients and carers receive is poorly defined and sometimes inadequate. As a result of the shift towards care in the community, the informal carer occupies an increasingly central role in the care of these patients and the issue of how the best quality of care may be defined and delivered is an issue which is now ripe for review. The objective of this paper is to redefine the type of support that patients and carers should receive so that the disease can be managed more effectively in the community. The needs of patients with Alzheimer's disease and their carers are many and this should be taken into account in defining the quality and structure of healthcare support. This paper shows how new initiatives, combined with recently available symptomatic drug treatment, can allow patients with Alzheimer's disease to be maintained at home for longer. This will have the dual impact of raising the quality of care for patients and improving the quality of life for their carers. Moreover, maintaining patients in a home environment will tend to limit public and private expenditure on institutional care due to a possible delay in the need for it.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand. 1987 Nov;76(5):465–479. [PubMed]
  • Rocca WA, Hofman A, Brayne C, Breteler MM, Clarke M, Copeland JR, Dartigues JF, Engedal K, Hagnell O, Heeren TJ, et al. Frequency and distribution of Alzheimer's disease in Europe: a collaborative study of 1980-1990 prevalence findings. The EURODEM-Prevalence Research Group. Ann Neurol. 1991 Sep;30(3):381–390. [PubMed]
  • Ostbye T, Crosse E. Net economic costs of dementia in Canada. CMAJ. 1994 Nov 15;151(10):1457–1464. [PMC free article] [PubMed]
  • Gray A, Fenn P. Alzheimer's disease: the burden of the illness in England. Health Trends. 1993;25(1):31–37. [PubMed]
  • Hu TW, Huang LF, Cartwright WS. Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist. 1986 Apr;26(2):158–163. [PubMed]
  • Brodaty H, Gresham M. Effect of a training programme to reduce stress in carers of patients with dementia. BMJ. 1989 Dec 2;299(6712):1375–1379. [PMC free article] [PubMed]
  • Baumgarten M. The health of persons giving care to the demented elderly: a critical review of the literature. J Clin Epidemiol. 1989;42(12):1137–1148. [PubMed]
  • Clipp EC, George LK. Psychotropic drug use among caregivers of patients with dementia. J Am Geriatr Soc. 1990 Mar;38(3):227–235. [PubMed]
  • Jones DA, Peters TJ. Caring for elderly dependents: effects on the carers' quality of life. Age Ageing. 1992 Nov;21(6):421–428. [PubMed]
  • Jackson LD. The role of medications in treating the behavioural disturbances of dementia sufferers. Perspectives. 1995 Fall;19(3):9–22. [PubMed]
  • Rogers SL, Friedhoff LT. The efficacy and safety of donepezil in patients with Alzheimer's disease: results of a US Multicentre, Randomized, Double-Blind, Placebo-Controlled Trial. The Donepezil Study Group. Dementia. 1996 Nov-Dec;7(6):293–303. [PubMed]
  • Iliffe S, Mitchley S, Gould M, Haines A. Evaluation of the use of brief screening instruments for dementia, depression and problem drinking among elderly people in general practice. Br J Gen Pract. 1994 Nov;44(388):503–507. [PMC free article] [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]
  • Mulligan R, Mackinnon A, Jorm AF, Giannakopoulos P, Michel JP. A comparison of alternative methods of screening for dementia in clinical settings. Arch Neurol. 1996 Jun;53(6):532–536. [PubMed]
  • Lubeck DP, Mazonson PD, Bowe T. Potential effect of tacrine on expenditures for Alzheimer's disease. Med Interface. 1994 Oct;7(10):130–138. [PubMed]

Articles from Quality in Health Care : QHC are provided here courtesy of BMJ Group

Formats:

Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    NCBI Bookshelf books that cite the current articles.
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...