Where are we now?
There are currently around 900,000 people living with dementia in the UK1 in Cheshire West and Chester this stands at 4,600. With our ageing population profile this number is likely to increase. Latest population data predicts that those aged 65 years and over in Cheshire West and Chester will form 28 percent of our population in 2038, a change from 21 percent in 20182. The number of people aged 85 or above will more than double over the same period, increasing from 9,400 in 2018 to around 19,400 in 20382. Therefore preventing dementia, and providing support for those living with dementia and their carers is an important challenge for both the local authority and local health partners.
There are several actions we can take to prevent and delay the onset of dementia. Key lifestyle issues which we know to have an impact on dementia include smoking, unhealthy weight, unhealthy diet, physical activity, and excessive alcohol consumption:
Smoking is associated with increasing the risk of vascular issues, we know that some dementias are linked to problems with the vascular system. By giving up smoking we can prevent these vascular problems and their link to dementia. Smoking levels have fallen markedly in recent decades and although our smoking rates are lower than the England average, they still remain a cause for concern. Data shows that 11.3 percent of adults in Cheshire West and Chester currently smoke.
A sedentary lifestyle and poor diet can cause issues later in life. We want more people to be more active, to eat well and maintain a healthy weight. Exercise in older people is associated with a slower rate of decline in memory and some thinking skills that occur with ageing. Being overweight and unfit can cause a number of cardiovascular diseases that increase the risk of a person developing dementia. Data for Cheshire West and Chester residents shows that:
- Around half of Chester West and Chester’s adults do not eat the recommended amount of fruit and vegetables (5 a day) daily.
- Currently 60.2 percent of adults within the borough are overweight or living with obesity, this equates to almost 2 in 3 residents over the age of 18.
- 7 percent of adults in Cheshire West and Chester are physically inactive
Excessive alcohol consumption can increase the risk of dementia. Nationally, about 10 percent of cases of young onset dementia (people in their 40s and 50s) that are diagnosed, are related to alcohol. By reducing our alcohol intake and staying within the recommended limits as advised by the NHS, we can challenge this statistic. Estimates indicate that a higher percentage of residents in Cheshire West and Chester aged 16 and over drink alcohol compared to the England average.
Improving mental and social activity can also help to reduce dementia risk by improving mood, relieving stress, reducing the risk of social isolation, depression and loneliness. Keeping the brain active and challenged by learning new skills, joining clubs, connecting with others, and protecting your mental health can all play a part in preventing the onset of dementia. Current data shows that the prevalence of depression in those 18 years old and over is around 13.5 percent in the borough.
Early diagnosis of dementia is important in improving quality of life. We want more people across the borough diagnosed earlier, and less people diagnosed at a time of crisis. By receiving an earlier diagnosis and appropriate support we want to reduce the chance of such a crisis occurring. We recognise that some people do not want to know whether they have dementia, this may be as a result of fear and perhaps, for some, the perceived stigma associated with the diagnosis.
We recognise that services may need to be redesigned, so that people living with dementia are diagnosed in a timely manner. Ensuring that they, and their carers, receive the right care and support, enabling them to live as well as possible with dementia. The drive to improve the diagnostic rate must not be an end in itself, improving the support available to people once they have been given the diagnosis is equally as important.
The Dementia Diagnosis Rate (DDR) in Cheshire West and Chester is below the national target of 66.7 percent and has been for some years . Prior to COVID-19, the rate was slowly improving, with a rate of 65.1 percent in 2020. During COVID-19, presentations and referrals for memory assessments dropped acros the country. In 2021, the rate in Cheshire West and Chester had dropped to 58.9 percent from 65.1 percent in 2020. In 2022, the rate is slowly increasing again, standing at 60.5 percent in March 2022.
We know that more work needs to be done to increase our local rate. We will therefore work to raise the profile of dementia and the support that is available across the borough, to encourage more people to seek help.
We recognise that dementia does not only affect older people; we will ensure a specific focus is given to younger people living with dementia, in order that we might better understand their needs and how these can best be met.
In Cheshire West and Chester we want to support and encourage those who live with dementia to remain as independent as possible, for as long as possible. Continuing to enjoy their usual activities in environments that are well designed and supportive of their needs. We want them to maintain their employment (those that are working at the time of diagnosis) and encourage our communities and workplaces to work together to help people to stay healthier for longer.
Across the borough we are striving to meet the Prime Minister's Challenge on Dementia which was launched in 2012. It focuses on developing communities where people are aware of and understand more about dementia and enable those living with dementia to have a sense of belonging and feeling a valued part of family, community, and everyday life.
Locally, we understand the importance of listening to people living with dementia, their families and carers, to inform and enable changes across all our services to raise awareness, challenge stigma and to inspire and enable dementia inclusive communities.
Our mental and physical health are important whether we are living with a health condition or caring for someone with a health condition. Evidence tells us that isolation and depression are common amongst those living with dementia and those caring for someone with dementia. It is therefore vital to ensure we provide the right care and support at the right time and in the right manner to those living with dementia or their carers.
Many people are able to live well with dementia and continue to work following their diagnosis. We believe that following a diagnosis, people who are still in employment should be supported to continue to work and engage in their regular activities for as long as possible. We want people within the borough to have the support to build confidence and resilience and be better able to cope with the condition.
It is important that health professionals, and those delivering dementia prevention and intervention services, are aware of the wider issues of minority groups and trained on equality and diversity and that support offered to our residents is equitable and respectful. Some of this may involve understanding language and communication barriers, the reliance on formal care services for support, awareness of the differences in the onset of symptoms, particularly for those with learning difficulties, and overcoming issues of stigma for particular groups.
Dementia also impacts on carers too. We will therefore focus on carers and and how their needs can best be met.
Following a diagnosis of dementia, putting legal, financial and end of life plans in place is one of the most important steps to take. Advance Care Planning forms part of the assessment and care planning process, supporting people living with dementia to think about, plan for and make choices about their wishes and preferences for their future care including decisions about end of life. One of the national drivers for end of life care is to support more people to die in their usual place of residence. Creating a plan for the future in the early stage of the disease can be empowering, allowing the person living with dementia to participate in making decisions that help family and friends know their wishes.
We want to raise the standards of care for people with dementia reaching the end of life, and ensure that every person living with dementia, their family and carers, are given the opportunity and support to plan ahead, adopting a person centred approach.
Those living with dementia, their carers and dementia health and care support services, were all impacted by the COVID-19 pandemic. Whether this was in relation to receiving a timely diagnosis, or accessing support for people living with dementia and their carers during lockdowns. Evidence from Carers UK (2020) highlights the loneliness and isolation felt by carers during the pandemic and the negative impact on their mental health
In response to the impact of COVID-19, NHS funding has been received to increase dementia diagnosis rates. This includes providing support to local memory clinics to assess more people who may have dementia.