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Ageing and dementia care in Finland - current discussions and challenges
 

Ageing and dementia care in Finland - current discussions and challenges

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Adj. Prof. Ulla Eloniemi-Sulkava in Japanese-Finnish seminar 10.09.13

Adj. Prof. Ulla Eloniemi-Sulkava in Japanese-Finnish seminar 10.09.13

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    Ageing and dementia care in Finland - current discussions and challenges Ageing and dementia care in Finland - current discussions and challenges Presentation Transcript

    • www.helsinki.fi/yliopisto Ageing and dementia in Finland – current discussions and challenges Ulla Eloniemi-Sulkava Adjunct Professor, PhD, RN 10.9.2013 1ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Population aged 75+ years in Finland Age v.2000 v. 2010 v. 2020 v. 2030 v. 2040 75+ 340 409 7 % 411 864 8 % 518 312 10 % 748 144 14 % 826 351 15 % 10.9.2013 2ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Life expectancy in Finland • Male – 75 yrs: 11 yrs – 80 yrs: 8 yrs – 85 yrs: 6 yrs – 90 yrs: 4 yrs – 95 yrs: 3 yrs – 100 yrs: 2 yrs • Female – 75 yrs: 13 yrs – 80 yrs: 11 yrs – 85 yrs: 7 yrs – 90 v: 5 yrs – 95 v: 4 yrs – 100 v: 2.5 yrs 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 3
    • www.helsinki.fi/yliopisto Dementia in different age groups in Finland (%) 0,26 4,20 10,70 35 0 5 10 15 20 25 30 35 30-64v 65-74v 75-84v 85- v 10.9.2013 4ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Prevalence of dementia in a population aged 75+ years and older (Kuopio 75+ Study) Prevalence of dementia 22.7% Alzheimer’s disease (AD) 46.7% Vascular dementia 23.4% Dementia with Lewy bodies + AD 21.9% Other 8.0% 10.9.2013 5ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Number of people with dementia in Finland (2013) • Total 130 000 • Moderate to severe dementia 95 000 • Mild dementia 35 000 • Patients aged 65 years and less 7 000 • Patients aged 80 years and over 60 000 • New cases every year 14 000 10.9.2013 6ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Costs of community and long term institutional care in people with dementia in Finland, million euros (Sulkava 2006) 2005 2010 2015 • Community 893 980 1 105 • Institutional 2 231 2 449 2 760 • All 3 124 3 429 3 865 10.9.2013 7ulla.eloniemi-sulkava@helsinki.fi Year
    • www.helsinki.fi/yliopisto Dementia in Finland • Only one half of people with memory disorders are properly diagnosed and accordingly treated • Three out of four aged people receiving 24-hour care have dementia • 60 % of people with dementia are in community care, 60 % of them living alone (no informal caregiver) • There are increased needs for services with aging population, therefore it is needed – to promote brain health – to prevent memory disorders – to detect memory problems as early as possible – to have an effective and seamless clinical pathway for treatment, rehabilitation and support 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 8
    • www.helsinki.fi/yliopisto10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 9 Even a minor change in the efficacy of treatment or care can significantly decrease costs and improve quality of life of people with dementia.
    • www.helsinki.fi/yliopisto National Memory Programme 2012–2020. Creating a "memory-friendly" Finland Four pilars: 1. Promoting brain health 2. Fostering a more open attitude towards brain health, treatment of dementia disease and rehabilitation 3. Ensuring a good quality of life for people with dementia and their families through timely support, treatment, rehabilitation and services 4. Increasing research and education http://www.stm.fi/c/document_library/get_file?folderId= 6511574&name=DLFE-26234.pdf 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 10
    • www.helsinki.fi/yliopisto10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 11 There is a friction between the service system and caregiving families
    • www.helsinki.fi/yliopisto We studied dementia caregiving families (Raivio et al 2007) • In what terms spouse caregivers do their every day work? • How do spouse caregivers adjust to their situation? • What are the subjective needs of these spouse caregivers from our service system? • How our services meet the needs of dementia caregiving families? 10.9.2013 12ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto • Cross-sectional postal survey to spouse caregivers of people with Alzheimer’s disease (AD) in Finland • A random sample of Alzheimer drug users’ register (N= 1989) Methods HELSINKI TAMPERE LAPLAND NORTH CARELIA MIDDLE FINLAND 10.9.2013 13ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Demographics • 75% returned the questionnaire • 1214 spouses acknowledged themselves as the main caregiver of the spouse with AD • 63% of the caregivers were women • Mean age of caregivers: 78 years • Mean age of spouses with AD: 80 years • Mean years in marriage: 52 years • A third of caregivers had a poor subjective health 10.9.2013 14ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Behavioral and psychological symptoms of spouses with dementia (n=1214) 0 10 20 30 40 50 60 70 80 Need for constant supervision Depressed Agitated Cooperation difficulties Hallucinations Incontinence 10.9.2013 15ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Physical impairments of spouses with dementia (n=1214) 0 10 20 30 40 50 60 70 80 Poor functioning Needs spouse's aid when walking Rigidity Dizziness Muscle weakness Pain 10.9.2013 16ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Adjustment to caregiving situation • Caregiving limits social life 63.5% • Well or quite well adapted to the spouse’s Alzheimer’s disease 92.2% • Satisfied with their marriage 63% 10.9.2013 17ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Psychological well-being of spouses (n=1214) 0 10 20 30 40 50 60 70 80 90 100 Satisfied with life Feeling needed Zest for life Constantly depressed Lonely 10.9.2013 18ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Official services most often offered for AD caregiving families • Financial support to caregiver 36% (”caregiving salary”) • Various aids and devices (e.g. walking aid) 33% • Physiotherapy 32%, of which 86% was rehabilitation to II world war veterans based on law • A respite care in an institutional setting 31% 10.9.2013 19ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Services wished and received by spouse caregivers 0 10 20 30 40 50 60 70 Physiotherapy Society's financial support House cleaning Home respite Wished services Received services 10.9.2013 20ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Satisfaction to the services in the families • Only 39% of the families were satisfied with the services they received. • Only 29% found it was easy to get information about available services. • Only 31% felt they could have any influence on what services they received. 10.9.2013 21ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Key messages • Spouse caregivers of the spouses with AD were old and many in poor health. • People with AD have high rate of behavioral and psychological symptoms and need for continuous help. • Caregivers have adjusted well to their life situation, often satisfied with their marriage and have quite good psychological well-being. • Services meet poorly needs of these families. 10.9.2013 22ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto In complexity of the service system a coordinator is needed to work in cooperation with people with dementia and their families FAMILY PRIMARY - CARE - PHYSICIAN SPECIALIST- DOCTOR DEMENTIA- NURSE HOME CARE - NURSE- NUTRITIONIST- MEALS ON- WHEALS FOOT - CARE DENTIST- PHARMACY PHARMACIST TAXI - SERVICES INVALID PARKING - (POLIS) DEVICES- OCCUPATIONAL THERAPIST - -DIPERS II WORLD WAR- VETERANS’ - REHABILITATION- SERVICES II World war VETARNANS’- SERVICES Third sector services various private services - domestic help - caregiver groups -Alzheimer clubs -doctors, etc - l OFFICIAL ECONOMICAL CAREGIVER SUPPORT SOCIAL - CARE WORKER - RESPITE -CARE - VARIOUS DAYÄ CARE DEMENTIA- COUNCELER PHYSIO- TERAPY - SOCIAL SERVICE OFFICE:-l SUBSTITUTIONS FOR DRUGS, LIVING ARRANGEMENTS, REHABILITATION, - - - - TAX OFFICERS- NURSE - SOCIETAL: LEGAL ISSUES BANK -legal issues - lawyers DOMESTIC SERVICES- - SHOPPING CLEANING - - NURSING HOMES SPEECH THERAPY 10.9.2013 23ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Two randomized controlled trials with the main element of a dementia care coordinator 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 24 Kuopio Dementia Study (Eloniemi- Sulkava et al 2001) Family care as collaboration (Eloniemi- Sulkava et al 2009)
    • www.helsinki.fi/yliopisto Aika, kuukautta 0 2 4 6 8 10 12 14 16 18 20 22 24 Laitostuminen,% 0 5 10 15 20 25 30 35 40 45 50 Kontrolliryhmä Hoitoryhmä During the follow-up time p = 0.27 Time in community care (Eloniemi-Sulkava et al 2009, in line with the survival curve in 2001) At 1.6 yr, 11% of people with dementia in intervention group vs 24% of those in control group were in permanent institutional care (p=0.027)10.9.2013 25ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto Cost of services (Eloniemi-Sulkava et al 2009) • Mean cost of municipal social and health care services/ couple/ year: in intervention group 15 568 € vs control group 23 553 € • Mean savings/couple/ year 7 985 euros in municipal social and health care services (p=0.03) • Mean cost of intervention/ couple/ year was 2 923 € 10.9.2013 26ulla.eloniemi-sulkava@helsinki.fi
    • www.helsinki.fi/yliopisto 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 27 The panel of experts: Finnish recommendations for best practices in the treatment of progressive memory disorders (Suhonen J, Alhainen K, Eloniemi-Sulkava U et al, 2008)
    • www.helsinki.fi/yliopisto Main points of the recommendation • Prevention of dementia • Early diagnoses • Good medical care including AT medication • Diagnostics, effective treatment, family support and guidance by memory clinics • Comprehensive assessment and care planning • Continuous chain of care and services throughout disease process • Support of community care is arranged by dementia care coordinator 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 28
    • www.helsinki.fi/yliopisto Guidelines for medical treatment • Current Care Guideline for Memory Disorders (The Finnish Medical Society Duodecim 2010) 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 29
    • www.helsinki.fi/yliopisto10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 30 Guidelines for the competences of multiprofessional team (Eloniemi-Sulkava et al 2010)
    • www.helsinki.fi/yliopisto10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 31 Increasing interests in: • a person with dementia as a human being • interaction and communication issues •Environmental issues • quality of life and wellbeing issues • effective psychosocial interventions
    • www.helsinki.fi/yliopisto • Disease-orientated approach: – behavioural and psychological symptoms of dementia (BPSD) – behavioural problems – neuropsychiatric symptoms • Nurse-orientated approach: – challenging behaviour • Person-orientated approach: – Unmet needs behaviour – Need-Driven Dementia-Compromised Behaviours 10.9.2013 32ulla.eloniemi-sulkava@helsinki.fi Behavioral symptoms or needs of a person with memory disorder?
    • www.helsinki.fi/yliopisto Recent Finnish RCT’s with positive results • Supporting staff towards person-centeredness, and to identify and meet unmet needs of people with dementia decreased challenging behaviours and increased quality of life in people living in long term care settings. (Eloniemi-Sulkava and Savikko 2011) • Tailored nutrition guidance and care has beneficial effects on nutrition and health related quality of life in home-dwelling people with AD. (Suominen et al 2013) • An intensive and long-term exercise program had beneficial effects on the physical functioning of people with AD without increasing the total costs of health and social services or causing any significant adverse effects. (Pitkälä et al 2013) 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 33
    • www.helsinki.fi/yliopisto10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 34 For past 20 years : • We have gained much knowledge. • We have conducted high level RTC’s. •We have national recommendations and guidelines from diagnoses to death. •We even have guidelines to professional competences.
    • www.helsinki.fi/yliopisto10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 35 How to implement evidence based practices in real life? 1. High quality multidisciplinary reseach team 2. Funding We need to study
    • www.helsinki.fi/yliopisto Lights of the day (Päivänvaloja, artist Nanna Susi) 10.9.2013 ulla.eloniemi-sulkava@helsinki.fi 36