Where next for the dementia and
prevention agenda?
Monday 14th July 2014
This event is kindly supported by Alzheimer’s Res...
Welcome
Rebecca Wood
Chief Executive
Alzheimer’s Research UK
This event is kindly supported by Alzheimer’s Research UK and...
Sally-Marie Bamford, Director of Research and
Strategy, ILC-UK
Kieran Brett, Director, Improving Care
Phil Hope, Director,...
Preventing Dementia:
How can we do more to prevent
dementia, save lives and reduce
costs?
A Provocation by
Improving Care ...
ILC-UK Planning Tomorrow, Today
• Westminster based think tank
• Evidence based research organisation
• Focussed on policy...
The Climate and Context
Steps in the right direction:
• The World Health Organization (WHO) and Alzheimer’s
Disease Intern...
Making the political case
for dementia prevention
Ageing population and funding constraints mean we
need to innovate to ge...
The Authors
Improving Care
– Kieran Brett, Co-Director, Trustee at DEMOS, former
Special Adviser to the Prime Minister and...
The presentation
Section 1: The human and financial costs of dementia
Section 2: Risk factors for dementia
Section 3: Inte...
Numbers of people with dementia – ‘Policy Off’
10
Number of years of life lost to dementia – ‘Policy Off’
11
The annual cost to the state
of dementia in 2013 was £10.54bn
12
Cumulative cost to the state and to
individuals of dementia 2013 -2040
Year Cost to State Costs to
Individual
Total Costs
...
Relative risk of developing dementia
• Relative risk indicates how much of an
increased chance of developing dementia a
pe...
The top six relative risk factors for
dementia
15
Reducing risk factors
• Reducing the number of people with a given risk factor
should lead to a reduction in the number of...
The Levin Formula
From this calculation, we can say:
Projected proportion of people developing dementia due to diabetes is...
Projections of the impact of reducing a risk factor on
life years saved and costs reduced
The expected impact on dementia ...
Potential savings to the state of reducing diabetes in
the population by 10%
19
Effective interventions for
reducing risk factors
• For each risk factor we have identified what
appears to be the most ef...
Impact on dementia of intervention to
reduce diabetes
21
Savings from reducing diabetes as a risk
factor for dementia
22
Summary of impact of interventions for each risk factor
23
Summary of savings for each risk factor
Note of caution: these savings do not take account of the cost of the
intervention...
Cumulative savings to the state - £42.9bn
25
Total savings 2013-2040
Where savings accrue Amount 2013-2040
The state £42.9bn
Individual self-funders £16.4bn
Informal c...
Rebecca Wood
Chief Executive
Alzheimer’s Research UK
This event is kindly supported by Alzheimer’s Research UK and Improvi...
A blueprint to
defeat dementia
Blackfriars Consensus on promoting brain
health: Reducing the risks of dementia in
the population
Dementia is a common syn...
G8 Dementia Summit, December 2013
The G8 countries announced:
• Identify a cure or a disease-modifying therapy for dementi...
DEFEAT DEMENTIA: £100M, 5 YEARS
Prevention / risk reduction
• We will introduce a new Prevention Fund by challenging the scientific
community to answer th...
Dr Charles Alessi
Lead Dementia
Public Health England
This event is kindly supported by Alzheimer’s Research UK and Improv...
Dementia risk reduction: update
on developing PHE work
programme
Charles Alessi
Why is dementia a public health
priority?
37
Why is dementia a public health priority?
• 21 million of the UK population have a
close friend or family member with
d...
DEMENTIA
Ref: Global Burden of Disease Study
• Dementia is the leading cause of mortality.
• It’s the 3rd biggest cause of...
Can we reduce the risk of
dementia?
Action on dementia risk reduction is vital
• In the absence of a cure, risk reduction is the only way we can reduce the
nu...
41
Action on dementia risk reduction is evidence based
• PHE and the UK Health Forum have
published the Blackfriars Consen...
• Autopsy evidence suggests that Cerebrovascular disease contributes to
neurodegenerative disease cases.
42
Action on deme...
What can PHE contribute?
BigAmbitions
• PHE wants to maximise our impact
through focusing on a small number of
Big Ambitions for the public’s healt...
PHE is planning action to promote dementia risk reduction
We want to work with system partners to change the game on demen...
PHE Dementia work programme
Issues Action
Risk
Reduction
Lifestyle action can reduce risk –
poorly understood locally.
• C...
Shirley Cramer
CEO
Royal Society for Public Health
This event is kindly supported by Alzheimer’s Research UK and Improving...
Johan Vos
Deputy Director
Alzheimer’s Disease International
This event is kindly supported by Alzheimer’s Research UK and ...
About Alzheimer’s
Disease International (ADI)
• Established 1984
• The umbrella
organisation of
Alzheimer associations
aro...
World Alzheimer’s Month
• September is
World Alzheimer’s
Month
• 21 September is
World Alzheimer’s
Day
• International
cam...
5 ways to help reduce risk
www.alz.co.uk/world-alzheimers-month
5 ways to help reduce risk
www.alz.co.uk/world-alzheimers-month
World Alzheimer Report
Sept 2014
www.alz.co.uk/research/world-report
• Modifiable Risk and
Protective Factors
• Global Obs...
• New WHO ADI factsheet
launched July 2014
• Reveals smoking can
increase dementia risk
by 45%
• 14% of dementia cases
aro...
NCD Alliance
www.ncdalliance.org/
• ADI joins NCD Alliance
in May 2014
• Dementia shares
common risk factors to
NCD’s
• St...
Estimated increase in dementia worldwide
Follow ADI on Twitter
https://twitter.com/alzdisint
Like us on Facebook
https://www.facebook.com/alzheimersdi
seaseinterna...
Panel Debate and Q&A
• Do we now have a sufficient evidence base on dementia risk
reduction to justify action in this fiel...
Where next for the dementia and
prevention agenda?
Monday 14th July 2014
This event is kindly supported by Alzheimer’s Res...
14Jul2014 - Dementia and Prevention
14Jul2014 - Dementia and Prevention
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14Jul2014 - Dementia and Prevention

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We invited experts from the field of public health and dementia to discuss the growing interest in dementia risk reduction and the implications of a new paper launched at the event entitled 'Preventing dementia: a provocation. How can we do more to prevent dementia, save lives and reduce avoidable costs?'

Building on the momentum of the Blackfriars Consensus from Public Health England and the UK Health Forum on “promoting brain health and reducing risks for dementia in the population”, we are keen to stimulate debate and discussion about how we could tackle dementia risk factors at scale and the potential economic, health and societal benefits of dementia risk reduction.

The provocation to be launched on the day posits that we can have a significant impact on reducing the number of people who will develop dementia. The paper identifies a number of risk factors for dementia that are amenable to intervention and have modelled the impact of matching the best-practice interventions on reducing the six main risk factors from global case studies. It is estimated that over the 27-year period from 2013-2040 this could prevent nearly 3 million people developing dementia in the UK. This would reduce the costs to the state in the UK by £42.9 billion (calculated from 2013 and 2040, minus any associated costs of intervention).

We see this paper as a provocation and a starting point for more detailed and rigorous research in this field, and are keen to hear views on further research gaps in this area and other research and policy analysis being carried out.

Speakers included Rebecca Wood (Alzheimer's Research UK), Sally-Marie Bamford (ILC-UK), Phil Hope (Improving Care), Keiran Brett (Improving Care), Shirley Cramer (The Royal Society for Public Health), Dr Charles Alessi (Public Health England), Johan Vos (Alzheimer's Disease International).

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14Jul2014 - Dementia and Prevention

  1. 1. Where next for the dementia and prevention agenda? Monday 14th July 2014 This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  2. 2. Welcome Rebecca Wood Chief Executive Alzheimer’s Research UK This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  3. 3. Sally-Marie Bamford, Director of Research and Strategy, ILC-UK Kieran Brett, Director, Improving Care Phil Hope, Director, Improving Care This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  4. 4. Preventing Dementia: How can we do more to prevent dementia, save lives and reduce costs? A Provocation by Improving Care and the ILC-UK Funded by Pfizer 4
  5. 5. ILC-UK Planning Tomorrow, Today • Westminster based think tank • Evidence based research organisation • Focussed on policy • Independent and non partisan • Experts in ageing, demography and longevity • Produced a range of reports on dementia • Part of the ILC Global Alliance with 14 soon to be 17 centres across the world • Formally affiliated to University College London
  6. 6. The Climate and Context Steps in the right direction: • The World Health Organization (WHO) and Alzheimer’s Disease International show smokers have a 45% higher risk of developing dementia than non-smokers. • Blackfriars Consensus Statement from Public Health England and the UK Health Forum receives high level support from all four nations in the UK. • Global Actions and Initiatives: Australia’s Dementia Prevention Strategy 6
  7. 7. Making the political case for dementia prevention Ageing population and funding constraints mean we need to innovate to get better outcomes at lower cost Dementia is a very high political priority but preventing dementia has not been the focus Need to convince No.10 and HMT of the case for investment in prevention Interventions, health benefits and savings claimed for preventing dementia have to be rigorous 7
  8. 8. The Authors Improving Care – Kieran Brett, Co-Director, Trustee at DEMOS, former Special Adviser to the Prime Minister and Secretary of State of Health – Phil Hope, Co-Director, Adjunct Professor Imperial College, former Secretary of State for Care Services, – Steve Beales, Policy Fellow in Health Infomatics, Imperial College International Longevity Centre – Sally-Marie Bamford, Director of Research and Strategy 8
  9. 9. The presentation Section 1: The human and financial costs of dementia Section 2: Risk factors for dementia Section 3: Interventions that reduce risk factors for dementia Section 4: The human and financial benefits of applying interventions to reduce the risk factors for dementia Section 5: Next steps: • Comments on the analysis • Strengthening the case: – identifying best practice interventions for the risk factors – Identifying additional risk factors for dementia • How to to take this argument forward 9
  10. 10. Numbers of people with dementia – ‘Policy Off’ 10
  11. 11. Number of years of life lost to dementia – ‘Policy Off’ 11
  12. 12. The annual cost to the state of dementia in 2013 was £10.54bn 12
  13. 13. Cumulative cost to the state and to individuals of dementia 2013 -2040 Year Cost to State Costs to Individual Total Costs 2013 £10.54bn £4.03bn £14.57bn 2040 £18.31bn £7.15bn £25.46 2013-2040 £392bn £151bn £543bn 13
  14. 14. Relative risk of developing dementia • Relative risk indicates how much of an increased chance of developing dementia a person might have for a particular condition • For example the relative risk for a person with diabetes is 1.39 – that is, the chance of developing dementia is 1.39 times greater for those with diabetes than when compared to someone with out diabetes, all other things being equal 14
  15. 15. The top six relative risk factors for dementia 15
  16. 16. Reducing risk factors • Reducing the number of people with a given risk factor should lead to a reduction in the number of people developing dementia. • To work out the proportion of people developing dementia due to a risk factor we use the relative risk factor and the prevalence of the risk factor within the target population. For example: – Relative risk (RR) of diabetes for dementia is: 1.39 Current prevalence (PRF) of diabetes in the UK is for men 65+: 15-16% and for women 65+:12-13% • We then apply the Levin formula to identify the projected proportion of people developing dementia due to a risk factor 16
  17. 17. The Levin Formula From this calculation, we can say: Projected proportion of people developing dementia due to diabetes is ~5.3% 17
  18. 18. Projections of the impact of reducing a risk factor on life years saved and costs reduced The expected impact on dementia of a 10% reduction in diabetes prevalence Life years are calculated by looking at the difference in life expectancy between people with and without dementia 18
  19. 19. Potential savings to the state of reducing diabetes in the population by 10% 19
  20. 20. Effective interventions for reducing risk factors • For each risk factor we have identified what appears to be the most effective intervention for reducing its prevalence among the population • And we have identified the impact this given reduction would have on the numbers of people developing dementia • For example we have found an intervention that has been shown to reduce type 2 diabetes by 58% 20
  21. 21. Impact on dementia of intervention to reduce diabetes 21
  22. 22. Savings from reducing diabetes as a risk factor for dementia 22
  23. 23. Summary of impact of interventions for each risk factor 23
  24. 24. Summary of savings for each risk factor Note of caution: these savings do not take account of the cost of the interventions 24
  25. 25. Cumulative savings to the state - £42.9bn 25
  26. 26. Total savings 2013-2040 Where savings accrue Amount 2013-2040 The state £42.9bn Individual self-funders £16.4bn Informal care £28.95bn Total £88.25bn 26
  27. 27. Rebecca Wood Chief Executive Alzheimer’s Research UK This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  28. 28. A blueprint to defeat dementia
  29. 29. Blackfriars Consensus on promoting brain health: Reducing the risks of dementia in the population Dementia is a common syndrome closely associated with ageing, with some known underlying causes and others which are less well understood. Recent evidence suggests that risk in the population might be reduced so that fewer people at particular ages develop dementia. The scientific evidence is evolving rapidly and sufficient to justify considered action and further research on dementia risk reduction, both by reducing the modifiable risk factors and improving the recognised protective factors. HEADLINE CONSENSUS MESSAGE
  30. 30. G8 Dementia Summit, December 2013 The G8 countries announced: • Identify a cure or a disease-modifying therapy for dementia by 2025 and to increase collectively and significantly the amount of funding for dementia research to reach that goal. • Appoint a global Dementia Innovation Envoy UK Global action against dementia legacy event, June 2014 The UK-led event focused on the execution timeline and plan towards a Global Dementia Innovation Fund to: • stimulate greater social impact investment and innovation in dementia research • improve the prevention and treatment of dementia • improve quality of life for people with dementia and their carers
  31. 31. DEFEAT DEMENTIA: £100M, 5 YEARS
  32. 32. Prevention / risk reduction • We will introduce a new Prevention Fund by challenging the scientific community to answer the biggest questions in prevention, seed-funding the best ideas. • We will seek to understand why there has not been greater investment in prevention research • We will work in partnership to raise awareness of the ways in which you can reduce the risk of developing dementia, particularly Alzheimer’s disease and vascular dementia • Pursue recommendations in Blackfriars Consensus • Ensure the messaging does not lead to further stigma of the condition
  33. 33. Dr Charles Alessi Lead Dementia Public Health England This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  34. 34. Dementia risk reduction: update on developing PHE work programme Charles Alessi
  35. 35. Why is dementia a public health priority?
  36. 36. 37 Why is dementia a public health priority? • 21 million of the UK population have a close friend or family member with dementia. • Two thirds of people with dementia are women, and a higher number of carers are female • As well as the huge personal cost, dementia currently costs the UK economy £19 billion a year, more than cancer and heart disease combined. • The social and economic costs will keep rising as the number of people with dementia increases.
  37. 37. DEMENTIA Ref: Global Burden of Disease Study • Dementia is the leading cause of mortality. • It’s the 3rd biggest cause of over 70s disabilities, after lower back pain and falls. • 25% of hospital beds are occupied by people with dementia. • Low diagnosis rate (48%) and levels of support • There are significant health inequalities issues, with challenging cultural norms, both around the condition and with carers. Why is dementia a public health priority?
  38. 38. Can we reduce the risk of dementia?
  39. 39. Action on dementia risk reduction is vital • In the absence of a cure, risk reduction is the only way we can reduce the numbers of people getting dementia, postpone the onset and/or mitigate the impact of dementia. • Worldwide, risk reduction is increasingly becoming a key focus of those involved in dementia care. The Global Dementia Legacy Event in Japan, later this year, will focus on risk reduction, and it is included in the World Dementia Council statement of purpose. • Dennis Gillings, the World Dementia Envoy said (on 19th June 2014) “I am particularly keen for there to be a greater focus on prevention – in terms of minimising risk factors such as obesity, smoking, physical inactivity, diabetes and high blood pressure. There is growing evidence that these risk factors may be bringing forward the onset of dementia.” • Risk reduction and slowing the development of symptoms is more cost effective, and far better for individual wellbeing. 40
  40. 40. 41 Action on dementia risk reduction is evidence based • PHE and the UK Health Forum have published the Blackfriars Consensus statement, signed by 60 leading figures and organisations from across the dementia and public health community. • It stated that “the scientific evidence is sufficient to justify action on dementia prevention and risk reduction”. • Evidence suggests that effective public health policies to tackle the major chronic disease risk factors of smoking, physical inactivity, alcohol and poor diet across the population will help reduce the risk of dementia in later life.
  41. 41. • Autopsy evidence suggests that Cerebrovascular disease contributes to neurodegenerative disease cases. 42 Action on dementia risk reduction is evidence based Toledo JB, Arnold SE, et al. Brain 2013;135:2697-2706 Prevalence of Vascular Pathology (%) Vascular findings reaching or not a threshold sufficient enough to contribute to clinical status
  42. 42. What can PHE contribute?
  43. 43. BigAmbitions • PHE wants to maximise our impact through focusing on a small number of Big Ambitions for the public’s health for the next three, five and 10 years. • Dementia is one of PHE’s “Big Ambitions”, and we are in the process of developing and testing proposals. • We are exploring whether we might have an ambition around significantly reducing the numbers of people who get dementia, potentially linked to retirement age, with actions focused on 40 – 60 age group. • There will be more detail in PHE’s Health And Wellbeing Framework. 44
  44. 44. PHE is planning action to promote dementia risk reduction We want to work with system partners to change the game on dementia risk reduction. We are already planning action in five key areas: • System leadership: raise awareness and promote and coordinate work • Public awareness: develop world-class health marketing to raise awareness and enable action • Professional understanding: incorporate messages in training and curricula • Health improvement programmes: integrate dementia risk reduction, and building on the inclusion of dementia in the NHS Healthchecks programme from April 2013.. • Risk tool: develop a ground- breaking “rate of brain ageing tool” with UCL Partners, to support self-assessment, early diagnosis and preventative action. 45
  45. 45. PHE Dementia work programme Issues Action Risk Reduction Lifestyle action can reduce risk – poorly understood locally. • Clarify and articulate evidence • Test public-facing messages • Align with overall risk reduction work e.g. NHS Health Checks • Developing a “brain ageing” risk tool Living well People with dementia and carers often marginalised and poorly supported • Dementia Friends Campaign • Dementia friendly communities – support local action • Dementia friendly employers – drive best practice in HR • Align crosscutting issues eg carers, end of life, isolation Equity Significant cultural determinants. Little analysis of issues and best practice. • New national collaboration: best practice, analysis, and research K&I Fragmented data and intelligence • Dementia intelligence network 46
  46. 46. Shirley Cramer CEO Royal Society for Public Health This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  47. 47. Johan Vos Deputy Director Alzheimer’s Disease International This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION
  48. 48. About Alzheimer’s Disease International (ADI) • Established 1984 • The umbrella organisation of Alzheimer associations around the world • 84 member associations Aims to help establish and strengthen Alzheimer associations throughout the world, and to raise global awareness about Alzheimer's disease and all other causes of dementia
  49. 49. World Alzheimer’s Month • September is World Alzheimer’s Month • 21 September is World Alzheimer’s Day • International campaign to raise awareness globally • 2014 theme: Dementia: Can we reduce the risk? www.alz.co.uk/world-alzheimers-month
  50. 50. 5 ways to help reduce risk www.alz.co.uk/world-alzheimers-month
  51. 51. 5 ways to help reduce risk www.alz.co.uk/world-alzheimers-month
  52. 52. World Alzheimer Report Sept 2014 www.alz.co.uk/research/world-report • Modifiable Risk and Protective Factors • Global Observatory for Aging and Dementia Care, Kings College • Comprehensive systematic review with some new meta analysis • International Launch 17 Sept 2014 in London • Supported by Bupa
  53. 53. • New WHO ADI factsheet launched July 2014 • Reveals smoking can increase dementia risk by 45% • 14% of dementia cases around the world potentially attributed to tobacco • Urges governments to implement tobacco control measures and cessation services Smoking and dementia www.who.int/tobacco
  54. 54. NCD Alliance www.ncdalliance.org/ • ADI joins NCD Alliance in May 2014 • Dementia shares common risk factors to NCD’s • Strongest civil society voice at the UN and WHO The NCD Alliance was founded by four international NGO federations representing four main NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease. The NCD Alliance unites a network of over 2,000 civil society organizations in more than 170 countries. The mission of the NCD Alliance is to combat the NCD epidemic by putting health at the centre of all policies.
  55. 55. Estimated increase in dementia worldwide
  56. 56. Follow ADI on Twitter https://twitter.com/alzdisint Like us on Facebook https://www.facebook.com/alzheimersdi seaseinternational Visit our website http://www.alz.co.uk/ Thank you!
  57. 57. Panel Debate and Q&A • Do we now have a sufficient evidence base on dementia risk reduction to justify action in this field? • How can we incorporate dementia risk reduction into general health policies and what may be the implications of raising awareness of dementia prevention for the general public? • With such high level endorsement (including last week Rt Hon Jeremy Hunt MP, Secretary of State for Health, England, Norman Lamb MP, Minister of State for Care and Support) signing up to the Blackfriars Consensus, where do we go next and how can we work together to push this agenda further?
  58. 58. Where next for the dementia and prevention agenda? Monday 14th July 2014 This event is kindly supported by Alzheimer’s Research UK and Improving Care #DEMENTIAandPREVENTION

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