Ladies
and Gentleman,
It
is indeed with great pleasure that I open this International Conference on Alzheimer’s
disease: Alternatives to
Hospitalisation and Assistance to Caregivers. I would like to thank the
organising committee for inviting me. This is an opportunity to share our
thoughts on how we can continue to develop services to help people with
Alzheimer and their caregivers.
Over
the last decade, Alzheimer has attained increased public attention in view of
the growing number of people diagnosed with this condition. At long last this
condition is been given the importance it deserves. It seems that finally the
world has come to term that Alzheimer has been ignored and overlooked for too
long.
Worldwide a new case of dementia is diagnosed every four
seconds. Dementia as you know encompasses a
number of clinical conditions. The main cause of dementia is Alzheimer Disease.
And this explains the inter change of the word Alzheimer with dementia. The
likelihood of developing dementia increases with advancing age. In fact it
affects about 1 in 5 persons at the age of 80 years and 1 in 3 at the age of 90
years. In Malta, there are currently over 4,500
people with dementia. This figure is expected to 6,000 over the next ten years.
The societal costs of dementia are enormous. A recent
study published by the prestigious Karolinska Institute in Sweden estimated
that, in 2009, the global cost of dementia was 608 billion US dollars. This sum
is equivalent to 1% of the world’s Gross Domestic Product. In practical terms
this means that if dementia was a country, it would have been the 18th largest
economy in the world and would be invited to the G20 meetings. As the number of
dementia cases increases so does the cost. In fact the cost of dementia is expected to triple in the next twenty five
years.
Alzheimer
is a progressive condition. People diagnosed with this condition slowly and
gradually will lose their cognitive abilities. These patients will eventually
require increasing assistance with their activities of daily living. People
with Alzheimer rely on the support of others. They are usually looked after
either by formal or informal carers. In 2007, Dementia UK, reported that 63.5 %
of people with dementia are cared for in the community.
Our
departing objective should be to ensure the dignity of patients with Alzheimer.
People with Alzheimer should as much as possible be cared in the community
because that is the place they know. It is where they were born, where they
bred their children and lived with their loved ones. I came across a quote from
the famous British Actress Carey Mulligan which in my opinion sums it all and I
quote “Those with Alzheimer are still
people. They are still individuals. They
are still unique. They still have characters.
They still have their stories. And most importantly they still need
interaction with other human beings”
I
sincerely believe that we should keep this in mind when plotting the best way
forward for patients with Alzheimer. And
please let us plot the way forward with them rather than doing it for them. They
still have a voice, they still have a contribution to make and they still have
a right to determine their own future.
Unfortunately
Alzheimer is very often only considered from a medical perspective – thus
considerable emphasis is usually made on the initial assessment, investigation
and diagnosis. However, the story does not end here. Diagnosing the ailment is
only the beginning of a long journey. A treacherous journey characterised by
slow progressive deterioration and often made worse by acute-on-chronic
episodes. For example, people with dementia report increase incidence of
falling, increase traumatic injuries and are more prone to Infections.
Alzheimer
is much more than a physiological problem. In reality Alzheimer impacts not only
on the patient per se, but also on the immediate family who carry most of the burden of
informal care. This is even more critical in small countries like Malta with
very strong and durable family core structures. Research suggest that caregivers and relatives of patients with
dementia face great difficulties and are at a greater risk of developing mental
health problems including depression. It
is therefore the policy of my government to continue to support these
individuals within the community and try to meet their needs through person-centred community services.
Alzheimer
Centres can be very helpful to support people with dementia and their
caregivers. Such Day Centres provide an opportunity not only for day care and
but also to help and support relatives on how to deal with common day to day
situations The Activity Centre at St. Vincent de Paul Residence provides a very
similar role. I have to add that in Malta we have 19 Community Day Centres for
the elderly disseminated across the island with a daily attendance of
approximately 2000 elders. Amongst these are a number of elderly people with Alzheimer
who find respite and support within these day centres.
Home
safety is another growing concern for relatives of people with Alzheimer. Technology
is providing a helping hand and in Malta’s case the Telecare continues to be a
very popular service. Our aim is that together with the service provider we can
introduce other services apart from those already offered by Telecare. This is
because technological devices can nowadays provide for monitoring against gas
leaks, fire and flooding. Technology is also available to assist us in
monitoring wandering patients. GPS devices can facilitate patient tracking if
patients get lost.
People
with Alzheimer in the Community are in need of additional home care
support. Home help should not be limited
to domestic activities like home cleaning, shopping, cooking but it should also
involves assistance with personal activities including bathing and dressing. In
Malta this is done through a number of community services which include Home
Help, Community Nursing, Elderly Community Outreach team, Meals on Wheels,
Handy Man Services and many others. In fact we provide not less than 7500 hours
of Home Help every week to elderly people living in the community. Additionally our nursing community service
through MMDNA carry out 1,500 home visits every day and I can safely say that
most of their clients are elderly persons.
Respite
care is also considered an essential service to help caregivers of people with Alzheimer.
Respite care may take various forms depending on individual needs. Some carers
may need support to take e few days off or to attend for a family gathering.
Sometimes respite care is required to support a caregiver who is unwell or
needs hospitalization.
Caregivers
of people with Alzheimer are usually very stressed and concerned about their
ability to cope indefinitely with such a demanding role. They often ask the
questions, “What will happen if I need to be hospitalised or if I die?” or “Who
will take care of my loved-one?” Caregivers need reassurance that prompt
assessment and support is available in this unfortunate eventuality.
People
in the more advanced stages of Alzheimer may still be cared in the community if
their relatives wish and are able to take care of them at home. Obviously there
will be circumstances where people with Alzheimer need long term care. In Malta
during the last four years government has increased the number of Long Term Beds
for the elderly by nearly 900 beds.
Additionally all new homes of the elderly being built are dementia
friendly.
Malta has not been idle infront of the challenges posed
by Alzeihmer. Doing nothing is not an option and indeed Malta has been amongst
a few countries that have embarked on compilling a dementia strategy aimed at
enhancing the quality of life of individuals with dementia, their carers and
relatives. In May 2009, the Malta Dementia Strategy Group was set up. After a
thourough consultation process a Dementia Strategy has been finalised. This
Dementia Strategy will soon be officially launched. It is a long-term strategy
based on skills, knowledge and hard work involving both professionals and the
community.
Over
these last five years, I have witnessed a dramatic rise in the demand for
services and I am sure that this trend will continue to increase. I hope that
this conference will raise more awareness about the need to develop even more
supportive structures for people with Alzheimer and their caregivers.
Conclusion
In
conclusion may I recall that when the
financial crisis hit the world many were taken by surprise? The world was
not prepared and many countries are still struggling with the devastating
effects of this financial crisis.
Demographic projections of the World population are very telling. The world is getting older and older. Consequently the incidence of Alzheimer will most definitely continue to increase. Alzheimer will probably be the future pandemic. Its effects although different from those of the financial crisis may be as equally devastating. If this pandemic finds us unprepared it is only us to blame. This time round we have been warned.
Demographic projections of the World population are very telling. The world is getting older and older. Consequently the incidence of Alzheimer will most definitely continue to increase. Alzheimer will probably be the future pandemic. Its effects although different from those of the financial crisis may be as equally devastating. If this pandemic finds us unprepared it is only us to blame. This time round we have been warned.
So
being complacent is not an option. We have to act. And we have to act now. So this
is the right conference with the right topic at the right time.
I wish you all a successful conference.
