chapter  15
Dementia care in the community: Challenges for primary health and social care
BySteve Iliffe, Jill Manthorpe, Vari Drennan
Pages 11

Dementia is one of the main causes of disability in later life. Although the incidence of dementia in industrialized countries may have reached its peak (Matthews, 2013; Alzheimer’s Disease International [ADI], 2014), its impact remains profound. In terms of the global burden of disease, it contributes 11.2% of all years lived with disability; higher than stroke (9.5%), musculoskeletal disorders (8.9%), heart disease (5%) and cancer (2.4%) (World Health Organization, 2003). Nevertheless, in comparison with other areas of longterm disease management, the care of people with dementia currently constitutes only a small proportion of primary care family doctors’ workload with only three to four new cases a year handled by a doctor in a demographically average population. While family doctors may have few cases, their engagement with those patients and their families is likely to be over a long period, as the median length of time from symptom onset to death is 10 years for those under 65 years old at diagnosis and 4 years for those over 80 years at diagnosis (Xie et al., 2008). Even allowing for delays in diagnosis, median survival from diagnosis is 3.5 years (Rait et al., 2010). As populations rapidly age, this situation will change. Healthcare systems in many countries are anticipating the need to develop new services and recongure existing ones to respond to the increasing prevalence of dementia.