ObjectivesIn this paper we provide revised estimates of the prevalence of dementia in Ireland, the number of new cases per year and the severity mix. These estimates are a necessary input for any assessment of the potential demand for services and supports for people with dementia across all care settings in Ireland.MethodsThe prevalence, incidence and severity stage of dementia are calculated by applying rates from prominent international studies to population data from the 2016 census.ResultsWe show that the total number of people with dementia in Ireland ranges between 39 272 and 55 266, depending on the international rates used to measure prevalence. The incidence of dementia in Ireland has increased as the population has aged, to at least 7752 new cases per year. We estimate that there are at least 11 175 people living at home in the community in Ireland with dementia who have a serious functional impairment, based on an Activities of Daily Living measurement, of which an estimated 1876 are chair or bedbound.ConclusionsWithout a national prevalence study it is not possible to be precise about the estimates of the number of people with dementia in Ireland. However, having credible upper and lower bound estimates for the number of people with dementia, the potential number of new cases per year and severity rates is useful for planners and those charged with the responsibility of making resource allocation decisions in dementia.
Background Day care is an important service for many people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia-specific day care centres as well as generic day care centres that cater for people with dementia to various degrees. In this paper we examine the geographic distribution of day care services for people with dementia relative to potential need. Methods Using a national survey of day care centres, we estimate the current availability of day care services for people with dementia in the country. We use geographic information systems (GIS) to map day care provision at regional and sub-regional levels and compare this to the estimated number of people with dementia in local areas. Results There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia in the community varies from 14.2 to 21.3 across Community Health Organisation areas. We also show that 18% of people with dementia do not live within 15kms of their nearest day care centre. Conclusion Currently, day care centres, in many parts of the country, have limited capacity to provide a service for people with dementia who live in their catchment area. As the number of people with dementia increases, investment in day care centres should be targeted to areas where need is greatest. Our GIS approach provides valuable evidence that can help inform decisions on future resource allocation and service provision in relation to day care.
Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: The study employed a balance of care approach to assess resource allocation across six dementia case types, ranging from low to high needs. Decision-making workshops were held with 24 HSCPs from a range of backgrounds. Participants were asked to allocate services and supports across dementia case types in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants used ‘decision rules’ or heuristics to help them make decisions under fixed budget rules. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.
Case types were developed using the approach adopted by (Challis et al., 2014). As is the case in many jurisdictions, there is no single data set available in Ireland with all the required variables to generate case types, so data from several sources were combined. The case types were developed mainly from an Irish data set of anonymised home care assessments of 277 people with dementia in an urban area (O'Brien et al., 2017). Four variables were used to generate the initial dementia case types: dependency measured by the Barthel Index, falls risk, living alone, communication difficulty (See Table 1). A set of dementia case types with all the possible combinations of the four variables was firstly generated, resulting in 24 case types. A sub-set of six case types, comprising 46 per cent of the dementia case types in the dataset was then selected for the study. The level of cognitive impairment for the case types was derived using a dataset of anonymised InterRai assessments (HSE, 2017) for 453 inpatients over 65 some of whom had been diagnosed with dementia. Further discriminating variables were sourced from the literature, specifically Behavioural and Psychological Symptoms of Dementia (BPSD) and Comorbidities. In previous balance of care studies, the attitudes to care mainly focused on attitudes to nursing home care (Tucker et al., 2016). However, in this study as the research question is more focused on the continuum of care, attitudes to care cover preferences in relation to spending, privacy, day-care attendance, carer preferences and attitudes to nursing home care. Unit CostsUnit costs for these services were calculated based on Irish Health Service Executive staff pay scales and the Irish literature on unit costs (O'Shea & Monaghan 2016). The full service cost, including voluntary, public and private funding, was used irrespective of the funding source, so that service prioritisation could be compared on a like for like basis. The full cost of a Psychiatry of Old Age referral and a carer education programme were included in the budget allocation for the hypothetical month, although in practice this cost may be spread over a longer period.
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