Challenges in advanced dementia

This chapter presents the significant challenges in practice health professionals face in providing care to people with advanced dementia. These challenges constitute all facets of care giving inclusive of physical, psychological and spiritual care. Worldwide advanced dementia is an increasingly burdensome health issue. People with advanced dementia have substantial care needs at the end of their life. The Alzheimer's Disease International report (2010) stated there were 35.6 million people living with dementia. The report estimates the number of people living with dementia worldwide will increase to 65.7 million by 2030 and 115.4 million by 2050. Further the majority of people will live in low and middle income countries. In 2010, the financial burden of dementia was costed at US$ 604 billion. The Alzheimer’s Disease International, 2010 report predicts that “these costs account for around 1% of the world’s gross domestic product, varying from 0.24% in low income countries, to 0.35% in low, middle income countries, 0.50% in high, middle income countries, and 1.24% in high income countries”. A high proportion of people with dementia need some level of care to supplement their cognitive decline. This care can range from minimal support of individual activities for example, shopping to a full range of personal care. As the person declines and the disease progresses total supervision necessitating 24hr care across 7 days per week, of all activities of daily living, is required. The Alzheimer’s Disease International, 2010 report states that the cost of informal care (unpaid) provided by families and the direct costs of care by health professionals in residential aged care facilities, equates to being the world’s 18th largest economy. Evidence also suggests that a lack of training, education and support for both health professionals and informal caregivers is still present. Thus the challenges before the community are significant and need to be responded to in a planned, informed and educated manner so that people dying from dementia can be the recipients of quality care at the end of their life.