Is Dementia Just Gradually Slowing Down?
Dementia is associated with growing old and has a devastating impact on individuals’ capacity to self-care. The organization Alzheimer’s Disease International projects there will be more than 75 million people with dementia worldwide by 2030.
Today in the UK about 850,000 people are living with dementia, costing an estimated £26 billion a year according to figures from Alzheimer’s UK. The government expects the number of sufferers to rise to one million over the next five years in a development it has dubbed “a national crisis”.
Certainly, the number of individuals aged over 65 years is growing, while the number of people of working age continues to decline. A financial catastrophe is feared, with dementia cast as a demographic booby trap set to catch policymakers out as the cost of caring for the elderly cannot be supported by the people actively at work.
But despite such apocalyptic rhetoric there are those who question the basis on which a doomsday scenario is based.
One basis is the “dependency ratio”, a measure of dependent people as a percentage of the economically active. It is an important economic measure and a useful indicator when considering population ageing. As the number of working age adults to dependent people declines, the ratio rises.
In the EU-28 countries the ratio is expected to rise from 27.48 in 2013 to 39.01 by 2030. By 2060, it is expected to hit 50.16, meaning there will be just two people of working age to support each pensioner. Although the numbers and trend look alarming, the measure has a drawback in that it doesn’t take account of all people who are literally “dependent”.
In reality, many people aged 16 to 65 who don’t work are dependent. This group includes parents on career breaks, students, long-term sick and unemployed people, plus those who retired early. Any of these people might return to work before age 65.
The dependency ratio is also open to the influence of part-time working, falling numbers of teenagers and rising female participation in work. This calls in to question the accuracy of basing forecasts of future care needs solely on this measure.
Perhaps the relationship between remaining life expectancy and morbidity is a more revealing predictor of the future care burden? If these parameters are used, then old age dependency has actually fallen over recent decades and is likely to stabilise at current levels for the foreseeable future.
For further insight we must consider dementia prevalence (the proportion of people of a given age who have it at a point in time), and incidence (the number of new cases over a set period). There is cautious optimism about declining trends in dementia prevalence coupled with incidence shifting to higher ages. Despite the projected doubling every 20 years of the number of people living with dementia, the potential economic burden, at least in developed countries, may have been over-stated.
People are indeed living longer but they are also living longer in better health. Improved treatment of vascular risk factors is the most obvious cause but improvements in general health and education also play a part.
As life expectancy continues to rise, the typical onset of age-related health problems is delayed. The effect is that disabling morbidity - caused perhaps by dementia - when it finally comes arrives only very late in life and lasts for a relatively short period.
However, though the prevalence rate may fall as the population continues to age, the absolute number of cases will not and a real need for financial support to cover these costs across the community remains.
Indeed, an expectation of an emerging new insurance market underpins the UK government’s decision to limit what people pay for care from April 2016. Under the new rules, the state will pick up what are termed “catastrophic costs” beyond a capped amount, but individuals must fund their food and lodgings throughout.
It is hoped new and innovative insurance products will emerge to meet the inevitable shortfall in long term care funding, driven largely by the ageing population and the steps taken by the UK government to cap care costs in the future.
See my recent blog Demystifying Dementia for more on the biological aspects of the condition.