The world’s population is rapidly ageing and the number of people suffering from non-communicable diseases (NCDs), and dementia in particular, is increasing thus producing an ever more stress on public budgets and policies.

Despite good intentions and the financing of programmes such as Horizon 2020 and the “Third Health Programme”, Europe (28) has not yet implemented a common “European Dementia Strategy”. Each member states still have great discretion for the design of policies and strategies thus causing relevant discrepancies in the way the disease is addressed, sometimes even among regions in the same Country. A major effort and political will is needed from EU institutions to properly tackle dementia and provide a common European plan to address a disease that does not just reduce people quality of life but represents a relevant economic burden for member states

By Pietro Dionisio

EU Health Project Manager at Medea SRL, Florence, Italy

Degree in Political Science, International Relations Cesare Alfieri School, University of Florence, Italy

Dementia in Elderly People: an European Priority Non Ruled by a Communitarian Strategy

The world’s population is rapidly ageing. Between 2019 and 2050, the proportion of the world’s older adults is estimated to almost double from about 12% to 22%, from 900 million to 2 billion people over the age of 60. Older people face special physical and mental health challenges which need to be recognized.

Over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among people over 60 years is attributed to mental and neurological disorders. These disorders in older people account for 17.4% of Years Lived with Disability (YLDs). The most common mental and neurological disorders in this age group are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively.

Concerning Europe, ageing and mental cognitive decline, while causing dependency and disability for people, also represent massive economic burdens for countries’ economies. At this regard, it is estimated that in EU 28 the related costs are around the US$ 300 billion per year. In fact, according to the “Eurostat statistics”, 19.2% of the entire population is composed by elderly people (65 years or over) and the 32.1% of them live alone. In particular, dementia is the leading cause of dependency and disability among elderly people. Nowadays, almost 10 million people are affected and it is foreseen that the prevalence will double by 2030 causing a huge pressure on Countries’ social and healthcare system.

Actually, the World Health Organization Europe (WHO EU) and the EU Commission are looking at policies and strategies capable of improving elderly’s quality of life as well as to promote a better and more efficient allocation of economic resources in order to increase people health outcomes through a better disease’s management while reducing the economic burden that dementia and cognitive decline related diseases represent.

In particular, a key aspect of dementia policy and campaigning work across Europe over the past two decades has been to emphasize that people with dementia have the same human rights and that they should not be treated differently because of their condition.

Additionally, the EU Commission is moving towards the implementation of a “European dementia strategy” even if not yet reached. In fact, since the Glasgow Declaration in 2014, relevant actions have been implemented. Indeed, a thematic priority of the third EU Health Programme (2014-2020) includes a commitment to “support co-operation and networking in the Union in relation to preventing and improving the response to chronic diseases including cancer, age-related diseases and neurodegenerative diseases”. Furthermore, programmes such as the second EU Joint Action on Dementia, the Horizon 2020 programme -through the granting provided for projects such as ACTIVAGE (GA No. 732679) or REMIND (GA No. 734355), the Active Assisted Living programme (AAL) – and the ongoing work in relation to European Pillar on Social Rights (specifically Principle Nine on Work Life Balance) demonstrate that significant work is ongoing to improve the lives of people with dementia, their families and carers.

Unfortunately, an European strategy is not yet applied and each member state is implementing different plans and policies thus producing discrepancies on the way dementia is addressed (sometimes even at regional level).

For instance, such discrepancies have been identified among governments that opted for an open-ended national strategy and those that do not. The Czech Republic, Flanders (Belgium) and Scotland (UK) all have short-term time-limited strategies, of four years (Czech) and three years (Flanders and Scotland); by comparison, Denmark, Finland, Netherlands and Malta all have time-limited eight year strategies. However, about a third of the strategies (eight including one of the neurodegenerative strategies) were open ended, with no date in place for completion.

Nevertheless, there are relevant similarities too. In fact, quite all the member states’ plans emphasize the importance devoted to ensure that people with dementia, their families and carers are involved in the decision-making process relevant to their own care, as well as in the planning and delivery of services and the development of policy thus confirming the importance of keeping and stressing always more the relevance of a “community based approach”.

Moreover, in quite all the EU Countries the majority of commitments and actions are focused on issues relating to the care and support of people with dementia. In all member states significant attention has been provided to the coordination of health, social care and other supports in community settings, as there is the need to ensure that professionals working in these fields are sufficiently qualified and skilled to be able to deliver the highest quality care.

In all the EU Countries implemented policies are particularly aimed at improving the anticipation of dementia emergence in the elderly. Many strategies dealt with the issues of prevention, dementia-friendly communities and public awareness in similar ways; primarily focusing on improving public awareness of the condition both as a means to recognise the disease and its symptoms (thus supporting timely diagnosis). The progress towards healthy habits in order to reduce the tobacco and alcohol abuse as well as to improve healthy diets and healthy behaviors in general is one of the focus of EU Countries policies, together with the reduction of societal stigma associated with the condition.

Noteworthy, the relevance that each Country and the EU Commission are posing on technology is instrumental to improve dementia’s early detection, to increase the patients’ awareness and disease management, to reduce the burden on national budgets as well as to drive local economies while boosting the silver market. In particular, worldwide massive attention is devoted to IoT technologies and their capacities to improve elderly’s quality of life and economic savings.

In conclusion, despite European good intentions and preliminary steps taken in order to implement a “European Dementia strategy”, more efforts have to be devoted by EU institutions in order to reduce the member states discretion and improve the member states policies alignment.

At this regard, main actions could be related to:

Implementation at EU level of the WHO’s “best buy” practice (collection of best-practice policies to tackle key NCD risk factors, featuring measures on price, advertising, labelling, availability and awareness raising),
The refinement of EU financial instruments to support national investment in prevention programmes and measures, and
To improve the pursue of “EU flagship initiatives” in areas that can deliver co-benefits for NCD prevention and other SDGs.