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W ith cases of Alzheimer's disease set to rise by 150 per cent over the next 50 years, local authorities cannot afford to put the development of older people's mental health services on the back-burner.

It is estimated that by 2010 there will be about 840,000 people with Alzheimer's in the UK, rising to more than 1.5 million people by 2050. The Alzheimer's Society, which has made the predictions, believes that local authorities need to start planning for the future and investing in resources to cope with the potential explosion in cases in the years to come.


The figures for the UK from the Alzheimer's Society echo those in the US, where a recent study by the Rush Institute for Healthy Aging claims that more than 13 million Americans will have Alzheimer's by the middle of the 21st century.¹

Both the US study, based on census data, and the Alzheimer's Society's calculations, taken from population estimates, put the increase in cases down to a growing and ageing population, with more people living into their eighties and nineties. Both stress the need for solutions to the problem as well as extra resources for older people's mental health.

Jane Bell, deputy chief executive of the Alzheimer's Society, says that it is more than a matter of providing more elderly mentally infirm beds: "Local authorities need to keep their eyes on the issue and be more flexible about how they fund care packages for people who don't necessarily just want to be put in a care home.

"Local authorities need the flexibility to purchase a bit of this and a bit of that - a bit of domiciliary care and a bit of respite care, for example, so that people might be able to live in their own homes. At the moment you can't do that because the budgets don't allow for it."

Earlier this year, the Alzheimer's Research Trust commissioned a report by the London School of Economics and Political Science that looked at the impact that cognitive impairment, of which Alzheimer's is the most common cause, could have on future long-term care costs in England.²

The report estimated that the costs of providing long-term care to older people with cognitive impairment would more than double in real terms by 2031, from around £4.6bn to nearly £11bn. It also highlighted the fact that Alzheimer's research was underfunded - only £11 is spent on UK research annually per Alzheimer's patient compared with £289 per cancer patient.

Kathryn Willmington, policy officer for health and social care at Help the Aged, believes that a greater focus on mental health in the National Service Framework for Older People is also required.

"The NSF for mental health stops at the age of 65 and the NSF for older people only has one chapter on mental health. I would like either the NSF for mental health extended to cover those over 65 or a specific one for older people and mental health. At the moment the issue isn't covered in sufficient depth,"says Willmington.

She says that mental health services for older people are probably one of the areas that suffers the most in terms of investment. "If you compare it with mental health services for younger adults it is very underfunded. Local authorities need to start planning how they will meet the needs of these people whose needs are barely being met at the moment."

In Hampshire, the council is embarking on a project to create 500 new nursing home beds by the end of 2005. The council is also looking at its "skills base" after noticing an increase in care managers' case loads, with at least 50 per cent of their cases concerning people with mental health problems such as dementia.

It has also tried to develop innovative practices, such as the Alzheimer's Caf' in the north of the county where patients, carers and social services staff can meet informally in a supportive environment.

Claire Foreman, the county manager for older people, says that the council is committed to developing home care services and agrees with the Alzheimer's Society's assertion that care needs to be flexible and targeted at the individual. "Home is where the biggest capacity is and home is where most people want to be," she adds.

Also, Jane Alston, service manager for older people at Bournemouth Council, also has a series of plans to meet the needs of the increasing number of dementia sufferers, including the creation of a specialist dementia home care team. According to Alston, about 50 per cent of day care users have some form of dementia yet the centres are not specialised, a fact she is keen to turn around.


But Bill McClimont, chairperson of the UK Home Care Association, says that most councils need to lose their rigidity of response when it comes to older people with mental health problems. "There's no reason why you should dislocate the lives of older people by putting them into residential respite care.

"There will come a point when the advanced level of somebody's condition is likely to make a residential situation appropriate but this way you can delay the process. I don't think it is difficult for councils to be flexible with their budgets but there's a great deal of rigidity. There seems to be an automatic response to someone with Alzheimer's.

"Managers are often so pressured that they find it difficult to concentrate on the individual and they aren't given the authority to sort out problems on an individual basis. You can't put a square peg in a round hole and you can't hand an individual over to a residential home and then forget about them."

Age Concern is another supporter of the development of home care services as one solution to an ageing and growing population where one in five over the age of 80 has some sort of dementia, particularly in less severe cases of the disease. Although many older people with Alzheimer's do end up in residential care, especially as the disease progresses, Age Concern stresses the need to maintain community engagement and involvement to prevent further deterioration.

The charity's community care policy officer, Stephen Lowe, suggests replacing a Meals on Wheels-style service with a system of staff actually visiting the homes of people with Alzheimer's and cooking for them so that "the visit is longer and they get more stimulus".

Witham, Braintree and Halstead Care Trust in Essex already runs a volunteer scheme in which members of the community take an older person with a condition such as dementia into their homes for the day. The care trust is also planning to set up a specialist home care team for older people with some members of staff trained in how to deal with mental health difficulties.

Sally Sparrow, director of social care at the care trust, says: "Joint working is absolutely essential. We have tried to make it a seamless service and it's made communication a lot easier. Our aim ultimately is to have a single point of contact and these kind of things will help if the number of cases of Alzheimer's does rise. Lots of people want to stay in their own homes now instead of going into residential care so there is a need for flexibility in services that are offered."

Extra money, resources and new flexible ways of thinking are all essential if local authorities are to have the capacity to cope with a rise in Alzheimer's disease cases.

Jane Bell from the Alzheimer's Society says that it is important for care systems to keep evolving in order to keep up with needs of different generations. "We are talking about people who are in their thirties and forties now who will have very different expectations about what kind of care they might want.

"I know that I might not want residential care - I might want to stay in my home. We need to think about providing different styles of care and better care. We have 40-odd years to sort this out."

¹ The Rush Institute for Healthy Aging, published in the Archives of Neurology, available from www.rush.edu/news/media.html

² Alzheimer's Research Trust, A Biological and Socio-Economic Assessment of the Consequences of an Ageing Population, London School of Economics and Political Science, 2003, available from www.lse.ac.uk/Press/archive/Alzheimer's_Report.htm