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Tackling Dementia Using Epidemiology and the Life-Course

last modified Aug 21, 2018 05:16 PM

The case for public health policy engagement – a series of case studies

Professor Carol Brayne CBE is Director of the Cambridge Institute of Public Health (CIPH). Her ground-breaking research on the incidence and prevalence of dementia is shaping national and international policy.

Situation

Dementia and Alzheimer’s disease are a leading cause of death in England. 1 Dementia is a syndrome of progressive neurological issues, which may include difficulties with memory, speed of thought, comprehension, language, and judgment.

The risk of developing dementia increases with age, so there are significant concerns about dementia and its devastating impact on individuals, their loved ones, and on health and social care systems. In 2015, about 47 million individuals were estimated to have dementia, a number expected to triple by 2050. 2 The global annual cost in 2015 was estimated at US$818 billion. 3

In 1989, Prof Brayne started working on the multicentre, longitudinal Cognitive Function and Ageing Studies (CFAS). CFAS was established to provide evidence for policymaking and initially funded in part by the Department of Health (DH, now the Department of Health and Social Care, DHSC). It has continued to provide critical evidence that allows us to better understand and tackle dementia. Findings include:

• modelling long term care needs and forecasting costs 
• the high cost of informal care for people with dementia
• the key role of age in the development of dementia
• challenging conventional dementia diagnostic criteria on neuropathological determinants 
• the prevalence (number of cases in a population) and incidence (rate of new cases) of dementia are decreasing 
• the first population figures which could be confidently applied nationally and to specific geographical areas – their statistics are still used by the NHS
• the protective effect of higher education and confirming the role of ageing arteries (vascular pathology) in developing dementia
• the complexity of cognitive impairment and the relationship between illness and disability

I lead CIPH because I see the value of regional, national and international multidisciplinary collaboration, and how everything from understanding the public health challenges of our time to measuring success is impoverished by approaching challenges through the lens of a single piece of research in a single discipline.

– Prof Carol Brayne CBE

Strategy

To ensure that her findings advance our understanding of this complex public health challenge, Prof Brayne contextualises them within the life-course, investigating how social, economic and cultural elements impact generations. She also recognises the importance of the existing body of data across disciplines. Her multidisciplinary work on CFAS includes working with the MRC Biostatistics Unit. CFAS itself is a collaboration with universities including Newcastle and Nottingham.

In order to help make a difference on the ground, Prof Brayne invests in disseminating findings through papers, the media, and conferences. She meets with key stakeholders including MPs, DHSC, Public Health England, local authorities, and the Royal College of GPs. She ensures findings are disseminated in accessible formats, including press releases and policy briefing papers, which accurately summarise findings and policy implications in an accessible style.

Impact

The CFAS team’s world-class research has shaped international debate and policy. Their findings were used in the highly influential national report Dementia UK The Full Report 4 which led to the development of the DH report Living Well with Dementia: A National Dementia Strategy5 Prof Brayne also sat on a DH working group for the report, in order to contribute to the impact of the piece. The team’s prevalence figures were cited by the Secretary of State for Health during the 2012 announcement of increased funding for dementia research.

CFAS’ LSE collaborators modelled long term care and costs, which contribution significantly to the debate on the funding of long term care for the ageing population. The clear economic case made for better supporting dementia patients and carers was picked up by the Wanless Social Care Review6 which fed a debate that continued into the Dilnot Commission 7 and the White Paper on Social Care8

The team’s data has also impacted NICE guidelines, commissioning guides, and policy documents in end of life care. While providing oral evidence to the Health Select Committee, Simon Stevens, NHS England’s Chief Executive, cited Prof Brayne’s work: ‘[…] research from Cambridge […] showed that as a result of improved cardiovascular health we now have 210,000 people a year with a dementia diagnosis compared with 250,000 if we had not had those population health improvements.’ 9

The Lancet Commissions’ Dementia Prevention, Intervention, and Care cited CFAS, highlighting the possibility that a third of dementia cases could have been prevented through lifestyle interventions throughout the life-course. 10 Internationally, their findings have helped shape World Health Organization policy, including the Dementia: A Public Health Priority report. 11

Next steps

The CFAS team continues to provide national dementia incidence figures. Prof Brayne’s team continues to investigate what we can do throughout the life-course to prevent or delay the onset of dementia.

Through her research and leadership at CIPH, Brayne continues to enhance our understanding of dementia, and how we can tackle it, including through its links with wellbeing and sustainable global health. She also recently made significant contributions to the Academy of Medical Sciences’ Improving the Health of the Public by 2040 Optimising the Research Environment for a Healthier, Fairer Future, which looks at ‘how to organise our research environment to generate and translate the evidence needed to underpin’ strategies to improve public health.

Key learnings for researchers

• Consider what evidence public health policymakers and practitioners need on the ground and how you can create research proposals that fill those gaps. 
• Work collaboratively – leverage existing data and expertise available nationally and internationally.
• Recognise that public health challenges and their solutions are complex, and require a life-course approach, taking into account elements such as socio-economic context and key life stages.

Further readinghttps://acmedsci.ac.uk/policy/policy-projects/health-of-the-public-in-2040

Notes:

  1. Public Health England, “Major causes of death and how they have changed”, 13 July 2017. https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed 
  2. Livingston, G. et al. “Dementia prevention, intervention and care.” The Lancet 390, no. 10113 (2017). DOI: https://doi.org/10.1016/S0140-6736(17)31363-6 
  3. Ibid. 
  4. Personal Social Services Research Unit, London School of Economics and the Institute of Psychiatry, King’s College London. “Dementia UK The Full Report.” Alzheimer’s Society. 2007. https://www.alzheimers.org.uk/about-us/policy-and-influencing/dementia-uk-report 
  5. “Living well with dementia: A National Dementia Strategy.” Department of Health. 2009. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/168220/dh_094051.pdf 
  6. “Wanless Social Care Review, Securing Good Care for Older People, Taking a long-term view.” The King’s Fund. 2006. https://www.kingsfund.org.uk/publications/securing-good-care-older-people 
  7. Fairer Care Funding The Report of the Commission on Funding of Care and Support.” Commission on Funding of Care and Support. 2011. http://webarchive.nationalarchives.gov.uk/20130221121529/https:/www.wp.dh.gov.uk/carecommission/files/2011/07/Fairer-Care-Funding-Report.pdf 
  8. “Caring for our future: reforming care and support.” HM Government. 2012. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/136422/White-Paper-Caring-for-our-future-reforming-care-and-support-PDF-1580K.pdf 
  9. “Oral evidence: Impact of the Spending Review on health and social care.” The Health Committee, Parliament. 9 May 2016. http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-committee/impact-of-the-comprehensive-spending-review-on-health-and-social-care/oral/33270.html 
  10. Livingston, G. et al. “Dementia prevention, intervention and care.” The Lancet 390, no. 10113 (2017). DOI: https://doi.org/10.1016/S0140-6736(17)31363-6 
  11. World Health Organization and Alzheimer’s Disease International, “Dementia: a public health priority”, 2012. http://www.who.int/mental_health/publications/dementia_report_2012/en/ 

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