Islington Dementia Strategy 2025 - 2035

Context

What is dementia? 

Dementia is a term used to describe a range of progressive conditions that affect the brain. There are over 200 types of dementia. The most common are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia when a person has two types of dementia at the same time, most commonly Alzheimer’s disease and vascular dementia. 

Each type of dementia stops a person’s brain cells (neurones) working properly in specific areas, affecting their ability to remember, think and speak. 

It is the loss of the ability to think, speak, remember, and reason to levels that affect daily life and activities (Reference: What Is Dementia? (alzheimers.gov). Cited 14 June 2024). Although dementia is often associated with memory loss, it also affects concentration, planning, activities of daily living, language and communication, coordination and perception, and mood and emotional regulation (Reference: Mental, physical and speech abilities in later stages of dementia | Alzheimer's Society (alzheimers.org.uk).Cited 14 June 2024).

Dementia affects all people differently and people’s experiences can vary significantly. People can and do still live well with dementia with the right support, care, and treatment to manage symptoms and support maintenance of independence and capabilities (Reference: Understanding and supporting a person with dementia | Alzheimer's Society (alzheimers.org.uk).Cited 14 June 2024).

Dementia is more common in people over the age of 65 and about one-third of all people aged 85 or older may have some form of dementia. However, it is not a normal part of ageing and not everyone develops dementia as they grow older. Around 5% of people with dementia are under the age of 65 (Reference: Dementia Information, About dementia - Dementia UK.Cited 14 June 2024).

National context 

In 2015, the government launched the Dementia 2020 Challenge. The aim of the challenge was to make England, by 2020, the best country in the world for dementia care, support, research, and awareness. The Challenge identified eighteen key commitments under four themes:

• Dementia awareness
• Health and care delivery
• Risk reduction
• Research and funding.

(Reference: Dementia 2020 Challenge: 2018 Review Phase 1 (publishing.service.gov.uk))

Unfortunately, in the intervening period, the COVID19 pandemic, the financial constraints on health and social care services and the cost-of-living crisis has had negative consequences for people accessing care and support.  

The NHS Long Term plan lays out its commitment to go further in improving care for people with dementia whether at hospital or at home. The NHS published the Dementia Wellbeing pathway (Reference: Dementia Well Pathway (england.nhs.uk)) in 2022 with guidelines to achieve outcomes around prevention, diagnosis, support, living well and dying well. 

In the UK, Dementia is one of six major conditions that are the main drivers for around 60% of mortality and morbidity. It is increasingly common for people with dementia to experience at least one other comorbidity. In August 2023, the Department of Health and Social Care published the Major Conditions strategy (Reference: Major conditions strategy: case for change and our strategic framework - GOV.UK (www.gov.uk)) which focuses on early prevention, secondary prevention, diagnosis, prompt and urgent care and long-term care and treatment.   

• Nationally, diagnosis rates dipped during the pandemic and have not yet recovered (Reference: Dementia Profile - OHID (phe.org.uk).Cited June 2024).
• In Great Britain, 28% of non-white ethnic communities perceive they have little or no knowledge about dementia compared to 19% of white communities (Reference: Public understanding of dementia and its risk factors in Great Britain - Office for National Statistics (ons.gov.uk)).
• 46% of people with dementia in the UK reported that lockdowns had a negative impact on their mental health (Reference: Worst hit: dementia during coronavirus. s.l. : Alzheimer’s Society, 2021).
• In England, there is a higher prevalence of dementia amongst black and black British people (Reference: Pham TM, Petersen I, Walters K, Raine R, Manthorpe J, Mukadam N, Cooper C. Trends in dementia diagnosis rates in UK, Aug 2018).

Dementia in Islington

• As of May 2024, there are 1,115 people aged 65+ diagnosed with dementia, but the NHS estimates that the number of people aged 65+ with dementia is closer to 1,459. The diagnosis rate for people aged 65+ is 76.4% compared to London average of 67.2% and national benchmark of 54.8%. The national target is 66.7% (Reference: NHS Primary Care Dementia Data, May 2024.). There are around 190 people under the age of 65 diagnosed with dementia.
• The number of people living with dementia in Islington is expected increase to 2,056 by 2030 (Reference: Alzheimer's Society. Local Dementia Profile Islington. London : Alzheimer's Society, 2021). However, there are indications that this figure is an underestimate (Reference: Number of dementia cases could be 42% higher than previously estimated by 2040. UCL Home. [Online] 27 10 2023).
• Dementia has the third highest mortality rate in Islington after cancers and cardiovascular disease (Reference: Islington Public Health. Older person’s Joint Strategic Needs Assessment 2022, Islington Public Health. Cited 14th June 2024).  In 2022, dementia was the cause of death in 812 deaths per 100,000 residents aged over 65, similar to London and England (Reference: Public health profiles - OHID (phe.org.uk).Cited 22nd Nov 2023).
• The estimated annual cost of dementia care in Islington is £68 million, projected to increase to £112 million by 2030 (Reference: Local Dementia Profile Islington. London: Alzheimer's Society, 2021). 
• People living with dementia in Islington will have one emergency hospital admission on average. This is higher than the London and England average, although this may relate to higher rates of local diagnosis (Reference: OHID. Dementia Profile. OHID Finger Tips. [Online], 16 March 2022. Cited 22 Nov 2023).
• 83% of care home beds available to residents with dementia in Islington are rated as ‘good’ or ‘outstanding’ by CQC in May 2024, which is slightly higher than the London average of 81% (Reference: ADASS Bed-Based Care Market Overview QIS - Power BI. Cited 14th June 2024).
• 56% of people living with dementia in Islington died in their usual place of residence. Significantly lower than the England average of 70% Reference: OHID. Dementia Profile. OHID Finger Tips. [Online], 16 March 2022. Cited 22 Nov 2023).
• 20% of carers reported caring for someone living with dementia. The value of dementia support contributed by unpaid carers in Islington is £39m (Reference: Alzheimer's Society. Local Dementia Profile Islington. London: Alzheimer's Society, 2021).