An exploration of the UK unpaid carer's world

 

DMCs in Austria

Dementia service centres in Austria:

A comprehensive support and early detection model for persons with dementia and their caregivers – theoretical foundations and model description

Stefanie R Auer M.A.S Alzheimerhilfe, Austria; Department for Clinical Neurosciences and Preventive Medicine, Danube University, Austria

Edith Span M.A.S Alzheimerhilfe, Austria

Barry Reisberg Department of Psychiatry, New York University Langone Medical Center, USA

 

1  Abstract

1.1

Despite the highly developed social services in Austria, the County of Upper Austria, one of the nine counties of Austria had only very limited specialized services for persons with dementia and their caregivers in 2001.

1.2

Support groups existed in which the desire for more specialized services was voiced. In response to this situation, funding was received to develop a new structure for early disease detection and long term support for both the person with dementia and their caregivers.

1.3

This article describes the development of the model of the Dementia Service Centres (DSCs) and the successes and difficulties encountered in the process of implementing the model in six different rural regions of Upper Austria. The DSC was described in the First Austrian Dementia Report as one of the potential service models for the future.

1.4

Keywords

caregiver support, persons with dementia, early disease detection, integrated care, nonpharmacological treatment of dementia.

 

2  Introduction

2.1.1   Structured professional approaches

In recent years, pharmacological and nonpharmacological therapies (Olazaran et al., 2010) have emerged as strong reasons for structured professional approaches to persons with dementia (PwD).

2.1.2   Early diagnosis has multiple benefits

There is evidence that early diagnosis has multiple benefits both for the PwD and the support provider (SP)

2.1.3   early access to a range of treatments and support

such as in preventing crises, facilitating disease adjustment, providing early access to a range of treatments and support (Prince, Bryce, & Ferri, 2011; Vernooij-Dassen, et al., 2005) and

2.1.4

promoting appropriate and early care planning (Iliffe et al., 2002).

2.2.1   Early disease detection and treatment

The benefit of early disease detection and treatment on the prevention of premature institutionalization has been demonstrated (Koch & Iliffe, 2010; Mittelman, Ferris, Shulman, Steinberg, & Levin, 1996).

2.2.2   Only a fraction of PwD benefit

Despite this encouraging evidence, only a fraction of PwD benefit from early disease detection and treatment (Banerjee et al., 2007; Bunn et al., 2012; World Health Organization, 2012).

2.2.3   Low detection rate

The National Dementia Strategy of England (Department of Health, 2009) identified three factors that might contribute to a low detection rate namely:

(1) the stigma of dementia itself preventing open discussion and encouraging the withdrawal of affected persons and families;

(2) the belief that memory problems are part of normal aging;

(3) and the nihilistic perspective that nothing can be done.

2.2.4.1   Early disease detection and stigma

Early disease detection and the fight against stigma are the major goals of most National Alzheimer and Dementia Plans,

2.2.4.2

for example the Australian National Framework for Action on Dementia (Alzheimer’s Disease International, 2012).

2.2.4.3   First symptoms of dementia

Some national dementia strategies identify the general practitioner (GP) as well positioned to recognize the first symptoms of dementia. However, multiple barriers have been identified (Bunn et al., 2012; Koch & Iliffe, 2010; Vernooij-Dassen et al., 2005). Vernooij-Dassen et al. (2005) conclude that stigmatization by health care professionals including GP’s is the over-riding factor in delaying early diagnosis.

2.3.1   Shortage of medical specialists

Additionally, a reason for a delayed diagnosis in rural areas is a serious shortage of medical specialists (Turyn, 2001).

2.3.2   Supportive services availability after diagnosis.

The Scottish National Dementia Strategy (Alzheimer’s Disease International, 2012) emphasized that individuals were more likely to seek help if they believed supportive services would be readily available after diagnosis.

2.4.1  ‘‘Meeting Centres’’

Psychosocial support models for helping PwD and their SP dealing with the difficult post diagnostic disease phase have been developed. In the Netherlands, for example, the concept of ‘‘Meeting Centres’’ was developed (Dro¨es, Meiland, DeLange, Vernooij-Daassen, & Van Tilburg, 2003; Droes, Meiland, Schmitz, & Van Tilburg, 2004).

2.4.2  France