Guidance

Dementia: applying All Our Health

Updated 22 February 2022

The Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.

This guide is part of ‘All Our Health’, a resource that helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help frontline health and care staff use their trusted relationships with individuals, families and communities to promote the benefits of focusing on dementia.

We also recommend important actions that managers and staff holding strategic roles can take. View the full range of ‘All Our Health’ topics.

Focusing on dementia in your professional practice

Dementia is a term used to describe a collection of symptoms including memory loss, problems with reasoning, perception and communication skills. It can also lead to a reduction in a person’s ability to carry out routine activities such as washing, dressing and cooking. Dementia is caused by different brain diseases, most commonly Alzheimer’s disease.

The number of people estimated to be living with dementia globally is 50 million, and it is thought this number will more than treble to 152 million by 2050. In the UK, it is estimated that around 850,000 people have dementia. This progressive condition can have a devastating effect, not just on the person with dementia, but also on families, carers and wider society. There is no cure for dementia and it is the leading cause of death in England.

Most people associate dementia with older people but there are more than 40,000 people in the UK under the age of 65 affected by this condition. Dementia costs society £34.77 billion a year in the UK and this cost is set to rise as the population ages.

Reducing the risk of getting dementia

Only 34% of UK adults think it’s possible to reduce their risk of dementia. Health and care professionals can promote evidence-based messages to middle-aged adults to help reduce their risk of getting dementia.

Working alongside other professionals and public health teams, health and care professionals can influence population-level impact by carrying out whole-system approaches to encourage people of all ages and stages of life to:

• be more physically active
• eat healthily and maintain a healthy weight
• drink less alcohol
• stop smoking
• be socially active
• control diabetes and high blood pressure

Smoking is one of the biggest risk factors for dementia and can double an individual’s risk, because it causes narrowing of blood vessels in the heart and brain, and oxidative stress, which damages the brain.

The Lancet Commission on the ‘Prevention and management of dementia: a priority for public health’ published in July 2017, identifies risk factors that, if eliminated, might prevent more than a third of cases of dementia. This report notes a link between hearing loss and the risk of developing dementia. Work is underway to understand more about this relationship and whether wearing hearing aids can reduce risk in people with hearing loss.

A report by the World Health Organization (WHO) has also highlighted that engaging in the arts may help reduce the risk of cognitive decline.

Facts about dementia

There are many different causes and types of dementia. Alzheimer’s disease (caused by the abnormal build-up of proteins in and around brain cells) is the most common, followed by vascular dementia (caused by problems with the blood supply to the brain). There are also a few less common forms of dementia and in older age groups, especially, it is common for people living with dementia to have more than one type.

An estimated 540,000 people in England act as primary carers for people with dementia; half of these are employed, 112,540 have needed to leave employment to meet their caring roles and 66,000 carers have cut their working hours. This results in a lower standard of living for those carers and significant costs to society in general, including a £3.2 billion cost of working time lost to caring. There is evidence that staying in work for longer can increase years of healthy life expectancy, by giving people meaning and purpose, along with financial security and independence. Employers can play a role in creating these opportunities through implementing policies and practices that support unpaid carers.

All carers over 18 can have a free assessment to see what might help make their life easier. This is called a carer’s assessment and can be obtained through adult social services via the local council.

The Alzheimer’s Society shows that the contribution of unpaid carers of people with dementia in the UK totals £13.9 billion a year, costs which would otherwise have to be picked up by the government.

About 69% of care home residents were estimated to have dementia in 2014. The number of people with dementia admitted to hospital in an emergency rose by 70% between 2012 and 2018. Around a fifth of these admissions related to potentially preventable acute conditions such as urinary tract infections, pneumonia and other respiratory infections.

Core principles for health and care professionals

Health and care professionals should:

• think prevention first
• know the needs of individuals, communities and population and the services available
• think about the resources available in health and wellbeing systems
• understand specific activities that can protect and promote health and wellbeing
• consider their own internal policies and procedures that support health at work

Taking action

Frontline health and care professionals

Health and care professionals should provide support and advice on dementia risk reduction as part of their daily contact with individuals. Every contact counts as a chance to educate and empower people to make positive choices about their own health.

Health and care professionals can support the implementation of NHS England’s Well Pathway for Dementia (PDF, 146KB) and have an impact on an individual level by:

Preventing well

Advising people that their risk of developing dementia can be reduced by looking after their health, communicating that ‘what’s good for the heart is good for the brain’.

Diagnosing well

Knowing where to direct people for timely diagnosis, health and care services, and to personalised support and adaptations that will help them remain independent. If appropriate, checking if a person is suffering from delirium or dementia.

Living well

• promoting health messages to support the physical, mental and oral health of people living with dementia and their carers
• supporting people living with dementia to choose from a range of activities tailored to their preferences to promote wellbeing
• considering the language you are using (PDF, 2.2MB) when talking about dementia

Supporting well

• involving the individual and carers in all care and treatment planning, making it personal
• helping people living with dementia and their carers find out about opportunities to take part in research, such as through Join Dementia Research, and empower them to make their own decisions about getting involved
• considering the needs of carers and knowing where to direct them to get support
• completing dementia e-learning or training and becoming a Dementia Friend
• making small adaptations such as using adequate signage and lighting to support a dementia-friendly environment

Dying well

Offer the opportunity to complete advance care plans for people with dementia while they have the capacity for these discussions, so that people living with dementia are able to die with dignity in their place of choosing.

Team leaders or managers

Community health professionals and providers of specialist services can have an impact by:

• making preventing and managing dementia a priority at both strategic and delivery levels in community-based programmes
• promoting uptake of the NHS Health Check for 40 to 74-year-olds, which includes information on how individuals can reduce their risk of dementia and, for those aged over 65, the signs and symptoms of dementia to look out for
• engaging with communities to make links to local health and support services, encourage their take-up and reinforce the support they offer
• working with local public health teams to promote initiatives working with shops, supermarkets, restaurants, cafes and voluntary community services to support people to live well with dementia
• promoting the uptake of community-based interventions to support health and wellbeing and address social isolation and loneliness
• becoming a dementia friend and supporting changing attitudes to dementia
• being aware of opportunities for people with dementia and their families to take part in research and being able to discuss and signpost such opportunities
• supporting the uptake of flu vaccinations, and other vaccines, to reduce complications and avoidable hospital admissions
• identifying a dementia champion to maintain the focus on dementia

Senior or strategic leads

Health and care professionals should be aware of the interventions at population level, which could include:

• using every opportunity to promote ‘What’s good for your heart is good for your brain’ messaging, and incorporating dementia risk reduction in Making Every Contact Count programmes
• embedding dementia risk reduction for all attending the NHS Health Check, making use of the range of resources available through the NHS Health Check website, which has links to associated leaflets, e-learning and online resources
• maximising local signposting opportunities, including to the NHS Health Check, and providing information on support and information available locally online and in community settings
• local health and wellbeing boards addressing dementia in the Joint Strategic Needs Assessment (JSNA) and health and wellbeing strategy, action plan and local commissioning plans
• local authorities adapting the built environment towards being age-friendly and dementia-friendly, to make healthier choices easier
• encouraging all health and care professionals to complete dementia e-learning or training, and become a Dementia Friend

Another intervention could include local authorities setting out local approaches - such as sport and physical activity plans and food strategies to improve the diet and levels of activity in local communities - to support people to look after their health. This might include using supplementary planning guidance to limit the number of new hot food takeaways being opened near leisure centres, for example, or developing active travel plans for health services and leisure facilities.

Understanding local needs

The Dementia Intelligence Network brings together data about dementia and dementia risk factors. It aims to turn the data into knowledge and intelligence that can be used by commissioners when making decisions about dementia services.

The dementia profiling tool brings together a wide range of publicly available data on dementia. It can be used to understand the prevalence of dementia and how it is prevented and diagnosed locally. It also shows data on the care that is provided to people with dementia, including end of life care.

The further resources section of the dementia profile contains signposting links to dementia-related data products, indicators and datasets, which can be used to find out more about dementia and dementia services locally and in England.

Measuring impact

The Everyday Interactions Measuring Impact Toolkit provides a quick, straightforward and easy way for health and care professionals to record and measure their public health impact in a uniform and comparable way.

The dementia impact pathway is recommended for health and care professionals to record and measure actions undertaken as part of routine care that impact on dementia.

The Public Health Outcomes Framework has one measure on dementia: estimated diagnosis rate for people with dementia (E15).

Further reading, resources and good practice

Advice for the public

A range of information and advice is available for the public, including:

• Dementia guide on NHS.UK
• NHS Health Check dementia leaflet available in 15 languages
• Alzheimer’s Society national dementia helpline 0300 222 11 22
• dementia directory is Alzheimer’s Society directory of local dementia services
• information on becoming a Dementia Friend
• Alzheimer’s Research UK Dementia Research Infoline provides information about dementia and opportunities to get involved in research 0300 111 5 111
• Dementia: Reducing your risk (PDF, 4.2MB) (Alzheimer’s Society booklet)
• A quick guide to dementia is Alzheimer’s Research UK introduction to dementia, available in 8 languages
• Getting involved in dementia research (PDF, 913KB) is Alzheimer’s Research UK guide to getting involved in research and the opportunities available to people

Professional resources and tools

The Office of Health Improvement and Disparities (OHID) Health matters: midlife approaches to reduce dementia risk provides a resource for public health professionals, which brings together important facts, figures and evidence of effective interventions to address major public health problems.

A range of resources, training and guidance to deliver the dementia component of the NHS Health Check is available on the NHS Health Check website dementia training page. Resources include e-learning, videos and adaptable presentations for commissioners, providers and healthcare professionals.

Health Education England elearning for healthcare on dementia covers all aspects of care for people living with dementia and their family members, from prevention and risk reduction to diagnosis through to bereavement.

A range of other Health Education England resources is available to develop the dementia workforce, including the Dementia Training Standards Framework.

Join Dementia Research has an e-learning tool to help healthcare professionals understand research involvement and enable them to empower people they talk to about the opportunities available through research.

The Alzheimer’s Society’s Talking Point is an online discussion forum for anyone affected by dementia. You can ask for advice, share information, join in discussions and feel supported. This is a good place to get some qualitative feedback from service users.

Alzheimer’s Research UK provides a range of information, available free to order, including health information stands for foyers and waiting rooms.

Resources are also available to support individuals and organisations to become Dementia Friends.

Information on using language which is accurate, balanced and respectful when talking about dementia is available in the Alzheimer’s Society Dementia Language (PDF, 2.2MB) publication.

NICE guidelines

National Institute for Health and Care Excellence (NICE) pathways set out a structured approach to the identification of dementia and supporting people with dementia and their carers in health and social care.

Disability, dementia and frailty in later life – midlife approaches to delay or prevent onset (NG16) aims to increase the amount of time that people can be independent, healthy and active in later life. Dementia: assessment, management and support for people living with dementia and their carers (NG97) aims to improve care by making recommendations on training staff and helping carers to support people living with dementia.

There is one NICE Quality Standard for dementia, QS184, which covers preventing dementia, and assessment, management and health and social care support for people with dementia. It describes high-quality care in priority areas for improvement.

Good practice examples

Specialist link nurses in Surrey Downs aims to increase diagnosis rates in the Surrey Downs community by adopting an innovative approach of using specialist link nurses.

Primary care early detection and support services for dementia in Kent and Medway aims to establish a primary care-based model of memory assessment to increase the recognition, diagnosis and targeted case management of people living with dementia.

Family support rooms at Pinderfields Hospital, run by Mid Yorkshire Hospitals NHS Trust, enable families to stay together when a family member has dementia or is at palliative care stage.

The Dementia Training Standards Framework was updated in 2018 and sets out the essential skills and knowledge necessary for all health and social care staff involved in dementia care.

Talking Together is a handbook that includes facilitating peer support activities to help people with learning disabilities understand about growing older and living with dementia.