According to a comprehensive study of more than 1.2 million patients in eight global regions, people diagnosed with dementia survive longer than in previous years.
The University of Waterloo study showed that five of the five of the eight study areas between 2000 and 2018 had a decrease in the risk of death, suggesting that earlier diagnosis and improved care strategies are prolonging life after the diagnosis of dementia.
These findings challenge long-term assumptions about dementia prognosis, while highlighting significant differences in the quality of care across healthcare systems. Most notably, the study found that 84% of participants lived in areas where the risk of mortality continued to decline during the study period, indicating widespread improvement in dementia management and treatment approaches.
Global progress, with obvious exceptions
Dr. Hao Luo, assistant professor and study author of the School of Public Health Sciences, highlights the public health implications of these trends. “Dementia is a global public health priority,” she notes. “Understanding how the survival of dementia patients changes across health systems over time can help policy makers evaluate its real-life impact on health and social care services.”
The study analyzed patients over the age of 60 in Ontario, the United Kingdom, South Korea, Taiwan, Hong Kong, Finland, Germany and New Zealand. While five regions show a lower risk of death, New Zealand has a counter-trend trend related to increased risk of death, while data from Finland and Germany have proven to be inconclusive.
Regional results include several key patterns:
- Ontario, the United Kingdom, South Korea, Taiwan and Hong Kong all show a steady decline in death risk
- New Zealand shows an increase in the risk of death, especially between 2014 and 2018
- Countries with established national dementia strategies show better survival outcomes
- The structure of the healthcare system greatly affects the patient trajectory
Healthcare policies have unintended consequences
New Zealand’s findings reveal how good policy changes can produce unexpected results. “We were surprised to observe a steady increase in mortality risk in New Zealand between 2014 and 2018,” Luo explained. “We later found that this coincides with a nationwide effort to transfer the diagnosis and management of simple dementia to primary care to release professional services.”
This policy shift inadvertently created choice bias, and hospitals began to see only the most severely affected patients. She observed that with more primary care, patients with dementia were more likely to attend hospitals at a more advanced stage of the disease, resulting in higher mortality rates after the first hospital record for the diagnosis of dementia. ”
The New Zealand case study illustrates how healthcare delivery models significantly affect obvious survival statistics, even if potential care quality may be improving. This finding is of great significance to other countries considering similar health care restructuring programs.
Progress drives the results of progress
Luo attributes the overall improvement in survival to a variety of fusion factors that have enhanced dementia care over the past two decades. Advances in dementia prevention strategies, more effective drug treatments, and personalized psychosocial interventions have all contributed to better patient outcomes.
The study also reflects a greater improvement in early detection capability, allowing patients to receive interventions in the most beneficial situations. Earlier diagnosis provides patients and families with the opportunity to plan care while cognitive function remains higher, which may lead to better long-term management.
Countries that develop national dementia strategies (including Canada, the United Kingdom, South Korea, Taiwan, Finland and Germany) generally show better survival trends. These comprehensive approaches often coordinate care in multiple healthcare areas, while highlighting prevention and quality of life improvements for patients and caregivers.
Impact on family and healthcare programs
Survival improvements have profound implications for healthcare planning and family decision-making. “The survival knowledge after the diagnosis of dementia is crucial for patients with dementia and their families to make informed decisions about subsequent care arrangements,” Luo stressed.
Extended survival requires a health care system to meet long-term care needs, and families must plan to expand care responsibilities. The findings also suggest that dementia patients may benefit from interventions that previously believed to be limited in value due to shorter life expectancy.
Future research directions will examine how a variety of health conditions affect the survival of dementia. Luo acknowledged: “To use standardized methods to analyze transnational data, some compromises were made, including not considering the impact of comorbidities on dementia survival.” Understanding these complex interactions will further refine prognosis and care programs to keep the global population of dementia growing.
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