Dementia experts urge for health system ‘shake up’

Australia’s healthcare system will buckle under an increase in cases of Alzheimer’s disease unless systemic reform is introduced, experts have warned.

The nation’s top brain doctors and advocates outlined a number of strategies to better treat the condition in the Future for Alzheimer’s disease in Australia White Paper.

Associate Professor Michael Woodward, who helped to develop the paper's key recommendations, said there are not enough resources to give future generations the care they will need.

“We’ve estimated that all of the memory clinics in Australia can only assess only about a quarter of all people with new cognitive disorders,” Woodward told Aged Care Insite.

“Private specialists can do some of the work, but they have difficulty accessing neuropsychology and other investigations, which can be very expensive.”

The number of Australians with Alzheimer’s disease is expected to rise to one million by 2058.

According to the treasury, estimated costs for treatment rose to more than $15 billion in 2018, a figure expected to nearly triple as the population ages. 

Woodward, who heads the Austin Memory Clinic in Victoria, said that general practitioners and nurses should be armed with better training to help meet growing demands.

“We don’t have any such specialist training of general practitioners here in Australia,” he said.

“We know GP’s talk about preventing heart disease and preventing cancer, but preventing cognitive decline is important because Alzheimer’s will be the main cause of death in our society.”

In response to rising rates of dementia, the UK introduced admiral nurses in 2012 to give specialist support to patients and their families.

Studies have shown the program reduced pressure on the public hospital system and helped to initiate more personalised forms of care.

Establishing a similar program in Australia could help to minimise delays in diagnosis and treatment, said Woodward.

“We need primary health care teams to better recognise cognitive disorders and to have a clearer root or pathway into diagnosis,” he said.

“A recent patient of mine I saw just a few days ago has been struggling to work out where to go, the GP finally referred him to me, but he just said to me that the precipitant was the people in his golf club who contacted his wife.

“His mates knew that there was something going on but the health professionals hadn’t really done much about it and didn’t know what to do about it.”

Experts are also calling for increased awareness around the development of treatment options for Alzheimer’s disease.

Earlier this year, the US Food and Drug Administration approved the first new drug in nearly twenty years designed to slow the progress of the condition.

Aducanumab, sold under the brand name Aduhelm, is currently under review in Australia and is expected to be approved by early 2022.

The drug has divided the scientific community due to its side effects and efficacy on symptoms.

“This is a major breakthrough, no question about it, but it’s one of several,” said Woodward.

“We need our colleagues to better understand that even though these drugs aren’t absolute miracles, they are the beginning of a process whereby we are only going to have better and better drugs as time goes on.”

In preparation for the shifting treatment landscape, the public should continue to demand better quality drugs, Woodward said.

“We saw the same with other conditions such as AIDS where it was argued that the healthcare professionals were a bit slow, but the public didn’t lie down and accept that.

“Unfortunately, older people with Alzheimer’s are not quite as good as advocating as 40-year-olds with HIV, but nevertheless I think that advocacy by the aged care industry and advocates is going to help.”

Following the recommendations outlined in the report, an expert brain health committee has been formed to continue to advocate for reform in the new year.

“There’s no doubt that if we start treating hundreds of thousands of people with very expensive drugs it will put a huge cost on the health care sector,” said Woodward.

“We need to significantly shake up the system for the tsunami of Alzheimer’s and dementia which is upon us.”

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