Reason for recommendation
WHO released the "2017-2025 Global Action Plan for Dementia in the Public Health Field" in 2017, making dementia a focus on public health and calling for high-quality treatment and support for patients with dementia and their family caregivers. The plan is a guiding outline for the formulation of the National Action Plan for Dementia in WHO Member States, providing WHO Member States and stakeholders with a comprehensive action blueprint for the prevention and treatment of dementia. This article systematically sorts out the priority areas and measures for dementia policies, strategies, plans or action frameworks formulated by 25 countries (regions) before and after the WHO released the "Global Action Plan" in 2017, and explores the reference significance of international experience for my country's formulation of a national action plan for dementia.
WHO and 25 countries (regions) specific measures for the action plan to respond to dementia
At present, most countries have reached consensus on the areas of priority actions proposed by the WHO to prevent and treat dementia, including establishing a sense of friendship, controlling risk factors, developing information systems, encouraging research and innovation, and continuing to provide support to caregivers. Within the overall framework of the WHO's "Global Action Plan", many countries (regions) support it from the legislative environment and assessment mechanisms. This article summarizes the specific measures of the dementia action plan of each country (region) into seven aspects: prevention, intervention, research, support, implementation, legislation, and evaluation.
Figure WHO and 25 countries (regions) Dementia Action Plan Release Time
Prevention
Most countries (regions) list building a friendly awareness of dementia and controlling risk factors as the top priority of prevention work.
(1)Austria encourages grassroots communities to spread knowledge and information related to dementia to the public through publicity and education activities, and promote the formation of a social atmosphere of understanding, respecting and helping patients.
(2)Welsh Through continuous public education activities and awareness training, individuals, communities, businesses and public authorities can better understand dementia.
(3) The United States, Australia, Czech and others are actively advocating the promotion of the "Dementia Friendly Program" to the world.
(4)Greece delays the onset of dementia by controlling variable risk factors. It is recommended that adults choose Mediterranean diet to reduce the risk of cognitive decline.
(5) Indonesia calls on families, communities, governments and business to focus on the risk factors of dementia throughout the life cycle, and use "ABCDE screening" (A-Daily Activities, B-Balance, C-Cognition, D-Disease and Risk Factors, E-Emotion) to perform routine brain health checks in people at risk of dementia in primary and secondary medical institutions.
(6) Cuba By conducting regular examinations and family doctor follow-up in health clinics, patients with cognitive impairment are detected early, and patients are promptly referred to mental cognitive medical institutions or departments.
Intervention
Most countries attach importance to the importance of diagnosis, treatment, care and intervention of dementia.
(1) The UK has improved the support and quality of care services for dementia in primary and secondary health care institutions through performance incentives and supervision and inspection of primary and secondary health care institutions.
(2) Israel proposes a long-term care model of "people-oriented, gender-sensitive, culturally appropriate, and quick response".
(3) The Scotland and Switzerland governments in the UK emphasized the need to ensure the safety and effectiveness of dementia treatment and reduce inappropriate prescriptions of psychoactive drugs.
Research
(1) 13 countries (regions) including the United States, Luxembourg actively responded to the WHO's suggestions on establishing a dementia information system and developed, implemented and improved the dementia information system.
(2) Greece collects information in a timely manner and formulates targeted policies to deal with dementia through a comprehensive recording system for dementia.
(3) Australia supports the use of telemedicine and information technology to strengthen research and education on dementia.
(4) The UK has promoted the transformation of research findings into practical measures to benefit people with dementia through a complete social science research program in dementia.
(5) Denmark actively promotes cooperation among international dementia research institutions, and a large number of advanced research resources are shared.
Support
Many WHO member states have proposed to provide systematic and sustainable support services for patients with dementia and caregivers.
(1) To early detection and treatment of dementia, Cuba provides many medical care , psychological and family medicine professional training programs on topics related to cognitive impairment.
(2) The Norwegian government has formulated an action plan for the professional ability development of nursing staff to ensure that the medical department has sufficient and competent staffing.
（3）The UK Scotland region provides at least 1 year post-diagnosis support for every patient newly diagnosed with dementia.
implementation
(1) The UK Scotland region, Ireland , Netherlands has clearly established a leadership management team that assumes the overall responsibility for the prevention and control of dementia, responsible for leading and integrating all health service execution departments and subsidiaries.
(2) The " Alzheimer's Disease Program" in the United States supports the implementation of 15 evidence-based interventions to prepare for the promotion of targeted dementia responses nationwide.
(3) Malta will provide a large amount of human and financial investment in the nine years of its national strategy for dementia to coordinate the planning of the connections between health and social care workers, dementia patients and their families.
(4) Indonesia coordinated the relationship between the government and the community and stakeholders at all levels, and encouraged them to participate in the formulation and implementation of cross-departmental and cross-project dementia management activities.
Legal
Human rights-based laws can protect the rights of patients with dementia and their family caregivers and reduce patients' sense of shame.
(1) Italy empowers and eliminates stigma for patients with dementia from an ethical perspective, and helps improve the quality of life of patients and their families.
(2) Indonesia encourages the promotion of intergenerational and economic empowerment of elderly people with cognitive impairment through various possible efforts.
(3) Slovenia has formulated a Patient Rights Law and a Mental Health Law to protect the rights of patients with dementia and calls for respecting and safeguarding the rights of patients with dementia in all environments.
Assessment
Many countries (regions) evaluate and demonstrate the action plans from the aspects of the sustainability and quality of care, economic benefits, completion progress, etc.
(1) U.S. Department of Health and Human Services expands and strengthens the construction of data infrastructure to facilitate federal agencies and other researchers to share data, which is conducive to multi-level monitoring and evaluation of the progress of the national action plan.
(2) Italy requires the assessment of the dementia prevention and control situation faced by its country, continuously supervise the completion of priority goals, and follow up on the implementation effect of the national action plan.
Internationally actively explores and implements relevant measures for dementia:
01. At the government level, according to the framework of the WHO "Global Action Plan", many developed countries (regions) that have entered the aging stage in advance have included the response to the risk of dementia in the country (regions) for a long time. The action plan was launched, and a strategic management leadership group was established at the national (regional) level to protect the rights of dementia patients and caregivers from a legal perspective
02. At the social level, it advocates the construction of a dementia-friendly community, carries out community-based prevention and management, creates a friendly social atmosphere, and allows dementia patients to adapt better in the social environment
03. At the level of medical care institutions, it improves the clinical standardization of dementia diagnosis, treatment, care and intervention, strengthens the professional development ability training of caregivers, and improves the participation autonomy of grassroots medical and health service personnel
04. At the level of family, it focuses on long-term family care for dementia elderly, provides economic and sustainable support for family caregivers of dementia patients, alleviates the psychological pressure of family caregivers of dementia patients, and helps dementia elderly people to gain respect and care
05. At the individual level, adopts a healthy lifestyle to promote brain health, participate in meaningful daily activities, and improves happiness and quality of life
The above experience is of great reference value for my country's formulation of a national action plan for dementia.
enlightenment on my country's formulation of a national strategy for dementia
01. Launching a national-level strategic action plan
Formulating a national-level strategic action plan is an effective measure for the government to treat dementia in macro-governance, which is conducive to promoting government departments, social groups and medical institutions to actively improve medical care strategies. It is recommended that relevant administrative departments in our country draw on the experience of internationally increasing the response to dementia in the elderly to a high level of national strategy, and start from our country's specific national conditions, and formulate a national-level long-term response strategy around the priorities and key links of the WHO's "Global Action Plan" to bridge the gap in international diagnosis and treatment in early prevention and intervention, medical resources, etc.
(1) From the perspective of content, the national strategic action plan can fully demonstrate the urgency of the problem of dementia, the necessity of the plan, the priority of the action framework, the implementation and implementation of the goals, the proportion of the planned coverage area, and the pilot arrangements, to provide an authoritative reference for overcoming my country's dementia and its social problems;
(2) From the perspective of form, with the WHO's "Global Action Plan" as the fundamental guideline, China's dementia strategic action plan should adopt medium- and long-term standardization for 5 to 10 years of medium- and long-term standards for 5 to 10 years;
(2) From the perspective of form, with the WHO's "Global Action Plan" as the fundamental guideline, my country's dementia strategic action plan should adopt medium- and long-term standardization for 5 to 10 years. Regulations are to improve strategic effect and ensure additional effects;
(3) From the perspective of support and guarantee, the government should gather personnel from the fields of social policies, pension systems and health regulations, increase financial investment and support, actively implement and strengthen supervision;
(4) my country's strategic action plan should be organically integrated with national plans related to mental health, aging, chronic non-communicable diseases, disability and other dementia, and effectively promote the integration of resources and sharing of advantages in dementia prevention and control.
02. implements early screening in high-risk groups
As there is still a lack of practical and effective intervention methods for cognitive impairment, early screening in high-risk groups is particularly important for delaying cognitive decline and retaining the ability to live a normal life. Large-scale screening in the general population is not recommended considering that early screening means more financial and health resources are invested. According to the characteristics of the large proportion of elderly people in my country's population and the absolute number of patients with early cognitive impairment, the formulation of screening strategies should be given priority among high-risk groups.
(1) In the community, early screening for dementia can be considered in the health examinations carried out by people aged ≥55 years old every year;
(2) In the workplace, it can be considered to add early screening for dementia in people aged ≥40 years old when conducting physical examinations for employees;
(3) In medical institutions, all middle-aged and elderly people with progressive cognitive/memory dysfunction and personality/behavior changes, those with positive family history of mental disorders, and cardiovascular and cerebrovascular disease are all key groups for early screening.
It is recommended to establish an early screening system for dementia up and down:
(1) In primary diagnosis and treatment, doctors determine high-risk groups for dementia through medical history inquiries, risk factor screening, and cognitive function scale evaluation;
(2) For high-risk groups for dementia, early screening and identification in superior hospitals through complete set of neuropsychological scale evaluation, brain health physical examination, and memory clinic examination.
Promoting early screening of dementia can help grasp the "golden window period" and slow down the occurrence and development of dementia, but most elderly people do not realize the importance of early screening, which has become one of the obstacles to standardizing early screening. In order to achieve the phased goal of the National Health Commission's cognitive function screening rate of 80% for community (village) elderly people in 2022, it is recommended to continue to increase publicity and guidance, provide professional health science popularization channels, help the elderly establish aware of disease prevention and promote healthy aging.
03. advocates a healthy lifestyle and actively manages risk factors
Although there is no solution that can cure dementia or change its course of disease, active management can control risk factors, thereby postponing or delaying the occurrence and development of dementia. According to the WHO Guidelines for Reducing Cognitive Recession and Dementia Risk, a variety of healthy lifestyle interventions can be adopted to reduce the risk of dementia.
In terms of lifestyle and behavioral habits, it is recommended to maintain moderate physical activity every week, recommend Mediterranean diet, quit smoking and limit alcohol; in terms of controlling chronic diseases, actively manage hypertension, control diabetes, and regulate dyslipidemia ; in terms of ensuring good mood, drug or psychological intervention for depression as soon as possible to support the elderly to integrate into society and carry out social activities.
In addition, controlling body mass, timely identifying and managing hearing loss is also beneficial to reducing the risk of dementia. It is worth noting that primary prevention of dementia should emphasize the whole population strategy with the high-risk population strategy. For the general population, health administrative department needs to formulate a broad public health education plan, strengthen health lifestyle education, establish awareness of dementia prevention and control in the whole society, and use policies, economics, laws, environment and other means to reduce obstacles that hinder individuals from taking healthy behavior; for high-risk groups, multidisciplinary and departments need to take joint actions to link the risk factors of dementia with the prevention and treatment of other non-communicable diseases, formulate guidelines and consensus on reducing the risks related to dementia, and improve the health awareness of high-risk groups through various forms of social publicity and education, and help them control the risk factors that can be changed as soon as possible.
04. Improve the long-term care insurance system for dementia patients
At present, my country's long-term care insurance for dementia elderly people is in the pilot stage, and the overall level of protection for the population is low. As the social impact of the one-child policy and "less birth rate" gradually intensifies, the construction of the long-term care insurance system needs to be continuously improved to cope with the impact of aging.
(1) We must strengthen the top-level design of the system, accelerate the formulation of legal regulations on the long-term care protection system, and promote the legislative process of long-term care insurance in my country;
(2) We must fully establish a multi-level long-term care protection system of "social security + commercial insurance" to form a multi-party fund and financial, medical insurance fund and personal account payment mechanism;
l3 (3) We must speed up research and formulate national standards for nursing levels for dementia patients, and expand the effective supply of personalized and professional long-term care services;
(4) We must guide long-term care insurance agencies to refer to the experience and practices of each pilot city and region, strengthen the quality control work of evaluation institutions, and supervise and inspection mechanisms;
(5) We must build a full-process and full-factor service provision system such as reimbursement application acceptance, disability assessment, nursing service provision, and service support. The construction of the long-term care insurance system must be designed in the "big plate" of the long-term care security system to meet the diverse and multi-level long-term care security needs of patients and their families, and thus effectively solve the problems of home-based elderly care and family care for dementia.
05. Create a friendly social atmosphere and living environment
Friendly awareness of dementia is a basic policy of dementia prevention and control in various countries. In order to create a safe and comfortable physical environment and a sense of belonging for dementia patients and their caregivers, and effectively reduce the family burden of patients, measures can be taken. Including:
(1) Provide volunteer activities in the community to meet the needs of dementia patients and are easily available, and call on practitioners in the fields of public transportation, municipal services, commercial financial services, consumer rights protection, etc. that are more in contact with dementia elderly people, and provide volunteer services, conduct a series of online and offline public welfare activities such as business consultation, cleaning, health testing, and assisted eating, to gather social strength and demonstrate humanistic care;
（2）Give full play to the organizational role of streets and neighborhood committees, vigorously carry out grassroots dementia prevention education activities, use popular methods such as movies, national call for manuscripts, animations, etc. to strengthen health education for the whole population, and call on the public to speak out to improve dementia cognition, reduce stigma and prejudice against dementia, and provide better social support for the sick elderly;
（3）Assess and transform the community environment, road signs and signs The position should be easy to identify, the building number is larger and displayed, the bus stop sign road map is clear and easy to understand, and the auxiliary equipment such as handrails and lighting are installed in public areas such as stairs and toilets, and public fitness equipment and entertainment facilities are provided;
(4) Explore the establishment of "dementia station", "dementia coffee house", and "dementia peace of mind" in the community to attract dementia patients and community residents to communicate and interact, and integrate and connect various community care resources.
06. Establish a national monitoring information system for dementia
The goal proposed by the "Global Action Plan" is to routinely collect core dementia indicator data by 50% of countries by 2050. However, the current data on dementia prevalence in my country mainly comes from relevant laboratory testing, large-scale investigation and literature reviews, and the death data mainly comes from the Chinese disease monitoring point system cause of death monitoring and Chinese Center for Disease Control and Prevention Cause of Death Registration Report Information System. There is no unified planned national information system for dementia.
In order to improve the utilization rate of digital resources and support the formulation of three-level prevention strategies, my country should establish a national dementia information monitoring system to monitor the incidence, prevalence, risk and protective factors of dementia, so as to fully grasp the epidemiological characteristics and patient information of dementia .The construction of a national monitoring information system for dementia requires comprehensive and multi-level guarantees: (1) At the national level, supportive laws or policies for measuring, collecting and sharing dementia health, treatment and nursing related data need to be issued; (2) At the local level, local administrative departments, enterprises, society and other parties need to raise funds to jointly provide bottom-line guarantees; (3) At the software and hardware level, modular and structured design are adopted to deploy storage space on independent servers, retaining sufficient interfaces to meet the needs of different business processes; (4) At the data level, meeting the national health supervision information data exchange standards and specifications, and establishing a security guarantee system for accessing private data. Comprehensively promoting the construction of the national monitoring information system for dementia will help improve information services throughout the entire medical care process from prevention to end-of-life.
Source of this article: Wang Dan, Liu Yuehua, Zhu Xuemin, Yang Haopeng, Suo Jingdong, Shen Xianlei, Liang Wannian. WHO and 25 countries (regions) Action Plan for Dementia and Its Implications for my country[J]. China General Practice, 2022, 25(25): 3075-3082.
