Portugal

Dementia care in Portugal presents a mixed balance of strengths and important problems and challenges. This chapter begins by highlighting the scarcity of health service data on dementia, within a rapidly changing and complex array of health and social care systems. Public, private, and third-sector services are not integrated enough to fully meet the needs of people with dementia and their families. Despite examples of good standards in dementia care, some complex challenges still need tackling. Portugal does not have a National Dementia Plan, although formal efforts are being made and a general strategy has been proposed. The chapter briefly discusses leading issues, while highlighting that any selection of goals and the feasibility of achieving them are constrained by a shortage of resources. Taking the need to improve timely diagnosis and integrated formal services as an example, the exact role of primary care is one of the primary topics for discussion. In short, there are three aspects which Portugal does well in terms of dementia care: (1) every person with dementia has access to emergency services and, in principle, to primary care services within the public National Health Service; (2) there are examples of high-quality standards in clinical dementia care, mainly in urban centres, and an increasing interest from the social sector, non-governmental organizations, and private institutions in community or institutional social care; and (3) there is increasing interest in dementia-related service research, as well as in psycho-geriatric training. For the future, first, primary care should be more involved in early diagnosis of dementia and its appropriate disclosure, as well as in other areas, e.g. treatment monitoring in collaboration with specialized care, counselling and support, and monitoring caregivers’ health. Second, the complex bio-psycho-social needs in dementia should be better met through improvement of: timely access to community formal services or specialized accommodation when necessary; ‘dementia-friendly’ communities and health/social units (e.g. general hospitals, given the multimorbidity in people with dementia); management of behavioural and psychological symptoms of dementia (with more emphasis on non-pharmacological approaches, and less on antipsychotics); informal caregivers’ support, ensuring minimum standards of information, counselling, psycho-education, and other family interventions; and legal procedures, access to new technologies, and decent end-of-life care. Finally, gaps should be bridged between health and social care, fostering care coordination and case management in every phase of dementia (with standardization of dementia care processes, e.g. definition of the roles of professionals).