United States

In the United States, the National Alzheimer’s Project Act was signed into law in January 2011, and the first National Plan appeared just over 12 months later, with five goals: to prevent and effectively treat Alzheimer’s disease by 2025, to enhance care quality and efficiency, to expand support for people with Alzheimer’s disease and their families, to enhance public awareness and engagement, and to improve data to track progress. The National Plan has seen a rise in research funding (currently standing at US$1.4 billion). Individual states, at the same time, began discussions about initiatives aimed at addressing personal, societal, and financial implications of Alzheimer’s disease. An example is from Minnesota where counselling and support for caregivers are provided, with an estimated saving for the state of Minnesota of US$970 million by 2025. In addition, a number of treatment trials are under way, looking at the effect of monoclonal antibodies on Alzheimer’s disease and a series of genetic studies.

Wales

This chapter documents the developments in Wales relating to a National Dementia Vision and Strategy. A new Strategy is to appear by December 2016. While activity and progress are evident in many areas, much remains to be done. Wales benefits from having an Older People’s Commissioner, a statutory voice for older people, including those living with dementia, and from its rich cultural, linguistic, and artistic heritage, with active third-sector organizations. Like many countries, Wales has had well-publicized scandals in relation to quality of care in hospitals and care homes, which have provided learning and impetus for development. Compared with other parts of the United Kingdom, dementia diagnosis rates in Wales appear low and are now the subject of government targets. The new Strategy will need to fully engage with people living with dementia in order to address these challenges, while building on the growing social movement of dementia-friendly communities.

Turkey

Turkey has a rapidly ageing population, the issues of which are new to the country. To date, there is no National Dementia Strategy. The strong tradition of family caregiving in Turkey has perhaps influenced the demand for access to formal care services. Informal care provided by families, which includes living together with the elders and providing the most comfort, is one of the strongest aspects of dementia care in Turkey. Another positive aspect is new legal regulation of the social security system for the elderly. Moreover, there is an increasing awareness of dementia and dementia care, which will hopefully give new impetus to further advancements in dementia care. The future of dementia care in Turkey should ideally include: (1) the development of a National Dementia Strategy, (2) improvement of informal care, including support for caregivers, and (3) an increase in the number, as well as improved quality, of in-hospital geriatric services.

Serbia

Serbia is among the demographically older countries in the world, with 18% of the population aged above 65 years. One in two persons older than 65 years lives with an old spouse. The Serbian National Strategy on ageing identified poverty as a widespread companion of ageing, with a rising poverty index. In 2007, the first non-governmental organization, called ‘Alchajmer’, was established in Sremska Kamenica to support people with Alzheimer’s disease and their caregivers. In 2008, the first Centre for Memory Disorders and Dementia was established as part of the Neurology Clinic at the Clinical Centre of Serbia in Belgrade. A National Guide for Alzheimer’s disease was published in 2013. The Serbian health insurance scheme covers care costs for people with severe dementia through its support programme called Advanced Home Help, which includes provision of geriatric housekeepers from the palliative care programme, as well as modest financial support in accordance with the state’s financial capabilities. There are over 160,000 people with dementia in Serbia, comprising approximately 13% of the Serbian population aged above 65 years, of whom only 4% are prescribed appropriate pharmacological treatment.

Norway

Norway has 5 million inhabitants, of whom 200,000 are aged above 80 years. The country is a welfare state, with a tax system covering most health services for its citizens. It is estimated that 78,000 people in Norway suffer from dementia, of whom 60% live at home and the remainder in residential care. In 2007, the first National Dementia Plan was launched (2007–2015), and the second in 2016 (2016–2020). The main goals of the two Plans are to develop services across the country to improve the care and quality of life for all people with dementia and their family caregivers, as well as increase the knowledge of dementia among healthcare professionals. In addition, the Plans also aim to improve awareness of dementia in society as a whole and to develop and implement measures to help create a more dementia-friendly society.

Northern Ireland

The Northern Ireland (NI) Dementia Strategy was launched in November 2011, with similar strategic issues and priorities to those identified in the English, Welsh, and Scottish documents. There are a number of aspects of dementia care in NI of which the province can be proud, several of which are outlined. One of the major achievements has been the successful production of the Mental Capacity Act, which awaits implementation and publication of a code of practice for clinicians. Other challenges include the coordination of care for people with dementia across the healthcare spectrum and the anticipation and incorporation into practice of evolving diagnostic and therapeutic interventions.

Ireland

This chapter examines the prevalence and pathways to the diagnosis of dementia, as well as dementia care infrastructure, in the Republic of Ireland. The economic burden of dementia in Ireland is explored, including both formal and informal costs. Dementia care in the community, residential, and acute hospital settings is described. Associated policy, legislation, standards, and guidelines relevant to dementia care in Ireland are addressed. Current funding structures are examined. The contributions of dementia-specific educational efforts and relevant research in Ireland are highlighted. Challenges encountered in moving from a more traditional medical model of dementia care to a psycho-social, person-centred care model in Ireland, including inequitable funding allocation, are outlined.

France

In 2011, France began the launch of its National Alzheimer Plans to fund research on Alzheimer’s disease (AD) and related disorders, which resulted in a significant increase in French scientific research output, particularly after implementation of the Third National Alzheimer Plan (2008–2012). The 2014–2019 Neurodegenerative Disease Plan and the new Action and Prevention of Loss of Autonomy National Plan aim at extending the positive research outcomes in AD to other neurodegenerative pathologies. Interestingly, these plans also assign an important role to Information and Communication Technologies in the assessment and training of people with AD, frailty, and related disorders. This may contribute to shaping the new Silver Economy by creating new challenges and opportunities.

Belgium

Although, in Belgium, there is no national Alzheimer’s plan, several national initiatives are in place for promoting care for patients with dementia and supporting their caregivers. There are strict rules for reimbursement of the cost of dementia drug treatment, which also includes neuropsychological evaluation in the early stages of dementia. Memory clinics provide cognitive rehabilitation to adapt daily activities to help preserve the independence of patients with dementia and also to help support caregivers facing daily difficulties in their caregiving role. Belgium also has legislation in place relating to euthanasia and relating to impaired mental capacity and advance directives. The main challenges in dementia care in Belgium lie in care planning, ensuring the involvement of patients and their chosen caregivers, and the comprehensive assessment of prevention programmes.

Singapore

The main caregivers of elderly people with dementia in Singapore are the family. In recent years, community services like day care centres, home care, respite care, and nursing homes have expanded. Non-governmental organizations are actively involved in providing a spectrum of services, ranging from medical, nursing, physiotherapy, occupational therapy, and counselling. General hospitals have set up geriatric and psycho-geriatric teams for dementia patients. There is now a focus on dementia prevention, and a successful prevention programme has been extended to three additional community centres. The challenge ahead is not only having sufficient dementia services, but also ensuring there are sufficient trained health professionals to provide the services. Current strengths in dementia care include strong emphasis on family care, increased availability of dementia community services like day care centres, and increased number of health professionals trained in dementia care. Future priorities include integrating hospital care into the community, keeping down the cost of dementia care, and creating dementia-friendly environments.