In Italy in 2040 it is estimated that Alzheimer’s diagnoses will reach 2.5 million. An important impact for the sustainability of the National Health Service and an alarm bell, which must push to “urgently innovate health policies, define tools for measuring interventions and have data, and therefore homogeneous detection systems throughout the country, to deal with the large number of people with dementia among the Italian population “. This is the appeal that emerges from the table ‘Keep that in mind. How not to waste the resources allocated to people with dementia and their caregivers‘, promoted by Inrete, with the non-conditioning contribution of Roche Italia. An appointment that, on the occasion of World Alzheimer’s Day, made it possible to compare institutions, clinicians, patient associations and civil society experts.
Covid-19 – the promoters point out – has helped to illuminate a beacon on a family of pathologies, of which Alzheimer’s is only the best known expression, increasingly widespread and not only among the elderly. “In recent years, the Ministry of Health has taken numerous initiatives to support and protect patients suffering from dementia – comments the Undersecretary of State for Health Andrea Costa – disease that to date in Italy affects over 1.2 million fellow citizens, with more than 60% of cases represented by Alzheimer’s. In the Budget Law 2021, the Alzheimer’s and Dementia Fund was established in the budget of the Ministry of Health, with an endowment of 5 million euros for each of the years 2021, 2022 and 2023. The purpose of the grant is to improve the social protection of people with dementia, and to ensure early diagnosis and timely care of people with Alzheimer’s. ”
“The fund – continues Costa – is intended to finance the lines of action envisaged by the Regions and Autonomous Provinces of Trento and Bolzano in application of the National Dementia Plan, as well as to finance investments made by the Regions and public administrations, including through the purchase of health equipment, aimed at strengthening the early diagnosis, treatment and monitoring of patients with this disease, in order to improve the process of taking care of them. An important and necessary response for frail people and their families “.
Alzheimer’s disease alone affects about 600,000 Italians in our country, experts point out. It has been estimated – they recall – that the average annual cost per patient, including direct and indirect costs, both family and borne by the national health system and the community, is equal to 70,587 euros, a figure that, multiplied by the current share of sick people, translates into over 42 billion. However, these numbers could underestimate the size of the problem, as emerges from the most recent photograph of the disease in the Italian context, elaborated by Edra in the publication ‘The management of the patient with Alzheimer’s disease: from suspicion to early diagnosis up to integrated care’.
Dementias represent one of the greatest challenges for the health and social system of our country – the protagonists of the table continue – and require the implementation of homogeneous and integrated models of taking charge, as well as a reorganization of the care pathways. At the center of the political discussion is the draft decree of the Minister of Health, in agreement with the Minister of Economy and Finance, relating to the allocation of funds for Alzheimer’s and dementia. A draft ready to be discussed in the Conference of the Regions, which defines the modalities for the allocation of the 15 million euros allocated with the 2021 Budget law.
But how to intervene to stem an expense destined to explode by virtue of the increase in diagnoses? “Diagnosing Alzheimer’s long before the first typical signs of the disease develop is one of the biggest challenges facing the health systems of tomorrow. – he claims Alessandro Padovani, director of the Neurological Clinic of the University of Brescia – An early diagnosis ensures the possibility of a timely management and therefore a potential delay in the progression of the disease, with consequent optimization of health resources and with a lower social impact. This is why it is important that scientific research does not stop and that the foundations are created today for the sustainability of the new treatments that will arrive in the future “.
Dementias represent pathologies with a high social impact, continue the experts. About 3 million citizens, in their daily duties as family caregivers, are directly or indirectly involved in the care of their loved ones. The analysis of the costs associated with Alzheimer’s disease alone confirms how onerous is not only the psychological and social, but also the economic burden on families to meet the needs of the patient. Suffice it to say that funding is currently 10-12 times lower than those allocated for the oncology area, in spite of two elements: social costs double compared to those incurred for cancer, and the number of patients affected by far greater than that of patients who die each year from malignant tumors.
The issue of care costs assumes a leading role, also in light of the progressive increase in the number of diagnoses. On this front, as on that relating to research and therapies, a first positive signal comes from the Fund of 15 million euros allocated by the 2020 Budget Law for dementia and Alzheimer’s. But what are the main actions to be implemented thanks to these resources? “The priorities – he indicates Nicola Vanacore, head of the National Dementia Observatory of the Higher Institute of Health – are in our opinion those of review the organization of dementia services (Cdcd-Centers for Cognitive Disorders and Dementias, Day Centers and RSA) e focus actions on the topic of prevention, early and timely diagnosis, on telemedicine and tele-rehabilitation, as well as on psycho-educational, cognitive and psychosocial treatments “.
“Moreover – he adds – it is urgent draw up a guideline on the diagnosis and treatment of dementia for all health and social care professionals, as well as adopting a computerized medical record among all CDCDs in anticipation of creating an information system dedicated to dementia. It is therefore important to update the current National Dementia Plan. All of these activities are included in the Dementia Fund under approval “.
“The Fund represents the most important public health action ever carried out in our country, and provides for a very intense commitment and collaboration between all central (Ministry of Health and ISS) and regional institutions”, remarked Vanacore.
Collaboration that also goes through the involvement of patient associations, whose contribution is crucial not only for people with dementia, but also for the caregiver. An essential figure in the assistance path, who on average dedicates 4.4 hours a day to direct assistance and 10.8 hours to surveillance. However – the experts note – support for families on bureaucratic aspects such as the knowledge and application of Law 219 of 2017, or the application of the Support Administrator Institute (Ads), is still scarce. Patient associations become fundamental in helping families to orient themselves in the provisions of the law, in the regulations and in the bureaucratic steps.
“Dementia is a complex condition and the answers that our health and welfare system must give must be equally complex and personalized – he suggests Mario Possenti, general secretary of the Alzheimer Federation of Italy – Creation of a uniform assistance network on the Italian territory, fight against stigma, establishment of ‘dementia friendly’ initiatives and support for caregivers these are just some of the priorities that cannot be deferred “.