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Age and Ageing Advance Access originally published online on December 15, 2006
Age and Ageing 2007 36(1):16-22; doi:10.1093/ageing/afl126
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Review

Long-term care and dementia services: an impending crisis

Alastair Macdonald1 and Brian Cooper2

1 Professor of Old Age Psychiatry, SL&M NHS Trust, South London and Maudsley NHS Trust, MHOA Directorate, London, UK
2 Visiting Research Fellow, Institute of Psychiatry, London, Institute of Psychiatry, Psychological Medicine, London, UK

Address correspondence to: A. Macdonald. Tel: +44 (0)207 919 3238. Fax: +44 (0)208 690 9745. Email: alastair.macdonald{at}iop.kcl.ac.uk

Background and objectives: since the transfer of long-stay care to the independent sector, provision of places in care homes in the United Kingdom has varied in response to market trends, and has shown a consistent fall in the past 10 years. People with dementia constitute the largest diagnostic group affected by these changes, and are also likely to be the group that will determine future need. We therefore estimated the number and proportion of older residents in care homes who suffer from dementia relative to all those with dementia in the United Kingdom and projected future levels of demand on the basis of this data.

Design and method: the number of dementia cases in long-stay care was estimated from a random sample survey in south-east England and compared with data on age-specific prevalence. Projections of future demand were based on UK population projections for the next 40 years.

Main result: over half of all people with dementia in the United Kingdom are in care homes. The number of available long-stay places in care homes has fallen by one-sixth over the past decade. Projection of future demand suggests that well over double the present total places in care homes would be required by 2043 to maintain the present ratio of institutional to community services for dementia.

Conclusion: this finding suggests an impending crisis of availability. A more realistic scenario calls for investment in affordable domiciliary care of good quality, but it will also depend on the acceptance of the fact that the main function of long-stay care for old people is now to provide for advanced cases of dementia, with consequent requirement for improvement in staff ratios and training.

Keywords: care homes, dementia, elderly, long-stay provision, old-age psychiatry, service projections

Received 30 March 2006; accepted in revised form 11 August 2006.


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