ALZHEIMERS-DISEASE IN THE UNITED-KINGDOM - DEVELOPING PATIENT AND CARER SUPPORT STRATEGIES TO ENCOURAGE CARE IN THE COMMUNITY

Alzheimer's disease is a growing challenge for care providers and purc hasers. With the shift away from the provision of long term institutio nal care in most developed countries, there is a growing tendency for patients with Alzheimer's disease to be cared for at home. In the Unit ed Kingdom, this change of direction contrasts with the policies of th e 1980s and 90s which focused more attention on controlling costs than on assessment of the needs of the patient and carer and patient manag ement. In recent years, the resources available for management of Alzh eimer's disease have focused on institutional care, coupled with drug treatment to control difficult behaviour as the disease progresses. Fo r these reasons, the current system has led to crisis management rathe r than preventive support-that is, long term care for a few rather tha n assistance in the home before the crises occur and institutional car e is needed. Despite recent innovations in the care of patients with A lzheimer's disease, the nature of the support that patients and carers receive is poorly defined and sometimes inadequate. As a result of th e shift towards care in the community, the informal carer occupies an increasingly central role in the care of these patients and the issue of how the best quality of care may be defined and delivered is an iss ue which is now ripe for review. The objective of this paper is to red efine the type of support that patients and carers should receive so t hat the disease can be managed more effectively in the community. The needs of patients with Alzheimer's disease and their carers are many a nd this should be taken into account in defining the quality and struc ture of healthcare support. This paper shows how new initiatives, comb ined with recently available symptomatic drug treatment, can allow pat ients with Alzheimer's disease to be maintained at home for longer. Th is will have the dual impact of raising the quality of care for patien ts and improving the quality of Life for their carers. Moreover, maint aining patients in a home environment will tend to limit public and pr ivate expenditure on institutional care due to a possible delay in the need for it.