Dementia

Prevalence and getting a diagnosis

Diagnosis of dementia can take place through several pathways, usually beginning with a GP visit and a referral to Wakefield Memory Services, it can include further appointments and a brain scan to confirm the diagnosis (NHS, 2023). Of those over 65 years old in Wakefield District 2,736 people have a diagnosis of dementia recorded in their GP records, this is 4.1% of people in this age group (November 2023). To compare to England using the dementia dashboard it shows that in 2020 of the total population over 65 years old in Wakefield District 3.6% had a diagnosis of dementia, similar to the England average of 4.0% (see dementia profile dashboard below).

Not all those with dementia have yet had a diagnosis as they may be in the early stages of the condition or may not yet have completed the diagnostic pathway. In 2023 it is estimated 4,019 people have dementia in the Wakefield District based on applying expected population prevalence rates from the Medical Research Council Cognitive Function and Ageing Study II (CFAS II), a method used to give an estimate of all those with dementia not just those with a diagnosis (OHID, 2023).

It is a national aim to make sure as many people with dementia get a timely diagnosis so that they, their carers and healthcare staff can plan accordingly and work together to improve health and care outcomes. The national target for diagnosis rates is 66.7% (NHS England, 2020). In Wakefield District the current rate is 62.5%, compared to 65.6% in Yorkshire and the Humber and 63.8% for England (2023). Of the different types of dementia, across Wakefield in November 2023 the most common type is Alzheimer’s disease (43%) followed by vascular dementia (33%) and other types, including mixed (24%) (NHS England, 2023).
Young onset dementia is when someone aged under 65 years has the condition. In November 2023 for patients registered in Wakefield District, 138 under 65 year olds have been diagnosed with dementia. Comparing to national rates from the dementia profile (see dashboard below) in 2020 the rate for Wakefield District was 4.4 per 10,000 people aged under 65, higher than the England average of 3.05 per 10,000. Wakefield Memory Services run a special support group for those with young onset dementia and their families including walks and a coffee and chat meeting once a month.

Dementia Profile

The Office for Health Improvement and Disparities produces a dementia profile covering the six areas of NHS England’s Well Pathway for Dementia ( diagram here ). Below is the dementia profile for Wakefield Integrated Care Board (ICB), the health area that covers Wakefield District (this is slightly different to the Wakefield District figures as it includes patients registered in the ICB area but not resident in Wakefield.

Care and support after diagnosis

After diagnosis a dementia care plan is developed with local health services, in most cases through a person’s GP practice . It is expected a dementia care plan will be reviewed at least every twelve months (Alzheimer’s Society, 2023c). Across Wakefield 77.6% of care plans have been reviewed in the last 12 months compared to 73.7% across England (2022/23). Rates fell over the last few years due to the Covid pandemic but are beginning to return to pre-pandemic levels.

Many people with dementia will need additional care and support and some of this will be from family members or friends, classed as unpaid carers. According to the 2021 Census 9.5% of people in Wakefield provide unpaid care. The Wakefield Adult Health Survey carried out in 2023 found that 15% of people who took part classed themselves as care givers. The Adult Health Survey in Wakefield found that 62% of people who took part found providing unpaid care for a family member or friend strengthened their personal relationship with the person they cared for (62%), however, it also caused stress in the family (42%) and took time away from family life (39%) (Wakefield JSNA, 2023). A national survey carried out by the Alzheimer’s Society found those 8 out of 10 people who care for someone with dementia do the majority of caring responsibilities and 3 in 10 also said they didn’t have anyone they felt they could go to for help (Alzheimer’s Society, 2023d).

Sometimes, due to the progression of the dementia symptoms, an individual’s care may become more difficult to manage at home and they may need to move into a residential or nursing care home. Nearly four in ten people (38%) currently living with a dementia diagnosis in Wakefield live in a care home.

Hospital admissions

Unplanned hospital admissions for someone living with dementia can be caused by several factors including some which may be avoidable such as those caused by dehydration, falls and missing medication. A hospital admission may lead to a decline in a person’s health making it difficult for them to return home and lead to additional distress and confusion (NICE, 2020). Rates for all unplanned admissions for people with dementia (aged 65 years and over) in Wakefield for the 2019/20 financial year were 3,547 per 100,000 people, similar to the England average (3,517 per 100,000).

Risk Factors

There is no certain way to prevent all types of dementia, research is still investigating how the condition develops. However, there is good evidence that a healthy lifestyle can help reduce your risk of developing dementia when you are older. Experts agree that what is good for your heart is also good for your brain. Research has shown that by modifying the risk factors 4 in 10 cases of dementia could be prevented or delayed (Livingston, 2020). This means that people can help reduce their risk of dementia by:

• Eating a balanced diet
• Maintaining a healthy weight
• Exercising regularly
• Keeping alcohol within recommended limits
• Stopping smoking
• Keeping your blood pressure at a healthy level

Age is one of the main risk factors for dementia with risk increasing with age, Wakefield has a slightly higher percentage of the population aged 65 years and older (19.0%) compared to England (18.5%) but similar to Yorkshire (19.1%). The latest Quality Outcomes Framework (QOF) data collected by GP practices (2022/23) give prevalence rates of obesity for Wakefield (14.7%) showing they are higher than the national (11.4%) and local area (West Yorkshire ICB) averages (12.6%) and hypertension levels in Wakefield (16.2%) are similar to those nationally (14.4%). Data from the 2023 annual population survey show smoking prevalence in Wakefield to be 14.8% which is similar to West Yorkshire ICS (14.9%) and England levels (13.6%), the Wakefield JSNA has more information on smoking in the District here .

The population profile in Wakefield District is changing with a greater proportion becoming over the age of 65 years in the next decade, this will increase the number of people in the District who develop dementia. The Projecting Older People Population Information System (POPPI, 2023) predicts an increase in the number of people aged 65 years and over in the District who have dementia (diagnosed and undiagnosed) from the current estimate in 2023 of 4,019 to 7,186 by 2040, an increase of nearly 80%. Projecting current GP diagnosis rates to the 2040 Wakefield population projections suggests an increase in diagnoses for adults aged 30 years and older from 2,866 to 4,443, an increase of 55%. As numbers increase it will be important to make sure that support and care are available for this population.

In November 2023 SystmOne GP record data was extracted to look at all patients currently living with dementia. This showed that in Wakefield District six in ten people diagnosed with dementia are female, two in five are aged 85 years or older and nearly four in ten (38%) currently live in a care setting. Of those who had an ethnicity recorded nearly all were white (99%). Using these data shows that there is variation in the prevalence of those living with dementia in different wards across the district with Wakefield East (773 per 10,000), South Elmsall and South Kirkby (597 per 10,000) and Knottingley (559 per 10,000) having the highest prevalence in people aged 65 and over and Wakefield Rural (286 per 10,000), Stanley and Outwood East (286 per 10,000) and Ackworth, North Elmsall and Upton (177 per 10,000) having the lowest.
In the 2021/22 financial year there were 2,068 unplanned admissions in Wakefield District for people living with dementia (Hospital Episode Statistics (HES) data extract, 2023), this equates to 319 unplanned admissions for people living with dementia per 10,000 65+ year olds. This was a slight increase from 2020/21 but differences may be in part due to Covid. From 2017/18 to 2021/22, the annual numbers of unplanned admissions for dementia patients in Wakefield has stayed relatively constant, between 2,000 to 2,500 cases per year.
The majority of hospital stays recorded for 2021/22 were between 1-5 (25.9%) days, but a significant minority were at least 50 days (5.5%) (Source: HES data extract). When exploring the impact of different factors on hospital admissions, four out of 10 admissions were for people aged 85 years and older and 3 out of 5 were for female patients. The three most common primary diagnosis code groupings listed on admissions were:

• Injuries and fractures due to falls
• Respiratory infections including pneumonia
• Heart and circulatory disease

Electoral Wards with the highest unplanned hospital admission rates for people living with dementia per 10,000 65+ year olds for 2021/22 were: Knottingley: 478, South Elmsall and South Kirkby: 465 and Hemsworth: 460. When exploring directly standardised mortality rates where dementia was the underlying cause of death (5 year average – 2018-22), Altofts and Whitwood (1,152), Pontefract North (1,131) and Knottingley (942) had the highest rates whereas Wakefield South (371), Wakefield Rural (318), and Ackworth, North Elmsall and Upton (273) had the lowest per 100,000 65+ year olds.

Some of the variation in prevalence, admissions and mortality from dementia between areas will be due to where care homes and other residential housing schemes for older people who need extra support are based. Some of these specialise in dementia care, increasing the number of people with dementia in that area. There may also be other reasons for changes in the rates over time such as: variations in mortality rates leading to changes in the prevalence of the disease and differences in diagnosis rates between GP practices. Differences may also be due to varying life expectancy in different areas of Wakefield District as prevalence becomes much higher in people aged 80+ years and in some areas of Wakefield lower life expectancy and increased risk of death from other causes will reduce the number of deaths from dementia.

The interactive dashboard below gives some further information and figures for dementia rates in each ward, a map showing care homes and the number of beds and demographic profiles of those diagnosed with dementia in Wakefield District: