Study And Analysis Of Impact Factors And Health Service Of Dementia In Shanxi Province

BackgroundFollowing the heart disease, cancer, and stroke, Alzheimer is becoming the fourth leading cause of death among the elderly. In the World Alzheimer Report2009, ADI estimated that36million people worldwide are living with Senile Dementia (or Alzheimer Disease, AD), with one new case every seven seconds. The economic burden of dementia has increased76%in the past25years. The aging process of China's society is accelerating, and the problem will get even worse. The incidence rate of dementia will increase by above100%in the coming20years. Dementia brings overwhelming disease burden to the patients, families and the country as well. The name of "Dementia" is not new to most Chinese people, but few of them really know about it. The majority regards it as a part of normal aging, and does not understand the progressive pathological changes from incubation to onset. Many people do not have any knowledge about how to prevent or treat, nor about how to take care of patients. Other problems include that limited medical facilities, limited medical caregivers, lack of capital investment, and so on. Thus, it is important and meaningful for putting forward suggestion to investigate and analyze the status quo, the economic burden of senile dementia.ObjectivesIn this study, the economic burden of dementia in Shanxi province was learned and analyzed; The epidemiological survey was earned out to collect the epidemic data about dementia in Shanxi province and to explore the potential risk factors which influence the dementia's development; The relevance of empty nest elderly people and the dementia's morbidity was analyzed; The elderly's cause of death was analyzed, especially the dementia patients. Therefore, scientific basis was provided for the government and policy-maker to make proper plans of mental health service for elderly people and to establish intervention and prevention measures of dementia for the urban communities and rural counties in Shanxi. Subjects and methodsSubjects:The subjects include two parts:For analyzing the economic burden of dementia,29dementia inpatients was selected form2009-2010in the Mental Health Department of Taiyuan central Hospital, including22females and7males; And another10non-dementia inpatients in the same department were selected too, including4males and6females.The epidemiological survey of dementia was carried out in August2008, May2009and July2011respectively. The elderly people (Born before30, June,1948) who live in Kangle District and Zhuangzi County in Jinzhong City were surveyed as the subjects. First, the dementia patients were screened in2008; Second, the impact factors were analyzed in2009,1124cases were surveyed and1029effective cases were obtained; Third, the elderly's death causes were surveyed within the former group in2011, and909effective cases were obtained.Methods:By using self-made Economic Burden Questionnaire of AD, the data were collected, and the Disability Adjusted Life Years-DALYs was applied to measure the economic burden of dementia in Shanxi province preliminarily.The Geriatric Mental State Schedule (GMS) was introduced in Shanxi province, which was created by the Professor Copland in Geriatric Mental State Resource Centre of Liverpool University, and combined with other scales to analyze the mental status of elderly people. By clustering sampling, and using the above scales, the subjects were surveyed systematically and comprehensively. By using the Automated Geriatric Examination for Computer Assisted Taxonomy-AGECAT computer diagnostic system, the elderly's mental status was classified. The data which were input in the computer using EpiData3.1, were then analyzed by SPSS13.0software. The methods, such as descriptive analysis, chi-square test, unconditioned Logistic regression analysis, were used to study the relevance between factors (age, gender, martial status, physical disease, interests and so on) and the dementia.By using VA (Verbal Autopsy) tool, the door-to-door interviews of the dead's informant were conducted. Usually the spouse, children or other direct relatives of the dead, who take care of him/her at least in the last month, were chosen as the informant. Then the specific death causes were identified by the physician according to the VA tool and were classified and coded in line with the ICD (international classification of diseases) Findings and discussion1. The economic burden of dementia in Shanxi:The direct cost of dementia patients during the treatment is3times higher than the control group, and the DALYS is higher than the control group.2. The prevalence of dementia:According to this study, the prevalence of dementia in Shanxi urban community and rural county is3.7%(with urban community1.6%, and rural county5.8%).The prevalence of dementia in rural counties is almost3times higher than in the urban communities.3. Risk factors of Dementia:Single factor analysis indicates that statistical significance was found between different ages, regions, professions and education levels. The prevalence rate is2.0%,2.5%,13.6%for age group60-69,70-79, and80or above, respectively. According to the trend X2analysis, the elder the people, the higher the prevalence rate of dementia (X2=20.671,P<0.001); The prevalence rate in rural counties (5.8%) is higher than in the urban communities (1.6%)(X2=12.743,P<0.001), and it is higher in farmers (4.9%) and housewives (6.8%)(Fisher exact probability, P=0.003); Moreover, the dementia patients were more likely to be found in illiterate people (8.2%) or people completed primary education (1.6%) or junior secondary education (1.7%)(Fisher exact probability,P=0.000).The prevalence of dementia in females is higher than in males, but the difference is not significant because of other factors influence. And it needs to be further investigated. The prevalence of dementia in on-smokers is higher than in smokers (non-smoker4.8%, smoker2.4%,X2=4.203, P=0.040), so smoke is a protective factor. There is no significant difference in drink and non-drink people. The study also found that the prevalence of dementia in elderly people who take exercise frequently is lower than those who seldom do(4.1%), so taking exercise is a protective factor for dementia (X2=6.676, P=0.010).This study shows that the dementia's prevalence rate of the elders with hearing problems (7.1%) is higher than those without hearing problems(2.9%); The dementia's prevalence rate of elders with kidney disease (12.5%) is higher than those without the disease (3.2%)(Fisher exact probability, P=0.028)。 Moreover, the correlation between the dementia and the elder's performance state was analyzed by using the ADL scale. It found out that the more dependent the elder's become, the higher the dementia's prevalence rate.In the analysis of multi-factor regression, it shows that aging is the risk factor. People aged above80possess higher prevalence rate. And the prevalence rate in people live in rural counties is4.833times higher than those live in urban communities. The dependent elder is (2.058times) more likely to develop the dementia than the independent elders. The elder with hearing problems is (2.568times) more likely to develop the dementia than those without. While the support from neighbours is a protect factor for dementia. The elders who like to communicate with friends or neighbours are less likely to develop dementia.4. The correlation between empty nest elderly and dementia:In this study, there are624empty nest elderly people, which accounts for60.7%of the total1029effective cases. And within them,317are females, occupying59.6%; while307are males, occupying61.9%. There are more empty nest elderly people in urban communities (73.5%) than in rural counties (48.2%). After the study of four living conditions of elderly people, it is found that there are more widowed or single living elderly people in rural counties (11.9%) than in urban communities (9.6%). Comparing with the urban communities, there are more elderly people live with their spouse and children together (36.2%), while less elderly people live with spouse (36.3%).The study indicates that spouse is a protective factor for dementia. The prevalence of dementia in widowed or single living elderly people (4.6%) is higher than in those non-widowed people (3.6). The prevalence of dementia in people who live with their spouse and children together is lower than in people who live by their own or live with spouse.The study also states that "empty nest" would not only impact the elderly's quality of life, lower their self-care capacity, lead to loneliness and depression, but also is a risk factor for dementia. It is crucial to solve the empty nest problem and improve the prevention working of dementia.5. Analysis on death causes of dementia patientsThis study demonstrated that the dementia is a risk factor of accelerating the death process, and the death rate of dementia patients (42.1%) is much higher than that of non-dementia ones (8.6%). The following conclusions were made:First, the heavy disease burden of dementia leads to the exhaustion of the caregivers, both physically and psychologically. And the patients died accidentally due to lack of satisfactory care. Second, the dementia patients'self-care skills is poor, and the activity's range is restricted which gradually lead to the degeneration of organ function. Third, there is10%dementia patients were converted from depression patients. The depression patients suffered mentally and physically, and eventually developed to dementia and death. In short, dementia brings severely negative impacts to the society and families. The key impact factors must be found and be effectively prevented and intervened to face the disease.