REVIEW – April 2004

Demented person – a burden to society


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The demented person as a burden to society can be regarded in at least three aspects: economic burden to the state, psychoemotional burden to the carer and burden to the systems of health care and social support. Extensive evidence is required to decide which of these should be given priority in the Estonian society today. Yet all people need recognition of the problem as well as support at the level of the state. At present, the number of persons with the diagnosis of Alzheimer`s disease in the USA is about 4.5 million; the respective figure for the Western Europe is approximately 2.5 million. According to investigations conducted in these countries, a family spent USD 5,800 to 18,256 per year for caring their demented member in the last decade. An investigation carried out in Denmark showed that the amount spent for caring a non-demented senior is three- to tenfold smaller than the amount spent for caring a demented senior. Comparison of the material and medical-ethical aspects of the diagnosing and caring of patients with dementia syndrome in Estonia and in developed countries clearly demonstrates the inferiority of our social and health care systems. Among Estonian family doctors less than half are aware of the most common cause of dementia, while majority have no information about the dementia drugs available in the Estonian market of pharmaceuticals. The ability of Estonian physicians to diagnose dementia is inadequate: Alzheimer`s disease is underdiagnosed, the knowledge of the diagnostic criteria for specific dementia forms is insufficient. Such a situation can be explained by the fact that these issues were first dealt with as late as 20 years ago elsewhere in the world. The corresponding activity in Estonia was started with a 15-year delay. Here, the number of patients with dementia syndrome should be at least 10,000 and the number of patients with Alzheimer`s disease 7,000. However, as official statistics does not reflect this, health care leaders cannot make plans, in line with changes in the demographic situation towards the preponderance of the elderly population in the nearest future, consistent with the growing disease burden to society at the expense of this disease group.
Moreover, the aspect of the burden of care has been neglected and an operative counselling system is lacking altogether. According to the data of a pilot study conducted in Estonia the burden to the carer is high. Most of the expenses related to the diseased family member are borne by the family. In the nearest decades the state should take into account additional expenditure arising form the treatment and caring of persons with this diagnosis as well as from the organizing of the support system for the carers.