Dementia Care Mapping and Patient-Centred Care in Australian residential homes: An economic evaluation of the CARE Study, CHERE Working Paper 2008/4

Background

By 2030 the number of Australians aged 65 years or more is expected to increase to
over six million, of which 944,000 are expected to be aged over 85.[1] This represents
a 108% and a 154% increase respectively from 2008 figures.[1] The Australian
Institute of Health and Welfare estimates that the number of people with dementia
will increase from 175,000 in 2003 to 465,000 in 2031.[2] With the increasing
prevalence of dementia, health care costs associated with the condition are predicted
to increase by 225% between 2003 and 2030/1.[2]

The presence of behavioural and psychological symptoms of dementia (BPSD)
including agitation, aggression, resistance to care, hallucinations and delusions, are
often the main reason (or a significant contributory factor) for the admission of
persons with dementia to residential care [3]. Both pharmacological and behavioural
management techniques are used to assist in managing and minimising BPSD [4]
although behavioural techniques are more labour intensive. One of the issues faced by
the health care system is how to maintain acceptable standards of care and quality of
life for persons with dementia in the context of finite resources [5]

There is a significant association between dementia severity and the annual costs of
the disease, with costs increasing as the disease progresses. Direct costs include
prescribed medications [2, 3] specialist medical consultations and non-medical
services, such as respite and residential care. Indirect costs associated with increasing
severity include changes in care worker productivity, increased absences from work
and decreased caring ability as well as intangible costs, such as distress and lowered
quality of life in persons with dementia and their caregivers.

Individually tailored behavioural interventions have been identified as the most
promising way of supporting a persons’ quality of life [6]. However, as the residential
care sector is staffed mainly by people without specialist dementia care training, their
ability to incorporate behavioural techniques into day-to-day care is limited Two
accessible approaches to care are Dementia Care Mapping (DCM) and Person
Centred Care (PCC). However, as both require significant levels of staff training and
follow-up it is important to assess the extent to which the additional costs associated

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