Alzheimer's disease intheUnited Kingdom: developing patient andcarersupportstrategies to encouragecareinthecommunity

Alzheimer's disease isagrowing challenge forcareproviders andpurchasers. With theshift awayfromtheprovision oflong terminstitutional careinmostdeveloped countries, thereisagrowing tendency for patients withAlzheimer's disease tobe caredforathome.IntheUnitedKingdom,thischangeofdirection contrasts withthepolicies ofthe1980sand90swhich focusedmore attention on controlling coststhanonassessment oftheneedsof thepatient andcarerandpatient management.Inrecent years, theresources availableformanagementof Alzheimer's disease havefocused oninstitutional care, coupled withdrugtreatmenttocontrol difficult behaviour asthedisease progresses. Forthese reasons, thecurrent systemhasledtocrisis managementrather thanpreventive support-that is,long termcareforafewrather thanassistance inthehomebefore thecrises occurand institutional careisneeded. Despite recentinnovations inthecareofpatients withAlzheimer's disease, thenatureofthe support thatpatients andcarersreceive is poorlydefinedand sometimesinadequate.Asaresult oftheshift towardscare inthecommunity, theinformal carer occupies an increasingly central rolein thecareofthesepatients andtheissueof how thebestquality ofcaremay be defined anddelivered isanissue whichis nowripeforreview. Theobjective ofthis paperistoredefine thetypeofsupport thatpatients andcarersshouldreceive so thatthedisease canbe managedmore effectively inthecommunity. Theneedsof patients withAlzheimer's disease and theircarersaremanyandthisshouldbe takenintoaccountindefining thequality andstructure ofhealthcare support. This papershowshow new initiatives, combinedwithrecently available symptomatic drugtreatment, canallowpatients with Alzheimer's disease tobemaintained at homeforlonger. Thiswillhavethedual impactofraising thequality ofcarefor patients andimproving thequality oflife fortheircarers. Moreover, maintaining patients inahomeenvironment willtend tolimit public andprivate expenditure on institutional careduetoapossible delay in theneedforit. (Quality inHealth Care1997;6:146-152)