Statistical commentary: Dementia profile, April 2020 data update
Updated 5 October 2021
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This publication is available at https://www.gov.uk/government/statistics/dementia-profile-updates/statistical-commentary-dementia-profile-april-2020-data-update
New in this update
In total, 41 indicators have been updated in the dementia profile. Data used covers the financial year 2018 to 2019 or calendar year 2018, unless stated otherwise. For the full list, see the ‘recent updates’ section (April 2020) of the dementia profile.
One new indicator has been added: Dementia: Prescriptions of anti-psychotic medication in the last 6 weeks for patients with dementia and no diagnosis of psychosis.
Revisions have been made to the International Classification of Diseases 10 (ICD) codes used to define the dementia cohort and now includes dementias and Alzheimer’s Disease. The changes affect 17 indicators based on the Hospital Episodes Statistics database (HES) and the Office for National Statistics (ONS): Public Health England Annual Mortality Extract datasets. The indicators have been backdated 3 years and use the latest geographical boundaries.
Summary
The main points for this update are:
- prevalence of dementia in the under 65 age group has reduced significantly from 3.4 per 10,000 in 2018 to 3.2 per 10,000 in 2019, although there has been no significant change in all age prevalence
- the Care Quality Commission (CQC) quality ratings for residential care and nursing home beds rated as good or better has also increased significantly from 68.6% in 2018 to 73.0% in 2019
- short stay emergency admissions as a proportion of all emergency admissions of people with dementia aged 65 years and over has continued to rise – this proportion has increased significantly from 30.8% in the financial year ending 2018 to 32.4% in the financial year ending 2019
- the proportion of people with dementia dying at home has continued to increase with a significant rise from 9.9% in 2017 to 10.4% in 2018
- the proportion of people with dementia dying in hospital has continued to decrease with a significant reduction from 30.4% in 2017 to 29.8% in 2018
Findings
All values are given at England level. A value change is significant if the 95% confidence intervals do not overlap with the confidence intervals values for the year before. Variance is tested using a 2-tailed Fisher’s F test which determines whether the variance between the 2 years is equal. Significance is determined using the p value (p < 0.05). A significant value means that the variation between the 2 years is significantly different.
Prevalance domain
The prevalence domain of the dementia profile contains 5 indicators. Four indicators are shown in Figure 1.
Figure 1: Indicators overview
| Indicator | Value | Percentage change (compared to last year) | Trend |
|---|---|---|---|
| Prevalence (aged under 65): | |||
| People with dementia (aged under 65 years) as a proportion of all people of all ages with dementia per 100 – December 2019 | 3.4% | -6.5% (significant reduction) | No trend (3 years) |
| People with dementia: Crude recorded prevalence (aged under 65 years) per 10,000 – December 2019 | 3.2 per 10,000 | -5.9% (significant reduction) | No trend (3 years) |
| Prevalence (aged 65 and over): | |||
| People with dementia: Recorded prevalence (aged 65 years and over) - December 2019 | 4.3% | 0.2% (no significant change) | No trend (5 years or 7 data points) |
| Rate of people newly diagnosed with dementia registrations (Experimental) per 1,000 – financial year 2018 to 2019 | 11.4 per 1,000 | 3.0% (significant increase) | No trend (4 years) |
Prevalence
The recorded prevalence for people aged 65 years and over was 4.3% in December 2019, which was not a significant change compared to December 2018. However, the recorded prevalence for dementia in people aged under 65 years decreased significantly to 3.2 per 10,000 in December 2019. Within the recent available data, there is no visible trend for either of the age groups.
Figure 2: Dementia recorded prevalence by age group (under 65 years and 65 years and over) – snapshot as of end of December for years 2017 to 2019, England
In 2019, the dementia prevalence for people aged under 65 varied across the Clinical Commissioning Groups (CCGs) in England from 1.3 per 10,000 to 7.0 per 10,000. This variation was statistically lower than in 2018 (F-value =1.4, p = 0.022).
Supporting well domain
The supporting well domain of the dementia profile contains 9 indicators that describe the quality and provision of care home services and usage of inpatient hospital services by people with dementia in England. Four of the indicators are shown in Figure 3.
Figure 3: Indicators overview
| Indicator | Value | Percentage change (compared to last year) | Trend |
|---|---|---|---|
| Emergency admissions: | |||
| Short stay emergency admissions as a proportion of all emergency admissions for people with dementia aged 65 years and over – financial year 2018 to 2019 | 32.4% | 5.0% (significant increase) | Increasing (7 years) |
| Direct standardised rate of emergency admissions for people aged 65 years and over per 100,000 – financial year 2018 to 2019 | 3,479.8 per 100,000 | 0.3% (no significant change) | Increasing (7 years) |
| Residential care and nursing homes: | |||
| The percentage of residential care and nursing home beds with a CQC rating of good or better for people with dementia aged 65 years and over – monthly snapshot January 2020 | 73.0% | 6.3% (significant increase) | Increasing (3 years) |
| Percentage of CQC residential care and nursing home beds assessed for people with dementia aged 65 years and over – monthly snapshot January 2020 | 96.2% | 2.2% (significant increase) | Increasing (3 years) |
Hospital emergency admissions
The proportion of emergency hospital admissions for people with dementia aged 65 years and over classed as short stay (one night or less) in England increased significantly from 30.8% of emergency admissions for this group in the financial year 2017 to 2018, to 32.4% in 2018 to 2019. The proportion of short-stay admissions has increased significantly every year since the financial year 2013 to 2014 except in 2016 to 2017, where there was no significant change.
Overall, directly standardised rate of emergency admissions increased slightly this financial year from 3,470.8 per 100,000 to 3,479.8 per 100,000. The rate of emergency admissions has increased significantly every year since the financial year ending 2013 up until last year. This is the first year during the 7-year period shown in Figure 4 there has been no significant change.
Figure 4: Dementia direct standardised rate of emergency admissions and Dementia short stay emergency admissions (aged 65 years and over) – financial years ending 2013 to 2019, England
Across CCGs, the variation in the proportion of short stays ranged from 13.4% to 65.2% during the financial year 2018 to 2019. The variation between CCGs increased over the last 2 years of data (F-value 1.4, p=0.016).
The rate of emergency admissions varies across CCGs from 1,964.0 per 100,000 to 6,507.7 per 100,000 during the financial year 2018 to 2019. Over the last 2 years of data there was no statistical change in the variation between CCGs (F-value 1.1, p=0.443).
Residential care and nursing homes
The percentage of CQC residential care and nursing home beds assessed has increased significantly from 94.1% in 2018 to 96.2% in 2019. The percentage of residential care and nursing home beds for people with dementia aged 65 years and over given a CQC rating of good or better also increased significantly from 68.6% in 2018 to 73.0% in 2019.
Figure 5: Dementia quality rating of good and better for residential care and nursing home beds and percentage of assessed residential care and nursing home beds – snapshot as of end of January for years 2017 to 2019, England
Across CCGs, the variation in the percentage of residential care and nursing home beds (for people with dementia aged 65 years and over) assessed ranged from 85.0% to 100.0%, during 2019. The variation in the proportions between CCGs decreased over the last 2 years of data (F-value 1.8, p=0.0001).
The proportion of residential care and nursing home beds (for people with dementia aged 65 years and over) rated good and better across CCGs ranged from 25.6% to 100.0% during 2019. Over the last 2 years of data there was no statistical change in the variation between CCGs (F-value 1.1, p=0.598).
Dying well domain
The dying well domain of the dementia profile contains 5 indicators that describe place of death for people with dementia. Three of these indicators are shown in Figure 6.
Figure 6: Indicators overview
| Indicator | Value | Percentage change (compared to last year) | Trend |
|---|---|---|---|
| Place of death | |||
| Place of death – home: People with dementia aged 65 years and over – calendar year 2018 | 10.4% | 4.8% (significant increase) | Increasing (7 years) |
| Place of death – hospital: People with dementia aged 65 years and over – calendar year 2018 | 29.8% | -2.0% (significant reduction) | Decreasing (7 years) |
| Place of death – care home: People with dementia aged 65 years and over – calendar year 2018 | 58.1% | 0.04% (no significant change) | No trend (7 years) |
Note: These values will not add up to 100% exactly due to a small proportion of deaths that will have occurred at other locations.
Place of death
People dying with dementia are most likely to die in a care home, accounting for 58.1% of deaths in calendar year 2018.There has been no sign of significant change in the last 7 years. However, the proportion of people with dementia dying at home has slowly increased since calendar year 2013. In 2018, the proportion of people dying at home increased significantly from 9.9% in 2017 to 10.4% in 2018. Across CCGs in England, the proportion of people with dementia dying at home in 2018 ranged from 5.0% to 23.5%. There was no statistical change in the variation in proportions between 2017 and 2018 (F=1.1, p=0.655).
Figure 7: Place of death for people dying with dementia in calendar years 2012 to 2018, England
In contrast, the proportion of people with dementia dying in hospital has decreased since calendar year 2013, except for 2017, when it increased. The proportion of people dying in hospital decreased significantly from 30.4% in 2017 to 29.8% in 2018. The proportion of people dying in hospital across CCGs ranged from 13.3% to 56.1% in 2018. There was no statistical change in the variation in proportions between 2017 and 2018 (F=1.0, p=0.867).
The proportion of people dying with dementia in care homes has fluctuated since 2012, with no significant change over the last 2 years. The overall proportion has remained around the same in both 2017 and 2018. Across CCGs in England, the proportion of people dying in care homes ranged from 25.8% to 73.2%. There was no statistical change in the variation in proportions between 2017 and 2018 (F=1.0, p=0.764).
Background and further information
Definition of dementia
Dementia is an umbrella term for a group of diseases that permanently damage the brain. The 3 most common forms of dementia are Alzheimer’s disease (60% to 70% of all dementias) followed by vascular dementia (15% to 20%) and mixed dementia (10% to 15%).
For datasets in the dementia profile that use the International Classification of Diseases coding structure, dementia is defined as:
- F00 – dementia in Alzheimer’s disease
- F01 – vascular dementia
- F02 – dementia in other diseases classified elsewhere
- F03 – unspecified dementia
- G30 – Alzheimer’s disease
- G31.0 – circumscribed brain atrophy
- G31.8 – other specified degenerative diseases of nervous system
For the datasets in the dementia profile that use the Read code classification, dementia is defined using the Quality and Outcomes Framework (QOF) business rules 2018 to 2019.
Dementia profile
The dementia profile was first published in January 2016. The profile now contains a total of 43 indicators distributed across 6 domains. The structure of the profile reflects the Organisation for Economic Cooperation and Development dementia pathway and the NHS England Well Pathway for dementia. The 6 domains are:
- prevalence
- preventing well
- diagnosing well
- living well
- supporting well
- dying well
Indicator data is presented at Sustainability and Transformation Partnership (STP), Clinical Commissioning Group (CCG) and Local Authority (LA) geographies and gives local commissioners and providers the information they need to benchmark current practice against other CCGs, LAs and England. Data is available online and as a download document. Data sources and indicator methodologies are available within the definitions section of the online version of the profile.
Responsible statisticians: Michael Jackson, Emma Hodges, Katie Dowden.
Product Leads: Julia Verne.
For queries relating to this publication, please contact mhdnin@phe.gov.uk