Statistical commentary: Dementia profile, March 2018 update

Overview

The following indicators have been updated in March 2018 for every Clinical Commissioning Group (CCG), Sustainability and Transformation Partnership (STP) and local authority (LA) using data covering the financial year 2016 to 2017, unless stated otherwise.

Prevalence

• dementia: recorded prevalence (all ages)
• dementia: recorded prevalence (aged 65+) – as at September 2017
• rate of newly diagnosed dementia registrations (experimental)

Preventing well

• coronary heart disease (CHD): recorded prevalence (all ages)
• depression: recorded prevalence (aged 18+)
• diabetes: recorded prevalence (aged 17+)
• hypertension: recorded prevalence (all ages)
• obesity: recorded prevalence (aged 18+) – CCG only
• smoking: recorded prevalence (aged 15+) – CCG only
• stroke: recorded prevalence (all ages)

Diagnosing well

• DEM005: blood tests recorded (denominator includes exceptions) – CCG only

Living well

• carer-reported quality of life score for people caring for someone with dementia – LA only
• DEM002: dementia care has been reviewed last 12 months (denominator includes exceptions) – CCG only

Supporting well

Alongside adding the new 2016 to 2017 data, historical values for CCG have been recalculated for HES-based indicators within this section due to revised boundary definitions and methodological changes.

• Alzheimer’s disease: directly-standardised rate (DSR) of inpatient admissions (aged 65+)
• dementia: DSR of emergency admissions (aged 65+)
• dementia: ratio of inpatient service use to recorded diagnoses
• dementia: short stay emergency admissions (aged 65+)
• unspecified dementia: DSR of inpatient admissions (aged 65+)
• vascular dementia: DSR of inpatient admissions (aged 65+)

Dying well (all for calendar year 2016)

• deaths in usual place of residence: people with dementia (aged 65+)
• directly age-standardised rate of mortality: people with dementia (aged 65+)
• place of death – home: people with dementia (aged 65+)
• place of death – hospital: people with dementia (aged 65+)
• place of death – care home: people with dementia (aged 65+)

Summary headlines

The ‘Pathway on a page’ domain within the Dementia Profile includes a number of key indicators from across the wider profile. These indicators provide an overview of what the new data in this update shows and are described below. Where data is available, all values within this commentary are given in the format of ‘value (lower confidence interval (CI), upper CI)’. This update shows that:

• the recorded prevalence of dementia in the over 65 population has shown a small but significant increase from 4.29% (4.27, 4.30) in April 2017 to 4.33% (4.31, 4.34) in September 2017
• the recorded prevalence of smoking (a risk factor for dementia) has continued to decline significantly, falling to 17.6% (17.5, 17.6) of the population (aged 15+) in 2016/17 from 18.1% (18.1, 18.1) in 2015 to 2016
• the recorded prevalence of hypertension (a risk factor for dementia) has remained stable at 13.8% (13.8, 13.8) of the population in 2016 to 2017
• the proportion of people receiving a blood test around the time of their dementia diagnosis (recommended as good practice ) has shown a significantly large increase at the England level from 56.5% (56.2, 56.8) in 2015 to 2016 to 67.7% (67.5, 68.0) in 2016 to 2017
• the proportion of people with a diagnosis of dementia who have had their care reviewed in the last 12 months has remained stable for 2016 to 2017 at 78.1% (77.9, 78.2), the same as in 2015 to 2016
• the proportion of the population with a diagnosis of dementia that have used inpatient hospital services has increased significantly in 2016 to 2017 to 55.1% (54.9, 55.3), up from 53.8% (53.7, 54.0) in 2015 to 2016
• the rate of people with dementia who have an emergency admission to hospital has increased significantly in 2016 to 2017 to 3,482 (3,471, 3,494) per 100,000 people with dementia, up from 3,387 (3,376, 3,399) in 2015 to 2016
• the rate of people dying with dementia has dropped from 873 (867, 879) deaths per 100,000 people aged over 65 in 2015 to 868 (862, 873) in 2016, although the difference is not statistically significant
• the percentage of people with dementia who die in their recorded usual place of residence has fallen from 68.6% (68.3, 69.0) in 2015 to 67.9% (67.6, 68.2) in 2016. - a relatively small, but statistically significant, difference

Focus on new indicators

Throughout 2017 to 2018 the Dementia Intelligence Network (DIN) have developed a range of new indicators and made them available on the Dementia Profile.

Young onset dementia

In September 2017, 3 new young-onset dementia indicators were added. People diagnosed with dementia under the age of 65 have different needs and their care and treatment often follows a different clinical pathway. The development of recorded young-onset dementia prevalence indicators provides an insight into the number of people under age 65 who have been diagnosed and are now living with the condition. These indicators are available in a range of geographic areas and can be used to inform local service planning.

These indicators are companions and should be interpreted alongside each other to give a more complete picture of the population living with young onset dementia in an area.

Dementia: crude recorded prevalence (aged under 65 years) per 10,000

The crude recorded dementia prevalence is the number of people with dementia aged under-65 recorded on GP practice registers, as a proportion of all people aged under 65 registered at each GP practice (and then aggregated by geographical areas).

The England level prevalence for this indicator in 2017 is 2.99 (2.94, 3.04) persons per 10,000 people with young-onset dementia on the practice register. LA prevalence values range from 1.12 (0.77, 1.62) to 7.15 (6.14, 8.33). STP values range from 1.79 (1.50, 2.15) through to 4.89 (4.45, 5.38).

Dementia: indirect age-standardised recorded prevalence (aged under-65) per 10,000

The indirect age-standardised recorded dementia prevalence is the odds ratio of observed and expected cases of recorded dementia, standardised to England values. For further details on how this indicator is developed please see the associated metadata.

The England proportion for this indicator is 2.94 (2.89, 2.99). LA figures range from 1.41 (0.99, 2.01) to 6.23 (5.30, 7.32). STP values range from 1.57 (1.11, 2.23) through to 4.84 (3.90, 6.00).

Dementia (aged under 65 years) as a proportion of total dementia (all ages) per 100

The purpose of this indicator is to provide information on the percentage of people with recorded dementia under the age of 65 as a proportion of the total number of people with a recorded diagnosis of dementia.

The England proportion for this indicator is 3.2% (3.2, 3.3). At LA level this value ranges from 1.6% (1.1, 2.3) through to 6.2% (4.9%, 7.8%). STP values range from 1.9% (1.6, 2.3) through to 4.7% (4.3, 5.1).

Recorded cases of dementia

Rate of newly diagnosed dementia registrations (experimental)

This indicator, added to the profile in July 2017, shows newly diagnosed cases being added to dementia registers (assessed for payment under the quality outcomes framework business rules) as a proportion of the registered practice. This is expressed as a crude rate per 1,000 patients registered at the GP practice (aged 65+).

The indicator provides insight into the number of patients who are newly registered for dementia with their GP and is a proxy for an incidence rate; it should be considered as experimental.

In England, the rate of people newly registered with dementia in 2016 to 2017 was 11.3 (11.2, 11.4) per 1,000 people, falling significantly from 12.7 (12.7, 12.8) in 2015 to 2016. At LA geography in 2016 to 2017, the rate varied from 7.5 (6.8, 8.4) through to 15.4 (14.3, 16.5). STP values varied from 7.8 (7.5, 8.2) through to 13.3 (12.7, 13.9) during the same period.

Dementia: recorded prevalence (aged 65+)

This indicator, added in September 2017, quantifies the proportion of people aged over 65 with a recorded diagnosis of dementia. It is shown as the percentage of patients aged over 65 with dementia as recorded on all open and active GP disease registers.

In England the recorded prevalence figure for April 2017 was 4.33% (4.31, 4.34).

For CCG and STP geographic areas, the recorded dementia prevalence is the number of people with dementia aged over 65 recorded on GP practice registers within a CCG, as a proportion of people aged over 65 registered at each GP practice within a CCG. STP figures are derived by aggregating CCG level figures. STP figures range from 3.40% (3.30, 3.50) through to 4.90% (4.80, 5.00).

For LA geographic areas, the GP practice numerator and denominators are allocated to a local authority boundary by the practice postcode and then the same methodology as for CCG/STP is applied. LA figures range from 2.58% (1.54, 4.28) through to 5.49% (5.28, 5.70).

Capacity and quality of residential and nursing care homes

In November 2017 the Dementia Intelligence Network undertook an exploratory exercise into the potential uses of Care Quality Commission (CQC) data. Using a combination of the ‘Care directory with filters’ and ‘Care directory with ratings’ datasets, 3 indicators were developed. These explored the capacity and quality of beds suitable for a person with dementia in residential and nursing care homes.

Dementia: residential care and nursing home bed capacity (aged 65+)

This indicator illustrates the number of residential care and nursing home beds, suitable for a person with dementia (aged 65+), per 100 persons registered with dementia (aged 65+) at various geographic areas. It is highly recommended that this indicator is interpreted together with the 2 companion indicators described below. It is important to note that these figures are based on geographical location (postcode) of a care home and not use of beds by residents of a particular area. Caution should be taken with interpretation as care homes do not necessarily only serve the local population and it may be beneficial to consider larger areas (such as STPs) to get a clear overall picture of bed availability.

In England, the average bed capacity for persons with dementia is 69.2% (69.0, 69.4). LA values range widely from 20.2% (18.9, 21.6) through to capacities which exceed the recorded population of people with dementia in the immediate local area. At STP geographic areas the values range from 44.0% (43.2, 44.9) through to 96.8% (95.0, 98.6).

Dementia: quality rating of residential care and nursing home beds (aged 65+)

This indicator illustrates the percentage of residential care home and nursing home beds, suitable for a person with dementia (aged 65+), which are rated as ‘good’ or ‘outstanding’ by the CQC, per CCG and LA. A CCG or LA may have a low percentage of quality beds due to 2 reasons: the beds have received a low rating from the CQC or a number of beds have received no rating at the point of data collection.

In England, the percentage of beds that were quality assessed as a proportion of all dementia care home beds is 59.7% (59.5, 59.8), with LA values ranging widely from 12.6% (8.8, 17.9) through to a maximum figure of 100%. STP values range from 40% (39.2, 40.9) through to 80% (78.9, 81.0).

Dementia: percentage of assessed residential care and nursing home beds (aged 65+)

This indicator acts as a companion indicator for the indicator above. It provides information about the percentage of residential care home and nursing home beds, suitable for a person with dementia (65+), which have been subject to an assessment from the CQC within each CCG, STP or LA.

In England, 88.2% (88.1, 88.3) of beds had been assessed as of 1 April 2017, with LA area values ranging from 61.8% (58.7, 64.8) through to full coverage (100% of beds assessed) and STP areas ranging from 75.1% (73.9, 76.3) through to 95.8% (95.3, 96.3).

Background and further information

This commentary has been developed using data included in the Dementia Intelligence Network (DIN) Fingertips profile. The profile provides indicators arranged into six data domains:

• prevalence
• preventing well
• diagnosing well
• living well
• supporting well
• dying well

Data is available by STP, CCG and LA geographic areas and gives local commissioners and providers the information they need to benchmark current practice against other areas. Data and metadata are available online and as a downloadable document.

View the dementia profile.