Framework for strategic foresight in dementia care in Portugal
Main Article Content
Abstract
Introduction: Neurological disorders have become the leading cause of global disease burden, posing a significant public health challenge. With an aging global population, conditions like Alzheimer's disease and other dementias are expected to increase demands on healthcare services. Variations in risk factors and healthcare services across the country are impacting the diagnosis, treatment, care, and support, with many regions lacking sufficient resources. Additionally, there is a need to improve monitoring of dementia-related metrics and advance research, particularly regarding treatment and access to clinical trials. This study provides an overview of the current care landscape for dementia patients by analyzing real-world-based data. Gaps and challenges in dementia care, as well as suggestions for optimal care, are discussed.
Methods: Three plenary sessions were held, gathering healthcare professionals experienced in dementia care, along with representatives from patient associations. During these virtual meetings, participants shared their insights and discussed the current state of dementia care and treatment in Portugal. Key factors were proposed to guide a roadmap for transitioning from scenario planning to concrete strategic actions.
Results: National dementia care initiatives with implications for care quality were analyzed. The incidence of dementia continues to rise, including in Portugal, although comprehensive data remains limited. Dementia poses a significant healthcare challenge, necessitating a multidisciplinary approach at every stage of the disease.
Conclusion: Countries need detailed national plans that outline how resources will be allocated to enhance dementia awareness, train and support caregivers, and mobilize efforts to reduce risk factors and strengthen research capabilities. These plans should be shaped by input from consumers and adapted to local contexts, aiming to create an inclusive society for individuals living with dementia and their families.
Keywords:
Dementia, Portugal, multidisciplinary care, real-world data, patient-centered care
Article Details
How to Cite
VALVERDE, Ana Maria Herrero et al.
Framework for strategic foresight in dementia care in Portugal.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6118>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.6118.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Gonçalves-Pereira M, Marques MJ, Balsinha C, Fernandes A, Machado AS, Verdelho A, et al. Necessidades de Cuidados e Recurso aos Serviços na Demência: Avaliação Inicial da Coorte Portuguesa no Estudo Actifcare. Acta Med Port. 2019 May 31;32(5):355–67.
3. World Health Organization. Global status report on the public health response to dementia [Internet]. 2021. Available from: http://apps.who.int/
4. Wimo A, Guerchet M, Ali G, Wu Y, Prina AM, Winblad B, et al. The worldwide costs of dementia 2015 and comparisons with 2010. Alzheimer’s & Dementia. 2017 Jan 29;13(1):1–7.
5. Luengo-Fernandez R, Leal J, Gray AM. Cost of Dementia in the Pre-Enlargement Countries of the European Union. Journal of Alzheimer’s Disease. 2011 Oct 28;27(1):187–96.
6. Deuschl G, Beghi E, Fazekas F, Varga T, Christoforidi KA, Sipido E, et al. The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017. Lancet Public Health. 2020 Oct;5(10):e551–67.
7. Luo J, Rasmussen IJ, Thomassen JQ, Frikke-Schmidt R. Modifiable Risk Factors for Dementia: Causal Estimates on Individual-Level Data [Pre-print]. The Lancet. 2024 Oct 15;
8. Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024 Aug;404 (10452):572–628.
9. World Health Organization. A blueprint for dementia research [Internet]. 2022 Oct [cited 2023 May 31]. Available from: https://www.who.int/publications/i/item/9789240058248
10. World Health Organization. Intersectoral global action plan on epilepsy and other neurological disorders 2022-2031. 2023;
11. Portuguese Government. Diário da República n.o 251/2021, 1o Suplemento, Série I de 2021-12-29. 2021.
12. Valverde A, Lopes H, Pavão J, Barros R, Meira B, Albuquerque M. Sustainable Improvements in Dementia Care for an Expectably Increasing Number of Dementia People: Challenges and Opportunities. Med Res Arch. 2023;11(10).
13. Khanassov V, Vedel I, Pluye P. Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review. The Annals of Family Medicine. 2014 Sep 1;12(5):456–65.
14. Huber H. Abstract: Simple Finger Prick Test Exemplifies Advances In Alzheimer’s Disease Blood Tests. In: Alzheimer’s Association International Conference. Amsterdam; 2023.
15. World Health Organization. WHO framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. 2023.
16. World Health Organization. Global expenditure on health: Public spending on the rise? 2021.
17. Lee L, Hillier LM, Heckman G, Gagnon M, Borrie MJ, Stolee P, et al. Primary Care–Based Memory Clinics: Expanding Capacity for Dementia Care. Can J Aging. 2014 Sep 11;33(3):307–19.
18. World Health Organization. Global action plan on the public health response to dementia 2017 - 2025. 2017.
19. Saúde - Gabinete do Secretário de Estado Adjunto e da Saúde. Diário da República n.o 116/2018, Série II de 2018-06-19. 2018;
20. American Geriatrics Society Expert Panel on Person-Centered Care. Person-Centered Care: A Definition and Essential Elements. J Am Geriatr Soc. 2016 Jan;64(1):15–8.
21. Surr CA, Parveen S, Smith SJ, Drury M, Sass C, Burden S, et al. The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study. BMC Health Serv Res. 2020 Dec 5;20(1):512.
22. Pot AM, Petrea I. Improving dementia care worldwide. Ideas and advise on developing and implementing a national dementia plan. 2013.
23. Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet. 2015 Jun;385(9984 ):2255–63.
24. Albuquerque M, Meira B, Barros R, Pavão JF, Lopes H, Valverde AM. Dementia Appraisal: Overview of Good Clinical Practices, Barriers, and Gaps for Integrated Care. International Journal of Geriatrics and Gerontology. 2023 Nov 20;7(1).
25. W. Chan K, Mauborgne R. Blue Ocean Strategy: How to Create Uncontested Market Space and Make Competition Irrelevant. 1st ed. Boston: Harvard Business Review Press; 2005.
26. Kim WC, Mauborgne R. Blue Ocean Strategy: From Theory to Practice. Calif Manage Rev. 2005 Apr;47(3):105–21.
27. Gonçalves-Pereira M, Cardoso A, Verdelho A, Alves da Silva J, Caldas De Almeida M, Fernandes A, et al. The prevalence of dementia in a Portuguese community sample: A 10/66 Dementia Research Group study. BMC Geriatr. 2017 Nov 7;17(1).
28. Ruano L, Araújo N, Branco M, Barreto R, Moreira S, Pais R, et al. Prevalence and Causes of Cognitive Impairment and Dementia in a Population-Based Cohort From Northern Portugal. American Journal of Alzheimer’s Disease & Other Dementiasr. 2019 Feb 4;34(1):49–56.
29. Lopes MJ, Pinho LG de, Fonseca C, Goes M, Oliveira H, Garcia-Alonso J, et al. Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study. Int J Environ Res Public Health. 2021 Jun 30;18(13):7030.
30. Conselho Nacional de Saúde. Sem mais tempo a perder – Saúde mental em Portugal: um desafio para a próxima década. . 2019.
31. Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105–25.
32. Costa J, Borges M, Encarnação R, Firmino H, Gonçalves-Pereira M, Lindeza P, et al. Custo e Carga da Doença de Alzheimer nos Idosos em Portugal. Sinapse. 2021 Jan 20;21(4):201–11.
33. Jessen F, Kramberger MG, Angioni D, Aarsland D, Balasa M, Bennys K, et al. Progress in the Treatment of Alzheimer’s Disease Is Needed – Position Statement of European Alzheimer’s Disease Consortium (EADC) Investigators. J Prev Alzheimers Dis. 2024;
34. Sannemann L, Müller T, Waterink L, Zwan M, Wimo A, Stomrud E, et al. General practitioners’ attitude toward early and pre‐dementia diagnosis of AD in five European countries—A MOPEAD project survey. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. 2021 Jan 23;13(1).
35. Costa E, Pestana J, Barros PP. Primary health care coverage in Portugal: the promise of a general practitioner for all. Hum Resour Health. 2024 Aug 9;22(1):55.
36. Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017 Oct 8;7(10):e017902.
37. Serviço Nacional de Saúde (SNS). Norma no 053/2011 atualizada a 21/04/2023. 2023.
38. Serviço Nacional de Saúde (SNS). MySNS Tempos [Internet]. [cited 2024 Jun 10]. Available from: https://www.sns.gov.pt/apps/te-m-s-tempos-medios-na-saude/
39. Hlavka JP, Mattke S, Liu JL. Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer’s Treatment. Rand Health Q. 2019 May;8(3):2.
40. Gauthier S, Webster C, Servaes S, Morais JA, Rosa-Neto P. World Alzheimer Report 2022: Life after diagnosis: Navigating treatment, care and support. 2022.
41. Jeon YH, Krein L, O’Connor CMC, Mowszowski L, Duffy S, Seeher K, et al. A Systematic Review of Quality Dementia Clinical Guidelines for the Development of WHO’s Package of Interventions for Rehabilitation. Gerontologist. 2023 Oct 17;63(9):1536–55.
42. World Health Organization. Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders. 2023.
43. Instituto S. João de Deus - Telhal. Home360 [Internet]. [cited 2024 Jun 10]. Available from: https://home360appoiar.isjd.pt/index.php
44. Casa do Povo Abrunheira. Casa do Povo Abrunheira [Internet]. [cited 2024 Jun 10]. Available from: https://cpabrunheira.org/
45. Governo de Portugal. Despacho n.o 5988/2018, de 19 de junho. Diário da República.
46. Portugal Compassivo. Projeto Gaia Compassiva – Cidade com Paixão [Internet]. [cited 2024 Jun 10]. Available from: https://www.portugalcompassivo.pt/noticias/projeto-gaia-compassiva-cidade-com-paixao.html
47. Alzheimer Portugal. Alzheimer Portugal obtém certificação internacional [Internet]. [cited 2024 Jun 10]. Available from: https://alzheimerportugal.org/alzheimer-portugal-obtem-certificacao-internacional/
48. Mendonça MD, Alves L, Bugalho P. From Subjective Cognitive Complaints to Dementia. Am J Alzheimers Dis Other Demen. 2016 Mar 3;31(2):105–14.
49. Governo de Portugal. Decreto-Lei n.o 102/2023, de 7 de novembro. Diário da República Nov 7, 2023.
50. Yamakawa M, Kanamori T, Fukahori H, Sakai I. Sustainable nurse‐led care for people with dementia including mild cognitive impairment and their family in an ambulatory care setting: A scoping review. Int J Nurs Pract. 2022 Jun 18;28(3).
51. Governo de Portugal. Resolução do Conselho de Ministros n.o 14/2024. Diário da República Jan 12, 2024.
52. Alzheimer Europe. Helsinki Manifesto. 2024.
53. Portugal Clinical Trials. Portugal Clinical Trials: Advancing Healthier Together [Internet]. [cited 2024 Jun 23]. Available from: https://www.portugalclinicaltrials.com/
54. World Population Review. High-Income Countries 2024. 2024.
55. Federal Reserve Bank of St. Louis. Population ages 65 and above for Portugal. 2024.
56. Jeon YH, Foxe D, Suh GH, Wang H, Dominguez JC, Maukera R, et al. Post-diagnosis dementia care in the Western Pacific region: assessment of needs and pathways to optimal care. Lancet Reg Health West Pac. 2024 Sep;50:101182.
57. Burns A, Robert P. Dementia Care: International Perspectives. Oxford; 2019.
58. Choi M, Kim W, Moon JY, Shin J. The impact of the implementation of a national policy on dementia on healthcare costs in older patients with dementia in Korea: a quasi-experimental difference-in-difference study. Lancet Reg Health West Pac. 2024 Mar;44:101010.