Page 81 - Hospital Authority Convention 2018

Plenary Sessions

P4.1 Living with the Chronic – What Could be Done at Primary 16:15 Convention Hall B
Care

The Challenge of Managing Multiple Chronic Conditions
Guthrie B
Population Health Sciences Division, University of Dundee, UK HOSPITAL AUTHORITY CONVENTION 2018

The challenges faced by health services continually evolve. In the first epidemiological transition, patterns of disease shifted
from being dominated by acute conditions and trauma to non-communicable diseases or long-term conditions. Common
responses by healthcare systems include the widespread dissemination of clinical guidelines and the development of
structured care pathways with disease registers supporting regular recall to structured care. However, we are now in the
midst of a second epidemiological transition with increasing number of people now living with multiple long-term conditions.
It is important to recognise that multimorbidity is in part the price of success. Better survival from acute conditions like stroke,
cancer, premature birth and trauma is a triumph, but it means that more people survive with long-term conditions. Increased
life expectancy is to be celebrated, but in turn contributes to rapid population ageing. However, despite the increase in
multimorbidity, healthcare systems remain built around specialist care organised by body systems most commonly located in
hospitals. Virtually all clinical guidelines are for specific conditions, and are based on evidence from clinical trials that exclude
the majority of people with the condition the guideline is for. Clinical professionals, patients and families often struggle with
optimising the risks and benefits of treatment in complex patients, and in providing effective treatment to those that can
benefit while avoiding futile or harmful treatment in those that cannot. There is no simple solution to the challenges posed by
multimorbidity. This presentation will describe the epidemiology of multimorbidity, the challenges multimorbidity poses for
clinicians, policymakers and guideline developers, and ways in which health services and individual clinicians can respond to
optimise care. Monday, 7 May 2018

P4.2 Living with the Chronic – What Could be Done at Primary 16:15 Convention Hall B
Care

How Can We Respond to the Global Challenge of Dementia?
Wittenberg R
London School of Economics and Political Science, UK
Dementia has huge impacts on the quality of life of people living with the condition and their carers and huge impacts on
society more generally. Around 50 million people worldwide are living with dementia. Rising numbers of older people mean
that worldwide the number living with dementia could treble by 2050.
There are three major challenges to address in responding to this global challenge: prevention, treatment and care. One third
of cases of dementia are potentially preventable. Key risks factors include: in early life, level of education; in mid-life, hearing
loss, hypertension and obesity; and in later life, smoking, depression, physical inactivity, social isolation and diabetes. How
can we best reduce these risks?

There is currently no cure for dementia. All trials of potential disease-modifying drugs in recent years have failed and some
pharmaceutical companies have ceased research and development in this field. Others are currently conducting trials of such
drugs. A new drug which delayed onset of Alzheimer’s disease by three years could reduce societal costs of care by 30%
(before allowing for the costs of the drug). How should healthcare systems best prepare for the potential availability of new
drugs which prove effective but possibly costly?

People living with dementia require timely diagnosis, high quality long-term care and support and ultimately end-of-life
care. Most of this care in high-, middle- and low-income countries is provided by unpaid carers. They too may require care
and support. There are some symptomatic drugs which have been found to be cost-effective. Some non-pharmaceutical
treatments, including cognitive stimulation therapy, have also proved cost-effective in improving quality of life for people with
dementia and carers. How can these interventions be effectively made available to a higher proportion of people living with
dementia?
Tackling these challenges needs international cooperation to promote research and development and to facilitate learning
between countries. To this end, World Health Organization has recently established a Global Dementia Observatory and a
global action plan on the public health response to dementia.

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