Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

The Alzheimer Society of Finland insisted on a National Memory Strategy for Finland by collecting over 14,000 names on a petition in 2010. The Finnish Ministry of Social Affairs and Health started the development process for National Memory Strategy in December 2010 by setting up a working group consisting of 18 professionals including a representative from the  Alzheimer Society of Finland. The Strategy went through a commentary round in November 2011 and was released on 5 May 2012.

The English translation for the Finnish National Memory Strategy 2012-2020 is in process.

Duration of the National Dementia Strategy

The Strategy is valid from 2012 to 2020. It involves recommendations for policymakers. The actual implementation plan will be in liaison with a vast National Development Programme for Social Welfare and Healthcare (Kaste) with the National Institute for Health and Welfare. The implementation plan is in process.

How the National Dementia Strategy is funded

The development of the Strategy was funded by the Finnish Ministry of Social Affairs and Health. However, there is no mention in the Strategy of the funding for the various measures proposed.

Provisions or procedure for implementing the Strategy

The funding of the implementation plan is still to be determined. 

Procedure for monitoring progress made in achieving the goals set

The same as mentioned above.

Involvement of the Alzheimer association (and/or people with dementia)

The Alzheimer Society of Finland had one representative in the working group. There were no people with dementia involved. The Alzheimer Society of Finland recommended regional forums on the matter to ensure that people with dementia would be heard.

Alzheimer association’s overall assessment of the National Dementia Strategy

The Alzheimer Society of Finland is pleased to see the Strategy taking a firm stance on brain health and the prevention of memory-related diseases. Rehabilitation – in addition to good care, is also one of the four basic principles, and the right for self-determination is pinpointed as well. These are important aspects concerning the well-being and the quality of life of people with dementia.

The Society is now expecting a strict policy for the implementation and monitoring of the Strategy, including firm time schedules and details of the organisations in charge.

Diagnosis, treatment and research

Timely diagnosis in the National Dementia Strategy

A significant proportion of people with dementia are still not diagnosed, which leads to the excessive use of social and health services and is also extremely costly to society. That is why public and occupational healthcare professionals have to recognise early memory problems and direct people to memory examinations when required. The aim is to diagnose dementia and start medical treatment and good care and rehabilitation as early as possible. The investment in the good expertise of social and healthcare professionals is needed.

Which healthcare professionals are responsible for diagnosing dementia

In Finland, there is a memory nurse in every municipality whom older people can consult should they have concerns about their memory. These nurses are fully trained to administer the MMSE and if they detect a problem, they can make a report which the person can then take to the doctor. The municipalities are obliged to provide such a service and the memory nurse can visit people in their own homes.

Required tests to diagnose dementia

CT or MRI scans are often carried out and MMSE used. These are not obligatory but often used as part of the thorough examination carried out by specialists which are necessary if the AD drugs are to be reimbursed.

Issues related to medical treatment in the National Dementia Strategy

As stated above, one of the aims in the National Dementia Strategy is to start medication early and to ensure that healthcare professionals have the sufficient expertise.

The availability of medicines in general

In Finland, medicines are generally reimbursed at a level of 42% of the cost of medicines. Nevertheless, for serious and chronic conditions, the reimbursement system lists a number of medicines for which the reimbursement can be 72% of the cost or a refund of 100% of costs exceeding EUR 3 per product. Should the total pharmaceutical expenses of an individual exceed EUR 675.39 in a year, the excess of EUR 1.50 per product prescribed is refunded[1].

The availability of Alzheimer treatments

All AD drugs are available in Finland and are part of the reimbursement system.

Conditions surrounding the prescription and reimbursement of AD drugs

The reimbursement system does not provide a list of specific examinations to be carried out, but for Alzheimer treatments to be reimbursed a diagnosis of Alzheimer’s disease must be established by a specialist who carries out a thorough examination which often includes a CT or MRI scan. There are no upper or lower MMSE limits for treatment with different AD drugs. Any doctor can prescribe Alzheimer treatments, but to be reimbursed, the prescription must be accompanied by a statement from a specialist doctor. There are no restrictions as to the access of people living alone or in nursing homes to available Alzheimer treatments. In open wards, the normal reimbursement continues, whereas for formal institutional care, the institution covers the cost of these medicines.

Issues relating to research

Research and the competence of social and healthcare professionals is one of the four basic principles of the Strategy. Multidisciplinary and coordinated research is seen essential to combat the challenge that dementia builds on public health services and economy.

We have and need high-quality, versatile and nationwide research. Research on brain health, diagnostics and care services has already helped to develop new innovations, but we still need more on the psychosocial support and the possibilities of technology for the people with dementia. We also need to ensure that research results are rapidly transformed into action especially in the public healthcare services, so that practice is evidence based.

Finland is involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) and is an Associate partner in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

Any additional medical or scientific issues covered in the National Dementia Strategy

The Strategy has four basic principles:

1) Brain health is a life-long theme

Everyone needs to take care of their own brain health throughout life, but it has to be taken into consideration in every sector of the society, for example in social and health services and in education and community planning.

2) Memory-related diseases touch us all – attitudes matter

The negative and discriminative attitudes towards dementia have diminished the well-being of people with dementia. The attitudes need to be shifted in order to people with dementia living a meaningful life as an equal member of the society.

3) Good care pays off

The goal is to have a solid chain of social and health services, which are planned and coordinated. Medical treatment and rehabilitation support living at home. Palliative care is also being taken into account.

4) Strengthening the research and expertise

Acknowledgements

Heidi Härmä, Senior Expert, Alzheimer Society of Finland

Henna Nikumaa, Project Manager, Alzheimer Society of Finland

Eila Okkonen, Executive Director, Alzheimer Society of Finland

[1] European Commission (2012): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland: Comparative tables