This section presents data on dementia prevalence and on key risk factors for this condition; information is presented for Bexley, IMD Comparators, London and England.
The latest predictions show that there are estimated to be 2,654 people aged 65+ living with dementia in Bexley; this is expected to rise to 4,659 in the next 20 years.
Figure 3: Predicted number of Bexley residents aged 65+ living with dementia by age group, 2017 – 2035
Whilst there is no current data on the numbers of people with Dementia living in their own homes previous research by Dementia UK (Alzheimer’s Society,2007) has estimated that two thirds of people with dementia living in their own homes and one third living in care homes. Using these national estimates we could extrapolate that 1,768 Bexley residents with Dementia live in their own homes.
 Alzheimer’s Society (2007). Dementia UK: A report to the Alzheimer’s Society on the prevalence and economic cost of dementia in the UK produced by King’s College London and London School of Economics.
NHSE has set national diagnosis targets for dementia of 66.6%.
Of the 2,654 people aged 65+ estimated to be living with Dementia in Bexley 1,777 people aged 65+ years have been recorded on GP registers, a diagnosis rate of 67.2%. Whilst this rate is higher than the national target of 66.6% it is lower than both the England (68.7) and London (71.3) averages and has steadily declined over the past 12 months, from a high of 73.4% in January 2017.
Figure 4: NHS Bexley CCG Recorded Dementia prevalence
A total of 4.6% of patients’ aged 65+ registered with a Bexley GP have dementia; the proportion living with the disease is higher than the IMD Comparators, London and England averages. Bexley’s figure has remained relatively stable in the last 2 years.
Figure 5: Recorded dementia prevalence aged 65+, Sep-15 – Mar-17
Figure 6 shows recorded numbers of patients (aged 65+) with Dementia by Bexley GP Practice. There are significant variations in recorded numbers. It is probable that this is a reflection of the spread of older people across practices – there are more older people in some practice populations than others. Figure 7 shows these numbers as a percentage of the total practice population.
 NHS Digital Underlying GP Practice Level Data, England, November 2017
Figure 6. Numbers of practice population aged 65+ with recorded dementia
Fig 7. Percentage of practice population (aged 65+) with recorded dementia
Impact on acute care
People are not generally admitted to hospital for Dementia. The Alzheimer’s Society report that falls, hip fractures, stroke, urinary tract and respiratory infection are the major causes of hospital admissions for people with Dementia. The National Audit for Dementia 2017 reported that 50% of the primary causes for admissions were either for falls, hip fractures or dislocation, respiratory related or urinary infections.
The number of people with dementia admitted to hospital in an emergency rose by 48% between 2008 and 2013. Around a fifth of these admissions related to potentially preventable acute conditions such as urinary tract infections, pneumonia and other respiratory infections. Nationally, it is estimated that approximately 25% of beds in hospitals are occupied by people living with dementia. Their length of stay is often longer than for people without dementia and there can also be delays in supporting them to leave hospital. A significant number of these admissions could be avoided through better support in the community and greater integration of health and social care services.
The needs of people with dementia and behaviors that challenge which requires more intensive one to one support is emerging as a higher profile issue and is impacting on patient flow though the acute system – more market development is needed to meet this demand going forward.
Figures 9 and 10 and Table 2 present rates of emergency inpatient hospital admissions of people (aged 65+) with a mention of dementia. Bexley’s rate is statistically similar to England and statistically lower than the London averages.
 National audit for Dementia care in hospitals 2016-17. Third round audit report. http://www.rcpsych.ac.uk/pdf/National_Audit_of_Dementia_online_version_FINAL.pdf
 Public Health England. Dementia: Applying all our health 2017. Web access (accessed December 2017) https://www.gov.uk/government/publications/dementia-applying-all-our-health/dementia-applying-all-our-health
 Louise Lakey, Counting the cost. Caring for people with dementia on hospital wards. Alzheimer’s Society (2009)
Figure 9: Directly standardised rate of emergency inpatient admissions with a mention of dementia per 100,000 population aged 65+, 2015/16.
Nationally, the in-patient emergency hospital admissions with a mention of dementia has been rising steadily due to a combination of acute care clinicians becoming more effective at identifying dementia symptoms and recording dementia diagnoses. Bexley, London and our IMD comparator group mirrors this trend with the latest figure being 23% higher than the baseline 2012/13 rate.
Table 2: Directly standardised rate of emergency inpatient admissions with a mention of dementia per 100,000 population aged 65+, 2015/16.
Figure 10: Directly standardised rate of emergency admissions for dementia per 100,000 population aged 65+, 2012 – 2016
Admissions to hospital, particularly ones of short duration should be avoided if possible for this population, since people with dementia are particularly sensitive to changes in the surrounding environment which can increase the levels of anxiety and stress for an individual.
Table 3 highlights that 27.8% of these emergency inpatient admissions for people where dementia is mentioned are short stay (1 night or less). Whilst this figure is similar to the England average it has been significantly increasing since 2012/13, either due to lack of alternative provision or improvements in coding for dementia. It is probable that the increase is amongst the frail older population. Alternative models and pathways for the frail older population need to be explored to prevent short-stay admissions to hospital.
Table 3: Short term emergency admissions for dementia, 2015/16
Figure 11: Percentage of emergency admissions for people (aged 65+) with dementia that are short stays, 2012 – 2016.
Figure 12: Percentage of emergency admissions for people (aged 65+) with dementia that are short stays, 2015/16.
The proportion of people on dementia GP registers that receive inpatient care has been falling in Bexley and its comparator areas – mirroring the national and London pattern. The latest figure for Bexley shows that 53% of people diagnosed with dementia had been admitted to hospital in 2015/16 – this figure had reduced by quarter in the last four years. It is likely that this is a result of improvement in diagnosis rates and improved care received through GPs, the voluntary sector and Bexley Care.
Table 3 and Figures 13 and 14 show percentage of people with a recorded dementia diagnosis that were using inpatient hospital services at least once a year.
Table 3: Dementia – ratio of inpatient service use to recorded diagnoses, 2015/16
Figure 13: Dementia – ratio of inpatient service use to recorded diagnoses, 2012 – 2016.
Figure 14: Dementia – ratio of inpatient service use to recorded diagnoses by London LA, 2015/16