Re-framing the challenge of Alzheimer’s disease

Given that a cure for Alzheimer's disease is probably at least a decade away, a more holistic approach is needed to find ways to help manage the condition in the short term.

Pick up any newspaper and you will read headlines about the impending Alzheimer's crisis and how health systems will be unable to cope. The statistics support this too. By 2050, over 20 per cent of the world population will be over 60, and 115 million will be living with Alzheimer's Disease (AD) or other dementias.

This is a major issue and it is clear that the current model of care is both unsustainable (it is estimated that by 2026, dementia services will make up 75 per cent of all mental health service costs) and provides inadequate care, particularly in hospital and residential settings (AD monitoring in long-term residential care is poor and 15 per cent of patients are currently admitted with a primary diagnosis of AD).

The good news is that policy is turning to address the issue, but it is not going fast or far enough. Generally, at a system and political level, the focus tends to be on top-down structural change. This will rarely provide the desired solution, as it fails to recognise the local level interactions and customer, primarily patient, focus needed to make sustainable change.

So does that mean we are all doomed? Well, no, because the media is full of stories about the Alzheimer's cure coming along. However, the small print reveals that this 'cure' is still at the earliest stages of research and so at least a decade away. Given that the success rate of bringing new pharmaceutical products to market is around 1 in 5,000, perhaps we shouldn't be putting all of our eggs in this particular basket.

Where do we go from here? To concentrate on crisis or cure is a closed way of thinking and unlikely to yield the change needed to address the problem. Many in healthcare have long seen little point in diagnosing AD patients until a curative treatment is available, as not much can be done for them, but that belief has always seemed wrong to me.

"UK research found that just four sessions of quality educational content given to AD patients and their carers would delay institutionalisation by 550 days"

Fortunately there is a shift to a more holistic management approach, educationally and socially. For example, UK research found that just four sessions of quality educational content given to AD patients and their carers would delay institutionalisation by 550 days. The cost benefits of delaying onset are significant too. The AD 550 hypothesis states that an intervention that delays onset by five years would result in a 57 per cent reduction in the number of patients and would reduce Medicare costs by 40-50 per cent.

So, how can such change happen? In normal brand building, each market or situation should be looked at in a holistic way and as broadly as possible. Only by doing this can you see the world in a way that is relevant to your customers and be differentiated from your competitors.

Fortunately such solutions are rarely built by governments or the media and change is being driven by technology, the commercial sector and consumers themselves. There are some significant transformations taking place.

The demanding 'baby-boomer' generation

On a socio-demographic level, as the 'baby boomer' generation reaches retirement age, this well-educated cohort is hungry for information and demanding products and services to help maintain and improve health. These people are looking to live independently at home or in sheltered housing and enjoy rewarding, active social (and working) lives which will minimise potential isolation. Brain health is core to those objectives. An AARP (organisation for the over-50s in the US) survey in the US found that 80 per cent of members polled stated their top priority was to be 'staying mentally sharp'. So, how are these objectives of independence and brain health being addressed?

Brain health research

'Brain training' products and services from companies like Nintendo and Lumosity are a growing category. There is also more information on, and awareness of, the role of diet and exercise on mental health. But do they work? According to Alvaro Fernandez, CEO of SharpBrains, which provides information and guidance on the growing cognitive fitness market, the data set is growing.

"Whilst nothing has been shown to prevent dementia, there are evidence-based ways to improve and prolong brain functionality. We have found multiple such ways to promote and protect a range of brain functions: learning a new language, jogging, mastering meditation, rotating through complex professional assignments, proper nutrition, volunteering to run a hiking or cycling club, leveraging the emerging technology-enabled toolkit at our disposal, and more."

This is a very hopeful message, but one which often gets lost in the search for the next 'magic pill' that cures everyone. Back to crisis and cure!

Working life

Many employers are recognising the benefits and requirements of an ageing population and are adjusting their strategies accordingly. The DIY retailer B&Q has long been a pioneer in creating an age-diverse workforce through an active over-50s recruitment policy. They have seen significant benefits to the working culture of the organisation, customer service levels and their brand. They have expanded this to offer flexible working for both elderly employees (including leave for the birth of grandchildren) and employees who are carers and need additional flexibility.

This is important, too, in enabling those with AD to keep living at home. Alzheimer's Society research in the UK found that 300,000 people juggle caring responsibilities with paid work and 12 per cent of dementia carers have to adjust their working patterns in order to care for an elderly relative, with some even needing to give up work. However, in a recent survey, 87 per cent of employers stated that they have or would consider flexible working hours for those who need to care for someone living with dementia.

"Other businesses have created 'back office' roles ideal for employees with dementia so that they can continue to contribute to the world of work"

Other businesses have created 'back office' roles ideal for employees with dementia so that they can continue to contribute to the world of work. This means that older employees gain hugely through building friendships and the social atmosphere created through continuing work. Progress then.

Independent living

The next decade will see the uptake of mass-market assisted living technologies, driven in part by reductions in price as well as increased technological capability. One digital health platform, for example, uses a combination of an ingestible sensor taken with medications and a patch which captures and relays the body's physiological responses and behaviours to a Bluetooth-enabled device. This allows healthcare professionals and families integrated views of not only their loved one's daily medication taking, but also activity and rest patterns, which are important measures of health status for dementia sufferers. Such products provide peace of mind to families and a non-obtrusive monitoring function to support the parent or grandparent living at home. Many more technologies will become available in this space in the coming years.

The use of independent living facilities is growing too. At first glance the village of Hogewey near Amsterdam looks like any other small residential town. In fact, it is home to 150 men and women living with dementia in its 23 residential units. Around-the-clock-care is provided by 240 trained caregiver 'villagers'. All are dressed informally and take care of cooking meals, assisting personal care and administering medications. The setting allows residents to live as normal a life as possible within a safe and supported community environment; communal living, enjoying the day-to-day activities that they always have, family-style mealtimes, going for a walk to the village store, enjoying its 25 clubs, from baking to gardening to cycling. You can see how this would help give people there a sense of community and purpose and give them the physical and mental wellbeing they, their families and, indeed, their healthcare systems, want.

In summary

There are significant challenges associated with dealing with the rise in AD cases, but could using such brand-building thinking rather than traditional approaches help to identify the opportunities for successful interventions and solutions? I would argue that looking at the world through different lenses is paramount in starting to frame the problem in a new way. In the case of AD, instead of focusing on crisis or cure, would reframing the challenge be more productive?

• As a pharma company, how do we target a drug to delay the onset of AD by three years?

• As an employer, how do I increase the productivity of my workforce as the population ages?

• As an insurance company, what programmes should I put in place to ensure the long-term wellbeing of my members?

• As a health system, how do I enable independent living for the population for longer?

When you do that you inevitably start looking in different places and at different technologies for the solution. My question to you is, are you looking at your industry or therapy area in the same way that you always did? If so, maybe it's time to look again?

About the author:

David Coleiro is a Partner at Strategic North, a healthcare marketing agency which works with clients in the pharmaceutical industry around the globe to build the successful brands of tomorrow. This is achieved through developing seamless, future-focused strategies grounded in customer insight and understanding. David and his colleagues tweet @StrategicNorth and blog at www.strategicnorth.com/blog. Contact him at david.coleiro@strategicnorth.com

Have your say: What is the best course to support those with AD and their families?