One of the most significant age-related conditions that poses a challenge to health and welfare services is dementia, which is characterized by a decline in memory, cognition and daily functioning. Dementia has a devastating effect on those who suffer from it and on the family who care for them.
This is the first comprehensive study in Israel to examine the extent of dementia among elderly living in the community, the extent to which these people are known to the system of services, and the extent of their and their families’ unmet needs. The study was conducted in multiple stages, and included general screening of the elderly in the community, an in-depth clinical examination of cases of suspected dementia, and an in-depth interview to understand service needs. Special attention was given to identifying elderly in early stages of the disease. The study’s target population included elderly people age 65 and over living in the community in Jerusalem and Kiryat Gat (exclusive of the Arab population). We conducted a representative sample that included 2,425 elderly people. Data collection ended in December 2002. Selected findings:
The prevalence of dementia among people age 65 and over is estimated to be 16.7% (some 98,000 individuals). Nearly half of the elderly living in the community who suffer from dementia are in the initial stages of the condition. The prevalence of dementia increases significantly with age.
Only 20% of the family caregivers reported having been told by a physician that their elderly relative had dementia or Alzheimer’s Disease. Thus a considerable proportion of the elderly diagnosed by this study as having dementia were not previously diagnosed.
95% of the elderly with dementia had at least one other chronic condition, reflecting the complexity of caring for patients with dementia. However, 11% of those with severe dementia had not met with a family physician during the past year.
56% of elderly with dementia and 79% of those with severe dementia were receiving home care services under the Community Long-Term Care Insurance (CLTCI) Law. Eighteen percent of all elderly with dementia had a 24-hour personal-care aide.
26% of the elderly with dementia had visited a day care center or social club. Further, 40% did not visit a social framework though their families expressed an interest in their doing so.
97% of the caregivers were members of the elderly person’s family, mainly his or her spouse (27%), or son or daughter (62%). 43% of the caregivers were living with the person suffering from dementia.
38% of the primary informal caregivers reported that the burden they bore was very heavy or heavy. The percentage was greater among those who cared for an elderly person with severe dementia (52%).
Caregivers reported unmet needs for a range of services, notably for information and counseling, respite care services, volunteer visits to the elderly, and more personal-care aide hours.
The findings of this study have significant implications for the development of policies and services to better meet the needs of both elderly suffering from dementia and their families. These include a need to considerably increase public awareness of the early signs of dementia and of the diagnostic and treatment options available; a need to ensure regular medical follow-up; a need to examine models of respite care; a need for education and training programs for families like those developed in other countries; and a need to increase psychosocial interventions such as support groups.
These findings provide an important base of information for setting policies regarding elderly with dementia. They are being used to develop an experimental intervention to be implemented jointly by Clalit Health Services, ESHEL, and other organizations. The study was funded by the Levy Foundation (England), ESHEL, the National Insurance Institute, the National Institute for Health Policy and Health Services Research, the Myers-JDC-Brookdale Institute, and an anonymous benefactor.
Citations in the professional and academic literature
Rosen, B., Waitzberg, R., & Merkur, S. (2015). Israel: Health system review.
Feldman, H., Clarfield, A. M., Brodsky, J., King, Y., & Dwolatzky, T. (2006). An estimate of the prevalence of dementia among residents of long-term care geriatric institutions in the Jerusalem area. International psychogeriatrics, 18(4), 643-652.
Asiskovitch, S. (2013). The Long-Term Care Insurance Program in Israel: solidarity with the elderly in a changing society. Israel Journal of Health Policy Research, 2(1), 3.
Wertman, E., Brodsky, J., King, Y., Bentur, N., & Chekhmir, S. (2007). An estimate of the prevalence of dementia among community-dwelling elderly in Israel. Dementia and geriatric cognitive disorders, 24(4), 294-299.
Garfinkel, D., Radomislsky, Z., Jamal, S., & Ben-Israel, J. (2008). High efficacy for hip protectors in the prevention of hip fractures among elderly people with dementia. Journal of the American Medical Directors Association, 9(5), 313-318.
Sternberg, S., Bentur, N., & Shuldiner, J. (2014). Quality of care of older people living with advanced dementia in the community in Israel. Journal of the American Geriatrics Society, 62(2), 269-275.
Rosen, B., Waitzberg, R., & Merkur, S. (2015). Health systems in transition. Health, 17(6).
Bentur, N., & Sternberg, S. A. (2019). Dementia care in Israel: top down and bottom up processes. Israel journal of health policy research, 8(1), 22.