somefreshthinking ltd. UK
David Truswell has worked in community based mental health services in the UK for over thirty years developing services for people with complex care needs and enduring mental health problems in a career spanning the UK voluntary sector, local authority services, and the NHS. From 2009 - 2011 he was the Dementia Implementation Lead for Commissioning Support for London. He is the Chair of the Dementia Alliance for Culture and Ethnicity, a grassroots alliance of dementia organisations. He recently left the NHS to set up somefreshthinking (www.somefreshthinking.com) a health sector change management consultancy. He is also an independent writer on dementia support and services for Black, Asian and minority ethnic communities
Statement of the Problem: While there is now worldwide recognition of the challenges that dementia brings to national health economies, less well understood is the impact of dementia as a health issue in migration. As migrant communities settle both lifetime health risks and the age structure of the population may place some migrant communities at greater risk of developing dementias such as Alzheimer’s disease and vascular dementia than the mainstream population. Delayed presentation for diagnosis, fear of discrimination and cultural stigma all increases the likelihood that individual cases will be complex in nature and that overall numbers will increase in those metropolitan areas across the globe that are often called ‘gateway cities’ for international migration.
Methodology & Theoretical Orientation: Both nationally and internationally the study of health issues for migrant populations has yet to single out dementia as a focus for policy development and research. The number of people involved and complexity of the impact becomes apparent when considering the situation in metropolitan areas with long settled and diverse migrant communities where a significant proportion of people in the migrant communities concerned are over 65 and there are identified population specific health issues that increase the likelihood of dementia.
Conclusion & Significance: This is a high cost per case population likely to present late to services with complex care needs that challenge available resources. Along with polypharmacy risks there is a lack of understanding of any population specific pharmacological risks. The increasing scale of international migration and historical pattern of migration will lead to an increase in demand for dementia services from migrant communities not only as a result of generally increases in longevity but also due to differential health risk and age profile structure within migrant communities.. Health service planners are ill prepared for this