Department of Psychiatric Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Global Brain Health Institute, Trinity College, Dublin, Ireland.
Int J Geriatr Psychiatry. 2024 Jun;39(6):e6111. doi: 10.1002/gps.6111.
This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan.
This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023).
Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place.
This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.
本研究旨在全面了解改善痴呆症护理、治疗和支持的背景、障碍和机会。目的是为国家痴呆症护理计划的制定提供指导。
通过分析公共领域可获得的文献，包括科学出版物、项目文件/报告、媒体报道和医院记录，进行了这份文件回顾。此外，还审查了卫生部发布的年度报告、国家人口普查和人口与健康调查报告、老年之家和其他相关政府报告。根据世界卫生组织痴呆症计划情境分析框架，从相关利益攸关方收集了第一手资料。该框架包括四个领域：政策背景（国家部委、立法、政策、战略、与痴呆症、心理健康、老龄化和残疾相关的计划）、服务提供评估（卫生和社会保健工作者、服务、支持和治疗方案以及提高认识和理解）以及流行病学指标（痴呆症的患病率和发病率、风险因素）。本研究已获得 B.P. Koirala 卫生科学研究所机构审查委员会（IRC）的伦理批准（IRC 编号 2658/023）。
尼泊尔现有的政策未能充分满足痴呆症患者及其照顾者的需求。在卫生服务方面，尼泊尔政府为被诊断患有痴呆症的个人提供财政补贴；然而，许多障碍阻碍了他们获得护理。这些障碍包括地理和结构性障碍、低效的公共医疗体系、薄弱的治理、财政限制、低意识水平、耻辱感和劳动力不足。此外，尼泊尔缺乏关于痴呆症的强有力的全国代表性流行病学研究，这阻碍了制定基于证据的计划和政策。同样，没有针对痴呆症患者照顾者的干预措施，也没有预防痴呆症的举措。
本综述强调了制定全面的国家痴呆症护理计划以应对日益增长的挑战的紧迫性。重点优先行动领域包括将痴呆症护理纳入初级保健服务、培训提供护理的劳动力、提高认识、减少耻辱感、制定照顾者支持计划以及开展高质量研究以制定基于证据的决策。
