Adelina Comas Herrera

The London School of Economics and Political Science | LSE · Care Policy and Evaluation Centre (CPEC) Department of Health Policy

Jamaica’s ageing population, high prevalence of non-communicable diseases (NCDs), and associated functional impairments suggest the need for a sustainable long-term care (LTC) system. This paper describes the current LTC system in Jamaica. A review of empirical and grey literature on LTC was supplemented with consultations and interviews and group...

Evidence from middle-income countries indicates high and increasing prevalence of dementia and need for services. However, there has been little investment in care, treatment or support for people living with dementia and their carers. The Strengthening Responses to Dementia in Developing Countries (STRiDE) project aims to build both research capac...

Objectives In response to a commissioned research update on dementia during the COVID‐19 pandemic, a UK‐based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research. Methods We supplemented a rapid literatu...

Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean...

Objectives: In response to an NHS England enquiry, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the COVID-19 pandemic on dementia wellbeing and identify priorities for future research. Methods: We supplemented a rapid literature search (including unpublished, non-p...

This report provides an overview of the impact of COVID-19 so far on people who use and provide long-term care in England and of the policy and practice measures adopted to mitigate its impact. It finds that the initial policy responses did not adequately consider the social care sector and that the pandemic has laid bare long-standing problems in...

Context: COVID-19 has disproportionately impacted mortality in English care homes. the end of May and early June. Findings: Although social care policies in England have aligned with those advised by the World Health Organisation, they were arguably delayed and were not implemented effectively. Testing had taken place in 70% of care homes surveyed...

The STRiDE project sets out to support the development of effective dementia policy in middle-income countries (Brazil, India, Indonesia, Jamaica, Kenya, Mexico, and South Africa). As part of this it will generate new data about the prevalence of dementia for a subset of these countries. This study aims to identify the current estimates of dementia...

Background: Due to the progressive nature of dementia, it is important to understand links between disease severity and health-related outcomes. The aim of this study is to explore the relationship between disease severity and the quality of life (QoL) of people with dementia and their family carers using a number of disease-specific and generic m...

Background: Policy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and...

This perspective examines the challenge posed by COVID-19 for social care services in England and describes responses to this challenge. People with social care needs experience increased risks of death and deteriorating physical and mental health with COVID-19. Social isolation introduced to reduce COVID-19 transmission may adversely affect well-b...

Unpicking the costs of dementia care in care homes - Volume 32 Issue 3 - Sarah Cullum, Adelina Comas-Herrera

In most countries, it is clear that the costs of care, treatment, and support of people with Alzheimer’s disease and other dementias will rise considerably in the next few decades. This paper discusses dementia as an economic concern and looks at the policy questions addressed by the current literature on the costs of dementia. It then considers th...

Background: The number of older people with dementia and the cost of caring for them, already substantial, are expected to rise due to population ageing. Objective: This study makes projections of the number of older people with dementia receiving unpaid care or using care services and associated costs in England. Methods: The study drew on up...

Objectives To investigate associations between level and changes in social isolation and in memory in older men and women. Methods The sample included 6123 women and 5110 men aged 50+ from the English Longitudinal Study of Ageing. Extended Latent Change Score models from six measurement occasions every two years from 2002 were used to investigate...

The World Alzheimer Report 2019: Attitudes to dementia analyses findings of the world’s largest survey on attitudes to dementia, as well as expert essays and case studies from across the world. The report reveals the results of the largest attitudes to dementia survey ever undertaken, with almost 70,000 people across 155 countries and territories...

Introduction In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacologica...

Introduction There are more people living with dementia in low- and middle-income countries (LMICs) than in high-income countries. Evidence-based interventions to improve the lives of people living with dementia and their carers are needed, but a systematic mapping of methodologically robust studies in LMICs and synthesis of the effectiveness of de...

Objectives This study measures the average per person and annual total costs of dementia in England in 2015. Methods/Design Up‐to‐date data for England were drawn from multiple sources to identify prevalence of dementia by severity, patterns of health and social care service utilisation and their unit costs, levels of unpaid care and its economic...

Background: Existing models for forecasting future care needs are limited in the risk factors included and in the assumptions made about incoming cohorts. We estimated the numbers of people aged 65 years or older in England and the years lived in older age requiring care at different intensities between 2015 and 2035 from the Population Ageing and...

Objective: National and global dementia plans have focused on the research ambition to develop a cure or disease-modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention, and care and strategies for achiev...

Objective: National and global dementia plans have focused on the research ambition to develop a cure or disease-modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention and care, and strategies for achievi...

This chapter presents some findings from the research project ‘Modelling Needs and Resources of Older People to 2030’ (MAP2030). The project developed a set of projection models to estimate future family circumstances, incomes, pensions, savings, disability and care needs of older people in England. These projections included public and private exp...

Background: Little is known about how the proportions of dependency states have changed between generational cohorts of older people. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care. Methods: In this population-based study, we compared two Cognitive F...

MODEM is an ambitious project that is projecting how future costs, health and quality of life of people living with dementia and their family and other caregivers (carers) could be improved by wider availability of evidence-based interventions. It projects numbers, needs, costs and outcomes for people with dementia and carers over the period to 204...

The MODEM Dementia Evidence Toolkit is a public resource that gives access, via a website, to scientific evidence gathered as part of a systematic mapping of the literature on evaluations of interventions for treatment, care and support of people with dementia and carers. The Toolkit has two components: a bibliographic database and plain English ev...

The extent to which technology may be able to support people with dementia and their carers along the care pathway and in different care settings is of interest to policy makers and governments. In this paper we provide an overview of the role of technology in dementia care, treatment and support by mapping existing technologies - by function, targ...

Background The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources. Meth...

Dramatic global increases in future numbers of people with dementia have been predicted. No multicentre population-based study powered to detect changes over time has reported dementia incidence. MRC Cognitive Function and Ageing Study (CFAS) undertook baseline interviews in populations aged 65 þ years in England and Wales (1989–1994). Three areas...

"This paper is based on a European Commission-funded study of future long-term care expenditure in Germany, Italy, Spain and the United Kingdom. It investigates how sensitive long-term care expenditure is to assumptions about demographic trends, future dependency rates, care arrangements, and real inflation. Macro-simulation projection models for e...

We know that in the next decades there will be a huge increase in the numbers of people requiring long-term care, which will be a challenge to most long-term care systems. There are three key ways to respond to this challenge: the first is to moderate future need for care, through finding ways to moderate or even reduce the need for long-term care....

A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support(IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental hea...

Many long-term care systems in economically developed countries are reliant on informal care. However, in the context of population ageing, there are concerns about the future supply of informal care. This article reports on projections of informal care receipt by older people with disabilities from spouses and (adult) children to 2032 in England....

We present a methodology to measure the risk of incurring extremely large individual lifetime costs of long-term care (LTC). We show a method that can be used to compare the risk reductions achieved by alternative LTC protection plans. Our proposed methodology is illustrated with a case study. Our estimates show that, according to our proposed risk...

In England, Local Authorities (LAs) contribute to the care home fees of two-thirds of care home residents aged 65+ who pass a means test. LAs typically pay fees below those faced by residents excluded from state support. Most proposals for reform of the means test would increase the proportion of residents entitled to state support. If care homes r...

The financing of long-term care (LTC) has been among the most debated social policy issues in England since at least the mid-1990s (Royal Commission on Long Term Care, 1999; Brooks et al., 2002; JRF, 2006; Wanless et al., 2006, HM Government, 2010a). Underlying the debate are concerns about both the future affordability of LTC and the fairness of t...

Increasingly sophisticated efforts to project future long-term care (LTC) expenditure highlight that this is very sensitive to assumptions made about future rates of disability and dementia. This article reviews different ways of formulating such assumptions and gives examples of their impact on future LTC expenditure projections in England. Using...

The aim of this analysis is to examine the effect of different assumptions about future trends in life expectancy (LE) on the sustainability of the pensions and long-term care (LTC) systems. The context is the continuing debate in England about the reform of state pensions and the reform of the system for financing care and support. Macro and micro...

We present a methodology that allows for the ability to calculate the impact of a given Long-Term Care (LTC) insurance protection system on the risk of incurring extremely large individual lifetime costs. Our proposed methodology is illustrated with a case study. According to our risk measure, the current Spanish public LTC system mitigates individ...

Following more than a decade of intense debate, the long-term care system in England may be on the verge of major change. We argue that the current system can be characterized as a residual system where care is free only to those who cannot afford to pay for themselves, with access heavily targeted to those with the highest levels of needs and with...

This study explores how the views of a panel of experts on dementia would affect projected long-term care expenditure for older people with dementia in England in the year 2031. A Delphi-style approach was used to gather the views of experts. The projections were carried out using a macro-simulation model of future demand and associated expenditure...

As the numbers of older people rise in Europe, the importance of long-term care services in terms of numbers of users and expenditures can be expected to grow. This article examines the implications for expenditure in four countries of a national entitlement to long-tem care services for all older people, based on assessed dependency. It is based o...

Background: This collaborative study evaluates newly developed residential facilities in Andalusia and compares them with the established care network in London. Aims: The study aims to discover the similarities and differences in the quality and effectiveness of residential care provision in the two regions. Method: A comparative study of matched...

This study examines the sensitivity of future long-term-care demand and expenditure estimates to "official" demographic projections in four selected European countries: Germany, Spain, Italy and the United Kingdom. It uses standardised methodology in the form of a macro-simulation exercise and finds evidence for significant differences in assumptio...

This study examines the sensitivity of future long-term care demand and expenditure estimates to official demographic projections in four selected European countries: Germany, Spain, Italy and the United Kingdom. It uses standardised methodology in the form of a macro-simulation exercise and finds evidence for significant differences in assumptions...

This paper presents projections of demand for social care and disability benefits for older people (aged 65 and over) in England to 2041 and associated future expenditure. The projections were produced using an updated and expanded version of the Personal Social Services Research Unit’s (PSSRU) long-term care projections model. The version of the m...

Projections are presented of future numbers of older people with cognitive impairment (CI) in England, their demand for long-term care (LTC) services and future costs of their care. The sensitivity of the projections to factors that are likely to affect future LTC expenditure is explored. These factors include future numbers of older people, preval...

Using two linked simulation models, we examine the public expenditure costs and distributional effects of potential reforms to long-term care funding in the UK. Changes to the means tests for user contributions to care costs are compared with options for the abolition of these means tests (‘free’ personal care). The latter generally cost more than...

The future market costs of long-term care for older people will be affected by the extent of informal care. This paper reports on projections of receipt of informal care by disabled older people from their spouses and (adult) children to 2031 in England. The paper shows that, over the next 30 years, care by spouses is likely to increase substantial...

Summary report for the National Audit Office

As the numbers of older people rise in Europe, the importance of long-term care services in terms of numbers of users and expenditures can be expected to grow. This article examines the implications for expenditure in four countries of a national entitlement to long-tem care services for all older people, based on assessed dependency. It is based o...

Background: The number of people with severe mental illness who receive treatment whilst living at home has increased greatly over the last 30 years. Day centres and day hospitals frequently supplement this treatment. Objectives: To determine the effects of non-medical day centre care for people with severe mental illness. Search strategy: We...

This paper reports findings from a European Commission funded study of future long-term care expenditure in Germany, Italy, Spain and the United Kingdom, and presents projections of future long-term care expenditure in the four countries under a number of assumptions about the future. Macro-simulation (or cell-based) models were used to make compar...

How best to finance the long-term care of older people is the subject of considerable national debate in the UK, as in a number of other countries. The Report of the UK Royal Commission on Long Term Care in 1999, followed by the introduction of free personal care in Scotland in July 2002, has led to continuing pressure for further reform of the fin...

The financing of long-term care raises a great many questions. How many older people are likely to require long-term care services in the coming decades? How much are these services likely to cost? Will the cost to public funds prove affordable? Who should pay? How should costs be divided between public expenditure and private sources of finance? I...

The paper examines the links between degree of intellectual disability, challenging behaviour, service utilisation and cost for a group of people with intellectual disabilities living in care accommodation in England. A cross-sectional survey was conducted of people with intellectual disabilities, identified via provider organisations, with supplem...