Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1

Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
Global action plan
        on the public health
       response to dementia
                      2017 - 2025

1) WHA70/2017/REC/1
Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
Global action plan
        on the public health
       response to dementia
                      2017 - 2025

1) WHA70/2017/REC/1
Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
Global action plan on the public health response to dementia 2017–2025

    ISBN 978-92-4-151348-7

                                             © World Health Organization, 2017

    Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO
    licence (CC BY-NC-SA 3.0 IGO;

    Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided
    the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO
    endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the
    work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation
    of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created
    by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The
    original English edition shall be the binding and authentic edition”.

    Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules
    of the World Intellectual Property Organization.

    Suggested citation. Global action plan on the public health response to dementia 2017–2025. Geneva: World Health
    Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

    Cataloguing-in-Publication (CIP) data. CIP data are available at

    Sales, rights and licensing. To purchase WHO publications, see To submit requests for
    commercial use and queries on rights and licensing, see

    Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures
    or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission
    from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work
    rests solely with the user.

    General disclaimers. The designations employed and the presentation of the material in this publication do not imply
    the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or
    area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
    represent approximate border lines for which there may not yet be full agreement.

    The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
    recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted,
    the names of proprietary products are distinguished by initial capital letters.

    All reasonable precautions have been taken by WHO to verify the information contained in this publication. However,
    the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility
    for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising
    from its use.

    Photos © Cathy Greenblat.

    Layout by

    Printed by the WHO Document Production Services, Geneva, Switzerland.

Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
Dementia is a major cause of disability           families. It is an important opportunity
and dependency among older adults                 for individuals, communities and Member
worldwide, affecting memory, cognitive            States to realize the vision of a world in
abilities, and behavior, ultimately interfering   which dementia is prevented and people
with one’s ability to perform daily               with dementia and their carers receive
activities. The impact of dementia is not         the care and support they need to live a
only significant in financial terms, but also     life with meaning and dignity. The World
represents substantial human costs to             Health Organization looks forward to
countries, societies, families and individuals.   fulfilling the ambitious targets presented
                                                  in the action plan by working alongside
                                                  Member States and Non-state actors,
The Global Action Plan on the Public              including people with dementia and their
Response to Dementia 2017-2025 signals            families, to improve the health and well-
an important step forward in achieving            being of those affected by dementia, both
physical, mental and social wellbeing for         for present and future generations.
people with dementia, their carers and
Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1

Overview of the global situation                                     2

Vision, goals and cross-cutting principles                           4

Actions and targets for Member States, the Secretariat and
international, regional and national partners                        6

Action Areas                                                         8
  Action area 1: Dementia as a public health priority               10
  Action area 2: Dementia awareness and friendliness                14
  Action area 3: Dementia risk reduction                            18
  Action area 4: Dementia diagnosis, treatment, care and support   22
  Action area 5: Support for dementia carers                        26
  Action area 6: Information systems for dementia                   30
  Action area 7: Dementia research and innovation                   32
Appendix                                                            36

Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
    1. Dementia is an umbrella term for several                        3. Crucially, although age is the strongest
        diseases that are mostly progressive,                               known risk factor for the onset of
        affecting memory, other cognitive                                   dementia, it is not an inevitable
        abilities and behaviour, and that interfere                         consequence of ageing. Further, dementia
        significantly with a person’s ability to                            does not exclusively affect older people,
        maintain the activities of daily living.                            with young onset dementia (defined as
        Alzheimer disease is the most common                                the onset of symptoms before the age
        form of dementia and may contribute                                 of 65 years) accounting for up to 9%
        to 60–70% of cases. Other major forms                               of cases.4 Some research has shown a
        include vascular dementia, dementia with                            relationship between the development of
        Lewy bodies, and a group of diseases that                           cognitive impairment and lifestyle-related
        contribute to frontotemporal dementia.                              risk factors that are shared with other
        The boundaries between different forms                              noncommunicable diseases. These risk
        of dementia are indistinct and mixed forms                          factors include physical inactivity, obesity,
        often coexist.                                                      unbalanced diets, tobacco use and
                                                                            harmful use of alcohol as well as diabetes
                                                                            mellitus and mid-life hypertension. Other
    2. In 2015, dementia affected 47 million                               potentially modifiable risk factors more
        people worldwide (or roughly 5% of the                              specific to dementia include mid-life
        world’s elderly population), a figure that                          depression, low educational attainment,
        is predicted to increase to 75 million in                           social isolation and cognitive inactivity.
        2030 and 132 million by 2050. Recent                                Additionally, non-modifiable genetic risk
        reviews estimate that globally nearly 9.9                           factors exist that increase a person’s risk
        million people develop dementia each                                of developing dementia.5 There is also
        year; this figure translates into one new                           evidence suggesting that overall more
        case every three seconds. Nearly 60%                                women develop dementia than men.3
        of people with dementia currently live in
        low- and middle-income countries and
        most new cases (71%) are expected to                            4. Dementia is a major cause of disability
        occur in those countries.2,3                                        and dependency among older adults

    1.   See decision WHA70(17).
    2.   WHO. The epidemiology and impact of dementia: current state and future trends. Geneva: World Health Organization; 2015,
         Document WHO/MSD/MER/15.3, available at
         epidemiology.pdf (accessed 8 March 2017).
    3.   Prince M, Wimo A, Guerchet M, Ali GC, Wu Yutzu, Prina M. World Alzheimer Report 2015. The global impact of dementia: an
         analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; 2015.
    4.   Alzheimer’s Disease International and WHO. Dementia: a public health priority. Geneva: World Health Organization; 2012 (http://, accessed 8 March 2017).
    5.   Loy CT, Schofield PR, Turner AM, Kwok JBJ. Genetics of dementia. Lancet. 2014;383(9919):828-40. doi:
Global action plan on the public health response to dementia 2017 - 2025 - 1 WHA70/2017/REC/1
worldwide, having a significant impact                                    dementia in low- and middle income
     not only on individuals but also on                                       countries will contribute further to
     their carers, families, communities and                                   increasing inequalities between
     societies. Dementia accounts for 11.9%                                    countries and populations.
     of the years lived with disability due to a
     noncommunicable disease.1 In light of the                           6. Currently, the gap is wide between
     improved life expectancy globally, this                                the need for prevention, treatment
     figure is expected to increase further.                                and care for dementia and the actual
                                                                            provision of these services. Dementia
5. Dementia leads to increased costs for                                   is underdiagnosed worldwide, and, if
   governments, communities, families and                                   a diagnosis is made, it is typically at
   individuals, and to loss in productivity                                 a relatively late stage in the disease
   for economies.                                                           process. Long-term care pathways (from
                                                                            diagnosis until the end of life) for people
     ●● In 2015, dementia costs2 were                                       with dementia are frequently fragmented
        estimated at US$ 818 billion, equivalent                            if not entirely lacking. Lack of awareness
        to 1.1% of global gross domestic                                    and understanding of dementia is often
        product, ranging from 0.2% for low-                                 to blame, resulting in stigmatization
        and middle-income countries to 1.4%                                 and barriers to diagnosis and care.
        for high income countries. By 2030, it                              People with dementia are frequently
        is estimated that the cost of caring for                            denied their human rights in both the
        people with dementia worldwide will                                 community and care homes. In addition,
        have risen to US$ 2 trillion, a total that                          people with dementia are not always
        could undermine social and economic                                 involved in decision-making processes
        development globally and overwhelm                                  and their wishes and preferences for
        health and social services, including                               care are often not respected.
        long term care systems specifically.3
                                                                         7. WHO and the World Bank estimate
     ●● People with dementia and their                                       a need by 2030 for 40 million new
        families face significant financial                                  health and social care jobs globally
        impact from the cost of health and                                   and about 18 million additional health
        social care and from reduction                                       workers, primarily in low-resource
        or loss of income. In high-income                                    settings, in order to attain high and
        countries, the costs related to                                      effective coverage with the broad
        dementia are shared between                                          range of necessary health services.
        informal care (45%) and social care                                  In addressing dementia, expanding
        (40%). In contrast, in low- and                                      the health and social care workforce
        middle-income countries social care                                  with appropriate skill mixes as well as
        costs (15%) pale in comparison to                                    available interventions and services will
        informal care costs.3 The expected                                   be essential to prevent, diagnose, treat
        disproportionate increase in                                         and care for people with dementia.

1.    Prince M, Albanese E, Guerchet M, Prina M. World Alzheimer Report 2014. Dementia and risk reduction: an analysis of
      protective and modifiable risk factors. London: Alzheimer’s Disease International; 2014 (
      WorldAlzheimerReport2014.pdf, accessed 8 March 2017).
2.    Direct medical and social care costs and costs of informal care.
3.    Prince M, Wimo A, Guerchet M, Ali GC, Wu Yutzu, Prina M. World Alzheimer Report 2015. The global impact of dementia: an
      analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; 2015.

    Vision                                         Cross-cutting
    8. T
        he vision of the global action            principles
       plan on the public health response
                                                10. The global action plan is
       to dementia is a world in which
                                                     grounded in the following
       dementia is prevented and people
                                                     seven cross-cutting principles.
       with dementia and their carers
       live well and receive the care and
       support they need to fulfil their
       potential with dignity, respect,
       autonomy and equality.

    9. The goal of the global action plan is
        to improve the lives of people with      d.	Multisectoral collaboration on the
        dementia, their carers and families,        public health response to dementia
        while decreasing the impact of
        dementia on them as well as on             A comprehensive and coordinated
                                                   response to dementia requires
        communities and countries.
                                                   collaboration among all stakeholders
                                                   to improve prevention, risk reduction,
                                                   diagnosis, treatment and care.
                                                   Achieving such collaboration requires
                                                   engagement at the government level
                                                   of all relevant public sectors, such as
                                                   health (including alignment of existing
                                                   noncommunicable disease, mental
                                                   health and ageing efforts), social
                                                   services, education, employment,
                                                   justice, and housing, as well as
                                                   partnerships with relevant civil society
                                                   and private sector entities.

       RIGH N

a.	Human rights of people        b.	Empowerment and              c.	Evidence-based
   with dementia                     engagement of people             practice for dementia
                                     with dementia and                risk reduction and care
  Policies, plans, legislation,
                                     their carers
  programmes, interventions                                          Based on scientific evidence
  and actions should be             People with dementia,            and/or best practice, it
  sensitive to the needs,           their carers and                 is important to develop
  expectations and human            organizations that               strategies and interventions
  rights of people with             represent them should be         for dementia risk reduction
  dementia, consistent with         empowered and involved           and care that are person-
  the Convention on the             in advocacy, policy,             centred, cost-effective,
  Rights of Persons with            planning, legislation,           sustainable and affordable,
  Disabilities and other            service provision,               and take public health
  international and regional        monitoring and research          principles and cultural
  human rights instruments.         of dementia.                     aspects into account.

e.	Universal health and             Equity
                                  f.	                             g.	Appropriate attention
   social care coverage                                               to dementia prevention,
                                    All efforts to implement
   for dementia                                                       cure and care
                                    public health responses
  Designing and                     to dementia must support         Steps to realize this focus
  implementing health               gender equity and                include using existing
  programmes for universal          take a gender-sensitive          knowledge and experience
  health coverage must              perspective, keeping in mind     to improve prevention,
  include financial risk            all vulnerabilities specific     risk reduction, care and
  protection and ensuring           to each national context,        support for people with
  equitable access to a             consistent with the 2030         dementia and their carers
  broad range of promotive,         Agenda for Sustainable           and generation of new
  preventive, diagnostic and        Development, which               knowledge towards
  care services (including          recognizes that people who       finding disease-modifying
  palliative, rehabilitative        are vulnerable, including        treatments or a cure,
  and social support) for all       people with disabilities,        effective risk reduction
  people with dementia and          older people and migrants,       interventions and
  their carers.                     must be empowered.               innovative models of care.

    11. Effective implementation of the           12. The roles of these four groups often
        global action plan on the public                overlap and can include multiple
        health response to dementia will                actions cutting across the areas of
        require actions by Member States, the           governance, health and social care
        Secretariat and international, regional,        services, promotion of understanding
        national and subnational partners.              and prevention in dementia, and
        Depending on national context, these            information, evidence and research.
        partners include but are not limited to:        Country-based assessments of the
                                                        needs and capacities of different
       ●● development agencies, including               partners will be essential to clarify the
          international multilateral agencies           roles and actions of stakeholder groups.
          (for example, OECD, United
          Nations development agencies             13. Targets included in this global action
          and the World Bank), regional                 plan are defined for achievement
          agencies (for example, regional               globally. Each Member State can be
          development banks), subregional               guided by these global targets when
          intergovernmental agencies and                setting its own national targets, taking
          bilateral development aid agencies;           into account national circumstances.
                                                        Each Member State will also decide
       ●● academic institutions and research            how these global targets should
          agencies, including the network               be adapted for national planning,
          of WHO collaborating centres for              processes (including data collection
          mental health, ageing, disability,            systems), policies and strategies.
          human rights and social determinants
          of health, and other related networks;   14. The global action plan recognizes
                                                        that each Member State faces specific
       ●● civil society, including people               challenges in implementing these
          with dementia, their carers and               action areas and therefore suggests a
          families and associations that                range of proposed actions that each
          represent them, and other relevant            Member State will need to adapt to the
          organizations;                                national context.

       ●● the private sector, health insurance,
          and the media.
Action areas
15. The global action plan comprises seven action areas, which form the
     underlying structural framework:

    Dementia as a                               Dementia awareness
    public health priority                      and friendliness

     1                                            2

    Support for                                 Information systems
    dementia carers                             for dementia

     5                                            6

Dementia            Dementia diagnosis,
risk reduction      treatment, care and

 3                   4

Dementia research
and innovation


Action area 1:

     Dementia as a
     public health

     16. Given the range of the population                                     comprehensive, multisectoral approach
          affected directly or indirectly by                                    will support the recognition, and address
          dementia and the complexity of this                                   the complex needs, of people with
          condition, dementia requires a whole-                                 dementia within the context of each
          of-government, broad, multistakeholder,                               country. This approach is in line with the
          public health approach. Such an                                       principle of universal health coverage and
          approach will lead to a comprehensive                                 the standards outlined in the Convention
          response from the health and social                                   on the Rights of Persons with Disabilities.
          care system (both public and private)
          and other government sectors, and will
          engage people with dementia and their                           18.   Global
                                                                                	     target 1:
          carers and other relevant stakeholders                                	75% of countries will have
          and partners.
                                                                                developed or updated national
     17. Rationale. The development and                                        policies, strategies, plans or
         coordination of policies, legislation,                                 frameworks for dementia, either
         plans, frameworks and integrated                                       stand-alone or integrated into
         programmes of care through a                                           other policies/plans, by 2025.1

     19. Develop, strengthen and implement                                     and disability (or equivalent). These
          national and/or subnational strategies,                               undertakings should give consideration
          policies, plans or frameworks that                                    to equity, dignity and the human rights
          address dementia, whether as separate                                 of people with dementia and support
          instruments or integrated into other                                  the needs of carers, in consultation
          planned actions for noncommunicable                                   with people with dementia and other
          diseases, mental health, ageing,                                      relevant stakeholders.

     1.   The global target indicators and means of verification are provided in the Appendix to this Annex.

20. Promote mechanisms to monitor                  entity responsible for noncommunicable
     the protection of the human rights,            diseases, mental health or ageing within
     wishes and preferences of people with          the health ministry (or equivalent body),
     dementia and the implementation of             in order to ensure sustainable funding,
     relevant legislation, in line with the         clear lines of responsibility for strategic
     objectives of the Convention on the            planning, implementation, mechanisms
     Rights of Persons with Disabilities and        for multisectoral collaboration, service
     other international and regional human         evaluation, monitoring and reporting
     rights instruments. These mechanisms           on dementia.
     include safeguards for concepts such
     as legal capacity, self determination,      22. Allocate sustainable financial resources
     supported decision-making, and power             that are commensurate with the
     of attorney, and for protection against          identified service need and human and
     exploitation and abuse in institutions as        other resources required to implement
     well as in the community.                        national dementia plans and actions,
                                                      and set up mechanisms for tracking
21. Set up a focal point, unit or functional         expenditures on dementia in health,
    division responsible for dementia or              social and other relevant sectors such as
    a coordination mechanism within the               education and employment.

23. Offer technical support, tools and                 partners and establishing or
     guidance to Member States, and                     strengthening national reference
     strengthen national capacity in:                   centres, WHO collaborating centres
                                                        and knowledge-sharing networks;
   ●● leadership within health ministries
      and other relevant sectors for the            ●● coordinating programmes on
      development, strengthening and                   dementia with those on related
      implementation of evidence-based                 noncommunicable diseases, ageing,
      national and/or subnational strategies           mental health and health systems, and
      or plans and associated multisectoral            with service delivery and processes to
      resource planning, budgeting and                 ensure maximum synergy and optimal
      tracking of expenditure on dementia;             use of existing and new resources.

   ●● evaluating and implementing                24. Compile and share knowledge and best
      evidence-based options that suit               practices on existing policy documents
      Member States’ needs and capacities            dealing with dementia, including
      and assessing the health impact                codes of practice and mechanisms to
      of public policies on dementia by              monitor the protection of human rights
      supporting national and international          and implementation of legislation,

consistent with the Convention on the             principle of universal health coverage.
        Rights of Persons with Disabilities and           Collaboration and partnerships should
        other international and regional human            include all relevant sectors: health,
        rights instruments.                               justice and social services sectors, civil
                                                          society, people with dementia, carers
     25. Promote and support collaboration               and family members, and organizations
         and partnerships with countries at               in the United Nations system, United
         international, regional and national levels      Nations interagency groups and
         for multisectoral action in the response         intergovernmental organizations.
         to dementia and aligning these with the

     26. Create and strengthen associations and          paying explicit attention to the human
         organizations of people with dementia,           rights of people with dementia and their
         their families and carers, and foster their      carers as well as their empowerment,
         collaboration with existing disability (or       engagement and inclusion.
         other) organizations as partners in the
         prevention and treatment of dementia.         28. Support the development and
                                                           application of national dementia policies,
     27. Motivate and actively engage in dialogue         legislation, strategies and plans, and the
          between associations representing                creation of a formal role and authority for
          people with dementia, their carers and           people with dementia and their carers
          families, health workers and government          to influence the process of designing,
          authorities in reforming health and social       planning and implementing policies, laws
          laws, policies, strategies, plans and            and services related to dementia.
          programmes relevant to dementia, while

Action area 2:

     awareness and

     29. There is a common misconception that              aspects of dementia friendly initiatives
          dementia is a natural and inevitable part         include safeguarding the human rights
          of ageing rather than a disease process,          of people with dementia, tackling the
          resulting in barriers to diagnosis and care.      stigmatization associated with dementia,
          The lack of understanding also causes             promoting a greater involvement of
          fear of developing dementia and leads             people with dementia in society, and
          to stigmatization and discrimination.             supporting families and carers of people
          Furthermore, people with dementia are             with dementia. The concept of dementia-
          frequently denied their human rights in           friendliness is tightly linked to societies
          both the community and care homes.                also being age-friendly. Both age- and
                                                            dementia-friendly initiatives should take
     30. Dementia-awareness programmes                     into account the fact that a significant
          should: foster an accurate understanding          number of older people are living alone
          of dementia and its various subtypes as           and are sometimes very isolated.
          clinical diseases; reduce stigmatization
          and discrimination associated with             32. Dementia-awareness campaigns and
          dementia; educate people about the                  dementia-friendly programmes that are
          human rights of people with dementia                tailored to the cultural contexts and
          and the Convention on the Rights of                 particular needs of a community can
          Persons with Disabilities; enhance the              promote enhanced health and social
          general population’s ability to recognize           outcomes that reflect the wishes and
          early symptoms and signs of dementia;               preferences of people with dementia,
          and increase the public’s knowledge of              as well as improve the quality of life for
          risk factors associated with dementia,              people with dementia, their carers and
          thereby promoting healthy lifestyles and            the broader community.
          risk reduction behaviour in all.
                                                         33. Rationale. Increasing public awareness,
     31. A dementia-friendly society possesses               acceptance and understanding of
          an inclusive and accessible community               dementia and making the societal
          environment that optimizes opportunities            environment dementia-friendly will
          for health, participation and security for          enable people with dementia to
          all people, in order to ensure quality of           participate in the community and
          life and dignity for people with dementia,          maximize their autonomy through
          their carers and families. Shared key               improved social participation.
34.   Global target 2.1:                                               35.   Global target 2.2:
	100% of countries will have at                                       	50% of countries will have
  least one functioning public                                           at least one dementia-
  awareness campaign on                                                  friendly initiative to foster a
  dementia to foster a dementia-                                         dementia-inclusive society
  inclusive society by 2025.1                                            by 2025.1

36. In collaboration with people with                                    inclusive and age- and dementia-
     dementia, their carers and the                                       friendly, promoting respect and
     organizations that represent them, the                               acceptance in a manner that meets the
     media and other relevant stakeholders,                               needs of people with dementia and
     organize national and local public                                   their carers and enables participation,
     health and awareness campaigns that                                  safety and inclusion.
     are community- and culture-specific.
     This cooperative action will improve                             38. Develop programmes, adapted to
     the accuracy of the general public’s                                  the relevant context, to encourage
     knowledge about dementia, reduce                                      dementia-friendly attitudes in the
     stigmatization, dispel myths, promote                                 community and the public and
     early diagnosis, and emphasize the                                    private sectors that are informed
     need for gender- and culturally-                                      by the experiences of people with
     appropriate responses, recognition                                    dementia and their carers. Target
     of human rights and respect for the                                   different community and stakeholder
     autonomy of people with dementia.                                     groups, including but not limited to:
                                                                           school students and teachers, police,
37. Support changing all aspects of the                                   ambulance, fire brigades, transport,
     social and built environments, including                              financial and other public service
     the provision of amenities, goods and                                 providers, education and faith-based
     services, in order to make them more                                  organizations, and volunteers.

39. Offer technical support to Member                                          organizations that represent them
     States in strengthening global, regional                                   in decision-making within WHO’s
     and national capacity:                                                     own processes and on issues that
                                                                                concern them;
      ●● to engage and include people
         with dementia, their carers and                                     ●● for the selection, formulation,

1.    The global target indicator and means of verification are provided in the Appendix to this Annex.

implementation and dissemination                                  of what works in different contexts and
              of best practices for awareness-                                  disseminate this information.
              raising and reduction of
              stigmatization and discrimination                        41. Promote awareness and understanding
              towards people with dementia.                                of dementia, the human rights of people
                                                                           with dementia and the role of families
     40. Building upon the WHO Global                                     and/or other carers as well as maintain
         Network of Age-friendly Cities and                                and strengthen partnerships with
         Communities and its dedicated                                     organizations representing people with
         website,1 integrate and link dementia-                            dementia and their carers.
         friendly initiatives by documenting and
         evaluating existing dementia-friendly                         42. Develop guidance for Member States
         initiatives in order to identify evidence                          on how to implement, monitor and
                                                                            evaluate dementia-friendly initiatives.

     43. Encourage all stakeholders to:                                     ●● redress the inequities in vulnerable
          ●● raise awareness of the magnitude of
             the social and economic impact of                         44. Ensure that people with dementia
             dementia;                                                     are included in activities of the wider
                                                                           community and foster cultural, social
          ●● include people with dementia, their                           and civic participation by enhancing
             carers and families in all aspects                            their autonomy.
             of developing and strengthening
             services that support the autonomy                        45. Share in the development and
             of people with dementia;                                       implementation of all relevant
                                                                            programmes to raise awareness about
          ●● protect and promote human rights of                            dementia and make communities more
             people with dementia and support                               dementia-friendly and -inclusive.
             their carers and their families;

     1. (accessed 8 March 2017).

Action area 3:

     Dementia risk

     46. Growing evidence suggests an                                   and the harmful use of alcohol, social
         interrelationship between dementia                              engagement, promotion of cognitively
         on one side and noncommunicable                                 stimulating activities and learning as
         disease and lifestyle-related risk factors                      well as prevention and management of
         on the other. These risk factors include                        diabetes, hypertension, especially in
         physical inactivity, obesity, unbalanced                        mid-life, and depression.
         diets, tobacco use, harmful use of
         alcohol, diabetes mellitus and mid-                       48. Rationale. By improving the capacity
         life hypertension. In addition, other                          of health and social care professionals
         potentially modifiable risk factors                            to provide evidence-based,
         are more specific to dementia and                              multisectoral, gender and culturally-
         include social isolation, low educational                      appropriate interventions to the
         attainment, cognitive inactivity and                           general population, educate about and
         mid-life depression. Reducing the                              proactively manage modifiable risk
         level of exposure of individuals and                           factors for dementia that are shared
         populations to these potentially                               with other noncommunicable diseases,
         modifiable risk factors, beginning in                          the risk of developing dementia can be
         childhood and extending throughout                             reduced or its progression delayed.
         life, can strengthen the capacity of
         individuals and populations to make
         healthier choices and follow lifestyle
         patterns that foster good health.
                                                                   49.   Global target 3:
                                                                   	The relevant global targets
     47. There is growing consensus that the                        defined in the Global action
          following measures are protective and
                                                                     plan for prevention and control
          can reduce the risk of cognitive decline
          and dementia: increasing physical
                                                                     of noncommunicable diseases
          activity, preventing and reducing                          2013–2020 and any future
          obesity, promotion of balanced and                         revisions are achieved for risk
          healthy diets, cessation of tobacco use                    reduction and reported.1

     1.   See document WHA66/2013/REC/1, Annex 4, available at
          pdf#page=87, accessed 20 September 2017.

50. Link dementia with other programmes,        51. Develop, deliver and promote evidence-
    policies and campaigns on                        based, age-, gender-, disability- and
    noncommunicable disease risk reduction           culturally sensitive interventions
    and health promotion across relevant             and training to health professionals,
    sectors by promoting physical activity,          especially within the primary health
    healthy and balanced diets. Specific             care system, to improve knowledge and
    actions include weight management for            practices of such staff, and proactively
    obese individuals, cessation of tobacco          manage modifiable dementia risk factors
    use and the harmful use of alcohol, formal       when conducting counselling about
    education and mentally stimulating               risk reduction. Routinely update these
    activities as well as lifelong social            interventions as new scientific evidence
    engagement in line with the principle of         becomes available.
    balancing prevention and care.

52. Linking to the actions specified in the        ●● support the formulation and
     global action plan for the prevention and         implementation of evidence-based,
     control of noncommunicable diseases               multisectoral interventions for
     2013–2020, offer technical support and            reducing the risk of dementia.
     strengthen global, regional and national
     capacities and capabilities to:             53. Strengthen the evidence base and
                                                     share and disseminate evidence
   ●● raise awareness of the links                   to support policy interventions for
      between dementia and other                     reducing potentially modifiable risk
      noncommunicable diseases;                      factors for dementia by providing a
                                                     database of available evidence on the
   ●● integrate the reduction and control of         prevalence of those risk factors and the
      modifiable dementia risk factors into          consequences of reducing them.
      national health planning processes
      and development agendas;

     54. Encourage all stakeholders to engage      ●● take particular actions that have
         in activities to:                             been shown to reduce the risk of
                                                       dementia, particularly during mid-life;
        ●● promote and mainstream population
           health strategies that are age-          ●● support national efforts for
           inclusive, gender-sensitive and             prevention and control of
           equity-based at national, regional          noncommunicable diseases in
           and international levels in order to        general and dementia in particular,
           support a socially active lifestyle         for example, through exchange of
           that is physically and mentally             information on evidence-based
           healthy for all, including people with      best practices and dissemination of
           dementia, their carers and families;        research findings.

Action area 4:

     treatment, care
     and support
     55. Dementia is associated with complex           term care covers all activities, whether
         needs and high levels of dependency            these are provided by health, social or
         and morbidity in its later stages,             palliative care services or result from a
         requiring a range of health and social         dementia-friendly environment. Palliative
         care, including long-term-care services.       care is a core component of the
         People with dementia are also less likely      continuum of care for people living with
         to be diagnosed for comorbid health            dementia from the point of diagnosis
         conditions, which, when left untreated,        through to the end of life and into the
         can cause faster decline, and to receive       bereavement stages for families and
         the care and support they need to              carers. It provides physical, psychosocial
         manage them. The services that they            and spiritual support for people with
         require include case-finding, diagnosis,       dementia and their carers including
         treatment (including pharmacological           support with advance care planning.
         and psychosocial), rehabilitation,
         palliative/end-of-life care and other       57. The global action plan proposes some
         support such as home help, transport,            principles for organizing and developing
         food and the provision of a structured           health and social care, including long-
         day with meaningful activities.                  term care systems for dementia. Providing
                                                          sustainable care across the continuum
     56. People with dementia should be                  from diagnosis to the end of life requires:
          empowered to live in the community              timely diagnosis; the integration of
          and to receive care aligned with their          dementia treatment and care into primary
          wishes and preferences. To ensure that          care; coordinated continuity of health
          people with dementia can maintain               and social care including long-term care
          a level of functional ability consistent        between different providers and system
          with their basic rights, fundamental            levels, multidisciplinary collaboration and
          freedoms and human dignity, they                active cooperation between paid and
          need integrated, person-centred,                unpaid carers. Planning responses to and
          accessible, affordable health and social        recovery from humanitarian emergencies
          care, including long-term care. Long-           must ensure that individual support for

people with dementia and community                              59. Rationale. The needs and preferences
     psychosocial support are widely available.                           of people with dementia can be met
                                                                          and their autonomy from diagnosis
58. Adequately trained and qualified                                     to the end of life respected through
     workforces are required to provide                                   integrated, culturally appropriate,
     these interventions. The continuity of                               person-centred, community-based
     care between different care providers,                               health, psychosocial, long-term care and
     multiple sectors and system levels and                               support and, where appropriate, the
     active collaboration between paid and                                inputs of families and carers.
     unpaid carers are crucial, from the first
     symptoms of dementia until the end
     of life. Integrated, evidence-based,
     person-centred care is required in all
     settings where people with dementia                             60. Global        target 4:
     live, ranging from their homes, the
                                                                     	In at least 50% of countries,
     community, assisted-living facilities and
     nursing homes to hospitals and hospices.                          as a minimum, 50% of
     The skills and capacity of the workforce                          the estimated number of
     and services are often challenged by the                          people with dementia are
     complex needs of people with dementia.                            diagnosed1 by 2025.2

61. Develop a pathway of efficient,                                 62. Build the knowledge and skills of
     coordinated care for people with                                    general and specialized staff in the
     dementia that is embedded in the health                             health workforce to deliver evidence-
     and social care system (including long-                             based, culturally-appropriate and human
     term care), to provide integrated, person-                          rights-oriented health and social care,
     centred care as and when it is required.                            including long-term care services for
     The pathway should provide quality care                             people with dementia. (Mechanisms
     and management that integrates multiple                             may include teaching the core
     services, including primary health care,                            competences of dementia diagnosis,
     home care, long-term care, specialist                               treatment and care in undergraduate
     medical care, rehabilitation and palliative                         and graduate medical and paramedical
     services, household help, food and                                  training, and continuing training
     transport services, other social welfare                            programmes for all health and social
     services and meaningful activities, into                            care professionals, in collaboration with
     a seamless bundle that enhances the                                 key stakeholders such as regulatory
     capacity and functional ability of people                           bodies.) Earmark budgets and resources
     with dementia.                                                      for in-service training for these

1.   All people who are diagnosed should receive appropriate post-diagnostic health and social care.
2.   The global target indicator and means of verification are provided in the Appendix to this Annex.

professionals, or include such budgets                         community-based care settings and
          and resources in specific programmes.                          multidisciplinary, community-based
                                                                         networks that integrate social and
     63. Improve the quality of care towards the                        health systems and provide quality care
          end of life by: recognizing advanced                           and evidence-based interventions.
          dementia as a condition requiring
          palliative care; promoting awareness                      65. Enhance access to a range of
          about advanced care planning for                               person-centred, gender-sensitive,
          all people living with dementia to                             culturally-appropriate and responsive
          document their wishes for the end of                           services including liaison with local
          their life; using validated end-of-life                        nongovernmental organizations and
          pathways and ensuring that people                              other stakeholders in order to provide
          with dementia have their values and                            information that empowers people with
          preferences respected and are cared for                        dementia to make informed choices
          in their place of choice; and providing                        and decisions about their care. Respect
          training for health care professionals and                     their rights and preferences and foster
          palliative care specialists.                                   active collaboration between the person
                                                                         with dementia, their families and carers
     64. Systematically shift the locus of                              and service providers from the first
          care away from hospitals towards                               symptoms through to the end of life.

     66. Offer technical support to Member                             identification of gaps, specific needs
          States for documenting and sharing                            and training requirements for health and
          best practices of evidence-based                              social care workers as well as graduate
          service delivery and care coordination,                       and undergraduate education about
          and provide support to Member States                          integrated provision of long-term care
          in developing dementia care pathways                          that is person-centred from diagnosis to
          in line with the principle of universal                       the end of life.
          health coverage.
                                                                    68. Provide guidance on strengthening
     67. Develop and implement guidelines,                              the implementation of the dementia
         tools and training materials, such as                           component of the WHO Mental Health
         model training curricula, covering core                         Gap Action Programme1 to enhance
         competencies relating to dementia for                           capabilities of existing human resources
         health and social care workers in the                           and train more staff, and on improving
         field. Provide support to Member States                         the ability to provide quality care and
         in the formulation of human resource                            evidence-based interventions through
         strategies for dementia, including the                          primary health care.

     1.   See (accessed 8 March 2017).

69. Support people with dementia and             teaching institutions in revising the
     their families and carers, for example,      contents of curricula so as to place
     by developing evidence-based, user-          greater emphasis on dementia, and
     friendly information and training tools      ensuring that people with dementia
     concerning dementia and available            are engaged, as appropriate, in
     services to allow timely diagnosis           the development and provision of
     and enhance the continued provision          education and training.
     of long-term care, or by setting up
     national helplines and websites with      71. Promote community-based rehabilitation
     information and advice at local levels.        as an effective strategy to enable
                                                    and support people with dementia in
70. Support the training of health and             preserving their autonomy and rights and
     social care personnel to provide               ensuring that the person with dementia
     evidence-based treatment and care for          remains at the centre of all discussions on
     people with dementia, by developing            diagnosis, treatment and care.
     training relevant to needs, supporting

Action area 5:

     Support for
     dementia carers

     72. Carers can be defined by their                                        and well-being and social relationships.
          relationship to the person with dementia                              Health systems must consider both
          and their care input. Many dementia                                   the substantial need of people with
          carers are relatives or extended family                               dementia for help from others and
          members, but close friends, neighbours                                its significant impact on carers and
          and paid lay persons or volunteers can                                families, including economic impact.
          also take on responsibilities for caring.                             Carers should have access to support
          Carers are involved in providing “hands-                              and services tailored to their needs
          on” care and support for people with                                  in order effectively to respond to and
          dementia or play a significant role in                                manage the physical, mental and social
          organizing the care delivered by others.                              demands of their caring role.
          Carers often know the person with
          dementia well, and therefore are likely                         74. Rationale. The creation and
          to have knowledge of and information                                 implementation of means to deliver
          about the person with dementia that                                  multisectoral care, support and
          is crucial for developing effective                                  services for carers will help to meet
          personalized needs-based treatment                                   the needs of carers, and prevent a
          and care plans. Carers should therefore                              decline in their physical and mental
          be considered essential partners in the                              health and social well-being.
          planning and provision of care in all
          settings according to the wishes and                            75.   Global target 5:
          needs of the person with dementia.
                                                                          	75% of countries provide support
     73. It should be noted that being a carer                             and training programmes for
          for someone with dementia may affect                              carers and families of people
          the carer’s physical and mental health                            with dementia by 2025.1

     1.   The global target indicator and means of verification are provided in the Appendix to this Annex.

76. Provide accessible and evidence-based                       78. Develop or strengthen protection of
     information, training programmes,                               carers, such as social and disability
     respite services and other resources                            benefits, policies and legislation
     tailored to the needs of carers to                              against discrimination, for example in
     improve knowledge and caregiving                                employment, and support them beyond
     skills, such as coping with challenging                         their caregiving role in all settings.
     behaviour, to enable people with
     dementia to live in the community and                       79. Involve carers in the planning of care,
     to prevent stress and health problems                           with attention being given to the
     for their carers.                                               wishes and preferences of people with
                                                                     dementia and their families.
77. P
     rovide training programmes for
    health care and social care staff for the
    identification and reduction of stress
    and burn-out of carers.

80. Build evidence on and articulate the                        81. Facilitate access to affordable, evidence-
    importance of carers in the lives of                             based resources for carers to improve
    people with dementia, while raising                              knowledge and skills, reduce emotional
    awareness about the disproportionate                             stress and improve coping, self-efficacy
    effect on women, and offer technical                             and health by making use of information
    support to Member States by                                      and communication technologies
    monitoring trends in availability of                             such as Internet and mobile phone
    carer-support services. Provide support                          technologies (for instance, WHO
    to Member States in developing                                   iSupport2), for education, skills training
    evidence-based information, training                             and social support.
    programmes and respite services for
    carers, using a multisectoral approach,
    and foster outcome measurement.

2.   WHO iSupport: e-programme for caregivers of people living with dementia (
     dementia/isupport/en/, accessed 8 March 2017).

     82. Increase awareness of the involvement,      in accessing health and social care,
          and its consequences, of carers and         including long-term care services.
          families in the lives of people with
          dementia, protecting them from           83. Assist in carrying out appropriate
          discrimination, supporting their              training programmes: for carers
          ability to continue their caregiving          and families to enhance knowledge
          in a gender-sensitive manner, and             and caregiving skills across the
          empowering carers with opportunities          progression of dementia; and on a
          to develop self-advocacy skills to            person-centred approach to promote
          be able to meet specific challenges           respect and well-being.

Action area 6:

     systems for

     84. Systematic, routine population-level                            85. Rationale. Systematic monitoring
          monitoring of a core set of dementia                                 and evaluation of the usage of health
          indicators provides the data needed                                  and social care systems can provide
          to guide evidence-based actions to                                   the best available evidence for policy
          improve services and to measure                                      development and service delivery,
          progress towards implementing                                        and can improve prevention and the
          national dementia policies. By building                              accessibility and coordination of care
          and/or strengthening information                                     for people with dementia across the
          systems for dementia, the functional                                 continuum, from risk reduction to the
          trajectories of people with dementia,                                end of life.
          their carers and families can be
          improved. However, this will require
          significant changes, while respecting                           86. Global         target 6:
          existing regulatory frameworks, to the
                                                                          	50% of countries routinely collect
          routine collection, recording, linkage
                                                                            a core set of dementia indicators
          and disaggregation for the sharing of
          health and administrative data of each                            through their national health and
          encounter of a person with dementia                               social information systems every
          with the health and social care system.                           two years by 2025.1

     87. Develop, implement and improve,                                      access to health and social care
          as needed, national surveillance and                                 data and map available services and
          monitoring systems, including registers                              resources at national and regional levels
          that are integrated into existing                                    in order to improve service delivery and
          health information systems, in order                                 coverage across the care continuum
          to improve availability of high-quality,                             from prevention through risk reduction
          multisectoral data on dementia. Enable                               to the end of life.

     1.   The global target indicator and means of verification are provided in the Appendix to this Annex.

88. Update or create supportive policy           routine reporting on dementia.
    or legislation pertaining to the
    measurement, collection and sharing        89. Collect and use the necessary data
    of data on health and social care for          on epidemiology, care and resources
    dementia and integrate this information        relating to dementia in the country in
    routinely into national health                 order to implement relevant policies
    information systems so as to facilitate        and plans.

90. Offer technical support to Members           guidance, training and technical
     States as they:                              assistance on capturing information
                                                  and facilitating the use of these data
   ●● develop and/or reform national data         to monitor outcomes. WHO’s Global
      collection systems, including health        Dementia Observatory provides the
      information systems, in order to            mechanism to monitor systematically
      strengthen multisectoral dementia           and facilitate the use of data from these
      data collection;                            core indicators, offering a platform for
                                                  the exchange of data and knowledge
   ●● build national capacity and                 in order to support evidence-based
      resources for systematic collection,        service planning, sharing of best
      analysis and use of dementia specific       practices and strengthening of both
      data through development of                 policies on dementia and health and
      targets and indicators that account         social care systems.
      for national circumstances, yet are
      aligned as closely as possible with      92. Offer technical support to Member States
      indicators and targets of the global         in generating and providing information
      monitoring framework.                        for monitoring of global, regional and
                                                   national targets as required, through the
91. Develop a core set of indicators in           Global Dementia Observatory.
     line with this action plan and provide

93. Provide support to Member States and         dementia, carers and families; and enable
     the Secretariat in developing tools and      an assessment of trends over time.
     strengthening capacity for surveillance
     and information systems that: capture     94. Advocate the involvement of people
     data on core indicators on dementia;           with dementia and their families and
     monitor usage of health and social care        carers in the creation, collection,
     and support services for people with           analysis and use of data on dementia.

Action area 7:

     Dementia research
     and innovation

     95. If the incidence of dementia is to be                                 agenda, will increase the likelihood of
          reduced and the lives of people with                                  effective progress globally towards
          dementia are to be improved, research                                 better prevention, diagnosis, treatment
          and innovation are crucial, as is their                               and care for people with dementia.
          translation into daily practice. It is
          important not only that funding and                             97. There is a growing interest in, and call for,
          appropriate infrastructures for dementia                             the use of innovative health technologies
          research and innovation are available                                in prevention, risk reduction, early
          but also that mechanisms are in place                                diagnosis, treatment, care and support
          that assist appropriate recruitment of                               relating to dementia. These innovations
          people with dementia, their families and                             aim to improve knowledge, skills and
          carers into research studies. Research                               coping mechanisms in order to facilitate
          and development costs are higher for                                 and support the daily lives of people
          dementia than other therapeutic areas,                               with dementia and their carers while
          because of lower success rates, longer                               meeting, in particular, identified needs in
          development times, and low recruitment                               an evidence-based and age-, gender- and
          rates into trials; this disproportion                                culturally-sensitive manner.
          discourages investment in this area.
                                                                          98. Rationale. The successful implementation
          Research is needed to find a cure
                                                                               of research into dementia aligned
          for dementia, but research is equally
                                                                               with identified research priorities and
          needed into prevention, risk reduction,
                                                                               social and technological innovations
          diagnosis, treatment and care, including
                                                                               can increase the likelihood of effective
          the disciplines of social science, public
                                                                               progress towards better prevention,
          health and implementation research.
                                                                               diagnosis, treatment and care for people
     96. Collaboration among and between                                      with dementia.
         Member States and relevant
         stakeholders, with a particular focus                            99.   Global target 7:
         on strengthening North–South, South–                             	The output of global research
         South and triangular cooperation, to                               on dementia doubles between
         implement a global dementia research                               2017 and 2025.1

     1.   The global target indicator and means of verification are provided in the Appendix to this Annex.

100. Develop, implement and monitor                promote projects that: support
     the realization of a national research         collaborative national and international
     agenda on prevention, diagnosis,               research; promote sharing of and open
     treatment and care of people with              access to research data; generate
     dementia in collaboration with                 knowledge on how to translate what
     academic and research institutions;            is already known about dementia into
     this work could be stand-alone or              action; and support the retention of
     integrated into related research               the research workforce.
     programmes that focus on filling
     gaps in evidence to support policy or      102. Foster the development of
     practice. Strengthen research capacity           technological innovations that, in terms
     for academic collaborations on national          of design and evaluation, respond to
     priorities for research into dementia            the physical, psychological and social
     by engaging relevant stakeholders,               needs of people with dementia, their
     including people with dementia.                  carers or people at risk of developing
     Relevant steps may include: improving            dementia; these innovations include
     research infrastructure for dementia and         but are not limited to diagnosis,
     related fields, enhancing competence             disease monitoring and assessment,
     of researchers to conduct high-quality           assistive technologies, pharmaceuticals
     research, and establishing centres of            and new models of care or
     excellence for research into dementia.           forecasting/modelling techniques.

101. Increase investment in dementia           103. Following the national ethical
      research and innovative health                 requirements for research, promote
      technologies and improve research              equitable opportunities and access
      governance as an integral component            for people with dementia and their
      of the national response to dementia.          carers to be part of clinical and social
      In particular, allocate budgets to             research that concerns them.

104. Draw up a global research agenda               research, capacities, methods
      and work together with Member                  and collaboration in the fields of
      States to strengthen and build                 biomedical and social sciences
      capacity in the area of dementia               research, inter alia, through a network
      research by incorporating it in                of WHO collaborating centres,
      national and subnational policies and          countries from all WHO regions, and
      plans relating to dementia. Advocate           civil society organizations.
      increased investment in dementia

You can also read