Irish dementia services patchy with long waits for clinics

New figures have revealed significant gaps in dementia services in the State where patients face a “postcode lottery” and lengthy waits to access specialist memory assessment clinics.

Half of all counties in the Republic do not have memory clinics, and where memory clinics do exist patients may be waiting over a year for an appointment in some cases.

Memory clinics provide a range of specialist tests and scans to assess and diagnose patients for dementia or other conditions involving cognitive impairment.

It is estimated that 55,000 people in the State are living with dementia, but that less than half are diagnosed with the progressive brain disease. Over the next 25 years the number of people living with dementia in the Republic is projected to rise to over 130,000.

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The patchy availability of memory clinics has prompted calls for a network of specialist memory centres to be developed to meet patient demand for assessment and diagnosis now and into the future.

Brian Lawlor, professor of old age psychiatry at Trinity College Dublin, said: "As is the case for cancer care, we need a certain number of specialist memory clinics throughout the country, where you have a standard approach, where there's ready access to neuropsychological testing and neuroimaging, and where you can receive expert multi-disciplinary and multi-professional assessment."

Other jurisdictions

Memory clinics are well established as part of dementia services in other jurisdictions. In Northern Ireland memory clinics are available in each of the five health trust areas, although information obtained by Belfast-based website The Detail found variation in services and waiting times.

Close to 1,000 patients in the North were waiting to be assessed at memory clinics between December and February last, with some waiting for as long as nine months to be assessed.

However, in the Republic services are much less developed. There are 19 memory clinics across 13 counties, but no specialist memory services in counties Donegal, Sligo, Leitrim, Cavan, Monaghan, Galway, Mayo, Clare, Louth, Longford, Kerry, Waterford, and Wicklow.

The starkest gap is evident in the western and northwestern regions, which have the highest dementia prevalence rates in the State. An estimated 10,000 people are living with dementia across both regions. There is one memory clinic available in Co Roscommon.

Where no memory services are available the HSE said patients could access geriatric, neurology, and psychiatry of later life services. The HSE identified “27 possible memory clinics” but confirmed that only 19 were operational; the other eight “possible” clinics were either no longer in operation (three), were private (two), or were not considered memory clinics (three).

Regional gaps

In addition to regional gaps there is also a wide variation in the type and frequency of memory clinic available. Just one clinic operates on a full-time five-day per week basis; others run for between two days per week to six days in a year.

Figures obtained under Freedom of Information from the HSE also reveal that at least 544 patients were waiting for an appointment across all regions in December 2016/January 2017 (waiting list figures not available for two clinics) and that some patients were waiting as long as 14 months to be seen at a memory clinic.

The Alzheimer Society of Ireland has called on the Government and the HSE to “take an all-Ireland approach” to planning dementia services to ensure citizens are treated equally.

“It is not acceptable that there is such clear inequity of the availability of the service and of the provision of the service. We know this isn’t exceptional, and it certainly needs to change,” said Tina Leonard, head of advocacy at the society.

Progressive illness

“Dementia is a progressive illness, and one thing people with dementia do not have is time.one thing people with dementia do not have is time. The longer it takes to get a diagnosis or to access early interventions the poorer health outcome a person will have.”

If services are not developed patient waiting lists and waiting times will grow, said Prof Lawlor. “With the ageing demographic the wait lists are only going to increase unless we do something. So leaving aside increasing demand, the numbers that require assessment are going to increase anyway, so we need to be ready for that.”

The HSE’s national dementia office will begin a review of diagnostic services later this year.