Dementia Primary Prevention Policies and Strategies and Their Local Implementation: A Scoping Review Using England as a Case Study

Abstract

Background: Understanding the policy context and how policy is implemented at the local and clinical level is an important precursor to developing preventive strategies focusing on dementia risk reduction in primary healthcare settings.

Objective: Using England as a case study, we review policies and strategies relevant to dementia prevention from the national to local level and how these are translated into primary healthcare services.

Methods: We conducted a scoping review covering: 1) identification of national, regional, and local policies and strategies that include dementia prevention; 2) identification of national guidelines for implementing dementia prevention at the clinical level; and 3) evaluation of the implementation of these at the clinical level.

Results: Dementia prevention is addressed in national policy, and this filters through to regional and local levels. Focus on dementia prevention is limited and variable. Reference to modifiable risk factors is associated with other non-communicable diseases, placing less emphasis on factors more dementia specific. Evidence of implementation of dementia prevention policies at the clinical level is limited and inconsistent. Available evidence suggests messages about dementia prevention may best be delivered through primary healthcare services such as the National Health Service (NHS) Health Check.

Conclusion: The limitations identified in this review could be addressed through development of a national policy focused specifically on dementia prevention. This could provide a platform for increasing knowledge and understanding among the general population and healthcare professionals. It would be important for such a policy to cover the full range of modifiable risk factors relevant to dementia.

Keywords: Commissioner; government; modifiable risk; policymaker; primary healthcare.

Fig. 1.

Structure of the England’s Department of Health & Social Care, health care commissioning bodies, and flow of policies from national to clinical level.

Fig. 2.

Modified PRISMA flow diagram showing the policies and strategies including primary dementia prevention CCG, Clinical Commissioning Group; JHWB, Joint Health and Wellbeing Board; NHS, National Health Service; PHE, Public Health England; STP, Sustainability and Transformation Plan.

Fig. 3.

Summary of legislation, policies and strategies influencing the delivery of dementia prevention in England Direction of policy or structural change Influence to 2021 and beyond May influencing JHWS from 2016 CCG, Clinical Commissioning Group; JHWS, Joint Health and Wellbeing Strategy; JSNA, Joint Strategic Needs Assessment; LA, Local Authority; NHS, National Health Service; NICE, The National Institute for Health and Care Excellence; PHE, Public Health England; STP, Sustainability and Transformation Plan.