17 An improved dementia diagnosis requires a closer cooperation of health and social actors

The project team conducted review of international review on the benefits and drawbacks as well as ethical issues of early diagnosis. Based on an extensive desk research reports of the 26 cantonal diagnosis policies were produced. On this basis, an online survey was addressed to institutions providing dementia diagnosis in the Swiss cantons. Finally, the project team conducted cantonal case studies in four cantons that have adopted a dementia cantonal strategy (Saint-Gall, Tessin, Vaud, Zürich). These case studies articulated a public policy analysis and an exploration of practical and ethical dilemmas reported by health professional in selected diagnosis institutions (mainly Memory Clinics).

Dementia will increase significantly in the coming years in Switzerland. With the National Dementia Strategy 2014 -2019, the health system prepared itself for the associated challenges. The strategy emphasized early diagnosis and appropriate support for concerned people and their families. Early diagnosis benefits, however, are still debated and the cantons, which are mostly in charge of health and care policies, have adopted different approaches. However, little has been known about the concrete implementation of early detection and its implications.

This project aimed to shed light on the implementation of dementia diagnosis in the Swiss cantons. The following questions are addressed:

1. What are the characteristics of the dementia diagnosis network in Switzerland?

2. How do different cantons implement early diagnosis policy?

3. What are the key ethical dilemmas related to diagnosis practices?

Models of diagnosis policy and governance vary at the cantonal level in the degree of centralization, specificities in specialised actors' network and location in health and/or social care. In their practices, health professionals are mainly confronted with social implications of diagnosis for the persons and their families, especially shortages in long-term care and driving licence management. There is a need (and a strong potential) for increasing coordination between health diagnosis structures and social/care organisations. Moreover, many issues are related to how best to protect and promote the autonomy of patients and their families at each step in a diagnostic process.

Significance of the results for research and practice:

The present study sheds light on the diversity of cantonal dementia strategies in Switzerland. The results serve to promote the exchange of knowledge between the cantons on the conception and implementation of dementia strategies, thereby reducing blind spots and promoting equal opportunity access. In particular, the social issues that arise in connection with the (early) diagnostic of dementia should be given greater consideration in the cantonal dementia strategies.

Dementia Diagnostic between Cure and Care Policies Practices and ethical issues in the Swiss cantons