World Happiness Report 2024 Associations Between Wellbeing and Dementia – A Summary

As the global population of older adults increases, the number of worldwide dementia cases will also increase, with estimates predicting in the region of 139 million cases by 2050.

Given that there is currently no cure for the condition, and that medical treatments remain limited, prevention strategies that are not tethered to biomedical advancements take on a real significance. Higher levels of wellbeing have been robustly associated with lower risk for future dementia, offering the potential for a future focus on wellbeing as a non-pharmacological approach to dementia prevention.

A large scale study found that those with higher wellbeing experienced better than expected memory and thinking abilities and lower than expected decline in memory relative to the amount of dementia related neuropathology in the final years of life. This suggests wellbeing may serve as a protective factor for memory and thinking ability when pitted against the brain diseases linked to dementia (Willroth et al, 2023).

The association between wellbeing and reduced dementia risk is likely to be complex and may emerge as a by-function of the numerous known social and physical benefits associated with higher wellbeing; its causal effect may not be direct or straightforward. As a result, we have to be careful rushing to closure on causal explanations. The report is by no means suggesting that wellbeing enhancing interventions are the golden bullet we have been waiting for in dementia prevention. More randomised control trials are essential to test the effects of any wellbeing intervention in a range of diverse populations.

Even with the amazing work being done by dementia scientists, we are still a long way from eradicating this heartbreaking condition and there is, sadly, no suggestion that any dementia prevention strategies have the potential, at present, to prevent all cases. With 10 million diagnoses each year, enhancing the wellbeing of those living with dementia is paramount. Fortunately, the report highlights that those living with the condition can live well.

Social Determination theory has long posited that autonomy, competence and relatedness are fundamental for the experience of psychological wellbeing, and these needs are often negatively impacted by dementia. This gives us a good place to start with regard to targeted interventions. Engaging those living with dementia in personally meaningful activities has long been found to enhance wellbeing as they encourage opportunity for social connection, purpose and agency and improve mood, particularly when they are tailored to the individual.

Research consistently finds that social interaction (facilitating relatedness) is important to the well-being of people living with dementia, and that intergenerational interactions may be particularly effective.

Whilst some highlight the challenges and potential distortions arising from those living with dementia self-reporting on their wellbeing, others note high reliability for such ratings in those with moderate to severe impairment and that this is, obviously, the most accurate and person-centred way of measuring their subjective experience. Proxy Ratings of wellbeing by staff and relatives are often lower than self-ratings and should, therefore, not be treated as interchangeable.

More research is needed to investigate:

Scalable (including digital or micro) interventions that are effective in diverse populations

When in a lifespan the implementation of intervention is most effective with regard to potential dementia prevention

The elements of wellbeing which should be measured. This also requires further consideration of our operationalisation of wellbeing and the effectiveness of our measuring tools.

Policies and investments that enable equitable access to well-being and health enhancing activities across the lifespan may be especially beneficial, providing individuals with the resources needed to maintain their wellbeing and health, supporting late-life wellbeing and resulting in widespread benefits for dementia prevention.

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For the full chapter and references, see: https://doi.org/10.18724/whr-21fb-sb82