Do We Need A Paradigm Shift In Management Of Dementia

There has been a mark shift in India's demographics - the population of senior citizens has steadily increased in recent decades.  As cited by India's Longitudinal Ageing Study, there will be over 319 million elderly by 2050, threefold the number identified by the Census in 2011. Thus, the geriatric population is very important and shouldn't be disregarded.

Seniors suffer from many ailments – physical disabilities, mental health problems, etc. Most people in this population group have multiple medical conditions. While there are several conditions that plague seniors, Dementia is the most common type of disability and dependency in elderly worldwide. It has a physical, psychological, social and economic impact, not only on people suffering with Dementia, but also on their care-givers, families and society at large. By 2050, an estimated 131 million people are expected to be suffering from this health condition. Globally, India houses the second highest number of individuals suffering from Dementia - about 6 million. This number is expected to double by 2035. And yet, as a nation, we are under-served to provide the right care for this condition.

Dementia is a health condition where it is difficult to predict who will be affected, even though there has been much learned, written and understood about it. There is no definitive treatment line available and therefore, it is important to know how to manage Dementia.

Dementia is typically difficult to diagnose since it is considered an inevitable part of aging. This disorder is usually mistaken as a psychiatric illness due to its neurological nature. As per the WHO, there are 50 million people suffering from Dementia worldwide; and every 3 seconds one person is diagnosed with this health condition. Studies show that this number has doubled every 20 years, making it vital for us to understand and manage this. 

Unfortunately, the awareness of Dementia in India is poor since a large section of our population lives in rural areas. Majority of urban population too is not aware that this is a condition that requires medical attention and intervention like diabetes or hypertension. As per a study done in 2015 1 in every 16 household in India has an elder suffering from dementia however, only 1 in every 10 patients gets diagnosed (Copyright © 2010-2021 Swapna Kishore).

Several factors act as deterrents in management of dementia, including - lack of awareness, dearth of doctors who can diagnose and manage this condition, ad-hoc treatment protocols, lack of ROI on the treatment given, length of treatment, lack of infrastructure etc. The lack of attention by the government as well as private players is evident as there is negligible studies or research that exists.  Sporadic policies are made, but implementation of the same is a challenge. 

Dementia requires the same attention as any other non-communicable disease. Increasing awareness is essential, which will in turn increase the demand for care and in response to this lead to development of better infrastructure. 

Caring Dementia patients

Each stage of dementia needs a different kind of management. The initial stages can be managed at home with guidance from an experienced team of neurologists, psychiatrists, and counsellors. Memory Clinics also help by providing the family with an easily implementable care plan after a detailed assessment and under one roof.

For moderate cognitive decline, day care facilities are recommended. They provide better care than at home and offer some respite to family members. A good day care center ought to employ the same staff members as a memory clinic. 

For advanced stages of dementia, a residential facility equipped with adequate infrastructure and a super specialized team of experts is effective. 

Enabling a paradigm shift

India is far from prepared to deal with the scale of dementia and related conditions that is expected to increase in the country. We must start now. 

The government can play a huge role - by increasing awareness, to developing policies and protocols to build and run dementia care facilities, to providing opportunities for training of healthcare professionals familiar with treating dementia patients. 

Given the complexity of this disease, the nature of the treatment, and the volume, current protocols have shown to be ineffective. Dementia requires a paradigm shift in the way we plan, prepare and manage it.

Dr Reema Nadig

Guest Author The author is Chief Operating Officer & Group Medical Director at KITES Senior Care