Let us not forget…dementia

By Dr. Dineshani Hettiarachchi Sirisena

The darkness takes him over, the sickness pulls him in, his eyes – a blown out candle. Sometimes, I see a flicker, a light that shone from them…

Above are words from Lang Leav on dementia and describe the daily struggles of this daunting condition. I spoke to Dr. Neil Fernando, Consultant Psychiatrist and Senior Lecturer at the Kotelawala Defence University to gain some insight to this condition that takes one’s memory away.

What is dementia?

It is a chronic, irreversible, and progressive disease of the brain.

How common is it in Sri Lanka?

The exact number of dementia patients in Sri Lanka is unknown. However, studies conducted indicate an emerging problem.

Sri Lanka has one of the world’s fastest aging populations. Nearly 20% of the Sri Lankan population will be over 60 years by 2020. The projected number of cases of dementia for 2015 was 147,000, for 2030 is 267,000, and for 2050 is 463,000, which is a remarkably high number of cases.

Dementia care challenges in Sri Lanka

  •  Rapidly increasing aging population – according to predictions about the population in Sri Lanka, by 2075, the majority age group will be 80-plus
  •  Families changing from extended families to more nuclear families – children migrating to other countries for education and livelihood, leaving the parents to care for themselves
  •  Dementia being a chronic, irreversible, and progressive brain disease
  •  Burden on the carers of dementia patients

Current advances in dementia care in Sri Lanka at policy level

The Government has already recognised the need by establishing a Secretariat for the elderly

The Health Ministry has a separate directorate for the elderly

What else needs to be done

Recognising dementia as an emerging public health problem

Promoting the healthy aging concept with emphasis changing from “years to life” to “life to years”

The training of persons in taking care of the elderly, which includes not only medical, nursing, and social service professionals, but also encouraging more people to care for the elderly

Allocating more financial resources for the care of the elderly population

When asked about dementia care in the villages, Dr. Neil Fernando pointed out three main components that need attention:

  •  Creating public awareness
  •  The empowerment of dementia caregivers with the necessary knowledge and skills to overcome day-to-day challenges of care-giving
  • Initiating programmes that care for the carer – as physical and emotional demands of the caretakers are high, there should be programmes that help them look after themselves to prevent them getting worn out.

When asked about where we stand compared to the rest of the world and other Asian countries, he stated that we are fortunate to live in a country that considers looking after the elder family members a duty with meritorious benefits, rather than just an obligation. These cultural practices have greatly improved the quality of life of these patients as they are not confined to an institution and are surrounded by loved ones.

Dr. Neil Fernando

He sees this as one of the great privileges in this part of the world, and most Asian countries have a similar practice. However, countries like Japan are now showing trends toward institutionalising the elderly due to heavy financial and time constraints.

Early signs you should look out for

Memory impairment with recent memory more affected than distant memory

  •  Forgetting names, difficulty in recognising faces
  •  Neglect of personal care
  •  Quarrelling and interpersonal conflicts
  •  Wandering behaviour
  •  Prone to accidents, falls, and getting lost
  •  Difficulty in making decisions, judgements, and abstract thinking
  •  Disorientation of time, place, and person
  •  Deterioration in attention
  •  Deterioration in language functions

While scientists are working hard on developing the treatment for dementia, there is still no cure. Medication can treat some effects of the underlying disease, while other therapies help manage the symptoms. Hence, we should strive to delay its onset.

How can one delay the onset of dementia?

  •  Daily activities like calculations, problem-solving, and decision-making
  •  Engage in critical/analytical and creative thinking
  •  Mentally challenge your brain with new activities
  •  Physical activity also helps to reduce cognitive decline

The World Health Organisation (WHO) estimated 10 million new cases every year and among them, Alzheimer disease takes precedence by contributing 60-70% to the cases worldwide. As a result, dementia is gradually becoming a social burden owing to its physical, psychological, and economic impact. The principal goal of dementia care is to promote early diagnosis and delay further deterioration by optimising the quality of life of the affected. The care-giving system is an integrated one and at large, everyone should play a role.