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| Though dementia cases are set to soar by 2026, early diagnosis is one of the obstacles to better treatment | | Battling dementia | | Sunita Vakil | 5/26/2012 7:15:23 PM |
| Health is hardly a priority in India and mental health is an abjectly ignored area. Keeping in view the WHO's shocking revelation that nearly 3.7 million people in India are suffering from dementia and the figure is set to double over the next 20 years, the challenge posed by the disease as a health and social issue is of a scale we can no longer ignore. The report is further evidence that the government has woken up too late to the dementia epidemic, a largely un-recognised disease in India but one which threatens to emerge as the biggest public health challenge in the country in the coming years. Poor understanding of dementia and its consequences is currently leading to underdiagnosis, late diagnosis and inadequate care response. Medically, dementia is defined as a loss of brain function that occurs with certain diseases. It is characterised by a progressive deterioration in intellect including memory, learning, orientation, language, comprehension and judgement. Its more common in the elderly. But about 2% of cases start before the age of 65 years. After this, prevalence doubles every 5 years. There are several reversible causes of the disease too like alcohol abuse, low vitamin B12 levels and normal pressure hydrocephalus. Dementia is one of the major causes of disability in later life. Proper diagnosis is one of the obstacles to better treatment. Even in economically developed countries more than half of dementia cases are overlooked until the disease has reached a later stage. Despite the magnitude, there is a gross ignorance and services are scarce for people with dementia in India. It remains a largely hidden problem especially in those parts where poverty and illiteracy levels are high. The WHO recently warned that India, which is experiencing an ageing problem, will face serious problems in tackling the disease. Infact, health minister Ghulam Nabi Azad said, "it is estimated that India's elderly population will increase from 7.5% in 2001 to almost 12% in 20 years". Indeed, apathy and lack of awareness is quite scary in a country where dementia among the 60+ is said to explode in the next 20 years.
A new report, "Dementia-a public health priority", published by WHO and Alzheimier's Disease International recommends that programmes should focus on improving early diagnosis, raising public awa-reness about the disease and reducing stigma while providing better care and more support to care givers. One common myth is that dementia is inevitable. Most families live in denial as they think memory loss is only natural with advancing age, which it is not. Older people have problems with memory and cognition. But dementia is a disease wih much more rapid symptoms and progression. And the time patients realise something is seriously wrong, the disease may have progressed to a higher stage. There is a need to have regular national campaigns to educate the public about evaluating for memory problems in old age. The print, visual and web-based media may be used for educating the masses at different levels. WHO says a lack of diagnosis, information and understanding about dementia is a major problem. The disease often fuels stigma, contributiong to social isolation of both patients and their care givers. This invariably leads to delays in seeking diagnosis, health assistance and social support. Badly trea -ted or ignored, sufferers became isolated and vulnerable. As it is, poor understanding of dementia and its symptoms as well as the importance of getting a diagnosis is a growing challenge here. It is now vital to tackle the poor levels of public aw-areness since help available for those with the condition is often very limited. There is also a dire need to drastically reduce the stigma associated with the disease.
Dementia is a chronic disabling condition neglected by all concerned in the healthcare sector. Undoubtedly, governments all over the world prefer to give priority to prevention of mortality rather than to prevention of disability. Although mental health is a national clinical priority along with cancer and heart disease, it has not received the attention it requires. And this despite the fact that the disease affects many more lives apart from the lives of the people afflicted with it. It is time the policy makers recognised the importance of preventing disabling conditions like dementia and provided interventions to reduce the suffering of those who live with this disability in later life. It is estimated that Delhi will see a mammoth 226% increase in dementia cases among people aged 60 and above by 2026 as compared to 2006. While Maharashtra will see a 112% increase, Jharkhand will see the highest increase in these cases during the same period. The Union Ministry's projections for Bihar, Assam and Chattisgarh stand at 221%,183% and 177% respectively. Other states like MP(163%), Gujarat(159%), J&K(158%), West Bengal(154%), Kar-nataka (142%) and Tamil Nadu(110%) are expected to see considerable incr-eamnt in 20 years. But Kerala will see the least increase among all states (87%) followed by Punjab (93%) and Himachal Pra-desh (94%). What's worse, we are hardly prepared for this sort of rapid increase in dementia cases. The increased number of such patients will have a marked impact on the state's infrastructures and healthcare systems which are at present ill prepared in many regions. There are many barriers to dementia care in India including lack of awareness, lack of policy initiatives for people with the disease, lack of training and support services and last but not the least lack of funds for services, research and training. Given the unp-recedended pace of demographic ageing of our population, this is the challenge we need to face as we have more and more dementia patients in our midst. It needs no reiteration that both counselling and therapy are integral to tackle the disease. Given the disorientation and confusion of sufferers, one needs to be a trained counsellor to be able to guide them through this very difficult phase in their lives. Since the number of skilled counsellors in India is abysmally low, there is an urgent need to train our health professionals to look after such patients. There are hardly any standard practice guidelines and treatment centres in India to combat the condition. The current health and social care system is characterised by a widespread failure to support persons with dementia and their families. Immediate and decisive action at all levels is needed to provide a range of solutions that assure a life of dignity for people ravaged by the disease.
Mental health is a significant measure of one's well being. If treated, mental health can take care of many physical illness too. It is estimated that the annual cost of taking care of a person with dementia is about Rs 43,000. The financial burden will only increase in coming years. The impact of the disease on the individual, the family and the society will increase exponentially in terms of burden, disability and cost of care. As the increase spreads it will have social, political and financial ramifications. The government apathy is evident in paltry allocations and absence of political will regarding dementia care which is either absent or delivered piecemeal in an inefficient fashion. Its only now that there is a proposal to include mental health as a focus area in the twelth five year plan. The Rs 60 crore scheme of the Ministry of Social Justice and Empowerment to develop dementia care has not led to a single such home seeing the light of the day. It was only recently the WHO and Alzheimer's Disease International urged India to adopt strategies on a war basis to meet the challenge of dementia which has a mortality rate of 13.5 per 100,000 males and 11.1 per 100,000 females in the country.
There is a need to recognise dementia as a health and social welfare priority. It is hoped that the public health challenges posed by the disease which promises to shoot up in the near future will set the stage for the development of a national dementia strategy of India. Besides proper institutional care and awareness drives, there is need for more doctors and trained caregivers to tackle the disorder. Also family support is a must. Its time dementia does not carry a stigma and is viewed as any other health problem to be treated with equal urgency and care.
The writer is a Delhi based senior journalist and can be contacted at: [email protected] |
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