Dementia care in developing countries: The road ahead.

Byline: K. Shaji Demographic aging is a global phenomenon with differential impact on world regions. It began early in developed countries and progressed over longer period of time. They had more time to develop services. Regions like Asia, Latin America and Africa are now witnessing rapid demographic aging. The developing countries in this region will have comparatively little time to develop services. It is this unprecedented pace of demographic aging which makes it such a huge public health challenge for the region. Though the biological phenomenon of aging is universal, the daily life of an older person varies considerably according to social, economic, and cultural contexts. Aging and health has many socio-cultural determinants. Social status and available social support for older people vary in different cultures. In many developing countries, older persons are accorded great respect, both within the families and in society. But the traditionally strong social support systems seem to be under strain due to the rapid social restructuring and economic changes sweeping the region. Dementia: An Emerging Public Health Challenge Despite mortality due to communicable diseases, poverty and human conflicts, dementia incidence is destined to increase in the developing world in tandem with the ageing population.[sup] [1] According to the Alzheimer's disease International (ADI) Delphi consensus study, by 2040, 71% of all people with dementia will be living in developing countries. It is estimated that there are about 1.5 million people with dementia in India (compared with 2.9 million in the USA).This number is likely to increase by 300% in the next four decades.[sup] [2] This estimate is based on the premise that the Indian incidence rates are relatively low and will remain stable over time. The relatively high prevalence of smoking and the high and rising prevalence of type 2 diabetes are matters of concern in India. These coupled with anticipated life style changes could affect the incidence rates and lead to a higher than expected prevalence in the near future.[sup] [3] The levels of caregiver strain, including that contributed by behavioural disturbances and stress are as high as in developed countries despite extended family networks and home care. Dependency, moreover, is strongly linked to poverty, and imposes additional economic strain on families.[sup] [4] People with dementia are cared for at home, by their families. Most families cannot afford institutional care, which in any case is, unavailable in most parts of the developing world. Home Based Care In most developing countries, older people, whether or not widowed, typically live with their families in multi-generational households. This is a good social situation as there are more people in the household to share the responsibility of care. However, populations are becoming increasingly mobile in low income countries. More women are taking up employment out side their homes to supplement the family income. Consequently the caring responsibilities at home will have to be shared by all .It is no more the exclusive responsibility of the traditional housewife. Many developed countries have comprehensive health and social care systems, but even in such settings families do play a vital caring role in looking after older adults. Interestingly in developing countries, the reliability and universality of the family care system is often overestimated.[sup] [5] Assisted living facilities or institutions which provide long-term care are few in low income countries. This puts enormous pressure on the families and caregivers as home based care is the only available option to most people. Public Health of Caregiving Caregiving itself can be viewed from a public health perspective.[sup] [6] If the caregiver remains healthy, then qualify of life of the care recipient will be better. Conversely, a failure in the health of the caregiver may mean collapse of the fragile support systems. …