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More women at risk from dementia

A critical report on dementia’s and its spread throws out startling facts about why women are more affected than men.
by Alzheimer’s Disease International (ADI)

Across all regions of the world, dementia disproportionately affects women. More women than men develop dementia, and a large proportion of carers are women, in both informal and formal capacities. While the higher prevalence of dementia amongst women is noted in the research, there is little evidence of policy being put into place and actioned in response to this. In the few papers focussed on lower and middle-income countries (LMICs), there was often no governmental organisation or programmes to address the problems associated with dementia, either for the person with dementia or to support the caregiver.

Expectations are made in many countries that families will look after older relatives, including those with dementia. This expectation often extends to it being the women in the family who take on this direct caregiving role. There was often reluctance amongst women caregivers to access help from formal and informal support services, due to conflicts between cultural and family expectations or the ability and willingness to seek help on the part of the caregiver. In LMICs in particular it was seen to be important to ensure that community services were made more easily accessible to women with little or no education.

Dementia careWomen will continue to provide care, whether this is due to societal expectations, or an individual wish to support members of their family and friends. Whatever their motivation, there needs to be adequate and appropriate information and support in place to enable these women to provide care, and feel cared for themselves.

The India story

Dementia is a public health issue that will become increasingly visible in LMICs as the population ages. All countries need to understand the current and predicted prevalence and acknowledge that dementia disproportionately affects women; the impact on women needs to be ascertained in individual countries, along with a review of the support available currently and what is needed to meet future needs.

As the population ages, the prevalence of dementia will increase, given that advanced age is the greatest risk factor for dementia (Alzheimer’s Association, 2014). The number of people globally estimated to be living with dementia in 2013 was 44.35 million. This is predicted to rise to 75.62 million in 2030 and 135.46 million in 2050. The rates of increase across different parts of the world is not uniform, with rates increasing in India, China and South Asian and Western Pacific regions at three times the rate of increase in high income countries.

In 2013, Alzheimer’s Disease International estimated that around 38 per cent of people with dementia were living in high income countries, and 62 per cent in low and middle income countries (LMICs); this is predicted to rise to 71 per cent in LMICs by 2050 if current trends continue. These figures highlight the need for all countries, in particular low and middle income countries, to develop plans to ensure the provision of appropriate health and social care to manage the increasing need of the ageing population.

Influencing factors

Many factors influence carer burden and strain across different countries, ethnicities and cultures. In a survey of 11 sites in middle income countries (Latin America, China and India) the factors leading to carer strain were found to be the primary stressors of behavioural and psychological symptoms of dementia (BPSD), dementia severity, the care needs of the care recipient and time spent caring.

Cutting back on paid work to undertake care was significantly associated with higher carer strain in most countries. No significant associations were found in chi-square analyses on demographic variables, dementia diagnosis, severity of dementia, medications prescribed or where the person with dementia lives which would account for these high levels of carer strain. Elsewhere, in Iran, factors increasing the risk of psychological morbidity in dementia carers included being a spouse, having an affected person at home, and living together.

The impact on finance is also significant in LMICs, where the fewer than half of the people with dementia received any kind of pension; this proportion was lower in India and Nigeria. However, some LMICs have adopted policies of non-contributory pensions as part of social welfare programme, or have wide access to healthcare services, addressing some of the problems faced by the older population. The majority of caregivers in the 10/66 Dementia Research Group study had to cut back on paid work, or stop working altogether, in order to care for the person with dementia, with no provision of any kind of state caregiver allowance. In Tanzania, with no state care available, it was suggested that provision of community day care for people with dementia, either by the state or religious organisations, would allow caregivers to undertake more “productive work”.

Read the entire report here.

(Pictures courtesy www.dailymail.co.uk, www.huffingtonpost.co.uk)

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Dementia: How it strikes and whom

We’re observing Alzheimer’s Awareness Month all of September 2014, and kickstarting the series with basic information on dementia and its effects.
by The Editors | editor@themetrognome.com

We at The Metrognome have always supported the causes of elders in society. Last year, we observed all of September 2013 as Alzheimer’s Awareness Month. This year, too, we are kickstarting the Alzheimer’s Awareness campaign with a few nuggets of information about dementia, its effects and living with it.

The Alzheimer’s Disease International lists these facts about dementia:

– Dementia is a term used to describe different brain disorders that affect memory, thinking, behaviour and emotion.

– Early symptoms of dementia can include memory loss, difficulty performing familiar tasks, problems with language and changes in personality.

– Dementia knows no social, economic, or ethnic boundaries.

– Alzheimer’s disease is the most common cause of dementia. Other causes include vascular disease, dementia with Lewy bodies and fronto-temporal dementia.

– There are currently estimated to be 44 million people worldwide living with dementia. The number of people affected is set to rise to over 135 million by 2050.

– There is one new case of dementia worldwide every four seconds.

– The worldwide costs of dementia exceeded 1 per cent of global GDP in 2010, at US$604 billion. As a result, if dementia care were a country, it would be the world’s 18th largest economy. If it were a company, it would be the world’s largest by annual revenue exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion).

– Dementia is often hidden away, not spoken about, or ignored at a time when the person living with dementia and their family carers are most in need of support within their families, friendship groups and communities.

– The social stigma is the consequence of a lack of knowledge about dementia and it can have numerous long- and short-term effects, including:

  • Dehumanisation of the person with dementia
  • Strain within families and friendships
  • A lack of sufficient care for people with dementia and their carers
  • A lower rate of diagnosis of dementia
  • Delayed diagnosis and support

– The stigmatisation of dementia is a global problem and it is clear that the less we talk about dementia, the more the stigma will grow. This World Alzheimer’s Month we encourage you to find out more and play your part in reducing the stigma and improving the lives of people with dementia and their carers in your community.

We welcome your views, suggestions and articles on Alzheimer’s, dementia, caregiving, and indeed, the gamut of ageing. Do send us relevant content about events, news and personal anecdotes about Alzheimer’s to editor@themetrognome.in, and we will publish it in this space.

 (Pictures courtesy www.2gb.com)

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Wellness

Smoking ups dementia risk

A recent report by WHO confirms that smoking increases dementia risk, like it is a factor in cancer and cardiovascular disease.
by Alzheimer’s Disease International (ADI)

Smokers have a 45 per cent higher risk of developing dementia than non-smokers, according to information published recently by the World Health Organization (WHO), in collaboration with Alzheimer’s Disease International (ADI).

Evidence reviewed by WHO reveals a strong link between smoking and the risk of dementia, and the more a person smokes, the higher the risk. It is estimated that 14 per cent of Alzheimer’s disease cases worldwide are potentially attributable to smoking. WHO warns that exposure to second-hand smoke (passive smoking) may also increase the risk of dementia.

“Since there is currently no cure for dementia, public health interventions need to focus on prevention by changing modifiable risk factors like smoking,” says Dr Shekhar Saxena, Director of the Department for Mental Health and Substance Abuse at WHO. “This research shows that a decrease in smoking now is likely to result in a substantial decrease in the burden of dementia in the years to come.”

Tobacco use is already recognised as the one risk factor common to four main groups of non-communicable diseases (NCDs): cancers, cardiovascular disease, chronic lung disease and diabetes. “Tobacco is one of the biggest public health threats the world has ever faced, killing nearly six million people a year,” says Dr Douglas Bettcher, Director of the Department for Prevention of Noncommunicable Diseases at WHO. “WHO urges governments to actively implement and enforce the measures of the WHO Framework Convention on Tobacco Control, especially smoke-free environment laws and access to tobacco cessation services”.

Laurent Huber, Director of the Framework Convention Alliance (FCA) for Tobacco Control, comments: “It is no surprise to see these findings confirm that tobacco smoking is a major risk factor for dementia. This adds yet another item to the long list of the devastating consequences of tobacco and gives even more reason for personal and public health action to help people to quit smoking.”

“The research also shows that quitting smoking later in life might be beneficial so encouraging and supporting current tobacco users to quit should be a priority,” says Serge Gauthier, chair of the ADI’s Medical Scientific Advisory Panel.

Dementia affects more than 44 million people worldwide, with almost two thirds of them living in low- and middle-income countries. “Every year, there are 7.7 million new cases of dementia. In 2010, the global cost was calculated at US$ 604 billion, which represents 1 per cent of global GDP (gross domestic product),” says Marc Wortmann, ADI Executive Director. “No government can ignore the opportunity to link this new information into its planning and health system activities to reduce smoking and control NCDs.”

ADI believes that this information brief can form the basis for countries to add messages about brain health and dementia risk into public health anti-smoking programs and interventions.

(Pictures courtesy www.express.co.uk, www.dailymail.co.uk)

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City gets its first private geriatric clinic

PD Hinduja Hospital opens multi-disciplinary geriatric clinic from today; wants to create awareness of gerontology and devise specific treatment plans.
by the Editors | editor@themetrognome.in

Considering the high numbers of senior citizens in the country and the fact that by 2050, India will have the second highest numbers of elderly in the world (after China), it is a bit strange that there are not too many hospitals looking into specialised elderly care. Alarmingly, at least a third of this huge population will live alone and require care.

Dr._Preeti_Chhabria_Hearteningly, one of the city’s premier private hospitals, PD Hinduja Hospital, is opening the city’s first geriatric clinic today, on an OPD (Out Patient Department) basis. Says Dr Preeti Chhabria (in pic on left), consultant in internal medicine and who was instrumental in setting up the clinic, “As people age, there are several changes taking place in their bodies, which are accepted as ‘normal’ by virtue of ageing. We want to bring about the awareness of gerontology, and the idea that it is not necessary to accept these signs of ageing as normal.”

She says that these psychological and physical changes cause a sense of ‘burden’ in the elderly. “Their bodies change and their mobility is affected. Add to that the sense of being dependent, both financially and emotionally, on their children, plus the grief of losing children or the spouse, and the person undergoes a lot of pressure in his daily life,” Dr Chhabria explains. “The elderly suffer in silence because people around them may not be aware of or sensitive to the pressure that they are under.”

What to expect at the clinic

Dr Chhabria has worked in the field of elder care in the US for 15 years, and will use her experience in the multi-disciplinary clinic. There will be three doctors in attendance at the clinic – a consultant for internal medicine, a psychologist and a physiotherapist, all working in tandem to devise the best treatment plan for each patient. “We would evaluate their physical and mental status, and we would follow a ‘grading system’ for each patient. We have clinical scales for grading, to include the parameters Normal, Grey and Mild/Moderate Dementia. Anybody qualifying for the last scale is immediately brought to the attention of their families.

“The testing procedures we follow are fairly accurate, to the extent that we can determine if a person is suffering from ageing-related factors or if his or her condition is the product of other factors like illness or stress,” Dr Chhabria explains. The testing also involves evaluating a person’s mood, checking cognitive function and testing memory.

DSC_0033Back to the future

Dr Chhabria says that such a clinic is necessary in an environment that is extremely “tunnel visioned” towards providing only for the youth. “Geriatrics is the other end of the spectrum from paediatrics. In our daily lives, the young have to be aware of the fact that they are going to be caregivers for the elderly, and that they have to ensure that their old age is safe and peaceful. The elderly should not be marginalised, but taken care of with love and empathy.” In the future, Dr Chhabria says there are plans to offer counselling to caregivers of the elderly.

The clinic will remain open on Thursdays between 9.30 am to 5.30 pm. Please call the clinic on 022 39818181/67668181 for appointments and more details.

(Pictures courtesy PD Hinduja Hospital)

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10 warning signs for Alzheimer’s

How do you know if your loved one is suffering from dementia or Alzheimer’s? Use this checklist to know more.
by Sailesh Mishra, Silver Innings Foundation and Alzheimer’s Association National Office, Chicago

Dementia is a general term to denote a progressive degenerative disease of the brain resulting in loss of memory, intellectual decline, behavioural and personality changes. Mostly older people above 60 years of age are affected by this condition. In Latin, ‘dementia’ means irrationality, and this disorder results in a restriction of daily activities, and in most cases, leads in the long term to the need for care. There are many forms of dementia, the most common one being Alzheimer’s disease.

alzhiemersAlzheimer’s knows no social, economic, ethnic or geographical boundaries and affects people throughout the world. It is estimated that every seventh person in world will suffer from some form of dementia.

There is no cure for the disease, but some treatment and therapy is available to stabilise and arrest the progress of the disease. Here’s what you should watch out for if you think a loved one may be suffering from dementia or Alzheimer’s, and what is normal behaviour:

#1) Memory loss that disrupts daily life

One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (such as reminder notes or electronic devices) or family members for things they used to handle on their own.

What’s typical? Sometimes forgetting names or appointments, but remembering them later.

#2) Challenges in planning or solving problems

Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What’s typical? Making occasional errors when balancing a checkbook.

#3) Difficulty completing familiar tasks at home, at work or at leisure

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the alzheimer'srules of a favourite game.

What’s typical? Occasionally needing help to use the settings on a microwave or to record a television show.

#4) Confusion/disorientation with time or place

People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What’s typical? Getting confused about the day of the week but figuring it out later.

#5) Trouble understanding visual images and spatial relationships

For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining colour or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realise they are the person in the mirror.

What’s typical? Vision changes related to cataracts.

#6) New problems with words in speaking or writing or problems with language

People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”).

What’s typical? Sometimes having trouble finding the right word.

#7) Misplacing things and losing the ability to retrace steps

A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.

What’s typical? Misplacing things from time to time, such as a pair of glasses or the remote control.

alzheimer's #8) Decreased or poor judgment

People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.

What’s typical? Making a bad decision once in a while.

#9) Withdrawal from work or social activities/loss of initiative

A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favourite sports team or remembering how to complete a favourite hobby. They may also avoid being social because of the changes they have experienced.

What’s typical? Sometimes feeling weary of work, family and social obligations.

#10) Changes in mood and personality

The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

What’s typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

The Metrognome is committed to the cause of Alzheimer’s and dementia awareness through all of September 2013. If you want to share information or anecdotes related to Alzheimer’s or dementia, write to editor@themetrognome.in and we will feature it.

(Pictures courtesy www.webicina.com, www.firstpost.com, www.thehindu.com, www.indianexpress.com)

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Fun and learning with senior citizens

The city-based NGO Silver Innings Foundation organised events for senior citizens at the YWCA yesterday. Here are some event snapshots.
by The Editors | editor@themetrognome.in

The Silver Innings Foundation, which works in the field of elder care, counselling and assisted living for senior citizens, among other things, yesterday organised a series of activities for elders at the YWCA, Andheri. A few students from Nirmala Niketan College of Social Work  also participated in the events.

The Foundation’s events were a good success, with about 50 elders participating. Says Sailesh Mishra, Founder President, Silver Innings, “We did a street play, then an interactive PPT talk. We also conducted a memory checkup and held memory games and exercise for the elders. There was also a sharing session by family care givers, and the best part was the dance in which everybody took part!”

See pics of the events below:

The Metrognome is committed to the cause of Alzheimer’s and dementia awareness in India. If you have an experience or information to share on Alzheimer’s or dementia, do write to us at editor@themetrognome.in and we will feature your story.

 (Pictures courtesy Silver Innings Foundation)

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