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Dementia: An aging disengagement

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The Accra Psychiatric HospitalThe number of people suffering dementia around the globe is expected to nearly double to 65.7million sufferers by 2030, the World Health Organisation has warned.

By 2050 it is likely to rise 70 per cent above today’s figure of 35.6million sufferers.

Dementia is caused by a variety of brain illnesses that affect memory, thinking, behaviour and the ability to perform everyday activities.

Alzheimer’s disease is the most common cause of dementia and makes a chunk of the disease incidence globally.

The report published with Alzheimer’s Disease International said there are 7.7million new cases of dementia reported each year – with a new person diagnosed every four seconds.

The estimated annual cost of treatment and care is $604 billion (£379 billion).

Yet even in high income countries like the UK and U.S less than half of dementia cases are routinely recognised.

This statistics, thus, poses a lot of frightening challenges to public healthcare, moreso when illiteracy, poverty, stigmatization, failing health institutions and policies constitute the norm in Africa and that matter Ghana.

What Is Dementia?

The term dementia is often associated with misunderstanding and could sometimes be used inappropriately by people who do not fully understand its correct meaning. It is a word that is regularly used to describe older people who have developed confusion and behaviours that may be seen as challenging.

People sometimes use the term dementia, senile dementia and Alzheimer’s interchangeably but dementia is not an illness in itself, rather, it is an umbrella term which covers a whole range of signs and symptoms that are related to certain conditions or illnesses of the brain. This is therefore of public health relevance.

The signs and symptoms that occur with dementia are characterized by a progressive decline of a person’s mental ability, namely the ability to remember, make rational judgement and communicate.

This is also accompanied by challenges in personality and behaviour and will inevitably impact on a person’s ability to carry out everyday activities, such as cooking, cleaning, washing and dressing.

The Alzheimer’s Society defines dementia as “Evidence in memory and thinking which is a degree sufficient to impair functioning in daily living, present for six months or more. This may be accompanied by a decline in emotional control, social behaviour, motivation and higher functions. Onset may be age 45 but usually not before 65.

Global prevalence and incidence data for dementia reported in the international literature by the Stockholm Gerontology Research Center, Sweden,in the last 10 years, showed thatprevalence is equal to 0.3 – 1.0 per 100 people in individuals aged 60 to 64 years, and increases to 42.3 – 68.3 per 100 people in individuals 95 years and older.

The incidence varies from 0.8 – 4.0 per 1,000 person years in people aged 60 to 64 years, and increases to 49.8 – 135.7 per 1,000 person years when the population is older than 95 years.

Common types of dementia are; Alzheimer’s disease (constituting about 70 percent of cases), vascular, dementia with Lewy bodies and Pick’s disease.

Conditions which may develop into dementia include Parkinson’s disease, genetic illnesses (Huntington’s disease), Down’s syndrome, result from infection, HIV, Creutzfeld-Jacob disease.

Dementia affects the brain structure especially the frontal lobes, temporal, parietal or occipital lobes.

Treatment and drug application regimes come with some sophistication unless symptoms were diagnosed early. Its therapies are sensory, occupational, thyroid replacement and physiotherapy/ergotherapy.

Dementia Incidence in Africa

The epidemiology of dementia in Africa as reviewed by the European Institute of Health and Medical Sciences, University of Surrey, United Kingdom, indicates that very few of the 100 studies of the prevalence of the disease have been carried out in Africa. Much of the early work concerned small hospitalised samples.

However, series of studies from Ibadan, Nigeria and Korle Bu Teaching Hospital, Accra, Ghana, have produced consistent low rates of reported cases especially for Alzheimer’s disease.

The most recent studies reveal rather higher rates, but still lower than surveys carried out elsewhere. The possible reasons for these findings are considered: differential survival rates, the hiding of cases by relatives because of stigma and reluctance to seek medical assistance as inappropriate.

Others are poor access to medical care, the feeling that the old person has come to the end of his useful life, mis-diagnosis and defective case-finding techniques. The need for further research is therefore emphasised.

A World Health Organisation estimates indicates that about 650,000 people could be suffering from severe mental disorder and a further 2,166 being sufferers of moderate to mild disorders with a high treatment gap of 98 percent of the total population expected to have a mental disorder.

In Ghana, the “Alzheimer’s and Related Disorders Association of Ghana,” (ARDAG), a not-for-profit organisation, with vision to create a dementia friendly and literate society is championing awareness of the disease.

According to Mrs Esther Dey, Executive Director of ARDAG,“availability of information is key to breakthe silencesurrounding the disease. The Association is therefore poised to carry its task to the next level through action-packed activities.”

It is involved in needs assessment services, planning, coordinating and advising services. They are instrumental in sourcing, providing and organising care, care packages and other forms of support.

It has integrated mental health services into its agenda to improve diagnosis, treatment and support as well as developspecialised services for people who may be at risk.

It is a fact that majority of victims end up in witches or religious camps, a crime orchestrated or perpetrated by relatives and community members.

For lack of information, the people perish seemed a vivid description of the plight of victims of dementia as they are bound and chained, all in the spirit of delivering them from their predicament. The question is could dementia be diagnosed spiritually? A recent abuse occurred in Tema in 2010, when an evangelist with the connivance of a teacher and two others burnt to death a sufferer of dementia for her distorted thought, which they diagnosed to be witchery.

Resulting from this, the Association has established two day care Centres; in Hohoe and Accra for victims of dementia and hope to replicate this throughout the country. Services at the centres include memory clinics, self-help groups and a 24 hour helpline facility. Families and community members could explore the opportunities at the Centres.

Another innovation is its legal and financial services,offering support services to victims.

One of such outreach programmes was held recently at Bodada and Ayoma in the Volta region, where large crowds from these communities and Churches participated.

What are the Policy Issues

Government policies affect everybody’s life. Social security policiessimilarly affect people with dementia and their caretakers and families.

The passage of Ghana’s Mental Health Law was therefore a welcome development, which had given added impetus to the national consciousnesstowards addressing the predicament of victims of mental health including those of dementia.

This development would thus create the leverage forthe adherence to standards, conditions, acceptability and consequently check human rights issues and abuses including physical and sexual.

The policy shift to integrate victims into society from the institutional care would bring much more sanity into mental healthcare in general. Mental health was fashioned since 1888, referred to as the Lunatic Asylum Ordinance, CAP 79,had witnessed modifications until the passage of the new law in August 2012.

Another legislation that could add total relief to mental healthcare is the swift passage of a policy for the aged. This development could improve the general health, nutrition and well-being of sufferers of dementia, reduce poverty, improve income security and strengthen research, information gathering and processes as well as coordination and management of data.

ARDAG is poised to lead this crusade by mainstreaming dialogue to influence policy with government officials, relevant Parliamentary Select Committees,representatives of public and civil servants on the challenges of the aged in relation to dementia.

It is believed this action would engender dialogue and create the much needed awareness about the disease to facilitate promulgation of the requisite legislation to streamline processes for a safe mental healthcare delivery in the country.

By Maxwell Awumah

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