DEMENTIA: ENGAGING SOCIETIES AROUND THE WORLD

1. DEMENTIA: ENGAGING SOCIETIES AROUND THE WORLD Smt. Nirmala Narula President, ARDSI, Delhi Chapter Vice Chairperson, National Body

2. Understanding Dementia and Caring for the Victims • Support for Family Care Givers (In Terms of Facilities of Day Care) • Alternative (New) Drug Treatments

3. DEMENTIA • Worldwide - 24.3 million. • doubles every 20 years. • Developing countries. • 60% of people with dementia live here • prevalence of dementia ranges from 0.8% to 3.5%. (Courtesy WHO)

4. Dementia Results in • Lack of alertness • Anxiety due to inner security • Drawing curtain on reasoning • Abuse of elderly-highest in afternoon and night • Dementia has • No set pattern like cancer and other disease • Become an important health issue • Thrown new challenges to caregivers/policy planners • Many causes

5. Causes of Dementia • Alzheimer’s Disease 60% • Vascular Dementia 15% • Alzheimer’s + Vascular 10-15% • Others 15-10%

6. Dementia Victims : Conventions • Dignity and respect in old age and providing reasonable access to suitable health services besides government. • Under International Law • Universal declaration of human rights • International Covenant of • Civil and Political Rights. • Economic and Social Rights

7. Inter Covenant Rights • Cultural • Social • Economic • Elimination of all forms of discrimination against women • Rights of persons with disabilities which include AD. • African Human Rights Law, helps the elderly women in every sphere. • Agencies commitment to dedicate: • Help Age - Financial commitment/staff resource • UN - Human Rights- international law/violation • GOI - Recognized dementia • Together we have to show impact of care giving.

8. Diagnosis and Treatment, Role of GP’s • Lack of trained doctors. • Subject of dementia should be in medical curriculum. • Train doctors to identify types of dementia. • Life Style Intervention • Providing a community based resource • Respite centre • Hired trained personnel • Model respite centres reduce family burden • Hired care givers are expensive • Day Care Center • Provide respite during the day

9. UN Study : Life Expectancy • 1901 23 years • 1951 32 years • 1981 52 years • 1996 62 years • 2020 70 years • 2030 ⅓ of world population will be 60+ • 2050 1% will be 60+, 15% will be 80+

10. Older people are not necessarily taken care of by family members. • Young and old vie for attention - dignity suffers. • Each age group demands attention.

11. Solution? • Special care giving for ADL : • Treat with dignity • Emotional understanding • Early Memory Loss? • Requires interaction with others • Enjoys outings and activities – this strengthens memory • Needs to talk/socialize

12. DAY– CARE TO RELIEVE FAMILY CAREGIVERS • Day care services leave younger earning members free. • Provisions of health care services/day care complement the health services in general. • Respite for care giver? • ‘Home aide’ or a trained care giver needs respite. • Moving the person to a facility - not common, therefore aide needs respite. • To a primary care giver, real respite - a short while away/short vacation.

13. Most care givers will not take respite for: • Admission of failure/guilt. • Personal attachment. • Doctors to suggest options to the families. • Is respite the answer? • Effect of respite on people with dementia - unpredictable. • New friendships/varying activities improve their cognitive abilities. • Some might slump when taken back home. • Governments in most countries beginning to realize the importance

14. Training of Professional Caregivers • Training of Professionals Care givers • Following should help running these centers. • Senior, retired administrative personal • Trained Social Workers • Trained Care Givers • Trained Nurses • Medical Team of consultants. • Voluntary Social Workers. • Adult Day care • Provide good alternative to nursing homes. • Volunteers can be engaged in • Support groups • Day care centre • Home visits.

15. Support Groups • Volunteers/facilitators for day care services to be responsible for: • Bringing hope and help • Address concerns and questions. • Avoiding isolation of individuals’ early stages of AD. • Being aware “It is not a stigma to be a participant” in their program • Advantages of day care • People with early memory loss still desire • Socialization • Involvement in the community. • Old people need maximum attention during day. • Allows younger earning members to be free for work.

16. ALTERNATIVE (NEW) DRUG TREATMENTS IN ALZHEIMER’S • Alzheimer’s disease- neurodegenerative disease - stems from beta amyloid • Primary factor being age – three compound designed to combat AD – under study. • Research for a secretase inhibitors to prevent amyloid build up by inhibiting enzymes. • At present four commonly used drugs to treat symptom of AD. • Aricept • Razadync • Exselon • Namends

17. Future Treatment (Medical) • New drug called Rember (methylthioninum chloride) • Being tried on patients with moderate AD. • Found twice more effective then Aricept. • Attacks “tau” which promote tangles as opposed to amyloid plaques. • Can slow the progress of As for 19 months. • Can have side effect – diarrhea. • Phase 3 trial is expected • Non Medical • Gentle exercise (Tai chi) and pet therapy • Gross cultural innovative programs: • Music • Art • Stimulating programs by recreational therapists and social workers. • Care giving guidance on handling ADL persons with different background.