In light of Sri Lanka having one of the most rapidly aging populations in the whole of Asia, the psychiatric community has highlighted the increasingly high prevalence of dementia due to Alzheimer and Parkinson’s disease and the fact that the country was woefully underprepared and ill-equipped at present to tackle the scourge in terms of care and prevention.
Alzheimer is the most common cause for dementia. There are also other common types of dementia including vascular dementia, conditions that block or reduce the blood flow to the brain, and dementia associated with other diseases.
The Sri Lanka Cancer Society, part of the Non-Communicable Diseases (NCDs) Alliance Lanka (NCDAL) called for Alzheimer to be given priority as an NCD when dealing with the disease. In the opinion of the president of the SLCS, A.J.B. Anghie, the World Health Organization (WHO) did not seem to be doing enough in the country with regard to the diseases in question.
Public Relations Officer of the Sri Lanka College of Psychiatrists and Consultant Psychiatrist at the Karapitiya Teaching Hospital, Dr. Ramani Ratnaweera pointed out that Alzheimer’s related dementia, which was one of the most common diseases among the elderly population, was due to the fact that it is also one of the most unidentified of the diseases afflicting the particular age group.
The reasons for the disease being unidentified are twofold. One is that in certain families, the family members tend to ignore the initial signs of the disease such as old folk not engaging in much conversation, being silent, forgetful, having poor vision, hard of hearing, chalking such symptoms up to mere gradual and almost inevitable deterioration resultant due to aging or a fact of being old and getting older and therefore considering such signs as ‘normal’. The other reason is the stigma associated with, mental illnesses and the fact that having a mental illness in one’s own self or in one’s family is seen by certain persons as a sign of weakness, which should therefore not be revealed or discussed.
Elsewhere, depression and anxiety too are common among the elderly, Dr. Ratnaweera observed.
She added that at present anti-dementia medication was not made available in government hospitals.
The elderly population in the country is also increasing. According to Dr. Ratnaweera, currently the figure of aging among older people is about 10% of the general population which by 2025 is estimated to be 22% and could be much more than 50% by 2050.
“The elderly population is more than those whose age is 15 years and below,” she said. “At the same time, life expectancy is on the rise. According to the NCDAL, life expectancy in Sri Lanka is high at 74.9 years. We have found ways of overcoming certain physical illnesses by way of the technological advancements made in medicine,” she said.
Accordingly, the global prevalence of Alzheimer’s in those over 65 years of age is 5.6%.
“A local study conducted in 2003 found that the prevalence of Alzheimer’s was 3.9%, a percentage which is presently much higher,” she added.
Speaking of treatment modalities, Dr. Ratnaweera outlined that while early diagnosis was key for early treatment, apart from the provision of anti-dementia drugs, therapeutic exercises such as reminding patients of facts about themselves and their environment (reality orientation), validation therapy where medical professionals listen to what the patient has to say in complete tolerance and support without giving out any criticisms, and reminiscence therapy (to relive past experiences) should be administered.
She also highlighted the toll on those caring for Alzheimer’s patients.
“Caregivers suffer a lot. Over 50% or more of the caregivers are clinically depressed. This is due to the high levels of burden and stress. They must have some respite. Their well-being too must be looked into.”
She noted that Sri Lankans did not plan well for their retirement and as a result post-retirement following a brief period of being cared for by way of having attention being paid to them, they find out that they are being taken for granted.
Addressing the question of prevention, she highlighted the need to maintain a healthy lifestyle and healthy weight and the importance of protecting one’s head from injury, especially those resulting from road related accidents.
“With regard to treatment, we must establish special centres at which psychiatrists trained and specialized in old age treatment provide the patients with care based on a multi disciplinary approach,” she said.