More than 50 million people worldwide are affected by dementia, and the number is expected to increase by 10 million every year, the World Health Organisation (WHO) reported. There are 5 million patients diagnosed with the disease in India itself, and the experts believe it is just a fraction of the total. Dementia impacts life in all spheres, be it physical, psychological, social and economic impact, not only on the patients but also their carers, families, and society. Globally, it is one of the significant causes of disability and dependency among older people.
Economic Cost Projected To Increase Three-Fold
The Dementia India Report of 2010 had mentioned that there were 3.7 million cases of the disease in that year, and the number of patients was likely to double by 2030. Ten years later, till 2020, we had already crossed the 5 million mark. In 2010, the total societal cost of caring for known dementia patients was ₹14,700 crores, projected to increase three-fold by the end of 2030.
The term is used generally to describe a group of symptoms that occur due to damage or impairment of the brain cells. Impaired memory, thinking, language, prolonged comprehension, judgement, decision-making and orientation are all commonly experienced while suffering from the disease. As time passes, the patient cannot carry out their day to day tasks on their own. Eventually, the disease gets worse with ageing. A study by Alzheimer's And Related Society of India in 2020 stated that there are three stages of the progression of the disease.
The early stage, or the mild degree as experts call it, is when the patient can carry out their routine but often forgets and misplaced things and cannot do multi-tasking. They might face problems in remembering names and time and have a slowed concentration, planning and decision-making. In the middle stage or the moderate degree, patients face increasing dependency, forget personal information, are disoriented and experience behavioural changes like wandering and aggression. In the late stage or severe dependency, they can forget the names of relatives, and in worst cases of themselves too and face difficulty to communicate.
The Hindu quoted a paper published in 2017 in the international journal Dementia, which Dr Vaitheswaran co-authored. The paper mentioned that several times the carers have to give up on their jobs. Apart from that, diseases like Dementia and Alzheimer's can push caregiving families to poverty. A study titled Indian Journal of Public Health mentioned that the annual expenditure to care for a Dementia patient could go as high as ₹2,02,025 in urban areas and ₹66,025 in rural areas in India.
Nearly 10% Of Indians Are Above 60
Dementia in India calls for a 'specific legislation' which looks into several aspects like self-respect, adequate healthcare, rehabilitation facility, handling property, financial transactions and palliative care for patients, all of whom can become casualties. The Journal of Global Health Report mentioned that by 2050, there would 131 million older people worldwide. Apart from an individual, familial and societal impact, the ageing population would also impact the economic crisis. In 2018, India's population was estimated to be 1.35 billion. Out of this, 60 per cent of the working population while 10 per cent of its people are above the age of 60 years.
By 2031, India's senior citizen population is expected to rise to 12 per cent, and by 2050, it would rise to 19 per cent. The country is expected to have the largest population of Dementia patients in the coming decades. Such an increased rate of neurological disease will significantly impact the country's healthcare system. These families undergo mental, emotional and financial hardships and the society at large since the government would have an increased expenditure with reduced productivity.
Unfortunately, the treatment gap in India for Dementia patients is almost 90 per cent. This means that only one in ten patients receive a proper diagnosis, treatment and care. There can be several reasons to justify that. Some of the most common reasons are lack of awareness about the condition amongst people and the healthcare professionals, lack of human resources to treat the patients and the lack of public health priority for Dementia.
The World Bank has categorised India as a lower-middle-income country and is expected to become a middle-income country by 2047. Till 2020, we spent just over 1 per cent of our Gross Domestic Product (GDP) on healthcare. Of the money allocated to health, only a mere 1 or 2 per cent is reserved for mental health. In the budget of 2021, the healthcare budget was increased to 2.5 per cent due to the public health emergency, caused by COVID-19. The country had also enacted a National Mental Healthcare Act in 2017, under which every person has the right to access mental health care funded by the government, affordable and quality healthcare, equality of treatment and protection from inhuman practices, easy availability of legal services and the right to complain against cruelty.
Addressing The Crisis
Even though the schemes are a positive step in providing health and mental healthcare to its people, these steps would only benefit people if dementia is made a public health priority. This requires patients with mild dementia, caregivers, researchers and policy-makers to come together to identify the crisis and suggest remedial measures. Any health problem cannot be addressed without a practical, accessible and acceptable solution.
In Indian society, providing for the needs of parents, especially elderly parents, is essential. The modern nuclear family systems have weakened the traditional family bonds, particularly in urban areas. Thus, several elderly live alone, in some cases without adequate physical, emotional, medical and financial cushioning. The Maintenance of Parents and Senior Citizens Act, 2007 casts an obligation on children to look after their parents or grandparents and provide for their well-being.
Presently, the country is under a massive burden of dementia, and it is only expected to increase owing to the ageing population of the country. There is a pressing need for holistic development of Dementia care services in the country. Integrated community-based support to provide universal availability and accessibility of health services across the country can indeed slow down the pace of the imminent danger approaching us in the times to come.