Dementia Care In Low- And Middle-Income Countries: Challenges Of People With Dementia
Dementia can refer to a group of illnesses affecting brain function and their associated symptoms. Although anyone in the world can develop dementia, the Alzheimer’s Disease International’s 2023 World Alzheimer Report states that most new cases of dementia in the coming decades will be in lower- and middle-income countries. Research has found that people in these areas who have dementia may have less access to the care and resources they need to manage it. Stigma may also play a larger role than it does in higher-income countries. While it may take time to expand dementia care access, individuals can advocate for themselves by learning about dementia, making lifestyle changes, and caring for their mental health.
What is dementia?
Although it’s often confused with Alzheimer’s disease, dementia isn’t an illness itself. Rather, it usually refers to a group of symptoms caused by several different illnesses that affect the brain, including Alzheimer’s disease. Dementia can impact people’s abilities to think, interact, and do everyday tasks. Its symptoms often start out mild and worsen over time. Eventually, people with dementia may need ongoing help to function in daily life.
Symptoms of dementia
Although dementia can look different for different people, some common symptoms include the following:
- Memory loss
- Confusion
- Mood swings
- Personality changes
- Inappropriate behavior
- Changes in appetite
- Trouble moving
- Trouble communicating or following conversations
Diagnosing dementia
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) lays out the criteria doctors may use to provide a dementia diagnosis. It states that to be diagnosed with dementia, a person must show significant issues with their cognitive skills.
If someone has minor challenges with thinking or memory but can still do daily tasks, they might instead be diagnosed with “mild cognitive impairment.” This can sometimes, but not always, progress to full dementia.
Risk factors for dementia
It can be common to assume that dementia is an unavoidable part of aging, but this is not the case. As the CDC points out, many older adults go their whole lives without ever developing dementia.
Various factors may increase a person’s risk of dementia. Some of these can’t be controlled. For example, having a close relative with dementia may make you more likely to develop it yourself.
Modifiable risk factors
That said, there are also several modifiable risk factors:
- Obesity
- Diabetes
- Drinking too much alcohol
- Not getting enough exercise
- Smoking
- Hearing loss
- High blood pressure
Age
Age tends to be another common risk factor for dementia. Although young-onset dementia can occur, the CDC states that most cases of dementia affect people over age 65.
The challenges of dementia care in low- and middle-income countries (LMICs)
The World Health Organization reports that over 60% of people with dementia live in low- and middle-income countries (LMICs). This classification is given by the World Bank based on a country’s gross national income, or GNI.
Inequalities in dementia care in low- and middle-income countries (LMICs)
As of 2022, the GNI for low- and middle-income countries ranged from under $1,045 to $12,695 USD.
Research has uncovered inequalities in dementia care, diagnosis, and prevention in LMICs. In a 2017 report, researchers summarized existing data on these differences. They noted that in many LMICs, symptoms of dementia are considered a part of normal aging and, therefore, aren’t seen as needing special treatment.
Challenges faced by people with dementia in LMICs
The report also discusses how healthcare systems may contribute to the burden of dementia in LMICs. Although many of these countries provide public access to healthcare, the authors point out that a lack of mental health expertise may affect the quality of care received by people with dementia.
LMICs have lower access to dementia services
In a different review from 2019, researchers analyzed data from reports on dementia care in LMICs. They noted that, in general, people with dementia in LMICs have lower access to community dementia services, with family members often being responsible for their care.
How stigma affects people with dementia in LMICs
Tips for lowering the risk of dementia
Addressing inequalities in dementia care may require action from governments and organizations to expand community services, raise awareness, and improve access to care. However, individuals can also take action. Staying informed about dementia and spreading the word to others are steps you can take to help tackle the challenge of dementia as an individual. You can also take steps that may lower your personal risk of dementia, such as the following:
- Reducing your alcohol intake
- Getting plenty of exercise
- Eating foods rich in whole grains, lean meats, fruits, and vegetables
- Maintaining healthy blood pressure and blood sugar levels
- Quitting smoking
- Getting enough sleep
- Seeing primary care doctors for annual checkups and screenings
- Keeping your brain active with hobbies and activities
- Staying socially active
Taking care of your mental health may also help protect against dementia. In a 2022 study, researchers analyzed three decades’ worth of data on the mental health of 1.7 million people in New Zealand. They found that mental illness, even earlier in life, may be associated with dementia later in life.
Reducing the risk of dementia through mental health care
Being proactive about your mental health might help reduce this risk—and therapy may be one way to do it. In a 2023 study, researchers reviewed data on over 100,000 older adults who received therapy for depression. A majority saw an improvement in their symptoms, and those who did typically had lower rates of dementia in the following years.
How online therapy can help
It may be easier to attend therapy consistently if you enjoy working with your therapist. Finding the right fit can sometimes take trial and error, which is why online therapy may be useful. Platforms like BetterHelp match you with a licensed therapist and let you change therapists at any time, for no extra cost. In addition, an online therapy platform can be accessed from any location with an internet connection.
Effectiveness of online therapy
Research shows that online therapy can be an effective way to improve mental health. In a systematic review from 2022, researchers analyzed data from eight existing studies of online cognitive behavioral therapy (CBT). They found that the online treatments could effectively reduce symptoms of various mental illnesses.
Takeaway
Frequently asked questions
Which country has the best treatment for dementia?
Treatment for dementia requires specific knowledge and skills. It can depend on both governmental and nongovernmental organizations and can be challenging to rate. Countries are not officially ranked according to their delivery of dementia care.
That said, one study analyzing dementia care across Europe and the UK found that access to care can vary significantly from one country to the next. For example, in Bulgaria, Finland, Italy, Liechtenstein, Luxembourg, the Netherlands, Norway, Sweden, and the UK, nationwide dementia care structures are already in place. In five countries (Belgium, Greece, Ireland, Portugal, and Romania), services are only available in specific areas, while in Austria, Denmark, and Germany, outpatient community dementia services are widespread while in-patient care is not.
Other countries not included in the study are also concerned with the urgent need for access to dementia care and treatment and are developing innovative ideas to find a solution. For example, the National University Health System in Singapore has established a Geriatric Psychiatry Out-Reach Assessment, Consultation and Enablement (G-RACE) service, which, according to Dr. Chris Tsoi, Senior Consultant, Department of Psychological Medicine, “provides the necessary and timely support to both patients and caregivers [and] deal with crisis even at patients’ homes to keep them out of the hospitals.”
Which country has a dementia village?
The Hogeweyk Dementia Village was the first dementia village in the world, opening in the Netherlands in 2009. Since then, dementia villages have been established in other countries, including the United States, Canada, Denmark, Italy, Germany, and Australia.
Which country has the highest rate of dementia in the world?
Finland has the highest death rate from dementia in the world. Researchers speculate that this may be due to environmental factors, like increased exposure to toxins like heavy metals, fungus, and mold, as well as a selenium deficiency in the soil.
What is the biggest contributor to dementia?
The biggest risk factor for dementia is age. While dementia is not a typical part of aging, the risk of developing dementia roughly doubles every five years after age 69. For those older than 90, about 33% have dementia.
Why is dementia so common now?
A study published in 2022 reported that the number of adults ages 40 and older living with dementia is expected to triple by 2050. Population growth and an aging population may be the main cause of this increase in dementia cases, but as dementia is not a typical part of aging, other factors may be at play. According to the study, the four risk factors that may contribute to this increase in dementia cases are obesity, smoking, high blood sugar, and low education.
What type of person is most likely to get dementia?
Someone with multiple risk factors may be more likely to get dementia. These risk factors include the following:
- Age. Dementia risk increases with age. While some types of young-onset dementia can start in your 40s or earlier, most types of dementia occur after age 65.
- Genetics and family history. Many genes have been linked to dementia. While having a risk gene doesn’t necessarily mean someone will develop dementia, having a family history can increase the risk of getting this disease.
- Chronic health conditions. Medical conditions that affect blood vessels, like high blood pressure and diabetes, can increase dementia risk.
- Brain injury. The risk of getting dementia is highest in the six months following a brain injury, and the more brain injuries someone has in their lifetime, the higher the dementia risk.
- Hearing loss. Hearing loss is associated with changes in brain volume, increasing the risk of this condition.
- Social isolation. Research has found that people over 65 who have social support are 46% less likely to develop dementia.
- Other factors, like obesity, lack of physical activity, depression, alcohol use, lower education level, and exposure to pollution, are also associated with dementia.
Why is music so important to dementia residents?
Music is important to dementia patients for many reasons. It can improve behavior and mood, and its positive effects can last for days. People with dementia who listen to music may smile or dance when other forms of communication are lost. Some research has found that playing an instrument, singing, and even composing music can be preserved in people with advanced Alzheimer’s.
Research has found that music therapy can be quite effective for people with dementia. Both short-term and long-term music therapy can reduce depression and anxiety, and some studies show the results can last up to eight weeks. This may improve the quality of life for the person with dementia and their main caregiver or caregivers. Other researchers have found that music that is familiar and emotionally connected to the person leads to more specific memories and tends to be more positive.
What is the difference between Alzheimer's and dementia?
Dementia is an umbrella term for a group of behavioral, functional, and cognitive impairment driven by an underlying progressive degenerative brain disease. Alzheimer’s is the most common type of dementia.
What are the first personality changes with dementia?
The first personality changes in people with dementia can depend on the part of the brain that is affected. For example, if the frontal lobe is affected first, the person may have difficulty focusing or paying attention, have problems with impulse control, and be insensitive or rude.
In Alzheimer's, brain damage tends to start in the areas responsible for memory, which can make people forgetful or cause problems following conversations. These difficulties can also make them angry or frustrated.
Family members who notice these changes in their loved ones can be crucial in ensuring the person is seen by a doctor and receives an early diagnosis and specialist care.
Where is dementia least common?
Research has found that Indigenous Amazonian tribes have the lowest rates of dementia. Older adults in the Tsimane and Moseten tribes have only about a 1% rate of dementia, compared to 11%of people aged 65 and older in the U.S.
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