Dementia Care In Low- And Middle-Income Countries: Understanding The Differences
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.
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
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.
What makes a person more likely to develop 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.
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 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.
Are there differences in dementia care in low- and middle-income countries?
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.
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.
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.
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.
Managing dementia as an individual
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.
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.
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.
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.
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