Senior moment: The most common symptom of dementia is memory loss. — 123rf
JOE Biden is likely facing his greatest political challenge to date.
The American president is now under pressure to step away from his second presidential race by those who suspect his cognitive health is steadily declining. Several experts say that his performance during the recent debate with returning challenger Donald Trump is quite telling – incoherent speech, appearing momentarily confused and struggling to find the right words or following conversations.
Yet, Biden, 81, is adamant that he is fit to run for office, even as the chorus demanding that he quit grows rabid.
Understandably, the current allusion that he is showing symptoms of dementia is a worrisome prospect for his career and golden years. Dementia carries a host of challenges since patients, recorded to be mostly 65 and above, are commonly susceptible to a multitude of challenges ranging from social to economic aspects, such as stigma brought about by feelings of ineptness, communication difficulties, and expensive care services.
Caring for a large or growing population of dementia patients is an even greater challenge. In Malaysia, for example, the country’s likelihood of being a “super-aged” nation by 2056, corresponds with the World Health Organisation’s (WHO) findings that the number of adult dementia patients is also expected to increase to between 637,500 and 825,000 in 2050, from between 204,000 to 264,000 in 2020.
The Statistics Department also estimates 7.4% of the country population will consist of Malaysians aged over 65 this year, with Universiti Malaya’s geriatric medicine expert Prof Dr Tan Maw Pin saying one in 12 Malaysians are already living with dementia today.
“With the rapid increase in our older population, the number of people living with dementia will increase exponentially. Without adequate preventive measures and policies, the financial strain on families and healthcare systems will increase correspondingly,” she had noted in an article she recently co-wrote for a local business weekly.
As of now, while the country is making efforts to improve protection and services for those with the disorder, caring for them remains an arduous task.
Recognising pain
The most common symptom of dementia is memory loss, which potential patients or their loved ones usually regard as “forgetfulness”, says Alzheimer’s Disease Foundation Malaysia (ADFM) resource and training manager Jenny Lim.
ADFM was registered in 1997 to advocate and provide support for those suffering from dementia.
“(For example), when you tend to or often forget where you put your things,” she says.
ADFM chairman Datuk Dr Yim Khai Kee says when it comes to such instances, people, unfortunately, regard it as something “natural”, such as senility, that happens as a person grows older.
“That is why we (at ADFM) try to educate people that there is a difference between being senile and suffering from dementia. We teach people to tell them apart.
“(There are those) who do not understand the difference between the two.
“Some (families) who do not understand or are aware that their elderly family members may be suffering from dementia, decide to send them to old folks homes.
“When those who are suffering from dementia are not being cared for by suitable caregivers, who of course, do not understand what ails them, the situation may take a turn for the worse.”
Universiti Malaya Specialist Centre’s consultant geriatrician Assoc Prof Dr Khor Hui Min says the lack of public awareness and understanding of the disease may have imposed a misunderstanding that dementia is a normal ageing process.
“Changes in cognition may frequently be perceived as “being lazy” or “stubborn”. This may lead to late diagnosis and treatment.”
She also points out that on the other hand, the public may also perceive that there is no reversible medication treatment for dementia and subsequently, do not see the need for assessment with healthcare professionals.
“This is not entirely true as many persons living with dementia do better with proper management of their needs, which include medicinal as well as non-medicinal or lifestyle approaches.
“Cognitive stimulation therapy has evidence-based benefits for persons living with dementia and is usually provided in outpatient healthcare settings or dementia care centres. Hence, persons with dementia are encouraged to engage in such services where available.”
Social and fiscal woes
In 2019, the Global Dementia Observatory’s ballpark figure of the global total cost of treatment for dementia hovered over US$1.3 trillion (RM5.38 trillion back then), with the number expected to balloon to US$2.8 trillion by 2030.
Dr Khor says the cost of dementia care is high as it includes expenses for medical treatment that involves specialised care, hospital visits and medication.
“Other costs include paid caregivers and indirect costs, such as loss of income from the informal caregivers if they are to give up their jobs. In some cases, this may also include the cost of placement in healthcare institutions. When individuals with dementia lack support or are improperly cared for, they face an increased risk of hospitalisation and longer stays, which further escalates healthcare costs and caregiver burden.”
On Friday, StarMetro reported that elderly patient abandonment seems to be on the rise with Hospital Kuala Lumpur saying that from January to May this year, 166 seniors – many suffering from dementia – have been abandoned at its premises.
Support for caregivers of those living with dementia patients thus remains crucial to prevent a stressful situation, says Dr Khor.
“Most caregivers have limited emotional and financial support in carrying out their responsibilities which can lead to poorer physical health for both themselves and the persons living with dementia. Caring for dementia is a holistic process and should be relationship-centred, focusing on the well-being of the person living with dementia and their caregivers.”
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The Mind Faculty’s medical director and senior consultant, Dr Stephen T. Jambunathan says the despondence when facing a loved one suffering from dementia is understandable.
“It is well known that such caregivers are very distressed to see their loved ones, the parents who brought them up, losing memories and change in their behaviour.
“BPSD, or behavioural and psychological symptoms of dementia, is not about (the patient) being forgetful but rather the difficulties brought by (behavioural) changes that caregivers can’t cope with,” says Dr Stephen, who is also a psychiatrist and psychotherapist.
Call for improvement
Dr Khor says there are many dementia awareness events and campaigns organised by the government, with various societies and non-governmental organisations training focus on public education.
“For instance, the ADFM organises an annual memory walk, along with a series of webinars and public health talks to raise awareness about the disease.
“These efforts have significantly contributed to reducing stigma and facilitating early recognition and treatment. However, it is crucial to extend these initiatives to suburban areas to ensure equal access to information and assessment for everyone.”
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When it comes to long-term care options, she says most facilities for older persons in the country are operated by private institutions or non-governmental organisations.
“There are limited long-term care facilities that specialise in dementia care and many of these institutions may lack the expertise to care for persons living with dementia due to their complex and unique needs. Cost is another major issue as a large proportion of older persons do not have insurance coverage or sufficient retirement savings, hence most of the cost is borne by their adult children or relatives which imposes a substantial financial burden.”
Dr Stephen says, however, the government needs to do more to support dementia patients.
“Many patients and caregivers spend life savings on private care facilities that most Malaysians cannot afford. This cascades to other psychological factors and affects the productivity of caregivers, which (ultimately) affects the country.
“In Malaysia, we are doing very well but the need for psychoeducation, nursing aid, which is almost always very expensive, and government-funded support can be very much given a higher priority.”
At the same time, Dr Stephen calls for the term “dementia” to be replaced with “neurocognitive deficit” to reduce the associated stigma brought by the disorder.
“(This can result in) less stigma and (as) an international reclassification of the ageing challenges we face.”
