Sri Lanka has one of the fastest ageing populations in the world. According to recent projections, nearly 20% of Sri Lankans in 2020 will be those over 60 years. By 2031, Sri Lanka’s population is expected to start declining, which means, the proportion of the elderly will rise even further. As Sri Lanka’s population continues to age, illnesses such as, dementia and Alzheimer’s would become more prevalent in the community. Although these illnesses are not always age-related, they are often associated with old age as they relate to declining memory, and the risk of contracting these diseases increases with age.
Dementia is a group of illnesses causing a gradual decline in memory with the involvement of one or more other factors affecting cognitive domains. The patient’s functioning gradually deteriorates to a point where he is unable to attend to his day-to-day routine. He may forget to brush his teeth or wash himself and later become totally dependent on others.The common behavioural problems include aggression, lack of inhibition, wandering about and not attending to basic hygiene needs.
Clinical Psychiatrist, Dr. N. Kumaranayake stressed the point that we have to improve awareness of the symptoms of dementia, its early detection and treatment, as dementia is not reversible. He explained the early signs of Dementia:
“A common sign of Alzheimer’s disease, especially, in the early stage, is forgetting recently learned information. Others include, forgetting important dates or events, asking for the same information over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or on family members for things they used to handle on their own. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and would take much longer to do things they did before,” says Dr. Kumaranayake.
“People with Alzheimer’s sometimes, have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favourite game.They can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes, they may even forget where they are or how they got there,” he said.
According to Dr. Kumaranayake for some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining colour or contrast, which may cause problems with driving.Vision changes related to cataracts can occur with age. People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue, or may repeat themselves. They may struggle with the vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”).
“Misplacing things and losing the ability to find them is also a symptom of Alzheimer. Sometimes, they may accuse others of stealing. Such things could occur frequently, over time. Poor judgment is also a symptom, as well as in decision-making, e.g. when dealing with money, they may give large amounts to telemarketers. ” he said.
He explained that a person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. “They may have trouble keeping up with a favourite sports team or remember how to complete a favorite hobby.
They may avoid being social because of the changes they have experienced.The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or places,” he added.
The elderly population in Sri Lanka has grown rapidly in the past several decades. They were an unprecedented 2.5 million in 2012, and this is still increasing. One in eight Sri Lankans is 60 years or over. This is in contrast to about a sparse, one in twenty persons a few decades ago. Demographers project that the aged will double by 2041.
Along with Dementia, the prevalence of depressive symptoms among the elderly is also an issue. Depression in the elderly in Sri Lanka is higher than that reported in most Asian countries. Clinicians and caregivers need to be aware of the potential presence of depressive symptoms among the elderly, especially, among those with lower educational levels, functional limitations, hearing difficulty, physical disability, perceived income inadequacy, and among those who live alone.
Dr. Kumaranayake said, he handled a patient named Kamalawathi aged 65 recently with depressive symptoms such as poor sleep, poor appetite, lack of energy and irritability. “She lived alone as her only son resided abroad. Her husband had died a few years back and it worried her. She cooked for herself and spent every night watching TV until she fell asleep.
She gradually developed a lack of energy and found it unable to carry on with the duties of her day to day life. Her son came from abroad and took her to the doctors to be checked. But no physical illness was diagnosed and she was said to be normal.
Ultimately her condition became worse and she attempted suicide by swallowing some tablets, prescribed for her diabetes,” he said.
Elderly depression is common and usually, not diagnosed. The reason is stigma around mental disorders.
“The World Health Organisation (WHO) advises to improve awareness about depression among communities as it is the major way of combating this problem, as depression is easily treatable and suicide is preventable,” added Dr. Kumaranayake.