The dementia crisis

India's total population with some form of dementia is projected to increase to 1.4 crore in 2050 from the current figure of about 40 lakh, which paints a depressing picture of an emerging health crisis in the country. Prioritizing geriatric care in the national health programme is critical to ensuring adequate medical attention to people suffering from dementia. The population of people aged 60 years and above in the country is projected to increase to about 198 million in 2030. As a result of weakening of the joint family system due to family members migrating to cities and towns for livelihood and employment, a significant number of elderly couples or individuals are living by themselves. Rural areas, having more than 80% of elderly population, account for majority of such couples or individuals, including those suffering from dementia. Quoting from The Global Burden of Disease Study published in Lancet Public Health, the Ministry of Health informed the Parliament that dementia cases in the country, which were estimated at 38,43,118 in 2019, are expected to increase to 1,14,22,692 by the year 2050. The Longitudinal Aging Study in India (LASI) reveals that growing at around 3% annually, the number of elderly age population will rise to 319 million in 2050. About 75% of the elderly people suffer from one or the other chronic disease and 40% of the elderly people have one or the other disability and 20% have issues related to mental health. The Ministry says that the risk for dementia can be potentially reduced by better management of diabetes and hypertension. According to the Indian Council of Medical Research (ICMR), India is home to world's second-largest adult diabetic population and every sixth person with diabetes in the world is an Indian. The Guideline for Management of Type 1 Diabetes published by the ICMR states that the past three decades witnessed 150% increase in the number of people with diabetes in the country. Besides, about 28.5% of adult Indians have hypertension. These statistics point toward the huge challenge faced by health authorities in reducing dementia risk through better management of diabetes and hypertension. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) focusses on strengthening infrastructure, human resource development, screening, early detection and management of common Non-Communicable Diseases (NCDs) including diabetes and hypertension. The National Programme for Health Care of the Elderly (NPHCE) is a key intervention for geriatric care in the country and acknowledges the problem that the general healthcare system in not adequately sensitized to special health needs of the elderly population. The major activities of NPHCE include setting up of Geriatric Department in regional Geriatric Centres (RGC) with OPD care services and 30-bedded Geriatric Ward, setting up of Geriatric units at District Hospitals to provide specialized Geriatric Services, including a 10-bedded Geriatric Ward. Other activities include establishment of a rehabilitation unit at all Community Health Centres and Geriatric Clinics twice a week, setting up of weekly geriatric clinic by trained medical officers at primary health centres and information, education and communication activities on healthy lifestyle, home care to the bedridden and supporting devices for the needy elderly persons at sub-centre level. Official data show that in the North-eastern region, the NPHCE programme activities have been sanctioned in 117 districts and from April to June, 2021. Altogether 32,118 elderly people have been provided OPD care, 1,303 elderly patients admitted to indoor wards, 1,295 elderly persons provided rehabilitation sessions and 9,133 elderly persons received laboratory services through the various institutions operationalized for geriatric care services in the region. Overall, 288.73 lakhs elderly patients in the country received OPD care, 5.73 lakh elderly patients admitted to indoor wards, 8.72 lakh elderly provided rehabilitation sessions and 85.42 lakh elderly received laboratory services under the programme in 2020-2021. These figures and current and projected population of elderly people suffering from dementia call for scaling up the activities to ensure that every single elderly individual person gets adequate medical attention. The District Mental Health Programme (DMHP) under NMHP in 704 districts of the country for detection, management and treatment of mental disorders/illness and strengthening the programme and also decentralizing it to the panchayat and village level can produce significant outcomes in reaching out to a wider vulnerable elderly population in rural India. Socio-economic support to the elderly population belonging to low-income households is crucial to address the problem of elderly couples being compelled to live with either of them suffering from some form of dementia. With no other caregiver in the family, it often becomes difficult for an elderly spouse to provide necessary treatment and care to the dementia patient. More homecare services are needed to take care of the elderly population living a lonely life. A multipronged approach is needed to deal with the emerging health crisis compounded by new social realities of growth in nuclear families.