All in a day

The webinar to India and beyond on Saturday was every bit as fascinating and moving as it could be.

It was good to be reacquainted with colleagues still working in Wolverhampton – who told me they are looking after patients who remember me calling on them in our domiciliary clinics. Good times and a feeling of ‘family’.

Something like 400 people ‘attending’ and speakers from Japan, the UK and India. This was about health and loss of health amongst older people across the physical-mental health spectrum – with dementia featuring large.

India has a very big population – 1,380 million total, with 60 million aged 65+, near to the whole population of the UK. There may be 4 million people with dementia in India, while the UK is approaching one million. So, the numbers are there but for India it is matters relating to conception, childbirth, early years and youth, which are the main focus of healthcare planning and services. This is right and proper, so it is impressive that they and other middle-income and low-income countries are already taking such interest in the health and illnesses of older people, and especially the phenomenon of dementia.

By the1960s, the UK and other European counties had a large proportion of the population surviving into later life – about 15% being 65+ – and dementia had begun to swamp families and services. It was there, it had been known about as a phenomenon affecting older people, but there had been little interest or effort made to gain an understanding of its nature, causation or possible best treatment. The numbers and personal and societal costs made it an imperative.

Middle- and low-income countries now face similar challenges but with the benefit of what has been learned in 60 years.

I have been greatly impressed by a series of articles from Professors Steve Iliffe and Jill Manthorpe, which reflected on what has been learned. Their conclusion is that we know much more about risk factors, which increase the incidence of dementia – many of which can be reduced by appropriate actions by individuals and governments. Once dementia develops in individuals we have learned how to help them to live well despite the limitations which it produces – a safe place with informed and supported carers, continued involvement in activities, social, arts of all sorts – and maintained physical health through exercise and treatment as necessary. Only the cholinesterases and memantine have (small) beneficial effects on the dementia process. Despite vast expenditure on research no other medication has proved useful.

So this is what we said: where there was no hope, there is now much knowledge of at least twelve risk factors, which can be modified and could reduce the incidence of dementia, especially in middle and low-income countries by of the order of 40%. When dementia comes to individuals, approaches to tertiary prevention (reducing unnecessary complications, additional symptoms, suffering and costs) are understood and are effective.

It is a modest, honest worldwide story.

Some references:

Iliffe S and Manthorpe J (2017) Dementia: Is the biopsychosocial model vindicated? https://bjgp.org/content/67/661/344

Livingston et al (2020) Dementia prevention, intervention and care: 2020 report of the Lancet Commission https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext

Journal of Geriatric Care and Research https://independent.academia.edu/jgcr

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