BBC News - Louis Theroux on dementia: The capital of the forgetful

Nancy Vaughan is a charming and lively conversationalist, a friendly host, and at nearly 90, still has much of the sparkle and attractiveness that must have turned many heads when she was in her heyday as a model in New York.

But she also has trouble remembering her own name, or the fact that she is married (62 years and counting), or indeed, much of the time, some of the basics of the English language.
Nancy is in the advanced stages of Alzheimer's. 

On a sunny late autumn day I visited Nancy and her husband, John, at their home in Phoenix, Arizona. We made friendly conversation in the kitchen and for moments I could have believed that she was mentally well.
Her smile is still engaging, she is physically fit, and she can sometimes carry on brief exchanges. When I asked if she had any problems with her memory, she said an emphatic "no".

But when John posed the question directly "Nancy, what is your name?" she looked a bit baffled. Asked for her surname, Nancy said "Bread", a little uncertainly. I wondered whether this might be her maiden name, but was told that was Johnson.

Nancy and John's life has become surreal and stressful in many ways. John has taken to wearing a name tag with his name on it to help Nancy identify him. 

He has also stuck a copy of their wedding photo up in the kitchen so that, in her confused moments, he can prove to her that they are married.

John cares for Nancy fulltime. They have no children, so there is no family help take the strain - and they are not in the financial position to have Nancy go into a care home. 

Aged 88, John is the full-time carer for someone with many of the same needs as an adult-sized toddler.


It's reckoned that one in eight Americans aged 65 and over has Alzheimer's - the most common cause of dementia. Nearly half of the over 85s has the disease. As medical science has become better and better at prolonging our lives, the mental side of things hasn't kept pace.

Nowhere is this more in evidence than in Phoenix. For years Phoenix has been a mecca for America's elderly, who are attracted by the year-round sun and dry desert heat.

Now increasingly it is a kind of capital of the forgetful and the confused.

Not coincidentally, Phoenix is also pioneering the way dementia sufferers are cared for and treated.
One of the top destinations for people in need of round-the-clock care is Beatitudes, a gated retirement complex, which has, tucked among its many buildings, a memory support annex.

Most of the residents at Beatitudes have seriously impaired memories, to the point where they can no longer look after themselves, are quite often confused, and occasionally have delusions.


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BBC News - Louis Theroux on dementia: The capital of the forgetful

A fragile india, handled with care

Is the country doing enough for its elderly, dying and homeless? Shreevatsa Nevatia meets the providers and recipients of care to find out .

Not everyone is fortunate enough to be cared for, and not everyone witnesses the manifestations of this truth quite as often as Mona Mishra. Mishra is an administrative officer with Silver Innings, an initiative to help improve the lives of senior citizens by providing care and advocacy, by facilitating workshops and through services such as dementia management. Mishra also works as a counsellor in the organisation, and in some cases, a care-giver.

For reasons of confidentiality, she chooses not to disclose the name of a successful writer who has now settled in the West, but starts by talking about his mother who had been diagnosed with Alzheimer’s a few years ago. “When I went in, all I found was a woman with a single question — ‘I had spent most of my life looking after him, where is he when I need him most?’ For four months, we just made either eye or hand contact, and then came a day when I had to perform an enema on her. She was embarrassed, but that broke the ice.” In the years that have followed, Mishra’s relationship with the 80-year-old have deepened to an extent that she is keenly aware of its implications. “There are, of course, times when she considers me to be a substitute for her son.” And then with a wide grin, she adds, “Do you know what makes me really happy though? Taking this lady from her old-age home to a beauty parlour. You should see her face after a manicure and pedicure. It’s priceless.”

There have been times when Mishra has said ‘enough’. She remembers calling a son after his mother had passed away, asking if he’d return for her last rites. “He asked me to do the needful and inform him of the expenses. I came very close to depression around then.” Unlike much of the West, where the social services are now an accepted interventionist tool and where carers are a professionalised workforce unto themselves, the issues surrounding care, more specifically care-givers in India, are little known. Mishra talks about the different roles she has to play in her varied capacities. “The senior citizens who I meet ... I have to mail their children every week. In some cases, its emotional support that I need to provide, but in other cases its things like looking after diet charts and hygiene. And when I go to the slums, it’s even more basic ... getting them to use toothpaste and getting them to keep their homes clean.”

NOW ON LIFE SUPPORT

It is perhaps difficult to find a better representation of care being administered amongst the disadvantaged than in the offices of Jeevan Aadhar Seva Sanstha (JASS) in Khar. The organisation works with the destitute and the homeless in Mumbai. Sandip P Purab, JASS’ secretary, says, “We started with wanting to care for those who were in desperate need of life support. We find people on the streets, bathe them, take them to a hospital, and rehabilitate them.” Working on the street, adds Purab, is not that easy a task. “You don’t get that much support from the police and you get no support from the people.” With this, Purab begins to play some video clips of the work JASS has done. He can be seen hunched over a man’s leg on a pavement, cleaning an open gash of a wound swarmed with maggots. The question seems obvious. What compels him to do what he does? “Just want to sleep well at night,” he quips.

The JASS office is a rented mezzanine with a tin roof. On the other side of green curtains are three beds that together double as a makeshift ward. Michael D’Souza is 65, and was between drug habits when he ended up near Victoria Terminus. After being brought in by JASS and nursed back to health, he says, “I survived. That’s why this institution works.” Ever since JASS was founded in 2007, it has largely been provided for by the fund-raising capacities of Sandip Purab. “We never went to the government,” he says. But Purab does confess that models of self-sufficiency do come with their limitations and that he himself has had to feel the pinch.

 

DOING IT RIGHT

Dr Leena Gangolli, a family physician and a public health consultant, has found herself associated with varied aspects of care. First through home and health care for the elderly, and then with projects that deal with palliative care, situations where patients and their families have to cope with the ramifications of a life-limiting diagnosis. Making the case that the government’s responsibility must exceed beyond its budgetary allocations and extend to providing palliative care for children and the youth, she refers to the Constitution and points to the safeguarded rights to equality (article 14) and life (article 21). She says,"The government needs to understand that unlike building infrastructure like highways and sea-links which require raw materials and equipment, delivery of care requires people as the main raw material. Human resource is our biggest advantage ... there is no dearth of people in India who could be trained to deliver such care."

A need for a greater strengthening of care in the palliative sector was also reiterated at the Tata Memorial Centre, where associate professor Dr Manjiri Dighe works in the Department of Palliative Medicine. According to her, “There is a large demand coming from the families of patients who are dying, and from doctors like oncologists. But have a look at the number of specialised physicians in the state. There are maybe 10 or 15, just these small islands of care. And that is far from optimal. Far from what you’d get to see in places like the UK.”

 

A LEAP OF FAITH

Most of the patients that come to the Tata Memorial are impoverished. Fifty-year-old Priya Ubale is a housekeeper and waste activist who has now been volunteering with the hospital for the last four years. After all this time, she says, “You stop believing in God when you begin to realise that the blight isn’t cancer, it’s poverty.” Questions of faith often surface at the Bhakti Vedanta hospital, where Dr Vineeta Sharma has been part of the Department of Palliative Care since 2008. Though the hospital was formed and runs on the principles of the Krishna-worshipping ISCKON community, religiosity is never an essential component of care, informs Dr Sharma. She says, “It is patient-oriented. There are those who don’t want to talk about God. Then there are those who do.” Narayan Shetty, 75, seems to belong to the latter category. Suffering from liver cancer, he says he only feels fear when the pain in his body becomes excessive. It is at points like those, he says, while pointing to devotional literature he has borrowed from Dr Sharma, “do the doctor and these books help in forgetting.”

Niranjan Parikh and Narayan Shetty are both of the same age. For a large part of the last twenty-five years, however, Parikh has dedicated an early retirement to working with children, cancer patients, those with brain tumours and those in need of palliative care. There are several stories that the counsellor at Tata Memorial can recount. A girl being as dismissive of an amputation as she would have been of a lost plaything. A terminally ill teenager drawing a girl with a balloon and writing ‘life is an ice-cream’ below it. Doesn’t any of this rattle Parikh himself into feeling a certain fear? He comes closer and says, “Not for a minute. It is absolutely inevitable. What will I tell the people I counsel, if I’m scared of death myself.” If there’s one thing that Parikh says he wants to prove about care-giving in India, it’s simply this — “it’s never too late to start”.

As reported by : Shreevatsa Nevatia : n_shreevatsa@dnaindia.net

 

 Source: 15th April 2012 DNA Mumbai Edition Newspaper:  http://epaper.dnaindia.com/epapermain.aspx?edcode=820009&QuickEdition=yes
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India should harvest the advantage of healthy ageing - livemint.com

 India’s demographic profile, with nearly half its population younger than 25 years, is seen as a huge asset for its economy. But the World Health Organization (WHO) has projected that India’s elderly may outnumber children under the age of five in the next five years. In an interview, Dr Nata Menabde, WHO’s representative in India, said there was an urgent need to break stereotypes related to ageing and create models that use the elderly as a “valuable human capital” instead of treating them as an economic burden. Edited excerpts:

This year 2012 on the World Health Day 7th April, WHO is emphasizing on “new models of aging”. What does that mean in the Indian context?

We, in WHO, are of the opinion that there is a need to re-invent ageing. This year’s theme aims to redefine the perception of ageing. Ageing does not have to be associated with immobility, humiliation, uselessness and dependency. Giving financial protection, regardless of the family’s status, has to become a societal responsibility. Elderly persons cannot be left alone on the goodwill of family. We are talking about a societal change in the mindset. India’s legislation has taken case of this by the Senior Citizen Act, which states that a family has to take care of their elderly. But all solutions will not come through law. There is a need for adequate design in universal health coverage, which gives financial guarantees. Senior citizens should have access to social care. The key message is that senior citizens can continue to provide active input in families, in their communities and even engage in labour market. 

In addition to having a law in place, there is need to ensure that dignity of senior citizens is kept intact. No individual should be treated as a burden. We are talking about dignified aging without any humiliation. They do have a right to expect this from the society, not as an act of charity, but as an entitlement. 

What are the implications of a rising elderly population for India?

We should not be scared of this; instead, we should harvest advantage of healthy ageing. The growth of aging population in India is fast. Currently, we have 7.4% and this will go up to 12% by 2025, and by 2050, every fifth Indian will be in this age bracket. 

In the next five years, India will have more senior citizens than children under the age of five. Additionally, the family size is reducing with less number of children being born. We need to think on the lines of keeping our elderly population productive in the community. This will help release the younger workforce from certain responsibilities like taking care of children, etc. 

Speaking in absolute number, we will reach 300 million, but we have to stop looking at this as burden on the society. Right now is the time to build a mechanism, ensuring that senior citizens do not become a burden later on. 

The elderly and the economically weaker sections face the same problems with our public health system. Is the issue, then, of governance and healthcare delivery? 

Indeed. Many problems in the health sector are systemic and they affect all citizens, in all age groups. The healthcare reforms currently being discussed by the government will hopefully bring improvement in the systemic design, which will benefit all age groups, including the elderly. 

Having said so, I must add that historically in India, there is a tendency to perform better when specific interventions are designed for particular target groups. Those interventions are also needed to make problems facing the elderly a priority in governance. Adequate investments need to be made by the government in healthcare for the elderly. These, of course, will only give returns if health sector reforms are done to improve infrastructure, manpower, etc.

Are there any differences in the issues concerning the elderly in developed and developing countries?

Different countries have tried different mechanisms and developed nations are obviously ahead of the curve in this regard because they have been hit by the ageing population a little earlier than say India. The same issues presented themselves two decades earlier in the West. Age is catching up with India faster than realized. In my opinion, these models need to be studied in terms of applicability since all of those won’t be useful in India’s context. The rural population and gender issues are not common in other countries. Models that work in other countries have to be adjusted to India’s reality and implemented.

The government is planning to reform the healthcare sector. In your interaction with the health ministry, do you see the political will required to bring about a change?

Political will is important to make any headway, especially if the project involves changing set behavioural patterns. A good government addresses the gaps in the system to bring in the poor, aged and vulnerable in the fold of development. New initiatives or laws will not be successful if there is no political ownership. The tobacco campaign is a good example. In terms of political will, several initiatives have proven that the government is willing to alleviate problems raised by us. However, what we are saying is that looking solely at elderly care will not work without comprehensive reforms that bring the ageing population in the fold of active social life.

Is blaming everything on the increase in “nuclear families” fair?

Of course not. There is a rural-urban dimension to this problem. Almost 75% of India’s senior citizens live in rural areas. There is a need for special attention in this area. India needs to invest in institutional mechanisms such as day care centres, old-age homes, etc., which are currently concentrated in cities. We don’t know all the implications of a demographic shift in the society as yet. More understanding has to be gained in this from the latest census figures.

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India should harvest the advantage of healthy ageing - Home - livemint.com

WHO | World Health Day 2012 - Good health adds life to years

 03 April 2012 | Geneva - On World Health Day (7 April), WHO is calling for urgent action to ensure that, at a time when the world's population is ageing rapidly, people reach old age in the best possible health. 

In the next few years, for the first time, there will be more people in the world aged over 60 than children aged less than five. By 2050, 80% of the world’s older people will be living in low- and middle-income countries.

Noncommunicable diseases - the main health risk for older people

The main health challenges for older people everywhere are noncommunicable diseases, such as heart disease, stroke, cancer, diabetes, and chronic lung disease. 

“People in low- and middle-income countries currently face up to four times the risk of death and disability from noncommunicable diseases than people in high-income countries,” says Dr Margaret Chan WHO Director-General. “Yet most of these conditions are largely preventable or inexpensive to treat.”

Healthy lifestyles can help

The risk of developing all noncommunicable diseases can be significantly reduced by adopting healthy behaviours, such as being physically active, eating a healthy diet, avoiding the harmful use of alcohol and not smoking or using tobacco products. The earlier people adopt these behaviours, the better their chance of enjoying a healthy old age. 

“Healthy lifestyles from the very beginning of life is key to a healthy and active old age,” says Dr John Beard, Director of the Department of Ageing and the Life-course at WHO.

Cost effective measures

WHO highlights the need for countries to take steps to prevent noncommunicable diseases, and to ensure that systems and services are in place to provide treatment and care when it is required. Many of these services are highly cost-effective. For example, high blood pressure – a key risk factor for both heart disease and stroke – can be effectively treated for just a few dollars a year. Today, less than 15% of older people in low- and middle-income countries in need are receiving treatment for high blood pressure.

WHO has outlined four key actions that governments and societies can take now to strengthen healthy and active ageing.

• Promote good health and healthy behaviours at all ages to prevent or delay the development of chronic diseases.
• Minimize the consequences of chronic disease through early detection and quality care (primary, long-term and palliative care).
• Create physical and social environments that foster the health and participation of older people.
• "Reinvent ageing" - changing social attitudes to build a society in which older people are respected and valued.

 

Breaking stereotypes

Poor health is not the only concern people have as they grow older. Stigmatizing attitudes and common stereotypes often prevent older people from participating fully in society. Older people make important contributions as family members, volunteers and as active participants in the workforce and are a significant social and economic resource. 

“When a 100-year-old man finishes a marathon, as happened last year, we have to rethink conventional definitions of what it means to be ‘old’,” says Dr Chan. “Past stereotypes developed in past centuries no longer hold.” 

World Health Day is celebrated on 7 April to mark the anniversary of the founding of the WHO in 1948. 

For more information, please contact:

Tarik Jasarevic
WHO Communications officer
Mobile:             +41 793 676 214      
Telephone:             +41 22 791 5099      
E-mail: jasarevict@who.int

Fadéla Chaib
WHO Communications officer and spokesperson
Mobile:             +41 79 475 5556      
Telephone:             +41 22 791 3228      
E-mail: chaibf@who.int


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WHO | World Health Day 2012 - Good health adds life to years

Ageing well: a global priority

 April 7 is World Health Day, the 2012 theme of which is health and ageing. Globally, we are getting older. 5 years from now, for the first time in history, the number of people aged 65 years and older will outnumber children younger than 5 years. Advances in medicine, socioeconomic development, and declining fertility have all contributed to this demographic shift, and countries need to adapt to this change in a positive and inclusive way.

Sadly, as the authors of a letter in the April 7 issue of The Lancet note, population ageing is often framed in negative terms. Older people are viewed as a burden to society and resources. This negativity is also true at the individual level. Past a certain age, many people bemoan another birthday or a grey hair. But ageing is something that should be celebrated. Older people contribute to society in many ways—through their experiences and knowledge, within families and through work, both paid and unpaid. They also face specific health problems related to the ageing process that have been neglected internationally and deserve attention.

 

Non-communicable diseases are a particular threat to older populations. The biggest causes of years of life lost in people older than 60 years of age are stroke and ischaemic heart disease. Yet evidence suggests that only 4—14% of older people in low-income and middle-income countries are receiving effective antihypertensive treatment that could help prevent these conditions. Additionally, more than 250 million older people around the world experience moderate to severe disability, mainly visual impairment, dementia, hearing loss, and osteoarthritis. And an estimated 28—35% of older people are injured in falls each year. Maltreatment of elderly people is also a serious and under-reported health concern.

 

This World Health Day, WHO is championing a life-course approach to healthy and active ageing, which includes: promoting good health for all ages to prevent the development of chronic disease; early detection of chronic diseases to minimise their impact; creating physical and social environments that foster the health and participation of older people; and changing social attitudes to ageing. Later this year, The Lancet will publish a Series on ageing. We hope that this Series, together with WHO's renewed commitments, will help create a new movement for healthy ageing for all.

 Reference:
Ageing well: a global priority : The Lancet

WHO Study on global AGEing and adult health 2002 - 2011: WHO | SAGE

SAGE Cohorts: 2002-2011, Background and Objectives

The WHO Multi-Country Studies unit developed the Study on Global AGEing and Adult Health (SAGE) as part of a Longitudinal Survey Programme to compile comprehensive longitudinal information on the health and well-being of adult populations and the ageing process. The core SAGE collects data on respondents aged 18+ years, with an emphasis on populations aged 50+ years, from nationally representative samples in six countries (China, Ghana, India, Mexico, Russian Federation and South Africa). The survey instruments and methods described on this website were adapted from those used by the World Health Survey (WHS) and/or from 16 surveys on ageing (including the US Health and Retirement Survey (HRS) and the UK English Longitudinal Study of Ageing (ELSA)). 

Household and individual level data on persons aged 50+ years are available from 20 countries as part of the core SAGE, the World Health Survey Plus (WHS+), COURAGE and SAGE-INDEPTH. SAGE has pursued cross-study comparisons and analyses with other data collection efforts such as the Study on Health, Ageing and Retirement in Europe (SHARE) and demographic surveillance fieldsites in INDEPTH. The health and vignettes questions in the SHARE self-completed vignettes questionnaire were drawn from SAGE and were implemented in an additional 11 countries. Eight INDEPTH HDSS fieldsites have implemented an abbreviated SAGE instrument, and three HDSS completed the full SAGE in a small sample of respondents aged 50+ years. Survey tools for SAGE-INDEPTH and SHARE are available through this website (click on link, "3. Additional SAGE Data and Methods"), with data available on request.



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WHO | SAGE

Population ageing and health 2012: The Lancet

 As researchers, journal editors, and representatives of non-governmental organisations, we are writing to express our concern about the way in which the health implications of population ageing are misrepresented in the media, in policy debates, and sometimes in academic research. Ageing is most often framed in negative terms, questioning whether health services, welfare provision, and economic growth are sustainable. We argue that, instead of being portrayed as a problem, increased human longevity should be a cause for celebration. Moreover, population ageing provides opportunities to rethink health policy for the benefit of all—old and young.

Depictions of older people remain stereotyped and generalised, distorting public opinion and skewing policy debates. For example, the use of economic dependency ratios, one of the commonest measures of ageing, assumes that anyone aged 65 years or older is unproductive. Similarly, the use of disability-adjusted life years to capture the health of a population explicitly views older people as a social and economic burden. Yet many older people continue to make substantial social, economic, and cultural contributions, which can be enhanced by measures that improve their health and functional status.

 

Obviously we recognise that the ideals of active ageing might not be achievable for every older person, particularly if they have complex comorbidity or severe cognitive impairments. The economic and non-economic costs of care provision for these people are undeniable and will rise as the numbers surviving to very old ages increase. Yet their experiences cannot be extrapolated to older people in general; the effects of population ageing on health spending are not as inelastic as is often claimed. This is particularly true in low-income and middle-income countries, where the relation between health needs and spending is, at best, tenuous. In all countries, demographic effects are strongly mediated by a wide range of unrelated effects, many of which depend on political decisions. Health spending and health-service use are more closely associated with how close one is to death than with chronological age. Indeed, it is often the case that less is spent on older people than on younger people with similar conditions.

 

The key issue in determining the relation between population ageing and health spending is the health and functional status of older people. The association between chronological age and health status is much more variable than is often realised, particularly for those at relatively younger ages (60s and 70s). Newly available data from WHO1 show substantial differences in the health and functional status of older populations in different developing countries. There are also substantial differences in health status within the UK and other developed countries. We still do not understand fully these complex variations in health and functional status. Nevertheless, there is clear evidence that they can be affected substantially by relatively cheap and simple interventions such as the effective management of hypertension, diabetes, and hypercholesterolaemia, and the promotion of healthy lifestyles, in particular regular physical activity.2 Yet in most countries these interventions are not available to large sections of adult populations. The failure of national governments and international agencies to prioritise these cheap and effective treatments represents a missed opportunity to reduce mortality, illness, and disability on an unprecedented scale.

 

Although the non-communicable disease (NCD) agenda has gathered some momentum in recent years, international health spending in low-income and middle-income countries remains heavily focused on infectious diseases and mother and child health. Yet now that NCDs are on the policy agenda, there are worrying signs of discrimination against older people. Background documents from the UN High-Level Meeting in September, 2010, describe the deaths of people younger than 60 or 70 years as “premature mortality”,3 implying that deaths of people at older ages should receive a lower priority.

 

If we do not challenge existing policy paradigms and the social attitudes that underpin them, population ageing might indeed lead to a crisis in the provision of health and welfare services. Instead, we should see it as a welcome opportunity to challenge outdated public perceptions, political priorities, and policy models. This challenge will include reorientating health and welfare models to deliver more efficient, equitable, and sustainable interventions. It might also include the diversion of resources from consumer spending, which in many countries has risen spectacularly over the past 30 years, towards meeting the needs of vulnerable people, whatever their age. This is an overtly political challenge; responding positively to it will benefit people of all ages in all societies.

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Population ageing and health : The Lancet


Lets give them Dignity , Security , Love , Care & Smile.