COVID-19, at least at a surface level, seems all but entirely disconnected from conditions such as dementia — besides its evident effect on those who suffer from the condition. However, could there be a link between the two conditions?
Dementia is an umbrella term that encompasses a number of neurological conditions in which aspects of mental health such as memory gradually diminish. The main correlative factor for the condition is age. Diseases such as Alzheimer’s disease show a practical exponential increase in onset rates following the age of around 65, with risk elevating every year thereafter. This is the situation for many cases of dementia.
Many other things can increase the risk of the condition. Loneliness, for example, has been determined to raise the risk of dementia by around twenty percent. Loneliness may be the most apt word to describe 2020 for many people. Lockdowns put in place across the globe have forced swathes of the population to isolate themselves in their homes, not even allowed to interact with their neighbours in many cases. Indeed, India, at the onset of the COVID-19 pandemic, put in place some of the world’s most restrictive lockdown measures.
For many elderly people, the lockdown has imposed on them a prolonged period of total isolation. This isolation has now been the case for much of the year, with many still not regularly interacting with others even after the end of lockdown measures in order to socially distance themselves. For the elderly, who are in the “at-risk” category for COVID-19, many have no choice but to remain isolated or put themselves at risk.
“Evidence shows social isolation has many implications for older adults, including depression, generalized anxiety disorders, decreased sleep, and functional impairment. In the long run, if the isolation continues chronically, say more than six months, it may accelerate cardiovascular and brain aging and dementia,” said Dr Prasun Chatterjee, Associate Professor in the Department of Geriatric Medicine at the All India Institute of Medical Sciences (AIIMS) in Delhi.
“During normal times, patients affected by dementia are very vulnerable people and are hugely dependent on family or professional caregivers in their everyday life,” said Chatterjee. “This COVID-19 pandemic worsens their vulnerability directly, because of the virus’ morbidity and mortality and, indirectly, because of the lack of social and healthcare support which they depend upon…the double shock of dementia and COVID-19 pandemics has raised major concerns for people with dementia but also their caregivers,”
Experts suggest the use of digital social media platforms for the elderly to stay in touch with relatives and friends. However, this is very much a strategy feasible only for those in comfortable economic situations and, in many cases, only in urban areas. For those who have no access to the internet due to living in a rural setting, or who struggle financially, use of social media may be out of reach. Many of the elderly generation may simply be too unfamiliar with digital technology that they may struggle to make use of social media.
According to the Alzheimer’s Association, “in India, more than four million people have some form of dementia.” By 2030, the number is projected to rise to 7.6 million.” The increase in risk factors such as loneliness associated with the COVID-19 pandemic could elevate this figure even further in the years to come.
This figure could be an underestimate. According to studies such as the Dementia India 2010 report, published by the Alzheimer’s and Related Disorders Society of India (ARDSI), ninety percent of people with dementia are never diagnosed or treated.
“We had done a study on the care arrangements for people with dementia and it revealed that due to stigma and lack of awareness more than ninety percent of the people with dementia in India do not even get a diagnosis and deal with the condition without a clue, and this adversely affects the life of the person with dementia as well as the caregivers. Yes our strength is that people with dementia are still looked after by their families, but with the family structure breaking down, people are finding it difficult to cope and this often leads to abuse and a tremendous amount of caregiver burnout.”
This lack of public knowledge, coupled with inadequate diagnosis rates results in a number of issues. There is a prevailing stigma regarding mental illness that, while being legislated against, has not been removed from the mindset of many in India. This not only affects the individual with dementia, but often their family as well.
Another considerable issue for the family is the eventual necessity for 24-hour care in many with dementia. This can take two forms: paid care by nurses and health professionals, often paid out of pocket, or care provided by a family member, usually resulting in them being removed from the workforce and losing income. The annual household cost of caring for a person with dementia in India can be as high as Rs 2,02,450 in urban areas and Rs 66,025 in rural areas, according to a study published in the Indian Journal of Public Health in 2013 by professors Girish N. Rao and Srikala Bharath of the National Institute of Mental Health and Neurosciences (NIMHANS).
“We see a number of caregivers who have given up their job or sometimes the prospects of getting married and make a lot of sacrifices to look after their loved one with dementia,” said Dr Amit Dias. “On the other extreme, we see a large number of people with dementia who are neglected and even abused as the family cannot cope with the condition.”
Policy change must be enacted, or else India risks being overwhelmed by both the numbers of people being affected by dementia in the coming years, as well as the number of people leaving the workforce in order to care for elderly relatives.
Policy change is, however, just the start of changes that need to be made. These policies must translate to transformational change in primary healthcare structure to both diagnose and manage those with dementia. This is no easy goal, as such change would need to be enacted across all of India, with many healthcare workers requiring training to cater to those with issues stemming from dementia. However, to continue ignoring the situation as the number of those affected grow is to invite disaster, as India will inevitably need to address the situation, whether now, or later.