It is estimated that by 2050 the world population over the age of 60 will be 2 billion (Figure 1.1) (5). Population ageing is occurring rapidly in LMIC. A clearly negative effect of rapid ageing of the population is the increase in the number of people with dementia. Although dementia mainly affects older people, it is not a normal part of ageing. According to different estimates, between 2% and 10% of all cases of dementia start before the age of 65. The prevalence doubles with every five-year increment in age after 65. The number of people globally who are living with dementia in 2011 is estimated to be 35.6 million, and epidemiological studies indicate that this number is expected to grow at an alarming rate. It is estimated that numbers will nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050 (3).
The majority of these people will be living in LMIC. Dementia is one of the major causes of disability in later life. It accounts for 11.9% of the years lived with disability due to a noncommunicable disease (6). It is the leading cause of dependency (i.e. need for care) and disability among older persons in both high-income countries and LMIC. The estimated worldwide cost of dementia is estimated to have been US$ 604 billion in 2010. Direct medical care costs contribute to just 16% of the global cost. In low-income countries, most costs are due to informal care (i.e. unpaid care provided by family members and others) (7). While the numbers and the costs are daunting, the impact on those with the illness and on their caregivers and families is extreme – medically, psychologically and emotionally. The behavioural and psychological symptoms linked to dementia profoundly affect the quality of life of people with dementia and their caregivers.
There is a lack of awareness and understanding of dementia, at some level, in most countries. It is often considered to be a normal part of ageing or a condition for which nothing can be done. This affects people with dementia, their caregivers and families, and their support structure in a number of ways.
Low awareness levels contribute to stigmatization and isolation. Poor understanding creates barriers to timely diagnosis and to accessing ongoing medical and social care, leading to a large gap in treatment. Lack of awareness also takes its toll of the resilience of the family unit and increases financial and legal vulnerability. In many countries, including those in economic transition, the members of the extended family, who may have been able to absorb the impact of caring across the family network in the past, now live far from their kin for economic reasons. This change is likely to result in an increase in the need for formal care in coming years. At national level, the lack of awareness and lack of infrastructure for providing timely and appropriate support early in the course of the disease increase the likelihood of high costs of supporting increased dependence and morbidity. No treatments are currently available to cure or even alter the progressive course of dementia, although numerous new therapies are being investigated in various stages of clinical trials. There is, however, much that can be offered to support and improve the lives of people with dementia and their caregivers and families. The principal goals for dementia care are:
• early diagnosis;
• optimising physical health, cognition, activity and well-being;
• detecting and treating behavioural and psychological symptoms;
• providing information and long-term support to caregivers.