Amongst the more serious costs mankind has to pay for longer life-spans that advances in food and healthcare have facilitated is that of managing ‘aging’. More importantly, it is dealing with the cost of addressing mental health issues of increasing numbers with increasingly feeble minds, mostly age-related and attributed to dementia. This neurodegenerative syndrome encompasses failing memory, impaired cognition, compromised thinking and inability to independently perform everyday activities.
Globally, this affliction accounts for as much as 10 per cent of the health care costs, affecting between five per cent and eight per cent of people upwards of 60. In India, it is associated with “high morbidity and considerable socio-economic impact”. From the 1947 average life expectancy of 32 years to 68.3 years now, India has done well though the quality of life has not improved across the board.
Like every other aspect of health, mental health too has been a much-neglected space with little achieved vis-a-vis preventive care and treatment though there are upwards of four million people with dementia in India and numbers are expected to double by 2030 and treble by 2050. Early detection of dementia can considerably improve the lives of both the afflicted and the care-giver. Neglect apart, the other worrisome aspect of dementia is the potential cost of engaging with the disease. Global estimates based on insurance claims show an annual spend of $600 billion but there is inadequate data on both economic costs and social burden that the disease imposes on the Indian population, especially with much of the care being informal in nature and hardly ever built into any estimate.
In any event, such is the lack of awareness about the disease that mild cognitive impairment is, more often than not, ignored or laughed away as senior moments, even though it is an “intermediate prodromal stage of memory impairment with normal cognitive function (which) often, but not invariably, precedes dementia”. Ideally, that is when intervention is best initiated, pursuant to professional identification of the symptoms of cognitive decline.
Only this can help India prevent what should be a happy demographic transition to one that is fraught with troubled minds. Regrettably, this space distinguishes itself by the virtual absence of both empowered healthcare workers and professionals to manage detection and post-detection care. Without a national public health priority status, there can be little by way of effective culture-specific advocacy from state or private players that must begin with awareness programmes to initiate an informed approach involving the family, the community and mental health care provider.
The Dementia India Report from the Alzheimer’s and Related Disorders Society of India estimates the cost burden of care for 4.4 million people at around Rs 163 billion. Apart from raising the resources, it is a matter of the spending hitting the target.