“Public health [in dementia care] … cannot just focus on the cure of these chronic illnesses, but how to manage it.”

– Praja Vaikuntharajan, dementia care expert

INTRODUCTION

Just 100 years ago, in 1913, the global life expectancy was only 34.1 years old (Our World in Data, 2019). Today, that age has jumped to 72.8 years (Macrotrends, 2021), with life expectancies in some high-income nations reaching above 80 years (Our World in Data. 2019).

Thanks to improvements in technology, medicine, and social and environmental conditions, people around the world are enjoying longer, healthier lives. As a result, the average age of populations has increased. In Canada, seniors (age 65+) make up 16.9% of the current population, and are expected to grow to 20.1% by 2024 (Memoryz, n.d.). 

But as the aging population grows, so too does the incidence of age-related illnesses. Dementia is among the most common of these – an estimated 50 million people worldwide are living with the illness, with numbers expected to rise in years to come (Memoryz, n.d.). Most nations, however, are not equipped to handle this influx in cases, and misconceptions and stigma surrounding the condition only serve to make the problem worse.

How can countries prepare to address the increasing prevalence of dementia among their aging populations? In this blog post, we’ll explore:

• What is dementia?
• The global burden of dementia
• Misconceptions and stigma
• A pathway to healthy aging

What is dementia?

Dementia is an umbrella term that captures a wide range of symptoms related to memory, thinking, and cognitive function (Memoryz, n.d.). The illness mainly affects adults 65 years and older, though has also been diagnosed in some middle-aged adults. Symptoms typically come on gradually and can include: 

• memory problems
• confusion
• difficulty concentrating
• personality/behaviour changes
• loss of ability to do everyday tasks (Memoryz, n.d.).

Dementia is caused by damage to brain cells (Alzheimer’s Association, 2021), which can occur in a number of different ways. Alzheimer’s disease, which makes up between 60-70% of all dementia cases (WHO, 2021), is caused by a build-up of proteins inside and outside of brain cells, which makes it difficult for brain signals to be properly transmitted (Alzheimer’s Association, 2021). Vascular dementia, another common form, occurs due to microscopic bleeding and blood vessel blockage in the brain (Alzheimer’s Association, 2021). 

There are currently no cures for dementia. Treatment options are therefore mostly limited to management techniques and include early diagnosis, promoting physical and cognitive health, and managing behaviour changes (WHO, 2021). Unfortunately, many national health systems are not equipped to provide this type of chronic, long-term care. Canadian healthcare systems, for instance, are largely designed to address acute, short-term ailments among younger members of the population (Memoryz, n.d.). This model risks leaving those living with dementia behind. 

The global burden of dementia

While dementia affects aging populations in all parts of the world, low- and middle-income countries bear a disproportionate burden. In 2015, 58% of all persons with dementia lived in low- and middle-income countries (Memoryz, n.d.). By 2050, this figure is expected to increase to 68% (Memoryz, n.d.). 

Given that life expectancy rates in low- and middle-income countries tend to be lower than in high-income countries, this distribution may seem paradoxical. Experts have a few different theories to explain this – for one, it is important to remember that age is not the sole predictor of dementia onset, and up to 9% of all cases are in those under age 65 (WHO, 2021). Thus, a low average age may not inherently mean a country has a lower incidence of dementia. 

Apart from age, several lifestyle factors can increase one’s risk of developing dementia including nutritional deficiencies, physical inactivity, low educational attainment, and even air pollution (WHO, 2021). These conditions are more common in low- and middle-income countries, thus putting residents of these nations at greater risk. Moreover, low- and middle-income countries generally have fewer healthcare and public health resources than most high-income countries, making it even harder for residents to access the preventative care they need.

Misconceptions and stigma

Despite its prevalence in Canada and elsewhere, dementia is poorly understood by the general population. 

Historically, dementia has been incorrectly referred to as “senility” or “senile dementia”, reflecting the incorrect belief that serious mental decline is part of the natural aging process (Alzheimer’s Association, 2021). While mild confusion is common among aging adults, the symptoms caused by dementia are uniquely severe and should not be perceived as normal.

Many people also view having dementia as an impossible toll on one’s life. According to a 2017 Canadian dementia awareness survey conducted by the Alzheimer Society, 1 in 2 participants do not believe they could live well with dementia and 1 in 4 believe that their life would be over after receiving a diagnosis (Alzheimer Society, 2021). 

These misconceptions have contributed to the stigmatization of the illness. Many individuals living with dementia have reported experiencing discrimination and belittlement from others who assume that their diagnosis severely limits their abilities or quality of life (Alzheimer Society, 2021). Jokes about dementia and the use of negative language to describe the illness have further contributed to stigma and misunderstanding (Alzheimer Society, 2021). These conditions have severely affected the self-esteem of those living with dementia and discourages those with symptoms to seek help. 

A pathway to healthy aging

What can be done to prevent the onset of dementia and how can we support the millions of people around the world who currently live with the illness?

Most forms of dementia can be prevented by adopting simple lifestyle changes. Studies have shown that being physically active, maintaining a balanced diet, avoiding smoking and harmful use of alcohol, and maintaining healthy blood pressure, cholesterol and blood sugar levels can reduce one’s risk of developing dementia (WHO, 2021). These same measures also reduce one’s risk of other age-related ailments, such as cardiovascular disease and cancer. 

For those currently living with dementia, action must be taken to de-bunk harmful myths and stigma surrounding the illness. This will encourage those with symptoms to seek help and improve their overall quality of life. Additionally, healthcare systems must be re-fitted to provide long-term care and social support for those living with dementia. This includes the provision of financial and educational resources for caretakers, the creation of evidence-based standards of care among healthcare workers, and the promotion of early diagnosis and support (Government of Canada, 2019). 

Conclusion/Key Takeaways

Dementia is not simply a natural part of the aging process – but it is not a death sentence, either. With the proper preventative measures and supports, we can reduce the overall incidence of dementia among aging populations and help those living with the illness lead fulfilling, dignified lives. In this blog post, we’ve discussed:

• The symptoms and causes of dementia
• The global burden of dementia and the factors that contribute to its uneven distribution
• Common misconceptions of dementia and their effects on the lives of those living with the illness
• A pathway to healthy aging that includes dementia prevention and effective long-term management

Written by: Claire Borgaonkar BPAPM (c)