1. Future strategy for dementia care in an aging society in Asia and the world Dr Vijay Chandra Regional Adviser, Mental Health WHO/SEARO

2. Strategy for dementia care....  We assume others will do the caring  New dimension:  Care for yourself

3. Strategy for dementia care....  Mostly discuss strategy for caring in urban areas  Not discussed caring in rural areas  This discussion restricted to developing countries

4. Accepted facts….  Ageing of populations  Large numbers of elderly  Declining resources

5. Many regrets ….  Change in moral values of society  Change in moral values of youth  Change in moral values of the family

6. Many regrets ….  “Nobody lets you age gracefully in this country”  “We xxx abuse our elderly in a hundred different ways” Headlines from newspapers Reports condemn an entire nation based on few episodes

7. Traditional patterns of care ….  Family main care provider in developing countries  Based on:  Extended joint families  Availability of domestic helpers  Extensive physical resources

8. Dramatic socio-demographic changes….  For the first time in history, land no longer remunerative in rural areas  Large scale rural to urban migration  Elderly and the sick left behind in rural areas

9. What should we do ?  Be practical, not emotional

10. Has the traditional pattern of care completely disappeared ?  NO  Multiple families of multiple generations no longer live together  Single families of multiple generations still live together Family is still the main care provider

11. Single families of multiple generations still live together  Problems:  Entire burden of caring on one family  Self selection of carer, with others exploiting the situation

12. Should the entire burden of caring be on women ?  All over the world women are the main care givers  Historical pattern  Role of women in society is changing, women now work  In future, attempt to change attitude  Thought process must change early in life

13. What is the role of care for the carer ?  Carers must be practical, not emotional  Often the patient is totally dependent on the carer  Carers are often themselves elderly  Provide emotional care, less physical care Carers are under severe psychological stress

14. Are western patterns of care completely satisfactory ?  Designed for the local culture  Cannot pass judgment as good or bad  Nothing can be transplanted in toto  Sometimes called “Outsourcing of care”  Some problems:  cost  lack of emotional involvement

15. Are western patterns of care appropriate for eastern cultures ?  Western patterns apply only to urban areas  Against peoples ingrained expectations – so cannot be happy  Easy to build, difficult to maintain  Could attach old age homes to religious institutions

16. Can we think of any new and innovative ideas for dementia care ?  What can be do TODAY ?  Help ourselves, not wait for a change in policy  Glorify family values – ADI Medal  Provide physical support to family through trained care givers  Provide training to the family on care giving  Provide financial support to the family  Setup self help groups Someone has to do this – BIG LACUNAE ADI can help Need advocate

17. Can we prepare ourselves for our own care ?  WE MUST  Best old age security in developing countries is good health  Take a good health approach  Gene-environment interaction – nobody believed it in 1995, now nobody doubts it.  So we must take care of ourselves from early in life.

18. What do we need?  Caring community  Caring family  Caring spouse  Most of all: CARE OF OURSELVES

19. Thank You.