DEMENTIA TSUNAMI: IS TRINIDAD AND TOBAGO READY?
A dramatic demographic change is occurring worldwide wherein the oldest segments of the population are increasing at the fastest rate. The increase of life expectancy has given rise to the epidemic of the 21st century that being dementia. Dementia is being described as the single most significant health and social crisis of the 21st century. Dementia has a multifactorial impact on society. The financial burden derives from medical costs, long term care, home care, and lost productivity of the caregivers. USA In 1998, Alzheimer’s disease cost was $200 million which increased to $200 billion in 2012 and will increase to 1.1 trillion by 2050 (1,2). In 2012 = £23 billion in the UK will increase to 50 billion by 2038 (2). Not included in this amount is the estimated £690 million in lost income for those carers who have to give up employment or cut back their work hours. (3).
What is happening in Trinidad and Tobago?
According to our geographic location coupled with our special health problems Trinidadians are at a great risk for dementia? The World Health Organization estimates the prevalence of Dementia in the Caribbean and Latin America to be the HIGHEST IN THE WORLD at 8.1 and 8.5% of all people of over 59 years of age respectively (4). Both cardiovascular diseases and diabetes have been identified as significant risk factors for developing dementia notably Alzheimer’s disease. Both of these are prevalent among the population in Trinidad and Tobago. It is estimated that 156000 persons are affected by diabetes and that cardiovascular diseases cause 25% of all deaths. Thus it can be concluded that Trinidadians are at a great risk for developing dementia/ Alzheimer’s disease.
2. Alzheimer’s Association, “2012 Alzheimer’s Disease Facts and Figures” (“Includes a Special Report on People with Alzheimer’s Disease and Other Dementias Who Live Alone”) Alzheimer’s & Dementia, Volume 8, Issue 2 (issued March, 2012), p.14
4. The latest World Health Organization report ‘Dementia: a public health priority’.(2012)
AGEING AND RISK OF DEVELOPING DEMENTIA
Age is the most important known risk factor for dementia, with prevalence roughly doubling every five years over the age of 65.
The prevalence of Alzheimer’s disease is 10% for patients 65 years and older and doubles with every 10 year increment.
- 60 – 70 years – 10%
- 70 – 80 years – 20%
- 80 – 90 years – 40%
In Trinidad and Tobago there are 177 676 persons 60 and above. Based on international predictions that 7% of a given population 60 and above have dementia it is anticipated that there are 12437 persons with dementia in Trinidad and Tobago. In the absence of a national wide prevalence of dementia study it is not known whether dementia prevalence in Trinidad and Tobago is higher or lower than the international projections.
DARTT LAUNCHES NATIONAL PREVALENCE OF DEMENTIA and ITS ECONOMIC BURDEN STUDY.
Members of DARTT who hold academic positions at the Faculty of Medical Sciences at the University of the West Indies in collaboration with Faculty of the Health Economic Unit from the Faculty of Social Sciences at the University of the West Indies have launched an investigation which will establish the prevalence of dementia as well as its economic burden in Trinidad and Tobago.
The key research instrument known as the Community Screening Instrument for Dementia has successfully established the prevalence of dementia in a number of countries including Latin American, Caribbean, Asian, and African. This questionnaire together with a socioeconomic questionnaire (prepared by the HEU) will be used to conduct interviews.
The study is earmarked to begin March 15, 2014 and will include the following participants:
- 2000 persons randomly selected for interviews from all municipalities in age ranges as follows:
- 500 participants aged 60-69 years, 500 aged 70-79, 500 aged 80-89, 500 aged 90+
Approach Unique to Trinidad and Tobago
- First survey of a national population (rather than a geographic catchment)
- First such survey to adopt age-stratified sampling.
- The age range 60-65 will provide information on the likely prevalence of relatively early-onset dementia syndromes.
- Costing of dementia
Expected Impacts of Prevalence of Dementia and Its Economic Burden
- Accurate assessment of the number of dementia cases in Trinidad and Tobago thereby allowing government and health and welfare organizations to plan adequate services.
- Identify the prevalence of dementia subtypes in Trinidad and possible risk factors
- Describe the living circumstances and care arrangements of people with dementia
- Quantify the economic cost of dementia for households.
- Raise awareness of dementia.
Funding for the National Prevalence of Dementia and its Economic Burden Study has been provided by a generous grant from The UWI-Trinidad and Tobago Research and Development Impact Fund (RDI). http://sta.uwi.edu/rdifund/
WHAT IF YOU HAVE MEMORY PROBLEMS OR YOU ARE CONCERNED ABOUT A RELATIVE OR FRIEND?
Reluctance to go to the doctor when you or a family member has memory problems is understandable. Some people hide their symptoms, or family members cover for them. That’s easy to understand because Alzheimer’s is always about loss, such as loss of independence, loss of a driving privileges and loss of self. Many people may wonder if there’s any point in a diagnosis if there’s no cure for the disease.
It’s true that if you have Alzheimer’s or a related disease, doctors can’t offer a cure. But getting an early diagnosis can be beneficial. Knowing what you can do is just as important as knowing what you can’t do. If a person has another treatable condition that’s causing the cognitive impairment or somehow complicating the impairment, then doctors can start treatments. http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048075?pg=2
WHERE DO YOU GO IN TRINIDAD and TOBAGO TO GET A DIAGNOSIS
Initial diagnosis is usually conducted by your GP. Afterwards you may get a referral to a specialist.
- Neurologists, who specialize in diseases of the brain and nervous system
- Psychiatrists, who specialize in disorders that affect mood or the way the mind works
- Psychologists with special training in testing memory and other mental functions
The San Fernando Hospital has recently opened a Memory Clinic.