Making Dementia Care Affordable and Accessible

Dementia is a neurodegenerative disease characterized by progressive deterioration in intellect including memory, learning, orientation, language, comprehension and judgment. The main risk factor cited for dementia is increasing age. By the age of 65 years, proportion of people affected by dementia stands at 1 in 20 increasing to 1 in 5 by the age of 85 years. According to research, lifestyle and vascular risk factors such as hypertension, diabetes mellitus, cholesterol and cardiovascular disease play a significant role in the onset of dementia. Over the past decades there has been considerable research into identifying treatment for dementia. However, in spite of these efforts there is no treatment for dementia yet. Epidemiological research has indicated that modifiable risk factors and preventive interventions can reduce the risk of developing the disease.

The Dementia India report 2010 has estimated that over 3.7 million people are affected by dementia in India with a higher prevalence of the disease in women; 2.1 million are women while only 1.5 million are men. This is expected to double by 2030. Despite the magnitude, there is gross ignorance, neglect and scarcity of services for people with dementia and their families. The survey conducted on experts available for mental health problems / psychiatric problems in elderly reveals the ratio is about 1 psychiatrist per 50,000 patients and 1 expert (social worker, psychologist, trained nurses) for 25,000 patients. These figures indicate the need to develop innovative approaches to reach out to large number of people in a cost effective manner.

Presently, there are about 8 residential care facilities exclusively for people with dementia (PwD). Only ten day care centres offer professional care for people with dementia. Domiciliary care is provided in around five centres. About 100 memory clinics are fully functional. The available services are grossly inadequate to meet the needs of the over 3.7 million people with dementia in India.

The calculated societal cost of dementia for India has been estimated at Rs. 147 crore. The expenses are mostly met by the family. In an urban scenario the expenditure on a dementia patient per year is about Rs. 2, 02, 4502. Most PwD are in urban areas. It is estimated that about 7.1 Lakh PwD are in the middle class and about 78% of them require institutional care at some point of the illness. Middle class section of the society presently is unable to access the residential care option due to financial concerns as existing care facilities charge over Rs. 20, 000 per month for their services. Since majority of PwD are from this section of the society and need residential care, there is an urgent need to think about affordable dementia care model without compromising on the quality of care.

The field of telemedicine is projected to be an increasingly prominent feature of the healthcare delivery system, especially as the Indian geriatric population is on the rise. Our ETCM-Nightingales Dementia Care Centre is a telemedicine enabled residential care centre serving the purpose. It is set up based on Hub and Spokes model and the aim is to make dementia care affordable and accessible. The clinical core team of Nightingales Centre for Ageing &Alzheimer’s including geriatric psychiatrist, neurologists, psychologists and therapists constantly monitor the centre using specially designed Teledementia Management Software. Teleconferencing facility has been leveraged for the family members of dementia patients to connect to their loved ones.

With this, the Centre has led to increased access to services, improved functional outcomes, and high-levels of satisfaction, enhanced communication and continuity of care. Application of teledementia technology has allowed NMT to cut down costs by 30%. NMT wishes to set up 10 more similar centres to make dementia care affordable and accessible.