“Dementia is one of the more significant healthcare burdens facing particularly older members of our community and their families today. Despite this, there is a lack of awareness about dementia in South Africa, and insufficient numbers of medical professionals and care facilities specialising in this highly complex area of healthcare.”
This is the view of Dr Ryan Fuller, a Johannesburg psychiatrist, who specialised in old age psychiatry in London before returning to South Africa in 2010 to develop the multidisciplinary Memorycare Clinic in Johannesburg. According to Dr Fuller, dementia is not a specific condition, the term referring to a group of symptoms that result in a decline in memory and cognitive function.
“Dementia occurs particularly commonly among the elderly over the age of 65, although some individuals may experience symptoms earlier in life. If one considers that we have a growing aging population both internationally and here in South Africa, it becomes evident that dementia is a growing healthcare problem,” adds Dr Fuller.
Dr Fuller says from the age of 65 the risk of developing Alzheimer’s disease doubles every five years, and by the age of 80, approximately half of elderly people will have developed dementia symptoms of one kind or another.
High level of care
Ivan Oosthuizen, chief executive officer of Livewell Villages, which are pioneering dementia care facilities situated in Johannesburg and Cape Town, says that caring for those who are living with dementia is a highly specialised field, and residents require round-the-clock care.
“There is a great need for further resources and programmes to assist those with dementia in South Africa, as well as dedicated care facilities that specialise in caring for those with more advanced dementia. Traditional retirement villages, by way of example, tend to lack the facilities and trained staff to be able to provide the necessary levels of care for those who have more advanced dementia. We need to pay greater attention to the challenges posed by dementia to assist us to better meet the challenges that it may pose into the future.”
Dr Fuller adds that a comprehensive, multidisciplinary approach to the treatment of dementia tends to yield the best results. “Unfortunately, however, relatively few healthcare practitioners and care facilities in this country are experienced in this area.”
“As a result, numbers of people who are developing, or who have developed, more advanced levels of dementia symptoms, do not receive adequate support and care, while others who could benefit from appropriate early treatment and therapies often go undiagnosed, until it is too late to be able to meaningfully manage the symptoms,” he explains.
What is dementia?
According to Dr Fuller, dementia symptoms may develop as a result of a large number of underlying conditions such as Parkinson’s disease, Huntington’s disease or Alzheimer’s disease, which is a progressive condition responsible for 60 to 70% of all cases of dementia. Vascular dementia, on the other hand, may occur as a result of the thickening and hardening of artery walls due to build-up of plaque in the walls of the arteries. An individual may also develop dementia symptoms and cognitive problems after suffering a brain injury.
“We may all have problems with memory from time to time, and these are not necessarily an indication that one is developing dementia. There may, however, be possible early warning signs of dementia, particularly in the elderly, and should be investigated by a healthcare practitioner who is experienced in this field,” advises Dr Fuller.
The importance of early diagnosis
Given the fact that the underlying medical conditions that may be contributing to dementia symptoms can often be treated, and the progression of dementia symptoms may be delayed with appropriate therapies, it is important for the syndrome to be diagnosed and treated as early as possible, Dr Fuller points out.
“Appropriate early treatment using medications and psychological, occupational and memory therapies may greatly assist many people with dementia, delaying the progression of symptoms and providing support to their memory. The individual with dementia should ideally be managed by a multi-disciplinary team that should include elder care specialists; psychiatrists; psychologists, occupational and speech therapists and even dieticians,” he adds.
“Those people who are developing more advanced levels of dementia, and are losing their independence, require an increasingly high level of care,” affirms Oosthuizen. “This is when many families seek full time nursing support for their loved one or start to consider a dedicated care facility, such as one of the Livewell Villages, which have been at the forefront of dementia care since they were established in 2011.
“However, we find that those who have had the benefit of early and appropriate interventions tend to be the most responsive and benefit the most from our therapies and care,” he observes.
Possible warning signs
Dr Fuller says as so many conditions and factors can be associated with dementia, it is particularly important to be able to identify the causes of memory and cognitive decline, so that the individual can be properly managed and treated.
Given the importance of early diagnosis and intervention, what are some warning signs that may alert one to dementia? Dr Fuller says that these may differ from person to person but may typically include:
- Loss of memory
- Difficulties in thinking and reasoning
- Difficulties in communicating
- Difficulties with motor function and coordination
- Confusion and disorientation
Comprehensive care services
“We created the Livewell Villages as a result of heartfelt concern for the dignity and care of South Africans with dementia and a strong need for specialised individual care facilities in this country. They have been designed with the health, dignity and well-being of the person living with dementia in mind,” adds Oosthuizen.
“The Livewell Villages therefore offer a comprehensive range of services, including live-in as well as day respite care services, to support those with dementia and provide them with a safe, comfortable, caring and stimulating environment. The person with dementia is also closely monitored to establish whether they are responding to treatment and therapies.
“We also seek to partner with specialists such as Dr Fuller and the Memorycare Clinic, who have considerable experience in this area, in order to be able to tailor the best possible care programme for each of our residents, all of whom have unique needs and requirements.”
Livewell also hosts free monthly support groups where people can get advice and assistance from its teams, as well as obtain the support of others who are facing similar challenges and invites those who may in some or other way be impacted by the condition to join them at one of these sessions.
“They will find comfort and reassurance, as well as a wealth of practical information to assist in coping with the challenges presented by dementia. It is also one of the ways we are looking to assist those families who are faced with the challenge of a loved one who is developing dementia,” concludes Oosthuizen.