BY DR. INSHA RAUF
Alzheimer's disease, the leading cause of dementia, affects about 10% of those aged above 65 years and about 30% of people aged above 80 years. The World Health Organization projections suggest that by 2025, there will be about 900 million people aged above 60 years in the developing countries.
By 2040, if growth in the older population continues with no preventive measures for dementia in place, 71% of the global burden (81 million cases) of dementia will be in the developing world. Dementia is an important cause of morbidity and mortality in the elderly population and also results in substantial care giver burden. In addition, treatment modalities are limited to slowing the rate of decline, as such preventive measures form a very important part of management.
As per census of 2011 there are about 8 lakh people above the age of 60 in J&K. As per a study by Razdan et al there were no cases of dementia in a community population in 1980, however with changing dynamics of the population and increased life expectancy the scenario has changed drastically since then.
As per a recent study by Lee et al the prevalence of dementia in Kashmir is a staggering 15% against a national average of 7 %. Age though a robust risk factor associated with dementia is not modifiable, however there are certain factors that are potentially modifiable.
Two of these risk factors are social isolation and loneliness. Social isolation— defined as being not or no longer married, living alone, having a small social network, little participation in activities with others, or lack of social engagement (social connections)—have been shown to be associated with cognitive decline and Alzheimer’s disease. In contrast, having an extensive social network and social resources were found to be associated with less cognitive decline in old age.
Loneliness is a lack of quality of social attachments and the evaluation of being alone as negative. Unlike social isolation which is objective, loneliness is a very subjective experience.
In the context of the societal trend towards increasing numbers of single households and rapidly ageing population, loneliness and social isolation are big problems which need to be addressed.
Stress has also been associated with the dementia process. Emerging biological evidence suggests that stress is associated with detrimental effects to brain structures also affected in AD.
Prolonged exposure of older, non demented individuals to stress is associated with poorer memory performance. In a review of early-life risk factors for AD it was suggested that neuro-degenerative changes may begin decades before clinical disorder and that emergence of AD results from complex interactions between genetics and environmental exposures experienced throughout life. Loneliness and social isolation may be seen as chronic stress generating factors.
Several intervention studies have shown that stimulating friendships and increasing support in social networks are successful means to reduce loneliness and improve older people's cognitive functioning. Friendships are usually sought for the pleasure and satisfaction that they can provide, thus for companionship.
The shared activities, humour and social rituals that are part of friendship, as well as the stimulation one experiences in the company of friends, have a positive impact on an older individual’s well-being. In addition to providing companionship, friends may take on a supportive function in situations that are problematical or stressful.
The provision of emotional or instrumental support by others, including friends, helps to reduce the distress involved in major life transitions such as retirement, the loss of a partner and relocation to housing for the elderly.
Not only are transitions sources of stress, they also involve new situations that require adaptation in behaviour and attitudes by the individual involved.
Friends who have already experienced a similar transition are often important in helping an older person relinquish former roles and behavioural patterns and developing new ones.
By serving as examples, providing behavioural cues and information on the new situation, friends contribute to the process of socialization to old age.
Another way in which friends contribute to well-being is by helping older individuals sustain a sense of continuity in their lives. In a changing world old friends can help reaffirm their identity and their interpretations of both past and present life events.
As Jerrome (1981) pointed out, ‘‘Values which in contemporary terms are dated can be freely expressed with people whose life span has given them comparable experiences and outlook’’. With age this sustaining function of friendship becomes increasingly important.
Thus maintaining stimulating friendships which in our culture mostly come from immediate families, extended families and neighbours whose rights are considered even greater than our own families, in essence preserving our social fabric and culture can help us prevent dementia in our elderly.
(Dr Insha Rauf is a Consultant Psychiatrist DH Budgam)
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.