MALAYSIA: Care Needed For Senior Citizens' Mental Health

KUALA LUMPUR (Bernama), July 4, 2006: Hamimah Bee Abdul Kadeer is 70 years old, in good health but taken to see a doctor for memory lapses. For about a year now, she has had trouble shopping for groceries like forgetting to buy certain things and her problems extends to the kitchen. Either she puts too much salt or none at all, and at times forgets to switch off the stove after use. She forgets where she had placed her stuff and sometimes cannot even recognise those who visit her including her own grandchildren. The situation gets worse. When Hamimah cannot find her personal things, she accuses her daughter of taking them. She also claims that her daughter has not been feeding her well and accuses her of being after her wealth and wanting her to die soon. Hamimah often becomes restless and leaves the house looking for her husband who had died a long time ago. She also has trouble sleeping. Sound familiar? What Hamimah is suffering may well be happening to your mother or grandmother. SENILITY OR DEMENTIA Senility or dementia involves memory disorders with accompanying behavioural deterioration, and this problem is common among the elderly. Dementia originates from the Latin word "de" which means "apart" or "away" and "mens", "the mind". According to Dr Norazam Harun, consultant psychiatrist at Hospital Permai in Johor Baharu, dementia is a disease closely related to age and is permanent in nature. It occurs gradually and will change a person's personality and behaviour. There are several features of dementia. These include the difficulty to remember, to make out phrases or normal spoken words (aphasia), to recognise things that were known before (agnosia) such as faces or items, and to perform movements which involve small muscles (apraxia) like buttoning up a shirt. As a result, those afflicted with dementia lose their ability to plan, arrange, count and concentrate and are unable to perform tasks which they easily did before. "In the many cases I've seen, the patients don't even know they have dementia. Only the people around them would know," said Dr Norazam. "In early stage dementia, the difficulty to remember a new thing learnt may be an early symptom. Nevertheless, dementia is not part of the ageing process." IMPACT OF INCREASING NUMBER OF DEMENTIA SUFFERERS Dr Norazam said more focus was being given now on dementia worldwide as the number of senior citizens increased. "About 10 per cent of the world's population are those aged 65 and above. In 2002, there were 635 million people in this category worldwide and most of them were in developing nations. "Japan has five million senior citizens, China 30 million and the United States 34 million. These numbers are expected to increase to 30 per cent come 2050. In Malaysia, the number of senior citizens aged 60 years and above is expected to jump from 1.047 million in 1990 to 3.26 million in 2020," he said. Increase in the number of the silver-haired population will eventually see a rise in the number of dementia sufferers. But the cost of caring for the elderly with dementia cannot be measured merely in monetary terms as there are other impacts, especially on health, physical and emotional well-being. "The emotional and physical stress on the family, caregivers and friends of the dementia sufferers must also be considered," said Dr Norazam. He said a study conducted on dementia sufferers and their caregivers, showed that a substantial number of dementia patients were being cared for by their spouses (about 50 per cent). "There was a case of a wife with dementia being cared by her very sick husband who himself suffered from memory problem. The children just didn't care, maybe they were too busy with their own life," he added. CAUSE OF DEMENTIA Normally people with dementia only remember events that happened long ago. They can give a vivid account of what happened to them many years back but have problems remembering recent things they did or experienced. "They can recall stories about the Japanese Occupation or independence day, for example. But if we ask them whether they've eaten or not, they'll say no although they've already had," said Dr Norazam. This relates to the theory on memory. He explained: "When a person learns a new thing, this will be registered in the part of the brain called Hippocampus and when it has been registered, the part of the brain or nerve involved will form a template or mould. "That template will be stored in the Hippocampus and the person will remember it when required. But people with dementia are not able to make new templates and what they have are only old ones. That is the reason why they can only remember past events." He said people with dementia could not make new templates as the number of brain nerves had atrophied. The brain of an adult is as big as a medium-sized cabbage, weighing five to six kilogrammes. On average, a brain has 100 billion nerves (neurons) and 100 trillion joints (synapses) between the nerves. Studies on people with dementia show that their brains shrink in size as nerve endings atrophy (die). Dementia is due to the loss and reduction of synapses in the brain that leads to the death of brain nerve cells. "That's why the person can only recall past events but find it hard to remember recent happenings," he said. TYPES OF DEMENTIA There are two types of dementia -- degenerative (primary) and secondary. Generative dementia is further divided into five conditions -- Alzheimer, the vascular type (after a stroke), "Lewy Body" (such as Parkinson's), "Frontotemporal (glaring personality changes like difficulty in controlling emotions) and "Creutzfeld-Jacob" (due to bacterial infections like the mad cow disease). For the secondary category, it is caused by other medical problems such as brain tumor, meningitis, deficiency of thyroid hormones and vitamin B12, and chronic kidney disease that requires dialysis. For this type, the memory can be recalled if the cause is properly treated while for the generative type, the problem is permanent and it occurs gradually. "Therefore, prevention and early treatment is very crucial," Dr Norazam said. Out of the five degenerative types, the most common is Alzheimer which affects 50 per cent of dementia cases. Alzheimer or AD in short, takes after the name of Dr Alois Alzheimer, a German doctor who discovered this neurological disorder in 1906 when he found pathological changes in the brain tissue of a dead woman who suffered from dementia. Alzheimer involves parts of the brain that control thought, behaviour, memory and speech. "Until today, scientists still cannot fully comprehend the cause of AD and it still cannot be cured. Among the main factors for Alzheimer is age. The older the person is, the higher the risk to get AD," said Dr Norazam. Another risk factor is family history. Scientists have discovered that the genetic factor also has a role in most Alzheimer cases. "In Malaysia, there is no particular race that is more prone to have Alzheimer. However, in terms of gender, the percentage is higher among females," he said. Why? "Maybe because their life expectancy is longer than males," he said. Besides age, genetic and gender, other factors that contribute to Alzheimer include smoking, hypertension, high cholesterol and diabetes. TREATMENT AND PREVENTION There are several ways to treat dementia including medical treatment and food supplements. "We need to conduct a proper study before we can confirm the ailment," said the doctor. "There are people who become forgetful due to other medical conditions such as deficiency in thyroid hormones, infection in the brain or body, or excessive intake of alcohol. "Some people have memory problems due to anxiety and depression. So, we need to have a complete study. "For example, if we question a depressed person, he'll say he's tired or is not interested to answer but if we ask a person with dementia, he'll try to answer but the answer is incorrect. There are many ways for a doctor to examine this such as by taking blood sample and CT scan of the head." Dementia can be prevented, and what is important is to practise a healthy lifestyle, according to Dr Norazam. "Be active always and do physical exercise such as walking, jogging and light movements. Mind exercise such as reading, memorising, for example, dates, places and people around you, doing crossword puzzles and keeping track of current developments will also help. "At the same time, maintain your association and activities in the community such as by being involved in non-governmental organisations, and in spiritual and political activities. Continue with your hobbies. For pensioners, get involve in beneficial activities and don't just sit in the house." He also advised against smoking and consuming alcohol and to eat well, besides taking less food which contain cholesterol. He stressed on the need to control illnesses such as diabetes, hypertension and asthma besides having regular health examinations. "What's important is to seek treatment when memory diminishes. Don't delay. There are medications for those who have been diagnosed with dementia such as Rivastigmine, Donapezil, Galantamine and Memantine. "The medical treatment is to delay the dementia process so that sufferers and caregivers can lead quality life as long as possible before death occurs. Treatment must be from a certified doctor as medicines purchased from unknown sources can be harmful. "Family members caring for people with dementia also need to get counselling from doctors to safeguard their own health and that of their loved ones," said Dr Norazam. By Melati Mohd Ariff Copyright © 2006 BERNAMA. All rights reserved