Critical need to address healthcare challenges facing senior citizens

Dementia projected to increase substantially in next decades

Wednesday, June 5 2019

As the world’s population is increasing year after year, and more people are living for longer, the number of senior citizens is also increasing exponentially. Some health authorities have warned that this development, which is sometimes referred to as an impending “Silver Tsunami”, will place an increasing burden on health systems globally, including South Africa.

“We prefer not to use terms such as ‘Silver Tsunami’, as they paint our senior citizens as an alarming societal ‘problem’, and tend to obscure the fact that the elderly can, and indeed do, contribute much to our families and communities, particularly if they are appropriately supported,” says Dr Ryan Fuller, who specialises in geriatric psychiatry and has established psycho-geriatric MemoryCare units at both Akeso Parktown and Akeso Alberton.

“This said, senior citizens as a group do tend to face a set of often quite distinct mental and physical health challenges. These include dementia, which occurs much more commonly in the elderly than in the general population. Given the increasingly large number of senior citizens both internationally and in South Africa, the rate of dementia is projected to rise sharply over the coming decades. Indeed, the World Health Organization estimates that the number of people living with dementia worldwide will increase from 47 million to 75 million by 2030.

Dr Fuller says that an additional problem is that, for various reasons, mental healthcare for the elderly remains severely under-resourced in South Africa. There are too few healthcare practitioners and facilities specialising in the care of both the physical and mental health of the elderly, and particularly those who have more advanced dementia. As a consequence, this responsibility often falls on overburdened family members.

“There is a great deal more focus placed on conditions such as cancer and HIV and lifestyle diseases such as diabetes in this country, which is quite understandable, as these are national health priorities, and mental health problems in the elderly are harder to conceptualise. Nevertheless, there is a critical need for us as a country to find ways to meet the growing challenge that we face with regard to the care of the elderly.”

He adds that dementia is a blanket term used to describe a variety of brain conditions, such Alzheimer’s disease, that affect cognitive functioning including memory, behaviour and the ability to perform activities of daily living. Dementia can severely erode the independence of the individual over time, and those with more advanced dementia ideally require a high level of specialised care.

Dr Fuller, who underwent specialised training in geriatric psychiatry in London, says that there are, however, a number of positive developments with regard to improving access to mental healthcare for seniors. He notes that, for example, a sub-speciality course in geriatric psychiatry is now being offered by Professor Felix Potocnik through the University of Stellenbosch. There are also plans afoot to train more psychiatrists in geriatrics in Johannesburg and other centres.

“Geriatric psychiatry, also referred to as old age psychiatry, is a specialist field of psychiatry particularly dealing with mental health concerns in old age.  At our MemoryCare units at Akeso Parktown and Akeso Alberton, we provide specialised psychiatric consultations and in-patient and outpatient services for individuals who may be experiencing challenges with memory, mood and activities of daily living.”

Dr Fuller and his partner, fellow psychiatrist Dr Lolita Mostert, have established two multi-disciplinary teams at these MemoryCare units. In addition to psychiatrists, these two teams also include psychologists, general practitioners, social workers and administrative staff, who assist in the development of a detailed care plan for each patient.

“We have adopted a highly collaborative team approach to the diagnosis and comprehensive treatment of seniors who may experience a variety of mental healthcare challenges, a number of which are fairly particular to older age. Cognitive, emotional and physical rehabilitation all form a part of our holistic methodology. This approach to geriatric psychiatry is novel to South Africa but more and more clinicians are acknowledging its value and we are increasingly seeing it being replicated elsewhere,” notes Dr Fuller.

Asked what kind of mental health challenges the elderly tend to face, Dr Mostert said that, in addition to dementia, the elderly could be affected by a range of the other problems including depression and anxiety.

“We find that many of the seniors we see are highly stressed due to financial problems, concerns about their health, loneliness, and so on, while others suffer a crisis in finding meaning in their lives. These may result in anxiety and other mental health problems. We even find that some are suffering delirium as a result of taking large doses of medications that have been prescribed by different healthcare providers,” observes Dr Mostert.

“It should also be noted that stress and anxiety, and some drugs and drug interactions, can have a significant impact on memory, and may mimic the symptoms of dementia. It is therefore of great importance that the senior who is suffering from mental health and memory problems are referred to a specialist team such as ours for a proper cognitive assessment and diagnosis.

“We find that in approximately half of the cases referred to us, the patient does not have dementia but is in fact rather stressed, lonely and anxious. With the appropriate interventions, which may include individual or group talk therapies, improved family support, and where necessary using appropriate psychiatric drugs, we can usually successfully manage these patients. The other half of these patients do have dementia-related memory disorders but there are a number of interventions that could assist in supporting memory and dealing with symptoms.

Dr Fuller says that the multi-disciplinary teams find it of critical importance to involve the families of elderly patients in their care as far as possible. Developing a comprehensive care plan for each individual ensures that everyone is on the same page and family members and caregivers are empowered to provide emotional and other support to their elderly loved ones once they are discharged home.

“Our main goal is to find solutions for the unique set of challenges each individual senior faces in their lives, and to enable them to continue to play a positive role within their families and communities for as long as possible.

Dr Fuller believes that such an approach also provides a model for a national approach to the care of the elderly. He says that the societal challenges posed by an ageing population, and by mental health conditions such as dementia in particular, are too great to address by any individual or institution alone.

“We need to collaborate at all levels of society, including within the public and private health sector, civil society and even at an individual level, so that we can establish innovative ways forward to effectively address these critical challenges,” he concludes.

Ends

About the Akeso Group
Akeso is a group of private in-patient psychiatric hospitals, and is part of the Netcare Group. Akeso provides individual, integrated and family-oriented treatment in specialised in-patient treatment facilities, for a range of psychiatric, psychological and addictive conditions.

Please visit www.akeso.co.za, email info@akeso.co.za, or contact us on 011 301 0369 for further information. In the event of a psychological crisis, please call 0861 435 787 for assistance. Contact Akeso Alberton on 087 098 0456 and Akeso Parktown on 087 098 0458.

For more information on this media release, contact MNA at the contact details listed below.

Issued by:           MNA on behalf of the Akeso Parktown and Akeso Alberton
Contact:               Martina Nicholson, Graeme Swinney, Meggan Saville or Estene Lotriet-Vorster
Telephone:        (011) 469 3016
Email:                   martina@mnapr.co.za, graeme@mnapr.co.za, meggan@mnapr.co.za or estene@mnapr.co.za