The Hindu Business Line : A public health challenge ahead

SEPTEMBER 21 was World Alzheimer's Day and the whole of last week was observed as National Dementia Awareness Week. For Kerala, the observance was sombre and somewhat poignant for very good reason: Kerala has the greatest number of elderly among the population and also the largest proportion of patients suffering from Alzheimer's disease and other dementia-related ailments.

Alzheimer's disease, or senile dementia of Alzheimer's type, is a neurodegenerative disease that leads to a loss of mental functions due to the deterioration of brain tissue. Its exact cause is still unknown, but environmental as well as genetic factors are thought to contribute. The disease usually starts in a person's 40s or 50s; the first symptoms are impaired memory, which is followed by impaired thought and speech, and finally, complete helplessness.

For Kerala, Alzheimer's disease could prove to be a major public health challenge. According to demographer S. Irudaya Rajan, population projections predict that the elderly population in Kerala will increase to 4.6 million in 2011 to 8.3 million in 2026. According to the 2001 Census, the 60-plus population in Kerala is 33.62 lakh (10.5 per cent of the total). In 1991, the 60-plus segment was only 25.7 lakh (8.8 per cent). Projections say the 60-plus population will be 11.2 per cent of the total in 2011 and 14.3 per cent in 2021.

The main reason for this is that Kerala is ahead of the rest of the country in fertility transition by 25 years. Decreases in fertility and mortality, a decline in the infant mortality rates, and a continuing rise in life expectancy (currently the highest in India) have helped create this situation.

By 2026, says Irudaya Rajan, Kerala will have 6.3 million people aged 60-74 and 2 million people aged 75 and older. More significantly, more women will be in older age groups than men. As of now, over 80 per cent of Kerala's elderly population reside in rural areas.

According to the State Planning Board, "Statistics show that the prevalence rate of chronic diseases and the levels of disability among elderly people are increasing."

The Kunnamkulam-based Alzheimer's and Related Disorders Society of India (ARDSI) undertook a survey of people of over 65 years in 10 divisions of Kochi Corporation. The results showed that about 80 out of the 6,000 individuals in the category have been identified with dementia.

ARDSI has started a full-time Respite Care Centre for Alzheimer's disease patients at Kottappady, between Kunnamkulam and Guruvayur. Such a centre is a first for India and is a welcome sign of the growing recognition of the need to care for a society's dementia-afflicted population.

As the International Labour Organization noted in a paper contributed to the Second World Assembly on Ageing, "The vitality of our societies increasingly depends on ensuring that people of all ages, including older people, remain fully integrated into society. The realization of such "a society for all ages" requires the recognition and acceptance of ageing as a multi-generational and society-wide phenomenon, and not a phenomenon exclusively pertaining to older persons."

It is thus time for Kerala to think of special social assistance programmes for the elderly victims of Alzheimer's and related diseases. Such programmes could be patterned on the lines of the Kerala Destitute Pension Scheme (for the elderly, the widowed or those with disabilities) and the Agriculture Workers' Pension Scheme (for low-income agricultural labourers).

As a State that pioneered several forms of social and public action to further the quality of life of its citizens, Kerala owes it to its elderly not to forget them.

The writer can be contacted at kgkumar@gmail.com

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