Abstract
Dementia care in India is under-recognized, and there is a lack of specialized rehabilitation centres focusing solely on dementia rehabilitation. The present chapter unfolds the various challenges in dementia rehabilitation within the Indian cultural context and the need for geriatric mental health experts to take cognizance of the same. Dementia rehabilitation in India is riddled with difficulties across various spheres which include financial deficiencies, lack of trained staff, non-desire of caregivers to admit their patients into a rehabilitation centre and the lack of expert dementia care specialists to manage these patients. The interface of medical problems with dementia, multiple medical professionals managing the same patient, increased pill count, lack of systematized occupational therapy and psychosocial care along with ever-increasing caregiver strain and burden are some of the reasons for dementia care to receive serious setbacks in the Indian setting. This is coupled with a lack of knowledge among primary care physicians and poor awareness in the general public about this condition. Behavioural and psychological issues in dementia coupled with legal issues related to testamentary capacity, wills, property matters and family disputes complicate efforts at dementia rehabilitation further. The chapter outlines probable solutions to these challenges and tries to provide and erudite framework for clinically viable and practical dementia rehabilitation in hospital and home-based settings.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Acevedo, A., & Loewenstein, D. A. (2007). Nonpharmacological cognitive interventions in aging and dementia. Journal of Geriatric Psychiatry and Neurology, 20(4), 239–249.
Ahtiluoto, S., Polvikoski, T., Peltonen, M., Solomon, A., Tuomilehto, J., Winblad, B., Sulkava, R., & Kivipelto, M. (2010). Diabetes, Alzheimer disease, and vascular dementia: A population-based neuropathologic study. Neurology, 75(13), 1195–1202.
Andrade, C., & Radhakrishnan, R. (2009). The prevention and treatment of cognitive decline and dementia: An overview of recent research on experimental treatments. Indian Journal of Psychiatry, 51(1), 12–25.
Allan, L. M., Ballard, C. G., Rowan, E. N., & Kenny, R. A. (2009). Incidence and prediction of falls in dementia: A prospective study in older people. PloS One, 4(5), e5521.
Andren, S., & Elmståhl, S. (2008). The relationship between caregiver burden, caregivers’ perceived health and their sense of coherence in caring for elders with dementia. Journal of Clinical Nursing, 17(6), 790–799.
Anstey, K. J., von Sanden, C., Salim, A., & O’Kearney, R. (2007). Smoking as a risk factor for dementia and cognitive decline: A meta-analysis of prospective studies. American Journal of Epidemiology, 166(4), 367–378.
Bahar‐Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane of Systematic Reviews (6), CD003260.
Bardell, A., Lau, T., & Fedoroff, J. P. (2011). Inappropriate sexual behavior in a geriatric population. International Psychogeriatrics, 23(7), 1182–1188.
Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: A review. Alzheimer’s Research & Therapy, 5(4), 35.
Barberger-Gateau, P., Raffaitin, C., Letenneur, L., Berr, C., Tzourio, C., Dartigues, J. F., & Alpérovitch, A. (2007). Dietary patterns and risk of dementia: The Three-City cohort study. Neurology, 69(20), 1921–1930.
Beattie, A., Daker-White, G., Gilliard, J., & Means, R. (2004). ‘How can they tell?’A qualitative study of the views of younger people about their dementia and dementia care services. Health & Social Care in the Community, 12(4), 359–368.
Black, B., Muralee, S., & Tampi, R. R. (2005). Inappropriate sexual behaviors in dementia. Journal of Geriatric Psychiatry and Neurology, 18(3), 155–162.
Boise, L., Morgan, D. L., Kaye, J., & Camicioli, R. (1999). Delays in the diagnosis of dementia: Perspectives of family caregivers. American Journal of Alzheimer’s Disease, 14(1), 20–26.
Brayne, C., & Calloway, P. (1988). Normal ageing, impaired cognitive function, and senile dementia of the Alzheimer’s type: A continuum? Lancet, 331(8597), 1265–1267.
Brodaty, H., & Cumming, A. (2010). Dementia services in Australia. International Journal of Geriatric Psychiatry, 25(9), 887–995.
Burns, A., & Robert, P. (2019). Dementia care: International perspectives. Oxford University Press.
Burton, L. C., German, P. S., Gruber‐Baldini, A. L., Hebel, J. R., Zimmerman, S., & Magaziner, J. (2001). Epidemiology of dementia in nursing homes research group. Medical care for nursing home residents: Differences by dementia status. Journal of the American Geriatrics Society, 49(2), 142–147.
Black, B. S., Rabins, P. V., Sugarman, J., & Karlawish, J. H. (2010). Seeking assent and respecting dissent in dementia research. The American Journal of Geriatric Psychiatry, 18(1), 77–85.
Bynum, J. P., Rabins, P. V., Weller, W., Niefeld, M., Anderson, G. F., & Wu, A. W. (2004). The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. Journal of the American Geriatrics Society, 52(2), 187–194.
Cipriani, G., Lucetti, C., Nuti, A., & Danti, S. (2014). Wandering and dementia. Psychogeriatrics, 14(2), 135–142.
Clare, L., & Woods, R. T. (2001). Cognitive Rehabilitation in Dementia. Psychology Press.
Clare, L., & Woods, R. T. (2004). Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: A review. Neuropsychological Rehabilitation, 14(4), 385–401.
Cummings, J., Lee, G., Mortsdorf, T., Ritter, A., & Zhong, K. (2017). Alzheimer’s disease drug development pipeline: 2017. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 3(3), 367–384.
Das, S. K., Pal, S., & Ghosal, M. K. (2012). Dementia: Indian scenario. Neurology India, 60, 618–624.
De Giorgi, R., & Series, H. (2016). Treatment of inappropriate sexual behavior in dementia. Current Treatment Options in Neurology, 18(9), 41.
Dewing, J. (2007). Participatory research: A method for process consent with persons who have dementia. Dementia, 6(1), 11–25.
Dias, A., & Patel, V. (2009). Closing the treatment gap for dementia in India. Indian Journal of Psychiatry, 51(Suppl1), S93–S97.
Dhikav, V., Anand, K., & Aggarwal, N. (2007). Grossly disinhibited sexual behavior in dementia of Alzheimer’s type. Arch Sexual Behav, 36(2), 133–134.
Doyle, C. (2009). International perspectives on dementia education, training and knowledge transfer. International Psychogeriatrics, 21(S1), S1-2.
Douglas, S., James, I., & Ballard, C. (2004). Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment, 10(3), 171–177.
Draper, B., Low, L. F., Withall, A., Vickland, V., & Ward, T. (2009). Translating dementia research into practice. International Psychogeriatrics, 21(S1), S72-80.
Erkinjuntti, T., Østbye, T., Steenhuis, R., & Hachinski, V. (1997). The effect of different diagnostic criteria on the prevalence of dementia. New Eng J Med, 337(23), 1667–1674.
Etters, L., Goodall, D., & Harrison, B. E. (2008). Caregiver burden among dementia patient caregivers: A review of the literature. Journal of the American Academy of Nurse Practitioners, 20(8), 423–428.
Gauthier, S., Albert, M., Fox, N., Goedert, M., Kivipelto, M., Mestre-Ferrandiz, J., & Middleton, L. T. (2016). Why has therapy development for dementia failed in the last two decades ? Alzheim Dementia, 12(1), 60–64.
Garand, L., Lingler, J. H., Conner, K. O., & Dew, M. A. (2009). Diagnostic labels, stigma, and participation in research related to dementia and mild cognitive impairment. Research in Gerontological Nursing, 2(2), 112–121.
Geldmacher, D. S., & Kerwin, D. R. (2013). Practical diagnosis and management of dementia due to Alzheimer’s disease in the primary care setting: an evidence-based approach. Prim Care Companion CNS Disord, 15(4).
Gitlin, L. N., Kales, H. C., & Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. JAMA, 308(19), 2020–2029.
Gitlin, L. N., & Corcoran, M. A. (1996). Managing dementia at home: The role of home environmental modifications. Topics in Geriatric Rehabilitation, 12(2), 28–39.
Graff, M. J., Adang, E. M., Vernooij-Dassen, M. J., Dekker, J., Jönsson, L., Thijssen, M., Hoefnagels, W. H., & Rikkert, M. G. (2008). Community occupational therapy for older patients with dementia and their care givers: Cost effectiveness study. BMJ, 336(7636), 134–138.
Harris, L., & Wier, M. (1998). Inappropriate sexual behavior in dementia: A review of the treatment literature. Sexuality Disabil, 16(3), 205–217.
Hu, S., & Das, D. (2019). Quality of life among older adults in China and India: Does productive engagement help? Social Science and Medicine, 229, 144–153.
Karlawish, J. H., & Casarett, D. (2001). Addressing the ethical challenges of clinical trials that involve patients with dementia. Journal of Geriatric Psychiatry and Neurology, 14(4), 222–228.
Kawas, C. H., & Corrada, M. M. (2006). Alzheimer’s and dementia in the oldest-old: A century of challenges. Current Alzheimer Research, 3(5), 411–419.
Kim, H., Chang, M., Rose, K., & Kim, S. (2012). Predictors of caregiver burden in caregivers of individuals with dementia. Journal of Advanced Nursing, 68(4), 846–855.
Klein, D. A., Steinberg, M., Galik, E., Steele, C., Sheppard, J. M., Warren, A., Rosenblatt, A., & Lyketsos, C. G. (1999). Wandering behaviour in community-residing persons with dementia. International Journal of Geriatric Psychiatry, 14(4), 272–279.
Kramer, J. H., Jurik, J., Sharon, J. S., Rankin, K. P., Rosen, H. J., Johnson, J. K., & Miller, B. L. (2003). Distinctive neuropsychological patterns in frontotemporal dementia, semantic dementia, and Alzheimer disease. Cognitive and Behavioral Neurology, 16(4), 211–218.
Kukull, W. A., & Ganguli, M. (2000). Epidemiology of dementia: Concepts and overview. Neurologic Clinics, 18(4), 923–949.
Lawrence, V., Murray, J., & Banerjee, S. (2009). “Out of sight, out of mind”: A qualitative study of visual impairment and dementia from three perspectives. International Psychogeriatrics, 21(3), 511–518.
Larson, E. B., & Langa, K. M. (2008). The rising tide of dementia worldwide. Lancet, 372(9637), 430–432.
Lea Steadman, P., Tremont, G., & Duncan, D. J. (2007). Premorbid relationship satisfaction and caregiver burden in dementia caregivers. Journal of Geriatric Psychiatry and Neurology, 20(2), 115–119.
Mackenzie, J. (2006). Stigma and dementia: East European and South Asian family carers negotiating stigma in the UK. Dementia, 5(2), 233–247.
Mahoney, R., Regan, C., Katona, C., & Livingston, G. (2005). Anxiety and depression in family caregivers of people with Alzheimer disease: The LASER-AD study. The American Journal of Geriatric Psychiatry, 13(9), 795–801.
Minkman, M. M., Ligthart, S. A., & Huijsman, R. (2009). Integrated dementia care in The Netherlands: A multiple case study of case management programmes. Health & Social Care in the Community, 17(5), 485–494.
Miles, S. H., & Parker, K. (1999). Sexuality in the nursing home: Iatrogenic loneliness. Generations, 23(1), 36–37.
Mitchell, C. M., Zimmerman, S., & Beeber, A. S. (2010). Dementia care training for long-term care staff: If You provide It, will they come ? Alzheimer’s Care Today, 11(1), 40–50.
Mukadam, N., & Livingston, G. (2012). Reducing the stigma associated with dementia: Approaches and goals. Aging and Health, 8(4), 377–386.
Nygaard, H. A., & Ruths, S. (2003). Missing the diagnosis: Senile dementia in patients admitted to nursing homes. Scandinavian Journal of Primary Health Care, 21(3), 148–152.
Ostwald, S. K., Hepburn, K. W., Caron, W., Burns, T., & Mantell, R. (1999). Reducing caregiver burden: A randomized psychoeducational intervention for caregivers of persons with dementia. The Gerontologist, 39(3), 299–309.
Patel V, Prince M. Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India. Psychological Medicine, 31(1), 29–38
Papastavrou, E., Kalokerinou, A., Papacostas, S. S., Tsangari, H., & Sourtzi, P. (2007). Caring for a relative with dementia: Family caregiver burden. Journal of Advanced Nursing, 58(5), 446–457.
Pohjasvaara, T., Mantyla, R., Ylikoski, R., Kaste, M., & Erkinjuntti, T. (2000). Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia. Stroke, 31(12), 2952–2957.
Pomeroy, V. M., Warren, C. M., Honeycombe, C., Briggs, R. S., Wilkinson, D. G., Pickering, R. M., & Steiner, A. (1999). Mobility and dementia: Is physiotherapy treatment during respite care effective? International Journal of Geriatric Psychiatry, 14(5), 389–397.
Pachana, N. A., Emery, E., Konnert, C. A., Woodhead, E., & Edelstein, B. A. (2010). Geropsychology content in clinical training programs: A comparison of Australian. Canadian and US Data. Int Psychogeriatr, 22(6), 909–918.
Prince, M. (2000). Dementia in developing countries. A consensus statement from the 10/66 Dementia Research Group. International Journal of Geriatric Psychiatry, 15(1), 14–20.
Prince, M. J. (2009). The 10/66 dementia research group-10 years on. Indian Journal of Psychiatry, 51(Suppl1), S8-16.
Rajan, S. I. (2002). Home away from home: A survey of old age homes and inmates in Kerala, India. The Journal of Housing for the Elderly, 16(1–2), 125–150.
Salmon, D. P., & Bondi, M. W. (2009). Neuropsychological assessment of dementia. Annual Review of Psychology, 60, 257–282.
Schulz, R., & Martire, L. M. (2004). Family caregiving of persons with dementia: Prevalence, health effects, and support strategies. The American Journal of Geriatric Psychiatry, 12(3), 240–249.
Schaefer, D. C., & Cheskin, L. J. (1998). Constipation in the elderly. American Family Physician, 58(4), 907–914.
Scholzel-Dorenbos, C. J., Meeuwsen, E. J., & Olde Rikkert, M. G. (2010). Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the hierarchy model of needs in dementia. Aging & Mental Health, 14, 113–119.
Shaw, F. E. (2007). Prevention of falls in older people with dementia. Journal of Neural Transmission, 114(10), 1259–1264.
Shaji, K. S., Jotheeswaran, A. T., Girish, N., Bharath, S., Dias, A., & Pattabiraman, M. (2010). The Dementia India report: Prevalence, impact, costs and services for Dementia. Alzheimer’s and Related Disorders Society of India.
Sheehan, B. (2012). Assessment scales in dementia. Therapeutic Advances in Neurological Disorders, 5(6), 349–358.
Small, G. W., Rabins, P. V., Barry, P. P., Buckholtz, N. S., DeKosky, S. T., Ferris, S. H., Finkel, S. I., Gwyther, L. P., Khachaturian, Z. S., Lebowitz, B. D., & McRae, T. D. (1997). Diagnosis and treatment of Alzheimer disease and related disorders: Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society. JAMA, 278(16), 1363–1371.
Tretteteig, S., Vatne, S., & Rokstad, A. M. (2017). The influence of day care centres designed for people with dementia on family caregivers–a qualitative study. BMC Geriatrics, 17(1), 5.
Tretteteig, S., Vatne, S., & Rokstad, A. M. (2016). The influence of day care centres for people with dementia on family caregivers: An integrative review of the literature. Aging & Mental Health, 20(5), 450–462.
Torti, F. M., Jr., Gwyther, L. P., Reed, S. D., Friedman, J. Y., & Schulman, K. A. (2004). A multinational review of recent trends and reports in dementia caregiver burden. Alzheimer Disease & Associated Disorders, 18(2), 99–109.
Tatemichi, T. K., Paik, M., Bagiella, E., Desmond, D. W., Pirro, M., & Hanzawa, L. K. (1994). Dementia after stroke is a predictor of long-term survival. Stroke, 25(10), 1915–1919.
Tullo, E., & Allan, L. (2011). What should we be teaching medical students about dementia? International Psychogeriatrics, 23(7), 1044–1050.
Thara, R., & Patel, V. (2010). Role of non-governmental organizations in mental health in India. Indian Journal of Psychiatry, 52(Suppl1), S389–S395.
Valcour, V. G., Masaki, K. H., Curb, J. D., & Blanchette, P. L. (2000). The detection of dementia in the primary care setting. Archives of Internal Medicine, 160(19), 2964–2968.
Van Doorn, C., Gruber‐Baldini, A. L., Zimmerman, S., Richard Hebel, J., Port, C. L., Baumgarten, M., Quinn, C. C., Taler, G., May, C., & Magaziner, J. (2003) Epidemiology of dementia in nursing homes research group. Dementia as a risk factor for falls and fall injuries among nursing home residents. Journal of the American Geriatrics Society, 51(9), 1213–1218.
Warner, J., McCarney, R., Griffin, M., Hill, K., & Fisher, P. (2008). Participation in dementia research: Rates and correlates of capacity to give informed consent. Journal of Medical Ethics, 34(3), 167–170.
Wilson, B. A. (2002). Towards a comprehensive model of cognitive rehabilitation. Neuropsychological Rehabilitation, 5, 97–110.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Lodha, P., De Sousa, A. (2021). Dementia Rehabilitation: The Challenges. In: Shankardass, M.K. (eds) Ageing Issues in India. International Perspectives on Aging, vol 32. Springer, Singapore. https://doi.org/10.1007/978-981-16-5827-3_5
Download citation
DOI: https://doi.org/10.1007/978-981-16-5827-3_5
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-16-5826-6
Online ISBN: 978-981-16-5827-3
eBook Packages: Social SciencesSocial Sciences (R0)