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CASE STUDY  
Year : 2021  |  Volume : 46  |  Issue : 2  |  Page : 321-322
 

Importance of day-care centers in dementia care: A case study from India


Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India

Date of Submission11-Aug-2020
Date of Acceptance09-Feb-2021
Date of Web Publication29-May-2021

Correspondence Address:
Mr. Pallerla Srikanth
Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcm.IJCM_699_20

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How to cite this article:
Srikanth P, Antony S, Manjunatha S, Thirumoorthy A. Importance of day-care centers in dementia care: A case study from India. Indian J Community Med 2021;46:321-2

How to cite this URL:
Srikanth P, Antony S, Manjunatha S, Thirumoorthy A. Importance of day-care centers in dementia care: A case study from India. Indian J Community Med [serial online] 2021 [cited 2021 Jun 17];46:321-2. Available from: https://www.ijcm.org.in/text.asp?2021/46/2/321/317087




The caregivers of persons living with dementia (PLwD) have to provide full-time caregiving to the individual, in addition to other responsibilities in their own life.[1] Providing care to a PLwD affects their quality of life[2] and mental health. In such a context, clinicians have to guide caregivers in decreasing caregiver's burden through appropriate referrals. Day-care centers can be one such service, which is illustrated with the support of a case here.

Mr. Y was a 71-year-old male, married for 30 years, an undergraduate, retired government employee, from upper-middle socioeconomic status from urban Bengaluru; the socioeconomic status was assessed using the modified Kuppuswamy socioeconomic scale.[3] He was presented with insidious onset and continuous course of symptoms such as aggression, difficulty in walking, slurring of speech, difficulty in using the words and forgetting the things. The symptoms were persistent for last 5 years with significant Biopsychosocial impairments. This case had been referred for psychosocial management to the team which comprised the authors of this paper. Intervention was provided and follow-up was done for a duration of 1 year. The patient was diagnosed with dementia, along with behavioral problems. Premorbidly, the person was rigid and had difficulty in trusting others. There was no significant past history of medical illness. The patient had been on treatment for 5 years before the consultation at the tertiary mental health-care facility, but he reported only mild improvement. He had taken divorce from his first wife due to her behavioral issues secondary to epilepsy. He remarried after 10 years of his separation from his first wife. Currently, he lives with his second wife and daughter. The second wife has psychosis and hearing impairment. His daughter was diagnosed with a migraine headache, which has been getting aggravated for the last 2 years due to the stress associated with caregiving.

Assessment of his family dynamics indicated that the family members were not able to perform culturally expected roles. Gradually, the daughter, who was 19 years old, became the decision-maker; although she was a 3rd-year undergraduate student and the family nominal and functional leader, multiplicities of roles performed by her affected the caregiving process. The family did not have adequate emotional, social, and financial resources to provide quality care. The family was facing a severe economic crisis to meet caregiving expenses, medications, and the daughter's education.

Considering the high caregiver burden and limited social support, the PLwD was referred to a local day-care center. In the follow-up, it was seen that the caregivers felt empowered to handle their demands of life more effectively.

As per the World Alzheimer Report 2019, caregivers have reported that the process of caregiving has led them to face setbacks in their health, work, and social life (52%, 49%, and 62%, respectively).[4] In India, an estimated 3.7 million people aged over 60 years have dementia;[5] this number is expected to double from the current 4.1 million by 2030.[6]

In developing countries like India, prominent primary caregivers are either spouses or adult children for the PLwD. Providing care to the PLwD involves both direct and indirect costs to manage the medical, social, and rehabilitation expenses. One of the high costs is the change in the routine of the primary caregiver. In this case, the primary caregiver was an unmarried young girl, who was performing multiple roles, which drained her, causing her to consider stopping her studies for her caregiving duties. It directly led to compromising the caregiving, which led to the worsening of the person's symptoms; the same is explained in [Figure 1].
Figure 1: Conceptual map of the process of caregiving and its consequences

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Many caregivers are not aware of the benefits of day-care centers. Such services can easily reduce the burden of caregivers during the day time as stated in [Table 1]. The day-care centers also empower the caregivers on how to look after the person at home. After admitting the person to the day-care center, the primary caregiver could continue her studies. As mentioned in [Table 1], the caregiver gained more confidence and regained the quality of life.
Table 1: Caregiver's burden before and after seeking services from day-care centers

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The patient also acknowledged some positive changes such as being able to perform day-to-day activities in a structured way, improvement in self-care, better interpersonal relations, and improved interaction patterns with the family members. The patient appeared more relaxed and more cooperative with family members.

Government-funded day-care centers can act as an effective support center for PLwD and their families to ease caregiver's burden and enhance the quality of life among individuals and their family members.

Consent

Consent was taken from the patient's daughter and informed about the publication of the case. The confidentiality of the patient has been ensured.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's daughter has given her consent for images and other clinical information to be reported in the journal. The daughter understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chakrabarti S. Research on family caregiving for mental illness in India and its impact on clinical practice: Are we doing enough to help families? Indian J Soc Psychiatry 2016;32:19. Available from: https:// www.indjsp.org/text.asp?2016/32/1/19/176762. [Last accessed on 2021 Feb 16].  Back to cited text no. 1
    
2.
Koyama A, Matsushita M, Hashimoto M, Fujise N, Ishikawa T, Tanaka H, et al. Mental health among younger and older caregivers of dementia patients. Psychogeriatrics 2017;17:108-14.  Back to cited text no. 2
    
3.
Bairwa M, Rajput M, Sachdeva S. Modified Kuppuswamy's socioeconomic scale: Social researcher should include updated income criteria, 2012. Indian J Community Med 2013;38:185.  Back to cited text no. 3
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4.
Evans-Lacko S, BhattJ, Comas-HerreraA, D'Amico F, Farina N, Gaber S. World Alzheimer Report 2019: Attitudes to Dementia. London: Alzheimer's disease international (ADI); 2019.  Back to cited text no. 4
    
5.
Shaji KS, Jotheeswaran AT, Girish N, Bharath S, Dias A, Pattabiraman M, et al. The dementia India report: Prevalence, impact, costs and services for dementia. Alzheimer's and Related Disorders Society of India. 2010:1-38.  Back to cited text no. 5
    
6.
Kumar CS, George S, Kallivayalil RA. Towards a Dementia-Friendly India. Indian J Psychol Med 2019;41:476-81.  Back to cited text no. 6
[PUBMED]  [Full text]  


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