Care for the Elderly with Alzheimer's Disease

Pupils in Jinan, capital of east China's Shandong Province, help a senior resident wear a yellow wrist band in March, 2013. The band, specially designed for Alzheimer's patients, contains the information of senior residents and enables them to contact family members in case they get lost. [China Daily/Zheng Tao]

Alzheimer's disease is threatening the world's largest elderly population.
 
When Xie Weiying noticed her father losing his memory and suffering from similar lapses in his judgment and language ability, she thought it was just a sign of his old age.

But the symptoms worsened. In 2008, Xie's father, then 77, was diagnosed with Alzheimer's disease.

"Until my father was diagnosed to have Alzheimer's, I never thought that his condition was a disease," said Xie, 55, from Xi'an, capital of northwest China's Shaanxi Province. Her father died last year.

In early July, Beijing Normal University professor Li Xihui was riding a bike home before his wife reported that he was missing. The university offered a 50,000 yuan ($8,100) reward to anyone who could locate the professor. Three days after the police received the report about Li missing, a sanitation worker found him. The 57-year-old professor's plight drew widespread attention.

The two cases are just part of a major challenge facing the country as its population ages. Many Chinese have associated the signs and symptoms of Alzheimer's with the natural process of aging, but more are realizing that the disease can be managed even if there is no cure for it.

Statistics from the Ministry of Civil Affairs showed that the number of Chinese citizens aged 60 and above will reach 250 million in 2020. That means that 17 out of every 100 Chinese will be over 60 by then.

A research paper by MIT AgeLab, an organization under the US university that mainly translates technologies into practical solutions that improve people's health, showed that a quarter of Asia's population will be elderly people aged above 60 by the end of 2025. Similar conditions are expected to be faced in Europe, where the number of elderly will climb from 19.8 percent of the population in 2000 to 28.8 percent by 2025.

"An aging society can be followed by many problems and the most crucial one is that of chronic diseases such as Alzheimer's," said Fang Yiru, director of the Shanghai Mental Health Center.

"China's elderly population, which exceeds 100 million people, is the largest in the world," Fang said.

The current prevalence of Alzheimer's in China is about 5 percent in people aged over 65, Fang said. But the rate soars dramatically among people aged over 80, to 20 percent. The World Health Organization estimated that Alzheimer's patients in China will hit 11.7 million in 2020, which means that one out of every 10 Alzheimer's patients worldwide will be Chinese.

Lack of Public Awareness

Poor public awareness of the disease has also been worrying medical professionals. In June, the results of an online survey about senile dementia - a loss of brain function that occurs with certain diseases during aging - indicated that nearly half of the respondents considered dementia as a normal aging process.
 
Only 22 percent of the respondents said that they would take their parents to the hospital if he or she experienced memory loss.

Fang said the gap in the public awareness of senile dementia between China and the West is being narrowed. Still, awareness of the disease is high in Beijing and Shanghai but lower in small cities and remote areas.

"Some diseases, especially Alzheimer's, which usually surface in the process of aging but are actually not a part of normal aging, should be given more attention. Alzheimer's permanently damages the brain's nerve cells. The pain not only tortures the patients but also their family members," Fang said.

For Xie, who had taken care of her Alzheimer's-afflicted father for five years, the disease has become a painful memory for her and the family.

Her father got lost on a road for the first time in 2004, after moving from their rural home to the city to be closer to the children.

"I thought it was just because of a change in his living environment. But then he started trying to get in our neighbor's house," she said.

After his diagnosis, her father's actions began to get more dangerous.

"He started forgetting to turn off the gas and couldn't stand up by himself after using the toilet. His bad temper scared those around him, including the nurses," Xie said.

With the worsening of his memory, her father could no longer recognize his family. In 2011, the family held an 80th birthday party for him, but the senior hardly knew what the celebration was for.

Xie tried to find a nursing home for her father. But without guidance from experienced medical staff, her father refused to eat or sleep in the unfamiliar environment.

Zhang Xinqing, an expert on senile dementia from Beijing Xuanwu Hospital, said about 40 percent of elderly people aged above 80 in Beijing are suffering from dementia, among which about 80 percent are those afflicted by Alzheimer's disease.

"Treating and managing senile dementia should be promoted to the public, though the condition cannot be completely reversed. The symptoms can be improved, which means the quality of life for sufferers can also be improved accordingly, thus delaying its progression," Zhang said.

Chen Shengdi, a neurologist from Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine, said the annual direct and indirect costs of each dementia patient in Shanghai averages between 8,432 and 10,568 yuan, respectively.

"Compared to the prevalence of the disease, up to 90 percent of dementia patients remain undiagnosed or untreated. Many people believe that senile dementia can be treated with approaches like mental training or memory building, and medical or drug intervention seems to be unnecessary," Chen said.

Thanks to increased efforts on disease education, the public is acknowledging Alzheimer's disease more. But recognizing symptoms early is still inadequate, resulting in delayed medical assistance and continued misunderstanding over its management.

New Therapies

As part of measures to help address problems, Beijing's Xicheng District has arranged a series of weekend sessions for its residents, especially the elderly, since 2009. The pilot project is supported by MooYoo, a social workers' organization. The organization invited various professionals across disciplines, such as doctors and philologists, to talk about the issue.

Yang Liangliang, an official from the district administrative office, said that apart from group activities including singing, paper-cutting and cooking, the sessions during the first half of this year also focused on social skills and mental health.

"These group activities can help provide a comfortable environment for the elderly. Interacting with these professionals can alert us to any abnormal health conditions of the participants at an early stage," Yang said.

Jin Weiye, a new graduate of the Central Conservatory of Music majoring in music treatment, had been invited to lecture in the district in June this year. Jin said music can be used as assistance treatment in many areas, including for depression, Parkinson's disease, children's autism and senile dementia.

Jin is working as a music therapist in a nursing home of the district. There are 126 residents with an average age of 85 in the nursing home. The home evaluates the physical and mental conditions of the inhabitants and gives suggestions to those who are suspected of suffering from cognitive disorders or dementia to receive music treatment along with medication.

Jin said more than a quarter of all elderly people in the nursing home were diagnosed with dementia. To help the seniors with their brain functions, Jin designed various methods for different patients - for example, using adapted lyrics of songs that were popular in the 1950s to 1970s or teaching them simple dance steps to go with the music. Each of her class has eight to 10 patients.

"Music treatment can be effectively catered to the individual patient," Jin said. "Some patients have poor sense of direction while others might not be good at recognizing the consequences of events that occurred in their lives."

She said teaching elderly people is more challenging than treating children.

"But I get a stronger sense of satisfaction from recording each progress that they have made. China will have more elderly people in the future. The treatment is not medically as effective as drugs, but it delays the worsening process and enhances the quality of their lives," Jin said.

Apart from the music treatment, Xicheng District also plans to introduce more sessions on treating and preventing dementia, including the use of fragrances, said Yang, the district official.

"We've also learned other methods from foreign countries, like decorating homes with the style that was popular when the patients were young. The familiar environment helps them recall their past and it is good for the memory," she said.

(Source: China Daily)