Packages of care for dementia in low- and middle-income countries

Two-thirds of people with dementia live in low- and middle income countries (LMICs), where there are few services available and levels of awareness is low.  This paper focuses on the effective management of dementia in LMICs, reviews the evidence on efficacy of interventions and their delivery derived from LMICs where possible.

The authors propose a package of care for dementia through a combination of treatments aimed at improving the recognition and management of conditions to achieve optimal outcomes. They discuss pharmacological and psychological treatments, looking at evidence of effective treatments from countries including Brazil, China, India and Russia.

Summary Points

• after early diagnosis, the principal goals for management of dementia are optimising physical health,cognition, activity, and wellbeing; detecting and treating behavioural and psychological symptoms (BPSD); and providing information and long-term support to carers
  

• routine packages of continuing care should comprise diagnosis coupled with information, regular needs assessments, physical health checks, and carer support, and where necessary carer training, respite care, and assessment and treatment of BPSD
  

• care can be delivered by trained primary care teams working in a collaborative care framework. Continuing care with practice-based care coordination, and community outreach are essential components of this model
  

• primary health care services in LMICs often fail older people because they are clinic-based and preoccupied with simple curative interventions.  Therefore, efficient care delivery in LMICs involves integrating dementia care with that of other chronic diseases and community support programs for the elderly and disabled