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Revealing a hidden problem. An evaluation of a community dementia case-finding program from the Indian 10/66 dementia
K S Shaji1, N R Arun Kishore, K Praveen Lal
1Department of Psychiatry, Medical College, Thrissur-680596, Kerala, India. shajiks@vsnl.com
Background:
Dementia in India is largely a hidden problem with no community awareness and little help seeking from affected families, despite high levels of strain. Cases must therefore be identified before practical help can be offered.
Method:
After two and a half hours of formal training, local community health workers in rural Kerala were asked to identify possible cases of dementia from the community they served. Diagnoses were then verified by a senior local psychiatrist with clinical and research interests in old age psychiatry.
Results:
The community health workers identified 51 out of 1979 over 60 year old residents (a prevalence of 2.6%) as suspected cases of dementia. Following the psychiatrist's assessment, 33 met DSM-IV criteria for dementia. The majority of confirmed cases were of the Alzheimer's Disease sub-type. Most "non-cases" were found to be suffering from other major psychiatric disorders, with substantial unmet need. The positive predictive value of the community health workers informal screening was 64.7%.
Conclusions:
This simple cost-effective case-finding method can be of practical use in the development of community based dementia care services in India and other developing countries with similar health care systems.