doctors-view-dementia-aging-patna
When Dementia Is Mistaken for Normal Aging in Joint Families
In my seven years of practice as a Medical Officer, including my time at PHC Mandota and now observing patient trends across Patna, one scenario repeats itself with heartbreaking frequency. A family brings in their elderly father, usually in his late 70s or 80s, describing sudden aggression or severe confusion. When I ask when the symptoms started, the answer is almost always: “Just last week.” However, upon clinical examination, it becomes evident that the condition has been progressing silently for years. This is the tragedy of dementia in the context of the Indian joint family system.
The Patna Context: Cultural Strengths and Medical Blindspots
Patna, like much of Bihar, prides itself on its joint family structure. In areas like Kankarbagh and Bankman Colony, it is common to see three generations living under one roof. Culturally, this is a safety net. Elders are revered, and their daily needs—food, clothing, hygiene—are meticulously managed by daughters-in-law or grandchildren.
However, from a neurological perspective, this robust support system often acts as a mask for early cognitive decline. In a nuclear family setup in the West, an elderly person living alone might struggle to pay bills, miss medication doses, or burn food on the stove. These red flags trigger immediate medical attention.
In a Patna joint family, if the grandfather forgets to take his diabetes medicine, his daughter-in-law gently reminds him. If he forgets the way to the local market, his grandson accompanies him. If he cannot find his words, the family intuitively finishes his sentences. The “system” compensates for the deficit, effectively hiding the disease until the brain damage reaches a stage where compensation is no longer possible—usually marked by behavioral changes like paranoia, aggression, or incontinence.
Normal Aging vs. Dementia: The Clinical Differences
As a doctor, the first question I am asked is: “Doctor, he is 80 years old, isn’t forgetting things normal?” The answer is nuanced. While the brain’s processing speed slows with age, memory loss is not a packaged deal with aging.
⚠️ When to Seek Help (The 10 Warning Signs)
If your loved one in Patna exhibits these signs, it is not just “aging,” it requires a neurological evaluation:
- Memory Disruption: Forgetting recently learned information (forgetting an event that happened yesterday vs. forgetting something from 20 years ago).
- Difficulty Planning/Solving: Struggling to follow a familiar recipe or keep track of monthly bills.
- Familiar Tasks Become Hard: Difficulty driving to a familiar location like Gandhi Maidan or managing the remote control.
- Time/Place Confusion: Forgetting where they are or how they got there.
- Visual Problems: Difficulty reading, judging distance, or determining color.
- Word Problems: Calling a “watch” a “hand-clock” or stopping in the middle of a conversation.
- Misplacing Things: Putting things in unusual places (e.g., keys in the fridge) and losing the ability to retrace steps.
- Poor Judgment: Scams involving money are a huge risk; giving away large amounts of money to telemarketers.
- Social Withdrawal: Removing oneself from hobbies, social activities, or projects.
- Mood/Personality Changes: Becoming confused, suspicious, depressed, fearful, or anxious.
The “Chalta Hai” Attitude is Dangerous
There is a tendency to normalize these behaviors. We often hear, “He is old, let him be.” This attitude delays diagnosis. Dementia is progressive. While we cannot yet cure it entirely, early intervention (medications like Cholinesterase inhibitors and lifestyle changes) can significantly slow the progression and improve the quality of life. By the time a patient in Patna comes to me, we are often in the moderate stage, losing precious years where we could have helped.
The Burden on the Caregiver
I want to specifically address the “unsung heroes” of our society—the home caregivers in Bihar. Usually, it is a woman in the house—perhaps a daughter-in-law—who bears the brunt of the patient’s behavioral changes. As dementia advances, patients may become abusive, refuse to bathe, or wander off.
This leads to caregiver burnout. I see high blood pressure, anxiety, and depression in the family members of dementia patients. It is physically and emotionally exhausting to care for someone who no longer recognizes you, especially without professional training.
Integrated Care Model: The Way Forward for Patna
This is where the integrated care model becomes essential. We need to move away from the idea that “doctors are for emergencies” and “home is for care.”
An integrated approach involves:
- Medical Oversight: Regular neurological check-ups to manage medication.
- Professional Home Attendants: Trained staff who can handle hygiene and daily activities, relieving the family burden. Services like At Home Care provide trained attendants who understand the nuances of geriatric care.
- Cognitive Stimulation: Engaging the patient in simple activities to keep the brain active.
A Message to the Families of Patna
Please, do not mistake dementia for “old age.” If you notice a change in your loved one’s behavior, do not hide it out of stigma or fear. Early detection is the greatest gift you can give your elders. It allows them dignity, safety, and better health outcomes in their twilight years.
Dr. Ekta Fageriya
Medical Officer (RMC No. 44780)
Frequently Asked Questions
Q: Is forgetting things a normal part of aging?
A: Occasional forgetfulness (like where keys are) is normal. However, forgetting recently learned information, important dates, or asking the same questions repeatedly is not normal aging and may indicate dementia.
Q: How does the joint family system in Patna affect dementia diagnosis?
A: In joint families, children often compensate for an elder’s memory loss. While supportive, this masks the decline, leading to delayed medical consultation until stages become severe.