Help-seeking for 'memory loss' by older adults in India : patient, caregiver and health providers' perspectives

ABSTRACT: Background. In India, prevalence rates of dementia and prodromal amnestic Mild Cognitive Impairment (MCI) are 3.1% and 4.3% respectively. Most Indians refer to the full spectrum of cognitive disorders simply as ‘memory loss.’ Barring prevention or cure, these conditions will rise rapidly with population aging. Evidence-based policies and practices can improve the lives of affected individuals and their caregivers, but will require timely and sustained uptake. Objectives. Framed by social cognitive theories of health behavior, this study explores the knowledge, attitudes and practices concerning cognitive impairment and related service use by older adults who screen positive for MCI, their primary caregivers, and health providers. Methods. I used the Montreal Cognitive Assessment to screen for cognitive impairment in memory camps in Mumbai. To achieve sampling diversity, I used maximum variation sampling. Ten adults aged 60+ who had no significant functional impairment but screened positive for MCI and their caregivers participated in separate focus groups. Four other such dyads and six doctors/ traditional healers completed in-depth interviews. Data were translated from Hindi or Marathi to English and analyzed in Atlas.ti using Framework Analysis. Findings. Knowledge and awareness of cognitive impairment and available resources were very low. Physicians attributed the condition to disease-induced pathology while lay persons blamed brain malfunction due to normal aging. Main attitudes were that this condition is not a disease, is not serious and/or is not treatable, and that it evokes stigma toward and among impaired persons, their families and providers. Low knowledge and poor attitudes impeded help-seeking. Conclusions. Cognitive disorders of aging will take a heavy toll on private lives and public resources in developing countries. Early detection, accurate diagnosis, systematic monitoring and quality care are needed to compress the period of morbidity and promote quality of life. Key stakeholders provide essential insights into how scientific and indigenous knowledge and sociocultural attitudes affect use and provision of resources.

How to improve consumer decision skills in children? A case study of an intervention with institutionalized children

The aim of this study is to assess the institutionalized children’s skills as consumers but also to assess how we can improve their knowledge through an intervention. The sample was composed of two subgroups (38 institutionalized children and 36 non-institutionalized children). In order to assess children’s knowledge, a questionnaire and an interview were used. The method used as intervention was a 30-minute class. Results suggested that institutionalized children have lower levels of knowledge regarding consumption-related practices and lower levels of accuracy at estimating prices than non-institutionalized children. However, results also showed that the attitudes of institutionalized children towards advertising and making decisions based on price/quantity evaluation or based on the use of the same strategy in different situations are not significantly different from the non-institutionalized children. Regarding the intervention, it was possible to conclude that one class is not the best method to improve children’s knowledge. Institutionalized children need a longer and more practical intervention.