Background: Reducing vulnerability and building resilience in developing countries cannot be accomplished without the management of disease, particularly mental illness.

Managing Dementia is especially key to achieving several of the UN’s Sustainable Development Goals, which affect older persons. Dementia has the double impact of creating a vulnerable subgroup of persons with mental illness out of an already vulnerable, older cohort. It also carries a socio-economic burden beyond any other chronic illness due to the long-term care required; affects women more than men, and in many communities has hampered the earning potential of families due to the need for informal care.

Major challenges faced by practitioners in T&T in Dementia Management;

• Cultural attitude towards dementia.

As in many developing countries, there are widespread, outdated beliefs about ‘senility’ being a normal part of ageing. This is not only due to limited levels of education among the older population, but to the overall lack of awareness and strong stigma around mental illness in general.

• Late diagnosis/limited opportunity for treatment

Family members often dismiss early symptoms, only taking the patient to a health professional when the symptoms are unmanageable. Late diagnosis leads to families abandoning their loved ones at hospitals to avoid the burden of care, and also due to a lack of support from social services.

• Lack of public health interest and resource allocation.

No national dementia awareness campaigns have been done to date, unlike for other Non-Communicable Diseases (NCD’s) like diabetes or cancer. This is due to a broader neglect of mental illness, which receives an allocation of less than 1% of the national health budget. Most of this goes to the only mental hospital in the country, which serves both islands. With such limited resources, public health practitioners are often poorly trained in being able to adequately identify, treat or

refer persons with mental illness, including dementia patients.

• Lack of support for caregivers

Most persons provide informal care to loved ones with dementia, yet are uneducated about the disease. There is no institutional support for these caregivers, who often go years without respite care, may lose their jobs or suffer from carer burnout.

Conclusion

The Ministry of Health approached Age Caribbean about the inclusion of dementia in the National Strategic Plan for the Prevention and Control of NCDs (2017-2021). It is hoped that this leads to the launch of recommended national awareness and training campaigns.

Age Caribbean has led several private caregiver sessions on person-centred care and dementia, however there is a need for more public-private sector collaboration to optimise impact of sessions.

It is important when working with Caribbean countries to bear in mind the poor attitudes towards mental illness, as well as the political and economic factors at play surrounding budget allocations.