Dementia prevention and inclusion efforts in super-aging Korea

 

For several years, I have become close friends with a 94-year-old Korean War veteran whom I refer to as “Mr. Monday.” He visits the community library where I volunteer every Monday to borrow books. I enjoy talking with him because he uses his rich vocabulary and story-telling abilities to elaborate on what he has read each week. Mr. Monday leads an active lifestyle, cycling to grocery stores and participating in community events. Whenever he attends these events, he arrives looking neat and clean. His family provides him with emotional support and a deep sense of fulfillment. Mr. Monday embodies the ideal of healthy aging, independent and free from ailments, especially dementia. He is among the many who have proven that dementia is not an inevitable consequence of aging, highlighting the significance of a proactive approach to aging.

As Korea transitions into a super-aging society, dementia has become a common subject of discussion and misunderstanding. Dementia is not a single, specific disease that affects cognitive abilities (i.e., memory, orientation, problem-solving and language) alone but an umbrella term that also encompasses changes in emotions and behavior. The leading causes include Alzheimer’s disease, vascular disorders, Lewy body disease, frontotemporal degeneration and head injury. Each of these conditions affects the brain differently, leading to distinct symptoms and progression patterns. Given that our central nervous system regulates both cognition and mood, impairment can lead to depression, anxiety, hallucinations, flat affect or aggression. Dementia is permanent once it develops; however, similar symptoms that are reversible can be caused by vitamin deficiencies, malnutrition, thyroid dysfunction, depression and particulate air pollutants.

The risk of developing dementia increases with age. According to Korea’s National Institute of Dementia, over 10 percent of individuals aged 65 and older in 2022 were living with dementia. People in their 80s account for nearly 65 percent of all dementia cases. The annual cost of caring for a single dementia patient in 2022 was estimated at 22.2 million won ($15,192), one-third of the average household income. National dementia management costs, including direct medical expenses, long-term care and indirect costs (i.e., the loss of patient productivity), exceeded 20 trillion won in 2022, constituting 1 percent of the country’s GDP. These figures are expected to advance to 138 trillion won by 2050, with an estimated 3.14 million dementia patients. Early diagnosis, leading to prevention and treatment, seems to be crucial to meet this challenge.

Since the early 2010s, the Korean government has assumed a more proactive role in tackling dementia-related challenges. In 2012, the government established the National Institute of Dementia to serve as the central hub of the country’s dementia management system. The institute partners with local governments and regional Dementia Care Centers. It also manages data, supports research, implements dementia prevention and management programs, provides training for professionals and conducts awareness campaigns. Aligned with the “2017 National Responsibility for Dementia” initiative, regional Dementia Care Centers provide financial assistance for diagnosis and treatment (i.e., a maximum of 360,000 won annual subsidy for medications). These centers also provide supplies like adult diapers, operate prevention and management programs and facilitate family education and self-help groups. Such efforts encourage respect, support and inclusion in their own community for those who have dementia and for their caregivers.

Despite these efforts, challenges remain. First, public awareness campaigns depend largely on written materials, which alone may be ineffective in changing people’s perceptions and attitudes. Creating more opportunities for interaction with dementia patients across different stages of their condition would likely improve public awareness and help mitigate social stigma and exclusion. Second, campaign materials can be given to churches, libraries, subway stations and community centers to encourage families to seek help when in need. Third, the media often perpetuates negative stereotypes of dementia by showcasing extreme cases. Misperceptions can be countered by providing accurate and balanced narratives and developing robust media guidelines to ensure fair representation of individuals living with dementia. Fourth, dementia is vastly underresearched, compared to other chronic illnesses (i.e., cancer and diabetes). This inhibits effective policy development and evidence-based interventions. Lastly, there is an urgent need for respite programs providing temporary care for caregivers to prevent burnout, which sometimes leads to elder abuse and parricide.

In Korea, a new dementia patient is diagnosed every 12 minutes. Dementia is a national health priority requiring sustainable and concerted efforts from all members of society. We need to foster an empathetic and inclusive community where individuals with dementia live with dignity and autonomy. By educating the public, we can help more individuals live vibrant, fulfilling lives like Mr. Monday.

Ma Kyung-hee is an editor and researcher specializing in mental health.