Many people believe there is a lower incidence of Alzheimer’s and dementia in Costa Rica. However, Costa Rica is seeing an increase in the percentage of cases of dementia which equivalent to more developed countries. According to the Raul Blanco Cervantes Geriatric Hospital, there are presently an estimated 30,000 people in the country living with dementia, and, it is predicted that the number will quadruple by 2050..
The majority of us experience some memory challenges as we age. Some memory loss can be a normal part of aging, or it can be the early signs of a cognitive decline which might be leading to dementia. (In the past dementia was referred to as “senility” but that term is now antiquated.)
Dementia is a symptom caused by a neurological disease like Alzheimer’s, vascular deterioration, or hormonal imbalances; we do not get dementia because of aging alone. The symptoms usually begin with memory loss, although the person may begin losing executive function and experience delusional beliefs, personality changes, lack of emotional impulse control, or make some terrible decisions, even earlier.
What causes dementia? All the answers are not known, but some indicators do exist. (This needs to be separate from the blue zone paragraph.
In Costa Rica, we have the infamous “Blue Zones”, an area near the Gulf of Nicoya being the primary one, and others throughout the country, where we commonly encounter elderly in their nineties and over and a low incidence of dementia. (This is not true. Blue zones don’t mean lack of dementia) These generations lived very healthy lifestyles, were predominately farmers who ate animals they raised and vegetables they grew. They drank water from the land, had strong ties to their communities, and worked from sun up to sun down in lots of fresh air – the perfect balance for a long healthy life.
Modern Costa Rica, however, has changed that dynamic. The small farms are disappearing as the young people look to the city for education and jobs. Many elderly couples find much of their family has moved away and, eventually, they can no longer keep up their farms. And, when one spouse dies, the other usually moves in with the family, if they have one, and the farm is sold.
Something else that has also changed is the Costa Rican diet. In the past “junk food” was scarce, and packaged processed food was too expensive. Today, the majority of the elderly eat very poorly and exercise minimally; thus, medical problems like diabetes and heart problems are more common.
The country has also grown in the number of retired foreign seniors. We now have over 488,935 foreigners with residency, 24,201 of whom are United States citizens and 3,639 from Canada. Many of these persons are retired and over the age of 65; a number of them will eventually develop some cognitive decline.
Dementia commonly begins to appear after age 65, although early on-set dementia can begin at 30-50. According to statistics from Michigan University, one in seven seniors over 70 has dementia, and over half of the residents in elder care facilities suffer from the illness.
So, what happens when you or your partner begin showing signs of dementia in a foreign country, far from your family?
The most crucial first step is to get diagnosed. The Raul Blanco Cervantes Geriatric Hospital has a world-class memory clinic that offers all the testing necessary. With Costa Rican residency you must pay for CAJA services and are therefore entitled to use the CAJA medical system. In most areas there is an EBAIS clinic where persons over 60 may go and request a referral to the Blanco Cervantes memory clinic. Those who have private insurance can see a geriatric specialist or neurologist for testing.
Early diagnosis is very important. Many dementia symptoms are treatable and caused by conditions such as a vitamin B12 deficiency, thyroid imbalances, or alcoholism. Others issues, such as Alzheimer’s or Lewy Bodies, are incurable, but symptoms often improve with early interventions of diet, exercise, and some medications.
If you have been diagnosed with dementia, do not hide it. Let your family know and then, together with your partner, inform yourselves no matter how scary it may seem. Good decisions need to be made early on, and those who wait are headed for heartache.
When the time comes for a care giver, Costa Rica has many organizations training and certifying professionals. UNED is the online university providing care giver courses throughout the country, and INA, the national trade school, and other Universities like Santa Paula and UCR, also have courses. In addition, there are Facebook care giver groups, usually in Spanish, but where you can solicit an English-speaking care person with certification in your area. Odds are you will find several.
According to the Ministerio de Trabajo, the average pay for a care giver is about 15,000 colones ($30 USD more or less) for an 8-hour shift. (Remember, this person is not a maid; their job is care giving, although it is not uncommon for them to also do some cooking.
If a nursing home becomes necessary there are several private facilities from which you can select who accept foreign elderly. Choose wisely, just because a facility is the most expensive does not mean it is the best. Check out cleanliness; if there is a smell, leave. Is it a homey environment, is there a garden? Ask to see the kitchen and menus. Find out what programs there are to keep your loved one occupied, and find out what their staff to resident ratio is. Also, ask if any of the staff speak English. Before making a final decision, visit several times, preferably during mealtimes and activities, and take notice of how the staff treats the residents.
Both the person with dementia and their partner and family must work together proactively to create a quality of life for everyone involved.