By Annette Chrysostomou
If healthcare availability in Cyprus is a lottery in general, nowhere is that more true than in the treatment of Alzheimer’s and dementia.
Long described as a ticking time bomb for Cyprus’ ageing population, dementia now affects 14,000 people over 60. Of these, 9,500 suffer from Alzheimer’s disease, the latest figures show. In Western Europe, cases of dementia are predicted to double by 2050, and there is no reason to think that Cyprus is an exception.
Yet an investigation by the Sunday Mail reveals that there is no nursing home or any other full-time care centre anywhere in Cyprus for Alzheimer’s and dementia patients. What care is available varies greatly according to district. Shockingly, for example, Paphos has the worst level of care – it has no care centre at all – despite its high proportion of elderly European expat residents.
Our investigation discovered that Alzheimer’s patients and their families, struggling to cope with the terrible burden of the disease, had best live in Nicosia, the only city with a day care centre which runs five days a week. Privately funded, it can only cater for 25 patients and their families and charges only a nominal fee. Another centre is in Lythrodontas, but it is only open three days a week and only 12 patients can use it at a time.
The institution in Nicosia is the most advanced and is an example of what should be done, and what is sadly often not being done, for Alzheimer’s patients and their families.
The centre was founded in 2007 with the help of the Rotary Club and funding from the EU. The EU funding was only for the first two years. Since then the Rotary Club has taken on all the costs. In the beginning, it was small.
“It was strange for Cyprus. People were in denial and hid at home. Everybody was saying ‘I don’t have dementia’,” director of the centre Ersi Papayianni told the Sunday Mail. In the beginning, there was one social worker, one physiotherapist and one music therapist, which was sufficient for the ten patients visiting. This number has now increased to 25 regular visitors.
As increasing numbers of families admitted that they had someone suffering from Alzheimer’s in their midst, more facilities were needed for a growing number of patients. At the moment, there is a team of eight professionals who assess and treat the patients. If that seems like a lot for the number of patients, it is because each case is quite different and needs different assessment and treatment. The families also need support, maybe more so than the patients.
At this facility, a speech therapist, a doctor, a social worker, a clinical psychotherapist, an occupational therapist, a music therapist, a psychiatric nurse and a gymnast all work together. At the moment Papayianni is also looking into hiring a masseur in an effort to relax the patients. The whole team can give a complete assessment of the patient’s state, both physical and mental.
Technology also helps. The centre uses a computer software programme to assess a patient and has also started to collaborate with the University of Cyprus’ technology department for the recording of medical records. Various therapies such as physiotherapy and music therapy are used.
Apart from personnel and technology, the facilities are important.
Providing a sense of security is a priority.
“Their realities and our realities are not the same,” clinical psychotherapist Silia Rafti explained. “It is important to calm them down, so we follow their reality. It may take someone three hours to calm down an agitated patient. So our first aim is to provide an environment that feels secure to the patient.”
In addition to patients’ rooms, the centre has a speech therapy room and a gym. The garden and verandas are also used extensively, as Alzheimer’s patients don’t like to be inside.
Limassol has one day care centre which can accommodate a small amount of people. It is currently used by relatives of patients as a meeting point because it has run out of funding to accept the patients themselves.
In Paphos the situation is even worse.
“Doctors diagnose the disease and they give some advice and there it ends,” said Sonia Royer from the local Alzheimer’s association. She explained that members of the association try to help by setting up meetings where carers, who are mostly spouses, can support each other.
The lack of facilities is an enormous problem. “I ask people who have already been diagnosed with the disease and want live here to look at the facilities,” Royer said. “And there is a question mark.”
To some degree, patients are supported by state hospitals, but only in outpatients’ departments. Here, they are examined by doctors with the support of occupational therapists and nurses, according to Irene Georgiou from the mental health services department. “If they cannot come to the medical centres, nurses can go to their houses. Sometimes personnel also need to support the families.” The nurses have almost all have training for this, she said.
Asked about the situation in Paphos, she conceded it was not so organised and it depends on the workload whether staff are sent there.
The problem for all concerned is money. The Rotary Club is able to support the Nicosia day care centre, but still needs more money. The charge per patient is €5 per day for all the services which may also include a bath and €10 with food. This is only a fraction of what is needed. Up to last year, the government also gave some money and this year they are supporting the centre by sending some personnel.
The Alzheimer’s Association and the government have a strategic plan which dates back from 2010 but has yet to be fully implemented. Its main goals are to improve public awareness, upgrade facilities, provide higher quality care and develop a supportive social network.
“A lot of it can be implemented at low cost or at no cost, and we will concentrate on that,” said head of the Cyprus Alzheimer Association, Antigoni Diakou.
“We have achieved a lot already,” she added. “In the state hospitals Alzheimer’s patients get free medication, and we have the two day care centres in Nicosia and one in Limassol.”
In Limassol the efforts also centre on informing the public, as upgrading facilities is not an option at the moment. Maria Seleari from the Alzheimer’s association there explained that the association has organised a seminar on the subject together with the Cyprus University of Technology (TEPAK). In January they will start offering seminars on care for Alzheimer’s sufferers and how to understand them. The classes will be taught by psychologists and lecturers from TEPAK.
According to Irene Georgiou from the mental health services department, the state is implementing the plan in stages. She too focuses on increasing awareness of the disease, mentioning lectures in communities for patients and families.
The next stage, which will not be implemented until more money is available, is the establishment of day care centres in all cities and the employment of more trained staff.
“There is a lot to be done,” she conceded.
There is not even a centralised website informing the public about what support is available around the island.
“When we find a volunteer to run it we will set it up,” said Diakou from the Alzheimer Association.
There is indeed much to be done, and the opening of a much needed full-time institution for patients seems to be a long time in the making. For now, if you are looking after someone with Alzheimer’s, move to Nicosia.
Contact details for the Alzheimer’s Patients Association:
Larnaca: 47, Stylianou Lena, Flat 01, 6021 Larnaca Tel: 24 627104
Limassol: 11, Nicou Karvouni, 3027 Limassol Tel – Fax: 25 377370
Famagusta District: 243, Protaras Avenue, 5291 Paralimni Tel: 23740022
For Nicosia and Paphos call 24-627104