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Introduction: In Kenya, there is a lack of data on the number of people with dementia. In this article, we aim to estimate the number of community-dwelling older adults (aged 60 years and above) that are potentially living with dementia in rural Kenya. Methods: Recruitment of older adults occurred through adopting a convenience approach based on the catchment areas served by ten trained community health workers. Screening was conducted using the Brief Community Screening Instrument for Dementia (CSI-D), in which prevalence ratios were reported. Regression analyses were run to understand the association between screening outcome and wellbeing, social isolation, and employment status (adjusted for age, sex, literacy, geography, and social status). Results: Of the 3,546 older adults who were screened for dementia, 652 screened positive (PR = 0.18, 95% CIs: 0.17–0.20). Back estimating screen positives based on established sensitivity and specificity of the tool against a gold standard (clinical diagnosis), yielded a prevalence of 9.4% (0.09, 95% CIs: 0.08–0.11). Screening positive for dementia was associated with poorer quality of life (B = −0.17, p < 0.001) and loneliness (B = 0.28, p < 0.001). Conclusion: There are potentially 258,000 older adults living with dementia in Kenya, who likely have poorer outcomes. We need to encourage a timely diagnosis and develop better ways to support people living with dementia in Kenya and other resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: In Kenya, many people are currently living with dementia without a formal diagnosis or support; often attributing symptoms to normal aging or as a consequence of past behaviors. Dementia screening is not commonplace within Kenya. Improving the supply (or opportunity) of dementia screening within the region may promote uptake, thus leading to more people to seek a formal diagnosis and subsequently receive support within the Kenyan healthcare system. Community Healthcare Workers (CHWs) have successfully demonstrated their value in delivering health interventions within Kenya and have strong links within local communities. Objective: To integrate and evaluate a community-level dementia screening program among older adults in rural Kenya. Methods: Through leveraging this resource, we will deliver dementia screening to older adults (≥60 years) within Makueni County, Kenya over a 6-month period. Here, we present a protocol for the process evaluation of a dementia screening program in Kenya — DEM-SKY. The process evaluation seeks to understand the adoption, implementation, continuation, and implementation determinants, using quantitative and qualitative measures. Conclusions: Gaining perspectives of different participants involved in the program (i.e., older adults, CHWs, hospital staff, and trainers), will ensure that we understand the reason for successful (or unsuccessful) delivery of DEM-SKY. [ABSTRACT FROM AUTHOR]

Background: Primary health care providers face the challenge of making timely dementia diagnosis due to limited time available to interact with patients resulting in stigma, neglect and abuse. With training, these providers can collaborate with Community Health Workers (CHWs) to improve dementia detection and articulate the needs of communities whilst mobilizing resources that are salient in decision‐making, care coordination and service delivery processes. In this study, we outline the process that led to integration of a Community Level Dementia Screening Program in Rural Kenya (DEM‐SKY). Method: As part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, ten CHWs were trained to deliver a dementia anti‐stigma intervention to 59 members of the general public in rural Kenya, through four bi‐weekly psycho‐education sessions. This led to increased number of people turning up for dementia screening at a county referral hospital. However, due to lack of knowledge and busy waiting lines at the hospital, discussions on how to integrate dementia screening within the hospital began. Result: Findings from the STRiDE project formed the basis of integrating a community‐level dementia screening programme in Makueni County Referral Hospital in Kenya, a program that has seen more than 600 adults aged 60 and above screened for dementia by CHWs in a period of one month. Through partnership and collaboration with the hospital, a recording and reporting system for people living with dementia was established to provide an indication of the number of dementia cases and individuals referred from the community. This was made possible through: (i) training formal and informal providers on importance of dementia screening, (ii) continued awareness in communities to change existing negative dementia perceptions and (iii) motivating CHWs through project visibility materials and recognizing them in community events. Conclusion: Public awareness and stigma reduction using CHWs can be a precursor to strengthening health care systems through routine dementia screening for older people in community settings. This integration process also requires using task‐sharing approaches in order to promote timely detection and improve care coordination at all levels of care, thus forming a basis for formulation, implementation of policy and service planning. [ABSTRACT FROM AUTHOR]

Background: Sub‐Saharan African countries have the fastest growing rates of older people, yet little is known about the number of cases of dementia. In Kenya, the little we know about dementia is derived from studies involving the few individuals who receive a diagnosis, but typically in the more advanced stages of the condition when carers have reached a crisis point. Effective and routine data screening is important for the early detection of dementia, but also provides insights into the number of people living with cognitive and functional impairment associated with dementia. We aimed to describe the number of people screening positive for dementia within rural Kenya, and identify factors associated with screening positive. Method: Community Health Workers conducted an opportunistic household survey among community‐dwelling residents aged 60 and above in rural Kenya. The brief Community Screening Instrument for Dementia (CSID), which allows for potential cases of dementia to be identified without the need for specialist tools or intensive training was used to identify number of people living with dementia and socio‐demographic information collected. This is an interim analysis of the data. Result: 672 older adults (M = 71.0 years old; SD = 8.96) were screened for dementia. Participants were predominantly Kamba (n = 664, 98.8%) and from Makueni county (n = 617, 91.8%). 209 people screened positive for dementia (31.1% (95%CIs 27.6 to 34.8). Males (OR = 0.67, 95%CIs 0.52 to 0.87) and people who were literate (OR = 0.51, 95%CIs 0.41 to 0.64) were less likely to screen positive for dementia. Screening positive for dementia was also associated with old age, with the oldest age group (90 years+) being 3.7 times more likely to screen positive for dementia than the youngest group (60‐64 years) (OR = 3.67, 95%CIs 2.54 to 5.37). Conclusion: These findings form the first‐ever dementia screening programme in rural Kenya and highlight the numbers of people living with cognitive and functional impairment, potentially indicating dementia. Although such cases need to be clinically confirmed, these data can support the planning, policy development and inclusion of dementia care within policy discussions. [ABSTRACT FROM AUTHOR]

Background: Within Kenya, dementia is commonly under‐recognised and under‐diagnosed. As a result, many people living with dementia do so without any formal support. The DEM‐SKY project seeks to address this gap by implementing a dementia screening program in Kenya using Community Health Volunteers. The aim of this study is to understand some of the consequences of living with cognitive and functional impairment. Methods: Older adults (aged 60 years and older) were opportunistically screened for dementia using the Brief Community Screening Instrument for Dementia (CSID) within Makueni County, Kenya. Secondary outcomes included Quality of life (EUROHIS‐8) and loneliness (UCLA). Regression models were created to understand how quality of life and loneliness outcomes differ between those who screen positive and negative for dementia. Results: Of the 672 older adults screened, 31.1% (n = 209) screened positive for dementia. People who screen positive for dementia reported to have poorer quality of life (p = 0.01) and were also lonelier (p = 0.03) than those who screened negative. Quality of life (b = ‐0.93, 95%CIs = ‐1.83 to ‐0.02; p = 0.04) and loneliness (b = 0.34, 95%CIs = 0.03 to 0.65; p = 0.03) outcomes remained statistically significant after controlling for age, sex, ethnicity, geographic location, and social status. Conclusion: The findings indicate that people who experience cognitive and functional impairment (indicative of dementia) in Kenya are more likely to be lonely and have poorer quality of life. Further research is needed to understand the underlying mechanisms within a Kenyan context, but our findings are indicative that even without a diagnosis the impact of dementia can be felt by people living with it. [ABSTRACT FROM AUTHOR]