Mrs Anand is in her 70s and lives with her husband in a small village in rural South India. Mrs Anand’s daughter and her family live nearby. Over the last year her family has become increasingly worried about Mrs Anand, as she keeps losing things and puts items into odd places. A friend has told the daughter that Mrs Anand had been wandering in the village and seemed a bit lost. The daughter is worried about what people may think or say about and how they may react to her mother. Mrs Anand used to have a very neat house and looked after her appearance. She also helped her daughter with the children. Over the last few months Mrs Anand seems to be no longer interested in these things. Mother and daughter used to have a good relationship, but recently there have been a number of arguments.

The daughter decides to take Mrs Anand to an traditional medical practitioner. The traditional medical practitioner prescribes Mrs Anand with some traditional medicines to address her mother’s forgetfulness and behavioural problems. The daughter follows the advice for over three months, but notices that her mother’s symptoms were worsening. She mentions her mother’s symptoms to an Accredited Social Health Activist (ASHA) worker (ASHA workers are community health workers that exist in most states, but are not trained in dementia identification).The ASHA worker suggests to see a physician at the Primary Health Center (PHC) 5 km away and offers to take Mrs Anand and her daughter there. The PHC offers consultations free of charge. The daughter tells the physician that her mother has been losing things and forgetting names of relatives. The family assumed this was a normal part of ageing, until she began to wander alone aimlessly. The physician examines Mrs Anand and suggests that they see a specialist (neurologist or psychiatrist) at a government medical college hospital 200 km away. In rural India, there is unlikely to be adequate support outside of families, though in some states NGOs may provide help through mobile medical services. Due to the distance, the family is unable to visit the specialist and are compelled to manage on their own. Mrs Anand’s husband cannot provide care for his wife on his own, as he is almost 80 and suffers from arthritis. Mrs Anand’s daughter has taken the primary responsibility of caring for her mother. Children are responsible for providing care to their parents as they age. As a result, the father expects the daughter to aid him in taking care of Mrs Anand. However, the daughter is struggling to manage her household responsibilities along with spending around 5-6 hours per day caring for her mother. It is more culturally accepted for the daughter to spend time in care provision and cut down on her other activities.