Is highly likely that due to lack of knowledge about dementia, about cognitive decline, or the association of disruptive behaviours with dementia, this would be considered part of a normal ageing process. The daughter, however, feels something is not right and decides to take Mrs Aurora to the community health centre. It is unlikely that they perform any diagnostic tests or screening at the community health centre, as rural health posts rely on basic health teams, usually a General Practitioner and a nurse, with no training in dementia, and with very limited resources. Health professionals in rural posts do not have any training in Geriatrics, Mental Health, Neurology or any other speciality that would allow them to conduct cognitive tests, and other professions such as Psychologists would also not be available. In consequence, the most likely scenario is that the GP runs a general check-up to identify if Mrs Aurora has any other possible health problems (such as hypertension) and if needed, prescribes some medication to manage such chronic conditions.

Regarding the possible cognitive decline/dementia, the conditions/problems would likely be diminished, and the daughter is asked to be patient and “go with it”. Private services to consult a specialist are not available as they are located in large urban areas, so Mrs Aurora and her daughter would not have any further options in their rural community to get a diagnosis nor any support with managing the illness. Unfortunately, even when the dementia progresses and the situation deteriorates, the most the GP will be able to do is keep an eye on Mrs Aurora, but not much in terms of managing the illness and symptoms. By the description of the case, it does not seem that Mrs Aurora is showing any disruptive behaviours. While it mentions that some neighbours have seen Mrs Aurora wondering in the village, it is common that people know each other and they would either assist Mrs Aurora taking her to her home or contact her daughter (or any other known family member), so they could go get her when necessary. If/when highly disruptive behaviours occur, these are usually not being associated with “normal” ageing but likely with mental health problems, and as in many other countries, given the high stigma attached to and the lack of knowledge about mental health issues, it is likely that Mrs Aurora and her family will be stigmatised. As a consequence, her family may use all measures possible for restricting Mrs Aurora to going out of the house.

Regarding Mrs Aurora’s care, her daughter would go over to help her father care for her mother or with daily activities that she cannot do any longer such as cooking, cleaning, etc. It is also likely that, depending on their ages, Mrs Aurora’s grandchildren would help with “looking after” their grandmother, or with supporting their mother in performing daily activities needed. Depending on household size and structure, when support needed becomes too much, arrangements will be made so they all live in the same household where support and supervision of Mrs Aurora can be granted 24/7. Apart from little support from some close neighbours or extended family members, these rural communities have no infrastructure on care support services. It is likely that they never hear about dementia, or get specialised information about symptoms, its causes, etc., even when they might have a local term to refer people who develop dementia or its symptoms to. Unpaid family carers take up 100% of all needed care and support. Risk of abuse or neglect as a result of lack of knowledge and high burden on carers is therefore high.