5 minute read
Senior Living in Costa Rica
El Residente 20 Senior Living in Costa Rica by Katya De Luisa
The Geriatric Hospital and Memory Clinic
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The Raul Blanco Cervantes Geriatric Hospital was originally the Tuberculosis Hospital. When specialized hospitals were established in Costa Rica in 1989, it was converted to a teaching and research center for geriatrics. In 1992, in collaboration with the CCSS (Caja), a residency program was established with the School of Medicine of the University of Costa Rica. This hospital is today a shining light among the National health care system of hospitals in Costa Rica. Yes, it gets as crowded as the other Caja hospitals, but the quality of care and attention given to seniors seeking medical assistance is exemplary. The staff, many of whom speak English, are conscientious and kind, and even with the normal waits, at noon, everyone, including the person accompanying the senior, gets a complimentary cup of hot soup and crackers to nourish them and boost their spirits. It can be challenging for many seniors with chronic conditions to go through the regular Ebais clinics in their local area; at every consultation they see a different doctor, usually one recently graduated from medical school, and with only 15 minutes per consultation, the doctor usually doesn’t have time to completely review their history. For specialized tests, patients are sent to different hospitals and clinics, and the appointment dates can be months in the future. Often, test results get lost and have to be repeated. Blanco Cervantes, as it is known, is a one-stop facility for seniors with its own diagnostic clinic where the patient’s history is thoroughly reviewed at each visit. And most testing is done at the hospital. The hospital offers an array of specialists, such as gastroenterologists, ophthalmologists, cardiologists, and oncologists. They have their own in-house laboratory, pharmacy, and dermatology clinics; however, unfortunately, they don’t have orthopedic services available. (Some highly specialized testing services may be referred to other Caja facilities.) Their neurology service is an integral part of what they offer, and their Memory Clinic has been a pioneer in neurological services in the country. There they evaluate, diagnose, and treat those experiencing memory issues, mild cognitive decline, or dementia. Presently there are an estimated 20,000 to 25,000 persons with dementia in this country, but because many people are not diagnosed, that number could be much higher. The memory clinic was established in 2007 by gerontologists Drs. Erik Miranda and Daniel Valerio, and operates using the international protocols established by Mount Sinai Hospital in New York City. All cases include testing of blood, kidney, and liver function, electrolyte levels and thyroid function, HIV, and for vitamin B12 or folic acid deficiency. They can conduct a CT brain scan or, when warranted, an MRI.
The interdisciplinary team of specialists in cognitive decline includes geriatricians, neurologists, and psychiatrists, who together, once all testing is complete, each week assess the individual cases and render a diagnosis and treatment recommendation. Memory clinics are beginning to appear in hospitals like San Juan de Dios, however, only Blanco Cervantes uses the Mt. Sinai methodology of diagnosis by a consortium of neurological specialists. When diagnosed with Alzheimer’s, or another related dementia, the patient and their family attend an educational program on dementia and are referred to physical and cognitive therapy clinics designed to help improve and slow memory decline and the cognitive and physical disabilities associated with dementia. In 2014 the memory clinic conducted a study on dementia in Costa Rica for the Europe PMC, an open science platform that includes access to a collection of life science publications from around the world. In this study they identified and analyzed the main types of dementia and mild cognitive decline in a memory disorders unit under the social security health system in Costa Rica. Unfortunately, the numbers compiled in that study have increased threeto-four times more in the last years, and no other study has since been conducted. Medical students from the University of Costa Rica practice their residency for three-to-four months at the hospital, which gives them experience working with seniors and their medical issues. Sadly, their time spent at the memory clinic is minimal and doesn’t give them a comprehensive understanding of dementia. The numbers and information on dementia compiled by the memory clinic are sent to the Ministry of Health. There, a database on dementia in Costa Rica is in the process of being developed. This data will eventually be available to health practitioners throughout the country. Dr. Valerio expressed how, in rural areas, there is a scarcity of professionals educated in dementia, and often the elderly, with the beginnings of this condition, are told it’s a normal part of aging, and not treatable. That is incorrect. Dr. Valerio pointed out that not all cognitive decline is incurable or progressive, so early diagnosis is essential. The extensive testing done at the Memory Clinic is important because it enables doctors to reverse some treatable dementia causes, and provides medications and procedures to slow symptoms in the incurable cases. For instance, many seniors may have a Vitamin B12 deficiency which can create dementia-like symptoms and is reversible with a monthly injection. Thyroid
21 November / December 2020
imbalance and alcohol-induced dementia are also correctable. It is not simple or easy to qualify for obtaining services at Blanco Cervantes. First, you must be affiliated with the Caja, be over 60 years of age, and have a chronic condition. Then you must have a referral by your Ebais clinic doctor, which you present to the hospital for a doctor's review. (Some private physicians which are affiliated with the Caja can also make referrals.) Soon thereafter they will inform you if your condition qualifies inclusion in their services. Many expats are seniors over 65, and many may eventually experience some level of memory loss or cognitive decline. Residents of Costa Rica are, by law, required to join the Caja healthcare system, which gives them eligibility to use the geriatric hospital and its memory clinic services.
Katya De Luisa is an artist, freelance writer, and author, with 20 years’ experience working with those with dementia and their families. She is the founder/director of a non-profit dementia project here in Costa Rica: www. theinfinitemind.org
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