n Pakistan today, we often speak of youth as our greatest asset — a young population full of potential, vitality and hope. But while our gaze remains fixed on the aspirations of the young, a quieter demographic shift is taking place, one that could reshape the social and economic fabric of the country. Pakistan’s elderly population — those aged 60 and above — is set to triple over the next three decades. By 2050, we will have over 40 million older adults, many of whom will live longer, but not necessarily healthier or more independent lives.

This profound ageing of our population brings with it one of the most urgent yet least understood health challenges: dementia. Often dismissed as simple forgetfulness or “old age,” dementia is in fact a progressive brain disease that strips individuals of their memory, their personality, their ability to function — and eventually, their dignity. In a country like Pakistan, with a poorly developed public health system, limited elder care services and deep-rooted stigma surrounding mental decline, the burden of this disease is only beginning to emerge.

In a small village near Multan in rural Punjab, 68-year-old Fazal Hussain was once a respected school teacher. Known for his crisp memory of classical poetry, he had been retired for several years and spent most of his time tending to his back garden.

Over time, his family noticed subtle changes. He repeated stories, misplaced objects and sometimes forgot familiar faces. Then came more troubling signs — wandering aimlessly around the village, dressing inappropriately for weather and once mistaking his son for a stranger. His family, unsure of what was happening, believed that perhaps he had been bewitched or was being punished by fate.

It wasn’t until a local NGO arranged a visit by a mobile health unit that Fazal was examined by a doctor who had received basic training in cognitive screening. A diagnosis of dementia was made — likely Alzheimer’s disease. But even with the diagnosis, Fazal’s family was at a loss. There were no nearby specialists. The public rural health centre didn’t offer any support for dementia. And the neighbours? They whispered, “Un ka dimagh chal gaya hai (his mind is gone).”

This is not an uncommon story. In fact, in much of Pakistan, rural as well as urban, it is beginning to happen more often than we care to admit.

Pakistan is woefully unprepared for a rising tide of dementia. Research from across the country points to a stark reality that most people with dementia in Pakistan remain undiagnosed, particularly in rural and underserved communities. By the time families seek medical help, often from the nearby general practitioner, the disease has often progressed significantly.

And, GPs, who are the first point of contact for most families, rarely have training in recognising or managing dementia. The specialised memory clinics, geriatric neurologists or elder care facilities are few and far between, found mostly in private hospitals of major urban centres. Women in families — especially daughters and daughters-in-law — carry the burden of care without support or respite, and often with little understanding of how to respond to changing behaviours that accompany the disease.

Unlike many chronic illnesses, dementia requires not just medication or periodic check-ups — it demands a holistic approach to care, including consistent emotional support; patience with behavioural changes; modifications in home environment; long-term financial planning and compassionate caregiving, often over several years.

The health system, already strained with infectious diseases, maternal mortality and now rising non-communicable diseases, has no structured response for the care of those with dementia. The absence of geriatric care policies, long-term care plans or community-based services makes the caregiving burden deeply isolating and emotionally exhausting.

Unlike many chronic illnesses, dementia requires not just medication or periodic check-ups — it demands a holistic approach to care, including consistent emotional support; patience with behavioural changes; modifications in home environment; long-term financial planning and compassionate caregiving, often over several years.

In Pakistan’s collectivist society, where elders are traditionally revered, dementia carries an added layer of stigma and denial. People with dementia are often hidden from view, dismissed as “mad” or “possessed,” or simply ignored until their symptoms become unmanageable.

One study highlights how Pakistani families experience severe psychological distress, financial strain and breakdowns in family relations when left to deal with dementia alone. The moral obligation to care, while strong in cultural terms, is not matched by institutional support.

While large-scale reforms will take time, families facing dementia today cannot wait. There are steps, grounded in compassion and practicality, that can make a meaningful difference in their daily lives.

It begins with observation and medical attention. When a loved one shows signs of forgetfulness, confusion or odd behaviour, it is essential not to dismiss it as “just becoming old.” Consulting a trained doctor, even a GP with basic understanding of cognitive decline, can help make an early diagnosis.

Once the disease sets in, families often feel helpless in the face of memory loss or delusional thinking. Trying to correct or argue with a person who has dementia rarely helps. If someone insists on visiting a deceased relative or talks about events that never happened, it’s better to gently accompany them in their emotional world than to confront them with reality. This reduces distress for everyone involved.

Routines matter. When the world begins to feel unfamiliar, having meals at the same time, reciting prayers together, going for walks or simply sitting in the same spot every evening can provide much-needed comfort and predictability. These small acts of consistency become anchors in the confusion.

Equally important is making sure that the entire family understands what dementia is — and what it isn’t. Too often, the responsibility falls entirely on one caregiver, usually a woman in the household, while others remain passive. Sharing knowledge through family conversations, accessing Urdu-language videos or caregiver groups on WhatsApp and learning from others in similar situations can bring not only guidance, but a sense of solidarity.

Above all, families should not isolate themselves. Though services are limited, there are NGOs, elder care associations and religious institutions that offer training sessions, drop-in advice and moral support. In many communities, just finding someone who understands what you’re going through can make all the difference.

Across Pakistan, dementia needs to be seen not just as a family issue but as a pressing national challenge. As the country’s population ages, the state must begin by integrating dementia into its broader health and ageing strategies, recognising it as a non-communicable disease that deserves serious attention.

We need more than declarations — we need action that touches real lives. This includes training doctors and nurses at the primary care level so they can identify the signs of dementia early. It means launching awareness campaigns in everyday language, using storytelling and community outreach to reduce shame and misunderstanding. It also involves developing basic elder care services: local centres where caregivers can get respite, advice; even a few hours of support.

Dementia must no longer be hidden behind closed doors. Faith-based institutions, which play a powerful role in shaping social attitudes, can be mobilised to spread messages of dignity, empathy and shared responsibility.

As we look to the future, we must also learn from others who have faced this path before us. Countries like Malaysia — with similar cultural values and economic challenges — have shown that even with limited resources, it is possible to create community-based systems of dementia care. They have invested in training local health workers, supporting family caregivers and framing old age not as a burden, but as a phase of life that deserves support and honour.

In the Holy Quran, we are reminded: “It is Allah who created you in weakness, then gave you strength, then after strength gave you weakness and grey hair...” (Surah Ar-Rum 30:54). Growing old is not a burden — it is part of the divine design. The way we treat our elders, especially those who begin to forget us, is a reflection of the society we are becoming.

If we act now, Pakistan still has time to prepare. But if we don’t, dementia will become one of the defining crises of our ageing society.

The writer is a former vice chancellor of the Government College University, Lahore