Retirement arrived, and you finally live the pura vida dream in Costa Rica in your forever home. The initial honeymoon phase seemed like paradise, but ultimately reality set in. Living in a foreign country can be just as challenging as living anywhere. It’s simply life, and the “stuff” you bring isn’t always just the furniture. 

We have a Facebook group called Expat Dementia Support- Costa Rica.

Despite the bumps in the road (literally), you eventually became adept at handling the banking, bureaucracy, immigration, medical challenges, cultural differences, and maneuvering through life without knowledge of the language. Now, after several years, you finally feel at home.

The unexpected is something one learns to expect in Costa Rica. However, I wonder if many of you would see this one coming. 

Gradually you begin to notice you or your significant other begins to have memory problems. At first, it’s just misplaced items, forgetting appointments, or someone’s name. Nothing to be concerned about because this is what happens when we get older. But the forgetting gets worse, and it’s becoming apparent something else is happening. 

Not only are there memory lapses, mood swings, and some terrible decision-making complicating matters. These changes are usually first noticed by the spouse. Unfortunately, the person experiencing it is commonly in denial, and they blame others or fabricate some pretty good excuses. This certainly isn’t the “happily ever after” you planned for your Costa Rica life together.  

You start to fear this could be the beginning of dementia. Maybe someone in your family had it, and this is the worst you can imagine. Your family is in another country, and your friends don’t seem to have any answers. The situation escalates, and you feel very anxious, alone, and frightened. What can you do?

First, find out

The initial step is to get a medical diagnosis, preferably from a gerontologist, neurologist, or geriatric psychologist. Dementia isn’t always the dreaded Alzheimer’s; you need to find out. Alzheimer’s is the number one cause and, unfortunately, incurable and progressive. Vascular problems are the second cause of dementia, and TIAs (small strokes) are the cause and are usually progressive. High blood pressure or heart issues create a high risk and usually precedes this type of dementia.  

There are some genetic dementias such as Huntington’s and Pick’s disease, and a form of genetic early Alzheimer’s, which generally begins in one’s 50s or earlier. But most Alzheimer’s dementia — no matter how many people in your family have had it — is not genetic. 

Most cognitive conditions causing dementia are incurable; however, not all. Alcoholism is a significant cause, and commonly, stopping alcohol consumption slows or stops the progression. Also, deficiency of vitamin B12 and thyroid imbalances can create dementia symptoms and are reversible. 

In Costa Rica, residency requirements dictate the CAJA inscription in the national medical system. Most foreigners have both private insurance and CAJA. In my experience, most general practitioners don’t have the specialized knowledge of a senior professional, and most CAJA system doctors are just out of medical school. You’d go to a pediatrician for children, and you should see a gerontologist for the elderly. So, find a professional. 

Private and CAJA options

If you have private insurance, most private hospitals have excellent doctors who can do the testing for diagnosis. If you are going through the CAJA, the Raul Blanco Cervantes Geriatric hospital is one of their best facilities and specializes in treating seniors. Their memory clinic is part of an ongoing international study on dementia. They conduct all the physical and mental tests necessary to determine an official diagnosis. 

To qualify, you must be in the CAJA system, be over 60 and have a chronic medical condition or possible dementia. You must first go to your local EBAIS clinic with the person and request a referral from the doctor to Blanco Cervantes for probable dementia. Next, submit the referral to Blanco, and within a week, you return to see if the person qualifies. Your loved one doesn’t need to go with you for that. The initial appointment usually takes months, but it is essential if your significant other is possibly in early dementia that you have this hospital as a backup. 

Your loved one will be given a cognitive test at your first appointment. Then the doctor will authorize several other tests. At the finish of all the testing, they will provide you with an official diagnosis. If warranted, medication prescribed. If you speak Spanish, they offer an orientation talk for families on dementia to inform them about the condition and what to expect.

Some medications can improve memory and cognitive abilities, and in earlier stages, they help. However, dementia continues to progress. Eventually, when the medicines no longer have the effect, the symptoms will revert to wherever they would have been if they had never taken the drug. Be aware of side effects, as some people can’t tolerate these meds. 

Often as dementia worsens, the decision is made to return to one’s country of origin, usually because of wanting to be closer to family. This doesn’t usually turn out as expected because the support they are counting on from family often doesn’t happen. Families are busy with their lives, many scattered across the country, and commonly caregivers feel abandoned.

Affordable care

Here in Costa Rica, the cost of in-home care is affordable, and once you find the right fit in-home help becomes invaluable. The Costa Rican culture suits working with the elderly, as older people traditionally are supported in very heartfelt ways. There are some suitable eldercare facilities, and I always recommend the smaller group-style homes, which are well below the placement cost in another country. 

We have a Facebook group called Expat Dementia Support- Costa Rica 

There is also a zoom ex-pat caregiver support group every Saturday for those living in Costa Rica and caring for someone with cognitive decline. Contact Debra Hammen or Nora Kraidman through messenger on Facebook to join. 

Dealing with dementia in a foreign country can be viable and more affordable than returning to one’s country of origin.