In Africa, older people typically constitute the poorest groups of society. For example in Uganda according to the ‘Uganda Reach The Aged Association’, over 64 % of the older persons survived on less than one Dollar ($1) a day [19]. They did not have access to regular income and the majority did not benefit from social security provisions. The vast majority lived in rural areas where over 85 % of the active ones were engaged peasant subsistent farming. Many depended on one meal a day; others survived on one meal in two or more days, a situation that affected their health negatively [4, 8]. Various studies have found the elderly to often have many untreated health problems such as hypertension, stroke, diabetes, heart diseases, eye problems (trachoma and blindness), which diseases often lead to complications and permanent incapacitation [10]. Some of the most common mental health issues and concerns were depression, dementia, various psychoses, delirium and substance abuse (www.​Agingcare.​com). In Uganda, studies conducted at Mulago National Referral Hospital in Kampala reported similar findings with a reported 48 % prevalence of psychiatric morbidity among the elderly patients admitted on the non-psychiatric wards [12]. Depression and dementia were the most common mental health problems with a prevalence of 13 % and 8 % respectively [12].

Psychiatric services are poorly distributed in Africa, concentrating in urban areas and leaving many rural communities with no services [1]. Such services for the elderly are even more scarce. The vulnerability of the elderly in Uganda has increased especially over the last 30 years with elderly women bearing the brunt of it [1]. It is compounded by triad of “a culture which denies inheritance rights to women, the burden of HIV/AIDS orphans under their care and the absence of government run Social Security provision”. Thus to be elderly and mentally ill in Africa, e.g. with dementia, is to live a life of misery, suffering and penury [1].

Traditionally, Africa had had established social networks that protected the elderly. These systems ensured strong bonds within the extended African family system consisting of multiple generations of the old, the grownups, the youths and the children [3]. These relationships provided for the needs of the old. The elderly were regarded with the utmost of respect as they were seen as the repository of knowledge and wisdom. However socio-demographic changes in Sub Saharan Africa have caused the elderly to be neglected resulting in much misery and penury with no economic security, no health care and no social supports [1]. The main causes of this problem has been the changed economic system (to a cash economy), massive rural-to-urban migration, the brain drain, relentless wars, political instability, the HIV/AIDS epidemic and the failure of Sub Saharan African governments to put in place and implement programs that address the needs, concerns and care of older persons [1]. This has thus left the burden of care for the elderly to relatives. With the African extended family system rapidly disintegrating, the demented elderly in Africa have suffered the most with these changed circumstances as they have become a burden to everyone. The HIV/AIDS epidemic has added more insult to injury by leaving the elderly to look after the many AIDS orphans whose parents have died [1]. There is also now a new sub-epidemic of the elderly HIV-positive individuals with significant HIV-associated neuro-cognitive disorders (HAND) which complicates the clinical picture and care of dementia in the African elderly [15]. Thus in summary, today the elderly in Africa are no longer playing the important role in society they used to. They are not acknowledged and the prevailing negative attitude towards them causes them much suffering, poor health, depressive disorders and somatic illnesses. The elderly are often segregated and marginalized leading to loneliness, loss of self-esteem and economic deprivation [3, 5–9, 11]. They are often abuse, exploited or their property stolen. Older women have even been abused sexually and physically, the latter following allegations of witchcraft practice and sorcery. A number of older persons have lost their lives, property or have been maimed in such circumstances [11].