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Global Mental Health > Ageing populations and mental health > Flashcards

Ageing populations and mental health Flashcards

1
Q

What characterises the increase in people age 60 or over in the world?

A

Sharp increase in those aged 60 or over in less developed regions

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2
Q

What is the contributions of developed and less-developed regions to demographic ageing between 1950 and 2050?

A

> 1950: just over half of world’s population aged 60+ lived in less developed regions

> By 2050: 80% will live in less developed regions

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3
Q

What is observed in the speed of ageing in less and more developed countries?

A

Much faster speed of ageing in less developed regions compared to more developed countries

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4
Q

What is the demographic/epidemiological transition?

A

As people live longer, chronic diseases become more prevalent

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5
Q

What exacerbates the trend of demographic/epidemiological transition?

A

Changes in lifestyle and behaviours that predispose to chronic diseases
- increased high fat, salt and sugar diets and tobacco use

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6
Q

What is the current burden of neuropsychiatric conditions in the LMICs and HICs?

A

High burden of neuropsychiatric conditions in LMICs and HICs

- high level of DALYs estimated among people aged 60+

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7
Q

What is dementia?

A

A syndrome
- characterised by progressive cognitive impairment (memory, language, thinking, judgement)

  • many underlying causes: Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, frontal temporal dementia
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8
Q

What makes dementia a condition of later life in terms of prevalence?

A
  • Around 5% of cases have onset before age 60

- Prevalence doubles with every 5 year increase in age

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9
Q

What are the states of awareness and help-seeking in dementia?

A

Low levels of awareness and help-seeking

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10
Q

Why are there low levels of arenas and help-seeking in dementia?

A
  • Symptoms considered ‘normal part of ageing’
  • “Nothing can be done”
  • Stigma and shame
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11
Q

What is the societal impact of dementia?

A

> Large treatment gap

> Huge cost through medical, social and informal care

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12
Q

What characterises the large treatment gap of dementia?

A
  • Half to 2/3 not diagnosed in HICs

- over 90% of cases are not diagnosed in LMICs

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13
Q

What is the impact of dementia at level of the person and its relatives and caregivers%

A

> For the older person:

  • dependance and disablement
  • need for care

> For relatives and caregivers:
- increased risk of strain and psychological comorbidities

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14
Q

How does dementia contribute to disability in LMICs?

A

Dementia in LMICs represents 25.1% of the disabled mean population

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15
Q

What is observed in the epidemiology of the global dementia epidemic?

A

Dementia prevalence appears to be much higher in Europe

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16
Q

What are the potential explanations to why the prevalence rates of dementia are lower in areas of LMICs than Europe?

A
  • Low rates of cardiovascular diseases?
  • Methodological issues?
  • Different gene/environment interactions?
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17
Q

What was the global prevalence of dementia in 2004?

A

24.3 million people with dementia

18
Q

What was the global prevalence of dementia in 2020?

A

42.3 million people with dementia

19
Q

What is estimate of the global prevalence of dementia in 2040?

A

81.1 million people with dementia

20
Q

What is observed globally that contributes to the significant differences of prevalence rates of dementia between areas of LMICs?

A

Lot of missing data (prevalence unknown) in multiple areas of LMICs (e.g. Africa)

21
Q

What is the scope of the work of the 10/66 Dementia Research Group?

A

> Pilot studies (1999-2002)

> Population-based surveys - baseline phase (2003-2009) in Latin America, India, China, Nigeria

> Incidence phase (2008-2010)

  • risk factors
  • course and outcome of dementia

> INDEP study (2011-2014)
- socioeconomic impact of needs for care on household functioning

> LIFE2YEARS - 3rd wave - focus on frailty (2015-2019)

22
Q

What was observed about the prevalence of dementia according to the DSM-IV compared to the 10/66 criteria (Rodriguez et al., 1999)?

A

Prevalence is found higher with 10/66 criteria than previously reported with DSM-IV

23
Q

Why did the prevalence of dementia was higher using the 10/66 criteria compared to the prevalence rates with the DSM-IV?

A

Probably because 10/66 criteria would detect cases of dementia at milder stages than the DSM-IV at the time

24
Q

What is the consequence of the big difference between the criteria DSM-IV and 10/66 in the prevalence of dementia?

A

Leads us to question the validity AND relevance of DSM-IV criteria

25
Q

What lead to the 2009 revision of the global number of people living with dementia by Alzheimer’s Disease International?

A
  • Expansion of global evidence base

- Revision of WHO estimates

26
Q

What is happening to the global and regional incidence of dementia since 2015 (Prince et al., 2015)?

A

Numbers rapidly increase, especially in LMICs

27
Q

What is happening to the number of published prevalence studies on dementia since the mid 1990s (Prince et al., 2015)?

A
  • Decrease in number of studies in HICs

- Increase in number of studies in LMICs

28
Q

Where are most prevalence studies on dementia published nowadays?

A

In LMICs

29
Q

What did the newly reported evidence in LMICs show in the World Alzheimer Report 2015 (Prince et al.)?

A
  • Increase in prevalence rates of dementia especially in Africa and East Asia
  • Estimation that 58% of people with dementia in the world live in LMICs
  • Proportion of people with dementia living in LMICs estimated to increase to 68% in 2050
30
Q

What is the global distribution of dementia costs (Prince, 2015)?

A
  • 87,4% of global yearly dementia costs in HICs

- 10% in LMICs

31
Q

What does the global distribution of dementia costs by sector show (Prince, 2015)?

A
  • For direct medical and social costs: LMICs are the lowest contribution to the global costs of dementia

BUT

  • For informal care costs: LMICs are the biggest contribution (69.2%) to the global costs of dementia
  • > no balance with social costs in LMICs
32
Q

What is the impact of dementia?

A

Increase in care needs and dependence (higher in LMICs vs. HICs)
-> comorbidities for caregivers

=> High health costs

33
Q

What is the burden of dementia on family networks?

A
  • Onset of dementia in older people forces families to set up their own care arrangements
  • In LMICs: those suffering of dementia usually still live with their families (up to 3 generations together)
34
Q

What is the gender proportion for the main carer for people with dementia?

A

In up to 80% of cases, main carer is a woman

35
Q

What are the care needs for people with dementia?

A

> 3 to 4 hours of personal Activities of Daily Living (ADL) care per day
- 8 hours in cases for people with severe dementia

> Caregiver strain in LMICs is as high as in HICs
- caregivers frequently give up paid work to care, or hire paid caregivers

> Dementia not associated to help seeking (vs. physical illness or depression)
- 50% or more of people with dementia used no healthcare services in previous 3 months

36
Q

What is the problem associated with the demand for dementia care?

A

Dementia is a hidden problem

  • little awareness
  • problem is not medicalised
  • no help-seeking
37
Q

What is the problem associated with the supply of dementia care?

A

Health services do not meet needs of older people

  • no domiciliary assessment/care
  • clinic based service
  • no continuing care
  • ‘out of pocket’ expenses
38
Q

What are the social changes that put pressure on dementia care?

A
  • Women’s changing roles in society
  • Increasing employment / more formal jobs
  • Declining fertility
  • Mobility / migration
39
Q

What are the global implications of dementia?

A
  1. Rise dementia = new epidemic of unprecedented proportions
  2. Effects fall particularly on LMICs which are the least prepared
  3. Rising costs for society in terms of long-term care
40
Q

What is needed to face the new global dementia epidemic?

A

> Scalable models of evidence-based clinical care

> Social policy on long-term care

> Exploring the means for dementia prevention

> Monitoring population health, access to services, and equity

Global Mental Health (14 decks)

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