Ageing populations and mental health Flashcards
What characterises the increase in people age 60 or over in the world?
Sharp increase in those aged 60 or over in less developed regions
What is the contributions of developed and less-developed regions to demographic ageing between 1950 and 2050?
> 1950: just over half of world’s population aged 60+ lived in less developed regions
> By 2050: 80% will live in less developed regions
What is observed in the speed of ageing in less and more developed countries?
Much faster speed of ageing in less developed regions compared to more developed countries
What is the demographic/epidemiological transition?
As people live longer, chronic diseases become more prevalent
What exacerbates the trend of demographic/epidemiological transition?
Changes in lifestyle and behaviours that predispose to chronic diseases
- increased high fat, salt and sugar diets and tobacco use
What is the current burden of neuropsychiatric conditions in the LMICs and HICs?
High burden of neuropsychiatric conditions in LMICs and HICs
- high level of DALYs estimated among people aged 60+
What is dementia?
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
What makes dementia a condition of later life in terms of prevalence?
- Around 5% of cases have onset before age 60
- Prevalence doubles with every 5 year increase in age
What are the states of awareness and help-seeking in dementia?
Low levels of awareness and help-seeking
Why are there low levels of arenas and help-seeking in dementia?
- Symptoms considered ‘normal part of ageing’
- “Nothing can be done”
- Stigma and shame
What is the societal impact of dementia?
> Large treatment gap
> Huge cost through medical, social and informal care
What characterises the large treatment gap of dementia?
- Half to 2/3 not diagnosed in HICs
- over 90% of cases are not diagnosed in LMICs
What is the impact of dementia at level of the person and its relatives and caregivers%
> For the older person:
- dependance and disablement
- need for care
> For relatives and caregivers:
- increased risk of strain and psychological comorbidities
How does dementia contribute to disability in LMICs?
Dementia in LMICs represents 25.1% of the disabled mean population
What is observed in the epidemiology of the global dementia epidemic?
Dementia prevalence appears to be much higher in Europe
What are the potential explanations to why the prevalence rates of dementia are lower in areas of LMICs than Europe?
- Low rates of cardiovascular diseases?
- Methodological issues?
- Different gene/environment interactions?
What was the global prevalence of dementia in 2004?
24.3 million people with dementia
What was the global prevalence of dementia in 2020?
42.3 million people with dementia
What is estimate of the global prevalence of dementia in 2040?
81.1 million people with dementia
What is observed globally that contributes to the significant differences of prevalence rates of dementia between areas of LMICs?
Lot of missing data (prevalence unknown) in multiple areas of LMICs (e.g. Africa)
What is the scope of the work of the 10/66 Dementia Research Group?
> 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)
What was observed about the prevalence of dementia according to the DSM-IV compared to the 10/66 criteria (Rodriguez et al., 1999)?
Prevalence is found higher with 10/66 criteria than previously reported with DSM-IV
Why did the prevalence of dementia was higher using the 10/66 criteria compared to the prevalence rates with the DSM-IV?
Probably because 10/66 criteria would detect cases of dementia at milder stages than the DSM-IV at the time
What is the consequence of the big difference between the criteria DSM-IV and 10/66 in the prevalence of dementia?
Leads us to question the validity AND relevance of DSM-IV criteria
What lead to the 2009 revision of the global number of people living with dementia by Alzheimer’s Disease International?
- Expansion of global evidence base
- Revision of WHO estimates
What is happening to the global and regional incidence of dementia since 2015 (Prince et al., 2015)?
Numbers rapidly increase, especially in LMICs
What is happening to the number of published prevalence studies on dementia since the mid 1990s (Prince et al., 2015)?
- Decrease in number of studies in HICs
- Increase in number of studies in LMICs
Where are most prevalence studies on dementia published nowadays?
In LMICs
What did the newly reported evidence in LMICs show in the World Alzheimer Report 2015 (Prince et al.)?
- 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
What is the global distribution of dementia costs (Prince, 2015)?
- 87,4% of global yearly dementia costs in HICs
- 10% in LMICs
What does the global distribution of dementia costs by sector show (Prince, 2015)?
- 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
What is the impact of dementia?
Increase in care needs and dependence (higher in LMICs vs. HICs)
-> comorbidities for caregivers
=> High health costs
What is the burden of dementia on family networks?
- 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)
What is the gender proportion for the main carer for people with dementia?
In up to 80% of cases, main carer is a woman
What are the care needs for people with dementia?
> 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
What is the problem associated with the demand for dementia care?
Dementia is a hidden problem
- little awareness
- problem is not medicalised
- no help-seeking
What is the problem associated with the supply of dementia care?
Health services do not meet needs of older people
- no domiciliary assessment/care
- clinic based service
- no continuing care
- ‘out of pocket’ expenses
What are the social changes that put pressure on dementia care?
- Women’s changing roles in society
- Increasing employment / more formal jobs
- Declining fertility
- Mobility / migration
What are the global implications of dementia?
- Rise dementia = new epidemic of unprecedented proportions
- Effects fall particularly on LMICs which are the least prepared
- Rising costs for society in terms of long-term care
What is needed to face the new global dementia epidemic?
> 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
