L57 - Impact of degnerative diseases on public health and ageing population

Question 1

Factors for global ageing?

Answer 1

1. Increasing longevity

2. Decreasing newborn/ Sharp decreases in fertility rates below replacement level

Question 2

Difference between life expectancy and life expectancy at birth?

Answer 2

Life expectancy: average number of years an individual of a given age is expected to live if the current mortality rates continue to apply

Life expectancy at birth: average number of years a newborn is expected to live if mortality patterns at the time of its birth remain constant

Question 3

Define fertility rate

Answer 3

average number of children that would be born to a woman over her lifetime

Question 4

Why is poplation aging a more serious problem in low and middle income countries?

Answer 4

Similar/ double the disease burden as high-income countries, but has poorer accessibility to affordable health care

Question 5

Projected proportion of aging population in HK by 2040?

Answer 5

significant increase in both the number and proportion

double proportion of over 65 and over 85 from now

Question 6

List some health issues in elderly populations.

Answer 6

1. Increase multiple concomitant health problems: NCDs, neurodegenerative …etc
2. Decreased functional capacity
3. More disabilities causing dysfunction and dependency

Question 7

Factors that affect one’s functional capacity over lifetime? (think life course approach)

Answer 7

Changes in the environment&raquo_space; lower the disability threshold

Difference in lifestyles: diets, levels of physical activity, consumption of tobacco…

Question 8

Define ADL and IADL and how they relate to functional capacity/ dependency

Answer 8

Activities of Daily Living (ADL): Severe functional disabilities & define dependency
i.e. Dressing, Eating, walking…

IADL (Instrumental Activities of Daily Living): Less severe than ADL, but clearly cause dysfunction and lead to dependency
i.e. Shopping, Housekeeping

Question 9

List 2 major causes of dementia?

Answer 9

Alzheimer’s Disease = the commonest type (about 65%)

Vascular Dementia = due to multiple minor strokes = affects about 30%

Question 10

How does the incidence of dementia change with age?

Answer 10

Incidence of dementia increased with age and approximately doubled for every 5 years

one in four older persons by the age of 90

Question 11

Give reasons for the diagnosis and treatment gap for dementia?

Answer 11

• Usually late dx
• Low number of formal diagnosis
• Lack of access to treatment, care and support

Question 12

Describe the screening process of dementia? Is there routine screening?

Answer 12

No programme of routine screening

Opportunistic screening of cognitive impairment in primary health care:

• Mini-mental state examination MMSE
• Abbreviated Mental Test (AMT)

Question 13

What clinical presentation elicits suspicion of dementia?

Answer 13

• Impaired memory
  +
• Impairment in at least one other area of higher cognitive functioning
• Clear signs of interferance with normal social and executive functioning

Question 14

Treatment options for dementia?

Answer 14

No cure*

• Meds for improving memory and cognitive functions
• Meds for psychiatric disorders: depression, insomnia …etc
• Behavioral therapy
• Counseling, support groups

Question 15

Discuss the public health impact of dementia: perception of dementia in society, role of the healthcare system and families?

Answer 15

• General lack of awareness and understanding of dementia&raquo_space; stigmatization
• Heavy Physical, psychological and economical impacts on patient and families
• Most caregiving is provided by informal caregivers, NOT healthcare system (i.e. spouses, children)

Question 16

Discuss the burden of caretaking for dementia patients on informer caregivers.

Answer 16

• themselves prone to mental disorders (e.g. depression & anxiety)
• themselves often in poor physical health
• economical impact on work flexibility

Question 17

Compare the costs of dementia in informal care, direct costs of social care and medical care.

Answer 17

Majority of cost = Cost of informal care, direct cost of social care (i.e. community services)

Minority = Direct medical cares are very low in comparison

Question 18

List ways to improve the disease burden of dementia. (4)

Answer 18

• Make demnentia a public health and social care priority
• Promote understanding of dementia
• Invest in health and social systems to improve care
• Increase research on dementia

Question 19

Comment on the global economic impact of dementia?

Answer 19

1% of the world’s gross domestic product (GDP)

US$604 billion