|By Jose M. Martin-Moreno, MD, DrPH
Dean, National School of Public Health of Spain
President-Elect, Association of Schools of Public Health in Europe (ASPHER)
|Dementia as a Public Health problem: its importance and related challenges|
|The substantial increase in the absolute and relative numbers of older people both in developed and developing countries can be considered as one of the main features characterising the world population in the 20th Century. By 2020, the world population aged 60 years and older will exceed one billion, with more than 700 million living in developing countries. It is estimated that the total number of people currently affected by the various forms of dementia (of which Alzheimer’s disease is the most frequent) stands at 29 million. Yet by 2020, this figure may well surpass 55 million in Africa, Asia and Latin America alone. In some of the oldest age groups, dementia can reach the astonishing prevalence of 25%. Caring for this huge amount of people with dementia not only consumes a large proportion of national resources but also represents a tremendous emotional and financial burden on family members and care-givers alike.Population ageing has become an important development issue requiring urgent action. Projections show that ageing aggravates the magnitude of mental health problems and, as such, has a major impact on any given population’s overall level of mental health. This is inevitable, owing to the increasing life expectancy of those with mental disorders and the likelihood of an ever-growing number of people reaching an age at which the risk of such disorders is high.Incidence of dementia increases markedly with age, from about 1 per 1,000 person-years and over, with evidence to show that incidence is slightly higher in north-western versus southern Europe. These findings indicate that the European Union can expect to have nearly half a million dementia patients every year. Furthermore, these data confirm that such persons -women more so than men- are increasingly likely to need home-based nursing care. Among dementia sufferers, women also tend to survive longer than men.The social and economic impact must be viewed from two different perspectives: 1) the suffering, social restrictions and economic burden experienced by the patient and his/her family; and, 2) the voluntary social assistance which should be provided plus the financial burden to be covered by society as a whole. The progressive severity of dementia renders the patient increasingly dependent on family, professional and, in the latest stages, institutional help and care.
In years to come, health-care systems in Europe will be placed under increasing pressure and cries for reform will become ever louder. Despite the fact that the population is ageing and that there has been a drop in the fertility rate, accompanied by a logical decrease in the active population, public expectations of health-care system are nonetheless on the rise. The European Parliament is concerned at the problem posed by age-related death and disease. It has called on the European Commission to submit a specific programme of measures addressing Alzheimer’s disease. In the period 1994-1998, the European Parliament passed a budget amendment, allocating 9.1 million ECUS specifically to Alzheimer’s disease. The Commission has published an annual announcement in the Official Journal of the European Communities calling for ADRD-project proposals. Issues such as policy and economic questions, equity, treatment and interventions, training, ethics, communication and information, and informal care will need to be tackled in a spirit of teamwork and the keenest possible collaboration. The initiative put forward by the European Institute of Women’s Health is to be commended, and the report must certainly be welcomed as a most valuable tool with which to face the challenges lying ahead in the field of Dementia Care in Europe.
Jose M. Martin-Moreno, MD, DrPH