Everyone would like to reach a ripe old age. For the last half of the 20th century global aging has been a success story. That success will have an enormous impact on our societies over the next 50 years. Globally, the number of people over 60 will rise to 2 billion by 2050. But there is another side to this, as the number of people with dementia will also rise dramatically. Though dementia research is promising, governments around the world must prepare for a future global dementia crisis.
The recent story of aging is something unprecedented and without parallel in the history of any country in the world. The global impact of aging has been reported in a variety of government and scientific journals, most recently by the United Nations.(1) The figures shown in this report are astonishing. The number of people over 60 years old dramatically increased to 600 million in the year 2000, which was three times the number recorded in 1950. But the number will more than triple again by 2050, when it is expected to reach 2 billion, in other words 22 percent of the global community. In fact, the number of older people is increasing by 2.6 percent a year, compared with 1.1 percent for the whole population.
It is a fantastic achievement that so many people reach a respectable age because of medical and technological advances. They are able to enjoy a new phase in their life, after having worked hard for many years. However, the changing composition of our societies will lead to a structural shift that our global society may not be prepared to handle. Can we deal with it as governments, or as health suppliers or even as charities? There are three reasons for me to be concerned about aging. First, the imbalance between the numbers of older people compared with potential workers, the speed of the aging process in developing countries, and finally the prevalence of Alzheimer’s Disease and other forms of Dementia in relation to age.
WHO WILL CARE FOR THE ELDERLY?
Figure 1 shows the ratio of the number of people aged 15 to 64 compared with those over 65. Between 1950 and 2007 this ratio dropped from 12 to 9. It is estimated to decrease even further to 4 by the year 2050. Consequently, it will be more difficult to find people to work as professional caregivers, and to fund the pensions of retired people. This is a challenging situation and I don’t have an easy solution. Obviously we can’t continue to rely on institutional care in the way that we have for decades. As the next generation approaches retirement age, they will need to ensure that they are capable of providing for a larger part of their own care. Governments will have to develop strategies to encourage this kind of planning. It also means that we will have to change the way we think about care. For instance, we should focus on keeping our elderly population as self-sufficient as possible in terms of allowing them to deal with their own day-to-day activities and refrain from taking over every single aspect of their daily life.
AGING IN DEVELOPING COUNTRIES: A LOOMING CRISIS
At the moment, the aging population in lower and middle-income countries, especially in Asia and Latin America, is growing much faster than in developed countries around the world. Extending longevity took a century to evolve in Western countries. It is likely to reach the same levels in only 25 years in countries like China and South Korea. This is a dramatic change and policy makers in Asian countries are looking at ways to cope with the effects of aging. Within Alzheimer’s Disease International (ADI), we see associations in South-East Asia developing strongly in an almost breath-taking way. Whereas many associations didn’t exist a few years ago, a growing number of associations have developed well planned initiatives to educate policy makers about the needs of people with dementia.
THE CHALLENGE OF ALZHEIMER’S
In 2001, the number of people worldwide with Alzheimer’s Disease and other forms of dementia(2) was calculated to be 24 million(3). Researchers expect this number to rise to 43 million by 2025 and to 81 million by 2050. [See Figure 2] This means that every 7 seconds there is a new case of dementia somewhere in the world. Dementia affects more people than only those who live with the disease as the pressure on families is immense which is why they need support mechanisms such as national Alzheimer’s associations.
At the moment, researchers are diligently working to understand what causes dementia. There is no cure for it and only a few drugs that slow the disease down, especially in the early stage. Therefore, early detection is vital but because of the stigma surrounding dementia it is very difficult for people to notice or accept that they may be suffering from the disease. One of the main roles of ADI is to break the taboos and raise more awareness about dementia, stressing that it is a disease and not a normal part of aging. If we talk openly about the disease, we can also educate people to understand and cope with it and hopefully achieve a better quality of life.
ADI also has an important role to play in developing and strengthening the national Alzheimer associations that have been established recently. We produce a wide range of educational materials to encourage countries to share best practices with each other. Our regional conferences and training programs as well as ADI’s Twinning Program enables member associations to get one-to-one technical support. One successful example from this program is the support given by Alzheimer’s West Australia to the Pakistan Alzheimer association which led to the creation of a day-care center in Lahore.
Thanks to the work of the 10/66 Dementia Research Group we have learned a lot about the prevalence of dementia in countries throughout Asia, Latin America and Africa during recent years.
The name of this group refers to the fact that 66 percent of all people with dementia live in developing countries, where less than 10 percent of the research money is spent. The group unites some 130 researchers and is currently working in 11 countries where already over 15,000 patients have been interviewed (assessed) and diagnosed. Thanks to this research we now know more about prevalence numbers, both in cities and rural areas, but also about the effects of dementia on families and communities.
Finally, ADI is involved in advocacy as the organization represents people with dementia on a global level. Prior to 2007 we only supported our members in their own public policy activities by providing training courses and collecting and sharing information, but from this year on we are going to coordinate a strategy towards the World Health Organization (WHO) in order to make sure that dementia is high on their priority list.
Marc Wortmann was born in Groningen in the Netherlands in 1958. He studied Law and Art in the city of Utrecht. He was Executive Director of Alzheimer Nederland from 2000 to 2006 and was Vice-President of the European Fundraising Association until October 2007. He has been a speaker at many international conferences on fundraising, campaigning, raising awareness, public policy and ethical issues. At the end of 2006 Marc joined Alzheimer’s Disease International as Executive Director.
Alzheimer’s Disease International (ADI) was founded in 1984 in Washington, DC by members of Alzheimer’s association of the USA, Canada, Australia and the UK; just a few years after these associations were founded in their own countries. ADI’s office is based in London. In 2007 there are 77 member countries. They meet once per year at the annual conference. ADI also supports its members by organizing the Alzheimer University training courses twice a year and other projects. 21st of September is appointed by the UN as World Alzheimer’s Day which ADI is coordinating every year. You will find more information on www.alz.co.uk. This website is also a portal to find national associations around the world.
(1) World Population Ageing 2007, United Nations Department of Economics and Social Affairs.
(2) Other dementia’s are for instance Vascular Dementia, Lewy Body Dementia and Frontotemporal Dementia. Of all types of Dementia it is estimated that 60-65% is caused by Alzheimer’s Disease.
(3) Numbers publicized in the Lancet, Global Prevalence of Dementia, Ferri et al, December 2005.