More dementia care urged for Middle East as case numbers forecast to soar

Global report finds most nations unprepared for population care needs.

Demand for specialist elderly care is set to soar in the next 30 years, with the Middle East and North Africa said to be far behind with provisions to deal with dementia and Alzheimer's.

An annual report by Alzheimer’s Disease International (ADI), in association with the World Health Organisation, predicted the number of people living with dementia worldwide will rise to 139 million by 2050, up from about 55 million today.

There are currently almost 3 million dementia suffers in the Mena region, with cases predicted to rise by 367 per cent to more than 14 million by 2050.

Alzheimer’s is the most common form of dementia, a general term for memory loss and cognitive decline.

Due to underreporting and lack of diagnosis in the Middle East, the projections for the region, with its fast-growing population, are far higher than elsewhere.

A 75 per cent increase in dementia cases is expected in the UK in the same time period, with a 100 per cent rise forecast for the US.

Dementia is now the seventh-highest cause of death globally and is increasing due to ageing populations, lifestyle and environmental risk factors.

Despite that, only a fifth (39 out of 194) of all WHO member states followed through with their promise to create a national dementia plan by 2025, a commitment made during the 2017 World Health Assembly.

Paola Barbarino, chief executive of ADI, said even the wealthy Gulf nations were only beginning to look at complex elderly care.

“Alzheimer’s still carries a large amount of stigma but it is a huge surprise that wealthy countries in the Middle East do not have a preparedness plan to manage this kind of social care for the future," she told The National.

In the Gulf, along with large parts of Asia, families have historically cared for elderly loved ones at home.

As a consequence, formal diagnosis is relatively rare and treatment has not developed at the same pace as other nations. Residential retirement homes are almost unheard of.

“Culturally, people want to care for family members at home in a loving environment,” said Ms Barbarino.

“But training in dementia is a massive challenge, with medical professionals, on average, only receiving around 12 hours of training in dementia care.

“There is a lot of knowledge on how it can be done properly but it is not being shared widely enough.”

Expats retiring in the Gulf

People are living longer and starting to retire in the Emirates. Holders of the renewable 10-year golden visa are now able to sponsor family members, regardless of age, though the cost of medical insurance rises with age.

More than 65,000 such golden visas have been issued in the UAE since 2019.

Residents aged 55 and older with a monthly income of Dh20,000 ($5,445), have Dh1 million in cash savings, or own Dh2m worth of property in Dubai can stay long term in the UAE, provided they have adequate health insurance.

Last year, a specialist healthcare centre for the elderly for Dubai Healthcare City was announced under a public-private partnership deal, while developer Damac in 2020 unveiled a residential community featuring easy-access bungalows for older residents who have the finances to retire.

“As we live longer we are more at risk of getting dementia and Alzheimer’s, so we must look at the services that we provide to help in this area,” said Dr Hamad Al Senawi, chairman of the Oman Alzheimer’s Society, and psychiatrist at the Sultan Qaboos University Hospital in Muscat.

“Most countries in the Middle East have signed up to an action plan on dementia but some have gone into financial crisis so are unable to fund a plan.

“Covid has had a financial constraint on health services so dementia has taken a back seat. It was a big hit, as dementia care was already struggling.”

Drug treatment

Countries such as the UAE have been quick to approve drugs that could slow cognitive degeneration.

In October 2021, the UAE became only the second country to approve the use of Aducanumab, the first and only drug for the treatment of early stage Alzheimer’s.

A working national dementia plan has several modules in which nations must pass to qualify as having an adequate programme recognised by the WHO.

“It is not a case of one size fits all for these plans, as every nation is different,” said Dr Al Senawi.

“It depends on the percentage of older people in the population and economic ability to develop a plan.

“But the expense of developing a sophisticated individual national plan and without a dementia registry, it can be challenging to plan services.

“A very small number of people with dementia get diagnosed, as family members think it is a normal part of ageing, that can make it challenging to gather accurate data.”

In an Alzheimer’s Disease International survey in 2019, 62 per cent of healthcare professionals thought dementia was part of the normal ageing process, rather than a preventable disease.

To measure progress, ADI distributed a survey in January to 133 nations associated with a national Alzheimer's or dementia organisation.

Not always a 'very old person's disease'

Prof Tareq Qassem works at the Al Amal Hospital group of hospitals, which has in and outpatient services specifically for old age.

“Facilities are increasing and we are expanding," he said. "We now have a memory clinic and cognitive referral therapy unit.

“Our young generation now will become elderly and have more dementia."

He stressed that Alzheimer's was not always a disease of the "very old", with at least 5 per cent of patients suffering an early onset of the condition.

"Alzheimer’s is not synonymous with being old and it is getting more recognised," he said.

“The pandemic was problematic in all sorts of ways, with a lot of people showing significant decline after Covid.

“When people stay at home, they get physical complications and that can impact on cognitive performance.

“Sitting at home doing nothing is a killer.”

Most nations in the Middle East, Africa, South America and eastern Europe had no national dementia plan in place, while some were still under development.

Dr Ahmad Al Khayer, medical director at NMC Provita in Abu Dhabi, said dementia care planning has been set back as a result of the pandemic and shifting priorities.

Insufficient diagnostic and screening tools result in many people with dementia remaining undiagnosed without access to treatment and support.

“The UAE has historically been a working community and the golden visa is still new so there will be new services in place in the future to support retirement here,” said Dr Al Khayer.

“If you have dementia, you can visit any doctor for an examination and treatment.

“There is a good basic level of insurance that covers day-to-day needs and emergencies that can be purchased.

“The approach to social care is different here, with more reliance on families taking care of the elderly.

“But as we become more aware of their needs, it will continue to develop.

“In our culture, we like to keep people around at home as long as possible but there is room for improvement in what dementia care is available.”