Abstract
As the median age of populations around the world increases, due to the provision of better diets and better medical care, the number of elderly persons vulnerable to mental illness will inevitably increase too. We are not good at providing high-quality geriatric care, even in high-income countries. For example, Age Concern (a UK-based charity) states on its website: ‘Health and social care services have made some progress in tackling age discrimination‚ but older people still report feeling that they have had second class treatment and care simply because of their age’ (www.ageconcern.org.uk/AgeConcern/ageism-in-healthcare.asp). How much worse these matters are in low- and middle-income countries is the subject of our theme in this issue. We have drawn articles from three distinct geographic regions: India, Africa and South-East Asia. We often assume that cultural factors in lower-income areas lead to greater respect for, and better care of, the elderly than we experience in many parts of the Western hemisphere. This appears to be a misapprehension, and attitudes towards the elderly are changing as the impact of industrialisation increases.
Dr Henry and colleagues discuss the importance of supporting those caring for elderly people in India, and the services that could be provided for a geriatric population with a range of dementias, psychoses and emotional disorders. Group sessions aimed primarily at supporting the carers of elderly relatives appeared to be of some benefit.
The article by Drs Clausen and Wilson addresses a wider issue: the prospect of an ageing population in Africa. They point out that health budgets are severely limited for all African countries, and that priority is given to the needs of the younger generations, who are economically active. As the longevity of African adults increases in years to come, it is essential to maintain as high a proportion as possible of the ageing population in economic activity. This will entail a tradeoff between the cost of providing social and medical care, and the ability of that population to contribute to wealth generation. Currently, the provision of services to older patients with mental illnesses in most African countries is non-existent.
Finally, Professor Kua Ee Heok discusses the hidden burden of dementia among the elderly in South-East Asia. There is evidence that a very small proportion of all cases have been identified, and this is in part attributable to inadequate training of general practitioners. But even if identification were to be improved, would this lead to a higher priority being given to the care of elderly people with mental illness in the health services of that region? There is a change coming in the attitude of young people, who traditionally have cared for their extended families in multigenerational homes, such as the hutongs in Beijing. These young people want to live apart from their parents nowadays, in modern apartments, and community services have yet to compensate for that rapid change in cultural attitudes.