Mohamed Aly Pasha

“ The Burden of Dementia in an Extended Family Social Network - a Historical Perspective Nasser Loza & Waleed Fawzi Istanbul October 2005

Religious & moral culture Belief in life after death Historical records Migration and wars The Middle East General considerations

Ramses ll Died 96 years old Reigned 65 years 200 wives, 156 children, (96 sons 60 daughters ) Ramses ll Died 96 years old Reigned 65 years 200 wives, 156 children, (96 sons 60 daughters )

Pharaonic civilisation Djedi, a magician is congratulated by the pharaoh's son on reaching the age of 110 years : “Your condition is like that of a man who has not yet reached old age… who sleeps until the morning, who is immune from illness, without the slightest cough…”

Judaism “Show you fear from God by standing up in the presence of elderly people and showing respect for the aged. I am the LORD.” Leviticus 19:32

Islamic Civilisation Ibn Masud said, “I asked the Messenger of Allah (pbuh) which deed is the most beloved to Allah?” He said: “The prayer at its proper time.” I said: “What next?” He said: “ Filial piety to the parents.” I said: “What next?” He said: “The Holy Jihad for Allah’s sake.” (Al-Bukhari,Muslim)

Islamic Civilisation Abdullah bin Amr bin Al Aas related that the Messenger (pbuh) said: “Major sins are: To worship a partner with Allah, to disobey the parents, to kill the soul and to take a false oath.” (Al-Bukhari)

Overview Traditional structure of ME families Factors causing transition Care needs for dementia sufferers Patterns of provision of care

Family Structure The elderly population in Egypt

Family Structure Number of children (Contraception) Extended Polygamy Daughters in law

Who Cares? Community sample of 461 elderly Egyptians approached in street interviews and OP clinics. WHO study ( Sadek et al 2002)

Female role Education Employment

Factors causing transition Increased longevity A shift towards nuclear family Migration

Factors causing transition Egyptians > 60 years

Factors causing transition Egyptians > 80 years

Factors causing transition Migration External Migration –Middle East –West

Factors causing transition Rural to Urban population in Egypt

Factors causing transition Migration Rural to urban distribution in 1986: 56.1 / 43.9 vs 59 / 41 for the elderly

Systems of care Care in the community Day Centres and Day Hospitals Residential Homes Nursing Homes Care for Dementia patients with behavioural disturbances

Care needs for dementia sufferers Assistance with activities of daily living Social and psychological support Economic factors

Homes for the elderly in Egypt (2000) Cairo: 36 accommodating 1980 residents Giza 5 accommodating 183 residents Alexandria 13 accommodating 994 residents Rest of the country 27 accommodating 700 residents Total Beds for healthy elderly in Egypt 3857 residents

Leaving estimated elderly cared for in the community in 2000 Leaving estimated elderly cared for in the community in 2030

Caregiver Burden for Dementia Study on 40 carers (1999) shows Females are the primary caretakers Most frequent problems are  Exhaustion due to increased patients’ requirements  Insufficient time to care for children  Late for work  Decreased social interactions with family and friends  Fear of inheriting the disorder  Increased financial burden Hassan M, (1999). Assessment of Psychological stress facing family caregivers of elderly patients with dementia, (M. Sc. Thesis).

Caregiver burden in Egypt Abido AM, Ashour AM, Assad T, El Nahas G. (2000). Stress of geriatric patient caregivers, M.Sc. Thesis 30 psychiatric outpatients with care giving related problems in Cairo (Matareya Hospital) Assessed using –Psychiatric and medical history for patients –Assessment of financial situation –The burden Interview (Zarit, 1985) 5 cases suffering from dementia with behavioural symptoms 5 cases assessed qualitatively for medical social psychological and economical stresses and followed up after provision of support

Findings Abido et al carer in 70% of cases 2 carers or more 30% 43% working full time and 57% housewives

Findings Abido et al Patient related factors increasing caregiver stress Behavioural symptoms in dementia ADL abilities Sleep disturbance Incontinence

Findings Abido et al Carer related factors Gender Occupation Economic status Support from other family members

Findings Abido et al Carers received very limited support in the community and provision Councelling and education regarding coping techniques reduced caregiver burden substantially

Discussion Building on local traditions and values Vs. Adapting international approaches to caring for the elderly

Discussion Implications for services & research: Adopting local practices Translation & Validation of international questionnaires Developing local tools

Mohamed Aly Pasha