News archive 2009
Dementia largest contributor to disability in elderly27 Nov 2009, PR 259/09
Dementia, rather than visual impairment and blindness, is the largest contributor to disability in elderly people in low- and middle-income countries. This is the conclusion of an article published in this week’s disability special issue of The Lancet, written by Renata M. Sousa from the Institute of Psychiatry at King's and colleagues from the 10/66 Dementia Research Group.
Disability in older people in countries with low and middle incomes is little studied. Numbers of older people are expected to increase particularly rapidly in these regions, from 490 million to 1.6 billion between 2010 and 2050. Chronic diseases are also on the rise, partly because of this process of demographic ageing - most chronic diseases occur more commonly in older people.
However, chronic disease risk factors such as smoking, unhealthy diets and sedentariness are also becoming more common due to urbanisation, industrialisation, dietary and behavioural change.
Much of the focus on chronic diseases in countries with low and middle incomes has been on cardiovascular disease and cancer, conditions linked more to mortality rather than years lived with disability. In this study, the authors assessed the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability.
The study looked at around 15,000 people aged 65 years or older in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru), and worked out the proportion of disability that was due to each ailment, referred to as the population-attributable prevalence fraction (PAPF).
The team found that in regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25 per cent). Other substantial contributors were stroke (11.4 per cent), limb impairment (11 per cent), arthritis (10 per cent), depression (8 per cent), eyesight problems (7 per cent), and gastrointestinal impairments (7 per cent). Associations with chronic diseases accounted for around two-thirds of prevalent disability.
The authors conclude: ‘On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous.’
Notes to editors
The 10/66 Dementia Research Group
The 10/66 Dementia Research Group is a collective of researchers carrying out population-based research into dementia, non-communicable diseases and ageing in low and middle income countries. 10/66 refers to the two-thirds (66%) of people with dementia living in low and middle income countries, and the 10% or less of population-based research that has been carried out in those regions. 10/66 is a part of Alzheimer's Disease International, and is co-ordinated from the Institute of Psychiatry at King's College London. For more information visit http://www.alz.co.uk/1066.
King's College London
King's College London is one of the top 25 universities in the world (Times Higher Education 2009) and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 21,000 students from nearly 140 countries, and more than 5,700 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org.
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