Mohamed Aly Pasha

1769-1849

“ 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 llDied 96 years old

Reigned 65 years

200 wives, 156 children,

(96 sons 60 daughters)

Ramses llDied 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 StructureThe elderly population in

Egypt

3.242

4.4626.557

9.814

14.103

0

20

40

60

80

100

120

140

millions

1990 2000 2010 2020 2030

60+

Total

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)

0%

5%

10%

15%

20%

25%

30%

35%

Living Arrangements

Alone

Spouse only

Spouse & marriedchildren

Married children

Unmarried children

Relatives

Female role

• Education• Employment

Factors causing transition

• Increased longevity

• A shift towards nuclear family

• Migration

Factors causing transition Egyptians > 60 years

0

2

4

6

8

10

12

14

16

millions

1990 2000 2010 2020 2030

Factors causing transition Egyptians > 80 years

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

millions

2000 2010 2020 2030

Factors causing transition Migration

External Migration– Middle East– West

Factors causing transition Rural to Urban population in

Egypt1950

57%

43%

% rural

% Urban

2000

44%

56%

2025

29%

71%

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 4 458 882 estimated elderly cared for in the community in 2000

• Leaving 14 099 743 estimated elderly cared for in the community in 2030

Caregiver Burden for Dementia

Study on 40 carers (1999) showsFemales are the primary caretakersMost 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 EgyptAbido 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

FindingsAbido et al. 2000

• 1 carer in 70% of cases• 2 carers or more 30%• 43% working full time and 57%

housewives

Findings Abido et al. 2000

Patient related factors increasing caregiver stress

• Behavioural symptoms in dementia• ADL abilities• Sleep disturbance• Incontinence

FindingsAbido et al. 2000

Carer related factors• Gender• Occupation• Economic status• Support from other family members

Findings Abido et al. 2000

• 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

1769-1849