Population aging and the challenge of dementia – 08/13/2023 – Marcia Castro

Dementia mostly affects people over 60. It leads to deterioration in cognitive function and the ability to carry out daily activities, and is a major cause of disability and dependence. It results from diseases and injuries that affect the brain, such as Alzheimer’s disease or stroke.

The World Health Organization (WHO) estimates that 55.2 million people were living with dementia worldwide in 2019. This number could reach 139 million in 2050.

In Brazil, there are about 1.8 million people over 60 years old with dementia, but the vast majority, 77%, never had a formal diagnosis. The estimate is that in 2050 Brazil may have 5.5 million people living with dementia.

Despite the expected increase in the number of cases due to population aging, about 40% of cases of dementia in the world could be prevented by changing 12 risk factors throughout life: education (before 45 years of age), hypertension, obesity, hearing loss, traumatic brain injury and alcohol abuse (between 45 and 65 years) and smoking, depression, physical inactivity, social isolation, diabetes and air pollution (over 65 years).

Considering these 12 risk factors, 48.2% of cases of dementia in Brazil could be avoided. The change is even greater among the lowest income regions (54%).

Obesity and hypertension control between 45 and 65 years old could prevent 13.2% of cases. Ensuring that people under 45 have at least eight years of schooling could prevent 7.7% of cases (9.6% among the lowest income regions).

Prevention, therefore, demands actions whose effects are long and medium term. WHO has created a global plan with seven areas of action and specific targets to be achieved between 2017 and 2025. But progress is still slow.

Stigma and discrimination are barriers to accessing diagnosis and treatment. Services required by a person with dementia include primary health care, specialist medical care, community-based services, rehabilitation, long-term and palliative care. It involves health and social care professionals, in addition to family support.

In 2019, the global cost of dementia was estimated at $1.3 trillion, about $23,800 per case. There is a lack of public long-term care networks, burdening families financially and mentally. Half of the global cost is attributed to the time devoted by family members to the care of the person with dementia.

One of the most successful models is the one implemented in the Netherlands, where people with dementia live in a village in a dignified manner, receiving comprehensive and uninterrupted care. Residents interact with caregivers, doctors, nurses and other professionals, as well as family and friends. All funded by the government.

The Netherlands model is not easy to replicate globally. But it serves as an inspiration and challenge for others to be thought of.

In Brazil, the lack of public long-term care networks, the high rate of undiagnosed dementia cases, the growing trend of obesity, diabetes and hypertension, social inequalities and the aging of the population make it clear that a national policy of long-term actions term for dementia prevention and care should be a priority.

A social agenda is needed, with a focus on equity, that addresses the life cycle, from childhood, to ensure a dignified and healthy old age. Without these actions, inequity in care will be enormous and the social cost unacceptable.

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