Seeing Through the Haze - A Look at Asia’s Ageing Population and Dementia
Despite haze from distant forest fires obscuring the horizon, Singapore proved a revealing place to visualize the impact of the ageing population on the Asia Pacific region. The recently held Singapore Actuarial Society conference focused on health and retirement, and I had the pleasure to be a speaker.
The population of the Asia Pacific region is about 4 billion and 11% are over age 60, growing to 25% by 2050. The largest rise is in the “oldest old”. If current prevalence remains stable, the number of people living with dementia in Asia will triple. The figures are truly staggering - in China alone there will be an additional 20 million people living with cognitive impairment.1
Alzheimer’s Disease International has identified a number of challenges unique to Asian countries where awareness of dementia is limited. The cultural context often denies the condition exists because of the attendant stigma or an assumption cognitive impairment is an inevitable result of ageing. Much of the region lacks the human and financial resources to raise awareness, train professionals or manage care appropriately. Most areas lack even rudimentary structures to help the majority with dementia or support those who care for them.
Because this region is so diverse, the approach to dementia is unlikely to be identical in any two countries. However, significant possibilities exist for risk reduction programmes. Up to 66% of the population-attributable risk for dementia can be laid at the door of modifiable factors such as smoking, obesity, diabetes and hypertension.2 Reductions have been seen in the UK prevalence of dementia, attributed to the management of cardiovascular risk factors with calls for greater input into public health preventative measures.3 This link to these other disorders means they can be given priority. This is particularly helpful when the full impact of dementia itself is not recognized.
China’s adult overweight and obesity prevalence has doubled in the past 30 years and diabetes has grown substantially, yet another health problem that has been labelled an epidemic.4 In all, 2% of Alzheimer’s cases worldwide are linked to diabetes so interventions to reduce diabetes should have a significant impact on dementia rates.5
The sophistication of public health policy also varies greatly across Asia Pacific. There is a sense that awareness is being raised at the government level as part of a general response to population aging.6 The Singapore Actuarial Society conference sought to address the issue of fiscal support, not only through the state but also by developing a series of creative solutions tailored to both the individual and local markets.
Long Term Care (LTC) insurance provides cover against the risk of becoming too frail to care for oneself without physical assistance from another person despite using assistive devices. Even though the need is evident for setting aside funds for future care costs of an ageing population, few governments have acted to create public funding systems, whilst the uptake of private LTC insurance policies has lagged far behind expectations in almost all markets.
In the UK public-private partnerships have proved hard to forge. However, the relative blank canvas in Asia Pacific could lead to dynamic solutions. Singapore’s own ElderShield programme, an insurance scheme set up in 2002 and run by the Ministry of Health that provides a basic level of care for most of the population, is an example of this creativity.7
Although Alzheimer’s Disease International warns of the potential cultural problems for those experiencing dementia, it is important to learn lessons about the way care can be developed in this particular context and not merely transpose the models developed in post-industrial Europe and the U.S.8
It might be difficult to see very far out of the window on a hazy day in Singapore, but it is worth watching developments here and across the region. The future will bring innovative solutions, widening the possibilities in places where dementia awareness has a longer history.
- J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2015-310548.