Martin Prince is part of our 10/66 Dementia Research Group - a global network of researchers, mainly from low or middle income countries - coordinated from King’s College London.
We have been working together since 1998 gathering evidence on the emerging epidemic of dementia in the world’s poorer countries.
Population ageing is a global phenomenon. With increases in life expectancy and reductions in fertility, countries in Europe and North America were the first to have a significant proportion of their population aged 60 and over.
These populations are continuing to age, but those in Latin America, and countries such as India and China are ageing much more rapidly and catching up fast.
While nearly two-thirds of the world’s older people now live in low or middle income countries, this figure will rise to four-fifths by 2050.
Population ageing is undeniably a triumph for humanity. However, for those who live into older age, wisdom and maturity are accompanied by a higher risk of chronic disease, and indeed multiple chronic diseases affecting different organ systems.
Such older people are more frail, and likely to experience increasing disability and needs for long-term care.
Outlook for dementia worldwide
Projected increases in numbers of people with dementia worldwide - from 36 million now, to 66 million in 2030 and 115 million by 2050 - are mainly due to population ageing.
Therefore most of this rapid increase will occur in poorer countries that are least well prepared to deal with the considerable societal costs.
Studies in high income countries suggest that costs for dementia care exceed the combined cost of cancer, heart disease, diabetes and strokes.
Dementia and other chronic diseases of the mind and brain have a particularly profound effect on disability and needs for care and support from others.
Social care costs - care in the community, residential and nursing home care, as well as the ‘informal’ care provided by families and others - are very substantial.
Health care costs are comparatively modest, but this is explained by low levels of help-seeking, and under-utilisation of effective interventions.
In low and middle income countries there is a strong reliance on family care, given that community services are rarely provided and the residential care sector is only beginning to develop.
Privately employed but untrained live-in carers are a popular option, for example in Beijing, China.
Another challenge is in diagnosing dementia, so that treatment and care can be put into place.
In high income countries up to 60% of those with dementia may never have received a diagnosis, let alone treatment and care. In many low and middle income countries this figure likely exceeds 90%.
The challenges for governments and societies worldwide are serious, but not insurmountable.
Most older people are independent, enjoy reasonable health, and make important contributions to family and community life. This applies equally to low and middle income countries.
Even with dementia, it is quite possible to ‘live well’. The important role of family carers needs to be acknowledged, incentivised, and supported.
The development of accessible, age-appropriate heath and social care services is an urgent priority. These should provide continuing care for those with dementia and other chronic diseases, and support for carers.
Martin Prince is Director of Global Mental Health at the Institute of Psychiatry, King's College London
See Martin's presentation about dementia and other chronic diseases worldwide.