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Premium member Presentation Transcript Culture and Dementia: Culture and Dementia From Diversity to Partnership Helen Chiu Head, Department of Psychiatry The Chinese University of Hong KongCulture: Culture The ideas, customs, skills, arts, etc. of a given people in a given period Population Ageing: Population Ageing World Population --- 6.1 billion 80% live in developing countries Average life expectancy in developing countries: 41 years in 1950 62 in 1990 70 in 2020 By 2020, no. of people aged 60 or above > 1000 million, 70% in developing countries Slide4: Europe --- 20% 60 years 25% by 2020 oldest region in the world By 2020 --- Japan is “oldest country”, 31% 60 years 23% in N America 17% in East Asia 12% in Latin America 10% in S Asia Slide5: Nigeria New Zealand Under 15 44% 22.5% 65+ 3% 11% Life expectancy 52 77.8 Year 2000Dementia – a Worldwide problem: Dementia – a Worldwide problem In 2000, 18 millions have dementia. In 2025, an estimated 34 millions, with over two-thirds in developing countriesEpidemiology: Epidemiology Jorm et al (1987) --- prevalence rate doubled every 5 years from age 60 onwards Alzheimer’s Disease > Vascular Dementia in western countries VaD>AD in Japan, China, RussiaIncidence of dementia: Incidence of dementia Jorm & Jolley 1998 – meta-analysis of 23 studies East Asian countries, lower incidence of dementia and AD than Europe Developed versus Developing countries: Developed versus Developing countries 10/66 Dementia Research Group, Prince, 2000 – trend for dementia prevalence in developing countries lower than those in EURODEM e.g. Studies in Nigeria (Hendrie et al, 1995) and India (Chandra et al, 1998) showed very low rates of dementiaDementia in Nigeria: Dementia in Nigeria Hendrie et al, 1995, Ogunniyi et al, 2000 Survey of 2 communities (Ibadan and Indianapolis) with the same research method Age-adjusted prevalence of dementia and AD, significantly lower in Nigeria Africans than African Americans AD> VaDHendrie et al, 2001: Hendrie et al, 2001 FU after 2 years and 5 years Age-standardized annual incidence rates of dementia significantly lower among Nigeria Africans (1.35%) than among African Americans (3.24%) as well as for ADSlide12: No association between AD and ApoE4 in the Nigerians Marginal association between AD and ApoE4 in African Americans Lower cholesterol and other vascular risk factors in Nigerians ? Environmental factorsNative Americans: Native Americans AD is rare in Cree elderly living on reserves in Manitoba (0.5%), versus 3.5% in Whites (Hendrie et al, 1993) China (Chiu & Zhang, 2000): China (Chiu & Zhang, 2000) VaD more prevalent in Northern regions AD more in Southern regions ? Reasons stroke more common in the north diet other life style factorsJapan: Japan Homma & Hasegawa, 2000 37 community surveys on dementia Before 1990 VaD > AD Over 70% of surveys done after 1990 showed that AD>VaD Trend of in ADDifferences in prevalence rates of dementia across countries: Differences in prevalence rates of dementia across countries Definition of race and ethnicity Methodological issues Prevalence bias Genetic differences Environmental effectsMethodological issues: Methodological issues Problems in assessment tools and procedures; educational level; linguistic issues; test-taking behavior etc. Diagnostic criteria, in particular diagnosis of Vascular dementia Other methodological problemsPrevalence Bias: Prevalence Bias High mortality rate in developing countries (e.g. Katzman et al, 1994)Genetic Factors: Genetic Factors APOE ε4 Lower APOE ε4 => ? Lower prevalence of AD in Chinese Lack of association in sub-Saharan AfricaEnvironmental Factors: Environmental Factors Diet Vascular disease and risk factors Infectious agents Chemical neurotoxin Lifestyle and behaviour Others Culture and Dementia Care: Culture and Dementia Care Value system Role of elderly in society Attitudes towards ageing and dementia Utilization of services Provision of care Carer stressValue system and Ageing: Value system and Ageing The issue of independence In USA, emphasis on independence and individualism In China, dependency, reciprocity and obligation Chinese culture may provide an easier transition to a dependent role in old ageIndia: India 1 billion people 4% of population aged 65+ Life expectancy at birth 61 years A country with huge diversity 1,652 dialects Indian Tradition: Indian Tradition The Hindu culture prepares for old age with the disengagement theory Give up one’s authority over family and property and devote to self-realization Indian social norms – care of elderly by family Now states of elderly and traditional care undermined India: India Patel & Prince, 2001 Dementia regarded as normal part of ageing not requiring medical care Primary health physicians rarely saw patients with dementia Family care less reliable than before Japan: Japan 126 million 17% of population aged 65+ Life expectancy at birth 81Japan: Japan Elderly people prefer to be looked after by relatives Eldest son providing care Reluctance to use public service Carers’ concern for others’ opinions => utilization of public service (Arai et al, 2000)China: China 1.26 billion people 7% of population aged 65+ Life expectancy 71 Ancient history Huge diversityChina: China Poor awareness of dementia Dementia sufferers frequently not receiving service Stigma of mental illness and dementia Tradition of family care and filial piety Low rate of admission to residential servicesHong Kong China: Hong Kong China 6.8 million people 10.5% of population aged 65+ Life expectancy 80 British colony for over 100 years Returned to Chinese rule in 1997Hong Kong: Hong Kong in filial piety and respect for elderly trend of nuclear family crowded living area high rate of admission to residential facilities high level of carer stress Chung, 2000 – Preference to use external events to explain occurrence of dementiaCaregiving Experience: Caregiving Experience Janevic et al, 2001 21 studies White caregivers more likely to be spouses White caregivers tend to report greater depression than African American caregivers Findings in other groups more mixed Dementia Care – A Global Challenge: Dementia Care – A Global Challenge Particularly in developing countries Rapidly rising elderly population Breakdown of traditional family support Lack of awareness Lack of services Large rural areas Low priority by government Culture and Dementia -- Partnership: Culture and Dementia -- Partnership Dementia assessment – harmonization Collaborative Research – clues to risk factors 10/66 Dementia Research Group Training Dementia Care ADI You do not have the permission to view this presentation. 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Helen Chiu NZ 2001 Jolene Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 117 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: February 24, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Culture and Dementia: Culture and Dementia From Diversity to Partnership Helen Chiu Head, Department of Psychiatry The Chinese University of Hong KongCulture: Culture The ideas, customs, skills, arts, etc. of a given people in a given period Population Ageing: Population Ageing World Population --- 6.1 billion 80% live in developing countries Average life expectancy in developing countries: 41 years in 1950 62 in 1990 70 in 2020 By 2020, no. of people aged 60 or above > 1000 million, 70% in developing countries Slide4: Europe --- 20% 60 years 25% by 2020 oldest region in the world By 2020 --- Japan is “oldest country”, 31% 60 years 23% in N America 17% in East Asia 12% in Latin America 10% in S Asia Slide5: Nigeria New Zealand Under 15 44% 22.5% 65+ 3% 11% Life expectancy 52 77.8 Year 2000Dementia – a Worldwide problem: Dementia – a Worldwide problem In 2000, 18 millions have dementia. In 2025, an estimated 34 millions, with over two-thirds in developing countriesEpidemiology: Epidemiology Jorm et al (1987) --- prevalence rate doubled every 5 years from age 60 onwards Alzheimer’s Disease > Vascular Dementia in western countries VaD>AD in Japan, China, RussiaIncidence of dementia: Incidence of dementia Jorm & Jolley 1998 – meta-analysis of 23 studies East Asian countries, lower incidence of dementia and AD than Europe Developed versus Developing countries: Developed versus Developing countries 10/66 Dementia Research Group, Prince, 2000 – trend for dementia prevalence in developing countries lower than those in EURODEM e.g. Studies in Nigeria (Hendrie et al, 1995) and India (Chandra et al, 1998) showed very low rates of dementiaDementia in Nigeria: Dementia in Nigeria Hendrie et al, 1995, Ogunniyi et al, 2000 Survey of 2 communities (Ibadan and Indianapolis) with the same research method Age-adjusted prevalence of dementia and AD, significantly lower in Nigeria Africans than African Americans AD> VaDHendrie et al, 2001: Hendrie et al, 2001 FU after 2 years and 5 years Age-standardized annual incidence rates of dementia significantly lower among Nigeria Africans (1.35%) than among African Americans (3.24%) as well as for ADSlide12: No association between AD and ApoE4 in the Nigerians Marginal association between AD and ApoE4 in African Americans Lower cholesterol and other vascular risk factors in Nigerians ? Environmental factorsNative Americans: Native Americans AD is rare in Cree elderly living on reserves in Manitoba (0.5%), versus 3.5% in Whites (Hendrie et al, 1993) China (Chiu & Zhang, 2000): China (Chiu & Zhang, 2000) VaD more prevalent in Northern regions AD more in Southern regions ? Reasons stroke more common in the north diet other life style factorsJapan: Japan Homma & Hasegawa, 2000 37 community surveys on dementia Before 1990 VaD > AD Over 70% of surveys done after 1990 showed that AD>VaD Trend of in ADDifferences in prevalence rates of dementia across countries: Differences in prevalence rates of dementia across countries Definition of race and ethnicity Methodological issues Prevalence bias Genetic differences Environmental effectsMethodological issues: Methodological issues Problems in assessment tools and procedures; educational level; linguistic issues; test-taking behavior etc. Diagnostic criteria, in particular diagnosis of Vascular dementia Other methodological problemsPrevalence Bias: Prevalence Bias High mortality rate in developing countries (e.g. Katzman et al, 1994)Genetic Factors: Genetic Factors APOE ε4 Lower APOE ε4 => ? Lower prevalence of AD in Chinese Lack of association in sub-Saharan AfricaEnvironmental Factors: Environmental Factors Diet Vascular disease and risk factors Infectious agents Chemical neurotoxin Lifestyle and behaviour Others Culture and Dementia Care: Culture and Dementia Care Value system Role of elderly in society Attitudes towards ageing and dementia Utilization of services Provision of care Carer stressValue system and Ageing: Value system and Ageing The issue of independence In USA, emphasis on independence and individualism In China, dependency, reciprocity and obligation Chinese culture may provide an easier transition to a dependent role in old ageIndia: India 1 billion people 4% of population aged 65+ Life expectancy at birth 61 years A country with huge diversity 1,652 dialects Indian Tradition: Indian Tradition The Hindu culture prepares for old age with the disengagement theory Give up one’s authority over family and property and devote to self-realization Indian social norms – care of elderly by family Now states of elderly and traditional care undermined India: India Patel & Prince, 2001 Dementia regarded as normal part of ageing not requiring medical care Primary health physicians rarely saw patients with dementia Family care less reliable than before Japan: Japan 126 million 17% of population aged 65+ Life expectancy at birth 81Japan: Japan Elderly people prefer to be looked after by relatives Eldest son providing care Reluctance to use public service Carers’ concern for others’ opinions => utilization of public service (Arai et al, 2000)China: China 1.26 billion people 7% of population aged 65+ Life expectancy 71 Ancient history Huge diversityChina: China Poor awareness of dementia Dementia sufferers frequently not receiving service Stigma of mental illness and dementia Tradition of family care and filial piety Low rate of admission to residential servicesHong Kong China: Hong Kong China 6.8 million people 10.5% of population aged 65+ Life expectancy 80 British colony for over 100 years Returned to Chinese rule in 1997Hong Kong: Hong Kong in filial piety and respect for elderly trend of nuclear family crowded living area high rate of admission to residential facilities high level of carer stress Chung, 2000 – Preference to use external events to explain occurrence of dementiaCaregiving Experience: Caregiving Experience Janevic et al, 2001 21 studies White caregivers more likely to be spouses White caregivers tend to report greater depression than African American caregivers Findings in other groups more mixed Dementia Care – A Global Challenge: Dementia Care – A Global Challenge Particularly in developing countries Rapidly rising elderly population Breakdown of traditional family support Lack of awareness Lack of services Large rural areas Low priority by government Culture and Dementia -- Partnership: Culture and Dementia -- Partnership Dementia assessment – harmonization Collaborative Research – clues to risk factors 10/66 Dementia Research Group Training Dementia Care ADI