Healthy Ageing: Reviewing the Challenges, Opportunities, and Efforts to Promote Health Among Old People

Every country in the world is experiencing growth in both the size and the proportion of older persons in the population. While this shift in distribution of a country's population towards older ages – known as population ageing – started in high-income countries, it is now low- and middle-income countries that are experiencing the greatest change. This article reviews the challenges, opportunities and efforts to promote health among older people. The WHO defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” Functional ability consists of the intrinsic capacity of the individual, relevant environmental characteristics and the interaction between them. Being able to live in environments that support and maintain one’s intrinsic capacity and functional ability is key to healthy ageing. In fact, the environments that people live in as children – or even as developing fetuses – combined with their personal characteristics, have long-term effects on how they age. Older people suffer from psychosocial problems as social isolation, loneliness, and elder abuse. They are also subject to dementia, the most severe expression of cognitive impairment, which represents the main cause of disability in elderly people. Neurodegeneration due to Alzheimer disease (AD) underlies most of the dementia, with cerebrovascular disease (CVD) presenting the second-most common cause. Consistent evidence from observational studies estimates that one-third of Alzheimer disease cases worldwide are attributable to seven common modifiable risk factors: diabetes mellitus, midlife hypertension, midlife obesity, physical inactivity, depression, smoking and low education. Evidence from the multidomain clinical trials of dementia preventive interventions suggests that targeting these risk factors in individuals who are at an increased risk of dementia is an effective strategy. According to a recent systematic review on the prevalence of dementia in Egypt (2017), the prevalence of dementia ranged from 2.01% to 5.07%. Dementia increased with age, with the rapid increase among those aging ≥80. Also, its prevalence was higher among illiterate groups than among educated groups. There is an urgent need for the implementation of a national policy for elderly care in Egypt. Although such policies exist, the effectiveness of existing policies and the role of national committees need to be evaluated in order to revive and mobilize the resources available. Mohamed Salama, an Egyptian neurotoxicologist and Atlantic Senior Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), believes Egypt is unprepared for demographic ageing. While region-specific risk factors for dementia are available for Europe, North America and more recently for India, China, and Latin America, the Middle Eastern and Northern African (MENA) region has no such data to guide strategies for dementia prevention. In this context, Mohamed has been developing the vision for ‘A Longitudinal Study of Egyptian Healthy Ageing’ (AL-SEHA), which could reform the Egyptian research infrastructure and support policy-makers to address the challenges of demographic ageing.