The immensity of the impending epidemic of dementia was aptly summed up by the title, ‘A case of dementia is diagnosed every four seconds’ (24 October), of your report on the recent international conference organised by the International Federation of Associations for the Elderly (FIAPA).
The Parliamentary Secretary for the Elderly Mario Galea is quoted as saying that the primary aim in dealing with patients suffering from dementia is ensuring their dignity and assisting them within the community in the environment they know. This is fair comment, but surely the primary aim should, in the first place, be the prevention or, at least, mitigation of dementia? Unfortunately health policies often omit the aspect of preventive measures. While it is agreed that factors such as age, family history and heredity are unalterable, it must not be forgotten that measures based on encouraging a healthy lifestyle have been shown to significantly delay the onset of dementia or even reduce its incidence. Given the enormity of the projected frequency of dementia in coming decades, the benefits of such measures will be considerable in economical, social and psychological terms.
An active lifestyle which includes daily physical activity and a healthy diet has long been demonstrated to be of benefit at all ages in reducing the impact of dementia. Two recent studies have added further evidence for this. A general population study in Montpellier, France, (British Medical Journal, 2010;341:c3885) has shown that remaining physically and mentally active into old age combined with increased fruit and vegetable consumption can increase mental ability and delay the onset of dementia and somewhat reduce its frequency while also reducing the prevalence of mental depression and Type II diabetes. Another study (Neurology. 2012;79:1802-1808) yet again demonstrated the benefits of physical exercise in preserving cognitive function. Such benefits can be achieved by urban environmental measures aimed at improving the quality of life of the aged; this adds support to the importance of measures aimed at encouraging all types of physical activity on the basis that a healthy lifestyle today ensures that tomorrow’s old people remain physically and mentally healthy – and less of a burden to society.
It must also not be forgotten that this is the European Year of Active Ageing; this should serve as a reminder that the World Health Organisation (WHO) specifically recommends measures aimed at encouraging healthy lifestyles in anticipation of increasing population age. To this end WHO recommends the development of “age-friendly” urban environments to optimize the quality of life of aging populations by enabling active, healthy ageing by providing opportunities for physical exercise and social participation. As rightly mentioned by Mr Galea, the costs of dementia on society are phenomenal; the current global cost of dementia is estimated to be equivalent to 1% of the world’s Gross Domestic Product, or just over $608 billion. This makes action all the more urgent – such costs can only increase, especially if nothing is done now.
Even in Malta, measures that might succeed in delaying the onset of dementia or in reducing it frequency will have great future potential for savings in annual health costs. In addition to the economic dimension, the sheer enormity of the problem must be also be gauged in social and psychological costs, as those as who have cared for relatives suffering from dementia only know too well.
The combination of antiquated attitudes to street design and runaway urban property development have degraded our town environments and robbed streets of their social function – a function particularly crucial to the aged. This is a trend that must be reversed; an aging population living in dismal degraded urban surroundings is less inclined to go out. If nothing is done today to improve the urban environment, older people be more prone not only to depression and dementia; they will also be more likely to develop late-onset diabetes. The importance of providing an environment which promotes healthier ageing through modifying lifestyle factors recently stressed again at a meeting with the Association of Local Councillors in Sliema.
“Zoning” of shopping and entertainment areas has further depersonalised street life through concentrating shops other amenities far away so that people lose out on exercise through becoming become more reliant on cars - and therefore walking less - to do their shopping and other errands. This is also affecting the young who are tomorrow’s aged population. An unfortunate side effect of the latest trends towards supermarkets is the blow dealt to the old through further isolation from loss of the friendly grocer around the corner which served as a social focus that helps made life friendlier. Such supermarkets have also started to put impossible distance between where people live and where they can shop. As a consequence the old are being robbed of their independence through becoming increasingly dependent on others for their shopping; they will tend to buy the wrong food, missing out on fruit and vegetables.
A policy aimed at supporting the elderly suffering from dementia in the community through person-centred community services is not enough. It has an element of locking the door after the horse has bolted. As long as Malta continues to encourage car-dependency and keeps moving away from the recommended modern concept of a healthy, age-friendly urban environment in which shopping, with essential services and leisure spaces within walking (or cycling) distance, everybody, especially the old, will be not be enabled to live (and age) healthily by being given encouragement to keep walking and remain physically active as long as possible. Malta will pay dearly for this in the future.