Mohamed Aly

Pasha
1769-1849
“ The Burden of Dementia
in an Extended Family
Social Network - a
Historical Perspective
Nasser Loza & Waleed Fawzi

Istanbul October 2005

 The Middle East
General considerations

• Religious & moral culture

• Belief in life after death

• Historical records
• Migration and wars
Ramses
Ramses llll
Died
Died 96
96years
yearsold
old
Reigned
Reigned 6565years
years
200
200wives,
wives,156
156children,
children,
(96
(96sons
sons60 daughters))
60daughters
 Pharaonic civilisation
Djedi, a magician is congratulated by
the pharaoh's son on reaching the
age of 110 years :

“Your condition is like that of a man

who has not yet reached old age…
who sleeps until the morning, who is
immune from illness, without the
slightest cough…”
 Judaism

“Show you fear from God by standing

up in the presence of elderly people

and showing respect for the aged. I

am the LORD.”
Leviticus 19:32
 Islamic Civilisation
Ibn Masud said, “I asked the Messenger
of Allah (pbuh) which deed is the most
beloved to Allah?” He said: “The prayer
at its proper time.” I said: “What next?”
He said: “Filial piety to the parents.” I
said: “What next?” He said: “The Holy
Jihad for Allah’s sake.”
(Al-Bukhari,Muslim)
 Islamic Civilisation

Abdullah bin Amr bin Al Aas related that

the Messenger (pbuh) said: “Major sins are:
To worship a partner with Allah, to disobey
the parents, to kill the soul and to take a
false oath.”
(Al-Bukhari)
 Overview
• Traditional structure of ME families
• Factors causing transition
• Care needs for dementia sufferers
• Patterns of provision of care
 Family Structure
The elderly population in
Egypt
140 14.103

120 9.814
6.557
100
4.462
80
millions 3.242 60+
60 Total
40
20
0
1990 2000 2010 2020 2030
 Family Structure
• Number of children (Contraception)
• Extended
• Polygamy
• Daughters in law
 Who Cares?
35%
Alone
30%

25% Spouse only

20% Spouse & married

children
15% Married children
10%
Unmarried children
5%
Relatives
0%
Living Arrangements

• Community sample of 461 elderly Egyptians

approached in street interviews and OP clinics. WHO
study ( Sadek et al 2002)
 Female role
• Education
• Employment
 Factors causing transition
• Increased longevity

• A shift towards nuclear family

• Migration
 Factors causing transition
Egyptians > 60 years
16
14
12
10
millions 8
6
4
2
0
1990 2000 2010 2020 2030
 Factors causing transition
Egyptians > 80 years
1.6
1.4
1.2
1
millions 0.8
0.6
0.4
0.2
0
2000 2010 2020 2030
 Factors causing transition
Migration

External Migration
– Middle East
– West
 Factors causing transition
Rural to Urban population in
Egypt
1950 2000
% rural
% Urban
43%
44%

57% 56%

2025

29%

71%
Factors causing transition
Migration

Rural to urban distribution in 1986:

56.1 / 43.9 vs 59 / 41 for
the elderly
 Systems of care
• Care in the community
• Day Centres and Day Hospitals
• Residential Homes
• Nursing Homes
• Care for Dementia patients with
behavioural disturbances
 Care needs for dementia
sufferers

• Assistance with activities of daily

living
• Social and psychological support
• Economic factors
 Homes for the elderly in Egypt
(2000)
• Cairo: 36 accommodating 1980 residents

• Giza 5 accommodating 183 residents

• Alexandria 13 accommodating 994 residents

• Rest of the country 27 accommodating 700 residents

• Total Beds for healthy elderly in Egypt 3857 residents

• Leaving 4 458 882 estimated elderly
cared for in the community in 2000

• Leaving 14 099 743 estimated elderly

cared for in the community in 2030
 Caregiver Burden for
Dementia
Study on 40 carers (1999) shows
Females are the primary caretakers
Most frequent problems are
 Exhaustion due to increased patients’ requirements
 Insufficient time to care for children
 Late for work
 Decreased social interactions with family and friends
 Fear of inheriting the disorder
 Increased financial burden

Hassan M, (1999). Assessment of Psychological stress facing family

caregivers of elderly patients with dementia, (M. Sc. Thesis).
Caregiver burden in Egypt
Abido AM, Ashour AM, Assad T, El Nahas G. (2000). Stress of
geriatric patient caregivers, M.Sc. Thesis
• 30 psychiatric outpatients with care giving related
problems in Cairo (Matareya Hospital)
• Assessed using
– Psychiatric and medical history for patients
– Assessment of financial situation
– The burden Interview (Zarit, 1985)

• 5 cases suffering from dementia with behavioural

symptoms
• 5 cases assessed qualitatively for medical social
psychological and economical stresses and followed
up after provision of support
 Findings
Abido et al. 2000

• 1 carer in 70% of cases

• 2 carers or more 30%
• 43% working full time and 57%
housewives
 Findings
Abido et al. 2000
Patient related factors increasing
caregiver stress
• Behavioural symptoms in dementia
• ADL abilities
• Sleep disturbance
• Incontinence
 Findings
Abido et al. 2000
Carer related factors
• Gender
• Occupation
• Economic status
• Support from other family members
 Findings
Abido et al. 2000
• Carers received very limited support
in the community and provision
Councelling and education regarding
coping techniques reduced caregiver
burden substantially
 Discussion

Building on local traditions and values

Vs.

Adapting international approaches to

caring for the elderly
 Discussion
Implications for services & research:

• Adopting local practices

• Translation & Validation of

international questionnaires

• Developing local tools

Mohamed Aly
Pasha
1769-1849