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Commonwealth Health Partnerships 2015

U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g In most low- and middle-income countries, specialist resources for dementia are scarce or non-existent that use of biomass fuels might also be an important risk factor (Fletcher, 2010). In countries where visual impairment is highly prevalent, cataracts in older people from rural areas are an important underlying factor. Cataract surgery coverage is generally low, although very variable between studies, with rural populations and women being particularly underserved. The cost-effectiveness of screening for and correcting refractive errors with glasses in older people has not been specifically examined. Musculoskeletal disorders Musculoskeletal disorders accounted for 43.3 million DALYs in older people in 2010, 66 per cent of the burden arising in low- and middle-income regions. Lower-back pain is a syndrome based mainly on self-reported symptoms, with many underlying pathological changes, including mechanical causes (muscle and joint strain, disc degeneration or prolapse, or osteoarthritic and osteoporotic bone disease), with inflammatory back pain accounting for up to a third of cases. Psychosocial factors, such as stress, anxiety, depression, job dissatisfaction and low social support, predispose patients to chronicity. The WHO Scientific Group on Rheumatic Diseases estimated in 2003 that ten to 20 per cent of the world’s population aged 60 years or older have significant clinical problems attributed to osteoarthritis (Woolf and Pfleger, 2003). Prevalence increases sharply with age, since osteoarthritis is remorselessly progressive and cumulative. The outlook for chronic lower-back pain is poor and treatment outcomes have not improved, despite increased use of surgical and other invasive techniques. Dementia Numbers of people with dementia worldwide will increase sharply driven by global patterns of population ageing, from 44.4 million in 2013 to 75.6 million in 2030 and 135.5 million in 2050 (ADI, 2013). Proportionate increases over the next 20 years are predicted to be much steeper in LMICs than HICs. Currently, 58 per cent of people with dementia worldwide live in LMICs, a figure that’s expected to rise to 71 per cent by 2050. The total estimated worldwide costs of dementia were US$604 billion in 2010, equivalent to one per cent of the world’s gross domestic product (Wimo et al., 2013). In low-income countries (LICs), informal care costs predominate (58 per cent of all costs in LICs and 65 per cent of all costs in MICs, compared with 40 per cent in HICs). The progressive course of dementia cannot be altered, but symptomatic treatments and support are helpful. Earlier diagnosis allows those affected to participate in advanced care planning while they still have capacity to do so; education, training and support for carers is effective in reducing carer strain and psychological morbidity, and, in HICs, in delaying or avoiding 44 Commonwealth Health Partnerships 2015 Quick Shot / Shutterstock.com


Commonwealth Health Partnerships 2015
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