Ageing and mental health: Addressing the impact on health care Chee Ng, Brigid Ryan and Edmond Chiu Commonwealth health ministers have supported the principles of universal health coverage (UHC) as a Sustainable Development Goal for health on the post-2015 agenda. UHC includes an overarching policy framework, with public health, primary health care and community services as the cross-cutting structures for all health and health-related services. Increasing commitment to UHC is crucial to increasing healthy life expectancy, eradicating poverty, promoting equity and achieving sustainable development (Singh, 2014). Despite the growing burden of mental disorders globally, health systems have not yet adequately responded to this universal challenge, thus leaving a huge gap between the need for treatment and its provision (Ng, 2013). As rights and equity sit at the centre of UHC strategy, adequately addressing the needs of those with mental health problems, who are among the most vulnerable and disadvantaged groups of people, is both necessary and long overdue. This would require a focus on unifying a somewhat fragmented health agenda and mainstreaming mental health into all health and social sector policies (WHO, 2013). Further, UHC advocates for a life-course approach from primary prevention to long-term care and end-stage conditions. The commitment to UHC and the Commonwealth’s focus on ‘healthy ageing’ this year thus creates a window of opportunity for promoting mentally healthy ageing and mental health care for the older population, and in particular to explore future mental health needs of older persons in the rapidly developing Asia-Pacific region. Ageing and mental health patterns Globally, the number of people aged 60 years and over is projected to increase from the current 810 million to more than two billion in 2050 (WHO, 2011). This increase will mainly occur in low- and middle-income countries (LMICs), some of which are Commonwealth member states. In particular, the number of older persons in the Asia-Pacific region is estimated to triple between 2010 and 2015, going from 415 million (about ten per cent of the population) to 1.25 billion (25 per cent). As the region’s fastest growing population group, this demographic shift is driven by major social and health achievements, with increased life expectancy, lowered infant mortality, declining fertility, control of communicable diseases and general health-related gains (Chomik and Piggott, 2013). Such population ageing has profound and far-reaching social, economic and health-related implications for all countries, especially those in the Asia-Pacific region. The rise in the number of vulnerable older persons increases the overall incidence and prevalence of non-communicable diseases (NCDs), thereby accelerating the general shift from acute infectious and deficiency diseases – common in developing countries – to chronic NCDs – characteristic of modernisation and economically advanced countries (Wahdan, 1996). This includes mental disorders. For example, the incidence of dementia in developed countries was forecast to increase by 100 per cent between 2001 and 2040, while the same figure is expected to increase by more than 300 per cent in India, China, and Asian and Western Pacific countries (Ferri et al., 2005). The 2010 Global Burden of Disease study (Murray et al., 2013) has identified that some 20 per cent of adults aged 60 years and over suffer from a mental or neurological disorder; and 6.6 per cent of all disabilities among people over the age of 60 can be attributed to mental and neurological disorders. The most common of these disorders are dementia and depression, both of which are associated with increasing health care utilisation and costs. An estimated 35.6 million people lived with dementia worldwide in 2010, with numbers expected to almost double every 20 years, to 65.7 million in 2030 and to 115.4 million in 2050 (Prince et al., 2013). The majority of these people will live in LMICs, which are less prepared to respond to this emerging public health crisis. The mounting financial and social impact of this complex disorder is a concern for nations in the Asia-Pacific region, in particular how policies and implementation programmes can be strengthened to enhance dementia care in order to improve the social well-being and quality of life of those living with dementia – and their caregivers (WHO, 2011). About seven per cent of the general older population have unipolar depression, which accounts for 1.6 per cent of total disabilityadjusted life years (DALYs) among 60-year-olds (Murray et al., 2013). Depression in late life is related to reduction of functioning, mental suffering, worsening of physical health and illnesses, and early death through acute and chronic diseases, as well as by suicide. Of note, about a quarter of deaths from suicide are among those aged 60 years and above. Dementia and depression among older persons have been identified as significant public health challenges due to associated under-recognition; a large treatment gap; stigma and social exclusion; the economic impact on caregivers and communities; and the high global prevalence (WHO, 2012). Importantly, data remains sparse and largely unavailable in the Asia-Pacific region. Many Commonwealth countries do not have vital information to plan and implement appropriate intervention strategies and models of care or to chart effective assessment, treatment and prevention programmes. Studies are required to better understand how older people living with mental illness achieve and maintain wellness, and the impact of living with mental illness. Despite this gap, there is valuable information available through prevalence studies conducted in Australia, 78 Commonwealth Health Partnerships 2015
Commonwealth Health Partnerships 2015
To see the actual publication please follow the link above