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Commonwealth Health Partnerships 2015

A growing urgency exists to tackle cardiovascular diseases in LMICs through effective prevention and treatment, guided and monitored by robust estimates of disease prevalence and burden. These interventions mainly include drug therapy, which, although not costly, is not always available. Tobacco control is probably the most cost-effective prevention strategy, alongside combination drug therapy (statin, diuretic, β blocker and aspirin) for at-risk individuals, which include a high proportion of older people. In 2005, 62 million people were estimated to be survivors of stroke worldwide (Strong et al., 2007). Many survivors are likely to be disabled; in LMICs, stroke was the second leading contributor (after dementia) to disability and dependence in older people. Actions suggested for stroke prevention are the same as those for ischaemic heart disease. In the WHO-CHOICE modelling exercise for African and southeast Asian regions, acute treatments for stroke and organised stroke unit care were associated with slight benefits and were not cost effective. Greater yields would be obtained through secondary prevention methods. Cancer Cancer is a leading cause of mortality, accounting for 9.9 million deaths yearly, of which 5.4 million (54 per cent) occur in people aged 60 years and older. For four types of cancer, most of the disability-adjusted life year (DALY) global burden is in older people: prostate (89 per cent), oesophagus (52 per cent), colon and rectum (57 per cent), and trachea, bronchus and lung (57 per cent). The high background prevalence of multimorbidity in older people leads to inadequate diagnosis of symptoms. Rapidly ageing middle-income countries (MICs) face the daunting challenge of addressing the emerging cancer burden in the older population, alongside a growing disease burden from other noncommunicable diseases and other pre-transition traditional diseases. In view of the scarce evidence for the cost-effectiveness of cancer control and treatment programmes in LMICs, policy-makers have been advised to ‘start small, scale smart’ (Brown et al., 2006), gaining knowledge from pilot programmes, carefully monitored for efficiency, performance and effectiveness. Surgical treatment for treatable cancers, such as breast, cervical and colorectal cancer, is likely to be cost effective, as might be adjuvant therapy with conventional radiation and drugs. Diabetes Diabetes mellitus accounted for 22.6 million DALYs in older people in 2010, with 80 per cent of the burden arising in low- and middleincome regions. Burden in older people is forecast to increase by 96 per cent from 2004 to 2030. Diabetes is treated with diet, biguanide, sulphonylurea drugs or insulin. The WHO-CHOICE modelling exercise identified intensive glycaemic control (glycosylated haemoglobin less than seven per cent) combined with retinopathy screening and photocoagulation as highly cost effective for the African and south-east Asian subregions. The detection and control of diabetes in older people is suboptimum. Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) accounted for 43.3 million DALYs in older people in 2010, 86 per cent of the burden arising in low- and middle-income regions. The global burden has A g e i n g a n d d i s e a s e b u r d e n s Musculoskeletal disorders accounted for 43.3 million disability-adjusted life years in older people in 2010 been forecast to increase by 89 per cent from 2004 to 2030. The projected large increase in population burden is to be driven, mainly, by population ageing. Smoking is the most important risk factor, according to some estimates, for 90 per cent of the costs of illness (Feenstra et al., 2001). However, there is a substantial prevalence of COPD in non-smokers and other risk factors, such as exposure to biomass fuels and tuberculosis, might be important, particularly in LMICs. In LMICs, treatment recommendations have historically been complicated by the high costs and low availability of imported drugs. Visual impairment Visual impairment (blindness or low vision) accounted for 10.4 million DALYs among older people in 2010, 86 per cent of the burden arising in low- and middle-income regions. The prevalence of cataracts is strongly age-associated. In most world regions, adults aged 80 years and older either have a cataract or have had cataract surgery. However, prevalence in older people aged 60–64 years seems to be higher in Asian studies than in other regions (Vashist, 2011). The prevalence of unoperated cataracts in people aged 60 years and older was 57.8 per cent (north India site) and 52.9 per cent (south India site) in two large population-based studies. Smoking cessation is the main viable strategy at present for cataract prevention, although several studies from India suggest Commonwealth Health Partnerships 2015 43 Henk Badenhorst / istock.com


Commonwealth Health Partnerships 2015
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