Dementia is a global health challenge that impacts high-income countries (HIC), but has profound repercussions for low- and middle-income countries (LMICs). The World Health Organization (WHO) estimates that adults affected (estimates: 5-7% for ≥ 60 years old) with all-cause dementia will more than triple to reach 152 million by 2050 with at least 60% of them living in LMICs. This increase is driven by the overall growth of the population and demographic aging. 

Older women participating in a Group Model Building workshop in Vehari district, Punjab province, Pakistan.

Dementia-related costs will increase over the next three decades and LMICs will be responsible for shouldering this economic burden. Families will face most of these costs since formal geriatric care is largely unavailable. Older adults are both the recipients and providers of informal care, where the reciprocity of care between generations has been shown to improve well-being. Older adults with dementia become unable to provide care for other family members, a major problem in societies where social security and systems of care are not widely available. Similarly, adults with dementia need more financial, social, emotional, and physical support from other family members. This directly impacts the caregiver’s ability to work and attend school, especially since many children are tasked with providing care.

Group Model Building workshops, Yafta e Payan district, Badakhshan province, Afghanistan, March 2022.

Our study in Afghanistan, Pakistan and South Africa investigates social determinants of health (SDOH) of Alzheimer’s disease and associated cognitive disorders using mixed methods. We carried cross sectional surveys about household characteristics, older adults’ experience with SDOH, quality of life, and depression of older adults. We also carry out Group Model Building workshops to understand factors influencing quality of life of older adults (see pictures of workshops). Participants suggest some action ideas to be carried out to improve the system and hence, their quality of life. We interviewed 400 adults in South Africa, 1500 in Afghanistan and over 1000 in Pakistan. For the analysis, we used measures of multidimensional poverty to evaluate the association between dementia and other cognitive disorders and social determinants of health. Findings show that older adults with dementia and other cognitive disorders are more likely to be multidimensional poor than older adults without.

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