Brain health in an ageing population: "The ageing brain"

Authors:
Mohammad Wasay MD, FRCP, FAAN
Prof. Grisold Wolfgang, MD

An Ageing Population:

Globally those over the age of 60 are more than 800 million (12 percent of the world population) and this is growing, with the expectation that it will reach more than two billion by 2050 (21 percent of the population). Currently 70 percent of the world's older population live in developed and developing countries, but by 2025, 80 percent of the older population will be living in less developed countries. Older persons are projected to exceed the number of children by 2047. It has already started in developed countries. In 2015, Japan became the first country in the world where more adult than baby diapers were sold.

Population ageing has major social, health, and economic consequences. The prevalence of non-communicable diseases and disability increases with age. Poverty is high among older persons. There is increased pressure on social support systems for older persons. In the future with an ageing population, the growing burden of diseases leading to disability, as well as reduced financial and social support will be among the huge challenges for societies and governments with respect to their social and health care systems.

Brain Diseases in the Ageing Population

The prevalence of a number of neurological diseases increases with age, including stroke, dementia, and Parkinson's disease. It is estimated that 10 to 20 percent of people aged 60 to 80 years suffer from one or more of these diseases. More than 30 percent of persons who are 80 years or older suffer from at least one neurological disease.

Disability due to neurological diseases and other musculoskeletal diseases is very high and growing. It is estimated that more than 20% of people over the age of 60 years need support for activities of daily living.

The economic burden of this is huge. Today it is estimated that almost half of the health care expenditure is related to the care of older persons in developed countries, and it is projected to become two-thirds by 2030. The same trends are expected in developing and less developed countries by 2050.

The medical community, however, must be cautious on the wording when "burden" with regards to costs of the ageing populations is mentioned. We need to be aware that the word "burden" has a potentially negative connotations, which should be replaced with a more positive wording such as responsibility which we feel is more appropriate. So we can say social responsibility for ageing.

World Brain Day Theme: "Brain Health in An Ageing Population"

It is clear that brain health the most important determinant of social and economic well-being of older persons in the future. On the one hand, health care authorities are deeply concerned with the current status and future trends of our growing population, but little has been done to handle these growing needs.

The World Federation of Neurology has stepped forward to dedicate this year's World Brain Day to the ageing population and has chosen the motto: "The ageing brain." Our intention for this is to increase awareness about the management and prevention of brain and neuromuscular diseases affecting mostly elderly persons. The first step of prevention is to improve concepts and understanding of brain health among the younger population in order to help prevent brain disease later in life and to improve the quality of life for older persons.

Disease prevention is the concept. However, a much larger number of individuals will be affected by diseases of the brain and the neuromuscular system which at the moment have little prevention methods. Thus it is also the duty of society to care for the elderly with progressive neurological diseases, and to provide the framework for quality of life, dignity, and the necessary care.

In this group of patients, the focus has to shift from the aspect of a curative condition, towards the inevitable death of all individuals. The concept of palliative and hospice care need to be implemented in the ageing population in need of neurological care.

How Can we Improve Brain Health, Prevent or Treat Neurological Diseases and Care for Persons with Advanced Brain Diseases?

Stroke and vascular dementia are among the most important neurological diseases affecting elderly persons. For these conditions, there are preventable and modifiable risk factors. Education, cognitive exercises, physical activity, and nutrition are important areas of intervention for prevention and slowing down of cognitive decline. Parkinson's disease is a neurodegenerative disorder, but effective symptomatic treatment is available.

Emotional health is as important as cognitive health in elderly persons. Quality of life and a lack of disability can be associated with emotional well-being. Effective interventions are available for maintenance and promotion of emotional health.

Despite prevention strategies, age is a non-modifiable risk factor, just as effects of degenerative and hereditary diseases on the brain and the neuromuscular system. Supportive, palliative care, and the hospice concept need to be integrated into the concept of neurological care in dealing with an ageing population

WFN and National Societies Activities

To raise awareness with respect to the ageing brain and neurologic diseases in the elderly, the WFN is asking its members to use this year's "Day of the Brain" to advocate and campaign in their country for these emerging problems.

The WFN public awareness and advocacy committee will prepare publicity material for this campaign, which includes logos, banner ads for web sites, handbills, brochures, posters, billboards, and presentations.

There will be a press conference in collaboration with the WHO. A template press release will be prepared and circulated to delegate societies. They can be adapted for local use with respect to national/regional data, priorities, or by adding quotes from national/regional experts.

The most important target of this campaign is the public. We need to create simple messages in local languages and promote them via print, electronic and social media, billboards, banner, events, etc.

Other important areas of intervention are healthcare authorities and policy makers. Our campaign should result in policy and priority shift at the national or local level. We have to plan targeted activities to facilitate this outcome.

Another important area of intervention is awareness and training of general practitioners, nurses, and paramedical staff.

Involvement of the media is a must. Celebrities or scientists could be a part of this advocacy campaign.

Delegate societies are strongly encouraged to organize awareness activities that may include press conferences, media briefing sessions involving local media, seminars, conferences, public awareness sessions, presentations at local schools, colleges, universities, posters, essays, drawing competitions, and newspaper and magazine articles.

Collaborators

As in the past, the WFN will work with various health entities, and professional and welfare organisations to promote awareness for World Brain Day. The WFN is a NGO in an official relationship with the World Health Organisation (WHO), Alzheimer's Association, International Federation on Ageing, Alzheimer's support groups, Dementia support groups, American Association of Retired Persons (AARP), United Nations Population Fund, National Institute of Aging (USA), World Brain Council, and the European Brain Council. Local societies may also collaborate with local WHO country and regional offices, geriatric societies and support groups, and dementia organisations and support groups.

The WFN is hoping for your collaboration to improve the health and future of patients with an ageing brain. Please follow our website, www.worldneurologyonline.com , and our social media.

If you have suggestions, or ideas for World Brain Day 2017, please do not hesitate to contact us at wbd2016@wfneurology.org