Mohamed Aly Pasha 1769-1849

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Mohamed AlyPasha

1769-1849



“ The Burden of Dementia

in an Extended FamilySocial Network - a

Historical Perspective

Nasser Loza & Waleed Fawzi

Istanbul October 2005



• Religious & moral culture

• Belief in life after death

• Historical records

• Migration and wars

The Middle East

General considerations



Ramses ll

Died 96 years old

Reigned 65 years

200 wives, 156 children,

(96 sons 60 daughters)

Ramses ll

Died 96 years old

Reigned 65 years

200 wives, 156 children,

(96 sons 60 daughters)



Pharaonic civilisation

Djedi, a magician is congratulated bythe pharaoh's son on reaching theage of 110 years :

“Your condition is like that of a manwho has not yet reached old age…

who sleeps until the morning, who isimmune from illness, without theslightest cough…”



Judaism

“Show you fear from God by standing

up in the presence of elderly people

and showing respect for the aged. I

am the LORD.”

Leviticus 19:32



Islamic Civilisation

Ibn Masud said, “I asked the Messenger

of Allah (pbuh) which deed is the most

beloved to Allah?” He said: “The prayer

at its proper time.” I said: “What next?”

He said: “Filial piety to the parents.” I

said: “What next?” He said: “The Holy

Jihad for Allah’s sake.”(Al-Bukhari,Muslim)



Islamic Civilisation

Abdullah bin Amr bin Al Aas related that

the Messenger (pbuh) said: “Major sins are:

To worship a partner with Allah, to disobey

the parents, to kill the soul and to take a

false oath.”(Al-Bukhari)



Overview

• Traditional structure of ME families

• Factors causing transition

• Care needs for dementia sufferers• Patterns of provision of care

il



Family Structure The elderly population in

Egypt

3.242

4.462

6.557

9.814

14.103

0

20

40

60

80

100

120

140

millions

1990 2000 2010 2020 2030

60+

Total



Family Structure

• Number of children (Contraception)

• Extended

• Polygamy• Daughters in law



Who Cares?

• Community sample of 461 elderly Egyptiansapproached in street interviews and OP clinics. WHOstudy ( Sadek et al 2002)

0%

5%

10%

15%

20%

25%

30%

35%

Living Arrangements

Alone

Spouse only

Spouse & marriedchildren

Married children

Unmarried children

Relatives



Female role

• Education

• Employment



Factors causing transition

• Increased longevity

• A shift towards nuclear family

• Migration



Factors causing transitionEgyptians > 60 years

0

2

4

6

8

10

12

14

16

millions

1990 2000 2010 2020 2030



Factors causing transitionEgyptians > 80 years

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

millions

2000 2010 2020 2030



Factors causing transitionMigration

External Migration

– Middle East

– West

F t i t iti



Factors causing transitionRural to Urban population in

Egypt1950

57%

43%

% rural

% Urban

2000

44%

56%

2025

29%

71%



Factors causing transitionMigration

Rural to urban distribution in 1986:

56.1 / 43.9 vs 59 / 41 for

the elderly



Systems of care

• Care in the community

• Day Centres and Day Hospitals

• Residential Homes• Nursing Homes

• Care for Dementia patients with

behavioural disturbances



Care needs for dementiasufferers

• Assistance with activities of dailyliving

• Social and psychological support

• Economic factors



Homes for the elderly in Egypt(2000)

• Cairo: 36 accommodating 1980 residents

• Giza 5 accommodating 183 residents

• Alexandria 13 accommodating 994 residents

• Rest of the country 27 accommodating 700 residents

• Total Beds for healthy elderly in Egypt 3857 residents



• Leaving 4 458 882 estimated elderlycared for in the community in 2000

• Leaving 14 099 743 estimated elderlycared for in the community in 2030



Caregiver Burden forDementia

Study on 40 carers (1999) showsFemales are the primary caretakersMost frequent problems are

Exhaustion due to increased patients’ requirements Insufficient time to care for children Late for work Decreased social interactions with family and friends Fear of inheriting the disorder

Increased financial burden

Hassan M, (1999). Assessment of Psychological stress facing familycaregivers of elderly patients with dementia, (M. Sc. Thesis).



Caregiver burden in EgyptAbido AM, Ashour AM, Assad T, El Nahas G. (2000). Stress of geriatric patient caregivers, M.Sc. Thesis

• 30 psychiatric outpatients with care giving relatedproblems in Cairo (Matareya Hospital)

• Assessed using – Psychiatric and medical history for patients

– Assessment of financial situation – The burden Interview (Zarit, 1985)

• 5 cases suffering from dementia with behaviouralsymptoms

• 5 cases assessed qualitatively for medical socialpsychological and economical stresses and followedup after provision of support



FindingsAbido et al. 2000

• 1 carer in 70% of cases

• 2 carers or more 30%

• 43% working full time and 57%housewives



Findings Abido et al. 2000

Patient related factors increasingcaregiver stress

• Behavioural symptoms in dementia

• ADL abilities

• Sleep disturbance

• Incontinence



FindingsAbido et al. 2000

Carer related factors

• Gender

• Occupation• Economic status

• Support from other family members



Findings Abido et al. 2000

• Carers received very limited supportin the community and provisionCouncelling and education regarding

coping techniques reduced caregiverburden substantially



Discussion

Building on local traditions and values

Vs.

Adapting international approaches tocaring for the elderly



Discussion

Implications for services & research:

• Adopting local practices

• Translation & Validation of international questionnaires

• Developing local tools



Mohamed Aly

Pasha1769-1849

Mohamed Aly Pasha 1769-1849

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