Bridge at the Crossroads
21st International Conference of Alzheimer's Disease International
28 September - 1 October 2005, Istanbul, Turkey

Life expectancy is rising in almost every country, which means that the world's population is ageing. The World Health Organization (WHO) has estimated that by 2020 there will be over one billion people over the age of 60 in the world. Given that age is the biggest risk factor for developing dementia, an ageing population also signifies a dramatic increase in the number of people with dementia. Currently, Alzheimer's Disease International (ADI), the worldwide federation of Alzheimer associations, estimates that there are 18 million people with dementia in the world. Of these people, 12 million live in developing countries. ADI estimates this figure will nearly double to 34 million by the year 2025. Much of this increase will be in rapidly developing and heavily populated regions - indeed the projected increase of people with dementia between 1990 and 2020 in the Middle East/North Africa region is from 0.9 to 2.3 million.

Research findings on the impact of dementia in developing countries indicate that carers of a person with dementia experience high levels of perceived 'burden', a very high prevalence of 'common mental disorder', substantial economic disadvantage, unresponsive public health services and a reliance on private doctors. Much research has been directed towards looking at ways to improve the quality of life for people with dementia and their carers. Key interventions found to support carers and relieve their stress include:

• Early identification of problems
  
• Comprehensive assessment of social and medical needs
  
• Availability of treatments
  
• Information, advice and counselling
  
• Continued support and review ideally from a known and trusted individual
  
• Regular help with domestic and personal care tasks
  
• Regular breaks from caring
  
• Financial support and permanent residential care when it becomes necessary.

It is clear that people with dementia and carers need support and practical help. Priorities for action to meet these needs include the recognition that dementia is a disease, improved assessment, diagnosis and management of dementia, availability of facts and figures to convince policy makers of the need to make dementia a higher healthcare priority, and education and training for all involved in dementia care.

So how can we meet these priorities in countries with poorly developed primary care systems and few or no specialist services?

In many such circumstances, individuals have gone about setting up national Alzheimer associations. Such voluntary organisations exist to raise awareness amongst members of the general public, policy makers and professionals about dementia and the impact it has on families. This can be achieved in a number of ways but the dissemination of accurate and sensible information underpins all associations' work. Alzheimer associations also run self-help groups and training courses, advocate on behalf of people with dementia and their carers, and assist in the development of public policy issues.

Canada, the USA, UK and Australia were the first countries to develop national Alzheimer associations about 25 years ago. These associations are now well established, recognised and respected by their governments. They are run with large numbers of staff, large incomes and branches around the country. Professionals have played key roles in helping to get these organisations off the ground.

These four associations were also the impetus for the formation of ADI in 1984. Since then, Alzheimer associations have been founded in every world region. New associations continue to be formed and this year, ADI welcomed Iran, Lebanon and Portugal, bringing the number of associations in this federation to 69. The continued growth of ADI and the development and formation of new associations is vital; Alzheimer associations are more closely aligned to service users making them better positioned to identify need, understand barriers, propose solutions and help in the delivery of change. In addition, they provide somewhere helpful for professionals to refer people to, fill the gaps left by the health sector and can have a powerful influence on policy makers and professionals.

Getting a new Alzheimer association up and running is a huge task. Associations are often set up by individuals affected by dementia either in a personal or professional capacity when there is nowhere else to turn to. But healthcare professionals have a lot to offer such associations, especially in their formative years. They can provide status, resources, expertise and experience and can help associations by:

• Referring people with dementia and carers to associations
  
• Giving talks on dementia, writing/reviewing/editing articles
  
• Encouraging membership of the association
  
• Being freely available to offer advice to staff and volunteers
  
• Helping form a panel of medical/scientific advisors