Providing effective health care to ageing populations, in Africa and beyond
Sue Marcus is the Managing Editor of the Cochrane Dementia and Cognitive Improvement Review Group, based in Oxford, UK. Here she reflects on a recent conference focusing on issues relevant to ageing populations in Africa, on the global nature of many of the issues raised, and on the role of The Cochrane Collaboration in addressing the health care needs of ageing populations, in low- and middle-income countries and worldwide.
In October 2012, the Cochrane Dementia and Cognitive Improvement Review Group was invited to present a symposium (as part of the healthcare stream) at the first ever Africa-wide conference on ageing, held in Cape Town. Around 400 scholars, civil society representatives, policy-makers, practitioners, private sector role players and clinicians from 41 countries, including 21 from across Africa, spent four days together in dialogue on the theme of ‘Africa Ageing: Beyond Madrid + 10’.
The conference was convened by the Africa Region of the International Association of Gerontology and Geriatrics (IAGG) in partnership with the African Research on Ageing Network (AFRAN), Oxford Institute of Population Ageing. I worked at the Institute for five years before coming to The Cochrane Collaboration, and helped establish and run AFRAN. I’m a social gerontologist with a particular interest in global ageing, and it’s through my contacts in AFRAN that we were invited.
Our Cochrane symposium was truly eclectic! Co-ordinating Editor Rupert McShane spoke about drug therapy in dementia; editor Linda Clare presented research results on cognitive rehabilitation; review author Terry Quinn covered diagnosis of and screening for dementia using the IQCODE. A South African colleague from Oxford, now back in Cape Town, Celeste De Jaeger, presented her work on vitamin B treatment and homocysteine in cognitive decline; and one of the very few African epidemiologists in the dementia field, Professor Adesola Oguyunni from Nigeria, spoke about the prevalence of dementia in Africa. The presentations were very well received and it was clearly important to the participants that The Cochrane Collaboration was in evidence(!).
Aside from being reminded of the demographic certainty of huge numbers of older people in low- and middle-income (LMIC) countries in the very near future (with limited/no health or social security provision), these are my four main ‘take home’ points from IAGG:
- Human rights for older people should be inherent in any discussion on population ageing. We need to stop thinking about older people as a separate category with respect to human rights.
- Perhaps we’re starting to recognise more similarities between ageing populations in developed countries and those in LMIC: rural/urban migration problems; access to health care; changing family structure; desires and aspirations for healthy, happy lives.
- Despite an ongoing need for more evidence, there’s already plenty to support the implementation of the Madrid International Plan of Action on Ageing (2002). What is needed now is action.
- We need to bridge the gap between research/evidence and policy implementation – and that needs political will as much as anything!
From a Cochrane perspective, we may also need to think more inclusively with regard to Africa and LMIC. Our group is in the process of bringing two African geriatricians on to our editorial board, and we plan to invite clinicians from other LMIC in the future. Whilst the types and numbers of relevant reviews we can produce may currently be limited (lack of trial data, different demographics and healthcare priorities), it’s clearly important for all of us to maintain an open dialogue for the future. We’re also hoping to provide some training opportunities for emerging clinicians/scholars, with a view either to bringing them into existing author teams or to supporting them in writing their own reviews.
I was involved in many conversations where people from Africa were saying it was time we focused on our similarities rather than our differences. We all came away with the sense that there is both common ground and common purpose on which we can build.
For more information on the work of The Cochrane Collaboration in LMIC, please see the 24 January instalment of the Cochrane20 Video Series.