Ageing and Longevity

Middle Eastern cultures treasure the elderly, making Alzheimer's a complex scourge

A volunteers joins elderly for Iftar at an elderly care home in Amman, Jordan June 7, 2017

A care home for the elderly in Amman, Jordan. Image: REUTERS/Muhammad Hamed TPX IMAGES OF THE DAY - RC1B0E0ECDD0

Mohamed Al-Olama
Frank Tarazi
Professor, Harvard Medical School
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Ageing and Longevity

The number of people afflicted with Alzheimer’s disease (AD) worldwide has climbed drastically over the past few decades.

Major advances in healthcare have contributed to a rapid growth of our ageing population, which is at a higher risk of developing AD. The incidence of AD starts to increase by age 65, and by the age of 85 almost half the population will have the disease.

The Middle-East North African (MENA) countries are considered among the fastest growing regions in the world in terms of the incidence of AD. By 2050, the World Health Organisation estimates the number of AD cases in MENA countries will have increased by 125%. Such a profound increase will certainly put a strain on these countries' healthcare systems and will impose socioeconomic burdens on families and governments in the region.

Barriers and burdens

Middle-Eastern culture values close relationships between the elderly and younger generations in the family. The elderly are usually regarded with the highest degree of love, respect and wisdom, and are looked upon as a source of inspiration in the family. There is a sense of duty and responsibility among younger generations to care for the elderly, including those who develop AD, at their homes, and to not even consider moving them to nursing homes even if one exists next door.

 The predicted growth of Alzheimer's disease worldwide by 2050
The predicted growth of Alzheimer's disease worldwide by 2050 Image: Alzheimer's Disease International

This duty often results in time constraints at work and financial burdens on the family, and there is often a lack of appropriate knowledge on the part of family members on how to deal with AD patients. Moreover, and in many instances, a diagnosis of AD or other dementia disorders carries a degree of stigma and can erect a social barrier. Unfortunately many AD patients become isolated from society, deprived from interactions with extended family members or friends, and prevented from attending social activities. The accompanying sense of isolation may compound the physical and mental burden on patients, and can place additional strains on families and caregivers.

Many governments in the MENA countries assume that caring for the elderly, including AD patients, is the sole responsibility of the family, and therefore they have tended to ignore building the infrastructure that can provide more comprehensive support for AD patients and their families. However, the sharp increase in AD cases, and the heavier socioeconomic burdens on families caring for AD patients, have led to a few changes in laws around improving long-term care services for the elderly, including AD patients. Nonetheless, more changes are required, including the integration of these services in future government budgets to ensure allocation of the appropriate funds to support and improve the services for AD patients and the elderly at large.

Breaking the barriers

We propose a plan of 5 'B's to better combat AD in MENA countries and to break the barriers surrounding this disease:

1. Better training of healthcare providers in primary care services to recognise the early signs of AD and other co-morbid conditions such as depression and agitation, and to intervene early before the disease progresses to the point of no return.

2. Build infrastructure and support systems including nursing homes and long-term care facilities for memory-impaired patients. These facilities would be valuable in providing improved physical and mental health services for AD patients, and supporting family members and caregivers at a time when day-to-day care for AD patients becomes either more difficult or even unfeasible.

3. Better educational programs to inform the public about AD; to recognise first that this is a brain disease and not just erratic behaviour, to know its symptoms and progression, and more importantly, to understand how to react and what to expect when a family member is inflicted with the disease.

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4. Better support from government officials and policymakers for social and disease-preventative programmes promoting healthy lifestyles. This should include promoting healthier diets with less sugar and processed foods and more physical activity, as well as combating obesity, diabetes, alcohol and drug abuse, which constitute major risk factors for developing AD later in life. Providing incentives or subsidies for family members or caregivers of AD patients should lower the financial burden on families and support their prolonged care for their patients. Social activities that promote mental exercise, such as reading, writing, playing musical instruments or computer games, should greatly benefit the elderly and prolong their cognitive functions.

5. Better participation of AD patients in research programmes focused on deeper understanding of genetics, biomarkers, pathophysiology and the risk factors of AD in MENA countries, and better enrolment of AD patients in clinical trials evaluating new drugs for AD. Such programmes and trials may yield novel pharmacotherapies with added clinical benefits for AD patients in MENA countries.

To combat AD in MENA countries, all stakeholders should work together to remove the social stigma associated with AD, offer unconditional support to AD patients, increase public awareness of the disease, implement healthy lifestyles, and invest public and private funds in clinical research and long-term health services for AD patients. These proposals, if implemented, should help patients inflicted with this serious disease to live out their golden years in a dignified and respectable manner - which should be a common goal for both the citizens and governments of MENA countries.

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