Ageing and mental health resources for older persons in the African region of the World Health Organization

Africa is a region where a demographic transition from high child mortality and low life expectancy, to low child mortality and high life expectancy is only just beginning. Nevertheless, some countries already have a growing number of persons over the age of 60 – a number that is likely to increase rapidly. As a consequence, the number of older persons with mental disorders is likely to increase. To better understand the organisation of care for older persons, data are being collected to reduce the imbalance between ‘disease information’ and ‘resource information’ – information that addresses older persons’ needs in terms of mental health care. This review presents some results from the continent. Mental health problems among older adults are still not a public health priority in Africa, but careful examination of each country nevertheless reveals certain specificities, such as divergent life expectancy and different values regarding ageing. The authors present some recommendations for the development of care for old persons with mental disorders, based on the general recommendations made by the World Health Organization (WHO) in the World Health Report 2001 (WHR 2001), and by the WHO and the World Psychiatric Association (WPA) in some consensus statements on psychiatry of the elderly. Pg 8-12.indd 8 3/12/08 10:44:01 AM

To better understand the organisation of care for older persons, statistics are being collected under the auspices of the Atlas project. 1 One goal of this project is to reduce the imbalance between 'disease information' and 'resource information', an imbalance that is a significant impediment in planning mental health services, particularly for older persons (defined as persons >60 years).Lack of information on resources also hampers efforts made by non-governmental organisations (NGOs), professional associations and consumer groups to motivate the improvement of mental health care services and to highlight any needs specific to older persons.This paper presents some results from the project's African segment.[3][4]

Data and analysis
Preliminary research conducted by the authors [1][2][3][4] has already produced the following information, by country: • demographic distribution: total and >60 years • life expectancy at birth • total expenditure on health as a percentage of the gross domestic product (GDP) and the per capita total expenditure on health at the then official exchange rate (both for 2002) • identification of the NGOs in each country that are active in the field of mental disorders in old age (psychiatry, neurology, geriatrics/gerontology, and consumers of health services).
The first three data groups were taken from the World Health Report 2005. 5Data concerning the NGOs was obtained from the websites of the World Psychiatric Association, 6 the World Federation of Neurology, 7 the International Association of Gerontology and Geriatrics, 8 and Alzheimer's Disease International. 9e World Health Organization (WHO)'s Africa region comprises 46 countries.Some factors in this region that influence the population growth are: • the low overall density of the population • a history of having been the major source of slaves, the consequences of which even today are underestimated in the region's demographics and human and economic development A survey culling data from the websites of the World Psychiatric Association, 6 Alzheimer's Disease International (ADI), 9 the International Association of Gerontology and Geriatrics (IAGG) 8 and the World Federation of Neurology (WFN)7 enabled us to conclude that:

Ageing and mental health resources for older persons in the African region of the World Health Organization
• 9 countries had at least 1 national association of psychiatry • only 1 country (South Africa) had a section addressing psychiatry for the elderly in the national psychiatric association

Required actions for mental health in old age
The World Health Organization and the World Psychiatric Association defined psychiatry of the elderly as a branch of psychiatry that addresses concerns related to the psychiatry of people of 'retirement' age and beyond (65 years in general, but this may vary in some countries and according to local practices). 11 this context, what should the place of psychiatry of the elderly be in Africa, a region where the proportion of persons >60 years is less than 5% in 57% of the countries, and life expectancy at birth is <65 years in 91.3% of them?Even if we recognise that there are a growing number of older persons in this region, this trend may not justify the development of specific policies, programmes and services for this population.But surely this does not imply that the health authorities can neglect to provide care for older persons -in particular, mental health care?
Consequently, we adopted the WHO general recommendations presented at the WHR 2001, 10 and the WHO/WPA consensus statements of Psychiatry of the Elderly, 11,12 and propose the measures listed in Table II to promote the mental health of old persons in both regions.

Conclusion
Africa has a low proportion of older persons in its population

( 4 .. 1
7% of total population), and a low life expectancy at birth Table I.African countries and their total populations; percentage of persons above age 60; total expenditure on health as a percentage of gross domestic product (GDP); per capita total expenditure on health (US$); life expectancy at birth; and presence of a national association of psychiatry, psychiatry of the elderly, geriatrics/gerontology, neurology and Alzheimer'March 2008 -SAJP (49.7 years).Strong cultural forces affect the growth and ageing processes, and frequent international conflicts cause premature deaths and migrations.The continent's populations are substantially affected by epidemic and endemic communicable disorders.Lastly: poverty, with all the consequences it has upon health, is probably the biggest factor that negatively influences quality of life and life expectancy at birth.Mental health for all ages should become a priority issue in public agenda throughout the region.It is important to already be able to offer good care to the existing older populations and at the same time be flexible enough to adapt a care system that reflects the specific local needs of each country.The efforts of national governments to promote mental health should be made according to the principles of organisation of care for old persons with mental disorders, 12 adapted to local resources and cultures.As mental disorders in old age can severely limit the quality of life of older persons and their families, care should be extended to all concerned.The challenge of finding solutions for better living conditions for older people with mental health problems lies in the hands of researchers, policymakers and the broader population.Funding and creativity are two factors necessary to find solutions.