Nexus Between Demographic Change and Elderly Care Need in the Gulf Cooperation Council (GCC) Countries: Some Policy Implications

Forecasting Head and Neck Cancer Trends in GCC Countries: Implications for Public Health Policy and Strategy

Purpose

The data available on the incidence and mortality rates of head and neck cancer types (HNCs) in the Gulf Cooperation Council countries (GCC) have relied on global trends and covered only certain cancer sites, types or certain age groups. This study aimed to assess the incidence and mortality rates of head and neck cancer (HNCs) within the Gulf Cooperation Council (GCC) countries, providing insights into their geographic variability in 2020.

Methods

Prediction of the magnitude of the disease to 2040 was explored based on demographic projections. Estimates of incidence and mortality and the population projections were extracted from the Global Cancer Observatory (GLOBOCAN) database and the United Nations Department of Economic and Social Affairs respectively for the time frame 2020 to 2040. Additionally, we analyzed the distribution of cases and deaths by age and sex for both time periods.

Results

The analysis indicates varying patterns in HNC rates across GCC countries in 2020, with Oman and Saudi Arabia carrying the highest burden. Projections for 2040 reveal a substantial increase in new HNC cases and related deaths, particularly in Qatar, UAE, and Bahrain. Furthermore, incidence rates are predicted to rise significantly for individuals aged 50 and older, while remaining relatively stable for those under 50. With regards to sex, males generally exhibit higher rates, except in Qatar.

Conclusion

HNC burden is anticipated to rise significantly in the GCC, with variations per age, sex and geographical location. By 2040, a 2-3-fold increase in HNCs in the GCC is anticipated, emphasizing the need for focused public health strategies to address this rising health challenge.

Household Need and Unmet Need for Caregivers of Older Persons in Thailand

The need for caregivers is a crucial issue in Thailand. This research examined levels and trends of household needs and unmet needs for caregivers of older persons and explored potential factors associated with these needs. The analysis utilized data from the Survey of Older Persons in Thailand 2007, 2011, 2014, and 2017. The household need for a caregiver of older persons was defined as a household with one or more older people who needed a caregiver to help them perform basic activities of daily living. The unmet need for a caregiver referred to households where at least one older person in the household needed care but did not receive it. Findings illustrated the increasing levels and trends of household needs as well as unmet needs over time. In terms of potential determinants, older person households in Bangkok and households with higher socioeconomic status were more likely to be the household need for caregivers. In contrast, those households in the Northeastern, the poorest region, were more likely to be the unmet need household. These findings are indicative of the rising demand for long-term care services in Thailand. However, it is vital to consider unmet household needs, especially in the worse-off area, when designing national policies.

Retiring Unprepared in Abu Dhabi? Predicting Emirati Employees' Retirement Age and Self-Activation

The topic of retirement is rarely explored in the context of the Middle Eastern and Gulf Cooperation Council (GCC) countries. This study drew on data from a large-scale survey of retirees in the Emirate of Abu Dhabi, the United Arab Emirates (UAE), a universal welfare state characterized by the persistence of the traditional male-breadwinner model and gender roles, to analyze the determinants of retirement timing and post-retirement work. Multi-level regressions were performed to explore the effects of individual, family, institutional, and social-economic factors. The study revealed that Emirati females tended to retire earlier than men to fulfill their domestic duties and informal caregiving roles, rather than to retire together with their spouse. Additionally, early retirement incentives offered by Abu Dhabi pension systems appeared to attract employees into early retirement. On the other hand, securing more financial resources and reduced sense of belonging in society were among the most significant predictors of post-retirement job searching motivations among Emirati retirees.

Quality of life of older adults and associated factors in Ghanaian urban slums: a cross-sectional study

OBJECTIVE

This study provides insight into the quality of life (QoL) of older adults living in urban slums in Ghana.

DESIGN

The study employed a community-based, cross-sectional design to assess QoL among older adults in two slums between April and May 2020. QoL was assessed using the WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire.

SETTINGS

Participants were drawn from two slums in Ghana, one in a fishing-dominated community and the other in an industrial community.

PARTICIPANTS

This study included 400 participants aged 60 and above who had lived in either slum for at least 1 month and were able to communicate verbally.

RESULTS

Although the means of all participants' transformed scores were poor in the physical and psychological domains, they were moderate in all other domains. When viewed as a whole, the perceived overall QoL is neither poor nor good and participants were neither satisfied nor dissatisfied with their health. Participants had a moderate level of QoL in the WHOQOL-BREF psychological (mean score 45.7), social (mean score 57.0) and environmental (mean score 51.6) domains. The mean score for physical QoL of older adults was 43.3, which denotes poor QoL. In all domains, male participants have a significantly higher mean QoL than their female counterparts. An analysis of variance comparing the living arrangements of participants showed that those who lived with extended family had high mean scores in environmental QoL, overall QoL and satisfaction with health. Regression analysis revealed that QoL was influenced mostly by the environmental (46.2%), followed by the psychological (43.7%), physical (31%) and social (20.4%) domains.

CONCLUSIONS

The findings from this study show that older adults living in slums had moderate psychological, social and environmental QoL and poor physical QoL. Although the mean scores for QoL are higher than anticipated, health policy development must take into account the specific needs of older adults.

Current changes in the epidemiology of fall-related injuries in Al Ain City, United Arab Emirates

Background

Falls in the Gulf countries are the second most common cause of injuries. The United Arab Emirates government implemented various preventive measures to decrease injuries in the country. We aimed to evaluate the changes in the epidemiology of fall-related injuries in Al-Ain City over the last decade.

Methods

Data of hospitalized patients who presented with fall-related injuries to the Al-Ain Hospital during the two periods of March 2003 to March 2006 and January 2014 to December 2017 were compared. This included patients’ demographics, mechanism, location, anatomical distribution and parameters related to injury severity. Non-parametric tests were used for the statistical analysis.

Results

882 in the first and 1358 patients in the second period were studied. The incidence of falls decreased by 30.5% over ten years. The number of elderly, female patients, and UAE nationals increased, (p < 0.001, p = 0.004, and p < 0.001). Falls from height decreased by 32.5% (p < 0.001) while fall on the same level increased by 22.5% (p < 0.001). Fall-related injuries at home have increased significantly by 22.6% (p <0.001), while falls in workplaces decreased by 24.4% (p <0.001).

Conclusions

Our study showed that the overall incidence of falls decreased compared to a decade ago. The preventive measures were effective in reducing falls from height and workplace injuries. Future preventive measures should target falls at the same level and homes.

Value drivers for pharmaceutical products in health technology assessment (HTA) in Saudi Arabia: Results from a capacity Building, Multi-Stakeholder workshop

OBJECTIVES

Capacity building exercises are important to increase understanding of healthcare processes by key stakeholders, and to facilitate open discussions to build consensus. This study explored the views of a multi-stakeholder group of local Saudi experts on possible value elements that could be important for health technology assessment (HTA) processes and methods regarding pharmaceutical products in Saudi Arabia ('value drivers').

METHODS

A diversified group of local experts were invited to a two-day capacity building workshop from 18 to 19 December 2019 in Riyadh, Saudi Arabia. Information regarding the participants' demographic and educational/professional background, along with their self-assessed knowledge and experience of HTAs and the concept of value in the pharmaceutical market was collected. For each of 22 value drivers identified during a targeted literature search, participants were asked either to 'opt out' of its consideration for future HTA assessments, or rate it from 1 to 10 (low-high) on feasibility and acceptability.

RESULTS

Efficacy and safety were the highest rated value drivers for acceptability and feasibility. Explicit cost-effectiveness thresholds had the lowest ratings for acceptability and feasibility. Participants highlighted data availability and accuracy as a potential challenge to HTA implementation in Saudi Arabia.

CONCLUSIONS

Participants valued a pharmaceutical product's efficacy and safety alongside the consideration of disease characteristics for HTA processes. Participants also valued a binding HTA recommendation and the use of local real-world evidence, where available, to support HTA submissions.

Epidemiological changes of geriatric trauma in the United Arab Emirates

ABSTRACT

We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury

Background

Trauma is a leading cause of death in the United Arab Emirates (UAE). There have been major developments in the trauma system in Al-Ain City during the last two decades. We aimed to study the effects of these developments on the trauma pattern, severity, and clinical outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates.

Methods

This is a retrospective analysis of two separate sets of prospectively collected trauma registry data of Al-Ain Hospital. Data were collected over two periods: from March 2003 to March 2006 and from January 2014 to December 2017. Demography, injury mechanism, injury location, and clinical outcomes of 2573 trauma patients in the first period were compared with 3519 patients in the second period.

Results

Trauma incidence decreased by 38.2% in Al-Ain City over the last 10 years. Trauma to females, UAE nationals, and the geriatric population significantly increased over time (p < 0.0001, Fisher’s exact test for each). Falls on the same level significantly increased over time, while road traffic collisions and falls from height significantly decreased over time (p < 0.0001, Fisher’s exact test for each). Mortality significantly decreased over time (2.3% compared with 1%, p < 0.0001, Fisher’s exact test).

Conclusions

Developments in the trauma system of our city have reduced mortality in hospitalized trauma patients by 56% despite an increased severity of injury. Furthermore, the injury incidence in our city decreased by 38.2% over the last decade. This was mainly in road traffic collisions and work-related injuries. Nevertheless, falls on the same level in the geriatric population continue to be a significant problem that needs to be addressed.

Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis

To support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (PA) and sedentary behaviour in the Middle East and North Africa (MENA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The meta-analysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the PA measurement as predictors of PA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. The inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. The recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on PA behaviours is needed from low- and middle-income countries in the region.

Population ageing in a globalized world: Risks and dilemmas?

RATIONALE, AIMS, AND OBJECTIVES

This article aims to examine global population ageing and to evaluate the likely risks and dilemmas of demographic ageing within the context of the health and well-being of individuals.

METHODS

This paper is based on the author's research in the field of social gerontology, demography, and public health. In addition, a literature review has been carried out focused on the objectives of the research.

RESULTS

The study has identified potential risks and dilemmas that the older people may face in the globalized world. There are four main aspects that contribute to an unequal distribution of risks in later life: (a) burden of disease in epidemiological transition, (b) financial security in retirement, (c) familial resources for older peoples' care, and (d) availability of workforce for older peoples' care. Whilst population ageing is a global trend, its impact is not equal across the world, and this is highlighted in this research. There are some important dilemmas which are identified in this paper that may also fuel the potential risks and challenges facing ageing societies.

CONCLUSIONS

It is apparent that older people will face numerous risks in later life and those in developing countries are likely to face more challenges than those in developed countries. The findings may be useful to policymakers for formulating future plans and policy implementation. Further research is required to identify the number of health care workers needed to tackle the challenges of an ageing societies across the globe.

Population aging and long-term care policies in the Gulf region: a case study of Oman

Population aging is a phenomenon occurring across the globe including in countries traditionally exhibiting population dividends and "youth bulges." The Gulf Corporation Council countries are no exception as they currently experience a process of population aging, albeit at a different stage from many developed countries. However, due to historically high fertility rates and fast-paced epidemiological transition, some of these countries will experience population aging at a higher pace than what has been observed in Europe and the United States. This article reviews recent developments in long-term care policies in the Gulf region with a focus on Oman as an example of a high-income Arab country that is experiencing population aging while still being governed by traditional family aged-care norms. Utilizing existing data and published research complemented by policy analysis and field visits, we analyze the process of population aging in Oman and neighboring countries and its policy implications.

Atrial fibrillation in the Middle East: unmapped, underdiagnosed, undertreated

INTRODUCTION

Atrial fibrillation (AF) is the commonest persistent cardiac arrhythmia with an estimated incidence rate of between 1.5-2% and an important cause of strokes. Few epidemiological studies and clinical trials on the management of AF have been conducted outside Europe and North America. These gaps in our understanding of AF likely lead to sub-optimal management of patients with AF in the rest of the world. Areas covered: We discuss the epidemiology, treatment and clinical outcomes for AF in the Middle East after systematic review of published work for AF from the Middle East. We also discuss important clinical trials on AF conducted in the West in the same period to help contextualize our findings. Expert commentary: The few available Middle East studies suggest important epidemiological differences between Middle Eastern and Western AF populations. In particular, the Middle Eastern AF population is younger and have more co-morbidities than patients in the West. We find that significant numbers of moderate to high risk patients with AF are either undertreated or untreated placing them at increased risk of complications such as stroke. More studies in the Middle Eastern population are required to aid the development of region-specific clinical guidelines to improve patient care.