Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka evidence from NEESAMA

Background: The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. Objective: We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. Methods: We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science. Data on population demographics, human resources, health funding and social protection for older people were extracted. Local informants were consulted to supplement and verify the data. Results: In the study countries, the number of health professionals with expertise in elderly care was largely unknown, with minimal postgraduate training programmes available in elderly medicine or psychiatry. Older adults are therefore cared for by general physicians, nurses and community health workers, all of whom are present in insufficient numbers per capita. Total average healthcare expenditure was 2.5–5.5% of GDP, with 48.1–72.0% of healthcare costs covered by out-of-pocket payments. Pakistan did not have a social pension; only India and Nepal offered financial assistance to people with dementia; and all countries had disproportionately low numbers of care elderly homes. Conclusions: Inadequate healthcare funding, a shortage of healthcare professionals and insufficient government pension and social security schemes are significant barriers to achieving universal health coverage in LMICs. Governing bodies must expand training pro-grammes for healthcare providers for older adults, alongside increasing social protection to improve access to those in need and to prevent catastrophic health expenditure

Maternal mental health in pregnancy and child behavior

Maternal mental health research is a public health priority due to its impact on both maternal and child health. Despite the growing number of empirical studies in this area, particularly from developing countries, there is a paucity of synthetic review articles. Therefore, attempting to synthesize the existing literature in this area seems relevant to appraise the readers of the field's progress and to infer directions for future research. The present review aims to provide an overview of the literature on maternal mental health and its association with birth outcomes and child behavior. Specifically, the literature on mental health during pregnancy and in the postpartum period and its influence on birth outcomes and child behavior have been reviewed. Further, a conceptual and methodological evaluation of the existing literature has been provided to identify gaps in the literature and to suggest directions for future research

Alzheimer's Dementia: An Overview

Alzheimer's disease (AD), the most common cause of dementia, is a chronic illness characterized by cognitive symptoms, behavioural and psychological symptoms and difficulty in performing activities of daily living. Mild cognitive impairment (MCI) is regarded as a transitional state between healthy cognitive ageing and dementia and around 12-15% of individuals with MCI progress to dementia annually. This provides unique opportunity to initiate treatments targeted to delay or prevent the onset of AD. Based on the age at onset, AD is divided into two broad categories: early onset and late onset. Early onset AD follows the classical mendelian pattern of inheritance, whereas the late onset AD has a complex interplay of gene-environment interaction, with several lifestyle-related risk factors strongly implicated in the pathogenesis of this degenerative condition. The onset of AD pathology predates the clinical symptoms by several years. The neurodegenerative processes in AD is related to the accumulation of abnormally folded A beta and tau proteins in amyloid plaques and neuronal tangles. Diagnosis of AD is by presence of cluster of clinical features and aided by biomarkers such as CSF A beta 42 and PET amyloid imaging, CSF tau and tau imaging, 18fluorodeoxyglucose uptake on PET and atrophy on structural magnetic resonance imaging increase the diagnostic certainty. In the absence of curative treatments, the management of AD involves pharmacological treatment to delay the onset or progression of AD and supportive care by family members. Targeting these lifestyle-related factors in young adulthood and middle age may be protective against AD. High educational achievement in early life, involvement in cognitively stimulating activity, physical activity and social engagement including rich social network have been associated with reduced risk of late-life dementia and AD

Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka evidence from NEESAMA

Background The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. Objective We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. Methods We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science. Data on population demographics, human resources, health funding and social protection for older people were extracted. Local informants were consulted to supplement and verify the data. Results In the study countries, the number of health professionals with expertise in elderly care was largely unknown, with minimal postgraduate training programmes available in elderly medicine or psychiatry. Older adults are therefore cared for by general physicians, nurses and community health workers, all of whom are present in insufficient numbers per capita. Total average healthcare expenditure was 2.5–5.5% of GDP, with 48.1–72.0% of healthcare costs covered by out-of-pocket payments. Pakistan did not have a social pension; only India and Nepal offered financial assistance to people with dementia; and all countries had disproportionately low numbers of care elderly homes. Conclusions Inadequate healthcare funding, a shortage of healthcare professionals and insufficient government pension and social security schemes are significant barriers to achieving universal health coverage in LMICs. Governing bodies must expand training programmes for healthcare providers for older adults, alongside increasing social protection to improve access to those in need and to prevent catastrophic health expenditure