Mohamed Aly Pasha 1769-1849

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					Mohamed Aly
   Pasha
 1769-1849
“ The Burden of Dementia
  in an Extended Family
    Social Network - a
   Historical Perspective
 Nasser Loza & Waleed Fawzi

      Istanbul October 2005
   The Middle East
General considerations

•   Religious & moral culture
•   Belief in life after death
•   Historical records
•   Migration and wars
Ramses ll
Died 96 years old
Reigned 65 years
200 wives, 156 children,
(96 sons 60 daughters)
   Pharaonic civilisation
Djedi, a magician is congratulated by
the pharaoh's son on reaching the
age of 110 years :

“Your condition is like that of a man
 who has not yet reached old age…
 who sleeps until the morning, who is
 immune from illness, without the
 slightest cough…”
             Judaism

“Show you fear from God by standing

 up in the presence of elderly people

 and showing respect for the aged. I

 am the LORD.”
                           Leviticus 19:32
     Islamic Civilisation
Ibn Masud said, “I asked the
Messenger of Allah (pbuh) which deed
is the most beloved to Allah?” He said:
“The prayer at its proper time.” I said:
“What next?” He said: “Filial piety to
the parents.” I said: “What next?” He
said: “The Holy Jihad for Allah’s
sake.”
                        (Al-Bukhari,Muslim)
     Islamic Civilisation

Abdullah bin Amr bin Al Aas related
that the Messenger (pbuh) said: “Major
sins are: To worship a partner with
Allah, to disobey the parents, to kill
the soul and to take a false oath.”
                               (Al-Bukhari)
                Overview
•   Traditional structure of ME families
•   Factors causing transition
•   Care needs for dementia sufferers
•   Patterns of provision of care
       Family Structure
The elderly population in Egypt
           140                                   14.103

           120                           9.814
                                 6.557
           100
                         4.462
           80
millions         3.242                                    60+
           60                                             Total
           40
           20
            0
                 1990    2000    2010    2020    2030
          Family Structure
•   Number of children (Contraception)
•   Extended
•   Polygamy
•   Daughters in law
                  Who Cares?
 35%
                                              Alone
 30%
                                              Spouse only
 25%

 20%                                          Spouse & married
                                              children
 15%                                          Married children
 10%
                                              Unmarried children
  5%
                                              Relatives
  0%
              Living Arrangements

• Community sample of 461 elderly Egyptians approached
  in street interviews and OP clinics. WHO study ( Sadek et
  al 2002)
          Female role
• Education
• Employment
  Factors causing transition
• Increased longevity

• A shift towards nuclear family

• Migration
     Factors causing transition
       Egyptians > 60 years
       16
       14
       12
       10
millions 8
        6
        4
        2
        0
             1990   2000   2010   2020   2030
      Factors causing transition
        Egyptians > 80 years
         1.6
         1.4
         1.2
          1
millions 0.8
         0.6
         0.4
         0.2
          0
               2000   2010   2020   2030
 Factors causing transition
         Migration

External Migration
– Middle East
– West
 Factors causing transition
Rural to Urban population in
           Egypt
            1950                                2000
                         % rural
                         % Urban
43%
                                                         44%


                   57%                    56%



                                   2025


                                                       29%




      71%
 Factors causing transition
         Migration



Rural to urban distribution in 1986:
56.1 / 43.9     vs      59 / 41 for the elderly
          Systems of care
•   Care in the community
•   Day Centres and Day Hospitals
•   Residential Homes
•   Nursing Homes
•   Care for Dementia patients with
    behavioural disturbances
     Care needs for dementia
            sufferers

• Assistance with activities of daily
  living
• Social and psychological support
• Economic factors
  Homes for the elderly in Egypt
             (2000)
• Cairo: 36 accommodating                1980 residents

• Giza 5 accommodating                    183 residents

• Alexandria 13 accommodating             994 residents

• Rest of the country 27 accommodating     700 residents


• Total Beds for healthy elderly in Egypt 3857 residents
• Leaving 4 458 882 estimated elderly
  cared for in the community in 2000



• Leaving 14 099 743 estimated elderly
  cared for in the community in 2030
         Caregiver Burden for
              Dementia
Study on 40 carers (1999) shows
Females are the primary caretakers
Most frequent problems are
     Exhaustion due to increased patients’ requirements
     Insufficient time to care for children
     Late for work
     Decreased social interactions with family and friends
     Fear of inheriting the disorder
     Increased financial burden

  Hassan M, (1999). Assessment of Psychological stress facing family
    caregivers of elderly patients with dementia, (M. Sc. Thesis).
Caregiver burden in Egypt
Abido AM, Ashour AM, Assad T, El Nahas G. (2000). Stress of
geriatric patient caregivers, M.Sc. Thesis
• 30 psychiatric outpatients with care giving related
  problems in Cairo (Matareya Hospital)
• Assessed using
   – Psychiatric and medical history for patients
   – Assessment of financial situation
   – The burden Interview (Zarit, 1985)

• 5 cases suffering from dementia with behavioural
  symptoms
• 5 cases assessed qualitatively for medical social
  psychological and economical stresses and followed
  up after provision of support
             Findings
           Abido et al. 2000

• 1 carer in 70% of cases
• 2 carers or more 30%
• 43% working full time and 57%
  housewives
             Findings
            Abido et al. 2000
Patient related factors increasing
  caregiver stress
• Behavioural symptoms in dementia
• ADL abilities
• Sleep disturbance
• Incontinence
              Findings
          Abido et al. 2000
Carer related factors
• Gender
• Occupation
• Economic status
• Support from other family members
              Findings
           Abido et al. 2000
• Carers received very limited support
  in the community and provision
  Councelling and education regarding
  coping techniques reduced caregiver
  burden substantially
           Discussion

Building on local traditions and values

                  Vs.

Adapting international approaches to
 caring for the elderly
           Discussion
Implications for services & research:

• Adopting local practices

• Translation & Validation of
  international questionnaires

• Developing local tools
Mohamed Aly
   Pasha
 1769-1849

				
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