x Abu Dhabi, UAESaturday 20 January 2018

Experts warn of UAE's greying population

As the number of over-60s booms, authorities will have to work out how to look after a new generation of pensioners.

Family and carers work together to ensure Sayed Al Hashemi, centre, is well taken care of at his home in Dubai. Above, Sayed’s daughter Maryam, in the abaya, speaks with her father as he shakes hands with his physiotherapist, Iftikhar Shalla, last week. Jaime Puebla / The National
Family and carers work together to ensure Sayed Al Hashemi, centre, is well taken care of at his home in Dubai. Above, Sayed’s daughter Maryam, in the abaya, speaks with her father as he shakes hands with his physiotherapist, Iftikhar Shalla, last week. Jaime Puebla / The National

Looking after a rapidly growing number of elderly people is one the most significant challenges facing health authorities, experts in geriatric care have warned.

The number of Emiratis over 60 has increased by 22 per cent in five years, from 32,400 in 2005 to about 39,400 in 2010, and the Ministry of Health expects it to pass 47,000 by 2020.

To care for them there are only four public old people's homes with between 10 and 20 residents each, a limited number of elderly-care units and a handful of geriatricians, mainly in Dubai.

The elderly population comprises less than 5 per cent of the total compared with 11 per cent in the United States and 17 per cent in the United Kingdom, but calculating by percentages masks the scale of the problem, said Dr Senthil Raj Meenrajan, a geriatrician at the American Hospital Dubai.

"The geriatric population may only comprise a few percentage points of the entire cohort, but that runs into thousands when you look at the raw numbers," he said.

The elderly may not necessarily need to be placed in specialist care homes but they will require medical follow-up and management, Dr Meenrajan said. "You're talking about a lot of people."

Dubai Health Authority (DHA) has launched a home-based primary care programme for the elderly, in which a team of health professionals, including a doctor, a physiotherapist and a nurse, visit the person's home for a full assessment and draft a care plan.

The DHA programme is different from others in that the doctors are licensed geriatricians. There are eight geriatricians in DHA hospitals and clinics, three of whom also work in the home-care programme.

"These specialists are very rare, and we need at least two more in our programme with the expected increase," said Dr Amal Al Jaziri, a geriatrician who heads the DHA programme.

Dr Al Jaziri said there was also a lack of nursing homes, partly because of a cultural stigma attached to them.

"It's great that families would like to take care of their own, but some of these people have multiple medical problems and require special care. We have cases where we advise a patient to be admitted into a nursing home, but the family refuses.

"Perhaps the concept or name of a 'nursing home' should change into something more medical that is orientated to our cultural needs."

The Old People's Home in Ajman, with 10 residents, is the only such facility run by the Ministry of Social Affairs. Similar homes in Ras Al Khaimah, Sharjah and Dubai are run by each emirate's government.

Criteria for acceptance are strict. Residents must be Emirati, with no psychological or communicable illnesses and no children or immediate family.

"If the person has just one child, they are not accepted," said Fawzya Taresh Rabee, director of the family development department at the Ministry of Social Affairs.

"You might find that 10 people is very few, but this is because we don't want to remove the elderly person from their home. If they leave they will get this internal feeling that their community and home does not want them.

"The elderly people staying at the centre may be laughing, but inside you feel there's pain. That is why for those who do have a family, we provide a home-care service."

About 140 families are registered for the ministry's home-care service, which involves sending a team of two nurses, a doctor, and a physiotherapist to the patient's home. Only 40 families were registered when the programme launched three years ago.

The Ministry of Health runs a similar home-care programme in the northern emirates, with 290 elderly patients. The team, which consists of a physician and a staff nurse, visits the person's home for an assessment and then makes follow-up visits according to requirements. Families can register elderly members at one of 13 MoH centres in Dubai, Ras Al Khaimah, Sharjah, Ajman, Fujairah and Umm Al Quwain.

None of the staff are licensed geriatricians, but they are trained in elderly care, said Dr Muna Al Kuwari, director of the primary health department at the ministry.

"We launched the programme after a study in 2007 found that nearly half of elderly patients admitted to hospitals can be released with home care," she said.

However, families in need of such services say greater provision for the elderly is needed.

"This team might attend to the elderly person for one or two hours, but these people require round-the-clock care, not just a few hours," said Atallah Habib, who decided to launch his own nursing company after his elderly father suffered a stroke.

Criteria that require the elderly to have no direct family before they are admitted to a nursing home only worsens the cultural stigma, Mr Habib said.

"It discourages people from giving their parents the care they need. If someone is going to neglect their elderly family member, they will do so regardless."

Dr Habib recalled the case of an elderly Emirati woman with breast cancer who was neglected by her family. "The son would leave his mother in a room for 12 hours, without food or water," he said. "We would knock on his door, and he would refuse our help, which we were offering free."

Nurses would come into the room and find the woman dirty and the sheets not changed for days. Although this may be an exception, changing the negative misconceptions about nursing homes could help to reduce the likelihood of such cases, Mr Habib said.

The American Hospital Dubai's Dr Meenrajan suggested having dedicated units attached to a medical facility where families could keep their elderly members for extended periods of time.

"Having an independent unit for these people could work," he said. But he warned: "It'll be a few years before you can change the culture, and these people need a mechanism to be taken care of right now."