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Mohamed Aly Pasha 1769-1849

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

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Mohamed Aly Pasha 1769-1849

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  1. Mohamed Aly Pasha1769-1849

  2. “ The Burden of Dementia in an Extended Family Social Network - a Historical Perspective Nasser Loza & Waleed Fawzi Istanbul October 2005

  3. The Middle East General considerations Religious & moral culture Belief in life after death Historical records Migration and wars

  4. Ramses ll Died 96 years old Reigned 65 years 200 wives, 156 children, (96 sons 60 daughters)

  5. 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…”

  6. 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

  7. 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: “Filialpietytotheparents.” I said: “What next?” He said: “The Holy Jihad for Allah’s sake.” (Al-Bukhari,Muslim)

  8. Islamic Civilisation Abdullah bin Amr bin Al Aas related that the Messenger (pbuh) said: “Major sins are: To worship a partner with Allah, to disobeytheparents, to kill the soul and to take a false oath.” (Al-Bukhari)

  9. Overview • Traditional structure of ME families • Factors causing transition • Care needs for dementia sufferers • Patterns of provision of care

  10. Family StructureThe elderly population in Egypt

  11. Family Structure • Number of children (Contraception) • Extended • Polygamy • Daughters in law

  12. Who Cares? • Community sample of 461 elderly Egyptians approached in street interviews and OP clinics. WHO study ( Sadek et al 2002)

  13. Female role • Education • Employment

  14. Factors causing transition • Increased longevity • A shift towards nuclear family • Migration

  15. Factors causing transitionEgyptians > 60 years

  16. Factors causing transition Egyptians > 80 years

  17. Factors causing transition Migration External Migration • Middle East • West

  18. Factors causing transition Rural to Urban population in Egypt

  19. Factors causing transition Migration Rural to urban distribution in 1986: 56.1 / 43.9 vs 59 / 41 for the elderly

  20. Systems of care • Care in the community • Day Centres and Day Hospitals • Residential Homes • Nursing Homes • Care for Dementia patients with behavioural disturbances

  21. Care needs for dementia sufferers • Assistance with activities of daily living • Social and psychological support • Economic factors

  22. 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

  23. 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

  24. 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).

  25. 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

  26. FindingsAbido et al. 2000 • 1 carer in 70% of cases • 2 carers or more 30% • 43% working full time and 57% housewives

  27. FindingsAbido et al. 2000 Patient related factors increasing caregiver stress • Behavioural symptoms in dementia • ADL abilities • Sleep disturbance • Incontinence

  28. FindingsAbido et al. 2000 Carer related factors • Gender • Occupation • Economic status • Support from other family members

  29. FindingsAbido et al. 2000 • Carers received very limited support in the community and provision Councelling and education regarding coping techniques reduced caregiver burden substantially

  30. Discussion Building on local traditions and values Vs. Adapting international approaches to caring for the elderly

  31. Discussion Implications for services & research: • Adopting local practices • Translation & Validation of international questionnaires • Developing local tools

  32. Mohamed Aly Pasha1769-1849

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