Dementia in Eastern Mediterranean countries: A systematic review.

Abstract

Globally, there is an increase in the older population, whose lives are affected by local cultural norms. In Eastern Mediterranean countries (EM), dementia is conventionally hidden from view with few dedicated services or recognition for diagnosis. The aim of this systematic review is to explore the limited literature on dementia and cognitive impairment among older people in EM countries to present an evaluation of current practices and to consolidate knowledge for future planning. A systematic search of scientific databases was conducted February 2017. Thirty-three studies were identified for inclusion in the review, and four themes were apparent. Firstly, prevalence, comorbidity, and gender: In EM countries, many studies identify that the prevalence of dementia is high. As is the case elsewhere, many older adults in EM countries have at least one coexisting long-term condition, and some experience low life-satisfaction. Secondly, culture: In EM countries, the older adult is highly respected, and placement outside of the family home is considered an abandonment of family duty. The term dementia carries stigma, and it is widely believed that dementia is caused by ‘fate’. Thirdly, recognition and tools: There are a lack of verified assessment instruments to assess for dementia. Despite concerns about the cultural appropriateness of the Mini Mental State Exam, particularly for people who have low literacy levels, and low literacy being the norm in EM countries, the Mini-Mental State Examination is the main assessment instrument. Translation and transition of non-Arabic assessment instruments and tools with psychometric properties presents a challenge for clinicians. Finally, workforce issues: health care workers lack knowledge about dementia, as dementia care is a relatively recent addition to the nursing and medical syllabi. While there were some inconsistencies in the papers published, many of the articles call for increasing educational programmes and health and social care policies to promote improved and practical gerontological nursing and medicine. Healthcare professionals need education about sociocultural, religious, and language needs to deliver improved culturally sensitive care.