MUSONDA SIMUTOWE

GA14011013

ZAMBIA

Global health report.

How to improve the health status

among the aging based on disease burden.

 Background
What is disease burden?

Burden of disease is concept that was developed in the 1990s by

the Harvard School of Public Health, the World Bank and the
World Health Organization (WHO) to describe death and loss of
health due to diseases, injuries and risk factors for all regions of
the world.

The burden of a particular disease or condition is estimated by

adding together:

the number of years of life a person loses as a consequence of

dying early because of the disease (called YLL, or Years of Life
Lost) and the number of years of life a person lives with
disability caused by the disease (called YLD, or Years of Life
lived with Disability).

It is important to estimate disease burden.why?

Scientific evidence is key to improving global public health,

because national and international health policies should be
based on accurate and meaningful health information. Poorly
informed policy-making can be one of the reasons why attempts
to improve public health fail, jeopardizing the attainment of the
health-related Millennium Development Goals.

Older adults, those aged 60 or above, make important

contributions to society as family members, volunteers and as
active participants in the workforce. While most have good
mental health, many older adults are at risk of developing mental
disorders, neurological disorders or substance use problems as
well as other health conditions such as diabetes, hearing loss, and
osteoarthritis. Furthermore, as people age, they are more likely to
experience several conditions at the same time.

In Africa, HIV/AIDS, lower respiratory infections and diarrhea

disease are the leading causes of burden of disease.

Data analysis
Burden of disease 2012

Disease burden - Non-communicable diseases and conditions

Zambia is currently experiencing a major increase in the burden
of Non-communicable Diseases (NCDs). The common NCDs
include cardiovascular diseases, diabetes mellitus (Type II),
cancers, chronic respiratory diseases, epilepsy, mental illnesses,
oral health, eye diseases, injuries (mostly due to road traffic
accidents and burns) and sickle anaemia. Most of these health
conditions are associated with lifestyles, such as unhealthy diets,
physical inactivity, alcohol abuse and tobacco use, while some
are also associated with biological risk factors, which run in
families. Figure 1 and 2 below present the trends in morbidity
and mortality due to some of the NCDs,

Figure 1: Zambia: NCDs Morbidity at Primary Health Care:

2008-2009 
Figure 2: Zambia: NCD Mortality at Primary Health Care

2008-2009 
A needs assessment for the NCD programme was carried out and
key findings were made, which also identified the gaps. Table
xxx below, summarizes the key identified gaps.

Based on the recommendations from the NCD symposium

(MOH NCD Symposium 2009), the NCDs programme has
embarked on a number of interventions for the prevention and
early detection of NCDs. 
These include: the development of treatment protocols that will
be used at the second level hospitals, where specialized clinics
are being set up for NCDs; development of clinical nutrition and
dietary guidelines; training of health workers in the management
of NCDs; raising awareness levels on NCDs, through IEC
materials like TV documentaries, posters, brochures and media
discussions; and collaboration with various associations, to
carryout screening programs, such as Blood Pressure (BP) check,
Nutritional assessment, prostate and breast cancer; and
advocating for change in unhealthy lifestyles. However, these
interventions are yet to be extended to all districts and
institutions. 

The other interventions that have been identified, but not yet
being implemented, include: development and implementation of
an NCD policy; introducing and strengthening physical activities
in all schools; community physical/sporting activities; promotion
of healthy diets; strengthening enforcement of legislation on
tobacco use and harmful use of alcohol; operational research;
and monitoring and evaluation.
Risk factors for mental health problems among older adults

Multiple social, psychological, and biological factors determine

the level of mental health of a person at any point of time. As
well as the typical life stressors common to all people, many
older adults lose their ability to live independently because of
limited mobility, chronic pain, frailty or other mental or physical
problems, and require some form of long-term care. In addition,
older people are more likely to experience events such as
bereavement, a drop in socioeconomic status with retirement, or
a disability. All of these factors can result in isolation, loss of
independence, loneliness and psychological distress in older
people. 

Mental health has an impact on physical health and vice versa.

For example, older adults with physical health conditions such as
heart disease have higher rates of depression than those who are
medically well. Conversely, untreated depression in an older
person with heart disease can negatively affect the outcome of
the physical disease.

Older adults are also vulnerable to elder abuse - including

physical, sexual, psychological, emotional, financial and material
abuse; abandonment; neglect; and serious losses of dignity and
respect. Current evidence suggests that 1 in 10 older people
experience elder abuse. Elder abuse can lead not only to physical
injuries, but also to serious, sometimes long-lasting
psychological consequences, including depression and anxiety.

Treatment and care strategies 

It is important to prepare health providers and societies to meet

the specific needs of older populations, including:

training for health professionals in care for older persons; 

preventing and managing age-associated chronic diseases
including mental, neurological and substance use disorders; 
designing sustainable policies on long-term and palliative care;
and 
developing age-friendly services and settings.

Health promotion

The mental health of older adults can be improved through

promoting Active and Healthy Ageing. Mental health-specific
health promotion for older adults involves creating living
conditions and environments that support wellbeing and allow
people to lead healthy and integrated lifestyles. Promoting
mental health depends largely on strategies which ensure the
elderly have the necessary resources to meet their basic needs,
such as:

Providing security and freedom;

Adequate housing through supportive housing policy;
Social support for older populations and their caregivers;
Health and social programs targeted at vulnerable groups such as
those who live alone and rural populations or who suffer from a
chronic or relapsing mental or physical illness;
Programs to prevent and deal with elder abuse; and 
community development programs.

Interventions
Prompt recognition and treatment of mental, neurological and
substance use disorders in older adults is essential. Both
psychosocial interventions and medicines are recommended. 

There is no medication currently available to cure dementia but

much can be done to support and improve the lives of people
with dementia and their caregivers and families, such as: 

Early diagnosis, in order to promote early and optimal

management;
Optimizing physical and psychological health and well-being;
Identifying and treating accompanying physical illness;
Detecting and managing challenging behavioral and
psychological symptoms; and
Providing information and long-term support to caregivers.

Findings

How to improve health status among the aging.

Promote Healthy Aging

Communicate and promote the message that “it’s never too late.”
Older adults can benefit significantly from adopting healthy
lifestyles. Its evident that the following can be implemented
Conducting communications campaigns targeted at seniors;
Using the media for public service announcements, e.g.,
showcase health-enhancing behaviors practiced by senior
legislators;
Supporting the state’s Senior Olympic Games; and
Promoting and participating in Older game activities

Encouraging state and local entities to provide volunteer

opportunities for older adults. Volunteerism is a proven
component of good health and quality of life.

Broaden the Use of Preventive Services

Encourage collaborative work between the state’s public health

department and state unit on aging to reach older adults with
evidence-based health promotion programs and to ensure that
such programs are delivered most effectively and with the
broadest coverage.

Establish incentives for third-party insurance coverage of

preventive services, e.g., screenings and immunizations.
Establish statewide chronic disease self-management programs.
Work to improve the rate of adult immunizations by broadening
access points and improving

Coordination and communication between providers and the

community.

Establish the state employees’ and retirees’ health care system as

a model of improved access to health-enhancing behaviors and
preventive services.

Support funding to increase training on prevention-focused

geriatric care for health care and aging services professionals.

Support Aging in Place

Provide funding to support community-based programs that are

collaborations between health care and social service agencies.
The most successful aging in place strategies recognize and build
on integrated health and social services.

Provide incentives and guidance to local planning boards and

other bodies to incorporate com- munity and housing design
features that help achieve “livable communities” for older adults
by:
Increasing availability of alternative modes of transportation;

Increasing opportunities for safe, regular physical activity;

Including universal design features in new home construction to

increase accessibility, us- ability and safety for all household
members—from kids to aging adults and people with dis-
abilities;

Promoting pedestrian safety and safe driving among older adults;

and

Developing walkable communities.

Work to eliminate the institutional bias in Medicaid by providing
funding for home and community based services.

Health Services

The Patient Protection and Affordable Care Act of 2010 includes

provisions that added certain preventive services to Medicare,
including cancer screenings and immunizations. These services
can prevent disease or help to detect disease early, when
treatment is more effective.  Unfortunately older adults,
especially those from certain racial and ethnic groups, underuse
these services.
Professionals, paraprofessionals, as well as paid and unpaid
caregivers need basic and continuing geriatric education to
improve care for older adults.

Chronic Illness

Physical activity can help prevent disease and injury. However,

less than 60% of older adults engage in physical activity and
strength training.

Federal efforts to improve chronic illness services for older

adults include: 

Programs to fund evidence-based Chronic Disease Self-

Management Education (CDSME) programs, which help older
adults with chronic diseases better manage their conditions and
take control of their health

Older Americans Act programs that fund a wide array of services

and supports. They are targeted to low-income older adults and
help millions of people maintain their health and independence. 
Injury Prevention

Falls, the leading cause of injury among older adults, are treated
in emergency departments every 13 seconds and claim a life
every 20 minutes. Every year, 1 out of 3 older adults fall, yet less
than half tell their doctor.

Falls-related injuries and deaths can be prevented by addressing

risk factors.  

The Administration for Community Living supports evidence-

based falls prevention programs that are implemented in
community settings through aging services and other community
providers.

Center for Disease Control and Prevention's Stopping Elderly

Accidents, Deaths, & Injuries (STEADI) tools and educational
materials can assist health care providers in reducing their
patients’ risk of falling

Caregivers
Caregivers help people needing ongoing assistance with
activities of daily living. The need for unpaid and paid caregivers
will likely increase as the U.S. population ages

Caregivers are at increased risk for negative health

consequences, including stress and depression, and need
increased support to preserve their own health. These risks are
greater for caregivers of people with Alzheimer’s and related
dementia

Conclusion and summary

It is felt by many interested in ageing issues that the lack of an

ageing policy compliance of various ageing related procedures
and ageing rights will be difficult to achieve.

Government shares this thinking and that is why the ageing

policy is now a priority.

Since most of the older persons lack income and live below
poverty line, something should be done to help the needy older
people. Younger members of the society should be encouraged to
look after their elder ones.

Secondly government should consider interventions like social

pension, support and incentives to families looking after older
people, and provisions of credit for income generating activities.

References

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