Geriatrics and Care of the Elderly in the Middle East and Africa: Challenges and Opportunities!

Abstract

“Knowing is not enough; we must apply. Willing is not enough; we must do.” Goethe The world’s population is aging rapidly, in absolute numbers and percentages, relative to the younger population.1 In 2018, for the first time in history, persons aged 65 years or over worldwide outnumbered children under age 5. In the current issue of this journal, Beshyah et al2 examined physicians’ perceptions of geriatric medicine in the Middle East and North Africa (MENA) region. The authors surveyed 137 doctors practicing in the MENA region in 2017 using an online questionnaire that included attitude scales of geriatrics and nursing homes. The article is a commendable attempt that highlights the need for additional representative surveys that will have implications for policymakers and universities. That are ultimately responsible for advancing the specialty of geriatrics and gerontology across the comprehensive health care team. The countries in the MENA region are the cradles of civilization and urban culture. Significant demographic changes are affecting the MENA region. The percentage of older persons in the MENA region is expected to increase with improving health care delivery in the area. Presently, Lebanon and Tunisia have the highest percentage of older people (65þ ) (7.3 and 7%, respectively). By 2050, the percentage of older persons will exceed 20% in 6 out of the 22 MENA countries. It will range between 12 and 19% in nine others.3 Therefore, the region will develop rapidly aging populations within the next few decades. Countries with lower economic development and access to adequate health care than more developed countries will be hard-pressed to meet the challenges of more numbers of older people, especially as traditional family support systems for older persons are breaking down. Policymakers in the Middle East need to invest in formal old-age support systems to meet these challenges in the coming decades.4–7 MENA countries have made significant strides in the welfare of their older populations over the past decade. However, the achievements have significantly varied depending on their economic development, resources, and commitment. Theyare affected by the degree of aging in each country. The authors of the survey paper addressed a critical issue that reveals the gaps in training in the aging field.2 However, the sample size was small, and as such, we cannot generalize to the MENA region. In addition, it would have been helpful to know from which countries the physicians were located and their specialties. While aging has long been a problem in wealthier countries, it has only recently become a problem in some Arab countries. For example, in all Arab countries, there is a dearth of geriatric medicine specialization and education. When available, nursing homes are ill-equipped to care for senior citizens.4–6 Due to a lack of adequate geriatric services, elderly persons in the Gulf Cooperation Council countries are typically treated by general internists or physicians and admitted to acute care hospitals. Most older individuals claim that advanced home services are insufficient or unavailable and that caregivers lack social and economic support. There is a need to improve education and training, increase recruitment and retention, and develop innovative models of care.8,9 The survey revealed a suboptimal attitude of practicing physicians to geriatrics that needs improvements.1 The respondents were concerned about several issues when dealing with the elderly and nursing homes, including financial and lack of adequate training. The survey revealed that just over a quarter received formal training in geriatric medicine at some stage of their career. There is an urgent