Towards a Longitudinal Study of Egyptian Healthy Aging

As our GBHI delegation walked through downtown Cairo, one of the most densely populated cities in the world, we were immediately struck by the lack of grey-haired men and women. Demographic data for Egypt showed us that our observations were correct; less than 5% of the Egyptian population are aged 65 years and older. 

However, that’s set to change. And fast.

Like many other low and middle income countries; Egypt’s future includes a significant increase in older adults. As one local we met wryly observed, Egypt is losing its pyramid (see Fig.1)

Figure 1

Today, less than one in twenty of the Egyptian population are aged 65 year and older. In just one generation that will change to one in five, through life expectancy gains due to improvements in nutrition, health technologies and living standards, alongside a falling fertility rate.

This seriously concerns Mohamed Salama, an Egyptian neurotoxicologist and Atlantic Senior Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), who believes Egypt is unprepared for demographic ageing. 

While region-specific risk factors for dementia are available for Europe, North America and more recently for India, China, and Latin America, the Middle Eastern and Northern African (MENA) region has no such data to guide strategies for dementia prevention. Similarly, high quality data on the costs, patterns and outcomes of healthcare utilization which are available in many high income country settings, are difficult to come by in this region. This significantly limits the ability of these governments to develop evidence-based policies around the financing and provision of cost-effective, person-centred healthcare and long term care. 

In this context, Mohamed has been developing the vision for ‘A Longitudinal Study of Egyptian Healthy Ageing’ (AL-SEHA), which could reform the Egyptian research infrastructure and support policy-makers to address the challenges of demographic ageing. 

The first major outcome of this work was the recent workshop ‘The Longitudinal Population-Based Study Paradigm: Towards a Longitudinal Study of Aging in Egypt’, led jointly by the American University in Cairo (AUC) and GBHI. The event was convened to examine the value and need for a longitudinal aging study in Egypt, to initiate a dialogue with Egyptian stakeholders to identify best practices for developing the study and to connect GBHI with key leadership and academia in Egypt and other stakeholders in the Middle East. 

A GBHI delegation travelled to Cairo for the workshop, including GBHI Executive Director Professor Victor Valcour, GBHI Deputy Executive Director Professor Brian Lawlor, and current and senior Atlantic Fellows for Equity in Brain Health: Hany Ibrahim, Mohamed Salama, Kirsten Bobrow, Lorna Roe, and Laurent Cleret de Langavant, (pictured L-R below).

The GBHI team were joined by Dr Ann Hever, Research Manager with The Irish Longitudinal Study on Ageing (TILDA); Professor Kenneth Langa, Associate Director of the Health and Retirement Study (HRS) and Professor Axel Borsch-Supan, Managing Director of the Surveying the Health, Aging and Retirement in Europe (SHARE) study. 

Event participants heard from Egyptian academia about the needs, challenges and opportunities for Egypt, including: the Egyptian social landscape and the need for health equity framing of AL-SEHA; the environmental dimensions of health and ageing in Egypt; the current status of Alzheimer Disease in Egypt and the state of geriatric care in Egypt including the recent opening of a new geriatric hospital at Ain Shams, a first in the MENA region.

In a session moderated by Mohamed Salama, GBHI Deputy Executive Director Brian Lawlor presented key facts about dementia as an illness, and showed evidence for the potential to address modifiable risk factors which give us reason for hope and action, countering the narrative dominated by fear and despair.

Professor Lawlor said: “Raising awareness and tackling modifiable risk factors for dementia, such as level of education, age-related hearing loss, hypertension and diabetes, has the potential to reduce the projected numbers of people affected, but we must act now.” 

The experiences from other longitudinal studies of ageing included an illustration of how data from these studies can be used in novel ways, such using machine learning to classify older adults with dementia; how data from TILDA has influenced Irish policy and can be used to inform solutions to the economic challenges of demographic ageing, some of which the Egyptian healthcare system are already experiencing; and a look at the contextual design of The Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community’ in South Africa (HAALSI) and some of its work on dementia prevention.

AUC’s President Francis Ricciardone said: “Collaborative initiatives such as these are key to AUC’s role as Egypt’s Global University. The teaming of GBHI and AUC’s Institute of Global Health and Human Ecology (I-GHHE) are a hallmark of the commitment AUC brings to the region.”

The meeting is one step along the journey in the preparation and piloting of activities for a Longitudinal Study of Egyptian Healthy Ageing. Continuous discussions and open dialogue with stakeholders, including Government, researchers, NGOs and the public, will lay the foundation for a solid and sound national longitudinal study of aging in Egypt, that could be reflected in other countries of the MENA region.