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5th Mediterranean Alzheimer meeting May 14 th - 17th, 2015 (Thesalloniki, Greece)

Alzheimer and other dementias inMorocco, situation and pitfalls

Najib Kissani,President of SMA(Morocco)

Making Moroccan older people abetter place

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Pr Kissani Najib-Neurology department,Marrakech Univ. Hospital;Morocco-President of SMA

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Morocco:Geographical situation


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Morocco: Some Epidemiological data

Moroccan population about 34millions inhabitants, in about 700000Km2

Life expectancy is actually 74.8 inall Moroccans (68 in men and 77 inwomen). It was only 47y in 1960 and

progresses to 71y in 2006.


Situation of elderly in Morocco


Situation of elderly and AD in MoroccoThe Moroccan population is estimated at 34 millionsinhabitants in 2013.People > 60 accounted for 7.61%.Long term projections =>increasing of theproportion of people aged over 65:5% in 2004 to 13% in 2034.

Moroccan Centre for Demographic Studies and Research (CERED)


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Elderly people (>60y) only 7%. WHO report, estimated AD in Morocco at 73 000 cases,

(WHO report 2007)

AD 1st cause of all dementias in Morocco, followed by vasculardementias. (60%)

Rabat memory units statistics, 2007


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Moroccan population is getting older, as in developpingcountries

Morocco will face a huge problem related to geriatric disordersin next decades (>40% are <20y of age).

Proportion of elderly people>60 ans: 11,1% en 2020 20% in 2040 And 24% in 2050.

Centre for studies and demographical researches in Morocco (CERD), 2009.


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Who deals with AD in Morocco?

Neurologists Psychiatrists And since 2003 geriatrics Who could be Geriatric?: Neurologists and specilized in Internal medicine

Since 2005, Griatry is officially recognized by Moroccanministry of health Up to 2008, only 16 Geriatrics, Most of them in private sector.


Centers and associations ofAlzheimer in Morocco


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Memory and dementia units in thecountry

19982013

2012


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Published data in Moroccan AD

– January 2000- May 2011:• 401 cases of dementia

diagnosed in RabatUniversity centre

• In 182 cases: AD (45.4% descases), in all cases

• And 33.8% in <65 years.Benabdeljlil M et al, Rev Neurol, 2012.


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AD, cultural particularities in Morocco

Familial solidarity For religious obligation, Also moral and social, But in urban areas, life style is changing: People are more and more busy Less children Women have their works outside Also due the starting of some elderly institutions, with nice environement Encouraging people to keep the elderly people in specialized institutions Finally the charge for the carers is to much in some difficult cases, before

they collapse.


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Problems related to AD actually in Morocco

Some specialists are not will armed for taking care ofAD and other demantias, Need of good trainig in medical and nurse staff, Socially, the few existing institutions are, Either not free of charges Far away from patient’s home Or of bad quality.


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Need of specialized teams for takingcare of dementias

Geriatrics Neurologists Specilized nurses to assist Geriatrics Physiotherapists Ergotherapists Dieteticians Psychologists and Neuropsychologists And especially home workers and Nurses for home

care.


•Association (+) 3•Medical and social center (-)•Retiring center (+)

•Association (+) 3•Social center (+) 1•Retiring center (+)

Casablanca

•Association (+)1•Social center (-)•Retiring center (+) 1

v

•Association (+) 1•Social center (+) 1•Retiring center (+) 3

•Association (+) 1•Social Medical and research center (+) 1•Retiring center (-)


Are theyenough

neurologists totake care of AD

patients inMorocco?


Projectof AD and other D in Essaouira inaugurated

April 4th, 2015

-facilities to have an existing center, given byMogador association-Big support of Ampa and rallye des Gazelles-help of the King’s chancelor (Mr Azoulay).


Essaouira has many opportunities-Stable temperatures all the year (15 – 25 all the year)-Good facilities-International aeroport-Turistical site-Relaxing city-With many festivals and celebrations all the year.…


Project of a ‘memory and Solidarity Restaurant’ in the Terrasse inits final study

Shared between SMA and Solidarity Association with Women,sponsored by Cœur des Gazelles Association.


Wich cities will be served by thiscenter?

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3


We already started to register carers fromMarrakech, safi to benefit from Essaouira’scenter experience-A bus projetc for the center is on its way (INDH, FoundationMohamed V…)


Purpose of such a project?- This Centre will be an innovative response to the basicneeds of people with Alzheimer's disease and their families:- it will offer a range of multifaceted interventions to act onboth medical, social and scientific aspects:- its role is to respond to needs 51. medical attention?2. Information and listening needs?3. needs for psychosocial support and respite?4. needs welfare and maintenance of social life?5. needs of scientific expertise


1. Memory consultation :to better identify and refer patients and theirfamilies?Ensure mission brief consultation to identify, detectand diagnose elderly people with or at risk ofdisorders related to Alzheimer's disease or relateddisorders- will be responsible for monitoring andcoordination of care for related local actors.


2. PLATFORM for listening, guidance, information forfamilies and caregivers :-to increase awareness, understanding of the disease andbreak the isolation-will host a mission nearby, listening, guidance, information,support and training for families- Can organize awareness and training on Alzheimer's diseaseor related diseases for caregivers and volunteers to betterexplain the consequences of this disease and providepractical and concrete advice- Fight against the isolation of families and promote thesharing and expression of personal experiences by organizinggroups of discussion and group therapies for patients andcaregivers.


3. A PLACE OF SUPPORT FOR SICK AND RESPITE FORFAMILIES:-To maintain independence and improve quality of life- ensure political support at home and provide respiteservices for caregivers during the day by welcoming peoplewith Alzheimer's disease or related disorders living at homein dedicated and suitable premises (by day or half-day, one ormore times per week)- Can propose and organize psychosocial activities fortherapeutic purposes in particular to preserve or maintainthe autonomy of sick people.-Can be deployed for activities such as workshops cognitiverehabilitation or reminiscence, cognitive stimulation,workshops, art therapy, music therapy ...


4. A "FEEL AT HOME" FRIENDLY space:-to promote well-being and maintain a social life andrelationshipsIn an environment designed specifically for conditions like AD- propose interventions that promote the welfare of the sick,as mild physical activities (relaxation, gym ...)- Will aim to maintain social, cultural and relational sickpeople and their families lives.-May be proposed occupational activities of daily living, suchas games, cooking, gardening, art, music, dance …- Will be open to the City with the organization ofintergenerational gatherings and festive place, as well asother outdoor activities (outings, walks, visits ...)


5. SPACE RESEARCH AND EXCHANGE:to promote ethical reflection and develop scientificexpertise?-This center will be a place of scientific expertise to enhanceand develop medical and societal knowledge aboutAlzheimer's disease and related disorders- will promote ethical reflection, an approach of welfare andrespect for rights and Freedoms.-Could host meetings, conferences, seminars with topicsabout AD and related disorders to educate all our staffnationally and internationally


Some statistics of Essaouira centersince April 4th, 2015

• 6th till 25th April:– 1 Neurology consultation /week– 1 secretary 2h each day to provide information– 8 AD patients consulted /week

• From 27th April till 9 May:– 2 Neurology consultations /week– 1 secretary 2h, twice a day to provide information– 14 AD patients consulted /week– Medications give, for free (Donepezil…)– Wheel chairs and canes

• From 11th may till 15 June:– 3 Neurology consultations /week– 1 secretary 2h, twice a day to provide information– 18 AD patients consulted /week– Medications give, for free (Donepezil…)– Wheel chairs and canes

• Since 16th June:– 3 to 4 Neurology consultations /week– The Director to be recruited– 1 secretary full day to provide information– All patients to be consulted– Firts educational ,program provided by Monaco Hospital team and Ampa.


New techniques available inEssaouira and Marrakech will profit

our centerteleconsultations…


-But also to share experiences from otherpartner centers in Europe, USA…(telemedecine, teleconsultations…)-We anticipated, by preparing our medicalschool and University Cadi Ayyad inMarrakech in advance of the project.

Use of modern techniques ofcommunications Marrakech/Essaouira

CHU MarrakechCHR Essaouira


Leaflets and brochuresfor our patients

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With manytks to

AlzheimerIndonesia

Federico andSalome

Need of good education of AD carersOne example: Bad nutritional state of Moroccan AD patients

Mauvaisétat

nutritionnel41%

Risque demalnutritio

n49%

Etatnutritionnelsatisfaisant

10%

Evaluation de l’état nutritionnel chez des patients atteints de lamaladie d’Alzheimer

J. El Mesbahy, N. Louhab, M. Elmellakh, N. Adali, N. Kissani, 2014University Neurology department of Marrakech

Using the Mini NutritionalAssessment (MNA), in alongitudinal cohorte of 47 ADpatients in 2014.


Our center could help in such lackof efficacy in nutritional aspects

The restaurant of Essaouira AD center could helpand sharing meals between patients, staff and

famillies We will give an added value in conviviality.


And since 2015 the rallye des Gazellesincluded AD as one of its medical

activities


We offered :More than 230 consultationsDiagnosed 13 cases of ADDitributed more than 350 brochures explaining ADAnd we gave eduactional program for more than 400 persons 355th Mediterranean Alzheimer meeting May 14 th - 17th, 2015 (Thesalloniki, Greece)

What kinf of activities?-In short term (Day care and home care):-Home care-All sort of occupational activities of daily living-Then:-Day and night activity (why not to have an extension in theEssaouira hospital)?-Training and qualification of staff

-


More meetings and educationalactivities

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In this center we expect to keep naturalenvironement

and warm atmosphere


Some positive points in SouthMediterranean countries to be

shared with our collegues in theMediterranean alliance:

1-Elderly people remain very active during all their life2-Keeping at home as long as possible

3-Wide use of Mediterranean Diet4-Less stress like in rural areas …


Keep patients as long as possible activewith workshops in partenership with stores

owners nearby


Conclusion

-Alzheimer's disease and related disorders are of big concern in Morocco-The aging of our young population will enhance this big issue-The university hospitals and the few centers are not enough to face this challengingproblem-Lot of efforts are to be done and good collaboration between our institutions andMinistry of health and also inside our Mediterranean alliance .


Many Thanks to

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AMPA andits staff

SMA and all commissions and publicinstitutions in Essaouira & Marrakech

All the staff of NeurologyDepart. of Marrakech

University Hospital

All the activemembers of ourMediterranean

AllianceAll our patients and

their families

FeuKhaldounour past

president

Mr Azoulayand

President ofMogador

Association

Documents

Alzheimer and other dementias in Morocco, situation and ...static.livemedia.gr/livemedia/documents/al16726_us147_201505201… · therapeutic purposes in particular to preserve or