Population aging and dementia management

 

I am often asked by foreign friends what I regard as the biggest challenges the Korean economy is facing. I would say it is demographic changes, including low birthrate and rapid aging, and the declining growth potential. Korea has the world's lowest fertility rate of 0.7 per woman in 2023 and the fastest-aging population. The proportion of Korea's population aged 65 or over is 18.4 percent in 2023 and is expected to reach 20.6 percent, making it a super-aged society. Consequently, the twin demographic deficits are closely correlated with the declining growth potential.

Health problems we frequently encounter in our daily lives are age-related. They include chronic diseases such as diabetes, hypertension and hyperlipidemia, the decline in physical function and dementia. Among these, relatively less attention is paid to dementia, perhaps because many people perceive it to be a natural phenomenon that comes with aging and because it still has no cure.

According to the National Institute of Dementia of Korea, as of 2022, 10.38 percent of the population aged 65 or over is suffering from dementia. By 2050, the ratio is estimated to reach 15.9 percent, much higher than the world's average of 8.5 percent. The number of dementia patients is expected to increase to 1.35 million in 2030 and over 3 million in 2050. Every year, 10 percent to 15 percent of patients with mild cognitive impairment (MCI) progress to dementia.

Traditionally, dementia was seen as a personal mental health issue that would have to be dealt with by the family. As the psychological and economic burden on families increases due to dementia treatment and care, various problems arise, including the disappearance of dementia patients, "care killing" of a spouse suffering from dementia and abuse of a person suffering or suspected of suffering dementia.

Also, given the speed of aging and the increase in the number of dementia patients, it no longer remains a family issue but an issue that requires national and social treatment and care. Appropriate early identification and diagnosis of MCI and dementia patients and national policy support are needed. The demand for more roles and support by the state in dementia management is expected to increase. In light of this, Korea legislated a national law called the Dementia Management Act in 2011 that took effect in February 2012.

Social costs ensuing from the increase in dementia patients are also rising. The annual cost of dementia care is expected to increase from 16.5 trillion Korean won, 0.9 percent of GDP, in 2019 to 103.1 trillion Korean won, 3.8 percent of GDP, in 2050, according to the Ministry of Health and Welfare.

As with other chronic diseases, prevention and early treatment are very helpful in slowing MCI's progress to dementia. Buyeo, a mid-sized county in Korea's South Chungcheong Province, demonstrates the benefits of prevention and early treatment. A super-aged county with 36 percent of its citizens aged 65 or older, it launched three years ago a dementia prevention project in partnership with private companies to halve the average morbidity rate of dementia, 15 percent. It was participated by about 220 older adults with MCI. The program provides brain training twice a week, including simple brain use, such as expressing the current time with clock hands or remembering the order of shapes, simple problem solving and simple movements. The dementia morbidity rate has already decreased to 3.2 percent, much lower than the target rate of 7.5 percent.

The success of Buyeo's project offers some insight into better dementia management. First, it proves the effectiveness of community-based treatment and care. The participants gathered at local community centers and participated collectively in the brain training. It is no secret that lack of social interaction and lack of cognitive activity are risk factors. Second, it targets older adults with MCI to slow the progression to dementia. The cost of managing severe dementia patients is twice as high as that of patients with MCI. Third, it is a public-private partnership project, with an incentive scheme for private partners and dementia professionals to secure the sustainability of dementia management. The private sector can provide digital therapy based on AI and robot technology to diagnose and manage dementia patients. AI-based cognitive training is proven to help slow the progression of dementia. Robots can be used as a means of assisting patients with movement difficulty due to dementia.

Also, wider family and community involvement is needed for better dementia management. In Japan, which is the world's most aged society with over six million dementia patients, there are about 7,000 dementia cafes where dementia patients, their families, volunteers, and local residents can easily gather, interact, and exchange information. Starbucks also participates in this community endeavor. It is a good project to emulate. It also gives the patient and the family a sense of community to support each other, showing them they are not alone.

Community-based, well-managed prevention and early treatment of dementia will reduce social costs and increase the health and well-being of older adults and their families. It requires solid national and local policy support.

Dr. Song Kyung-jin (kj_song@hotmail.com) led the Institute for Global Economics, based in Seoul, and served as special adviser to the chairman of the Presidential Committee for the Seoul G20 Summit in the Office of the President. Presently, she is executive director of the Innovative Economy Forum.