“Challenges
and Opportunities in an Ageing Society”
Summary of Lecture delivered at the 50th
Anniversary Reunion Academic session of the Medical Entrants of 1962 in Sri
lanka on the 1st of September 2012 by Dr Mahendra Gonsalkorale.
The World population is growing rapidly.
From an estimated 2.5 billion in 1950, it reached 6.1 billion in 2000 and is
projected to grow to 8.2 billion in 2025. It took over 4000 years to reach 2
billion but it will take less than 75 years to quadruple that number. Sri
lanka’s current population of just over 20 million will grow to 23 million by
2030. People are also surviving longer at all ages and more and more are
achieving old age. Increased life expectancy is a Global phenomenon.
Correspondingly, due to decease in fertility rates, there is less than the
expected numbers of younger people, and the net result is a change in the age
distribution pyramid from the familiar broad based, gradually tapering shape as
in the mid 60s and before, to one with a relatively narrower base with a “fat”
middle (the older people) and a taller shape (because of the persistence of the
very old).
The proportion of elderly people in all
countries is increasing. From about 4-10% just 50 years ago to 15-20% now and
expected to increase to 25-30% in the mid 2000s. In Sri lanka, there are about
1.9 million over the age of 60 (10%) and this is expected to increase to 4.5
million (25%) by 2040. In America, there are currently around 40 million over
65s compared to 23M just 50 years ago. Within the over 60s, there is a massive
increase in the very old. The balance between the older and younger is affected
and this will have a significant effect on the care of older people and in the
financing of pensions.
More old people and less
(proportionately) young people means
•
More age associated diseases
such as dementia (Alzheimer’s), cardiovascular
diseases,
degenerative
neurological disorders, cancer, arthritis and related disorders, chronic respiratory disease, other chronic diseases.
•
Increase in disability levels in
the population
•
Less people to support and care
for older people.
•
Large increases in health and
social care costs.
The burden of Dementia is one of the
most worrying concerns for the future. The WHO estimates that worldwide, nearly
35.6 million people live with dementia. This is expected to double by 2030
(65.7 million) and more than triple by 2050 (115.4 million). The vast majority
of these will be elderly.
Dementia affects people in all
countries, with more than half (58%) living in low- and middle-income
countries. By 2050, this is likely to rise to more than 70%. The WHO observes
that only eight countries worldwide currently have national programmes in
place to address dementia.
This may all sound very negative but
there is a more optimistic view to be taken and with greater preparation and
anticipation of need, the lives of both the elderly and the young could be
enhanced. Older people can have a better quality of life and the young could
look forward to a time of fulfilment and relative leisure when they become old.
Some of the challenges that need to be
met are the following.
(1) Meeting health, social and housing needs. These are also fuelled by
rising expectations, technological advances which are often costly, medical
breakthroughs and other factors
(2) Resourcing (financial and
other) the demands of an ageing population
who consume more resources, with the added factor of a relative decrease in economically productive young wage earners
(3) Evolving a society devoid of intergenerational disputes and replete
with respect and love - a cohesive, equitable and productive society, with the
wisdom and maturity of old age balancing the exuberance of youth. Today’s young
are tomorrow’s old, all have a stake.
These challenges could be met by
adopting various measures such as,
(1) A major shift in attitudes and perceptions of what it means to
progress through life from birth to death, getting rid of the negative image of
old age, utilisation of a range of skills and talents of old people set free
from the need to pursue active employment, greater involvement in voluntary
work, providing support for children and grandchildren.
(2) When the retirement age was set years ago, the expectation was that
retired people would live on the average about 5 years more before they die
according to life expectation at the time. This has changed over the years and
at present, retired people can expect to live at least a further 10 years or
more. This has major funding implications and current pension arrangements are
not sustainable and the concept of retirement needs to be reviewed. The Shakespearean
concept of 3 score years and 10 is outmoded and a good model is one of the 3 ages,
the first is one of growing up and learning, the second is one of adulthood
with employment, marriage and parenthood and the third age is one of gradual withdrawal
from active employment with pursuit of leisure. These are blend into each
other.
(3) Forward planning to meet the demands of a large increase in the
number of old people.
(4) Change emphasis from a Disease Model to a Preventive model. The aim is
to ensure that longevity is matched by a long disability-free period and not by
the nightmare scenario of prolonging life by extending the period of disabled
life that often precedes death, using the old adage, “add life to years and not
years to life”.
(5) Towards this end, the message that for a healthy old age, living a
healthy life when you are young has to be promoted. Among suggested measures
are :-
•
control of hypertension,
•
attention to a proper diet,
weight control
•
regular mental and physical
exercise
•
correction of lipid
abnormalities
•
smoking cessation
•
correction of abnormalities of
heart rhythm such as atrial fibrillation
•
Social interventions, e.g., the
provision of libraries, heating allowances, free health checks which though
needing funding will produce long term savings and benefits.
•
Imaginative housing and home
care schemes
•
incentives such as low cost or
free recreational facilities and transport for older people
(6) Creative use of new technologies e.g., use of telemedicine, smart
homes, house robots.
(7) Suitable national and international legislation to protect older
people.
(8) It is also suggested that we need to rethink our attitude to death
and prolongation of life. The largest proportion of the total healthcare budget
spent per person is at the end of life.
Death
is as inevitable as life and without death, life cannot be sustained. Death is not
a failure, accept death with dignity and equanimity.
In conclusion,
We have to change the way we think
about how we live and progress from birth to death.
We have to re-engineer the concept of
retirement
We need to devote more resources
towards dementia research
We need to fight against ageism,
paternalism. We need to get away from the concept of a World for the Young to a
World for All.
We need to harness the immense
potential of technology and remain optimistic.
