Health

Ageing and the elderly

It is natural for everyone to expect to be happy and healthy in the later parts of life. We all dream of an old age without dependence or incontinence, but with good health and grace. Anyone living in any part of the world should have the opportunity to live a long and healthy life. Ageing and the elderly

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Dr Ramesh Kandel

Published at : December 6, 2018

Updated at : December 6, 2018 11:35

Nepal too is entering a phase of demographic transition. In the next few years, the over-60 population is predicted to reach 10 percent of the overall population, congruent with global changes in the elderly population.

Wealthier countries tend to have larger elderly populations, displayed demographically as a reversed age pyramid. This is because prosperous countries are able to take better care of the elderly, resulting in healthier, longer life spans. The World Health Organisation (WHO) defines ‘healthy ageing’ as “the process of developing and maintaining the functional ability that enables well being in older age”. Older people are considered to be ‘functionally able’ if they have the capabilities that enable them to be and to do what they value. Healthy ageing is one of WHO’s primary focuses, between 2015-2030, as the decade between 2020-2030 has been dubbed the ‘decade of healthy ageing’. This policy stresses inter-sectoral coordination to enable older people to remain a resource, and not a burden to their families, communities and the economy.

Objectively, older people are said to be functionally able if they have the ability to meet their basic needs, learn, grow and make decisions, to be mobile, build and maintain relationships and contribute to the society. Various intrinsic factors like mental and physical capacities and extrinsic factors like family and social support, affordability and accessibility to quality health care contribute to the functional status of the older people. We often hear our older people saying that they want to die peacefully before being dependent on their next generation, even for minor issues and requirements of daily life. These expectations also can be considered as a part of ‘functionally able ageing’. Thus, functional stability and independence contribute as major components of happy and healthy ageing.

There are a lot of challenges in Nepal for healthy ageing. The population is ageing at such speed that the existing health care system and economy might fail to mitigate the challenges of ageing. The 60-plus population currently constitutes around nine percent of the total population, which is expected to rise to 11 percent by 2030. In this light, a paradigm shift is expected in the pattern of diseases within this population. Non-communicable diseases have now surpassed the burden of communicable diseases. Diseases like diabetes

mellitus, hypertension, chronic diseases of the lungs, liver, heart and kidney, neuro-degenerative disorders like Parkinson’s, Alzheimer’s and other dementias, fatal diseases like cancers are on the rise. Consequently, the burden of disability attributable to these illnesses is enormous.

Despite this, health has been one of the least prioritised sectors by the government, constantly reflected in the budget of the last decades. Even in the current fiscal year, the health sector received just 4.29 percent of the total federal budget of Rs 1,315 billion. Moreover, the concentration of health-related infrastructure, as well as human resource, in the urban regions poses another threat to the accessibility and availability of quality care, not only for the older but also the general population. In terms of geriatric care, the situation is pitiful. Nepal, despite having a geriatric population of nearly nine percent, has only had three registered geriatricians till date (one geriatrician for every hundred thousand older people). Among various health institutions, only eight of them have started geriatric services. Despite the government’s policy to establish geriatric wards in every hospital with more than 100-bed capacities, the crunch of skilled human resources (doctors as well as paramedics) is a serious issue that needs to be addressed immediately.

Another challenge with regards to healthy ageing is the lack of rehabilitative and long-term care services for older people. Over the past decades, we have witnessed a boom in curative health services (large hospital-based) both in the public as well as the private sector. But long-term care services have always been under-shadowed. With non-communicable diseases on the rise, long-term care services are necessary to address the enormous burden to both family and society of disabilities that can result due to these morbidities.

Older people will not be healthy and happy if their care is simply limited to providing quality health facilities. Our growing cities and urban areas are unfriendly to the older populations. The lack of proper infrastructure for the disabled and the elderly has meant that they have a difficult time navigating cities.

Multiple sectors and partners need to take up collective strategic efforts to meet WHO’s goals for the healthy ageing decade. Our country needs active support for planning and action from international agencies like WHO. Relevant research should be promoted and the existing healthcare system should be aligned with the needs of the elderly. The importance of long-term care services, besides usual curative services, should be accepted at the policy level. The country needs to increase its expenditure in health and focus in the development of skilled human resources (geriatricians as well paramedics). The state should provide healthy, active, independent and contributory living prospects to senior citizens. We should remember that ‘older people might be retired, but they are not tired’.

Local governments, in collaboration with communities, must strive to create geriatric-friendly communities that guarantee physical, familial as well as social security for the older population. Stakeholders must take into consideration the convenience of older people while building local infrastructure and make them as geriatric friendly as possible. The younger generations of families should play a pivotal role in ensuring ‘healthy and happy ageing’ for seniors at home. Our children will learn from the way we treat our parents and grandparents.

Furthermore, the prompt evaluation of seemingly minor health issues with geriatricians can prevent catastrophic complications.

Kandel is a Consultant Geriatrician and Dementia Specialist at the Patan Academy of Health Sciences.