Let’s add ‘life’ to the years of the elderly
Dr. Padma Gunaratne on the ticking time bomb of ageing Sri Lanka and the path forward
Are we, as a country and a people, ready?
This is the crucial question being posed in the light of a rapidly ageing population, by the President of the Sri Lanka Association of Geriatric Medicine (SLAGM), Dr. Padma S. Gunaratne.
She is turning a strong focus on ‘ The ticking time bomb of ageing Sri Lanka’ as the SLAGM takes a concerted look at ‘Caring for the Silver Years’ at its Annual Scientific Sessions on Friday (October 26) at the Galle Face Hotel, Colombo.
The Chief Guest at the inauguration is Health Minister Dr. Rajitha Senaratne, while the Guests- of- Honour are the President of the British Geriatric Society, Dr. Eileen Burns and the Regional Vice President of the World Federation of Neuro-rehabilitation, Dr. Nirmal Surya.
Among the all- important topics that will be addressed at the sessions are Noncommunicable diseases ( NCDs) in older people; End-of-life decisions; Elder abuse; Establishing geriatric services; Management of senile osteoporosis; Urinary incontinence in older people; Dementia; Rehabilitation of stroke; and Parkinson’s disease.
‘Healthcare for Older People: Dementia – A Holistic Approach’ will also be launched at the inauguration.
The facts and figures put on the table by Dr. Gunaratne are disturbing and are a pointer that not only Sri Lanka as a country, but each and every one should also “brace” to meet this “ticking time bomb”. While the elderly population is rising rapidly in Asia, it is “very rapid” in Sri Lanka.
While the over- 60 population rose only by 1.2% from 1953 to 1981; from 1981 to 2012 it doubled to 12.4%.
Predictions for the future are ominous – by 2037, the over- 60 population will be 20% (1 in 5 people) and by 2050 it will be 29% (nearly 1/3rd of the population).
She gives more disturbing statistics based on the ‘Population & Housing Census’ of 2012: The median age in 1981 was 21 years, while in 2012 it was 31 years. More importantly, the base support for elders ( the number of people who are there to support an elder) who are in the age- group 20- 59 in 1981 was: 7 for 1 elder. By 2012, the number had dropped to: 4 for 1 elder. The ‘ Young Old’ in the 60- 69 year group are 61% of the total elderly population; the ‘Middle Old’ from 70- 79 years are 28%; and the over-80s are 11%. Reiterating that the support base left for the elderly is also “shrinking”, Dr. Gunaratne underlines that this is why “we need to be prepared”. There would be different needs as well as different healthcare needs for the different elderly groups, with the life expectancy at 60 years being 20 more years and healthy life expectancy being 16.2 more years.
Preparation should take the form of support for all elderly through acceptable services for graceful ageing. These services should include health – physical and mental -- and socio-economic and cultural aspects. With females living longer than males, there are many widows, she says, citing an example across the seas too, in the United Kingdom ( UK), where nearly three times as many women live into their 90s than men. Dementia is now a leading cause of death for women in the UK.
“What is important is quality ageing and for active ageing the need is for the health services to manage chronic diseases properly and try as much as possible to reduce disability. Active ageing will be the process of optimizing health opportunities and participation and security to enhance the quality of life as people age. It emphasizes the need for action across multiple sectors and has the goal of ensuring that older people remain a resource to their families, communities and economies,” she said.
The components of the health policy in active ageing should be: Preventing and reducing the burden of disabilities, chronic disease and premature mortality; reduction of risk factors associated with major diseases and increasing the factors that protect health throughout life; developing a continuum of af fordabl e, accessibl e, high-quality and age-friendly health and social services that address the needs and rights of people as they age; and providing training and education to caregivers.
Dr. Gunaratne says that the health problems in the elderly will produce symptoms that are completely different to those of young people. While sometimes there would be failure to report illness, there would be multiple pathological processes, high prevalence of cancers, high incidence of complications, multiple medications, rapid progression of disease and not only health problems but also social and financial sequels.
The common diseases of the elderly include falls, sarcopenia ( degenerative loss of skeletal muscle mass), neurodegenerative conditions, cognitive impairment, osteoporosis and malnutrition.
Is Sri Lanka ready to address these problems? The demographic changes are dramatic and unlike many other natural changes that are happening, predictable. It gives time for preparation which is a dire need particularly for low middle income countries, she adds.
Dr. Gunaratne looks at the vital group of social workers. High-income countries have 15.7/ 100,000 population. How many does Sri Lanka have?
“Let’s change our attitudes towards the elderly. Old people are ill not because they are old but because they are ill. We added years to life. Now let’s add life to years,” she urges.
According to Dr. Gunaratne health should not be the limiting feature or the dominant feature of older populations. Many health problems are chronic and many can be prevented or disabilities can be postponed by healthy behaviour or correct management. The availability of long- term care and support can ensure that the elderly live dignified lives.