Population ageing is a success of development and a result of significant improvements in public health, education, nutrition and economic well-being. But a rapidly ageing population presents multi-faceted challenges for all societies.
Today there are more people over the age of 60 than children under 5. Populations are ageing fastest in low- and middle-income countries (LMICs). By 2050, 80 per cent of older people will live in LMICs. For example, Sri Lanka’s population over 60 years old is expected to double in less than 20 years.
As population demographics shift, it is critical that governments revolutionise healthcare and social protection systems in order to respond to ageing and the needs of ageing populations.
The critical question is how do we enable older people to maintain their quality of life and autonomy for as long as possible? HelpAge is exploring this question through its programmes at community level and through the development of the GlobalAgeWatch Index which provides evidence of older people’s wellbeing around the world.
Health is only one factor affecting quality of life and autonomy in older age even though maintaining our quality of life is linked to sustaining physical and mental wellbeing as we age, and our ability to access age-friendly healthcare services.
Accessing quality health and care services are crucial and often dependent on the availability of social protection mechanisms. Non-contributory pensions or health insurance, for example, can enable people to access health services and protect older people and their families against catastrophic health costs. A study in Thailand found that catastrophic health costs are more likely in households with a greater proportion of older people and in households with chronically ill members.
There has been a significant shift in the disease burden globally. Non-communicable diseases (NCDs) now take the greatest toll on life globally. However, communicable diseases (e.g. HIV) still pose a great threat in many LMICs, especially sub-Saharan Africa. Reforming primary healthcare services is essential to meet the health and care needs of older people at the community-level.
Older people often require access to continuous treatment over long periods. An effective primary healthcare system can create environments for healthy ageing, enable the detection and management of chronic diseases (communicable and non-communicable) and provide routine health screening.
Distance to hospitals and even health centres can be a major barrier to older people accessing the healthcare they desperately need. This is especially vital for the frail old. Community health workers can play a vital role in linking older people to much-needed secondary health services as part of a continuum of care. In Tanzania and Ethiopia we have found that taking services to older people, through home-based care providers, has led to a demand for additional health and care services. Providing HIV-specific care at the community level was found to have the potential to meet older people’s broader health and social protection needs.
Protecting quality of life and enabling autonomy will be critical for healthcare services in an ageing world, especially if universal health coverage is to become a reality.
Image source: © U Myo Thame/HelpAge International 2013
Category: Funding longer lives: Health/medicine, Long-term care, Pension/retirement