Our world is facing a rapid population ageing. The number of individuals above 60 years is at an all-time high and estimated to reach 2.1 billion by 2050. Increased life expectancy and improved healthcare services contribute to this demographic transition. Worldwide researches such as the Study on Global AGEing and Adult Health (SAGE) and The Global Ageing Survey have shown changing attitudes, expectations and behaviours towards later life and retirement. This brings us to a vital question -- are we prepared to care for our ageing population?
Once equated with frailty, disease and other negative connotations, narratives around old age are now changing. ‘Healthy ageing’ forms the core of preventive medicine and is defined by the WHO as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” Functional ability means the capabilities that enable people to be and do what they value. The concept of healthy ageing is to be incorporated in medical and social services alike and affects ‘elder care’.
Elder/aged care serves the needs and requirements of older persons. It consists of a huge range of services such as home care, hospice care, nursing home (residential care), long-term care, adult daycare and assisted living. While the form and context of care varies across cultures and nations, the central principle stays the same -- personal and social requirements of older persons who wish to age with dignity and human rights while needing assistance with daily activities or/ and healthcare.
Traditionally, family members were responsible for providing care to their older members, sometimes within the extended family home. Globally, there have been changes in elder care and responsibilities due to shrinking families, longer life expectancy, geographical dispersion, difference in generation dynamics and influences of culture. Usually government-run elder care is rare in many Asian nations, where they are still expected to be taken care of by their families. On the other hand, in many Western countries, the common care facilities for older people are free-standing assisted living facilities, residential family care homes, nursing homes and continuing care retirement communities. The type and timing of care, finances and duration are often determined by the age of retirement, pension plan and social security benefits of the old age, awareness of legal provisions and respect for human rights. While familial bonds are thought to be stronger in developing nations, financial independence and policy benefits are considered to be the mainstay for developed countries. Let’s look at the state of elder care in some parts of the world.
The US and UK: Western cultures are known to be youth-centric, stressing on independence and individualism. A person’s value is often linked to his/ her ability to work, which diminishes with age. Nearly 22% of the medical expenses of a person in the US happens during the late years of their life. Many older adults choose assisted living, home care services or respite care. Though the lack of familial care with increasing age is often criticised in both these countries, the government assumes added responsibilities through social care benefits. The number of retirement communities is growing in these countries.
Canada: Private for-profit and not-for-profit elder care exist in the country but some services are subsidised by the health ministry. In public elder care homes, the older people pay on a sliding scale, based on their pre-retirement income.<
France: Elderly rights law is the strongest among Western cultures. France has a unique legal decree requiring its citizens to take care of their parents and older patients. The crux is that it’s rarely implemented.
China: Eastern cultures such as China’s adhere to the Confucian tradition of “filial piety,” which prioritises the family unit and values elders with utmost respect. However, with industrialisation, family dynamics are changing. A recent elderly rights law that makes neglecting older parents punishable provides hope.
Korea and Japan: They potentially set an example for elder care and are also faced with a rapid ageing population. Legal provisions are strong and ‘ageing’ is also celebrated socially.
South Asia: Traditional values demand honour and respect for older persons and equate old age with wisdom and experience. Certain legal provisions mandate protection and maintenance of parents and senior citizens (in India), and social security benefits (India, Nepal, Bangladesh) -- however the practical implementation is rarely smooth.
Though legal provisions, financing and responsibilities of elder care vary, they are connected by the common ominous thread of ageism, stigma, misinformation and the lack of respect for human rights. The recent Global Report on Ageism, released by the WHO, shows that one in every two individuals worldwide bear ageist tendencies. The ongoing Covid-19 pandemic has only widened these health inequalities in older persons. We should remember that the right to health is fundamental and age cannot be an exception. Also medical and psychological-social care in older persons need integration.
Promoting independence, autonomy, dignity, respect and shared decision-making are the central principles of healthcare for older persons. Improving physical and personal mobility will help them gain confidence and providing legal protection services would aid social causes. Financial protection is imperative and abuse of the elderly needs to be prevented at all costs. Health workers, media and policymakers need to be sensitised about these nuances of elder care.
One of the best ways to go forward is strengthening intergenerational bonds (between ageing parents, adult children and grandchildren) through quality time. Establishing intergenerational relationships allows both groups to learn about each other’s differences and similarities while building relational capacity and a sense of fulfilment. Some of the ways could be: participating in family rituals, sharing stories, teaching new skills, reading/ singing together, playing games, gardening, etc.
How we care for older people today decides how we will be treated tomorrow.
Dr Debanjan Banerjee is a Consultant Geriatric Psychiatrist at the Apollo Multispeciality Hospitals, Kolkata. He can be reached at dr.djan88@gmail.com.