World Elders Day 2018 October 1st Theme “Celebrating Older Human Rights champions”.
India Greying Faster -Credit Goes to Health Scheme/ Health Insurance
-Dr.M.A.Aleem M.D.D.M (Neuro)
Emeritus Professor of Neurology
The Tamilnadu Dr.M.G.R. Medical University
Past President
Tamilnadu Pondycherry Association of Neurologists
Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.
Fromer HOD and Professor of Neurology Senior Neurology civil surgeon KAPVGMC and
MGM Govt. Hospital
Consultant Neurologist
ABC Hospital
Trichy 620018
Tamilnadu
India
drmaaleem@hotmail.com
Phone 9443159940
International Day of Older Persons
Resolution 45/106, passed by the United Nations General Assembly on December 14th 1990, declared October 1st to be the International Day of Older Persons. The theme for the 2018 celebration is “Celebrating Older Human Rights champions”.
Facts
Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%.
By 2020, the number of people aged 60 years and older will outnumber children younger than 5 years.
In 2050, 80% of older people will be living in low- and middle-income countries.
The pace of population ageing is much faster than in the past.
All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.
People worldwide are living longer.Today, for the first time in history, most people can expect to live into their sixties and beyond. By 2050, the world’s population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. Today,125 million people are aged 80 years or older. By 2050, there will be almost this many (120 million) living in China alone, and 434 million people in this age group worldwide. By 2050, 80% of all older people will live in low- and middle-income countries.
The pace of population ageing around the world is also increasing dramatically. France had almost 150 years to adapt to a change from 10% to 20% in the proportion of the population that was older than 60 years .However, places such as Brazil, China and India will have slightly more than 20 years to make the same adaptation.
While this shift in distribution of a country's population towards older ages – known as population ageing - started in high-income countries (for example in Japan 30% of the population are already over 60 years old), it is now low- and middle-income countries that are experiencing the greatest change. By the middle of the century many countries for e.g. Chile, China, the Islamic Republic of Iran and the Russian Federation will have a similar proportion of older people to Japan.
In India
For all the talk of India's demographic dividend, its bulging youth population, the country is also greying rapidly. According to a 2016 report by the ministry for statistics and programme implementation, India has 103.9 million elderly, people above age 60, about 8.5 per cent of the population. These numbers are reliant on the 2011 census. The elderly population has grown at about 3.5 per cent per year, double the rate for the population as a whole; a 2014 report by the non-profit HelpAge India shows that while India will be the youngest country in the world by 2020, by 2050, as many as 325 million people, or 20 per cent of the population, will be 'elderly'. While the overall population of India will have grown by about 40 per cent between 2006 and 2050, the report adds, the elderly population will have grown by 270 per cent.
The life expectancy of those above 70 has increased by 18 per cent. The statistics ministry report shows that the old-age dependency ratio, a measure of the pressure on the economically productive section of the population, rose from 10.9 per cent in 1961 to 14.2 per cent in 2011. Though 41.6 per cent of the elderly population still works (with significant differences between rural and urban, men and women), few feel financially secure. The large majority of the elderly in the workforce are rural men (66.4 per cent over 60 work, compared to just 11.3 per cent urban men) and formal pension coverage is limited and largely inadequate. A 2016 survey by the Agewell Foundation with 15,000 rural and urban respondents showed 65 per cent reported themselves as either financially dependent or facing a financial crisis. Nearly 80 per cent of those in financial trouble said it was due to medical costs.
Meanwhile, a 2015-16 AISCCON survey shows that 60 per cent of elderly people living with their families face abuse and harassment, 66 per cent are either 'very poor' or below the poverty line and 39 per cent have been either abandoned or live alone. The associated mental health issues of living alone, especially for the elderly, are so serious .
Ayushman Bharat
India spends just 1.2 per cent of its GDP on healthcare. Prime Minister Narendra Modi has said that by 2025, spending on healthcare as a proportion of GDP will rise to 2.5 per cent.
In September 23rd 2018 the government of India announced the Ayushman Bharat world largest insurance national health programme, promising health coverage of up to Rs 5 lakh per family per year, suggesting it understands the need to step up spending on public health. About 100 million families will be covered under this new scheme by our prime minister Modi .
In Tamilnadu
Tamil Nadu has the second highest percentage of senior citizens (above 60 years) in the country, only next to neighbouring Kerala. And the State is greying at a rate of 2.2 per cent, according to a study by United Nations Population Fund. Tamil Nadu has 11.2 per cent of elderly population and is ranked behind Kerala, which has 12.3 per cent of greying population.
In India southern states are greying faster along with Himachal Pradesh, Maharashtra, Odisha and Punjab when compared to Central and Northern States like Uttar Pradesh, Rajasthan, Madhya Pradesh, Bihar, Jharkhand, Chhatisgarh and Uttarakhand which have lower proportion of aged population. In the last decade (2001) the elderly population in Tamil Nadu was 9 per cent, while in 2011, it has increased to 11.2 per cent (2.2 percent growth).
In Tamilnadu greying women in the state outlive men in the age group. As per statistics available, Tamil Nadu has 17 per cent of 60 plus male population while women in the age group is 19.4 per cent. Also, the sex ratio of elderly has increased from 938 women to 1,000 men in 1971 to 1,033 women in 2011 and is projected to increase to 1,060 women by 2026.
In Tamilnadu, life expectancy at the age of 60 has increased from 14 years in 1970-1975 to 18 years in 2010-14 with women living about two years longer than men.
The old age dependency ratio shows that there are over 14 elderly per 100 working age population with significant variation across states. In Tamil Nadu, Kerala, Goa, Punjab, Himachal Pradesh, Maharashtra, Odisha and Andhra Pradesh, the old age dependency ratio is higher .
In 60-plus population, 66% are married while 32% are unmarried and 3% separated/divorced
53.7% of population above 60 live in rural Tamilnadu.Tamilnadu has 13.7% of elderly living alone - highest when compared with other states
A longer life brings with it opportunities, not only for older people and their families, but also for societies as a whole. Additional years provide the chance to pursue new activities such as further education, a new career or pursuing a long neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on one factor: health.
There is, however, little evidence to suggest that older people today are experiencing their later years in better health than their parents. While rates of severe disability have declined in high-income countries over the past 30 years, there has been no significant change in mild to moderate disability over the same period.
If people can experience these extra years of life in good health and if they live in a supportive environment, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are more negative.
Ageing explained
At the biological level, ageing results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease, and ultimately, death. But these changes are neither linear nor consistent, and they are only loosely associated with a person’s age in years. While some 70 year-olds enjoy extremely good health and functioning, other 70 year-olds are frail and require significant help from others.
Beyond biological changes, ageing is also associated with other life transitions such as retirement, relocation to more appropriate housing, and the death of friends and partners. In developing a public-health response to ageing, it is important not just to consider approaches that ameliorate the losses associated with older age, but also those that may reinforce recovery, adaptation and psychosocial growth.
Common health conditions associated with ageing
Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia. Furthermore, as people age, they are more likely to experience several conditions at the same time.
Older age is also characterized by the emergence of several complex health states that tend to occur only later in life and that do not fall into discrete disease categories. These are commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.
Geriatric syndromes appear to be better predictors of death than the presence or number of specific diseases. Yet outside of countries that have developed geriatric medicine as a specialty, they are often overlooked in traditionally structured health services and in epidemiological research.
Factors influencing Healthy Ageing
Although some of the variations in older people’s health are genetic, much is due to people’s physical and social environments – including their homes, neighbourhoods, and communities, as well as their personal characteristics – such as their sex, ethnicity, or socioeconomic status.
These factors start to influence the ageing process at an early stage. The environments that people live in as children – or even as developing foetuses – combined with their personal characteristics, have long-term effects on how they age.
Environments also have an important influence on the development and maintenance of healthy behaviours. Maintaining healthy behaviours throughout life, particularly eating a balanced diet, engaging in regular physical activity, and refraining from tobacco use all contribute to reducing the risk of non-communicable diseases and improving physical and mental capacity.
Behaviours also remain important in older age. Strength training to maintain muscle mass and good nutrition can both help to preserve cognitive function, delay care dependency, and reverse frailty.
Supportive environments enable people to do what is important to them, despite losses in capacity. The availability of safe and accessible public buildings and transport, and environments that are easy to walk around are examples of supportive environments.
Challenges in responding to population ageing
Diversity in older age
There is no ‘typical’ older person. Some 80 year-olds have physical and mental capacities similar to many 20 year-olds. Other people experience significant declines in physical and mental capacities at much younger ages. A comprehensive public health response must address this wide range of older people’s experiences and needs.
Health inequities
The diversity seen in older age is not random. A large part arises from people’s physical and social environments and the impact of these environments on their opportunities and health behaviour. The relationship we have with our environments is skewed by personal characteristics such as the family we were born into, our sex and our ethnicity, leading to inequalities in health. A significant proportion of the diversity in older age is due to the cumulative impact of these health inequities across the life course. Public health policy must be crafted to reduce, rather than reinforce, these inequities.
Outdated and ageist stereotypes
Older people are often assumed to be frail or dependent, and a burden to society. Public health, and society as a whole, need to address these and other ageist attitudes, which can lead to discrimination, affect the way policies are developed and the opportunities older people have to experience Healthy Aging.
A rapidly changing world
Globalization, technological developments (e.g. in transport and communication), urbanization, migration and changing gender norms are influencing the lives of older people in direct and indirect ways. For example, although the number of surviving generations in a family has increased today, these generations are more likely than in the past to live separately. A public health response must take stock of these current and projected trends, and frame policies accordingly.
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