A defining feature of the 21st century will be the large number of persons described as ‘elderly’ (over 60 years) and ‘very elderly’ (over 80 years) living across the world. It is estimated that the number of elderly persons presently alive exceeds the cumulative number of all elderly persons throughout preceding human history. Between 1950-2050, the world population would have increased three-fold, but that of the elderly and very elderly would have risen nine- and 28-fold respectively. India, too, is witnessing a rise in the number of its elderly.
As socioeconomic development and scientific advances extend healthy life years, we no longer see ageing as a cataclysmic change that occurs on a pre-determined calendar date and abruptly guillotines good health and productivity. Accordingly, we need to steer our society towards promotion of healthy ageing with protection of functionality, and gear our health systems to effectively and empathetically address the health needs of the elderly.
Unhealthy ageing is the result of cumulative inequities and behavioural indiscretions experienced over life. Heart diseases, stroke, diabetes, cancers and chronic respiratory diseases become major causes of death and disability across midlife and older years. Mental illness poses a major threat to the quality of life as Alzheimer’s disease, vascular dementia, depression and a variety of other neuropsychiatric disorders affect the elderly.
Health of the elderly poses distinct problems such as higher frequency of multiple co-morbidities, physical frailty and gait instability in advanced years. However, healthy living and supportive health systems in earlier years can help people cross the ageing threshold with a substantial credit balance of good health. As one enters the ‘golden years’, there is increasing need for attention to structure (biological integrity of body parts and their coordination), function (physical and mental ability to carry on living with minimal dependence on others) and participation (social engagement with family, friends and external world).
While healthy living in earlier years can keep the elderly fit and functioning, the reality of multiple physical and mental impairments falls to the lot of many as they age. In clinical care settings, recognition of multi-morbidity and prioritising restoration of functionality should lead to new professional approaches, which provide patient-centred, multi-disciplinary and integrated care. Geriatricians and family physicians who can provide multi-system evaluation and integrated care play a greater role than disease- or organ-specific specialist care providers.
Non-physician case managers, trained to provide care for multiple-chronic conditions, have been shown to be effective in providing integrated and continuous personalised care over long-term. Advances in technology should be appropriately utilised to reduce physical dependence, improve mobility and reduce social isolation. Innovations in systems of care delivery must improve both independent and assisted living by overcoming access barriers by moving care to, or closer to, home.
Universal Health Coverage (UHC) becomes especially vital for addressing the health needs of the elderly who require healthcare and at the same time are often financially vulnerable. Often health insurance schemes do not provide coverage to persons with pre-existing health conditions or do so at unaffordable premiums. The elderly, who often fall into this category, need healthcare, which is tax-funded or heavily-subsidised through government-sponsored insurance schemes.
Access to essential drugs, diagnostics and technologies needs to be an integral part of an age-sensitive UHC framework.We need to motivate our elderly to preserve their health. They should not experience active discrimination (social exclusion), apathetic neglect (social isolation) or disability-induced non-participation (social withdrawal). Elderly abuse must be curbed through strong legal safeguards and public education.
ksrinath.reddy@phfi.org