Making the Elderly Count
The Tokyo Institute of Gerontology in Japan is currently developing a ‘Smart City’ for about 400,000 older people. It is inbuilt with all the support facilities needed for them to continue living a life within the community, despite their increasing frailty. Another project of the institute is to find work for people in their 70s –second life careers - such as running a cafe or growing vegetables.[i]
Hogeway[ii], also referred to as ‘the dementia village’, is a similar facility operating in the Netherlands where elderly residents can live a seemingly normal life. Although they don’t realize it, they are being watched all the time by caretakers and staff at restaurants, the grocery store, saloon, theater etc. The simple goal in both these cases is to provide a normal environment that is reminiscent of each individual's former years, and to guarantee they receive the highest quality of life.
The actions of these two countries are significant in the context of today’s world - in a society that has increasingly less time to extend basic compassion and sensitivity to one another; that labels the elderly as an ‘economic burden’; and discards them when they are no longer contributing towards development.
These attitudes are further inflamed in light of the rapidly ageing population across the globe.
The Imminent Challenges of a Rising Elderly Population
For the first time in history people over 65 years of age will outnumber children below 5 years.[iii] Between the years 2000-2050, the number of people above 60 years will escalate to a mammoth 1.4 billion. In Japan alone the life expectancy has increased by 35 years within a mere 7 decades.[iv]
While high life expectancy implies that medical advancement and economic development has trumped injury and disease, the increasing rates of age-related poverty, non-communicable disease (NCD) and disability worldwide reflect another story. In fact, the ageing population poses a multitude of economic, social and health challenges for the future.
Sri Lanka is facing similar prospects. It is currently the fastest ageing country in South Asia.[v] The life expectancy at birth is 74[vi]years and based on future trends in mortality, fertility and international migration, it is projected that between the years 2010-2041 the elderly population will double from 2.5 to 5.3 million.[vii]
Due to lifestyle changes taking place in the country – urbanization, industrialization, the rise in living costs, the increase in female labour participation- the extended family structure which traditionally supported the elderly, is beginning to crumble. According to a poverty brief published by the Centre for Poverty Analysis, ‘Sri Lanka is showing a growing trend of nucleation and urbanization of families that is leading to more elderly people living on their own.’[viii] Individualistic attitudes inherently linked to the neoliberal paradigm are creeping in as the double-earner system leaves little room for nuclear families to take care of the older generation. The majority of the aged are being marginalized and dumped into elders’ homes as a result. In Vavuniya, there are approximately 13,000 elderly citizens in need of care. Yet, there are only four elderly homes to cater to these needs.[ix]
From the elderly perspective, ‘loneliness’ is an escalating factor that is disrupting social wellbeing and peace of mind. The Manager of an Elders’ Home in Kotte expressed that despite all the facilities provided for the elderly, they were unhappy because they missed their children.[x] Moreover, a growing body of studies reveals that ‘loneliness is linked to a host of other problems and in itself can kill, typically by raising blood pressure and increasing risk for heart disease and stroke.’[xi] It suggests that a supportive social network is strongly connected to attaining positive health outcomes, whether psychological or physical. It is clear therefore, that many of these problems are intrinsically linked and often serve to trigger the other off.
NCDs have already become the largest contributor to disease burden in Sri Lanka, accounting for 85% of ill health, disability and early deaths[xii]. Furthermore, a regional study proved that South Asians suffer their first heart attack six years earlier than people in other regions, worldwide.[xiii] It is possible then that many of these ill effects stem from an overall atmosphere of unhappiness and negativity.
Rethinking the Way Forward
Although elders’ homes and day centers appear to be an easy solution, they are a far cry from being the answer to the problem. Merely providing material wellbeing for the elderly does not ensure that they are well taken care of.
The initiatives taken by Japan and the Netherlands look beyond the mere provision of material benefits. The two systems have been designed to make the elderly independent and empowered; to allow them to actively participate and be part of a vibrant community life. Sri Lanka may not have adequate funding to develop such advanced facilities, yet this shouldn’t avert us from drawing inspiration from the notion of placing the overall wellbeing of the elderly at the center of our agenda.
As expected, with an increase in the ageing population a whole new dimension of health problems have arisen and huge costs must be borne. Yet, in Sri Lanka there is little prominence placed on a specialized geriatric care system – with every patient being treated in a common ward. Even more noteworthy is the fact that there are no specialist geriatricians and health care workers in the country, with the skills to manage elderly complaints; as a result delirium, depression and dementia often goes overlooked.[xiv]
Dementia is a condition which affects an estimated 150,000 elderly in Sri Lanka but only 15% of patients ultimately seek medical help.[xv] There are numerous policies and schemes in place – the National Health Policy, the Public Assistance Scheme, the Ministry of Social Services – that provide general facilities to cater to the needs of the people. Yet, it is perhaps more important to establish specialized organizations that target the specific problems likely to heighten with the passing of time.
For instance, Alzheimer Europe is a non-governmental organization (NGO) that has created a mechanism for co-ordination between Alzheimer organizations throughout Europe.[xvi] This type of support system that assists families to cope and handle lifelong illnesses such as Alzheimers is severely lacking in Sri Lanka. In fact, Help Age Sri Lanka is the only (NGO) in the country that provides leadership to improve the lives of the elderly and help them “claim their rights, challenge discrimination and overcome poverty.”[xvii]
When balancing out the country’s future prospects, the mechanisms already in place seem far from sufficient. It is critical that additional schemes are developed to support the unprecedented rise in the ageing population that is looming ahead.
Although the Protection of the Rights of the Elderly Act was passed in 2000, it has been slow in implementation. One of the clauses of the act is that children shall not neglect their parents. Another clause emphasizes the non-discrimination of people based on age.[xviii] Through the years, our cultural values of respecting and caring for elders have strongly embodied these ideologies. Yet, at the turn of the century, a majority of us have lost touch with basic sensitivity, patience and compassion – and these age old practices have slipped out of our lifestyles.
From the context of reimagining development, one of the motivations should be to safeguard the long-term physical, mental and social well-being of the elderly. Regardless of whether they are rich or poor their fundamental rights must be upheld. In order to achieve this, an overall change in attitude is required. To purge out the negative mindset prevalent in the country we need to begin viewing the elderly as a source of knowledge and experience as opposed to marginalizing them and confining them because of their age. Instead of proliferating negative attitudes that will result in the continuation of a vicious cycle of illness and unhappiness among the elderly – Sri Lanka needs to channel a rush of positive energy into the system.
It is only by looking at the issue subjectively, through fresh eyes, that we can begin to reverse our attitudes and create an environment that allows the elderly to play a more active role in the community and ultimately aim to achieve development for ALL.
Where do we start? Perhaps, by accepting our own mortality and the idea that we will never be younger than we are today. It is inevitable that by the year 2035, one out of five people will be a part of the ageing population[xix]. It could be any one of us.
We must then ask the question: when it is our turn, how would we want to spend the ‘winter’ of our lives?
[iii] Why Population Ageing Matters: A Global Perspective http://www.nia.nih.gov/research/publication/why-population-aging-matters-global-perspective
[v] Poverty and the Challenges of the Elderly , Poverty Brief 12, Centre for Poverty Analysis, http://cepa.lk/library/Cepa_publication_details-6-4011.html
[viii] Poverty and the Challenges of the Elderly , Poverty Brief 12, Centre for Poverty Analysis, http://cepa.lk/library/Cepa_publication_details-6-4011.html
[xviii] Poverty and the Challenges of the Elderly , Poverty Brief 12, Centre for Poverty Analysis, http://cepa.lk/library/Cepa_publication_details-6-4011.html