Ageing gracefully:

Caring for elders with dignity

By Lionel WIJESIRI

According to reliable statistics, more than 22 percent of our population will be over 60 in about two decades. Of the rest of the population, there will be 61 dependents for each 100 adults. According to another survey, Sri Lanka has been rated as the country with the fastest growing ageing population in South East Asia.

What do these revelations mean? It means that we should be ready with a comprehensive action plan to protect the rights of the elderly population within the next decade to avoid all possibilities of any ageing crisis.

The real challenges of caring for the elderly in 2020s will involve: (1) making sure society develops health systems for long-term care that work better than existing ones, (2) taking advantage of advances in behavioural health to keep the elderly as healthy and active as possible, (3) changing the way society organises community services so that care is more accessible, and (4) altering the cultural view of ageing to make sure all ages are integrated into the fabric of community life.

Preparation

To meet the long-term care needs of today’s 50+ generation, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if changes are made now rather than when that generation actually need long-term care.

Public policy goals related to an ageing society must balance the need to provide adequate services and transfers with an interest in maintaining the economic and social well-being of the non-elderly. The economic challenges should be such that public and private progress that begins in the near future will make the future burden substantially easier to handle.

Healthy ageing

Perhaps the most important challenge related to ageing populations is the challenge of healthy ageing. Healthy ageing (or successful or productive ageing) is the concept of keeping seniors disability-free and thus avoiding some of the need for long-term care. Keeping seniors healthy and functioning could have significant economic impacts. In addition to reducing long-term care costs, healthier elderly are more likely to be productive members of society.

In contrast to the scarce attention being paid to improving financing for long-term care, the healthy ageing challenge has generated significant interest.

Better management by the medical care system of a broad range of chronic diseases could also reduce the incidence of disability. Society’s understanding of what the health system needs to do to encourage prevention and clinical care management of chronic diseases has improved tremendously in recent years. Despite this, the right formula has not emerged for setting incentives that will lead to widespread adoption of good clinical care management principles among the numerous medical providers, including the children, who care for the elders.

Cultural change

The other important challenge related to meeting the long-term care needs of an ageing population is quite intangible and is dependent on culture rather than public policy. The idea

of elders as an economic burden or as frail and weak is a twentieth-century construct. An interesting book by Thomas Cole traces the history of society’s views on ageing.

In ages when death struck randomly and evenly at all ages, people did not focus so much on a birth to death, linear view of life. And, agrarian economies, like Sri Lanka, where the young, the middle-aged, and the old all play productive roles enhanced the sense of the value of all ages.

So, in past eras life was viewed more as a circle - the Lion King image. But, since the colonial domination from 19th century and especially during the twentieth century, as more people have lived to old age, the linear interpretation of the life cycle has become dominant.

The past century’s improvements in medical and economic conditions for older people have been accompanied by cultural isolation and a change in the conception of old age. Old age has been removed from its once spiritual location in the journey of life to being redefined as a medical problem.

Perhaps it is time to rethink the value of ageing and the positive aspects of ageing and to adopt a cultural view captured by the imagery of the “Long Late Afternoon of Life.” While it is difficult to change “culture” per se and the way elders are viewed in society, there are practical steps communities, employers, and individuals can begin to take to prepare for a society with greater numbers of healthy elders.

Assets

First, it is worth reassessing the responsibilities and assets of elders. All ages need roles in life. According to Erik Erikson, the hallmark of successful late-life development is the capacity to be generative and to pass on to future generations what one has learned from life.

Marc Freedman has called the elderly “a country’s number one growing resource” and views the ageing of the population as an opportunity to be seized. More than half of all elderly volunteer their time.

Companies are integrating workforces through programs of “non-retirement” or by hiring retirees as temps, consultants, and part-time workers. Surveys suggest that the 60-year trend of a decreasing number of elderly working has reversed itself as Baby Boomers reconsider their financial needs for retirement as well as how they want to spend more than a third of their adult life.

The young elderly (people in their 60s) have reported increased ability to work. Most forecasters project this trend to continue as more elderly work longer for economic, social, and personal reasons, employers become more flexible and aware of the needs and benefits of older workers.

Since the sheer size and energy of the older generation has led to other dramatic social shifts, some experts see hope that a new imagery for ageing is possible. A growing interest in “age integration” - a process that takes advantage of the broadened range of accumulated “life course” experiences in society - has occurred over the past few decades. In an age-integrated society, changes made to bring older people into the mainstream could simultaneously enlarge personal opportunities and relieve many other people who are in their middle years of the work–family “crunch”.

Message

Cultural change also is possible, in terms of one-to-one relationships. Older generation have made an art of enjoying and taking pride in everything about caring for children; some even go so far as managing to almost “enjoy” paying for specialising in preferred subjects. The needed cultural shift is for children and communities to find more enjoyment and pride in providing for the care of parents and neighbours.

The simple message - and the intangible goal - is to recognise the give and take of all parts of society. Anyone who has spent time caring for an elderly friend or relative recognises that in the end, caregivers receive far more than they give in the relationship. Everyone benefits when the elderly can be integrated fully into a caring society.

Elders are precious. They deserve our best care. Keeping elders in their homes means keeping them in the community where they can continue to provide leadership and impart knowledge so their grandchildren can one day become wise elders…keeping the circle intact.