United Nations Population Fund

Ageing

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Adapting While Ageing

Getting older and dying are often topics given little attention. That is, until we have to actually deal with these realities in our own lives. Imagine what life is like for our elder character, Marta, as she is slowing down, and the world around her is speeding up. At 79, Marta has lived a full life with all kinds of twists and turns. Inside her tiny house, the home her late husband, Igor, grew up in, and where they raised their own children, exist many memories—some hard and sad, and many happy and joyous. One picture in particular is capturing her attention lately—an old photo of herself dancing. In the photo, she is dressed in the traditional clothing of her Eastern European country, performing a traditional folkloric dance. She smiles at the memory of what she used to be able to do and how she used to look. Her dear Igor loved to watch her dance.

“One of humanity’s greatest achievements is that people are living longer and healthier lives, with the number and proportion of older persons aged 60 years or over rising in all countries.”

Marta has danced and performed since she was a little girl. She, like several other community members, is committed to keeping old traditions alive. Her mother taught her, and her mother’s mother taught her. Marta takes great pride in passing these traditions to her children, her grandchildren and now soon, her great-grandchildren. While Marta’s body aches just looking at that picture, it brings her great pleasure. Getting older hasn’t been easy. She has many debilitating ailments that seem to keep adding up and complicating her daily life.

A few years ago, Marta slipped and broke her hip. Now, physical activity of any kind is a challenge. Accepting this hasn’t been easy, because dancing was such a fundamentally joyous part of her social life. While her social life isn’t as vibrant as before, Marta does still meet her friends for tea and backgammon. They take turns coming by bus to each other’s homes, bringing homemade treats and sitting for hours gossiping about their families, friends and loved ones.

“More people are getting older, with the population of people over age 60 rising from 490 million in 1990 to 765 million in 2010.”

Marta has a male companion, Boris. They visit with one another when they can. Boris is a few years younger than Marta, and was a transformative support for her when they met a few years ago at a gender-based violence support group. In the last year, Marta finds herself now caring more and more for Boris—just as she did for Igor—and neglecting her own health.

The neglect has caught up with her, leaving her feeling physically and mentally challenged. Thus, she is leaning more and more on her family, friends and government services. Staying connected to her community keeps her spirits up. Watching her children and grandchildren carry on the traditions she passed on to them gives her great pride. The intimacy she enjoys with Boris gives attention to her femininity. Her group of girlfriends is a release for all of the challenges they are collectively grappling with, and in many cases, they are seeking better support to address such challenges.

“In 2012, there were 84 men per 100 women aged 60 years and older, and 61 men per 100 women aged 80 years and older.”

Getting Older

Population ageing is an inevitable consequence of demographic changes resulting from fertility decline and increased longevity. The number and proportion of people over age 60 is rising in all countries. Population ageing presents social, economic and cultural challenges to individuals, families and societies. Ageing also creates opportunities to enrich entire households and the larger society.

Globally, in the past 20 years, the population of people over age 60 has increased by 56%, from 490 million in 1990 to 765 million in 2010.

Living Longer

Elderly women outnumber elderly men in most societies. Globally, in 2012, there were 84 men per 100 women aged 60 years or over, and 61 men per 100 women aged 80 years or over.

Ageing Alone

The rise in one-person households reflects social changes among both young adults and older persons in different regions. As the world grows increasingly more urban and the proportion of older persons in the global population increases, the proportionate increase in one-person households is likely to continue. The majority of older and widowed people living in one-person households are women.

What Your Government Can Do

States should modify legislation, design and planning guidelines, and infrastructure to ensure that the increasing number of older, single persons have access to needed and appropriate housing, transport, recreation and the amenities of communal life.

States, including through local municipalities, should take into consideration the growing diversity of household structures and living arrangements, and the corresponding needs for housing and communal social spaces for one-person households among both young and older people in order to reduce social isolation.

Post-retirement Living

Marta worked full time in a factory for nearly five decades. She and her friends joked, “We will rest when we are dead!” She retired at 68-years-old, when the factory shut down. Not ready to retire, and still wanting and needing to continue working, she found day work cleaning homes and offices. It was important to Marta to continue to be an earner, and it was a way, although physically strenuous, to keep her engaged with society. Unfortunately, over time, the work further aggravated her arthritic hands and knees, making it difficult to do her job. Where Marta lives, many of the roads are broken, making walking an unsteadying experience. The gap between the curb and the street is high, which can make it hard to even get to her bus stop. After the serious slip that broke her hip, Marta is even more fearful of falling, so she does not go out of the house as much as she used to. Staying home means seeing less of her friends, family and Boris unless they come to her.

“Flexible employment, lifelong learning and retraining opportunities are critical to enable and encourage older persons to remain in the labour market, for their own benefit, for that of their families, and as an essential resource for successful economies that cannot afford to lose their experience and expertise.”

Marta lives alone and has been living alone since her husband, Igor, passed away almost 10 years ago. Throughout their marriage, she cared for all of his and her children’s needs. Toward the end of his life she was his only caregiver. After Igor died, it was Boris who helped her find her independence, her confidence and her sense of her self. He encouraged her to stop cleaning offices and use her mind instead. They met at a centre that works with victims and perpetrators of gender-based violence. Members of their group introduced Marta to the opportunities that state-supported lifelong learning programmes offer older people in her community. It was outside of her comfort zone, but Marta pushed herself and took a chance. She learned how to navigate the Internet and to email, and she gained basic computer skills, something few people her age in her community were doing. These skills combined with her age made her an asset, which helped her acquire a part-time job in an office at the age of 73. Working with new skills was a life-changing opportunity. Her job and new career gave Marta a stronger sense of identity and self-sufficiency.

“Among persons 65 and older, illiteracy remains at 26%. ”

In addition to the money Marta brings in with her part-time job, she also lives off the income from Igor’s pension. She is fortunate to have this. She sees some of her friends struggling financially. Many are without either contributory or noncontributory pension schemes. More than Marta, they rely heavily on their families to support them. Some have no choice but to continue to work despite disabilities and illnesses that make residential, transportation and health-care needs more acute.

Lifelong Learning

Lifelong education enables people of all ages to strengthen and augment their literacy and related skills, to adapt to changing employment opportunities, and to participate fully in changing personal and economic conditions, to the benefit of themselves, their families, their communities and the society at large. Lifelong learning is not only for older persons. It is also for young or middle-aged workers experiencing loss or change of employment, or who may have missed earlier opportunities to get an education because of poverty, early entry into employment, early childbearing, or voluntary or forced mobility.

Elder Employment

Women make up an increasing proportion of the older workforce. The likelihood of their participating in the labour force after age 65 has risen for several decades, while it has declined for men. Women’s increased participation in the older workforce and greater rates of illiteracy contribute to the persistent inequalities faced by working women, and the greater likelihood of their participating in informal, insecure and lower-paid work.

Social Protection Systems

As people live longer, benefits related to pensions, health care and old-age support will need to be paid over longer periods. Further attention is needed to the long-term viability of social support systems crucial for both older and younger generations. Countries with larger populations of older people are increasingly addressing their needs: 94% have provided social services including long-term care; 91% offer affordable, appropriate and accessible health care; 88% have extended or improved old age allowances; 89% seek to enable older persons to live independently as long as possible; and 88% are collecting disaggregated data that make the issues of the elderly visible to policy makers.

What Your Government Can Do

States should strengthen lifelong learning and adult literacy opportunities that enable all persons, regardless of age, to gain new skills for a changing economy, pursue better employment and income, or simply explore the development of personal talents and ambitions.

States should monitor and eradicate all forms of discrimination in employment against older persons; and develop labour protection policies and programmes that ensure employment that is safe, secure, and that provides a decent wage.

States should ensure the social protection and income security of older persons, with particular consideration for older women, those living in isolation and those providing unpaid care, by extending pension systems and noncontributory allowances and by strengthening intergenerational solidarity, and by ensuring the inclusion and equitable participation of older persons in the design and implementation of policies, programmes and plans that affect their lives.

Mounting Health Issues

While most of Marta’s health issues have been manageable with the help of her children, including her treatment for cervical cancer years ago, recently she has begun exhibiting symptoms of Alzheimer’s disease. As her condition worsens, she will need dependency care services. Her combined income doesn’t cover these new medical expenses. The more complex her health issues, the more Marta’s family will be confronted with the fact that the care that does exist for her is quite limited. Essentially, Marta’s cost of living is increasing, while government support is decreasing.

“Increasing longevity may also result in rising medical costs and increasing demands for health services, since older people are typically more vulnerable to chronic diseases.”

With these new health challenges come different medical professionals for various treatments. Transportation between her home and medical facilities is frequently unreliable and challenging to access. On her bad health days, it is impossible for her to visit with anyone on her own. The streets, with their high curbs and potholes, are too dangerous. This is the kind of challenging scenario where the state needs to step in.

Realistically, as her condition worsens, Marta should move to a place closer to her children, and with access to appropriate health-care services. Marta, however, is firm in expressing what she wants. She will die in her home and only her home. She refuses to live her last days in a hospital or elder care home. This is a complicated situation for her children, because they want her to be safe, but they also want her to be happy. It is good that at least her home is on one level. The compromise may be in getting her to agree to regular care as it becomes necessary.

“Over 46% of all people over age 60 have a moderate to severe disability.”

Meanwhile, Marta’s children are already helping out a lot. Their help is not daily, however, since they don’t live very close and are busy with their own families. They each visit her once a week. This won’t be enough to ensure Marta’s safety when her condition worsens, however. For now, Marta and her family are taking things one day at a time, trying to make her home life safer.

Non-communicable Diseases

Mental illness is a key non-communicable disease affecting hundreds of millions of people globally, and is the leading cause of disability-adjusted life years lost from non-communicable diseases. According to Alzheimer’s Disease International, 44 million people currently live with the disease, a number that will grow to 135 million by 2050. In addition, by 2050, 71% of cases will be in low- and middle-income countries.

Sexual and Reproductive Health

The sexual health of older persons is often overlooked both in academic discourse and policy responses to rapid population ageing. This is perhaps because the subject of sexuality in older people remains largely taboo in many cultures. In a recent large study of older adults in the United States, in which a broad definition of sexual functioning was used, women between 57 and 74 years showed no decline in sexual activity. Sexual functioning was found to be more associated with self-rated physical health than age.

Strengthening Health Systems

Despite decades of unprecedented medical advances and innovations in health care, stark inequalities in the accessibility and quality of health systems persist across and within countries. Sub-Saharan Africa and, to a lesser extent, South Asia continue to have some of the least accessible and most fragile health systems, as measured by indicators such as health worker density, coverage of critical services, commodity stock-outs and record-keeping, or by health outcomes. Within selected middle- and high-income countries, pockets of weak and poor health system coverage or quality abound for selected areas or populations, such as for indigenous peoples, urban slums, the uninsured and undocumented groups.

What Your Government Can Do

States should strengthen health and care systems by promoting universal access to an integrated, balanced continuum of care through old age, including chronic disease management, end-of-life and palliative care.

States should monitor and eradicate all forms of direct and indirect abuse, including all forms of violence, over medication, substandard care and social isolation.

States should adopt policies and programmes on sexual health to better meet the changing sexual needs of older persons.

It is critical to address the rising burden of reproductive cancers, including breast, cervical and prostate cancers, by investing in prevention strategies including the human papilloma virus vaccine and routine screening, early treatment at the primary care level and reliable referrals to higher levels of care.

It is also necessary to reduce risk factors for non-communicable diseases through the promotion of healthy behaviours and lifestyle choices, particularly among children, adolescents and youth.

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