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International Day of Older Persons 2021: ‘Wrinkles should merely indicate where smiles have been’

By Dr. Charuni Kohombange

The International Day of Older Persons is observed on 1 October each year. At the UN General Assembly held on 14 December 1990,  this date was declared as the International Day of Older Persons, as recorded in Resolution 45/106. This was preceded by initiatives such as the Vienna International Plan of Action on ageing which was adopted by the 1982 World Assembly on Ageing and endorsed later that year by the UN General Assembly. Virtually, every country in the world is experiencing growth in the size and proportion of older persons in their population. In 2019, there were 703 million persons aged 65 years or over in the world and this number of older persons is projected to double to 1.5 billion in 2050. According to the UN’s world population data, one in six people in the world will be aged 65 years or over by 2050 which accounts for 16% of the world population.

Sri Lanka too is experiencing a large and rapid increase in the elderly population due to a combination of low fertility and high life expectancy rates. With the provision of free quality healthcare for all citizens, Sri Lanka has become the fastest ageing population in Southeast Asia. According to the last census of 2012, the population above 60 years of age is 12.4% and the over 80 years population is 5% of the total population. The share of the population aged 60 years and older is expected to double during the next three decades.

The following are excerpts of an interview with Ministry of Health Directorate of Youth, Elderly, and Disabled (YED) Director Dr. Deepa Saranajeewa and Ministry of Health Directorate of YED Consultant Community Physician Dr. Shiromi Maduwage regarding matters related to elderly health in Sri Lanka. 

In your point of view, what is the importance of having a day for elders? 
Each year since 1990, the International Day for Older Persons has been celebrated with an identified theme which is equally important to the whole world. Actions identified according to a theme are not only confined to that particular day but all actions progress for the long term. Advocacy and awareness on selected themes have a vital role to play, focusing on all multi-stakeholders, older persons, and their family members.

With the rapid ageing of the global population, healthy ageing is a topic widely discussed. What do you mean by healthy ageing and why is it so important?
The World Health Organisation (WHO) defines healthy ageing as the process of developing and maintaining functional ability to enable wellbeing in older age. Wellbeing incorporates physical, mental, and social health and is the birthright of every human being. The UN declared this decade (2020-2030) as the “Decade for Healthy Ageing”, paying attention to every nation addressing the importance of inter-sectoral collaboration to achieve healthy ageing targets. The Decade of Healthy Ageing is proposed as a global collaboration, led by WHO, that will work to improve the lives of older adults, their families, and the communities in which they live.

Basically, any individual aged 60 and above, who is free from chronic diseases, leading autonomy in activities of daily living and quality lifestyle while participating actively with or without cognitive or functional impairments or disabilities, can be considered as an example for healthy ageing. It is an individual experience that is influenced by healthy behaviours over the course of a lifetime, including good nutrition, physical activity, access to high-quality healthcare, and social engagement. 

Life expectancy from birth is longer with advancement of medical services. However, functional life expectancy is an important aspect to consider since poor functional life expectancy highlights poor health in elderly. Achieving quality physical and mental wellbeing combined with environmental friendliness for the elderly are focused on when obtaining healthy ageing.

In Sri Lanka, what are the steps taken to promote healthy ageing?
Sri Lanka has taken many steps on fostering healthy ageing. A policy, act, and regulations are already in place for achieving the wellbeing of older persons; Act No. 9 of 2000 (Protection Of The Rights Of Elders Act) is to protect the rights of older persons. Based on that, the National Council for Elders was established to make policy decisions for the wellbeing of older persons in Sri Lanka. The Elderly Secretariat is the focal point for maintaining social wellbeing of older persons in the country and the elderly policy provides guiding principles to achieve the wellbeing of elders.
The Directorate of YED is the national focal point which plays a major role in achieving better health among older persons, following the elderly policy.

Sri Lanka has laid down strategy and action plans on ageing and health in par with a global strategy and action plan on ageing. The strategy addresses and commits to actions including combatting ageism, developing an age-friendly environment, strengthening long-term care, and person-centred care.

What is our responsibility to create elderly-friendly environments and societies? What is the role of the Directorate of YED in this?
In Sri Lanka, being the fastest ageing population in Southeast Asia, there is a high demand and responsibility to create elderly-friendly environments and societies with the intention of giving them suitable living and life standards to maintain healthy and enjoyable lives through social inclusion and protection. The WHO introduced the standards of elderly-friendly cities and the Directorate of YED is ready to provide technical assistance to any government or non-government organisation in the implementation of the standards and accessibility in public places, and the main focus should be on improving transport facilities.

The Directorate of YED is currently implementing projects to create elderly-friendly environments in hospitals and establish intermediate elderly care units in underutilised divisional hospitals to improve elderly care services. Fifty-two such institutions will be established islandwide with laboratory facilities, physiotherapy, and occupational therapy units. The concept of community-based elderly care will be introduced next year with the assistance of the Japan International Co-operation Agency (JICA) creating environments for young generations to serve older people as community leaders.

What are the steps taken by the Ministry of Health to improve care in elderly care home settings? 
The availability of trained informal caregivers is limited for the elderly homes in Sri Lanka. Caregiver training is facilitated by the Directorate of YED to fulfil this gap. Training of elderly care home staff on creating accidents-free environments at elderly homes is currently in progress.

During the Covid-19 pandemic, guidelines were developed for elderly homes, about preventive measures for Covid-19. Elders’ rights promotion officers and social service offices were trained on implementing these guidelines at elderly homes. Further, the Directorate of YED provided partnership for the home-based vaccination programme for older persons.

What is the importance of inter-sectoral collaboration in promoting elderly care? And what are the steps taken by the Ministry of Health to promote that?
Inter-sectoral collaboration among government ministries is extremely important in the provision of supportive services and to create elderly-friendly environments. The National Secretariat for Elders is the main government body responsible to maintain the social aspect of the ageing population and they will be the contributory partner in the implementation of community-based elderly care projects. In the creation of elderly-friendly environments in urban and semi-urban settings, public places, and in the provision of transport, the relevant ministries have major responsibilities. Prevention from falls and injuries leading to disabilities is the key area to focus on in this regard.

A considerable number of elders who have retired from the government sector are very unhappy about their retirement life. Most of them have to stay for months and years to receive their pension which is the only income for many of them. The Pensions Department should take urgent measures to solve this problem.

During the Covid-19 pandemic what are the special difficulties faced by the elderly and what measures have been taken by the Ministry of Health to facilitate them?
Covid-19-positive elders were reported mostly in unregistered care homes. The home managers and caregivers were not aware of the health guidelines issued by the Directorate of YED, since they are not registered under the National Secretariat for Elders and run the care homes only with business registrations. Introduction of a regulatory mechanism to streamline the registration is important.

In addition, public health nursing officers have provided home-based care for the older persons who needed palliative and end-of-life care. Loneliness among older persons has become an issue especially during the pandemic lockdown time. The Directorate of YED has conducted the “Hello” project to assist the psychological wellbeing of elders during the lockdown periods.

What is your message on this International Day of Older Persons?
Elders are the most vulnerable group during the Covid-19 pandemic. We have to live with this virus for many years to come, adapting to the new normal; and vaccination is the main protecting factor for elders. If you are still not vaccinated, please come out from the doubts and myths and save your lives by obtaining the vaccine.

With this years’ theme, “Digital equity in all ages”, you are welcome to learn and use digital devices to stay connected while staying safe at home. Digital inclusion adds quality to the life of older persons and it will help them understand and be flexible towards youth and minimise the generation gap. Everyone needs to plan their elderly life in advance towards the journey of achieving healthy ageing. 

(The writer is a Medical Officer at the Directorate of Healthcare Quality and Safety of the Ministry of Health)