The Global AgeWatch Index 2013 ranked 91 countries in terms of the well-being of their older populations (a loose term, but generally defined as individuals aged 60 years). Unsurprisingly, high-income countries did best, with the highest scores for Sweden and Norway across the assessed domains of income security, health status, employment and education, and presence of an enabling environment. Some countries with high overall scores were let down by poor performance in specific domains; the US was ranked only 24th for health but reached eighth overall. Conversely, South Korea (67th overall) was eighth best for health, but was let down by poor income security (90th).
For many countries, population ageing and how to ensure well-being for older citizens is portrayed as a cataclysm in waiting, with too few people left in work paying for an overbalancing population pyramid.
True, fewer people of working age will be looking after a greying society (especially in rich countries) and retirement ages will need to be raised, but such gloomy predictions are based on the assumption that with age comes expensive morbidity. If successive cohorts age healthier than previous ones (so called morbidity compression), and care systems improve, the crisis can be averted.
However, this optimistic course is not guaranteed. In the Global Burden of Disease 2010 Study, overall life expectancy at birth increased by 4,7 years for men and 5,2 years for women between 1990 and 2010, but healthy life expectancy increased only by 4,2 years for men and 4,5 years for women. In another assessment, although life expectancy at birth for the European Union increased by about 1 year in the 4 years up to 2009, healthy life expectancy stayed the same overall. This expansion of morbidity, during which people live longer with ill health, drives up health costs and decreases well-being.
So why does this discrepancy exist? All countries will feel the effects of the obesity and tobacco epidemics in the coming decades. In poorer countries, success against maternal and child mortality and infectious diseases has improved overall survival, but has shifted the burden of disease such that health systems encounter long-term disorders for which they are under-prepared. Funding should not be diverted from successful programmes, and new funding (with fewer advocates) has to be secured. In richer nations, access to long-term social care for older individuals can be inadequate.
Investment in services for elderly populations to improve well-being can bring its own health benefits: a sense of purpose is associated with reduced severity of Alzheimer’s disease and, conversely, depression and stress are linked with coronary heart disease and premature mortality.
Ageism bars older people from good health care. Wrongly, illness is viewed as an inherent part of getting old, treatments are seen as ineffective because of multi-morbidity, and any economic or health gains as minimal because elderly patients die soon anyway.
Thus, elderly patients are excluded from clinical trials, and do not receive the same standard of care as equivalently sick young people. Greater investment is needed into secondary and ambulatory care, and older patients must be included in well designed clinical trials. We must focus not only on what society can give to the elderly, but also on what the elderly can give to society. Successful ageing will benefit all age groups from the altruism, wisdom, and perspective of the most senior members of society.
Proactive rather than reactive health systems planning is needed. Older populations in India, Indonesia, Mexico, and Russia will double in the next 40 years, yet are in the bottom half of the Global Age Watch Index. India (health status rank 85th) needs to increase its share of GDP devoted to health (currently about 2 percent) if truly universal health care is to be delivered to its ageing population.
Services need to adapt to improve care for their ageing populations, including better use of mobile services and technology to facilitate home visits. An upcoming Series on ageing in The Lancet will assess the health and socioeconomic effects of the 2 billion people who will be older than 60 years in 2050.
Better data are needed to gauge success (in terms of well-being) of interventions to address the long-term needs of an ageing population, and track progress on morbidity compression. Although a promising start,
The Global AgeWatch Index was only able to provide rankings for 91 countries, including just seven from Africa. By 2050, more than 20percent of the global population will be older than 60 years and 80 percent will live in low-income and middle-income countries. Success in other medical specialties means that the world’s population is getting old. To allow it to do so gracefully will require early investment and cooperation between health and social care. — The Lancet.