Sunday Gleaner | 4 November 2012
by Professor Denise Eldemire-Shearer, Contributor
The
Jamaican population has been ageing since the 1970s, a fact now clearly
seen in the 2011 census and which warrants analysis and discussion. The
60-and-over population has increased to 305,164, representing 11.3 per
cent of the total population, an increase of nine per cent over 2001.
This discussion uses 60 because it is the official age of retirement.
The census findings highlight the need for a wide discussion of changes,
even within the older group.
A significant finding is the
increase in the older old, i.e., those above 80, increasing to almost
60,000, an increase of 34 per cent. This finding of the census supports
the notion that people are living longer, i.e., 20-25 years after
retirement. So we have increased numbers of persons living longer. This
change warrants special consideration, as with increased age, especially
in later years, there is increased frailty.
Contributing to
ageing is the decline of the population under 15, by 26 per cent, and
which is expected to continue falling, influencing the changing age
structure.
The declining younger population, with consequent
reduction in family size, and the increased education and workforce
participation of females, will impact on the caregiving capacity of
family units and their ability to support frail older persons, both
physically and financially, even when they want to.
Gender
considerations are important. While the sex ratio of the general
population is equal, this is not so for the older population. The impact
of the gender finding needs analysis and policy intervention, as with
age, there is increasing feminisation, and females outnumber males.
Sixty per cent of persons over 80 are females, and 67 per cent of those
over 90. Older females have been identified as being at greater risk for
poverty and vulnerability, and so need special consideration. Older
females also have more illnesses and disabilities.
HEALTH CONSIDERATIONS
As
bodies age, needs, vulnerabilities and medical requirements change.
Health care is one of the three areas which will be most impacted by the
increasing older population and which needs analysis and intervention.
Much of the initial reaction and focus have been on the anticipated
increased costs associated with delivering care to increasing numbers of
persons with chronic diseases, although there is no evidence to suggest
that this is true.
Increased health-care cost is concentrated in
the old old. Health need is also accompanied by increased financial
need for medications and advanced health care.
There are many
aspects to the discussion of health care and what is needed. Systems and
people need to change. There is the question of the appropriateness and
availability of services. The emphasis on 'age-friendly' care has
raised questions about how and where services are delivered for older
persons, including transportation, environmental suitability of health
facilities, i.e., ramps and hand bars.
The current approach of
the health-delivery system, with its focus on managing acute situations,
needs to be reoriented to ongoing chronic disease prevention and
management. Staff at all levels of the health-delivery system should be
trained in the special needs of older persons, including communication.
Clinical care of older persons is a specialist area. Yet there is no
geriatric training available in Jamaica.
Prevention needs to be
stressed at all ages. Older persons have different health-promotion and
disease-prevention needs. Such activities need to complement those in
place for younger persons so as to increase the number of healthy older
persons entering their 60s and 70s and, therefore, having less demand
for health services. This will need a fundamental change in attitude and
practice with regard to the prevention practices in the health-delivery
system.
Equally important is that older persons themselves must
understand the role of healthy lifestyle choices and assume more
responsibility for their health. Old age does not mean illness. The
foundation for this exists, as health promotion is a cornerstone of
programmes for younger people.
Who will provide the long-term
care traditionally provided by families given the changes already
described? Again this is not just about cost; it's about availability of
a wide range of services and about appropriately trained caring staff.
While as a country we may be able to provide some services in urban
areas, what will happen to rural older persons?
The census has
also suggested that there is rural-urban migration gradually of young
persons leaving older persons alone. The increase in the older old (80+)
suggests this will be an area of need over the next 20 years.
Read further - Prof Eldemire Shearer's comments on
SOCIAL SERVICES, ECONOMIC CONSIDERATIONS,THE POSITIVE SIDE
at:
http://jamaica-gleaner.com/gleaner/20121104/focus/focus1.html
Professor
Denise Eldemire-Shearer is senior lecturer in the UWI's Department of
Community Health and Psychiatry. Email feedback to columns@gleanerjm.com
and denise.eldemireshearer@uwimona.edu.jm
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