Sri Lanka is ageing fast at an unprecedented rate. The country has been ranked as the fastest ageing nation in the South East Asia. Estimated figure for the over 60 year population in Sri Lanka by 2021 is 23% while currently the figure is around 10%. This means one in every five people will be over 60 years in 2021.

Population ageing has become a prominent topic as ageing has emerged as a global phenomenon in the wake of the now virtually universal decline in fertility and, to a lesser extent, of increases in life expectancy. Along with the low fertility rates, the success story of both curative and preventive medicine which has contributed to longevity has resulted in change in the shape of the population pyramid to include a large number of elderly.

Ageing represents a challenge to the developing world in general and Sri Lanka in particular. The country’s economy, social support system and health care are not equipped for the dynamic change in social service planning, infrastructure and provision of adequate health care to cater for the explosive growth of older adults in the community.

This phenomenon is not unique to Sri Lanka, as many other developing countries worldwide are also lacking proper planning to face this kind of demographic change. Two questions arise: Are these countries facing the ‘failure of success’ as their populations attain longer life expectancies, being unable to support their health status and avoid dependency because of lack of resources and specific services? Or, are they facing an opportunity for creative social planning? If policy makers understood the immediacy and implications of the phenomenon and the connections between population aging and economic growth, the actual lack of infrastructure would open the way to create alternative approaches to address this problem.

Economic implications of ageing

We need a balanced, comprehensive view of the implications of the rising elderly population in order to formulate a national strategy to address the issue. During the demographic transition the developing countries are now undergoing, the decline of fertility causes not only an increase in the proportions of older people, but also, conversely, a reduction in the proportions of younger people. This invariably signifies a contraction in the country’s labour force with dire economic implications. As the productivity declines due to reduction in the labour force and the dependence on pension schemes escalates, the burden on the economy becomes unavoidable.

As developing countries struggle to cope with their economic problems, the aged individual is marginalized. The manifestations of poverty are much severer for the aged. Rural poverty leaves older people alone in the village to look after themselves while the family migrates to urban areas in search of jobs. In the middle of competing priorities at national and family levels, the welfare of the elderly is given low or no priority

The elderly, with their greater needs for health care, put considerable strains on systems of health care in all societies and provide additional urgency to the search for solutions. The ideal of healthy aging requires that the elderly not only share the general facilities available to the population at large but also have additional care to meet their special needs. These include the social and physical environments, the promotion of healthy lifestyles, and the provision of medical and nursing care. Freedom of access to the services is needed . Few professionals choose to care for the elderly, and, as the majority of the world’s elderly are women, their low status in developing countries will continue to be a major barrier to their health as they age. Poverty is the greatest single cause of ill health at all ages, and while its reduction is not strictly a role of the health sector, it is certainly a prerequisite for the provision of good health for the community.

Health Issues

Extension of human life imposes a new vision of the health of the elderly comprising self-sufficiency, economic independence, and individual development. But, how can this new paradigm be integrated into the health services of the developing world, which at present is primarily oriented towards curative care? We need a revaluation of these health care models looking towards restructuring to fulfil the requirements of an epidemiological scenario that is undergoing a rapid transformation in the face of the challenge of balancing priority of care for the health problems characteristic of these countries, along with the care of the elderly. Indeed, this is a double challenge: Caring simultaneously for the aged and for an ageing population.

The focus of most developing countries is on maternal and child health; health care for the elderly people is neglected. Both facilities and trained personnel are lacking. Health workers who are the first point of contact for elderly people are inadequately trained and equipped to care for them. Government hospitals mainly providing curative health are obviously overcrowded and long queues at out-patient departments are mostly of the older adults. No secondary of tertiary institutions have separate health clinics for the elderly. Outpatient departments and departments of general medicine provide care but there is a long waiting time and the care is often inadequate; minimal attention is paid to personal care and counselling. Separate inpatient facilities are rarely designated for elderly patients.

As the pattern of diseases is ever changing with a reduction in infectious diseases and a rise in non communicable diseases like high blood pressure, ischaemic heart disease and diabetes more attention needs to be paid for the prevention of the same and educating the public as these diseases can lead to an increase in the morbidity and prolong hospital stay among the elderly. Elderly care medicine is the need of the day with more health care personnel being trained as allied health members in physiotherapy and occupational therapy so that following medical illness the elderly will be rehabilitated for an independent lifestyle. This will take strain off the family care givers and social service system. Most developing countries cannot afford to develop specialist geriatric services. Special provisions will have to be made in the existing health system in order to train primary care professionals in the field of geriatrics.

Problems faced by the elderly

In addition to the health issues, which are the same as elsewhere, elderly people in developing countries have become especially vulnerable because of the rapid social changes occurring in many of these countries. Until recently, elderly people in developing countries enjoyed considerable status, respect, care, and social and psychological support from their families. Migration, urbanization, changes in value systems and aspirations, changes in the role of women, and the breakdown of the family system have eroded traditional familial support and elderly people suddenly find themselves poor, uncared for, and without power or influence. The civil war situation that prevailed in the country has fuelled this crisis and left a larger number of elderly without family support or fixed income.

There is almost no social support for elderly people outside the family. Except for a tiny minority who have worked in the formal sector and are therefore entitled to pensions etc economic support does not exist for the elderly.

At the simplest level of analysis, concern for ageing is merely a function of the proportion of older people in a population. Where that proportion is low, the magnitude of related issues is limited. This does not mean that those issues are easy to handle, because a poor society will have difficulties tackling even a modest per capita burden. When the proportion of older people starts increasing, it is important to start acting upon the related issues in a progressive fashion. Otherwise, the magnitude of the delayed tasks would become unmanageable. The overall demographic context drives the possibilities of responding to the challenge of ageing and a diminishing proportion of children enables reallocating resources for the increasingly elderly population.

Elderly participation in economic growth

Empowering the elderly through their participation in society is necessary to avoid marginalization. The crucial issue is the avoidance of poverty. Mutual support structures could provide older persons with more control over their own lives, but such organisations will not be able to satisfy the basic needs of the elderly people. What requires reconsideration most is the retirement age. Most rich countries spend around 8% on public pensions. With the shrinkage of labour force and an increase in longevity generous public pension schemes become a unsustainable burden to the government. Increasing the retirement age means more elderly participation for the work force and it would solve many of the problems associated with ageing populations.

Social support

Improving social services is also an urgent need, for the ageing situation will generate tremendous demand for social services. Some of these will be very basic such as food and shelter and others not so basic such as dealing with disabilities. To improve these services, the first step is probably to recognise ageing as an emerging and significant issue; second, to consider that a large majority of elderly people will have neither savings nor access to social security benefits; and third, to recognise that their need of social services will be high ranging from basic to rehabilitative services. The development must be on the basis of the existing informal support system for the ageing and the existing social service infrastructure. In this context, adult day care centres can be developed with little additional input.