The world locates on the threshold of a spectacular demographic
alteration, known as global ageing (Farhud, 2015). The rapid ageing of the
world's population has become the enduring an unprecedented trend in the
worldwide healthcare system, creating unique challenges worldwide. (McPhee et
al., 2016). The effects of ageing are adversely affecting the quality of life
and productivity on a high scale. The influence of ageing worldwide may see in
the health, economic, social, and personal decline (World Health Organization,
2009).
The prevalence of ageing is rapidly rising not merely in the
developed countries, but also in developing countries, like Pakistan (Keyes,
2002). Life expectancy of the elderly population has increased dramatically as
compared to the elderly people of past decades. In the past decades, the life
expectancy of the peoples was lesser, but now the average life expectancy in
America is found to be 78 years (Garko, 2018). The life expectancy has
increased, but the elderly people do not spend a productive and healthy life on
average due to a fragile body state (Keyes, 2002). The reason of fragile body
is that elderly Population spends more time indulging in sedentary
health-related behaviour, ignore the physical activities and prefer to depend on
other people for their tasks (Santoni et al., 2015).
Literature also suggests that the people after 60-65 years become
dependent on other people for their physical functioning (Frieden, 2010). The
dependency deteriorates their healthy health habits and due to their extreme
dependence upon other for even minor tasks, their physical strength and stamina
decline with the time. As a result, they become more and more dependent upon
others (Ferrucci, Giallauria, & Guralnik, 2008). They may not walk or move
independently due to functional dependency, and the self-help care and
functioning in other area demand assistance for accomplishing the task
(Ferrucci, Giallauria, & Guralnik, 2008). They become more vulnerable
towards medical diseases like HIV Aids, Cancer, Hepatitis, Joint Pain, Limbs
issues and many other diseases (McPhee et al., 2016). In an elderly population,
not only the physical functioning declines but the mental function also
deteriorates to some extent. For example, the elderly population suffers from,
dementia, anxiety, depression, somatoform disorder, cognitive decline and
psychosis (Sidik, Rampal, &Afifi, 2004).
The prevalence of mental disorder among the elderly population is 15%
throughout the world (WHO, 2017).
According to ageing statistics currently, 625 million people are
over 60 years, and among 1 out of 10 people are elder (Leslie, Hankey, 2015).
The estimation regarding the ratio of the elderly population suggests that in
2050 the proportion will increase and 1 out of 5 people would be elderly in the
coming years (World Health Organization, 2017). This rising geriatric
population is projected to offer new challenges to health care providers
shortly, such as psychological problem, low health status, limited health care
services, and increased mortality ratio (Ohrnberger, Fichera, & Sutton,
2017). The phenomenon of ageing is strongly associated with the health care
system. The healthy and productive body in old age is primarily associated with
the healthy health-related behaviours (Ashiq, & Asad, 2017). The
health-related behaviour depends on the health consciousness, and literature
suggests that elderly people are not conscious about their health status that
leads to poor practices of health-related behaviour (Ashiq, & Asad, 2017).
The most common poor health-related behaviours are the functional dependency
and lack of physical activity that determine the health status of elderly
people (Moody, Bijani, Hosseini, & Hajian-Tilaki, 2016). These figures
imply that there is a need to focus on the health consciousness of the aged
population in improving the health status so that they may contribute to the
development of the society. Numerous biological, psychological, social,
cultural, individual and developmental models are associated with the progression
of health consciousness, functional dependency and health-related behaviours
(Germov, 2014). Health status is a complex state that should be an overview in
a holistic manner. Mental health practitioners and professionals have developed
theories and models to elaborate on the relationship between health
consciousness and health-related behaviour or functional dependency concerning
the developmental course and consequences (Schofield, 2015).
Global Aging Effects
The principal challenge
of the ageing population in many developed countries is primarily associated
with health status (Germov, 2014). The literature suggests that the
health-related impact of ageing may divide into two categories the medical or
physical effects and the mental or psychological impact (König et al., 2010).
The physical or medical effect suggest that numerous medical diseases are
associated with elderly age such as atherosclerosis, cancer, cardiovascular
disease, arthritis, type 2 diabetes, hypertension, cataracts, osteoporosis, and
Alzheimer's disease (World Health Organization, 2017). The mental or
psychological impact is primarily interlinked with anxiety, depression,
cognitive impairment, dementia and bipolar disorders (World Health
Organization, 2010). According to DSM V, the mental and psychological impacts
of ageing deteriorate the personal, social and occupational functioning of an
individual (American Psychiatric Association, 2013). The impact of ageing may
also see in the social and economic decline of any country.
The physical and mental effect of ageing in developed countries. The physical and mental effect of ageing in developed countries
differs in their nature. The physical diseases are less frequent compared to a
mental disorder, but still, the physical conditions are also imperative with
the growing age (Lunenfeld, & Stratton, 2013). The ageing in western
countries found to be associated with mental health issues such as isolation,
hopelessness, dementia, mood disorder and Parkinson's disease.
The economic effect of ageing somehow depends upon the economy,
that depicts the cost of expenditure is likely to increase dramatically as
population age (Lunenfeld, & Stratton, 2013). As ageing is associated with
many physical and mental problems and the low health status require particular
medical and healthcare attention (Jin, Simpkins, Ji, Leis, & Stambler,
2015). Therefore, the ageing depends on the economy and consequently adversely
affects the economic status of any nation (Mwanyangala et al., 2010). Recent
studies demonstrate that the dramatic rising costs of health care are more
attributable to increased expenses on examination, medicines, and increased use
of diagnostic testing for diagnosis. The ratio of elderly population is
predominant, and the availability of resources such as health assessment and
treatment equipment, nurses and healthcare professionals are limited. Not all
elderly people can access the healthcare facilities due to lack of resources
(Jin, Simpkins, Ji, Leis, & Stambler, 2015). The US Government is working
to abolish the health inequalities between healthcare institutes
(Fernández-Ballesteros, Robine, Walker, & Kalache, 2013).
Striving for the eradication of health inequalities is difficult in
Asian Countries due to the limited resources and sedentary lifestyles of people
(Keyes, 2002). In developed countries like USA, UK, Australia, and England the
health status of the elderly population found to be appropriate due to the
availability of healthcare services (Hayes et al., 2002). The healthy
health-related behaviours are common in developed countries such as exercises,
a balanced diet, regular medical examination, and lack of dependency (Jin,
Simpkins, Ji, Leis, & Stambler, 2015). The European countries also
specified the damages caused by ageing such as poor health and economic dearth.
Furthermore, the mental and physical disease increases the likeliness of
mortality ratio and decreases the life expectancy (Ohrnberger, Fichera, &
Sutton, 2017).
The social determinants shape the health-related behaviour, which
further determined the health status of the elderly population. The younger
population responds and copes with the undesirable situation better as compared
to the elderly population (Lunenfeld, & Stratton, 2013). The low socioeconomic
status, income, illiteracy, cause stress and in the elderly ages the
vulnerability to cope with stressors decreases. As a result, the elderly
population becomes mentally ill (Hayes et al., 2002). In addition, lack of family support, physical
activity, smoking has also negatively impact on the health status of the
elderly population which adversely affect their mental functioning. The above
social determinants are least alarming and prevalent in the developed
countries, as compared to developing countries. The government policies provide
the elderly people support for independent living, but they suffer from
isolation, anxiety, fear and grief due to separation (Lunenfeld, &
Stratton, 2013). Furthermore, the literature also suggests that the elderly
people in developed countries spend healthy, productive and independent life
(Hayes et al., 2002).
The physical and mental effect of ageing in developing countries. Asian countries, in particular, Afghanistan, India, Bhutan,
Pakistan, Indonesia, and Iraq the health status of elderly people predict
numerous physical and mental symptoms (Keyes, 2002). The physical diseases are
more common in developing countries as compared to mental suffering. In
developing countries, people prefer to take care of their elderly people and
pay more attention to their physical and emotional needs. Therefore, the ratio
of mental suffering is below (Henriquez-Camacho, Losa, Miranda, & Cheyne,
2014). The rate of physical disease is more prevalent in elderly age, due to
dependent behaviour. The people become more vulnerable towards illness with the
growing age (Christensen, Doblhammer, Rau, & Vaupel, 2009). The elderly
person in developing countries purely depends on their children for daily
tasking. The lack of mobility and physical activity worsen their health status
(Bergman et al., 2013). Furthermore, the trend of exercise among elderly people
is rare in an Asian country that also leads to dependency in an elderly age
that further adversely affects the health status (Sidik, Rampal, &Afifi,
2004).
The prevalence of ageing is increasing in developing countries that
not merely affecting the elderly population but also damaging the economic
growth (Shrivastava, Shrivastava, & Ramasamy, 2013). The economic budget of
Asian countries such as Pakistan and India is low, and the quality of life
cannot be enhanced to an optimal level due to socioeconomic barriers.
Unfortunately, the increasing elderly population rate globally
putting more burdens on the health care system and with decreasing working population
rate health providers are not enough to tackle the elderly in the society
(Sidik, Rampal, &Afifi, 2004). This would present governments with hard
choices between higher taxes, including a possible reweighing of tax from
earnings to consumption, and a reduced government role in providing health care
(Keyes, 2002). The remarkable demographic transformations in the past century
have not only led to increased medical needs of elderly people, who often have
multiple chronic conditions, decrements in functional ability and age-related
disease, but also to the expansion of social security systems, such as pension
funds and health insurance, to support them.
Social security systems have also begun to experience problems.
Earlier defined benefit pension systems are experiencing sustainability
problems due to the increased longevity (Springer &Mouzon, 2011). The
extension of the pension period was not paired with an extension of the active
labour period or a rise in pension contributions, resulting in a decline of
replacement ratios in developed countries (Christensen, Doblhammer, Rau, &
Vaupel, 2009). Due to the ageing population, age discrimination could take
place globally; many countries seem to be increasing the age for old age
security from 60 to 65, to decrease the cost of the GDP scheme.
Elderly people have higher average expenditures than do younger
people and required more multiple services to play an active role in society
because in elderly age the body becomes more vulnerable towards mental and physical
diseases. This implies that elderly people in Asian Countries are economically
and emotionally dependent on their caregivers, and without any earnings, they
entirely rely on the family and society and thus putting the burden on the
healthcare system- for their medical needs which is already over-burden
(Christensen, Doblhammer, Rau, & Vaupel, 2009). Local governments are well
positioned to meet the needs of local, smaller populations, but as their
resources vary from one to another (e.g., property taxes, the existence of
community organisations), but the greater responsibility on local governments
is likely to increase inequalities in their social system.
The increase in the prevalence of non-communicable diseases shows
the need to invest in the kinds of services and programs which people require
later in life in developing countries. Developing world is hard-pressed to meet
the challenges of more elderly people, especially as traditional family support
systems for the elderly are breaking down (Hubert, Krishnan, Bruce, &,
Lingala, 2012).
The social effect of aging indicates that the, SES, income,
education, place of residence, capital, and occupation, housing, smoking,
social support access to health care services, ethnicity, family support,
insurance coverage, family safety, residence area, religious, physical
activity, and social capital are highly associated with the betterment of
health status. In Latin America and Asia, the health status of the elderly
population partially depends on the socioeconomic status. In elderly age the
independent functioning concerning the occupation decline that restrained the
elderly people living lives (Christensen, Doblhammer, Rau, & Vaupel, 2009).
The idle routine negatively affects their self-esteem, and they feel themselves
useless part of the society.
Developed countries always focused on the provision of primary
health and rehabilitation facilities to their marginalised older population as
compared to developing nations (Mwanyangala et al., 2010). The global effect of
ageing is pervasive and need the attention of health care professional,
psychologists, sociologists, Government, and policymakers to formulate the
policies to improve the adverse consequences of ageing. The necessity of
healthy and productive life in elderly age is imperative for the personal,
social, and economic growth of the nation.
Ageing in Pakistan
A not merely global aged population is rising, but Pakistan elderly
population is also growing, and the current ratio of elderly people in Pakistan
is 4.8% and (Ashiq, & Asad, 2017). Pakistan is developing country that
meets head-on with the difficulties that make the elderly life more demanding
and tricky including weak infrastructure, political instability, out of pocket
expenditures, weak pension system, low investment on health facilities, more
privatization of health institutes, lack of health insurance policies and
awareness of health-related facilities that may worsen the effects of aging
(WHO, 2007).
Services of Government agencies and Non-Governmental organisations
in our country to support marginalised elderly populations are very few and in
questionable value. The Edhi nursing homes provide shelter with the elderly
people of Pakistan, gills shelter old age home provide medical facilities to elderly
people (Mwanyangala et al., 2010). The geriatric care for senior citizen
working for the health and well being of an old citizen, and the senior citizen
foundation of Pakistan raises the issues the elderly people are facing in the
society are widespread organization provide health and shelter oriented
facilities to elderly people (Ashiq, & Asad, 2017). Government employees
have some revenues available for health coverage after their retirement but who
spend their lives as private sector employees have no residential facilities,
no dedicated funds or discounts for primary care, no concessions in medical
coverage and no allowances after retirement. All the above organisations are
working for the betterment of the elderly people, but many gaps can be seen
such as these organisations are available in the advanced cities of Pakistan.
In the rural area or backward cities of Pakistan, the condition is a bit
miserable.
The lack of state and societal support particularly for the elderly
population has been traditionally compensated by the presence of unconditional
and robust family support. Now where the
nuclear family system is substituting the extended family system, the health of
the elderly population is neglecting, and changes in the family structure put an
additional burden on family members as well (Christensen, Doblhammer, Rau,
& Vaupel, 2009). In the present transitive era of elevating financial
recession on the individual families, a lot of effort is required for care and
increase dependency on the caregivers and healthcare providers. Older
individuals with any functional disability required assistive devices which are
not easily accessible to everyone and are very expensive. Thus, family members
have no time to take care of their older members, and they remained engaged in
earning money for providing basic facilities to their members. In general,
older adults have no savings or bank balance, and sometimes they are dependent
on their family for the fulfilment of needs (Shrivastava, Shrivastava, & Ramasamy,
2013). Elderly population of the nuclear family system in Pakistan is facing
difficulties in this regard. Therefore, these demographic transitions
essentially require shifting the global focus from curative diseases to the
preventive health-care and even more essential to health promotion.
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