Geriatrics - Global Concern

Population ageing is a global concern and it has thrown a challenge to every country in the world. Population ageing is an inevitable and irreversible demographic reality. There is a rapid increase in the number of older people in both developing and developed countries. Its effect is felt to a great extent in less developed countries as it is exerting great demands on the health care system. Even the developed countries have to attend to the increasing number of ageing population. With the ageing population, requirement for their special care needs have increased.

It is estimated that the total number-absolute and relative of older people (persons aged 60 years and above) is increasing in all countries. The number is expected to increase from 605 million in 2000 to 1.2 billion by 2025.¹ About 60% of elderly persons are living in developed world and the number is expected to increase to 75% by 2025. Developing countries have not lagged in this rise. The average life expectancy at birth (LEB) was around 40 years in most of the developing countries. It increased to 64 years by 2000 and is projected to reach 71 years by 2025.¹

India has shown similar trends. LED which was 53 years in 1975 rose to 64 years in 2000 and is expected to reach 72 years by 2025.1 India has become ‘an ageing nation’ with 9% of its population being elderly. Improvement in the quality of life of elderly calls for a holistic approach and concerted efforts by the health and health-related sectors.² People are living longer due to improvements in nutrition, sanitation, health care, education and socio-economic wellbeing. Ageing has far-reaching influence on all aspects of the society. The society has to take cognizance and put effort to make their life happy. In 1990, World Health Organization (WHO) developed the concept of ‘active ageing’ in response to the challenge of ‘global ageing’. Active ageing is a process of optimizing health, safety, and active life style opportunities to improve the quality of life of the elderly.³ By active ageing, people have to realize their potential for physical, mental and social well-being throughout their lives to take active part in social, economic and religious life as per their needs, desires and capabilities.⁴

Rapid increase in LEB is due to a sharp fall in mortality rates that has occurred by prevention and/or treatment of various infectious diseases associated with premature death. Universal immunization and improved nutrition helped millions of children to survive and reach adulthood. Epidemiological transition from changing causes of diseases and death from communicable and non-communicable diseases has posed many challenges to formulate policies pertaining to health care of the population. There has been a significant shift from communicable diseases to non-communicable diseases such as hypertension, diabetes, cardiovascular diseases, chronic obstructive and restrictive diseases, degenerative diseases, walking disabilities, visual defects and deafness, neuropsychiatric disorders, urinary problems, and cancer. The accidents and injuries are also to be included. This view was greatly affected by the global pandemic of Coronavirus disease 2019 (COVID-19) during 2020-21. It had significant influence on elderly persons and persons with co-existing diseases.

The increasing number of elderly populations has thrown greater demands on health care systems. Rapid urbanization, disappearing joint families, and ‘empty nest syndrome’ have necessitated the need for long-term care for the aged. Efforts are to be made through education to prevent and treat non-communicable diseases. Attention must be given to cater to the special needs of elder persons.

The co-morbid conditions in the elderly are to be taken care and they should receive proper medication. Poly-pharmacy must be avoided. Persons with dementia pose a great challenge to the caregiver. The emotional and spiritual well-being must be maintained. The health care providers need training to attend to the physical, psychological and social problems of the elder persons. They have to be adequately trained in ‘older age care’.

The life style pursued during youth and adulthood has a great impact on the life in the old age. Life style factors such as smoking, alcohol consumption, different levels of physical activity and diet have influence on the health status of the elderly.⁵ The acceleration in decline and the gradient in decline in the health status will have influence on the disability seen in the elderly.

Graceful ageing can only occur in a healthy body. This statement probably answers the puzzle of restoration of youth. Healthy ageing requires an immune system that is working properly. It helps to prevent or slow the process of disease and regulates the speed of ageing process.

Elderly population comprises people who have given their best during their productive years to the society and to the nation. These people are still a part of our main stream which is benefited by their experience. The elderly is living in a private universe of physical weakness and mental decay. There is a great need to focus our attention towards their medical and health needs.

American Gerontological Society in 1953 in its motto said, ‘Adding life to years, not just more years to life’. A successful living according to Vaillant becomes, ‘learning to live with neither too much desire and adventure, nor too much caution and self-care’. As Abraham Lincoln once said, ‘and in the end it’s not the years in your life that count. It’s the life in your years’.

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