Our world is entering into an age of ageing, an unprecedented era which will have profound impact on the way in which humans live and on their well-being. The United Nations’ World Social Report 2023 made for an instructive study on this matter. As per the report, by 2050, the number of people aged 65 and above is expected to double to reach about 1.6 billion. Of this, the number of people who are 80 years or above is expected to rise from 155 million in 2021 to 459 million by 2050. Summarily put, whereas in 2021, 1 in 10 people are currently above the age of 65, by 2050, this is expected to become 1 in 6. Amalgamate this projection with the population plateaus being witnessed in countries like India and the milestone decline in China, the world is witnessing a demographic shift, one which the world needs to prepare for. Epigrammatically the demographic dividend of the late 20th and early 21st century can become a demographic debt in the years.
Impacting this change in demographics, will be its major impact on the health and social wellbeing of this elderly population. The welcome longevity of individuals, thanks to decades of advancements in preventive medicine, treatments, socio-economic development, and education, has also led the path to an increase in the number of non-communicable and age-related illnesses. With a rise in the number of people above 65, disease patterns are expected to witness a commensurate or exponential rise. Dementia and Parkinson’s Disease are all seeing a steady rise in numbers. Along with these, degenerative disorders like arthritis and related issues of mobility will see health care services needing to pivot to provide appropriate services for such patients. The entire cohort of cancers is expected to report increases as individuals live longer – thereby needing a bolstering of an entire eco-system of cancer care from new treatments, novel disease and individual specific interventions, clinical specialists, technology, and infrastructure.
Along with the need for ‘traditional’ health services, nouveau models of care need to be deployed. Only recently has geriatric medicine become a standalone science of its own, and hereto a limited one. The need to create a formal integrated clinical specialty around ageing and geriatrics has become critical for countries across the world. The fact that this will entail a blending of a cross-section of existent clinical specialties like orthopedics, oncology, general medicine, neurosciences, physiotherapy and rehabilitation services etc. requires institutional push from Governments and regulators to make it a widespread reality. Similarly, the need for “ageing in the right place” will mean that most health services for the elderly will need to be given at places where they reside. Hence the need for large scale and integrated expansion of affordable and equitable home monitoring, and wearables that ensure continuous and synchronous care. Again, the rise of assisted & home care services is a welcome step, but it needs regulatory cover and structured protocols on monitoring, reporting and continuity of care to ensure quality and uninterrupted services. On the horizon are also newer technologies to aid organ failures and replacements. 3D printing of organs, once considered to be in the realm of science fiction has become a reality and it needs adequate research and funding to ensure it mass deployment.
While much attention has been given to new technologies, the greater challenge remains not in the what, but in the who. The rise in the number of the elderly, will require a paradigm shift in health
human resourcing. Most health systems already face a crippling deficit in the number of healthcare workers, an issue that will only exacerbate over time. From the availability of trained workforce to a projected mismatch in the number of able individuals in health services as against the number of elderlies in the community requiring care will emerge as a cause for concern. As per projections, the EU will have 1 in 3 women and 1 in 5 men over 65 years needing long term care. While the infrastructure for institutional or tech-enabled, home-based, long-term care may come along, trained and widely available health workers will impede any infrastructural advancements. Currently, as per the UN, a deficit of 13.6 million long term care workers exists, an issue that needs immediate addressal and forward planning.
Health systems will also need to adequately plan for financing this rise in the elderly. Given the current dismal state of healthcare funding, especially in the developing world, a focus on how geriatric care will be funded needs Governmental attention. The projected rise in the elderly, will put fiscal pressure on governments as they face the challenge of a depleted pool of workforce, mismatched pension contributions versus dispersals and rising cost of social services. Countries in the developing world need to be mindful of what funding long term care will cost. Currently, the rich cohort of OECD countries spent 1.5% of GDP in 2019 on long term care, with calls for major increases on this front. Compare that with what the developing world spends on their entire tab for the health sector, and the challenge becomes apparent and daunting. Within this Gordian Knot, the need for budgetary allocation for long term care is something that Governments will do well to pay immediate attention to lest it becomes a structural health financing challenge in the future.
The emergent 21st century global challenges like climate change, ensuing social migrations, mortality due to new diseases and the prospect of new pandemics will all impact the elderly, especially when their numbers in the total population mix increases. We must celebrate the significant milestones that humans have made on health care, mother and childcare and human longevity. These achievements have ensured that individuals are able to see multiple generations, improved living standards and that of health for many parts of the world. Equally though, the din of these achievements should not take away our sights from a global challenge that has ironically emerged from human progress.
Dr. Karan Thakur is a healthcare administrator with Apollo Hospitals and tweets at @karanthakur
Copyright©2023 Living Media India Limited. For reprint rights: Syndications Today