The World Assebled on Aging

By Simone Powell

This past April in Madrid, Spain, Canada joined 156 other countries as well as nongovernment organizations, to take part in the United Nations Second World Assembly on Aging. The purpose was to modernize the International Plan of Action on Aging that had been adopted at the First World Assembly on Aging held in 1982, in Vienna. In the intervening years, some countries had incorporated aging issues into various plans, policies and programs, but generally, adherence to the plan had been limited. Developing countries, in particular, faced a number of barriers to its implementation.

The Second World Assembly provided an opportunity to once again bring countries together to discuss the challenges of aging and pinpoint key issues. What made this Assembly different from the first one was that there would now be a greater focus on the issues facing developing countries, specifically, the relationship between aging and development, in an increasingly global world.

The Canadian delegation, led by the Honourable Sharon Carstairs, Leader of the Government in the Senate and Minister with Special Responsibility for Palliative Care, had a very strong presence at the World Assembly. Other members of the delegation included representatives of the National Advisory Council on Aging, the Congress of National Seniors Organizations, Help the Aged Canada, the Canadian Institute of Health Research’s Institute of Aging and the Quebec Ministry of Child and Family Services. In her address, Senator Carstairs talked about the progress Canada has made in maintaining and improving the health of seniors and decreasing the rate of poverty over the past few decades. She also outlined Canada’s own priorities for addressing the challenges of its aging population: improving health, well-being and independence in later life; enhancing the participation of older Canadians in economic and social life; strengthening supportive environments for seniors within Canada; and sustaining government programs benefiting older Canadians.

Aging Matters, Globally

The fact is, the world is getting older. The number of people over the age of 60 will triple over the next 50 years, growing from approximately 600 million to nearly 2 billion. This is due to a combination of factors including a significant decrease of birthrates (below replacement level) and an increase in longevity. Currently, one in every ten persons is 60 years and older; by 2050, this number will grow to 1 in 5. At that point, nearly 80% of the world’s older population will be living in less developed regions of the world.

For developing countries, these changing demographics are particularly challenging. In most developed countries, the population aging process occurred gradually over time following a long period of socio-economic growth. Developing countries are facing the challenges of development and rapid population aging simultaneously. In other words, developed countries have had the chance to grow affluent before they grew old whereas developing countries are growing old before their wealth increases.

The Plan of Action is a long term strategy on aging and a tool to help governments and other players develop priorities and policies that respond to the demographic changes and ensure that aging has a place in all policy agendas. It identifies three priority directions:

These priorities reflect the broader goals of ensuring that “persons everywhere are able to age with security and dignity and to continue to participate in their societies as citizens with full rights.” Along with these priorities, the Plan provides recommendations covering a wide range of issues.

Countries Are Not Equal and Neither is the Aging Experience

The Plan acknowledges that the experience of aging varies greatly between different regions of the world. To be poor, to be sick, or to be a woman in a developing country greatly alters the experience of aging. Older people, especially women, are consistently and disproportionately among the poorest of the poor, often lacking the basic necessities of food, water, shelter and health care.

In terms of health, older people in developing countries not only face a higher risk of chronic and degenerative diseases than in developed countries, they also face the continued threat of communicable diseases such as tuberculosis, and malaria and HIV/ AIDS. In fact, older people have been greatly affected by the dramatic spread of HIV/ AIDS. Older people, especially women, are the primary carers of family members infected with the virus as well as the children orphaned by it. For example, in Thailand, two-thirds of all those affected with HIV-related illnesses are nursed at home by parents in their 60's and 70's. Furthermore, assumptions about the sexuality of older persons have left them at high risk of infection since public information campaigns do not include them as targets.

Older women living in developing countries face many challenges as a result of a lifetime of disadvantage and exclusion. Poor education and nutrition as well as a lack of access to services and the labour market throughout life leave many women facing old age in poor health and with few material resources. Also, while all older people are vulnerable to abuse as a result of increased frailty and dependence, older women remain most at risk due to a combination of age and related physical, social and economic disadvantages.

Finally, in rural areas of developing countries, where the majority of older adults live, traditional family supports and social networks have been threatened as a result of increased urbanization and migration of the young. This has left many older people isolated and at risk.

The Work Ahead for Canada

In comparison to many other regions of the world, Canada has made progress in improving the lives of older adults, particularly in terms of decreasing poverty. Nevertheless, the Plan of Action on Aging does point to many areas that can be improved to better the lives of older adults. These include eradicating poverty; ensuring the availability and affordability of a range of housing options; implementing health promotion activities to support healthy aging; ensuring employment opportunities for all older people who want to work; providing access to training and lifelong learning opportunities; implementing services for seniors living in rural areas; and strengthening relationships between generations.

Many of these areas come under federal responsibility. That is why, as a first step federal departments and agencies are currently evaluating their programs and services with respect to the Madrid Plan of Action on Aging. But, implementing the recommendations of the plan of action will require collaboration of government and non-government sectors alike. For example, The plan calls for action in areas that are relevant to long term care.

Recommendations for Long Term Care

The very first recommendation of the Plan of Action addresses the issue of human rights. An important aspect of human rights is ensuring that older persons everywhere are able to age with dignity. Maintaining dignity in long term care settings can be a serious challenge. Therefore the recommendation to treat older adults fairly and with dignity regardless of disability or other status, to take account of their needs and respect their right to live in dignity in all stages of life is certainly relevant within the context of long term care.

The Plan also stresses the need for a continuum of care that includes long term care. Specifically, it calls for the establishment and coordination of a full range of services in the continuum of care, including prevention and promotion, primary care, acute care, rehabilitation, long term and palliative care so that resources can be deployed flexibly to meet the variable and changing health needs of older persons.

Palliative care is an important but sometimes overlooked element of health care systems. This is why the Plan recommends supporting the provision of palliative care and its integration into comprehensive health care. In addition, it calls for the development of standards for training and palliative care, and encourages multidisciplinary approaches for all service providers of palliative care.

The participation of older persons in all aspects of their care is crucial not only for maintaining dignity but also ensuring that their needs are met. The Plan recommends action which will not only fully include older persons in decision-making related to their own care but also in the planning, implementation and evaluation of social and health care, including long term and rehabilitative care.

In order to have long-term care that serves the needs of older persons, it is crucial that health workers and professions have appropriate training. Thus, the Plan of Action recommends the initiation and promotion of education and training programs, as well as continuing education, for health professionals, social care professionals and informal care providers in the services for, and care of older persons.

Mental health problems are a growing concern and the number of older persons with mental illnesses is expected to increase as the population ages. The Plan of Action draws attention to this issue and recommends that mental health services be provided to older persons residing in long term care facilities and that health care professionals receive on-going training in the detection and assessment of all mental disorders and depression.

Older adults, in all settings, face the risk of abuse and neglect. There are a number of reasons why older adults living in institutions can be vulnerable to abuse, including insufficient institutional resources and the difficulties encountered by health care workers. The Plan recommends that training for the caring professions includes how elder abuse is addressed in institutions. In addition, it calls for action which will encourage health and social service professionals as well as the general public to report suspected elder abuse.

The above highlights some of the many issues that were discussed during the Second World Assembly on Aging. With so many recommendations – 117 in total – the task at hand does seem quite daunting. Without question, the transformation in the make up of the population will have profound consequences on every aspect of life – for individuals and for societies. Yet, it is important not to lose sight of the positive side of population aging. Too often we focus on the negative and see the aging of the population as a problem to be solved and seniors as a burden to be borne. The reality is that people do not cease to contribute to society as they age. On the contrary, older adults have a lifetime of experience from which we can all benefit. The task for Canada, and all countries, is to ensure that we create the conditions so that people can age with dignity and remain full participants of society. In the words of Kofi Annan, Secretary-General of the United Nations:

“Trees grow strong over the years, rivers wider. Likewise, with age, human beings gain immeasurable depth and breadth of experience and wisdom. That is why older persons should not be only respected and revered: they should be utilized as the rich resource to society that they are.”