Demographers predict that children born in, for example, Brazil or Myanmar in 2015, are going to live 20 years longer than their compatriots who were born some 50 years before them. And if in Iran people over 60 made up only 10% of the population in 2015, then in just 35 years they will already be up to 33%.
Today, the proportion of people over 60 exceeds 30% of the population in Japan alone. However, according to demographic forecasts, by the middle of the 21st century, people over 60 will make up a third of the population not only in European countries, the USA and Canada but also in Vietnam, China, South Korea, Chile, and Thailand.
Medical advances have unprecedentedly influenced life expectancy. In low- and middle-income countries, this was mainly due to an improvement of childbirth assistance, a reduction of infant mortality and mortality from infectious diseases, in rich states – mainly due to a decrease in the mortality rate of older people. Also, as the authors of the report note, a reduction in the birth rate, which is observed in almost all countries of the world, has a noticeable effect on changes in the population structure.
Such a global change in the demographic situation cannot but affect the economies of countries. It will require significant changes in the work of health systems, social services, and preparations for this should begin today.
Although the transformation of health systems will require action in several areas, the providers of medical care distinguish three priority tasks out of them:
- reorientation of clinical practice to maintaining individual viability;
- restructuring health systems to provide integrated care for older people;
- retraining of medical personnel to improve the quality of care following the requirements of new networks.
Not to be a burden
Older people contribute to society in a variety of ways – whether in their own family, in the local community, or in society as a whole. Nevertheless, such human and social resources, as well as opportunities available to each of us as we age, largely depend on one key characteristic, which is our health.
To live for a long time, to feel young at one’s age and die healthy, not to be a burden for your loved ones is everyone’s dream. However, for many, it remains unattainable. Not all centenarians can boast of an excellent supply of health and vitality.
According to some long-term studies, the prevalence of severe disabilities in wealthy countries may have generally declined over the past decades, but this trend has not affected the prevalence of a milder degree of disability. It has yet to be reduced. In low- and middle-income countries, the situation is even worse.
The body becomes decrepit, the muscles weaken, the bones lose their density, and the joints degrade. Of course, years take their toll. Irreversible changes occur not only at the physical level. In the elderly, the speed of information processing decreases, the ability to work associated with solving several problems at once is gradually lost. But, as it turns out, this does not always negatively affect labor productivity and can even be compensated to a certain extent by their experience. Studies show that where it is necessary to find a way out of difficult situations, and then concentrate on performing other urgent tasks, older workers are better than younger colleagues. Besides, it was noted that a team of employees of different ages could be a determining factor for increasing labor productivity, especially when solving creative problems. In a word, even in old age, a person can bring a lot of benefits to society.
If people live these extra years of life in good health, their ability to realize what they consider valuable will be practically unlimited. If these additional years are accompanied by a decrease in physical and mental skills, then the consequences for the elderly themselves and society will be much more harmful.
However, experts conclude that poor health need not be the predominant and limiting factor inherent in the elderly population.
Age begins to tell
Older people are more susceptible to hypo- and hyperthermia, more often suffer from dehydration than young people. Among them is a high prevalence of chronic diseases and multimorbidity, that is, the presence of several chronic diseases that are interconnected by a single pathogenetic mechanism. At the same time, public health services pay very little attention to the tasks of treating chronic diseases.
Another problem with age is the activity of T-lymphocytes that form the immune response decreases, and this means that the older the person, the weaker the protective functions of his body. All the worse, he copes with new infections. By the way, the elderly and vaccines are much more vulnerable due to a decrease in immune function. Also, the level of inflammatory cytokines in serum increases over the years. This phenomenon is known as a continual sluggish inflammatory process in old age. It leads to some consequences – senility decrepitude, atherosclerosis, and sarcopenia (loss of mass and strength of skeletal muscles).
How to slow the aging down
Most of the health problems in old age are a consequence of chronic diseases. Many of them can be prevented or delayed due to a healthy lifestyle. Even at a very advanced age, physical activity and good nutrition can bring tangible benefits to health and well-being. Other health problems can be effectively overcome, especially if they are identified early enough.
To meet the needs of an aging population, it is necessary to make significant changes to the structure of health systems and the procedures for providing medical care, to create a favorable environment for their lives. After all, even if people experience a decrease in vitality, an enabling environment can help them to continue to move wherever they wish and do what they need to do. Long-term help and support can provide them with a decent life, full of opportunities for continuing personal growth. However, health systems are still poorly adapted for the needs of the elderly.
Medicine for senior people
The older a person is, the more he becomes addicted to drugs and health care. The absence of both can put him in a complicated situation and even have life-threatening consequences. However, for older people, taking medications is associated with higher risks and a higher prevalence of adverse side reactions. And yet they cannot live without medicine. Often, people in their late years suffer from several chronic diseases at once, and they have to take pills on an ongoing basis, drink handfuls literally.
Medicines for the elderly should be safe, and well-chosen must be available and accessible. However, for most health systems, the solution to these problems is elusive.
In general, an aging body responds very differently to pharmaceuticals. The reason for this is the profound changes in vitality and body functions, which are accompanied in many cases by comorbidity. And this is another serious problem. After all, older people are usually excluded from clinical trials of drugs, and even if in the history of their illness not one, but several chronic diseases are indicated, all the more so such candidates are eliminated from the list of volunteers who are testing the drugs. This means that the results of most clinical trials are very arbitrary.
To more accurately determine the response of older people to various drugs and their combinations, it is necessary to revise the design of clinical trials. For example, this concerns the further study of the effects on people with multimorbidity of the most commonly prescribed drugs. Indeed, in the treatment of a patient with more than one health problem, a combination of different types of medical interventions is used. In the meantime, new approaches to conducting clinical trials that would better meet the needs of older people will not be developed, and experts suggest more thorough after-sales monitoring of drugs to study their effect on older people, especially those who have multiple diseases.
Additional studies, according to WHO experts, also require drugs for the prevention and treatment of such frequent senile ailments as dementia and sarcopenia, because convincing evidence has not yet been accumulated in their respect that justifies the need for drug treatment. Only after that, they can be included in the relevant lists.
As for the lists of essential medicines for the elderly, experts believe that they should be reviewed, taking into account the dynamics of changes in their health status. For example, nutritional supplements, vitamins, and micronutrients are usually not included in these lists. But they, as practice shows, have a positive effect on the elderly, improving the functional state of their body.
With an eye on the age
Another topic raised is that the likelihood of misuse of drugs also increases with age. Therefore, it is essential to ensure the proper use of medications by older people, including through the appropriate administration of medicines. This task requires urgent attention.
So, it may be necessary to develop guidelines for doctors on the proper prescription of medicines for elderly patients.
Besides, over the years, a person often becomes helpless in solving the simplest tasks. This usually applies to the implementation of medical prescriptions regarding medication. And this is what they need help with.
For example, in Australia, a unique pharmaceutical service called Home Medicines Review has been set up to guardianship of older people who are at increased risk of drug-related problems. Service staff works closely with a general practitioner. They take on the patronage of the elderly, advise them at home about the effective and safe use of drugs. Due to such optimization of the procedure for prescribing medicines, the development of excessive side effects during drug therapy is prevented.
However, these medicines are still required. And they are not in free access for everyone. The authors of the report believe that it is necessary to try to make them accessible for older people to at least essential medicines. And they bring a positive experience in Brazil. There, for older people receiving treatment under the national health system, access to drugs was expanded through the provision of five essential medicines free of charge. People aged get them through the health care service.
More attention to the older generation
The authors of the report draw attention to the fact that to develop measures to slow down the decline in the viability of older people, translational studies of aging and life expectancy must take into account social aspects to a greater extent.
For example, it is important to understand the reasons why many older people violate the treatment regimen prescribed by the doctor, refusing to take medication. This can help increase the effectiveness of therapy.
Today, relatively small funds are being allocated to finance research related to older people. It is necessary to review the budgets allocated for these purposes.
Besides, you need to consider what kind of information messages and strategies that stimulate a healthy lifestyle, may be required for people of older age groups.
Finally, for health systems to remain sustainable, it is essential to develop cost-effective strategies for providing care for older people in advance. For example, to determine which screening programs will bring the most significant effect, the prevention, and treatment of which diseases should be given primary attention.
Of course, an analysis of the economic effectiveness of medical care is necessarily carried out in all countries of the world. But, as a rule, they feature data on the prevention and treatment of patients of younger and middle age groups that cannot be extrapolated to older people. They are characterized by entirely different levels of risk and a higher prevalence of adverse effects. Healthcare providers and sociologists need not only to focus more and more specifically on the study of trajectories of changes in individual vitality and functional ability but also to overcome discriminatory perceptions of older people and revise policies and procedures by including older people in the design of research.
This article was written exclusively for you, by our friend and author, Melisa Marzett who also writes excellent articles for www.resumeperk.com