Areas of concern to ageing individuals
- Health and nutrition
- Protection of elderly consumers
- Housing and environment
- Social welfare
- Income security and employment
Promotion policies and programmes
- Data collection and analysis
- Training and education
The Plan of Action can only include proposals for broad guidelines and general principles as to the ways in which the international community, Governments, other institutions and society at large can meet the challenge of the progressive ageing of societies and the needs of the elderly all over the world. More specific approaches and policies must, by their nature, be conceived of and phrased in terms of the traditions, cultural values and practices of each country or ethnic community, and programmes of action must be adapted to the priorities and material capacities of each country or community.
There are, nevertheless, a number of basic considerations which reflect general and fundamental human values, independent of culture, religion, race or social status: values induced by the biological fact that ageing is a common and ineluctable process. The respect and care for the elderly, which has been one of the few constants in human culture everywhere, reflects a basic interplay between self-preserving and society-preserving impulses which has conditioned the survival and progress of the human race.
The pattern by which people are judged to have reached old age at a point set only in terms of the number of years they have completed, and where the loss of employment status may entail their being placed on the sidelines of their own society, is one of the sad paradoxes of the process of socio-economic development in some countries. The aim of that development was originally to improve the general living standards, health and well-being of the population at large, including the elderly.
The close historical interaction between the socio-economic and technological development of the industrialized countries from the last century onwards, and the old-age security systems they adopted as a part of the same process, should be analysed and kept in mind; however, other options corresponding more closely to the circumstances and needs of the developing countries ought also to be considered.
Ageing is simultaneously a sign of and a result of socio-economic development, in the quantitative as well as the qualitative sense. One major example of the effects of the imbalance between the sectoral approaches taken to national and international development during the past decades is the fact that advances in medicine and public health have by far outpaced progress over the same period in production, income distribution, training, education, housing, institutional modernization and social development in general terms. The developing countries are in this sense about to 'age' without all the sectors necessary to ensure balanced and integrated development being able to follow at the same pace and guarantee a decent living standard for the dramatically increasing numbers of elderly people foreseen for the next few generations.
The following summarized considerations, based on the above remarks, may provide guidelines for the consideration of policies and specific actions:
- The progressive ageing of societies, the continuing increase of the elderly population both in absolute and in proportional terms, is neither an unexpected, unforeseeable event nor a random result of national and international development efforts. It is the first and most visible outcome of a sectorally-based approach to socio-economic development all over the world and should be accompanied by equally efficient interventions in other areas in order to ensure balanced growth and integrated development;
- With a long-term view to slowing down the overall ageing of the community, Governments may be able to take the measures necessary to adjust or avoid imbalances between age groups, while preserving the right to life of the elderly;
- To this end, policies and actions should be inspired by the determination to give further qualitative content and meaning to a quantitative process in order to make sure that the generally expanding lifespan of individuals the world over will be accompanied by efforts to fill these extra years with a sense of purpose and accomplishment, and that people will not be relegated to a marginal and passive role after a certain age level;
- As the transition into old age is a gradual and individual process, notwithstanding the statutory retirement age limits adopted in some countries and cultures, all policies and programmes should be based on the fact that ageing is a natural phase of an individual's life cycle, career and experience, and that the same needs, capacities and potentialities usually prevail over the entire lifespan;
- As most people can expect to survive their own retirement age by a substantial number of years, the concept of 'preparation for retirement' should not continue to be conceived as a last-minute adaptation but be proposed as a lifelong consideration from adulthood onwards -- as much to the individual for his or her future benefit, as to policy makers, universities, schools, industrial work centres, the media and society at large. It should serve as a reminder that policies on ageing and for the elderly are an important society-wide concern, and not solely a question of caring for a vulnerable minority. For this reason, this calls for a general policy of prevention;
- Policies to meet the challenge of a growing, healthier and more active elderly population -- based on the view of the ageing of society as an opportunity to be utilized -- automatically benefit the individual ageing person, materially and otherwise. Similarly, any effort to ameliorate the quality of life for the elderly, and to meet their diverse social and cultural needs, enhances their capacity to continue interacting with society. In this sense, the developmental and the humanitarian aspects of the question of ageing are closely intertwined;
- It is imperative that, when considering the question of ageing, the situation of the elderly should not be considered separate from the overall socio-economic conditions prevailing in society. The elderly should be viewed as an integral part of the population. They should also be considered within the framework of population groups such as women, youth, the disabled, and migrant workers. The elderly must be considered an important and necessary element in the development process at all levels within a given society;
- Ageing is apparent in the working-age population long before the number of persons over 60 increases. It is essential to adapt the labour policy as a whole and technology and economic organizations to this situation;
- This consideration should be accompanied by recognition of the fact that for the elderly in general -- and particularly for those beyond a certain higher age (the 'old old') -- policies have to be considered and programmes implemented in response to their specific needs and constraints. Sectoral interventions in such fields as health and nutrition, housing, income security, and social, cultural and leisure activities are as necessary for the elderly as for other population groups, and should be provided for by each country or community according to the means available to it. It is recognized that the extent of the provision that can be made, and its timing, will be affected by prevailing economic circumstances;
- Policies and action aimed at benefiting the ageing must afford opportunities for older persons to satisfy the need for personal fulfilment, which can be defined in its broader sense as satisfaction realized through the achievement of personal goals and aspirations, and the realization of potentialities. It is important that policies and programmes directed at the ageing promote opportunities for self-expression in a variety of roles challenging to themselves and contributory to family and community. The principal ways in which older people find personal satisfaction are through: continued participation in the family and kinship system, voluntary services to the community, continuing growth through formal and informal learning, self-expression in arts and crafts, participation in community organizations and organizations of older people, religious activities, recreation and travel, part-time work, and participation in the political process as informed citizens.
A priority consideration for all countries is how to ensure that their vast humanitarian efforts in favour of the elderly do not result in the maintenance of a growing, relatively passive and disenchanted sector of the population. Policy makers and researchers, as well as the mass media and the general public, may need a radical change of perspective in order to appreciate that the problem of ageing today is not just one of providing protection and care, but of the involvement and participation of the elderly and the ageing. Eventually, the transition to a positive, active and developmentally oriented view of ageing may well result from action by elderly people themselves, through the sheer force of their growing numbers and influence. The collective consciousness of being elderly, as a socially unifying concept, can in that way become a positive factor. Since spiritual well-being is as important as material well-being, all policies, programmes and activities should be developed to support and strengthen the spiritual well-being of the ageing. Governments should guarantee the freedom of religious practices and expression.
The trend towards the successive ageing of population structures is bound to be one of the main challenges to international and national planning efforts during the last decades of this century and well into the twenty-first. In addition to the general considerations outlined above on the status and predicaments of the elderly sections of societies, and the review of the needs and potentialities of the elderly, attention should be given to the vast and multifaceted impact which the ageing of populations will have on the structure, functioning and further development of all societies of the world. The role of the public and private sectors in assuming responsibility for some of the functions now provided by the family in developing countries will probably have to increase under such circumstances.
In the first instance, it is evident that ageing, both in terms of absolute numbers and in terms of the relative proportion of the elderly in any society, will necessarily change the structure and composition of the economically active population. The most basic manifestation of this phenomenon will be the gradually deteriorating ratios between the economically active and employed sectors of society and those dependent for their sustenance on the material resources provided by these sectors. Countries with established social security systems will depend on the strength of the economy to sustain the accumulated charges of income-basis and deferred retirement benefits for a growing elderly population and the costs of maintaining dependent children and of ensuring training and education for young people.
Changing dependency ratios -- in terms of the number of old people depending for their material safety on younger, economically active and wage-earning people -- are bound to influence the development of any country in the world, irrespective of its social structure, traditions or formal social security arrangements. Problems of a social nature are likely to emerge in countries and regions where the ageing have traditionally benefited from the care and protection of their next of kin or the local community. Those relationships may become increasingly difficult to maintain when the number of dependent elderly increases while at the same time traditional care-providing structures, such as the extended family, are undergoing radical change in many regions of the world.
As mentioned above, the total dependency ratio in many countries may eventually be maintained at close to present levels, owing to the progressively decreasing number of non-employed and dependent children and youths resulting from shrinking birth rates. There remains, however, a political and psychological problem related to the perceptions of the relative urgency of covering the material and other needs of population groups not directly participating in production and public life. The costs of programmes in favour of the younger generations may be more easily acceptable in view of their value as a form of investment in the future; conversely, such costs in favour of the elderly -- especially when not directly related to individual savings or wage-related benefits -- are less easily accepted, particularly when they weigh heavily on already overstrained national budgets.
The problem of deteriorating dependency ratios, and hence of guaranteeing even minimal material security for older people with reduced capacities for earning, will be most acute in the rural areas, particularly in the less productive, subsistence farming areas of the developing countries, which already suffer from an escalating flight of the younger and more active sectors of the population towards the urban areas in search of wage-earning employment. This trend naturally leads to an even more insecure future for the older persons left behind and -- in a vicious circle of further deprivation -- reduces the chances of further simulating public investment in agriculture and services which would benefit the remaining farmers.
To some extent this phenomenon could be considered as partially offset or at least mitigated by the transfer of sustenance funds back from the younger people who have found salaried employment in the urban and industrialized areas. In many cases, the size of the remittances indicates an effort not only to help sustain the family, but to save for future investments, productive or not. For the immediate future, this phenomenon may help to soften the effects of the rural exodus and provide a certain level of material safety for the older and inactive left behind. Nevertheless, it can hardly be seen as a long-term reliable compensation for the migration of the young, active people from the rural areas or from their own countries. Concentrated efforts aimed at improving the socio-economic conditions prevailing in rural areas are indispensable, particularly considering the migrants' return to their country of origin.
Rural development should be seen as a key to the overall problem of the ageing in large parts of the world, as much as it is a key to balanced and integrated national progress in countries with an essentially agricultural economy. To some extent, policies to improve production and productivity in rural areas, to stimulate investment, create the necessary infrastructures, introduce appropriate technologies and provide basic services, could strengthen the generalized social security systems in force in other and more industrialized countries.
The slowly expanding lifespan of the population even in developing areas constitutes a hidden resource for national economies which, if properly stimulated and utilized, might help to compensate for the exodus of younger people, decrease the real dependency ratios, and ensure the status of the rural elderly as active participants in national life and production, rather than as passive and vulnerable victims of development.
A desirable compensation for the emigration of young people to other countries would be an improvement in the continuity of social benefits in terms of contributive rights to a pension, including favourable provisions for financial transfers in whatever form the benefits are granted to migrant workers. This would be not only equitable, but also consistent with the stimulation of the development of the economy of the home country. Bilateral and multilateral social security agreements must be developed to this effect. Other measures should accompany these efforts, notably in terms of providing housing for repatriates. While ageing migrants have the same needs as other elderly people, their migrant status gives rise to additional economic, social, cultural and spiritual needs. In addition, it is important to recognize the role the older migrants could play in the support of their younger counterparts.
In countries with fully developed social security systems linked to compulsory retirement age levels, overall ageing is, and will continue to be, one of the most important structural factors affecting the composition of the labour force. This phenomenon should not be considered solely in terms of its repercussions on the elderly. Because of their sheer dimension and close interaction with other sectors and processes affecting the active labour force, retirement policies cannot be treated in an isolated manner as a separate phenomenon. For various countries the most visible relationship is that between arrangements for retirement and problems of unemployment, especially among young people about to enter the labour force.
Much has already been said about that relationship, and various governmental actions have been considered or taken to respond to it. Whatever the apparent wisdom of lowering retirement age levels in order to open up employment opportunities for the young, such action can hardly be seen as anything but a short-term and partial solution of one social problem through the creation of another, probably longer-lasting one. More innovative actions should be considered at both extremes of the labour force structure.
On the other hand, the wide varieties in personal interests and preferences among people approaching retirement age could, without too many administrative or organizational changes, be taken into account in a system of elastic retirement plans catering to the individual. Where retirement is preferred, different age levels for voluntary early retirement can be established with reduced benefits and counterbalanced by extended employment periods for those older persons whose job constitutes their main commitment, and occasionally their main reason for living. Other arrangements, such as part-time or occasional work or consultancies, are already in use, especially at the higher technological and administrative levels, and could be extended to a greater part of the labour force. In order to implement this measure, provision should be made for training and retraining and the development of new skills.
The interrelationship between the employment and income needs of the young and the elderly raises particularly acute problems for women, whose longer life expectancy may mean an old age aggravated by economic need, isolation and with little or no prospects for paid employment.
Where social security systems based on accrued retirement benefits exist, the growth in the number and longevity of retired persons is now emerging as a major aspect of the husbandry of national economic resources, and is sometimes presented in terms of a gradual freezing of a large share of national wealth for so-called non-productive purposes. On the other hand, it will probably be recognized that the accumulation of retirement funds could constitute a stabilizing factor in the national economy, in the sense of providing for long-term and conservatively utilized sources of funding on a substantial scale, whose impact on otherwise fluctuating economic systems can be beneficial. In such systems, the purchasing power of the pensions paid should as far as possible be maintained.
Similarly, most pension payments from retirement funds represent deferred earnings by the individual retiree. The natural use of pension payments for immediate material needs rather than for long-term and insecure investments may also be a stimulating factor in societies heavily dependent on individual spending and consumption for their economic health.
Where formal retirement benefit systems do not yet exist, the economic implications of the ageing of societies are for the time being largely negative, and will probably continue to be so, unless serious and far-reaching efforts are made to turn this liability into a potential benefit for the whole of society. Governmental initiatives to promote material development and social well-being, and international action to sustain such initiatives, could be taken jointly in an effort to prepare for the future of those approaching old age in areas where traditional structures of protection are about to dissolve.
The recognition that all aspects of ageing are interrelated implies the need for a coordinated approach to policies and research on the subject. Considering the ageing process in its totality, as well as its interaction with the social and economic situation, requires an integrated approach within the framework of overall economic and social planning. Undue emphasis on specific sectoral problems would constitute a serious obstacle to the integration of ageing policies and programmes into the broader development framework. Although the recommendations in the following narrative have been divided under broad headings, it should be recognized that there is a high degree of interdependence among them.
Within the framework of recognizing this interdependence, particular attention could be given to coordinating preventive efforts in order to combat the detrimental effects of premature ageing. From birth onwards, the detrimental effects of premature ageing on the individual could be avoided by:
- An educational effort designed specifically to make young people aware of the changes which will occur as they grow older;
- A healthy general life-style;
- Appropriate adjustments to working hours and conditions;
- Splitting up each individual's time and responsibilities among various types of activities so that he can have several different jobs as he grows older, and achieve the best possible balance between time spent in leisure, training and work;
- Constant adaptation of the man to his work and, more important, the work to the man, and changing the type of work in accordance with the changes in each person, in family circumstances, and in technological and economic development. In this sphere, occupational medicine and permanent education should play an essential role.
In resolution 1981/62, the Economic and Social Council called upon the Secretary-General to elaborate a set of general guidelines for consumer protection. Furthermore, the Food and Agriculture Organization of the United Nations has adopted a Code of Ethics on International Trade in Food and the World Health Organization an International Code of Marketing of Breast Milk Substitutes to protect children's health. Elderly consumers should be protected, since the good health, safety and well-being of the elderly are the objective of the World Assembly on Ageing.
Health and nutrition
While the rapidly increasing number of old people throughout the world represents a biological success for humanity, the living conditions of the elderly in most countries have by and large lagged behind those enjoyed by the economically active population. But health, that state of total physical, mental and social well-being, is the result of interaction between all the sectors which contribute to development.
Epidemiological studies suggest that successive cohorts of the elderly arriving at the same age have better levels of health, and it is expected that, as men and women live to increasingly greater ages, major disabilities will largely be compressed into a narrow age range just prior to death.
Care designed to alleviate the handicaps, re-educate remaining functions, relieve pain, maintain the lucidity, comfort and dignity of the affected and help them to re-orient their hopes and plans, particularly in the case of the elderly, are just as important as curative treatment.
The care of elderly persons should go beyond disease orientation and should involve their total well-being, taking into account the interdependence of the physical, mental, social, spiritual and environmental factors. Health care should therefore involve the health and social sectors and the family in improving the quality of life of older persons. Health efforts, in particular primary health care as a strategy, should be directed at enabling the elderly to lead independent lives in their own family and community for as long as possible instead of being excluded and cut off from all activities of society.
There is no doubt that, with advancing age, pathological conditions increase in frequency. Furthermore, the living conditions of the elderly make them more prone to risk factors that might have adverse effects on their health (e.g., social isolation and accidents) -- factors that can be modified to a great extent. Research and practical experience have demonstrated that health maintenance in the elderly is possible and that diseases do not need to be essential components of ageing.
Early diagnosis and appropriate treatment is required, as well as preventive measures, to reduce disabilities and diseases of the ageing.
Particular attention should be given to providing health care to the very old, and to those who are incapacitated in their daily lives. This is particularly true when they are suffering from mental disorders or from failure to adapt to the environment; mental disorders could often be prevented or modified by means that do not require placement of the affected in institutions, such as training and supporting the family and volunteers by professional workers, promoting ambulant mental health care, welfare work, day-care and measures aimed at the prevention of social isolation.
Some sectors of the ageing, and especially the very old, will nevertheless continue to be vulnerable. Because they may be among the least mobile, this group is particularly in need of primary care from facilities located close to their residences and/or communities. The concept of primary health care incorporates the use of existing health and social services personnel, with the assistance of community health officers trained in simple techniques of caring for the elderly
Early diagnosis and treatment are of prime importance in the prevention of mental illness in older people. Special efforts need to be taken to assist older persons who have mental health problems or who are at high risk in this respect.
Where hospital care is needed, application of the skills of geriatric medicine enables a patient's total condition to be assessed and, through the work of a multidisciplinary team, a programme of treatment and rehabilitation to be devised, which is geared to an early return to the community and the provision there of any necessary continuing care. All patients should receive in proper time any form of intensive treatment which they require, with a view to preventing complications and functional failure leading to permanent invalidity and premature death.
Attentive care for the terminally ill, dialogue with them and support for their close relatives at the time of loss and later require special efforts which go beyond normal medical practice. Health practitioners should aspire to provide such care. The need for these special efforts must be known and understood by those providing medical care and by the families of the terminally ill and by the terminally ill themselves. Bearing these needs in mind, exchange of information about relevant experiences and practices found in a number of cultures should be encouraged.
A proper balance between the role of institutions and that of the family in providing health care for the elderly -- based on recognition of the family and the immediate community as elements in a well-balanced system of care -- is important.
Existing social services and health-care systems for the ageing are becoming increasingly expensive. Means of halting or reversing this trend and of developing social systems together with primary health care services need to be considered, in the spirit of the Declaration of Alma-Ata.
The trend towards increased costs of social services and health-care systems should be offset through closer coordination between social welfare and health care services both at the national and community levels. For example, measures need to be taken to increase collaboration between personnel working in the two sectors and to provide them with interdisciplinary training. These systems should, however, be developed, taking into account the role of the family and community -- which should remain the interrelated key elements in a well-balanced system of care. All this must be done without detriment to the standard of medical and social care of the elderly.
Those who give most direct care to the elderly are often the least trained, or have insufficient training for their purpose. To maintain the well-being and independence of the elderly through self-care, health promotion, prevention of disease and disability requires new orientation and skills, among the elderly themselves, as well as their families, and health and social welfare workers in the local communities.
The population at large should be informed in regard to dealing with the elderly who require care. The elderly themselves should be educated in self-care;
Those who work with the elderly at home, or in institutions, should receive basic training for their tasks, with particular emphasis on participation of the elderly and their families, and collaboration between workers in health and welfare fields at various levels;
Practitioners and students in the human care professions (e.g. medicine, nursing, social welfare etc.) should be trained in principles and skills in the relevant areas of gerontology, geriatrics, psychogeriatrics and geriatric nursing.
All too often, old age is an age of no consent. Decisions affecting ageing citizens are frequently made without the participation of the citizens themselves. This applies particularly to those who are very old, frail or disabled. Such people should be served by flexible systems of care that give them a choice as to the type of amenities and the kind of care they receive.
The control of the lives of the ageing should not be left solely to health, social service and other caring personnel, since ageing people themselves usually know best what is needed and how it should be carried out.
Participation of the aged in the development of health care and the functioning of health services should be encouraged.
A fundamental principle in the care of the elderly should be to enable them to lead independent lives in the community for as long as possible
Health and health-allied services should be developed to the fullest extent possible in the community. These services should include a broad range of ambulatory services such as: day-care centres, out-patient clinics, day hospitals, medical and nursing care and domestic services. Emergency services should be always available. Institutional care should always be appropriate to the needs of the elderly. Inappropriate use of beds in health care facilities should be avoided. In particular, those not mentally ill should not be placed in mental hospitals. Health screening and counselling should be offered through geriatric clinics, neighbourhood health centres or community sites where older persons congregate. The necessary health infrastructure and specialized staff to provide thorough and complete geriatric care should be made available. In the case of institutional care, alienation through isolation of the aged from society should be avoided inter alia by further encouraging the involvement of family members and volunteers.
Nutritional problems, such as deficient quantity and inappropriate constituents, are encountered among the poor and underprivileged elderly in both the developed and the developing countries. Accidents are also a major risk area for the elderly. The alleviation of these problems may require a multisectoral approach.
The promotion of health, the prevention of disease and the maintaining of functional capacities among elderly persons should be actively pursued. For this purpose, an assessment of the physical, psychological and social needs of the group concerned is a prerequisite. Such an assessment would enhance the prevention of disability, early diagnosis and rehabilitation.
Adequate, appropriate and sufficient nutrition, particularly the adequate intake of protein, minerals and vitamins, is essential to the well-being of the elderly. Poor nutrition is exacerbated by poverty, isolation, maldistribution of food, and poor eating habits, including those due to dental problems. Therefore special attention should be paid to:
- Improvement of the availability of sufficient foodstuffs to the elderly through appropriate schemes and encourageing the aged in rural areas to play an active role in food production;
- A fair and equitable distribution of food, wealth, resources and technology;
- Education of the public, including the elderly, in correct nutrition and eating habits, both in urban and rural areas;
- Provision of health and dental services for early detection of malnutrition and improvement of mastication;
- Studies of the nutritional status of the elderly at the community level, including steps to correct any unsatisfactory local conditions;
- Extension of research into the role of nutritional factors in the ageing process to communities in developing countries.
Efforts should be intensified to develop home care to provide high quality health and social services in the quantity necessary so that older persons are enabled to remain in their own communities and to live as independently as possible for as long as possible. Home care should not be viewed as an alternative to institutional care; rather, the two are complementary to each other and should so link into the delivery system that older persons can receive the best care appropriate to their needs at the least cost.
Special support must be given to home care services, by providing them with sufficient medical, paramedical, nursing and technical facilities of the required standard to limit the need for hospitalization.
A very important question concerns the possibilities of preventing or at least postponing the negative functional consequences of ageing. Many life-style factors may have their most pronounced effects during old age when the reserve capacity usually is lower.
The health of the ageing is fundamentally conditioned by their previous health and, therefore, lifelong health care starting with young age is of paramount importance; this includes preventive health, nutrition, exercise, the avoidance of health-harming habits and attention to environmental factors, and this care should be continued.