Better care for our older persons

With the rapid changes that have taken place during the past decade, it appears that we have left a group of South Africans behind: our older persons. ELMIEN WOLVAARDT reports.

South Africa has one of the most rapidly ageing populations in sub-Saharan Africa, and after Nigeria, houses the second-largest number of older persons - 3.3 million - in the region.

Despite the impact of HIV and AIDS, the population of older people is expected to continue growing for at least the next two decades. And, according to the WHO, having more older persons than ever before means an increased prevalence of frailty, chronic disease and disability.

Although primary health care in South Africa is free to all older persons, dedicated geriatric services in the public sector have been marginalised as older persons' health care became overshadowed by an emphasis on child, maternal and reproductive health care.

Several studies have also highlighted older clients' dissatisfaction about inefficient appointment systems, long waiting times, understaffed facilities and shortages of medication.

'This growth is coming at a time when a mere 13% of persons 65 years and older have access to a medical aid fund and when escalating costs render private care out of the reach of most older persons,' says Jané Joubert, specialist scientist in the Medical Research Council's Burden of Disease Research Unit (BOD).

Unfortunately, South Africa didn't have much of a chance to prepare for an ageing society and its changing health needs. Just when the growth rate of the older population in South Africa started its strong upward trend during the 1990s, the country was hit by HIV and AIDS, an epidemic of unprecedented proportions. This primarily affects the country's child and young adult population, with major impacts on health planning and provisioning.

However, many older persons are now themselves caring for those suffering with AIDS or looking after their orphaned grandchildren at a time when their physical abilities generally decline; a time when many of them can reasonably expect to receive, rather than provide, care and housework assistance.

'It remains a challenge at societal level to ensure that HIV and AIDS will not divert all attention from the needs of an ageing population to the needs of a severely affected infant, child and young adult population,' says Jané Joubert.

At present, Government has an integrated general development approach to address inequalities arising from our Apartheid past. It is with this approach that they are hoping to address older people's basic needs: through the provision of water, housing and electricity; and through strengthening the public health sector.

'This is important and useful work that will have an impact on health,' says Jané Joubert.

'But to deal effectively with our rapidly ageing population, more is needed. In addition to basic services, there needs to be appropriate tertiary health care as well as an ongoing education programme around ageing actively and healthily. Healthy lifestyles need to be promoted at all ages, which will reduce the levels of disease and disability in later life,' she says.

'Age-friendly primary health care services should also be implemented, as has been suggested by the WHO,' says Prof Debbie Bradshaw, unit director of BOD. 'Chronic conditions, such as high blood pressure and diabetes, also need to be better managed at primary care level, where the emphasis is still very heavily on reproductive health, child health and acute conditions.'

'Research into the issues around ageing, and the funding thereof, is another concern - for example, there is very little evidence to inform the improvement of primary health care for older persons,' says Jané Joubert.

The good news is that, in the MRC's strategic plan for 2004/ 5, one of the priorities is to flesh out the research portfolio in the area of chronic diseases and ageing.

'This is saying that the MRC is certainly keen to develop this area of research,' says Jané Joubert.

Mental health and ageing
The Canadian Mental Health Association (www.cmha.ca) has the following advice to help you cope with the mental and emotional aspects of ageing:

• Keep a positive attitude. Slowing down doesn't mean that you have to come to a complete stop. Learn to pace yourself.
• Take responsibility for your own health. Do not hesitate to ask your doctor questions.
• Stay active, and look for new social contacts. Try to make friends with people of different ages. Very young children can brighten up your life.
• Learn to recognise and deal with signs of depression. Loss of appetite and weight, inability to sleep, loss of energy and motivation, and thoughts of suicide are all signs of depression. Ask your family doctor for advice.
• Renew your interests in hobbies and activities you enjoy.

Exercises you can do in bed
1. Breathing and stretching:
2. Back stretch:
3. Arm stretch:

Ageing actively
Like death and taxes, the chances are extremely good that - sooner or later - all of us are going to have to deal with the challenges of ageing.

'It helps to think of healthy ageing as an investment. It's never too late to start saving money, but the sooner you start, the bigger your reward at the end,' says Jané Joubert.

There are some things that older people can do to both enhance their current health status, and to have a better chance of remaining active members of their communities and ensuring that their remaining years are more satisfying.

The Department of Health has released a document called Guideline for the promotion of active ageing in older adults, which contains sets of bed and chair exercises for older people. Although these exercises are easy and require minimal effort, they can still improve the balance and flexibility of those who perform them on a regular basis. Additional benefits may even include improved quality of sleep and better memory.

For the (slightly) younger ones among us, the Department of Health is distributing a WHO practical guide with step-by-step advice on how to live a healthy lifestyle: a lifestyle that can help prevent a large number of serious illnesses, such as heart disease and some types of cancer, and early death.

The three main pillars on which a healthy lifestyle rests, are: have a healthy diet, exercise regularly, and reduce your exposure to harmful substances such as alcohol and tobacco. It doesn't have to cost extra money (and might even save you some!), and what's more, having a healthy lifestyle can help you enjoy more aspects of your life in the present by improving your physical, mental and social well-being as well.

• Department of Health: Guideline for the promotion of active ageing in older adults: www.doh.gov.za/docs/index.html (click on Fact Sheets/Guidelines, then find the document under the heading Guidelines)
• World Health Organisation: Healthy living: what is a healthy lifestyle? www.euro.who.int/Document/E66134.pdf