DailyNews Online Edition

International day of the elderly persons 1st October, longevity shapes the future

By 2020 world population will include more than 1 000 million people aged 60 and older; with more than 700 million living in developing countries.Nearly one million people cross the 60-year threshold every month.

The 20th century has seen a serious increase in the absolute and relative numbers of older people in developed and developing countries. Accordingly, the health and nursing professionals must sharpen their attention on the issues of healthy aging.Projections for population ageing into the first quarter of the 21st century include: By 2020, the Japanese population will be the oldest in the world, with 31% over 60 years of age, followed by Italy, Greece and Switzerland.

By 2020, five of the ten countries with the largest population of older persons will be in the developing world: China, India, Indonesia, Brazil and Pakistan. By 2020 the population of older persons from developing countries will rise by nearly 240% from the 1980 level, as a result of rapid decline in fertility and an increase in life expectancy, due to the use of advanced technology and drugs. Women outlive men in almost every country. They make up the majority of the oldest old and the elderly widowed, and are almost frequently the carers of the worlds’ older persons.

By 2025 Tanzania will have population of 63.5 million, the elderly population above 65 years will be 4% of the total population and that will be 2.54 million.Impact on health: Health of the older person is best measured in terms of function rather than pathology. Good health and successful ageing is defined in terms of the ability to function autonomously, within a given social setting. If socially and intellectually active, the older person may be considered healthy, even in the presence of chronic disease.

Health care of the older person includes helping the individual maintain adaptive behaviour, promoting wellness, and providing care during acute and long-term illness, and furnishing care and comfort in dying. The reality of an increasing population susceptible to a chronic or debilitating disease must however be faced.

What has the Tanzanian nation put for the elderly in the health sector? Where are the elderly who are above the age of sixty and cannot pay for their medical/health care are they exempted from cost sharing? The process has been said over and over again? The policy is available but there are no definite and concrete implementation plans? The National Health Insurance Fund has given free health services to the retired beneficiaries and not the dependants, and for those who contributed from 2002.

There is need to revisit our policies as the ageing population in Tanzania is increasing. It is estimated that 4% of our population are people above 65 years. There are no specialists doctors for the elderly in the whole of Tanzania. This is a tragedy for the nation that wants to honour their older citizens in words but not in deeds.

The most common chronic conditions affecting older adults around the world are cardiovascular (pertaining to the heart and blood vessels), high blood pressure (shinikizo la damu) strokes (kiharusi), cancer, diabetes, bone and joint conditions of aches and pains, pulmonary disease, psychiatric disorders, most commonly depression and dementia (partial loss of memory). Older people also suffer from HIV/AIDS in the developing world because of caring their sick children infected and cared without protection.

The nutritional status of older persons in Tanzania leaves a lot to be desired. I attended an older person who was 103 years old in Korogwe was under nourished but able to walk and talk with clear mind.By 2020, it is projected that three-quarters of all deaths in developing countries could be ageing related. The largest share will be caused by non-communicable diseases, such as diseases of the circulatory system (heart problems-sudden deaths due heart attacks, strokes and varieties of cardiomyopathies), cancers.

Hypertension rates (high blood pressure) and diabetes prevalence is rapidly increasing in the developing world. Circulatory System Diseases and cancer are the leading causes of mortality in Argentina, Cuba, Uruguay and parts of Asia.In developing countries including Tanzania, all acute and chronic diseases of the older persons are exacerbated by the presence of persistent poverty. Among developing countries like Tanzania, malaria continues to be a major cause of impairment or disability, and causing deaths if prompt medical services for the elderly are not available.

Eye diseases such as cataract (mtoto wa jicho), glaucoma (increased pressure inside the eyes) trachoma (trakoma-vikope) and dryness of the eyes (xerophthalmia) underlie visual disabilities in the developing world.In more developed regions, major chronic conditions affecting older persons are arthritis and other musculoskeletal diseases, sensory impairments (sight and hearing and toothlessness. It has been estimated that as many as 27% of people over 60 years have problems of failure to control urine outflow (incontinence).

We have no old people’s homes or earmarked hospitals for the elderly in the health sector in Tanzania. The elderly are being taken care of by relatives, kith and kin in the extended families. This is a greater asset that our communities may under estimate. It is this concept of care of the elderly that needs back up from our health services/ centres we have. Is the staff competent to handle old persons, what will happen to them during their retirement period? Lucky those who will be under National Health Insurance Fund, what about those who are not? It is very expensive to be poor.

There is need, for the Ministry of Health and Social Welfare to train community nurses, together with physiotherapists and clinicians to handle the males and females older people when they fall sick. Ideally Health promotion and diseases prevention should be a permanent agenda when designing community health interventions to be sustainable within the existing health services.