| The aging trend of the world
The population of the world is aging, both in developed and under-developed countries. From WHO information, the average age of the world climbed from 46 in 1950 to 66 in 1998. This posts a great challenge to the social support system and health care system of the place. The dual demographic trends of declining births would exacerbate the problem, resulting in poverty of the elderly in the decades to come. This is particularly worse in Asia, according to a recent United Nation report. In Hong Kong, age 65 and above will rise from 11% at present to 24% (Mean age - male 78 -> 82; female 84 -> 88) of our population in 2031. It is particularly the old-old (> age 75) would post a challenge to the health care system. We have to be alert of the urgency of the situation and start off to manage it. Solution to the aging problem involves many areas like housing, financing and welfare. However, health care is central to the issue. Successful aging - but not youth worship
Prevention of sickness, handicap and dependence in the elderly population is the direction to pursue, as proclaimed by many governments and the medical profession. People should be encouraged to adopt healthy life style, do regular exercises and seek medical advice early if they are ill. The society should promote self-alertness and responsibility for one's health. However, promotion of successful aging is not equivalent to the pursuit of indefinite youth. This culture of youth worship is gaining its foot in some developed societies. Becoming old is to be accepted, well prepared and not to be avoided. Avoidance of this fact will hinder the proper development of proper and realistic services to the care of the elderly. Unsuccessful aging - the need for caring
Despite our own effort and those of the society, every one of us would get old and most of us would fall sick at our last months or years of life. It is a common observation that most of the illness actually falls in the last few years of life attacking the "old-old" population. Thus, caring of the chronic sick and disabled should be the main direction of health care when facing the aging population. The traditional medical model of "cure" should give way to "care". The Catholic belief and tradition of caring for "the least of the brothers among us" have set up a very good caring role model in many countries. Mother Teresa is probably the best example in the recent decades. We have to preach our philosophy and influence the health care system. The successful example of palliative care in terminal cancer patients in many countries laid down a good pathway for us to follow. Many of the old and chronic sick people are cared by informal care-givers in the community. Forming supportive network for them is instrumental in assisting them to take up the great burden of providing care. The culture of strong family link and mutual support should be recovered especially in many Asian countries with old tradition of strong family ties. Long term care - the key area for improvement
Majority of those sick and disabled elderly required formal caring during part of their life span, usually the period towards the end. Long term care in nursing homes is prevalent in many countries and is expected to increase exponentially in the decades to come. The financing of long term care and the standardization of practice and care will greatly affect the recipients of the service, namely the elderly. Moreover, we need to appreciate the cultural differences between different societies. Successful models in the West may not apply well to Asian countries where many elderly still expect to live with the next generation. Many Asian elderly still think that living alone or being institutionalized means being abandoned by their offspring. Thus, how to provide formal care to these elderly needs a lot of skills and tactics. Again, our Catholic nursing homes can build good models for the community to follow. Ageism and elder abuse - prevailing but covered
Ageism is prevailing in many countries. Old people are declined from many medical benefits just because of rationing by age. It should be insisted that chronological age should not be used as a reference, or at least not the only reference, in deciding for service provision. Elderly Abuse is also very prevalent in different societies but are seldom reported. This fact should be brought to public understanding. Strategic action e.g. legislation or setting up protocols should be taken to educate both the medical profession and the society in order to manage or better, to prevent elder abuse occurring. UK and USA have been making progress in this issue. Hong Kong has just started looking into the problem. Ethical framework for elderly care - prepare the elder and the carer
A correct attitude to face retirement, old age and death is part and partial of a good life. As Catholics, we are lucky that we understand life as being just a passage towards eternal life. This spiritual belief of ours is actually the best framework for the preparation of aging, both at personal level and societal level. Proper understanding and handling of the death process is important and would give euthanasia no footing to grow. Love, rather than personal or societal responsibility, should form the backbone of elderly care. The culture of filial responsibility is diminishing, even in Asian countries with strong Confucian influence. The prevalence of nuclear families and decrease in birth rates makes filial responsibility difficult to enforce and sustain in practice. Only though love can we make these burden bearable. Again, our Catholic teaching and philosophy can be very instrumental in influencing our society and culture. Conclusion
I would like to borrow the motto from hospice workers and apply it to elderly care: "To cure sometimes, to relieve often, to comfort always and to care unceasingly". Good and appropriate caring with love, both physically and spiritually, is the key to success in facing the challenge of aging in this century. Questions to share with during the workshop
- What is the expected demographic change in your country in the coming two to three decades?
- What strategies has your country adopted to promote healthy aging?
- How is our Church assisting those facing retirement and aging?
- How are the sick, poor and chronically disabled elders being managed in your country?
- How can the Catholic Church (including we Catholic doctors) set up good examples in the models of elderly care?
- How is the running of Catholic nursing homes in your country?
- How is long term care financed in your country - by government or by self?
- What is the medical input in controlling the practice and setting up good standards of long term nursing care in your country?
- Is ageism prevailing in your society? In the medical profession?
- Do you have formal community structures or protocols in your society to deal with elder abuse?
- How can we prepare our elders, especially those sick ones, to face death?
- How to promote good and appropriate care with love for elderly care in your society? |
