Ageing in the 21st CenturyReflections on the current context

Lena GanDirector Ageing ProgramsHealthy Ageing Forum28 June 2018

Overview1. Context

2. Myths & stereotypes

3. Definitions

4. The changing face of ageing

5. Determinants of healthy ageing

6. Ageism

7. Approaching healthy ageing

Longevity revolutionWe are living 25-30 years longer than we did a century ago

Gift of the 20th century

Birth & death rates have dropped

This is a new situation for humanity

By 2060, 25% of Australia’s population will be 65yrs+

‘Population Ageing and Australia’s Future’

http://press.anu.edu.au/publications/population-ageing-and-australias-future/download

Global ageing populationsSocieties are being transformed by ageing populations

We need new paradigms

Major Societal Impacts1. Healthcare: system is no longer fit for purpose

2. Workforce: ratio + aged care sector

3. Built environment & infrastructure: age-friendly

Facts & figures

33% of LGA’s are considered vulnerable with multiple

supply gaps & fewer resources to meet their needs

through private funding

Myths & stereotypesThere are six myths about old age:

1. That it’s a disease, a disaster

2. That we are mindless

3. That we are sexless

4. That we are useless

5. That we are powerless

6. That we are all alike.

Maggie Kuhn

Myths & stereotypes #11. Ageing is a natural lifelong process. It is NOT a disease.

It begins before we are born and continues throughout our lives

Ageing processes are biological + social + psychological,

NOT just physical!

Ageing is not inherited

Myths & stereotypes #44. Professionals, volunteers and unpaid carershttps://www.volunteeringaustralia.org/wp-content/uploads/VA-Key-statistics-about-Australian-volunteering-16-April-20151.pdf

The Australian economy benefits annually from:

$40 Billion in unpaid care +

$25.4 Billion in volunteer work

Much of this is done by older people

There are an estimated

2M Australians 50yrs+

not employed who

would like to work

Myths & stereotypes #66. Our differences increase with age.

We begin with differences of gender, culture, beliefs, sexual preference, socio-economic status, education…

In addition, we all age differently according to genetic, attitudinal, life situation and lifestyle factors.

Myths & stereotypes"Ageing is not lost youth but a new stage of opportunity and strength." Betty Friedan

“Ageing is an extraordinary process where you become the person you always should have been.”

David Bowie

“The longer I live, the more beautiful life becomes.”

Frank Lloyd Wright

Some DefinitionsAge: chronological vs physiological

“We don’t stop playing because we grow old. We grow old because we stop playing.” George Bernard Shaw

“ How old would you be if you didn’t know how old you was?”

Satchel Paige

Some DefinitionsTime: chronological vs experiential

"You can live to be a hundred if you give up all the things that make you want to live to be a hundred." Woody Allen

Some DefinitionsHealth: biomedical vs sociological

"Those who think they have no time for bodily exercise will sooner or later have to find time for illness." Edward Stanley

WHO Active Ageing PolicyThe WHO defines Active Ageing as:

‘the process of optimising opportunities for health, participation and security in order to enhance the quality of life as people age’

Four Pillars:

1. Health

2. Participation

3. Security

4. Lifelong Learning

Changing Face of AgeingLife-course approach to replace outmoded models

Age-friendly citiesTo facilitate the inclusion of older persons is to make our world more age-friendly.

An age-friendly world enables people of all ages to actively participate in community activities & treats everyone with respect, regardless of their age.

A place that makes it easy for older people to stay connected to people that are important to them.

Helps people stay healthy and active even at the oldest ages and provides appropriate support to those who can no longer look after themselves.

Many cities and communities are already taking active steps towards becoming more age-friendly.http://www.who.int/ageing/age-friendly-world/en/

Determinants of healthy ageing1. Behavioural

2. Personal

3. Physical environment

4. Social

5. Economic

6. Health & social services system

WHAT is Ageism?A socially tolerated form of discriminationMost commonly experienced form of prejudice & discrimination in the UK (2011)

Has transformed ageing from a natural process into a social problem!

There are three integrated aspects:1. Prejudicial attitudes2. Discriminatory practices3. Institutional practices & policies

Butler 1980 | Robertson 2017

“It is ageism, far more than the passage of time, that makes growing older harder for all of us” (Applewhite 2015)

WHY be concerned?Many reasons but the key ones are:

1. We will all age & be subject to ageism

2. Ageing populations > volume of older people

3. Productivity > the workforce

4. Health (individual) & the health system

5. Civil rights issue

6. Attitudes shape policy > institutionalisation

Palmore 2015 | Butler 1980

Impacts & cumulative effectsAgeism can be a chronic stressor overall and has many cumulative negative impacts on health:

1. Physical: hearing, risk of cardiovascular event, recovery time, balance, gait speed, handwriting

2. Mental: memory

3. Emotional:, self-care, self-esteem, identity, will to live, depression, anxiety, PTSD

4. Lifespan: reduced by 2.5 - 7.6 years

5. Social: social isolation & loneliness

Marshall 2014 | Nelson 2015 |

Ober Allen 2016 | Robertson 2017

Loving life

“Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul.”

Samuel Ullman

How does ageism occur?Part of our culture > pervasive in literature & media

Policy and practice institutionalises ageism

1. Government

2. Private practice

And:

1. Internalised at 4-6 yrs & reinforced across the lifecourse

2. Can be unconscious

3. Shapes ageing identities > impacts self-esteem

4. Influences at many levels:

psychological + behavioural + physiological

Marshall 2014 | Robertson 2017

WHAT can we do about ageism?1. Recognise, acknowledge & raise awareness

2. Educate

3. Foster continued & positive family relations & social support

4. Promote education & training of healthcare professionals to dispel myths & stereotypes

Nelson 2016 | Palmore 2015 | Robertson 2017

Thinking about ageingAt age 20, we worry about what others think of us.

At age 40, we don't care what they think of us.

At age 60, we discover they haven't been thinking of us at all.

Ann Landers

Ageing in today’s world!Many of the systems, stereotypes and thinking we have today are to varying degrees, from previous times.

Are we thinking for today’s world, tomorrow’s world or yesterday’s world?

Inclusive ageing> In every way except demographics, older people differ as much, or more than any other group categorised by chronological age.

> They do not see themselves as a group and are highly heterogeneous.

> This makes designing products and services for them quite complex.

> So instead of making assumptions, ask them & include them.

Approaching healthy ageing• Holistic

• Outcomes-focus

• Person-centred

• Consumer driven

• Access & equity

• Rights-based

• Effective & efficient

• Integrated

• Co-designed

• Robust

• Sustainable

• Flexible

A different world needs different thinking!

References• Butler, R. (1980). Ageism: A Foreword. Journal of Social Issues Vol 36:2

• Chrisler, J., Barney, A., Palatino, B. (2016) Ageism can be Hazardous to Women’s Health: Ageism, Sexism and Stereotypes of Older Women in the Healthcare System. Journal of Social Issues Vol 72:1

• Ernst & Young (2016). Health Reimagined: a new participatory health paradigm

• Kalache, A. (2013). The Longevity Revolution: Creating a society for all ages

• Marshall, L. (2014). Thinking Differently About Aging: Changing Attitudes Through the Humanities. The Gerontologist Vol 55:4

• Nelson, T. (2016). Promoting Healthy Aging by Confronting Ageism. American Psychologist Vol71:4

• Ober Allen, J. (2016). Ageism as a Risk Factor for Chronic Disease. The Gerontologist Vol 56:4

• Palmore, E. (2015). Ageism Comes of Age. The Gerontologist Vol 70:6

• PWC (2018). Practical Innovation: Closing the social infrastructure gap in health & ageing

• Robertson, G. (2017). Ageing and ageism: the impact of stereotypical attitudes on personal health and well-being outcomes and possible personal compensation strategies. Self & Society, Vol 45:2