Ageing in Jamaica - a looming crisis
Professor Denise Eldemire-Shearer, Contributor
The Jamaican population has been ageing since the 1970s, a fact now clearly seen in the 2011 census and which warrants analysis and discussion. The 60-and-over population has increased to 305,164, representing 11.3 per cent of the total population, an increase of nine per cent over 2001. This discussion uses 60 because it is the official age of retirement. The census findings highlight the need for a wide discussion of changes, even within the older group.
A significant finding is the increase in the older old, i.e., those above 80, increasing to almost 60,000, an increase of 34 per cent. This finding of the census supports the notion that people are living longer, i.e., 20-25 years after retirement. So we have increased numbers of persons living longer. This change warrants special consideration, as with increased age, especially in later years, there is increased frailty.
Contributing to ageing is the decline of the population under 15, by 26 per cent, and which is expected to continue falling, influencing the changing age structure.
The declining younger population, with consequent reduction in family size, and the increased education and workforce participation of females, will impact on the caregiving capacity of family units and their ability to support frail older persons, both physically and financially, even when they want to.
Gender considerations are important. While the sex ratio of the general population is equal, this is not so for the older population. The impact of the gender finding needs analysis and policy intervention, as with age, there is increasing feminisation, and females outnumber males. Sixty per cent of persons over 80 are females, and 67 per cent of those over 90. Older females have been identified as being at greater risk for poverty and vulnerability, and so need special consideration. Older females also have more illnesses and disabilities.
As bodies age, needs, vulnerabilities and medical requirements change. Health care is one of the three areas which will be most impacted by the increasing older population and which needs analysis and intervention. Much of the initial reaction and focus have been on the anticipated increased costs associated with delivering care to increasing numbers of persons with chronic diseases, although there is no evidence to suggest that this is true.
Increased health-care cost is concentrated in the old old. Health need is also accompanied by increased financial need for medications and advanced health care.
There are many aspects to the discussion of health care and what is needed. Systems and people need to change. There is the question of the appropriateness and availability of services. The emphasis on 'age-friendly' care has raised questions about how and where services are delivered for older persons, including transportation, environmental suitability of health facilities, i.e., ramps and hand bars.
The current approach of the health-delivery system, with its focus on managing acute situations, needs to be reoriented to ongoing chronic disease prevention and management. Staff at all levels of the health-delivery system should be trained in the special needs of older persons, including communication. Clinical care of older persons is a specialist area. Yet there is no geriatric training available in Jamaica.
Prevention needs to be stressed at all ages. Older persons have different health-promotion and disease-prevention needs. Such activities need to complement those in place for younger persons so as to increase the number of healthy older persons entering their 60s and 70s and, therefore, having less demand for health services. This will need a fundamental change in attitude and practice with regard to the prevention practices in the health-delivery system.
Equally important is that older persons themselves must understand the role of healthy lifestyle choices and assume more responsibility for their health. Old age does not mean illness. The foundation for this exists, as health promotion is a cornerstone of programmes for younger people.
Who will provide the long-term care traditionally provided by families given the changes already described? Again this is not just about cost; it's about availability of a wide range of services and about appropriately trained caring staff. While as a country we may be able to provide some services in urban areas, what will happen to rural older persons?
The census has also suggested that there is rural-urban migration gradually of young persons leaving older persons alone. The increase in the older old (80+) suggests this will be an area of need over the next 20 years.
Given that retired persons are more active nowadays, there is a need to redefine 'social services'. Such services will have to move beyond the traditional welfare services, although these are still important, as poverty persists. An older population will need services to meet the needs of inadequate income, frailty, and lack of social support, but they also need services to promote active ageing and community participation. The range includes transport, housing maintenance, social activities, and home-related services, such as housekeeping, meals, and bill payment.
As a country, we prefer living at home than in institutions, and the concept of activity centres (intergenerational to incorporate young and old) may well replace the now common childcare centre.
There will need to be a discussion of how these will be funded given the inadequacies of current pensions. Public-private mixes are one way. Community-based organisations have worked in other countries. Success of any such ventures will depend on integration of social and health services and less vertical-type programmes.
The ageing of the Jamaican population raises economic questions, especially about how older persons will finance longer lives. The current discussion on pensions is not addressing the important issue of the low levels of pension in the country. Over the next 15 years, close to 350,000 persons now 45-59 will retire.
Recently, the country was told that only 18 per cent of persons in the private sector are contributing to pensions, coupled with unemployment. Daily, there are discussions of the poverty and plight of older persons and the inadequacy of their incomes. This problem is going to continue given the above statistics, as another 320,000 persons enter retirement without adequate financial arrangements. Pension reform must address issues such as compulsory pension portability and indexation.
There is a positive side to the demographic change - the increase in the working population with fewer dependents to support. This is a window of opportunity, as working persons tend to have more income to put towards savings and investments, presuming there are economic opportunities to earn.
The changing demographics also have implications for workplace policies as the median age increases and the number of persons entering the workforce declines.
There are also opportunities associated with an ageing population, as there is increased need for services related to activities and community participation. How will Jamaica respond?
Developed countries are having a discussion on retirement age, but countries such as Jamaica, with economic challenges, cannot yet look at this. As the young population falls, and after the current 45-59ers enter the realm of the retired, it may be an important discussion, though.
Clearly, there is the need for long-term planning to ensure that we, as a country, have the systems, structures and supports to address the challenges and maximise the opportunities. The good news is that we still have time to initiate action if we begin now. Hopefully, the findings of the census will create awareness and kick-start the process.
The issues raised above are the tip of the iceberg. Much more analysis and thought is needed as we seek a comprehensive approach to the ageing of the population.
Professor Denise Eldemire-Shearer is senior lecturer in the UWI's Department of Community Health and Psychiatry. Email feedback to firstname.lastname@example.org and email@example.com