Are Latin America and the Caribbean ready to meet the health challenges of the coming senior boom?

Advances in medicine and public health have dramatically increased life expectancy in Latin America and the Caribbean.But is the region ready to meet the challenges of the coming "senior boom"?

“Reprinted with kind permission from Perspectives in Health, the magazine of the Pan American Health Organization, published in English and Spanish.”

Aging in the Americas
by Matías Loewy

On October 14, 2003, the world's oldest person died. Elizabeth "Ma Pampo" Israel was born on the Caribbean island of Dominica in 1875, before telephones or light existed. At 128, Ma Pampo had a weak voice and had all but lost her eyesight, but she still loved visitors. For much of her life, she had worked in the sugarcane fields, and until her death she rose every morning at 5 a.m. to pray. Authorities say her longevity owed much to the tranquility of Dominica , the world's "centenarian capital," with more than 20 men and women over age 100 among its 70,000 inhabitants.

Ma Pampo's long life made headlines around the world, but within a few decades, stories like hers may become much more common. The aging of the world's population—already observable in the most developed countries—is having ripple effects throughout Latin America and the Caribbean . In 2000, one of every 12 people in the region was over 60. By 2025, the ratio is expected to rise to one in seven as the elderly population grows from 42 million to 100 million, a 138 percent increase. Within 20 years, 10 percent or more of the elderly in every country of the region will be over 80, and in five countries this group will make up 8 percent of the general population by 2050. Although centenarians will certainly remain a minority, they could be a significant one in the new population pyramid.

At the beginning of the last century, life expectancy averaged only 30–40 years in Latin America and the Caribbean , compared with 70.4 today. Biomedical research suggests that it is within the realm of possibility to extend human life expectancy to 100–120 years. Yet social concepts of aging have not kept pace with these advances. "It's not a bad thing that the population is aging; the problem is that societies are not taking note of the phenomenon," says Martha Peláez, regional advisor on aging at the Pan American Health Organization (PAHO). "Avoiding premature death and aging are public health achievements. Yet we condemn the elderly to suffering from this achievement because we don't give them the resources or the care they need to live their final years with dignity.

At the beginning of the last century, life expectancy averaged only 30–40 years in Latin America and the Caribbean , compared with 70.4 today. Biomedical research suggests that it is within the realm of possibility to extend human life expectancy to 100–120 years. Yet social concepts of aging have not kept pace with these advances. "It's not a bad thing that the population is aging; the problem is that societies are not taking note of the phenomenon," says Martha Peláez, regional advisor on aging at the Pan American Health Organization (PAHO). "Avoiding premature death and aging are public health achievements. Yet we condemn the elderly to suffering from this achievement because we don't give them the resources or the care they need to live their final years with dignity.

It's as if we as a society are not prepared to face up to this achievement with actions that value this stage of life." Peláez, a medical epidemiologist by training, is one of the authors of "The State of Aging and Health in Latin America and the Caribbean ," sponsored jointly by PAHO and the Merck Institute on Aging and Health. This report, the first of its kind, presents a panorama of aging in the region and proposes a plan of action "to ensure that older adults in Latin America and the Caribbean not only survive but thrive, and that the health span in Latin America and the Caribbean increases with the life span." The report says that meeting this challenge will require the involvement not only of health services providers but also of governments and society at large. If the effort is successful, we will all be beneficiaries.

Stress on families

Because the word "elderly" too often brings to mind a feeble person just waiting to die, Peláez says the authors of the aging report chose to use the term "older adults" instead. The average older adult in Latin America and the Caribbean is female (women represent 60 percent of the total), lives in an urban area, and has only a primary education. But the demographic and socioeconomic profile of older adults varies across subregions and countries, and within countries.

In the Andean Region, the "aging index"—the number of people 60 and over per 100,000 children under 15—will double in two decades. Cuba and Puerto Rico will have more people over 60 than under 15. In the Dominican Republic , Costa Rica and Panama there will be at least one adult for every two children. Experts suspect that nutritional and metabolic illnesses among older adults, many of whom live in poverty, will become one of the most serious health threats in the region.

The English-speaking Caribbean and the Netherlands Antilles will have one of the highest rates of aging in the hemisphere. Migration patterns in this region complicate the picture: Grandmothers often find themselves becoming primary caregivers for grandchildren, as young adults emigrate for better economic opportunities; other older adults return after years of working abroad to retire in their home countries, putting pressure on local social and health services.

The Southern Cone ( Argentina , Brazil , Chile , Paraguay and Uruguay ) and Mexico are home to two-thirds of all older adults in the region. Uruguay has the hemisphere's oldest population, with more than 17 percent of its inhabitants over 60. Within two decades, the number of older adults will equal the number of children. In Mexico , the aging index is expected to increase from 20.5 in 2000 to 153.5 by 2050.

Experts warn that population aging can provoke a crisis in the region's health systems and in the very structure of society.

"The population pyramid is becoming more vertical, but so are families," says Julieta Oddone, professor of sociology at the University of Buenos Aires and head of the Aging and Society project in the local office of the Latin American Faculty of Social Sciences. "Before, families supported one or two elderly people. But we're starting to see families where two or three generations of elderly live with a few descendants, or where people over 60 have to care for those over 80…. This is something that needs to be looked at more broadly—not just in terms of health and social security systems—because these families cannot bear the entire burden of these changes alone."

Meeting the special needs of older adults can demand time, effort and money from other family members. A recent PAHO survey in seven Latin American and Caribbean cities shows that a fifth of older adults living in the community (as opposed to retirement homes) have at least one functional limitation that impedes everyday activities such as eating, dressing or using the bathroom. Half of all men and two out of three women suffer from arthritis, osteoporosis, poor eyesight or incontinence, all conditions that cause some degree of limitation.

In Villa Elisa, Argentina , a local spa fillsits thermal baths with naturally heated 106-degree water. Héctor Vincón and his wife Susana, aged 78 and 70, respectively, immerse themselves in the baths about twice a month to reduce swelling in their ankles, relieve backaches and improve the flexibility of their joints. "We try to stay as active as when we were young," says Susana Vincón.

Like the Vincóns, more than half the visitors to Villa Elisa's thermal baths are over 60 and come primarily to relieve physical ailments. They pay the entrance fee from their own pockets, since health insurance doesn't cover such treatment. They, and others like them around the region, also face barriers in access to conventional medicine and health services.

The challenge of aging is to achieve longer but also better lives. In the last half-century, Latin America and the Caribbean have gained some nine years in life expectancy after age 60. Experts say the most effective way to ensure continued gains is through prevention of cardiovascular disease, which today increases the risk of dying from external causes by a factor of 20—versus a risk factor of 6 for infectious diseases, 3 for cancer and 2 for all other causes.

The good news, according to the PAHO report, is that men and women over 60 today have a 21 percent and 29 percent (respectively) lower risk of dying of diseases of the circulatory system than they had in the 1980s.

Another way to assess the health of the elderly is through "self-reported health status." According to PAHO's seven-city survey, 42 percent of women over 60 and 49 percent of older men report having "good" or "excellent" health.

Positive responses such as these depend primarily on how well older people are able to prevent functional limitations, malnutrition and chronic diseases. Research shows that 70 percent of the physical decline that occurs during aging is related to modifiable risk factors, including tobacco use, sedentary lifestyles, poor nutrition, and access to health services.

Patricia Barry, executive director of the Merck Institute of Aging and Health, says it should be obvious that older adults have specific and more complex health needs than younger people. Yet, in general, epidemiological surveillance has not sufficiently documented these needs nor the incidence and prevalence of the serious health problems of this stage of life.

"Older adults need adequate care to prevent illness, to increase their independence and to improve their quality of life," says Barry.

Plan of action

Leopoldo Salvarezza is a gerontological psychologist and former head of the Faculty on Aging in the Department of Psychology at the University of Buenos Aires . He has studied the phenomenon of aging for some 35 years.

"No one wants to identify himself as, or put himself in the shoes of, that old man that he is inevitably going to become. It's as if they're at fault for being old, or for creating a problem that society doesn't want to deal with. This leads to inconsiderateness toward the elderly. A few weeks ago, a German organization that adopts out puppies decided to stop giving them to older people so that the dogs would not suffer when their owners died. It's grotesque," says Salvarezza. "The rights of a dog are worth more than those of the elderly!"

The problems of aging cannot be completely solved through a public health approach, but it provides a good start. To promote better health among older adults in Latin America and the Caribbean, the PAHO report recommends a series of targets to be met by one- to two-thirds of the region's countries by the year 2010:

• Develop guidelines and processes for monitoring the health status of older adults, and implement a surveillance system;
• Promote and fund a public health research agenda to identify threats to the health of older adults;
• Promote healthy behaviors and environments for older people;
• Develop a regulatory framework for protecting the rights of older people in long-term care settings;
• Define standards of appropriate geriatric health services and monitor and evaluate access for the elderly to essential health services;
• Develop national plans for training in geriatrics and ensure that every health care worker has some education and training in the field.

"These are feasible goals with realistic time frames," says PAHO's Peláez. "But we need to get started on them as soon as possible. We're talking about a stage of life that can last up to 30 years; it's not a waiting room for death. In the last century, girls began to prepare themselves for motherhood starting at 13 years old, but as life expectancy began to grow, we created adolescence. Today, the period from 60 years old to 75 or 80 is something like a second adolescence. Teenagers and older adults have in common a lack of definition in their personal identities and the struggle for independence by the individual vis-à-vis his or her environment. But this new stage is something we have yet to fully de-fine. The individual and society must create new roles for this age period. It is a social and cultural challenge that we can no longer afford to put off."

Matías Loewy writes on science and health for Noticias magazine in Argentina.

“Reprinted with kind permission from Perspectives in Health, the magazine of the Pan American Health Organization, published in English and Spanish.”