Ministry of Health, Sri Lanka.
Strengthening Care and Support Systems for Older Persons
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International day of older persons 2024: 'Ageing with Dignity: The Importance of Strengthening Care and Support Systems for Older Persons Worldwide'

1 October 2024
Highlights

Ageing is a natural phenomenon. The process has not often resulted in healthy active older persons who are still independent. As countries addressed communicable diseases and improved health and living conditions, a global trend for increase in life expectancy can be seen.  Health services must be inclusive of the needs of older persons.  The International Day of Older Persons, is commemorated on 1 October each year, to raise public awareness about the opportunities and challenges with ageing populations and to mobilize the families, community groups and stakeholders to address the difficulties faced by older people.

This year’s theme,  ‘Ageing with Dignity: The Importance of Strengthening Care and Support Systems for Older Persons Worldwide’ encourages the governments, policy makers and social services across the world for a concerted and sustained action to address the physical, social, psychological and health needs of older persons. The commemoration also underscores the importance of promoting healthy living conditions for elderly that respect the dignity, beliefs, needs, and privacy of older persons, and for the right to make decisions about their care and quality of their lives.

Based on the latest projections by the United Nations, the number of older people (defined as those aged 65 years or older) will be tripled from around 260 million in 1980 to 761 million in 2021. Between 2021 and 2050, the global share of the older population is projected to increase from approximately 10% to 17%. It is further projected that by 2050, the number of individuals aged 65 years or above across the world will be twice the number of children under age 5 and almost equivalent to the number of children under 12 years. Due to the female advantage in life expectancy, women outnumber men at older ages in almost all populations and will expect preponderance of females in the future.

Sri Lanka, being the fastest ageing country in South Asia, the proportion of the elderly aged 60 years and above, which is 12.4% (2.5 million) of the total population in 2012, is projected to double by the year 2041 where one in every four Sri Lankan will be the elderly. Increasing share of very old people is a main feature of ageing in Sri Lanka, where 1.3% of the total population was aged eighty and above in 2012 and is projected to be more than three times higher in 2041.

Ageing population is continuing to pose an increasing demand on health services in Sri Lanka. As elders survive, longer years, a multitude of serious consequences are expected that increase the unmet need for healthcare. As age advances, risks to decreasing physical health, sensory and cognitive abilities increase, requiring demand for mental health needs, long-term care, support and rehabilitation.

Ministry of Health, Sri Lanka is leading the overall dialogue in revisiting and developing the health master plan for the next policy cycle 2026-2035. Healthy ageing will be an important component in this policy. Better care of the elderly is revisited with WHO technical facilitation supporting integrated approaches to mental and physical health care for older people, through implementation of appropriate care integrated within the primary health care service delivery, which provide easier access to services as well as more opportunities to socialize.

A policy dialogue on healthy ageing was initiated with the aim of providing impactful support to build better and resilient primary health care-centered health system. The dialogue contributed to improve evidence-based decision-making, which entails creating the platforms supporting pathways between key stakeholders.  This was followed by, in a series of dialogues with key stakeholders to identify a rational model on Healthy Ageing, taking into consideration evidence synthesis, a SWOT analysis, the WHO framework for Implementation of Integrated care for older persons, related global best practices and the synthesized outcomes derived from the first policy dialogue.  The model is likely to focus on care integration through strengthening the shared care cluster model.  A standard package incorporating long term care needs is being defined for integration with primary care for the empaneled population, together with wellness preservation through existing Medical Officer of Health system.

Picture depicting a policy dialog on healthy aging

Policy Dialogue on healthy Aging; Photo credit: World Health Organization, Sri Lanka

Sri Lanka would be building from existing public health system to take the healthy ageing agenda forward.  The WHO initiative of Integrated Care for older persons (ICOPE) which led to development of a country customized health professional training manual by the Directorate of YED in Ministry of Health, and WHO Long-term care for older people package for Universal Health Coverage will be used to support in the delivery of the standard package at primary care for the older persons.

Box 1: In progress:   Developing A standard package of care considering long term care for elders integrated to PHC

  1. Comprehensive assessment for all older persons in empaneled population via WHO ICOPE tool adapted for PHC
  2. The general standard package addressing the common presentations:
    • Chronic pain management
    • Vision
    • Hearing
    • Dizziness and imbalance
    • Dementia Loss of memory
    • Inability to eat- loss of appetite 
    • Sleeping problems
    • Urinary and bowel issues
    • Oral health issues- sensitive teeth
  3. Care giver training
  4. Linking with social support, assistive devices, carer needs for long term care
  5. Home care
  6. Community care (community centers for day care and recreational facilities, intermediate care centers for rehabilitation and palliative care and promotion of healthy aging)

The process has been focusing on the need to address aged care in relevance to the current country context,  being resource constrained, confounded by the economic crisis and a higher out-migration of health professionals. 

Availability of competent health workforce and caregivers for elderly care is also vital to improve health services for the elderly. Currently Public Health Nursing Officers (PHNOs) play an important role in delivering community health services in Sri Lanka. As a first step to address the challenges of health workforce, WHO is supporting a plan to improve the capacities of PHNOs, especially to deliver health services for elderly at community level. Training programs will improve knowledge and skills for provision of long-term care and common mental health problems for elderly at community level. WHO is also conducting comprehensive assessment of health workforce needs of elderly population to inform human resource development plans for longer term.

Nursing staff engaging with elders during field visits

 Field care by PHNO, Photo Credit: Ministry of Health, Sri Lanka

These measures provide an opportunity for the country to design and implement inclusive, comprehensive care services based on UHC to provide best possible environments to older generation to live with healthy and socially inclusive, while facilitating governments and service providers, to enable to influence decisions on the healthy ageing and well-being of the communities.