Overviewing the looming crisis of ageing population in Sri Lanka
The phrase Silver Tsunami (also known as The Grey Tsunami or Gray Tsunami) is a metaphor used to describe population ageing. Ageing is inevitable. In the world, the number of people aged 60 years and over has tripled since 1950, reaching 600 million in 2000 and surpassing 700 million in 2006.It’s projected that the combined senior and geriatric population will reach 2.1 billion by 2050.
Sri Lanka, with the highest ageing population in the whole South Asia, has around 14.6 million out of a total of 21 million people who over the age of 55 years. Standard population projections indicate that one in every four persons will be aged 60 years or over by the mid 21st century.
Apparently, we will soon have an unprecedented problem that the elderly population will soon outnumber the young population, leading to many social, health and economic problems. Is having more elder people in the country a factor that opens windows for new opportunities or is it a crippling challenge to a less developed country like Sri Lanka?
Can we accompany our elder population to a place where they can contribute more to the development of the country through their experiences and maturity or will they be vulnerable to productivity and be more affected with non-communicable diseases of which costs are skyrocketing in the country at the moment? The Daily Mirror attempts to create an overview of the emerging challenge and how it can be addressed in an effective way.
Reasons For The Rise in Ageing Population
Adopting nuclear family norm
Head of Demography Department of Colombo University Senior Lecturer Dr. E.L.Sunethra J. Perera said the phenomenon of population aging is described as the mature stages of the demographic transitional process.
Sri Lankan families are bound with religious, cultural and traditional norms. From time immemorial, the country has adopted an extended family structure and the fertility ratio was high. The extended families cared for older people in families while a higher number of children was born to families those days. However, as time passed nuclear family norms were adopted, she said.
Decline in fertility and mortality
She outlined that the changing process of the population age-sex structure in Sri Lanka during the past six decades was determined mainly due to the decline in fertility and mortality rates. Supporting her statement, data of the Department of Census and Statistics showed that the fertility rate which was 5.0 in 1963 has declined to 1.9 by 2000. The rate has kept falling even after 2000.
Increase in life expectancy
According to The Census Department, up to around 1960, the life expectancy of males was higher than that of females. However, this pattern reversed thereafter and during the period 1996-2001 females show an increase of 4.7 years compared to males.
“The increase in longevity reflected by increasing life expectancy at birth of the Sri Lankan population (for males and females approximately 72 and 78.6 years respectively) indicates a gender disparity of 6.6 years (female live longer than males),” Dr. Perera said. These unprecedented demographic transitions caused changes in the population structure, she added.
impact in old-age dependency and labour force
Dr. Perera stated that the change in age structure and an increasing number of older persons in the population would result in a significant shrinking of the labour force and increase in old-age dependency in the country. Thus, the shape of the population pyramid shifting from triangle to narrow based pyramid would increase the old-age dependency ratio.
In 2012, there were 60 total dependents including 40 child dependents and 20 old-age dependents. It’s hoped that old-age dependency ratio would increase than the child dependency ratio by 2050, she noted.
“Only 62% of the young population is employed. The employment contribution is at a very low level. When it comes to the females, their labour force participation is just 36%. The working population who can be called as young old population should have an employment, so that they will be able to make a living and look after themselves without depending on their families,” she remarked.
She also went on to say that eventually, female elders will be more of a burden to the society if they have no way of taking care of themselves financially.
Pressure on health system
Due to the rise in the ageing population in Sri Lanka, demands and the projected costs for health care of the growing number of elders will undoubtedly rise. As a developing country, having free health sector, this poses a huge challenge to the country in terms of public financing.
Alarming risk of NCDs
Deputy Director of Non-Communicable Disease Unit (NCD) of the Health Ministry, Dr. Ananthan said there is an increasing risk of Non-Communicable Diseases (NCDs) in Sri Lanka.
Dr. Ananthan’s statement was established by the finding of a national household survey carried out by the Ministry of Health in collaboration with the World Health Organization (WHO) in 2015.
According to the survey, more than 90% of the Sri Lankan adults were estimated to have at least one of the NCD risk factors (73.5% with 1-2 risk factors, and 18.3% with 3-5 risk factors), with similar prevalence in males and females. Around 70% of the disease burden in Sri Lanka is due to non-communicable diseases. Nearly thirty percent of total hospital deaths are due to cardiovascular diseases which are the first leading cause of death in Sri Lanka during the past few years. Below are a few of NCDs that are spread throughout the country.
Raised Blood Glucose - The survey data showed that overall, 83.9% adults were estimated to be taking medicine for Raised Blood Sugar while 16.6% of them are currently on insulin healers.
Cholesterol - Nearly one fourth of the adults (23.7%) were estimated to either have raised total cholesterol or were currently on medication for raised cholesterol. 75.9% of adults aged between 60 and 69 are on medication for cholesterol.
Cardiovascular disease - Approximately 9% of the adults aged between 40-69 years were estimated to either have 30% or more 10-year CVD risk or an existing CVD. Only half of those (55.6%) had received drug therapy and counseling to prevent heart attack and stroke.
High Blood Pressure - It’s estimated that 77.8% of the adults with raised blood pressure were on medication.
Retirement and pension
A report of Human Development Unit of The World Bank on Sri Lanka’s ageing population issue outlined that the coverage of current retirement and pension schemes is limited to a minority of the working age population, the benefits are inadequate, and the financial sustainability of schemes questionable.
According to the finding of the report, pensions are received by less than one-fifth of the old people and only one-third of the labor force participates in pension scheme, with the vast majority of informal sector workers lacking coverage and considerable evasion among those in the formal sector.
The report also brings focus on the fact that the civil servants are the only group that has reasonable levels of benefits and longevity insurance, but costs may be unsustainable in the long run.
The report suggested that more resources have to be set aside for the support of the aged retired population and investment in pre-retirement preparation. In the informal sector comprising 70% employed, only 26% are covered by social security.
Retirement age likely to be increased up to 65
Assistant Director of National Secretariat for Elders (NSE) P.D.R.Kulatunga said that the increase in life span of Sri Lankans, which is around 72, hasn’t apparently been accompanied by an increase in working lives. He pointed out that as a result of it, many elders have to retire at a certain age even if they are physically able to continue working and contribute more to the country’s economy.
“Later, at the failure to find an opportunity to utilize their experience and maturity in order to make a living, many retired elders are wasting time following retirement,” he said.
Kulatunga said the NSE is currently working on a proposal to increase the retirement age up to 65. The Minister of Social Empowerment, Welfare and Kandyan Heritage S.B.Dissanayake had also given his consent to the said proposal. However, it is still in the process of being finalized, he added.
As the dependency ratio is expected to increase compared to the child dependency ratio by the year of 2050, the burden on those offering primary care might increase significantly. Despite Sri Lanka being a country which has adopted a culture where senior citizens are looked after by their respective families, recently a considerable number of incidents were reported regarding mistreatment and abuse of elders by their family members.
According to National Charter for Senior Citizens, Sri Lanka, lacks giving adequate attention to senior citizens. This is a matter of grave concern. As possible reasons, the document stated that the decline of traditional care- which derived from religion and culture in Sri Lanka- for senior citizens has diminished. This is due to challenging economic situations, competitive working cultures, changing values and expectations of women; who were originally supposed to look after elders in the respective families now seeking employment. It had underscored middle aged women migrating to The Middle East in search of employment as one of the causes which has severely affected the caring system.
Assistant Director of the NSE Kulatunga said that although it was believed that living in the presence of ageing parents enhanced emotional bond and also provided a great help in managing the family, advances in education, information technology, influence of media and changing lifestyles have now emerged as causes that discourage people from looking after their parents. “This is a tragedy,” he stated.
Abuse of elderly on the rise
Readers might not forget a heinous act of a daughter who chained her father in a kennel, with three dogs inside, for several years without providing food and other basic requirements, in Kundasale. The incident was reported in 2015 and the daughter was arrested. In April, 2017, a female graduate, who is a development officer, was arrested by the Pallewela Police for allegedly pouring boiling water on her 73-year-old mother. Even recently, a video in which an ageing father was crying and revealing his plight that his children, living in the US, had left him in Sri Lanka went viral in social media. The eyes of anyone with a heart will be wet after watching the video.
The abuse of elders is still largely a taboo topic not only in Sri Lanka, but also in the entire world. Around 1 in 6 older people experience some form of abuse. This figure is higher compared to previous statistics and the prediction are that it will rise as populations age worldwide, the World Health Organization in June, states in 2017.
A new study, supported by WHO and published in the Lancet Global Health, has found that almost 16% of people aged 60 years and older were subjected to either psychological abuse (11.6%), financial abuse (6.8%), neglect (4.2%), physical abuse (2.6%) or sexual abuse (0.9%).
Mushrooming elder care institutions to be regulated
Kulatunga said the NSE is currently working on a National Policy to regulate elder care institutions as many private institutions are mushrooming all over the country to meet the demands.
He said that there are only six elders’ homes maintained by the Government.
“We don’t encourage the concept of elders’ homes. The NSE is promoting day care centres for elders. Elders can come every morning to day care centers, engage in different activities, have a quality time and leave in the evening. It’s like a school. They shouldn’t be confined to the elders’ homes. We thoroughly advise that the care for elders should be mainly provided by their families,” Kulatunga remarked.
HelpAge to help the aged
Among such regulated and non-regulated private organizations, HelpAge is one of the globally accepted and pioneering organizations engaging in this activity.
The Daily Mirror visited one of day care centres funded by the HelpAge. The H.P. Gooneratne HelpAge Elders’ Day Care Centre located at Borupana Road, Ratmalana, established in 1988 is one of day care centers funded by the HelpAge.
Speaking to the Daily Mirror, HelAge Executive Director Samantha Liyanawaduge said that the aged should be empowered, so that they will be able to live with pride and confidence.
He said that many programmes are carried out by HelpAge for the betterment of helpless senior citizens.
“A strong social pension scheme on contributory basis or non-contributory basis from which the entire ageing population will be covered should be introduced in order to provide them with social security,” Liyanawaduge remarked.
The H.P. Gooneratne Day Care Centre provides a great opportunity for elders to involve themselves in diverse activities, enabling them to maintain their physical and mental status. The elders, who come to the centre, every morning, spenf quality time with the other elders. They engage in religious, social, recreational and other income generating projects that helps boost their mental status. Some of the income generating activities include, making lamp wicks, envelopes, paper bags and cement flower pots etc. Around 40 elders visit the centre daily.
Bold steps taken by Japan
Japan is already the oldest society on earth. At 83.4 years, Japan has the longest life expectancy at birth in the world. It created very important changes in several fields in order to face the ageing population challenge and to minimize its negative effects to the country. Below are some of the bold steps taken by Japan, according to an article published in the The Globe and Mail.
- A revival programme consisting of changes such as getting more women in the workplace, new medical technologies including experimental regenerative medicine and cell therapy.
- Supplementing its national pension plan with long-term-care insurance (LTCI), where people pay into the system starting in their 40s and are eligible to receive benefits starting at 65, or earlier in the case of illness.
- A care plan, allowing the patient to choose between competing institutions and service providers offering everything from home visits, bathing and help getting groceries to paying for short stays in hospitals or long-term residence in nursing homes and specialized group homes for dementia patients.
- A robotic seal called Paro, invented by Takanori Shibata, the chief senior research scientist at Tsukuba’s National Institute of Advanced Industrial Science and Technology. The fuzzy seal has been proven in various settings to reduce anxiety, stress, depression and even patients’ perception of pain during chemotherapy treatments.
What needs to be done
Dr. Sunethra Perera of the Colombo University said that the increase in older people will require policies and programmes that can support employment and retirement, health and long–term care, social welfare and social services, in order to reduce the burden of old-age dependency on the working-age population of the country.
Meanwhile, the World Bank Report on the Sri Lanka’s Ageing Population underscored that the increase of women’s participation by 20 percent could delay the reduction of the labor force by 15 years.
“More work is needed to examine the obstacles in the way of employing ageing workers (inflexible labor laws, etc.) and to determine whether other employers have negative perceptions about the adaptability and productivity of older workers. It must also be found out whether employing the aged will create work disincentives and how important an obstacle is weak employability with regard to old workers – and if so, what should be done about it,” the report stated.
We want to help abandoned elders to reunite with their families. Those who are physically able should have a means to make a living. A strong social pension scheme on contributory base or non-contributory base from which the entire ageing population will be covered should be introduced in order to provide them with social security.
HelpAge Executive Director
The NSE is currently working on a proposal to increase the retirement age up to 65. The Minister of Social Empowerment, Welfare and Kandyan Heritage S.B.Dissanayake had also given his consent to the said proposal.
Assistant Director of National Secretariat for Elders (NSE) P.D.R.Kulatunga
The increase in older people will require policies and programmes that can support employment and retirement, health and long–term care, social welfare and social services, in order to reduce the burden of old-age dependency on the working-age population of the country.
Head of Demography Department of Colombo University Senior Lecturer
Dr. E.L.Sunethra J. Perera