Abstract
Ageing has emerged as a major challenge in several developing societies. With falling fertility rates and increasing longevity as its main drivers, it is expected that by 2050, one in five people of the developing countries will be over 60 years of age. It is argued that on account of this, such societies would further encounter an increased demand for medical treatment, long-term care, financial and emotional support. They also are likely to face an enormous psychological burden. In the context of ageing, the article highlights some of the key issues and challenges encountered by the developing societies. Urbanisation, changing family structure and drifting intergenerational relationships are seen as factors that have led to a multitude of psychological problems like social isolation, loneliness, abuse and discrimination and depression in older adults. The article argues in support of health and other social protective measures and calls for the need to recognise the strengths of older adults with a view to integrate them into the mainstream.
Ageing is a developmental process of growing old, accompanied by major physical and cognitive changes. The process of ageing is perceived in multiple ways including chronological age and biological markers such as impairment in vision and hearing, wrinkling skin and fatigue. Others include reduced potential and capabilities for performing a task against a benchmark, interest shown in a task, lack of motivation to perform or an increased tendency to focus on the past rather than living in the present (Mayor, 2006). In the context of ageing, certain terms have often been used interchangeably like, ‘elderly’, ‘senior citizens’, ‘older adults’ and ‘oldest old’.
Population around the world is ageing rapidly. One in five people in developing societies by 2050 will be over 60 years old (United Nations Department of Economic and Social Affairs [UNDESA], 2020). Population ageing is mainly caused by two demographic changes: (a) decline in fertility rates and (b) increase in life expectancy. Such drastic changes are deep-rooted and unalterable (Mrsnik et al., 2010). The greatest challenge of population ageing may not be in Europe but rather in rapidly changing demography of regions such as Asia and Latin America which are said to be moving from being primarily young to being predominantly old within a span of 25 years (Harper, 2014). We are all set to witness a seismic shift of ageing to the developing world as by 2050, 80 per cent of the 2 billion older people on this planet will live in the developing world. This phenomenal acceleration of population ageing would be a peril for developing countries as they would face the emerging demands of medical treatment, long-term care, financial support for ageing societies and a huge psychological burden.
Most of the epidemiological data comes from the developed world. Lack of such data from developing societies may be due to the unique issues of developing societies marked by heterogeneity in the level of education, illiteracy in rural population, activities of daily living, perceived caregiver burden, lack of organised healthcare systems and lack of updated statistics. The disparities in old age reflect an accumulated disadvantage which is characterised by factors pertaining to location, gender, socio-economic status, health and income. In this regard, trends of ageing and economic inequalities interact across generations and rapid structural changes exacerbate older age inequalities, economic growth and social cohesion. With about 1–3 per cent older people aged above 80 years, managing the older adults will be an enormous psychological and economic challenge for the society.
Given the expected impact of population ageing in the coming decades in the developing countries, a plethora of questions and concerns arise as follows: (a) are the developing societies prepared for the seismic demographic shift? (b) How does changing family structure and drifting inter-generational relationships influence ageing? (c) How would developing societies address psychological issues such as social isolation, loneliness, abuse, discrimination and depression in older adults? (d) Is there an adequate safety net for the older population in terms of social and economic security? (e) What are the ways in which societies would grapple with the emerging issue of older adult care considering that fewer working-age citizens would be available to provide home care and long-term assisted care to the older adults? (f) How would individuals and society shape the trajectory of longer lives? (g) What efforts would be expended to integrate the older adults into the mainstream and give them a healthy life? This article will attempt to address some of these issues and challenges.
Ageing Demography in Diverse Societies
In developing societies, economies are moving towards globalisation, the population is moving towards urbanisation and technology is also advancing at the same time. Advancements in the field of health and medicine have led to increased life expectancy. According to a report by the United Nations Population Fund and HelpAge International (2012), life expectancy at birth has risen substantially across the world. In the years 2010–2015, life expectancy was observed to be around 78 years in developed societies and 68 years in developing societies. It is predicted that by 2045–2050, the newborn will be able to live up to 83 years in developed societies and 74 years in developing societies.
There is a tremendous increase in the number and percentage of older people within a single generation in developing countries, in comparison to developed countries (Avendano et al., 2009). A study by Cheng et al. (2009) found that the older population is rising at a greater speed in developing East and Southeast Asia than societies in Europe and America. For instance, the elderly population in Hong Kong, Macau, Singapore and China will increase to 243 per cent from 2005 to 2050 in relation to 113 per cent in developed societies.
Ageing and Urbanisation
Two of the major demographic trends in developing societies are urbanisation and ageing. More than 60 per cent of the total global population by 2030 will be staying in cities and 25 per cent of these will be over 60 years old (UNDESA, 2014). According to Gross and Monteiro (1989), there are three major causes of the rise in urban population in developing countries: (a) rapid overall population growth by natural increase, (b) rural-to-urban migration and (c) reclassification of rural areas as urban areas. Although there are numerous studies on ageing and urbanisation, not much research has examined these two challenges together.
A study by Smith (2009) identified three factors that prevent older residents from ageing well, in urban context. These include (a) neighbourhood problems, such as overcrowding, noise and air pollution; (b) living environment problems, such as practical fears in the daily lives of older people and (c) perceived city environment, such as fear of crime and access to high-quality services. In deciding where to live, older people often view their existing home or community as having the advantage of maintaining a sense of connection, security and familiarity (Casey & Yamada, 2002). Also, a strong sense of attachment to the existing place, inhibits older adults from adapting well to a novel environment.
Musselwhite (2017) talks about the ‘hypermobile’ society, where people tend to be mobile in order to maintain a sense of security and well-being. This becomes a challenge for old people because in old age mobility gets restricted, and with passing time older people feel trapped. The irony is that in old age people prefer staying at their homes but at the same time, they wish to stay connected to their friends and family, which creates a burden. These studies are limited to the case of developed countries but urbanisation with all its complexities is expected to expand rapidly in developing countries. Further studies are required to examine how environmental challenges affect older people in developing societies.
Changing Family Structure
Family occupies an important place in the healthy development of an individual. In most developing societies familism continues to remain strong and exerts a major influence on the behaviour of the individual and intergroup and inter-individual relationships (Sinha, 1991).
However, due to industrialisation, urbanisation, modernisation and changing values, significant transformations in the family and the pattern of formal and informal support took place (Dak, 1997). Radical changes in the size, composition, structure and pattern of intergenerational support and relationships between members of the family and kinship bonds failed to provide the social security and quality of care for the older adults that was prevalent in the past (World Health Organization [WHO], 2012).
In India, as in many East and South Asian countries, elders held an important position in the family. They wielded power, enjoyed supreme status and exercised control over finances and property. Children regarded them as a pillar of strength and an epitome of love. The decisions of the older generation were accepted and revered. The older adults not only participated in religious and social activities but also counselled their kith and kin in familial and community matters.
The family was the primary support source, wherein, ageing parents were looked after by their family members. However, rapid industrialisation, modernisation and migration created a dent in the system of traditional joint families (Nayar, 1999; Singh, 1997) and led to the creation of nuclear family structure, changed value patterns among new younger generations and pushed people towards individualisation (Jamuna, 1997, 1999). The elderly couple preferred staying alone and willingly separated from their children to maintain their self-respect or avoid any conflicts. Hence, a trend of post-parenting or uni-member households or living with the daughters increased in India (Suryanarayana, 1998). These older adults received financial aid and support from friends or relatives (Alam et al., 2012). Thus, with changes in the family system, values, bonds and headship, the quality of eldercare began shrinking.
Drifting Intergenerational Relationships
Intergenerational relationship refers to the interaction between two or more generations, which can be between grandparents, grandchild or any older adult and a young person whether related through blood or otherwise. It includes sharing kinship activities, having frequent contact with each other and engagement in a network of mutual assistance both within and across generations (Hill et al., 1970). With time, a shift in the nature of intergenerational relationships occurred due to (a) change in beliefs and values that affected the role of family relationships and (b) socio-economic transformation that led to changes in the family relationships (Harvey, 2003).
Studies by Jamuna (1996, 1997) on Indian families revealed that in traditional Indian joint families the interactions between generations and expressions of affection were high, but due to changing family dynamics and societal factors, the traditional care systems and support structures frayed, which resulted in the older adults experiencing alienation and loneliness. It was also reported that the younger generation of 1984 believed that elder caregiving was their duty whereas a decade later, a lesser number of younger people believed it was their duty. The younger generation of 1994 also believed that the old age homes were a good alternative for the care of older adults. However, studies show that older adults suffer from depression living in old age homes (Johnson & Rajan, 2010). They face greater stress in comparison to those who live with their families (Sethi et al., 2013). Research shows that callousness, apathy and estranged relations between family members and older adults is a major factor in sending the latter to old age homes (Asadulla et al., 2012), though this is the time when older adults are weak, dependent, physically and emotionally vulnerable, and need their close ones the most (Srivastava, 2013). Most common reasons for shifting to old age homes include conflict with son and insult faced by a son; need for an independent and peaceful life; loneliness and stress; no caregiver; no male heir; and not wanting to stay with their married daughters (Kumar et al., 2012).
Psychological Challenges
In developing societies, where social and economic changes have been abrupt and haphazard, the problems of older adults are severely accentuated (Lloyd-Sherlock, 2000). Along with physical, social and economic challenges, old age is also fraught with many psychological challenges such as social isolation, loneliness, ageism, abuse and depression.
Social Isolation and Loneliness Among Older Adults
Social networks play an important role throughout the life course of an individual. Social connections are as vital as the biological needs related to survival (Cacioppo & Cacioppo, 2014). Stable and rewarding social relationships serve as a basic psychological need which provide resources that act as a buffer against acute or chronic stressors and promote adaptive behavioural or neuroendocrine responses (Baumeister & Leary, 1995). In a meta-analytic review by Holt-Lunstad et al. (2010) it was reported that those who are socially connected live longer. However, migration of children to other cities, shrinking family size, changed values, lack of friends and poor social support contribute to feelings of loneliness and social isolation (Nicholson, 2012), and is a major challenge for the older population of developing countries.
Social isolation refers to a state in which social relationships and interactions are limited or absent. This can arise involuntarily, for example, through peer exclusion or bereavement, or by voluntary withdrawal from social contact. Older adults’ transition from full-time employment to retirement also changes their social networks which in turn decreases the chance to socialise in occupational and public forums (Holt-Lunstad et al., 2015). Together with general life events, gender appears as the second trigger for social isolation (Kudo et al., 2015).
Previous researches have demonstrated that older adults not only report social isolation but also experience loneliness. Peplau and Perlman (1982) stated that loneliness is an unpleasant experience that occurs due to a person’s discrepancy in either the quality or the quantity of expected and actual network of social relationships. Loneliness cannot be equated with being or living on your own (Bandari et al., 2019). In this modern era, loneliness is one of the rapidly increasing psycho-social health concerns (Cacioppo & Cacioppo, 2018).
Older adults are at a greater risk of experiencing loneliness than other age groups (Luhmann & Hawkley, 2016). According to Pinquart and Sorensen (2001), loneliness often increases when the social support networks of older adults deteriorate in quality. Most studies on loneliness are conducted in industrialised nations where older adults are subjected to many socio-economic stressors that affect social networks (Miyawaki, 2015). Similar problems are now surfacing in developing countries like India (Grover, 2019). A nationwide survey by Agewell Foundation (2017) which included 15,000 participants from 300 districts of 25 states and union territories across India reported that 47.5 per cent of older people reported being lonely. The factors associated with loneliness included residing in urban areas with infrequent interactions with members of the community, living alone or with their spouse only. Further, minimal interaction with family members and poor health conditions were also responsible for loneliness in old age.
The findings of the study by Scharf and De Jong Gierveld (2008) revealed that loneliness is related to decreased income and deteriorating health, as well as living conditions such as perceived quality of the neighbourhood, dependency, type of family, social network, place of residence and population migration. Studies have shown that loneliness is linked to depression, lower quality of life, Alzheimer’s or senile dementia and increased vulnerability to both physical and mental health problems in older adults (Cacioppo et al., 2006).
According to the evolutionary perspective, one feels safe being in the company of someone and endangered when one is alone unwillingly. Social isolation and perception of such threat may reinforce each other to promote a higher and more persistent level of wariness. Loneliness not only alters behaviour but also influences hormone regulation, immune function and cardiovascular function. These physiological changes are compounded over time and that may accelerate the ageing process (Cacioppo & Patrick, 2008).
Medical and healthcare providers have invariably focused on physical health working to minimise risks of chronic illnesses and debilitation among older adults. Proactive measures such as blood pressure and cholesterol control, cancer screening and exercise are the focus of interventions in developing nations. However, other less-recognised yet major health risks like loneliness also require attention. Although data from developed countries show the association of loneliness with negative physical and psychological health outcomes, research on loneliness in the ageing population is limited to a handful of studies in developing countries, for example, India (Grover, 2019). Various mediators such as familial, social and clinical factors are associated with loneliness, and findings from one country cannot be generalised to the other. Therefore, there is a need to evaluate the culture-specific factors associated with loneliness in developing countries which in turn influence the health outcomes.
Ageism and Abuse
Ageism is the stereotyping and discrimination against individuals or groups based on their age. Ageism can take many forms, including prejudicial attitudes, discriminatory practices or institutional practices and practices that perpetuate stereotypical beliefs (HelpAge International, 2006). Ageism has shown to cause lowered levels of self-efficacy, decreased productivity and cardiovascular stress (Asher, 2009). These negative attitudes are also widely present even within the health and social care settings where older adults are most vulnerable.
A report by United Nations General Assembly (2011), stated that the older adults face discrimination in health services and care and are found missing in health policies, interventions and resource allocation. Only a few comprehensive health policies comprise the prevention, rehabilitation and care of the terminally ill. They also face other types of discrimination, which are not only just based on age but also factors like gender, disability, or poverty. Moreover, this discrimination is enhanced if they are HIV positive or women. Thus, older women are subjected to a double jeopardy which places them as a ‘woman’ and as an ‘elderly’. Teo (1997) observed that older women tend to be subjected to discrimination in employment, access to daily needs, ownership of property and even participation in leisure activities. Further, in developing countries, older women tend to have lower educational levels and economic independence and are thus dependent on either their husband or relatives (Knodel & Chayovan, 2014).
In developing societies, older people are not only exposed to discrimination and different type of crimes but also abuse. Elder abuse is a general term used to describe certain types of harm to older adults. Elder abuse is defined as
any type of action, series of actions, or lack of actions, which produce physical or psychological harm, and which is set within a relationship of trust or dependence. Elder abuse may be part of a cycle of family violence; it may be caused by caregivers or maybe the result of a lack of training of social and health institutions, who cannot meet the needs of older people. (WHO, 2011)
Elder abuse takes many forms including physical, psychological, financial abuse, abandonment, neglect and serious loss of dignity and respect. The issue related to elder abuse is prevalent in both developed and developing countries. An estimated 4–6 per cent of elderly people belonging to high-income countries have experienced some form of abuse at the family level. For developing countries data from institutional settings is scarce (WHO, 2011).
Another issue that has drawn the attention of researchers in the discourse of elder abuse is ill-treatment and neglect (Decalmer & Glendenning, 1997). A study from Geriatric Centre Nepal (2010) reported 117 cases of elder abuse between July 2008 to July 2010 and it was found that an astounding 43 per cent cases reported physical abuse which was followed by 33.3 per cent cases of neglect. Data showed that physical abuse was the leading cause of death of the elderly, with 49 per cent succumbing to death. Another study from the Netherlands (Hannie et al., 1998) reported a prevalence rate of 5.6 per cent in terms of elder abuse among 1,797 older adults. The other dimensions of elder abuse include physical aggression, fraudulent behaviour neglect and verbal aggression. Victims who were subjected to abuse reported negative emotions such as anger and sadness (Hannie et al., 1998). It was also reported that older adults who were living with their families were abused more often than those who lived independently (Geriatric Center Nepal, 2011). The consequences of abuse can have serious ramifications for older people and especially for those who are vulnerable and belong to the lower or middle socio-economic status.
Depression in Older Adults
Growing number of older adults in the developing countries presages an increase of those affected by organic and non-organic, age-related mental disorders. One such disorder in old age is depression. Post (1966) observed a lack of social interest, suspiciousness and antipathy can lead to paranoid processes in old age and social isolation. The experience of social isolation, loneliness, abuse and discrimination may be a predisposing factor for depression. Backman (1973) reported that older adults suffer from lack of role definition and powerlessness, and this leads to feelings of inadequacy, insecurity and depression. Depression makes a person dependent on others.
A report by WHO (2012) shows that older adults with depression face a higher risk of chronic illnesses like cardiovascular disease, diabetes, cancer and hypertension. Depression not only has devastating consequences but also contributes significantly to misery in the older phase of life (WHO, 2017). It is also associated with increased risk of morbidity, decreased physical, cognitive and social functioning, and greater self-neglect (Sözeri-Varma, 2012). Depression not only decreases the quality of life but also influences the prognosis of other chronic diseases that further aggravate disabilities (Pilania et al., 2019). Consequently, older adults suffering from depression have significantly higher suicidal and non-suicidal mortality (Aziz & Stephens, 2013). Quality of life can be improved if there is an early diagnosis and treatment of depression. However, healthcare systems in low and middle-income countries are not resilient enough to deal with mental health problems including depressive disorders (WHO, 2014a, b). At present, depression has become an important public health challenge in developing countries. However, it is not yet identified as a priority in the agenda of public health policy and practice.
Inadequate Social Protective Measures and Income Insecurity
There is a considerable difference in terms of pace and scale of ageing transitions. Thus, the creation of social protective measures to cover the older population will be a common concern among developing societies (Lee et al., 2011). The main challenge for developing societies, where social welfare schemes are not yet well established, would be to address the escalating medical and other needs of the elderly. China, with its large ageing population, which is 160 million people aged above 60 years, will be worse affected (Chen et al., 2010). There is a shortage of nursing centres, and setting up care facilities to match the growing ageing population is a herculean task. Thus, it is imperative to train geriatric care workers, to frame a policy to cover uninsured older adults and to plan a strategy to cope with the expected increase of older persons with disabilities (Feng et al., 2012).
Income and housing security challenges further add to the plight of ageing population in developing societies. Pensions, especially social or non-contributory in nature, are a form of giving a minimum amount of income to people in old age. It is globally recognised as an important aid in reducing old-age poverty. Internationally, only 51.5 per cent of senior citizens receive old-age pension. Though these figures are showing an upward swing each year, pension inequalities still exist (International Labour Organization, 2014, World social security report, 2014–2015).
Due to income insecurity and poverty, the older adults join the workforce in twilight years of life. It has been found that 42 per cent of 60+ adults and 22 per cent of 80+ adults continue participation in the workforce (Government of India, 2011). UNFPA found that 24 per cent of 10,000 respondents aged 60+ were in the workforce for either 6 months a year or 4 hours a day. Workforce participation was higher in rural areas than in urban areas and higher for males than females. Alam et al. (2012) found that 70 per cent of older Indian workers stated economic necessity as their reason for working rather than personal preference. Also, older adults in the developing nations work largely in unorganised sectors, wherein they get irregular or poorly paid salaries. Hence, introducing pensions for older adults in developing countries is gaining momentum. Post-retirement pension is given to only those individuals who have served in government organisations or some private corporations. About 83 per cent of the older population work in the unorganised sector, and hence do not get pension or retirement benefits. Less than 10 per cent of the older population receives pension of any kind (Uppal & Sarma, 2007). Therefore, financial insecurity along with deteriorating health and physical condition becomes a challenge for them. Moreover, the absence of health insurance by the government, lack of quality healthcare infrastructure and an increase in health-related expenditures overburdens the older population. Failing economic and health insecurity exacerbates anxiety, stress, helplessness and leads to reduced sense of worth. They also tend to inculcate a feeling of dependency.
Inadequate Health Care Services
In countries with limited resources, longevity comes with a cruel twist. In addition to depression, an increasingly ageing population is bringing a new tide of illness associated problems such as dementia and Alzheimer’s disease. Lakhan and Ekundayo (2015) reported a significant positive correlation between old age and mental illness. According to Alzheimer’s Disease International, 115 million older adults will suffer from Alzheimer’s and dementia by 2050, and this figure will peak in the developing nations (Plassman et al., 2007). In a study by Reddy (1985), it was found that 27 per cent of the older population was dealing with mental illnesses like depression, anxiety, bipolar disorder, dementia and alcohol dependence.
Ageing, in developing countries, is seen to be affected by the rise of chronic non-communicable diseases like cancer, diabetes and cardiovascular diseases which are a result of changing lifestyle and diet. Over the past two decades, health systems of many countries have engaged in a precarious juggling act, trying to balance the fight against the existing burden of infectious diseases and chronic diseases. Along with these diseases, the ageing population has to deal with the economic and social costs attached to it (Abegunde et al., 2007). The older adults are particularly more vulnerable because of the existing comorbidities and psychological issues. Medical conditions involving cardiovascular diseases, respiratory disorders, hearing, visual impairments and other such illnesses are prevalent among older adults (Raja et al., 2010). In addition to health problems, the older population is also exposed to poor health services and health inequality. A root cause for the seeming nonchalance with which governments of developing countries are responding to the ageing crisis seems to be the assumption that in Africa, Asia and Latin America, where family units are still fairly cohesive, compared to the USA or Europe, families rather than governments can and should shoulder the burden of caring for older people (Shetty, 2012).
The health dynamics of older age are related to increased need for healthcare and it might be expected that increasing age would be associated with increasing healthcare utilisation. However, evidence indicates that there is a disconnect between healthcare need and healthcare utilisation. A study by Kaleche and Sen (1999) revealed that countries like India, Vietnam and Burkina Faso, with older populations belonging to low socio-economic status, show lesser utilisation of health services when faced with illness. It has also been found that in certain geographical regions, for instance, in countries of Sub-Saharan Africa and Latin America, a large section of the aged population remains deprived of the health services due to inadequate health infrastructure, no prior experience in gerontological services, low priorities of policymakers and lack of social security and insurance entitlements. These all compel the aged to respond poorly to public sourced services. The societal response to ageing will require transformation of health systems that moves away from disease based curative models and towards the provision of older person-centred and integrated care.
Older Adults as a Resource
Due to the influence of Confucian values of filial piety and ancestor worship, Asian societies were thought to promote positive views of ageing and high esteem for older adults (Sung, 2001). In contrast, western societies which were believed to be more youth oriented held more negative views about the ageing process and the older population. However, there is a paucity of research to support this proposed East–West divide. A study by Tan et al. (2004) found support for the belief that attitudes towards ageing are more positive in Asia as compared to Western cultures.
The notion that the older population is the most important and integral part of our society was once pervasive but now it has been relegated to the background. The older adults with their knowledge, skills, social and emotional maturity are the fastest growing, underutilised resource that developing countries need to cherish and preserve. In a transaction driven society, where value is assigned to every activity, there is a need to appreciate the contributions that older adults make to society. The strengths of older adults are to be recognised, not only for the sake of older people who deserve better but also doing so would make society a better place. A cultural shift of such magnitude will require a broad range of strategies to encourage people to be proactive, embrace and identify their ageing with that of the older adults and rethink ways in which they can be integrated into mainstream society. Such measures will provide sustainable and inclusive growth. Older adults have a repertoire of wisdom that communities can benefit from and rather than excluding them and leaving them at the mercy of charity for their survival, the integration of older adults can help communities to survive and thrive. They can be the glue that binds the community through traditional values by bringing together conflicting movements.
Social and Emotional Maturity of Older Adults
A unique characteristic of older adults is their social and emotional maturity. This maturity is the culmination of years of experience. It is a valuable resource that crosses geographical boundaries and is found in both developed and developing countries. The younger generation needs to cherish and preserve this resource. There is a dearth of studies in this area. The developing societies with their uniqueness and distinctiveness offer rich ground for conducting such kind of researches.
Earlier research focused on a uni-dimensional model of ageing, but in the past several decades, the decline of uni-dimensional models of ageing gave way to lifespan developmental models. These models illustrate how specific processes and strategies facilitate adaptive ageing. This conceptual change was highlighted due to the stark contrast of findings demonstrating that individuals in old age showed general satisfaction and relatively high levels of emotional well-being in comparison to decline in biological, physiological and cognitive capacity. This ‘paradox’ of ageing has now been addressed in review articles and empirical investigations. At no point in life, the need to feel embedded in a larger social group is diminished (Baumeister & Leary, 1995; Charles & Mavandadi, 2003; Maslow, 1947; Snowden, 2001). Social and emotional ageing is a stable characteristic but social and emotional life changes with age.
Old age implies a natural withdrawal from active roles and obligations. An older adult may feel ready to step back both from relationships and his or her social setting. This process of disengagement is a natural process in human life. Loss and breaking of ties represent a natural, indispensable and irrevocable process. Disengagement theory (Cumming & Henry, 1961) has directed studies on ageing for decades. It states that as people age, they tend to emotionally distance themselves from their loved ones as a symbolic preparation of death, but the observed patterns of empirical investigations did not support the key postulates of disengagement theory. Charles and Cartensen (2007) found that with age, though social networks reduce in size, older adults still exhibit positive attitudes and are socially engaged.
Healthy Ageing: Need of the Hour
According to the WHO (2015), the term healthy ageing refers to the process that facilitates well-being and helps in developing and sustaining functional ability in older age. It mainly focuses on optimising health, safety and active lifestyle opportunities that enhance the quality of old age. It is a holistic approach that emphasises the physical and mental well-being of individuals at the individual, community and societal levels. However, much less has been done to understand the factors contributing to and which may be intervened for healthy adaptive ageing in the context of developing societies. One way to achieve healthy ageing is to socially integrate older adults into the mainstream.
It has been reported that older adults will age well if promoting the health and well-being of adults becomes a priority (WHO, 2014a, b). As age advances and age-related changes take place, there is a decline in physical health. This decline poses greater challenges for ageing as well. With good physical and psychological functioning, older adults can perform more integrated functional tasks which include activities of daily living, and fulfilment of social roles. A study by Halaweh et al. (2018) shows that better physical functioning is associated with physical activity and interaction, and is positively reflected in physical and functional well-being. Furthermore, having positive mental attitudes towards ageing may contribute to ageing well.
Social Integration of the Older Population
Social integration is an important issue for the older population (Levy & Langer, 1994). Marginalisation of older people acts as a social divide between the older and new generation and it also hampers older adult’s participation in social, political or economic activity (WHO, 2012). Thus, a major challenge for developing societies is social integration of older adults into the mainstream. Hooyman and Kiyak’s (2008) study on the meaning of social integration revealed that it is understood in terms of social exchange with others, be it family, friends, or communities. Social integration is associated with features of the geographic environment, length of stay in the neighbourhood, self-concept and feelings of belongingness (Rowles, 1978).
Several studies have tapped the importance of social relationships and it has been evident that social relationships play a crucial role in shaping health along with the physical and emotional well-being of people. It is found to be an important factor for successful ageing (Rowe & Kahn, 1998). A study by Holt-Lunstad et al. (2010) reported that social integration and a larger network of close relationships are associated with positive health outcomes. Not only familial ties get strengthened but also the invaluable wisdom that the older adults possess and the experience which they carry can be shared with the members of the family and society at large. This would help in enhancing their self-esteem and dealing with issues related to belongingness. Studies have reported that social integration promotes life satisfaction, alleviates the distressing sense of loneliness (Rote et al., 2013) and improves physical and mental health (Cornwell & Waite, 2009).
Conclusions and Implications
This article focuses on the issues and challenges faced by older adults with special emphasis on ageing adults in developing societies. These complex issues pose a challenge not only to the ageing population but also to society as a whole. Age-based stereotypes impact behaviours, policy development and research. Addressing this must be at the core of any public health response to population ageing. A challenge for policymakers is to incorporate ageing in their developmental agendas and to expand the policy lens on ageing. This would first involve recognising that ageing is a part of the entire lifespan and not simply a loss suffered among age 60 and above.
A fundamental policy and attitudinal shift on ageing and old age is therefore needed to reflect and promote the contributions of older persons to society. Instead of focusing on the negative aspects of ageing, public debates and policies must focus on older person’s strengths as a solution to many development challenges (WHO, 2015). A paradigm shift from a deficit model to a resource model will help in reducing the stereotypical notions and myths associated with ageing.
The need for research in the area of ageing not only reflects the continuing interest of the scientific community but also the needs and worldwide growth of the ageing population that is moving ahead at a rapid rate. Country-based studies can be a start by redefining ‘old’, and the role of ageing in labour, health and care policies within these complex contexts. If countries are analysed based on changes over time rather than changes concerning a universal standard, then the complex interplay of development and demographic factors may be easier to discern. This might explain how a country can get old before it gets rich.
There is a need to plan dignified and active ageing for older adults. Empowering older adults by promoting their active participation within the social, economic and political lives is one way to ensure their inclusiveness and reduce inequalities. Further, exploring strategies that could help in integrating older adults into the changing world would lead to a healthy world. Tackling ageism will require building and embedding in the thinking of all generations, a new understanding of ageing. Healthy ageing can be achieved by combating ageism and enabling autonomy to older adults. The older adults deserve a future that gives them the freedom to live lives that previous generations could never have imagined.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.