Populations are rapidly ageing across the world, including in Africa whose population of 64 million older people (people over 60) is expected to increase to 105 million by 2030. Based on estimates made by the United Nations Department of Economic and Social Affairs in 2015, South Africa has the highest percentage of older people in Africa (8.7%). This is likely to increase to 17.4% by 2050 due to decreasing fertility rates and increasing longevity.
This demographic trend has important implications for our health, welfare and long-term care systems, which are not even equipped to deal with the needs of the current population of elderly people. Although older people around the world are living longer, according to the World Health Organisation, there is little evidence that they are living in better health than their parents, particularly in lower and middle-income countries where older people are more likely to experience poor health and correspondingly low levels of well-being. For South Africa, the link between chronic disease and old age means an increase in the already rapidly growing burden of chronic disease, presenting a challenge to a health system overburdened by communicable diseases such as HIV and tuberculosis. Moreover, high levels of unemployment and poverty will make it difficult for the future generation of older South Africans to save for old-age. This means that a large proportion of this growing population is likely to be poor and in need of state support for their health and welfare needs.
Despite the potential impact of population ageing, the needs and interests of older people have largely been invisible on the South African policy agenda. This is largely because of other sizable development and health challenges affecting the youth and working-age populations, such as: the HIV epidemic, poor education outcomes, unemployment, lack of access to basic services and general poverty. These challenges also constrain the ability of the younger population to care for the growing number of older people. In fact, in many cases, it is older people who have provided care for AIDS-sick family members and their children. Older people’s pensions are also often shared within households to supplement other social grant and wage income.
Despite the important role many older people play in their families, societal ageism feeds perceptions that older people have little to contribute to society or the economy. Although the Older Person’s Act of 2006 exists to maintain and promote the rights, status, wellbeing, safety and security of older persons, the act and its regulations are poorly implemented and these issues are overlooked as older people retreat (often without wanting to) from economic and social life.
The marginalisation of the elderly makes people highly vulnerable to poverty, social isolation, depression and abuse as they age. Although pension coverage for older people is very high in South Africa (92.6%) - thanks largely to the non-contributory state pension known as the Old Age Grant – 40% of the elderly are poor. Those receiving old age grants are also open to financial abuse by other family members and may not fully benefit from this income. Vulnerability to poverty is compounded by cumulative inequalities over the life course and health, function and survival are unequally distributed across the population. Poverty and poor living conditions significantly exacerbate the degenerative effects of ageing, increasing the likelihood of ill-health, disability and cognitive decline. In South Africa these inequalities in ageing are largely mapped along racial lines, both because the current population of elderly black people faced significant discrimination and disadvantage during apartheid and because of continuing racially-defined socio-economic disparities in the country.
Although elderly people are entitled to free health care in the public health system, they struggle to access quality care because of health system capacity constraints and age-related barriers to access. Health services tend to be clinic-based and focused on acute conditions. The health system does not have the capacity to deal with the complex needs of older people with multiple chronic conditions. Given time and resource constraints, fee structures and the typical nature of doctor-patient interactions, many healthcare professionals (including private healthcare providers) do not provide older people with adequate care or struggle to identify frailty and dementia. There is little specialised training in geriatrics in Africa and limited undergraduate focus on geriatric issues in medical training. Healthcare workers may also have negative attitudes towards older people which can affect care. As a result, manageable health issues are overlooked or attributed to the ageing process, resulting in low levels of functioning, poorer health outcomes and diminished quality of life.
Although appearing overwhelming, much of the burden of ill health and disability related to age can be reduced or managed. In its World Report on Ageing and Health report, the World Health Organisation highlighted four priority areas of action for developing an action plan on ageing and health:
1. Align health services with the needs of the older populations they now serve;
2. Develop systems for providing long-term care;
3. Ensure everyone can grow old in age-friendly environments;
4. Improve measurement, monitoring and understanding.
SIFAR has aligned itself with priority area number four and is developing a research agenda that aims to generate evidence to inform policy and support the development of age-friendly health and long-term care systems in South Africa. Please visit our Current Projects page for more information on our research.