Updated Country Profiles on Ageing and Health 1998-2002
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Improvements in social and economic conditions and better health have contributed to longer lifespans. This in turn has created new morbidity patterns, new health challenges, and correspondingly new demands on families, communities and health care systems that may not be prepared for a changing demographic profile. Currently, the Western Pacific Region is home to one third of the world's population of persons aged 65 years and over. Over the past 20 years, WHO has sustained a regional programme on ageing and health that has evolved from care of the aged, to improving quality of life and more recently to active ageing. Throughout this period there has been an upsurge in attention and action to address health needs of older persons. WHO has collaborated with Member States in the areas of epidemiologic studies to determine the nature, extent and magnitude of health and health-related problems of older persons; formulation of policies, programme development and implementation, promotion of community-based care of older persons, training of personnel in the care of older persons; and studies and research on priority problems of older persons.
enable stronger community and social support systems, urban-based strategies and gender-sensitive approaches. The report also highlights the importance of integration of ageing and health concerns with health systems development as many of the problems of older persons are inextricably linked to the more basic problems of limited access to care, poor quality of services and the lack of financial and materia I resources to meet the needs of this growing sector of the population. The increasing awareness and interest in meeting the health needs of older persons needs to be matched with policy and programme options that are practical and sustainable. Much has been accomplished, but much more needs to be done as WHO continues to work with countries to empower communities and older persons themselves to achieve better health. It is hoped that this report will provide information and insight into how different sectors can best support action to uphold the health of older persons.
Shigeru Omi M.D., Ph.D. Regional Director WHO Regional Office for the Western Pacific
Updated country profiles on ageing and health: A closer look at health resources for older persons builds on the 1998 publication, Ageing in the Western Pacific Region: A profile of policies and programmes, which was the first attempt to compile country specific data on interventions to protect and promote the health of older persons. In this new document, apart from the updates on demographic data, health profiles, and national policies and programmes, there is an attempt to take a closer look at health systems and resources for older persons in the community. Based on this report, in the future, WHO in collaboration with Member States will need to consider some key issues that are emerging. Among them are {1) the increasing nuclearization of the family, {2) the increasing urbanization of societies and (3) the feminization of the older segment of the population.
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Background The World Health Organization plays an important role in the Western Pacific Region in monitoring and promoting health in the ageing populations of its Member States. This is anchored in a policy guided by resolutions of the World Health Assembly (WHA32.2, WHA35.28, WHA40.29) and the Regional Committee for the Western Pacific (WPR/RC32.R15), WPR/RC36.R23) which, inter alia: recognize the leadership role of WHO in the health care of the elderly; promote increased awareness, the development of national policies and the establishment of comprehensive programmes for the elderly; advocate for the development of health-promoting behaviour; and encourage multisectoral collaboration. Efforts have been further encouraged following the adoption by the United Nations General Assembly of the Madrid International Plan of Action on Ageing 2002, which was the outcome of the Second World Assembly on Ageing, held in Madrid in April 2002, and the Shanghai Regional Implementation Strategy for the Madrid International Plan of Action on Ageing (2002), as well as the Macao Plan of Action on Ageing for Asia and the Pacific (1999), adopted by the Asia-Pacific Seminar on Regional Follow-up to the Second World Assembly on Ageing, held in Shanghai, China, in September 2002. In the WHO Western Pacific Region, the focus of the programme on ageing has evolved from the care of the aged, in the early 1980s, to, not only prolonging life, but improving their quality of life and productivity and the process of healthy ageing. In 1995, the programme came to be called 'ageing and health' in recognition of its broader 'life-course perspective' on the issues associated with health and old age. It is recognized that action to ensure quality of life in old age can begin well before that age is reached, and that a healthy childhood and adulthood may indeed be the most important determinant of a healthy old age. In the nearly 20 years during which the regional programme on older persons has been implemented, there has been an evident upsurge in awareness and attention given to the health needs of older persons in the Region. In a number of countries, such as Japan, Australia and New Zealand, and now Singapore and Hong Kong (China), policies and programmes for the health of
the elderly have become well established. Other countries are at various stages of formulating their programmes and developing health services for older persons, while, for some, ageing issues remain a relatively low priority. Until the publication in 1998 of Ageing in the Western Pacific Region: A profile of policies and programmes, there had been no attempt to compile information on the policies and programmes for the elderly of each Member State in the Region. This report updates the information provided at that time. It is intended primarily to document the progress being achieved in the Region with regards to the demographic data and the development of policies and programmes for older persons. The information contained in the profiles includes: demographic data and health profiles; national policies and programmes; and resources for older persons.
It is recognized that action to ensure quality of life in old age can begin well before tliat age is reached, ana that a healthy childhood and adulthood may indeed be the most important determinant of a healthy old age. Updated information provided by each Member State and taken from United Nations publications were used as primary sources for the report. Each Member State was asked to provide comments on its draft profile and to submit these within a specified time, after which the updated profile was finalized. The profiles reflect the general situation prevailing at the latest dates available and do not generally include initiatives taken by a number of countries following the Second World Assembly on Ageing, which took place in April 2002. All necessary precautions have been taken to arrive at reliable data, including several layers of screening for information used in the report. However, despite these efforts, there remain varying levels of reliability and comparability of data, especially in countries where the data collection infrastructure is extremely limited.
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The Western Pacific is a region of great diversity. It is home to both a continent-state, Australia, and island countries of varying sizes in the Pacific; to China, with a population of over one billion people and to Niue with a population of just under 2,000. The economies of the countries in the Region range from post-industrial, as in Japan, Singapore and Hong Kong (China) to tribal subsistence, as in Papua New Guinea. Political systems vary from centralized states to republics. Cultural homogeneity can be seen in Japan and China, while many Pacific Islands are multicultural and multi-ethnic.
These broad groupings by median age range are reflected in the degree to which countries have developed policies and programmes on ageing and for health and care of older persons. Thus the 'aged' countries identified above have developed relatively comprehensive services and, in recent decades, have fostered aged health care policies and programmes, including community-based and residential services. The lessons learned by these countries, that have largely passed through the classic demographic transition, have begun to be applied in the larger countries in the next lower level of population ageing, which might be described as 'newly ageing'. Those countries in the lowest tiers have generally not yet identified ageing issues as a priority area, although those with larger populations, such as Malaysia, the Philippines and Viet Nam, have emerging basic policies, programmes and services directed to the needs of older persons and their families.
At present, the Region is home to one-third of the world's population of persons aged 65 years and over. More than half are women. Despite such regional diversity, demographic shifts, resulting in population ageing, are occurring in almost all the countries of the Western Pacific Region. This has been the outcome of large birth cohorts in the past and improved chances of survival, even into older age groups. Average life expectancy for the Region in the period 1995-2000 was estimated at 70.5 years for both sexes, 68.6 for males and 72.5 for females, with significant variation between countries, as shown in the profiles. At present, the Region is home to one-third of the world's population of persons aged 65 years and over. More than half are women. The median age of a population provides a convenient index of population ageing. 'Aged' countries in the Western Pacific Region, with a median age of 35 years and over, include Japan (48); Hong Kong, China (37); Singapore (36); Australia (35); Macao, China (35); and New Zealand (35). Larger countries with a median age of 30 to 34 years include the Republic of Korea (33) and China (32); and, in the Pacific, Cook Islands (31) and Palau (30). Countries with a median age of 25 to 29 years include Brunei Darussalam and the Lao People's Democratic Republic (each with 26), and the Pacific countries of the Northern Mariana Islands (29), Guam and New Caledonia (each 28), Niue (27), French Polynesia (26) and Tuvalu (25). Those countries with a median age below 25 years include Malaysia and Viet Nam (each 24), Mongolia (23), the Philippines (22) and the remaining Pacific Island countries of Fiji (24), American Samoa (22), Nauru (21), Tonga, Kiribati and the Federated States of Micronesia (each 20). Papua New Guinea, Samoa, Solomon Islands and Vanuatu all have a median age of 19, and the Marshall Islands 18 years.
In just a few decades, the number of older persons in the Region will double. This will necessitate more government resources being allocated for this segment of the population if their well-being and productivity are to be maintained. Government action requires consideration of the health, housing, education, leisure, income and social security needs of the elderly. Australia has a government-endorsed national strategy on ageing and a package of services and benefits for the elderly, addressing the needs of both the healthy, the frail, the sick and disabled. These include community care services which help the family carry out its primary role of caring for the elderly; housing programmes that encourage multigenerational living arrangements; tax breaks for family caregivers; educational opportunities; and a range of levels of residential care when needed. Japan has adopted a comprehensive plan to promote health care and welfare for the elderly and has services such as home-help services, short-stay services, in-home care support centres, day care centres, etc. Among the countries in the Pacific, Palau, American Samoa and Guam are some of the countries providing aged care services, although at varying stages of implementation. A lack of policies for the elderly does not preclude the provision of services for them, as these are most often part of the general government welfare services for all
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disadvantaged groups in the country. The great majority of countries provide services which the elderly can access, especially in health care. In most countries, social security schemes are in place, albeit with varying degrees of coverage. In just a few decades, the number of older persons in the Region will double. This will necessitate more government resources being allocated for this segment of the population if their well-being and productivity are to be maintained. Government action requires consideration of the health, housing, education, leisure, income and social security needs of the elderly.
health sector reform efforts, financing schemes, quality assurance programmes in health facilities and health human resource development programmes at the country level. Building social capital to ensure action at the level of the family, the community and other social institutions is underscored in recognition ofthe broader implications of ageing, which go beyond health and welfare concerns and may be expected to impact on economic and political conditions in the future. As shown in these profiles, great strides continue to be undertaken in a number of countries in the Region, while in others the development of policies and programmes for the elderly remains a low priority. It is evident that much more needs to be done, but the initiatives that many countries are already undertaking to promote and protect the welfare of older persons continue to provide great encouragement and hope for further improvement in the lives of both the elderly and their communities across the Western Pacific Region.
Three issues continue to emerge as major concerns in the Region. These are the increasing nuclearization of the family, the increasing urbanization of societies and the feminization of the older segment of the population. Member States have been urged and provided support by WHO to develop national policies and programmes on older persons. To date, WHO has collaborated with countries in the following areas: epidemiological studies to determine the nature, extent and magnitude of health and health-related problems of older persons; formulation of policies, programme development and implementation; promotion of community-based care of older persons; training of personnel in the care of older persons; and studies and research on priority problems of the older persons. Three issues continue to emerge as major concerns in the Region. These are the increasing nuclearization of the family, the increasing urbanization of societies and the feminization of the older segment of the population.These trends direct attention to policy initiatives that increase community-based care services to deal with the reduced capacity for care-giving by family members; employment and income support for the elderly as urbanization further marginalizes them; and gendersensitive programmes and services as more and more females live longer. The report's sections on resources for the elderly highlight country-specific interventions, specifically in relation to health systems development. Clearly, there is a need to continue to advocate for integration of ageing and health concerns in
It is evident that much more needs to be done, but the initiatives that many countries are already undertaking to promote and protect the welfare of older persons continue to 2rovide great encouragement and hope for further tmprovement 1n the lives of both the elderly and their communities across the Western Pacific Region.
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A. Definition of terms
O[J{ tw rt;rJ1r,...J A key problem in research on older persons is defining the concept. National practices in regard to when a person is considered 'old' differ. In some countries, where life expectancy is about 50 years (as in Cambodia and the Lao People's Democratic Republic), it may not be appropriate to use 60 years as the cut-off point to define an older person. Other countries define the elderly according to the age at which a person becomes eligible to retire and draw a pension. For example, in Malaysia, a person is considered old at 55 years, which is the retirement age in the country. In the United Nations, 60 is generally used as the age to define an older person. The World Health Organization, however, traditionally uses the age group 65 and above as a measure of the older segment of the population. A population threshold of 7% of this age group is considered large in terms of ageing. For the purpose of establishing demographic trends in the Western Pacific Region, the conventional epidemiological age delineations of 60 and 65 years have been adopted In this report.
number of years lived, the expectation of life at a certain exact age or an interval between exact ages. Life expectancy at birth indicates the average number of years that persons can expect to live from the time of birth if they experience, throughout their lives, the age-specific death rates currently prevailing. The expectation of life at birth is heavily influenced by infant and early childhood mortality, because these deaths mean the loss of a whole lifetime, with a potential length of 60 to 70 years, Thus, countries with an infant mortality rate of 100 per 1000 live births can be expected to have an expectation of life at birth below 55 years. Life expectancy at age 65 years can also be computed from a life table. If life expectancy at birth is heavily influenced by infant mortality rates, life expectancy at 65 years is influenced by deaths later in life. This largely reflects lifestyles that erode health, such as drinking alcoholic drinks to excess or smoking, and how the government protects people from premature deaths from noncommunicable diseases such as cancer, diabetes and cardiovascular diseases, which are prevalent in the later years of life.
P,_e;,...J(t;J,4..Cj YA-t;ir Conventionally, the total dependency ratio is computed by dividing the sum of the number of persons less than 15 years of age ( 0-14 years) and the number of persons 65 years of age and over (the 'dependents') by the number of persons in the 'working population', or those aged 15-64 year. The answer is then multiplied by 100. In effect, this determines how many 'dependents' there are per 100 'working persons'. The ratio can be broken down into the young dependency ratio and the old dependency ratio, using the number of persons Q-14 years as the numerator, or those 65 years and over as the numerator.
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Percentage urban is the number of persons defined as 'urban' per 100 population. A most important and specific limitation of this term lies in the national differences in the definition of urban. A place or area may be classified as urban based on one or more of the following: size of population; population density; distance between built-up areas; predominant type of economic activity; conformity to legal administrative status; or urban characteristics, such as specific services and facilities. Knowing the degree of urbanization in a country is important in understanding the situation of older persons in society. For example, the positive roles formerly played by the elderly in traditional societies may be eroded in the process of urbanization. Also, the increased importance of the formal sector in urban areas may lessen the ability of the elderly who have been previously engaged in agriculture to support themselves by engaging in productive employment. In both instances, the elderly can be marginalized
B. Methods of data gathering and quality of data The main source of data was the country reports submitted to the WHO Western Pacific Regional Office in response to the call for information. It was not always possible to obtain comparable data for each country and coverage of each indicator was not always consistent. Country Health Information Profiles (CHIPS) and many country reports did not contain gender-disaggregated population data. For information on the policies and programmes for the elderly, reliance was primarily on country reports and mission reports of WHO consultants. The amount and quality of information varied from one country to another, depending on the priority each government placed on ageing issues.
1-:i{t e:ry-tet~j This is a summary index obtained from a life table. A life table consists of a series of functions of a hypothetical cohort, such as the probability of dying, the number of survivors, the total
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The Samoan culture is still very much alive in American Samoa. Within that culture, the extended family is responsible for the care of its members. This family support network usually ensures that the elderly have transportation access to health services and get routine home care such as bathing and other personal care activities. However, there is an increasing number of older American Samoans who need more skilled nursing care than that provided by family members. There are still no home health care agencies in the country, and only one agency that provides skilled nursing care for a very limited number of older persons. Public health field nurses periodically visit the homes of the elderly and disabled individuals to provide health education and nursing care. Elderly patients who require tertiary care services not available within the territory may be referred to off-island providers, if approved for referral by the hospital referral committee. Referral care is provided free of charge to such patients. The State also provides monthly food vouchers to those eligible, and subsidizes a 25% discount on eyeglasses, wheelchairs, walkers, hearing aids and other medical devices. Other services include transportation, escort services, legal services and information and referral.
Reflltenca: 2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific. 2003. (2) Health ofOlder Persons in the Western Pacific Region. Country Profiles: Manila WHOWestem Pacific Regional Office. 1998. (3) PrlceM.Misslon report:Pago-Pago,Amerlcan Samoa,4-7 June 1997. WHOWestem Pacific Regional Office {RS/97/0294). (1)
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HOW MANY OLDER PERSONS (June 2002) Total Population 19 707190 (19 925 000 in 2003) Age Groups Total Male Female DEPENDENCY RATIOS Year Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off (per 100)
The total dependency ratio of 48.66 per 100 is comparatively low. The increasing age of the population will result in an increasingly higher aged dependency ratio, estimated to be 18.71 per 100 in 2005. MORTALITY DATA 65+ 24994700 1106100 1 388 700 80+ 632000 225 700 406300
60+ 3 344000 1 531 600 1 812 400
2000 2005
Total Dep. Ratio 58.36 58.34
Old Dep. Ratio 25.68 27.42
Total Dep. Ratio 48.66 47.50
Old Dep. Ratio 17.98 18.71
The leading causes of mortality in the general population are chronic, noncommunicable diseases. The main causes of death for both women and men aged 65 years and over are diseases of the circulatory system, cancers and diseases of the respiratory system, with these accounting for over 75% of all deaths among people in this age group. For both sexes, the most common causes of morbidity revealed from hospital separation data and principal diagnoses are malignant neoplasms, ischaemic heart disease, diseases of the musculoskeletal system and connective tissues, diseases of the digestive system, and other heart diseases. The leading causes of death for the 65 years & over were coronary artery disease, stroke, cancer (prostrate cancer for males, breast cancer for females) emphysema and accidental falls.
LIFE EXPECTANCY
At birth 77.0 82.4 1.7
At65yrs 17.2 20.7
Male Female TOTAL FERTILITY RATE URBAN
84%
MEDIAN AGE 35
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As of 2002, 16.9% of the population were aged 60 years and over and 12.7% were 65 years and over. The total population in 2002 was 19 707 190. The majority of older people were women. The country is 84% urban. Life expectancy at birth was high, at 77.0 years for males and 82.4 years for females, in 1999-2001. Life expectancy at an older age is also high. In 1999-2002, a 65-year old male could still expect to live 17.2 more years, while a female could expect to live some 20.7 more years.
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A major initiative for Australia has been the development and adoption of the National Strategy for an Ageing Australia, providing the foundation on which to develop new policies and engage the community in responding to the diverse needs of older people and the challenges of the future demographic changes as the country's population ages over the next 50 years. Several national coordinating mechanisms are in place, including the National Advisory Committee on Ageing. The Commonwealth, State and Territory Strategy on Healthy Ageing provides a mechanism for coordinating activities between governments on community attitudes, health and well-being, work and community participation, sustainable resourcing, inclusive communities, appropriate care and support, and research and information. In programmes, a major initiative undertaken by the Australian Government to address issues in the care of the elderly is the Home and Community Care Programme (HACC). It is directed at assisting frail, aged persons at risk of being admitted to long-term residential care when they do not need to be. The programme aims to provide a range of basic support and maintenance services to enhance people's independence in the community and avoid premature or inappropriate admission to long-term residential care. About 2900 organizations provide community care services to 25 000 older clients over any three-month period through this scheme. In addition, a programme of community aged care packages (CAPS) provides support for people who prefer to remain at home but who require care equivalent to low-level care provided in residential aged care, and an Extended Aged Care at Home (EACH) programme supports people at home who require care equivalent to high-level care provided in residential aged care. The Aged Care Act was enacted in 1997 and has subsequently provided for reforms including the restructuring of the residential aged care system, and improving access and care for people who are financially disadvantaged. Promotion of healthy ageing is considered vital given the ageing of the population. Accordingly, the Healthy Ageing Task Force was established by the Health and Community Services Ministers in 1996 to develop a national healthy ageing strategy. The Task Force is composed of members from the Commonwealth and from each State and Territory. At present the Government is undertaking national consultations about the themes and issues that will form the focus of the national strategy .
Australia has a well developed aged care system which comprehensively addresses the needs of older people. Relatives and friends provide 70% of care. Older women are usually the carers for husbands, grandchildren and the disabled. To support the function of the family in care giving, the Home and Community Care Program (HACQ was established. The HACC programme provides funds for community nursing, home care services, personal care services, meals on wheels, community transport, respite care, day care centres, allied health care, home maintenance and repairs, and home modifications (ramps, rails, etc.) for frail older people with physical, medical or psychological needs which cannot be met in the community and who need ongoing access to nursing care. There are over 1480 nursing homes in Australia, providing some 75 000 beds. Hostels target frail older persons who do not require ongoing access to nursing care. It provides services such as domestic services and assistance with activities of daily living. Government health care services are provided through a network of health facilities, ranging from primary-level to tertiary-level care. As of 1994, there were 702 public acute care hospitals, 30 public psychiatric hospitals and 1457 nursing homes. A universal health insurance scheme, Medicare, financed through income tax, helps pay most of the medical costs for all Australians. Income security is one of the most important needs of older persons. Australia provides an age pension which is a flat rate, non-contributory payment funded from general revenue. It is not linked to previous labor force participation. It is both income and assets-tested, and is thus targeted at those in need. It is payable to men at age 65 years and women at 61 years. There is no statutory retirement age in Australia. The retirement incomes system envisages a possible span of retirement between the ages of 55 to 70 years, during which retirement savings can continue to accumulate or retirement income can be accessed. In addition to the publicly-funded age pension, Australia has a compulsory superannuation system which has the objective of facilitating the accumulation of private savings for retirement.
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Australia provides educational opportunities for older people. It has a wide network of the "University of the Third Age", where older people undertake courses in a variety of subject areas. The more recent Open Learning Initiative, where higher education is offered via the national television station backed up with printed learning modules, has provided substantial opportunities for disabled older people confined to their homes or in remote areas. Private organizations also play important roles in the provision of age care services. Private (for-profit) organizations, and not-for-profit organizations, also provide nursing homes and hostels. Self-help groups and political lobby groups, such as the Older Persons Action Centre, are developing all over the country. Activities independent of government include commercial ventures such as the 'rent a granny scheme' where older women provide a child-minding and 'grandparenting role' to families without grand-parents. The 'grannies' earn an income and play a socially important role.
~DOIS:
(1) (2) (3) (4) (5)
2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission fur Asia and the Pacific, 2003. World Population Prospects: The 2000 Revision. New York. United Nations, 2001.
(6) [7)
(8) (9) (1 OJ (11) (12)
Demographic YeGrbook 1998. New York. United Nations, 2001 OlderAustralia at a Glance, Third edition, October 2002. Downloaded from the website of the Commonwealth Department of Health and Ageing (www.heGith.gov.ou) Australian Social Trends 1999 (Health ·Health Status: Health ofOlder Persons). Downloaded from the website of Australian Bureau ofStatistics (www.ob.s.gov.aW'AusstaWob.s@.nsf) Aged care in Australia- August 2002. Downloaded from the website of the Commonwealth Department of Health and Ageing (www.heGith.gov.aW'acdoboutlogedaustlogedaus1.htm) Raclc L, Stuart, A. Australian l'edetaiGovemmentPerspectlw: Country Paper. Paper submitted at the W01kshop on Health and Ageing • Research, Education, Policy and Practice: Adelaide, Australia, 26 • 30 October 2000. TMn!'s No Place Ulce Home. Special Article, Year Book Australia, 2000. Downloaded from the website of Australian Bureau ofStatistics (www.ab.s.gov.au/AusstaWobs@.nsf) HeolthafOider Persons In the Wesl!!m Pacific Region: Country Profiles. Manila, WHO Western Pacific Regional Of!lce, 1998. Australian SocloiTrends 2000 (Health - Mo111JIIty and Morbidity: Suldde). Downloaded from the website of Australian Bureau of Statistics (www.obs.gov.aW'AusstaWob.s@.nsf) Table: Separations for moles byage group and principal diagnosis in ICD-1CJ-AM groupings. all hospitD/s.Austrofio_ 2000-01. Downloaded from the website of Australian Institute of Health and Welfare (www.aihw.gav.aul) Table: Separations forfrmales by age group and prindpaldiagnosis in ICD-10-AM groupings. all hospitals, Australia, 2000-01. Downloaded from the website of Australian Institute of Health and Welfare (www.alhw.gov.aul)
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HOW MANY OLDER PERSONS (2000) Total Population Age Groups
328 000 (347 000 in 2003) 60+ 65+ 80+
Total Male Female DEPENDENCY RATIOS Year
16000 7000 9000
10000 4000 6000
1000 0 1000
Dependency ratio 60+ cut-off (per 100)
Dependency ratio 65+ cut-off (per 100)
Total Dep. Ratio 59.98 55.93
Old Dep. Ratio 8.30 8.71
Total Dep. Ratio 55.19 51.20
Old Dep. Ratio 5.06 5.41
2000 2005 LIFE EXPECTANCY Male Female
At birth
74.2 78.9 2.5
MORTALITY DATA The leading causes of death for all ages are cancer, heart diseases (including acute rheumatic fever), diabetes mellitus, cerebrovascular diseases, bronchitis, chronic and unspecified emphysema and asthma.
TOTAL FERTILITY RATE URBAN 73%
MEDIAN AGE 26
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Brunei Darussalam has a young population: persons 60 years and over comprised 4.8% of the total population of 267 800 in 2000. Those aged 65 years and over comprised just 3.0% of the total population for the same year. There were more males than females in the general population. Among older persons, there is no significant difference in the proportion of males and females. Life expectancy for males was 74.2 years and 78.9 years for females in 2002. The dependency ratio is comparatively low at 53 per 100, with aged dependency at 6.06 per 100.
There is a growing realization that more attention should be given to improving the delivery of rehabilitation services within the framework of comprehensive national policies, particularly for older persons. This is reflected in the National Health Care Plan (2000-2010) of the Ministry of Health. Among the objectives of the plan is the provision of easily accessible rehabilitation facilities and programmes in collaboration with other sectors by 2004. The plan also stresses the need to give priority to primary health care as a means to support and maintain healthy lifestyles to prevent disease and disability in the most effective and equitable way.
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Each of the country's four districts has one hospital. Rehabilitation services are available in each hospital, as well as day centers, but access to these services is difficult for those who live far from the hospital. Availability of referral services is limited. Regular rehabilitation services are not generally available at the community level or integrated with other community and higher-level services. Aggravating the situation is the shortage oftrained and qualified rehabilitation professionals. There is no effective coordination among government ministries, agencies and nongovernmental organizations involved in disability-related concerns. Notwithstanding the increase in the incidence of chronic and degenerative conditions associated with ageing, there are no specific services that focus on disability prevention and rehabilitation of older persons. The elderly population use general health services. The essential policy of the Government is to maintain the elderly within the family. Elderly persons live with their adult children who are expected to look after them.
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Older Persons are admitted to the general hospital (RIPAS Hospital) for medical care as needed- there are no specialized geriatric services. There are at present few community services in Brunei Darussalam. Care provided by a steady supply of affordable amahs means that the usual spectrum of community services commonly found in other countries (home helps, meals-onwheels, laundry services, social day care, etc.) may not be required by the majority of households, except for the poor who cannot afford amahs.
(1) 2003 ESCAP Population Data Sheet. Bangkok, United Nations Economic and Social Commission for Asia and tne Pacific, 2003. (2) WolfdPopulatlonProspects: The2000R~Ion. New York, United Natlons,2001. (3) Health ofOlder Persons in the Wesll!m Pacific Region: Country Profiles. Manila. WHO Western Pacific Regional Office, 19911. (4) Jin, PCN. Mission report Brunei Darussalam, 15 August-7 September, 1999. WHO Western Pacific Regional Office (MR/1 999/0478). (5) Periquet A Mission report Brunei Darussalam. 23 July- 13 August 2001 . WHO Western Pacific Regional Office (MR/2001/0981). (15) SummoryofCountry Reports. Workshop on Health and Ageing- Research, Education, Polley and Practice: Adelaide, Australia, 215- 30 October, 2000
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MORTALITY DATA
HOW MANY OLDER PERSONS {2002} Total Population 13 204 000 (1 4 144 000 in 2003) Age Groups Total Male Female DEPENDENCY RATIOS Year Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off (per 100)
Leading causes of death are malaria, acute respiratory infections, tubercolosis, gynaecological and obstetric deaths and meningitis. 65+ 367 000 128000 239000 80+ 40000 16000 24000
60+ 571 000 205 000 366000
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The Health Care for Elderly and bisabled Policy, established in 1999, aims to achieve the following: (1) Improve the welfare ofthe elderly and disabled people i. provide special care to the elderly and disabled people with the establishment of preventive geriatric services in the national hospital, referral hospitals and health centres; ii. provide free health care to very old and disabled people who have no income. (2) Human resources training i. introduce health care for the elderly and disabled into the basic training curriculum for nurses and undergraduate medical training at the University of Health Sciences; ii. continue the professional training of health staff on health care for the elderly and disabled people at all levels; iii. long-term training oftrainers on geriatric care and rehabilitation in order to improve the quality of care. (3) Promote healthy ageing i. support health education for the elderly through mass media campaigns on practical rehabilitation, daily exercise, nutrition, diet, changing eating habits, personal care and environmental hygiene; ii. integrate health education for the elderly and disabled into the health education system of the other national programmes within the national referral hospitals and health centres; iii. develop and inform, through different media, about aged care and primary prevention of illnesses among older people in order to promote healthy ageing, and how to have a dignified old age.
2000 2005
Total Dep. Ratio 84.22 86.15
Old Dep. Ratio 8.93 8.68
Total Dep. Ratio 79.49 80.04
Old Dep. Ratio 5.55 5.11
LIFE EXPECTANCY Male Female TOTAL FERTILITY RATE URBAN
At birth
53.26 58.6 4.7
17%
MEDIAN AGE 18
Pt:#wJ vAJ'It-ic A#A ~tit- rv~fi lt As of 2000, 4.3% of the population were aged 60 and over and 2.8% were 65 and over. The total population for 2002 was 13 204 000. The majority of older people were women. The country is 83% rural. Life expectancy at birth is relatively low at 53.26 years for males and 58.6 years for females in 2000. The total dependency ratio of 84.22 per 100 is comparatively high, but the aged dependency ratio, computed at 5.55 per 100 in 2000, is quite low. The total dependency ratio of 84.22 is comparatively very high and the aged dependency ratio, computed at 5.55 in 2000 is quite low.
13
CA/vt-$0PIA
(can't.)
(4) Provide special care for old people in the community i. set up an appropriate pilot project on community-based nursing care for very old people with strong involvement from the Government, the community, international organizations, nongovernmental organizations and Cambodian elderly associations; ii. promote nursing care for disabled people in order to encourage and support them in positive attitudes towards an intergenerationalliving environment; iii. promote community participation in the areas of social welfare and reporting and refering the health situation of very old and disabled people to the nearest heath centre.
~i>'~+YCM
tvY tk ~tAew~
There are no specific services for the elderly, who are provided for by the general health care services. The two most serious problems at present are poverty and lack of competent and affordable health care. The vast majority of ageing people are poor and still work for their living. Declining physical strength means a declining income which leads to a decline in quality of life. Some elderly people are childless or have lost their children during wars and, therefore, have no one to support them as they become older. For these reasons, many elderly people are living in conditions of poverty, hardship and fear of the future.
(1) 2003 ESCAP Population Data Sheet. Bangkok, United Nations Economic and Social Commission fer Asia and the Pacific,2003. (2) WorldPopulationProspects:The2000Revision. New York, United Nations,2001. (3) Health ofOlder Persons in the Western Pacific Region: Country Profiles. Manila, WHO Western pacific Regional Office, 1998. (4) Ageing in Cambodia- Country Report. Paper submitted at the Workshop on Health and Ageing- Research, Education, Polley and Practice: Adelaide, Australia, 215- 30 October 2000. (5) Country Health lnformatlan Profiles,200T Revision. Manila, WHO Western Pacific Regional Office, 2001.
14
HOW MANY OLDER PERSONS Total Population 1 275 133 000 (1 319 767 in 2003) Age Groups
60+ Total Male Female DEPENDENCY RATIOS
65+ 87427000 40228000 47199 000
80+ 11 525 000 4046000 7479000
128898000 61564000 67 334000
In 2000-2005, life expectancy at birth is higher for females (73.5 years) than males (69.1 years). The dependency ratio for 2000 was comparatively low at 46.37 per 100, with young dependency comprising the main bulk of the dependency burden. The old dependency ratio was 10.02 per 100. MORTALITY DATA The leading causes of death in the general population in 1995 were noncommunicable diseases such as cerebrovascular disease, malignant tumours, coronary disease and respiratory disease. In general, mortality rates from cerebrovascular disease, malignant tumours and heart disease were higher in urban than in rural areas. Mortality rates from injury and poisoning, on the other hand, were higher in rural areas. In 1995, the main causes (of mortality) for those 60 years and over were cancer, stroke, respiratory diseases (chronic bronchitis, chronic obstructive pulmonary disease), and coronary disease in urban areas, but respiratory diseases, stroke, cancer and cardiovascular disease were the main causes of death in rural areas.
Year
Dependency ratio 60+ cut-off (per 100)
Dependency ratio 65+ cut-off (per 100)
2000 2005
Total Dep. Ratio 53.68 48.40
Old Dep. Ratio 15.52 16.09
Total Dep. Ratio 46.37 41.45
Old Dep. Ratio 10.02 10.65
LIFE EXPECTANCY Male Female
At birth (2000-05) 69.1 73.5 1.8
At60yrs 15.5 (1990) 18.4 (1990)
TOTAL FERTILITY RATE URBAN 39%
MEDIAN AGE 32
p~,.,.~h-ic AA+A h-uJth, r,.,.1r{Ilt China is the most populous country in the Region. For 2002, it had an estimated population of 1 292 656 000. By 2020, the total population is expected to reach about 1.5 billion. In 2001, 10.1% of the total population were 60 years of age and older and 6.8% were 65 and older. While the percentages are small, the absolute numbers of these sectors are large: more than 186 and 87 million in all, respectively. This makes China the country with the largest number of older persons in the Region. There are regional differencesin the percentage of older persons. For all age groupings in the elderly population, females outnumber males.
/'IAf11r,.,rJ r1r£icitJ AA+A r~YAMt.m.tJ 1997- National policy guideline on reform and development, which requires agencies to regard older persons as one of the most important groups needing health intervention and care. 1999 - Law of Right and Interests Guarantee for Old People to ensure social rights, independence, dignity and family support for the elderly.
15
C t<, fJ A • • • •
(con't.) China has integrated its community-based aged care services within the mainstream services, but implementation is uneven, with larger cities having better coverage than rural and isolated communities. Over 4000 community service centres have been established all over China There are many programmes for health promotion for the elderly, organized by the Ministry of Health and nongovernmental organizations. Most of them focus on activities for improving daily living, basic knowledge of eye care, and controlling blood sugar levels and blood pressure, as well as early diagnosis of glaucoma in the elderly. A research training centre for health promotion activities is being established in Beijing. It is a facility for teaching and training of community care staff (doctors, nurses and others) and also for research. This centre is affiliated with the Beijing Institute of Geriatrics. The Ministry of Health has established an in-service postgraduate training system for physicians, which includes geriatrics as a component. This type of training is also offered in nine medical schools and is available to nurses and community health managers. A teaching curriculum is available which includes nursing care for the elderly, and prevention and treatment of diseases common in the elderly, as well as the concept of ageing. For primary health care workers, whose training is 4 - 8 weeks, the textbook Guideline on primary health care in rural areas, with a chapter on health care for the elderly, has been published by the Ministry of Health Department of Medical Administration. Rural health workers must have at least six months training in general medicine and public health. Their training programme includes some training in health care for the elderly and long-term illness.
The Goverment of China has proposed policy reforms in the following directions: The health care delivery system will be more closely based on the actual demands of old people, by developing comprehensive, community-based health care for older persons; better health care for older persons in remote rural areas and minority regions; further improvement in the health insurance system for older persons; and health education and control of noncommunicable diseases, which afflict mostly older persons.
~v,.,YCt4/ Fry t~
e;[Aewl.J
China sees its major resource for the care of the elderly as the family. However, in the light of demographic, social, political and economic changes which have started to erode some of the functions of the family, China is making provisions to support and assist the family in its function of caring for the elderly. Volunteer activities are supported by the Government to provide assistance to the elderly. Volunteers from local government enterprises, workers unions, young people's organizations and religious groups are responsible for helping many people living alone. Special schools for the aged and centres for recreation have been put in place by the Government. The Ministry of Civil Affairs provides economic assistance to the poor, including the elderly and their families. Health insurance is available, but mainly in urban areas. The Government is now instituting a cooperative medical insurance system in the countryside to improve access to health care. A network of medical and preventive services at the county, township and village levels provide comprehensive health care to the population. In medium-sized cities in the eastern and middle regions, health services have been expanded to include health education, periodical check-ups of individuals and families, home health care, nursing, rehabilitation and others. These services are being carried out by general practitioners, community health workers and other volunteers. There are geriatric institutes in some national hospitals.
,.,.,._ {1) 2003 ESCAP Population Data Sheet Bangkok, United Nations Economic and Social Commission for .Asia and the {2) World Population Prospects: The 2000 Revision. New York, United Nations, 2001. {3) Zhu Honmln. Strotegy on Health Core of the Elderly: Post, Present and Future In Chino. Paper submitted at the {4) FrameviOrkfor Discussion ofAgeing and Health lnues in China. Manila, WHO Western Pacific Regional Office. {5) Updating the Profiles on Ageing and Health in China. Manila, WHO Western Pacific Regional Office. {6) Guidelines for National Policies and Programme Development for Health ofOlder Persons. Manila,
Pacific,2003.
Workshop on Health and Ageing- Research, Education, Polley and Practice:Adelaide,Australla,26- 30 October 2000.
WHO Western Pacific Regional Office, 1998. {7) Kq lndlcotors 2002: Population and Human Resoura! Trends and Challenges.
From the website of Asian Development Bank (http://www.adb.org/documentt/bookl/lcey-indicotors/2002/rtal.xls)
16
HOW MANY OLDER PERSONS Total Population 19 103 (20 000 In 2003) Age Groups (1996)
60+
65+ 1025 529
80+
Total Male
Fem.lle DEPENDENCY RATIOS
1620 851 769 o..,.ndency ratio 60+-
136
55 81
496
YHr 2000 2005
cut-off,.,., 100) 14.89 17.14
DeDMtchncY ratio 65+ cut-off (par 1 00}
Total Dep. Ratio 75.56 79.72
Old Dep. Ratio
Total Dep. Ratio 66.46 69.29
Old Dep. Ratio 8.94 1034
LIFE EXPECTANCY
Mille Female TOTALFERTILITY RATE URBAN 60% 3.7
At birth 70.0 73.0
JJM;j(r,..,M, rtictt<l M+A rYijYMM.Ut.tJ There is, as yet, no policy on care of the elderly. However, a draft policy statement on the care of the elderly, developed by a workshop which included key government officials, is to be referred to the existing government planning process for adoption.
MEDIANAGE 31
t>~~~ic AM-A k.MJt~t- rii>Vfl~,; The population of Cook Islands was estimated at 19 103 in 2002. Of this number, 6.9% were 60 years of age and older and 5.64% were 65 and over. The country Is 60% urban.
'R#(r~tc.~ fv~ t~ ~LA~~f1 Existing community-based health services are already well developed. Older persons are able to access this community health services in the same way as persons of any other age. The responsibility fur care falls on the elderly themselves and their families. However, the extended family system is showing sign of breaking down as society moves towards a cash economy. Community groups, such as youth groups and women groups,visit individual families at home.
MORTALITY DATA The present leading causes of mortality are diabetes, diseases of the circulatory system, diseases of the respiratory system, neoplasms, motor vehicle accidents and other accidents.
17
Coo~
fSJ-AfJf>S ccon't.J
Old age pensions of US$ 100 fortnightly are available to all eligible persons of 60 years and above. The Ministry of Health provides health services for patients and outpatients in clinics and community-based settings. Dental care is also provided without cost. The cost of medicines, services, etc. is borne by the Government. Public health nurses provide services and home visits and are well informed on a wide range of issues concerning health care of older persons. Access to specialized rehabilitation is limited.
United Nations ESCAP Population Data Sheet,2003 Country Health Information Profiles, 2001 Revision, WHO {3) Health of Older Persons In the Western Paclflc Region, Country Proflles:World Health Organization, 1998 {4) Mission Report of Dr. Michael Price, Health or Older Persons, Rarotonga, Cook Islands, 21 - 27 June 1997, ICP/AHE/001 , RS/9710430 {5) Survey Form for the Country Profile on Ageing and Health in WPRO from Dr. Han Tieru, WR.Samoa, 1 October 2002 {1) {2)
18
HOW MANY OLDER PERSONS (2000) Total Population 814 000 (840 000 in 2003) Age Groups (1996)
MORTALITY DATA The leading causes of mortality are a mix of infectious and chronic/noncommunicable diseases. Diseases of the circulatory system were the leading cause of mortality in 1994. There is a high prevalence of chronic disabling, largely preventable diseases like hypertension, diabetes mellitus, obesity, heart disease, stroke and chronic lung disease in persons of working age and in the young old (60-74 years). Mortality and hospital admissions due to cardiovascular and diseases mellitus have also been increasing steadily over the past 30 years. Data compiled from the Ministry of Health annual reports show a rising trend for stroke.
60+ Total Male Female
65+ 28000 13000 15000
80+ 4000 1000 3000
47000 22000 25000
DEPENDENCY RATIOS Year DependenCY ratio 60+ cut-oH (per 100) Total Dep. Ratio Old Dep. Ratio 68.09 8.63 64.26 9.62 DeDendencv ratio 65+ cut-off (Der 100) Total Dep. Ratio Old Dep. Ratio 62.64 5.11 58.16 5.55
fJAtJv~M. "f"lici~ AM-A rY9JYAM1--11K-~ There is, as yet no policy or programme for older people. An intersectoral workshop was held in 1997 to formulate a policy for the care of the elderly.
2000 2005 Male Female
LIFE EXPEOANCY
At birth 68.1 71.5
'fl..t;.rviM''Ct:J
fvr ~ ~tAtwlj
TOTAL FERTILITY RATE URBAN 51%
2.9
The majority of older people are cared for in the home. A tendency towards nuclear families is observed. A small number of older people are assisted on an ad hoc basis by carers from various nongovernmental organizations (NGOs). A few NGOs also run homes for the aged. The Government is the major provider of formal aged care services. It has established a number of homes for the aged, where about 0.4% of older people are now residing.
MEDIAN AGE 24
t>lM1Aj YAJ'"-1c AM-A kM-~;h, rYiTP ~ The total population of Fiji was 814 000 in 2000, with 5.7% aged 60 years and over, and 3.4% aged 65 and over. This makes Rji's a relatively young population. There were slightly more males than females in the general population while, among older people, females outnumbered males, especially in the 65+ age group. The country is predominantly rural. Life expectancy at birth was higher for females than males, at 71.5 years vs. 68.1 years, in 2002. For 2000, the dependency ratio was estimated at 62.64 per 100, with an aged dependency of 5.11 per 100.
19
ru
f (con't.)
The principal social service available to older persons is in the form of limited Family Assistance, provided to those who are without family support. The government has also instituted a social security scheme for the elderly. Those who were previously employed enjoy retirement benefits and the National Provident Fund system has been created to provide income support for older people. Government medical practitioners at divisional and subdivisionallevel hospitals and health centres provide health care to the general population. Only a few older people who qualify for the Social Welfare means-tested exemption certificate are completely exempted from any costs for health care services and essential medication. There is no special provision for the needs of older people in primary health care.
(1) 2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific. 2003. (2) World Population Prospects: The 2000 Revision. New York. United Nations, 2001 . (3) Health ofOlder Persons in the Western Padfic Region: Country Profiles. Manila, WHO Western Pacific Regional Office, 1998.
(4) FIJI Country Report. Paper submitted to the Workshop on Development of Programmes for Health of Older Persons,Seoui,South Korea,4-7 June 1999. (5) Letter from lloiT.Rabuka,Assistant Director Nursing Services (Community Health) to Dr. Linda Milan re: Updating of profiles on ageing and health. 19 October 2000. (6) ~y Indicators 2002: Population and Human Resource Trends ond Challenges. From the website of the Asian Development Bank (http//Www.adb.orgldocumenWboo/Wkey-/ndicotors/2002/rto/.xJs
20
HOW MANY OLDER PERSONS (2000) Total Population 233 000 (244 000 in 2003) Age Groups (1996)
fJMfi1r~+AJ -r-£ic1N 11M-Jf rri1JY~~N The Generalized Social Protection or PSG has improved the living condition of the elderly in French Polynesia by providing them with sickness insurance/coverage. There is a proposal to develop programmes that would provide home support and long stay centres for the elderly who have lost their independence, implement a Gerontological Prevention Programme, encourage independence and recognize the economic contribution of older persons in society.
60+ Total Male Female
65+ 9000 4000 5000
80+ 1000 0 1000
15 000 7000 8000
DEPENDENCY RATIOS Year Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off (per 100)
'/Zt;.JvwrCt;.J [vr Old Dep. Ratio 9.99 11.13 Total Dep. Ratio 59.77 54.52 Old Dep. Ratio 5.90 6.75
-&k e;lJ/t;r0
2000 2005
Total Dep. Ratio 65.94 60.85
LIFE EXPECTANCY Male Female TOTAL FERTILITY RATE URBAN 2.4
At birth 70.7 75.8
The family provides care and support to the elderly. In urban areas, however, many families find it difficult to provide care. Incidences of abandonment and even maltreatment of the elderly have been reported. With about 9% {US $300 million) of the gross domestic product currently spent on health, nearly all of the population have ready access to quality health care. Home support for the elderly has been made possible by the PSG. Where home support is not possible, the following alternatives can be resorted to: family placements, admission to the CAPA, admission to the ARUE retirement home and the Te Tiare convalescent centre after a period of hospitalization. Community-based services are still limited in scope and coverage and programmes on healthy ageing need to be established and widely implemented to reduce the noncommunicable disease burden. Income security for the elderly is maintained through retirement pension benefits to the previously employed, and an old age allowance equivalent to 60% of the prevailing minimum wage for older persons without revenue and residing in the Territory for more than 15 years. Part-time work for the elderly is also encouraged and supported.
51%
MEDIAN AGE 26
P~r~~ic 11M-A Wt~ rwfil(l} In 2000, 6.4% of the population of 220 000 were 60 years of age and older and only 3.86 were 65 and over. In the older population, females outnumbered males in all age groups. The country is 51% urban. Life expectancy in 2000 was 70.7 years for males and 75.8 years for females. The dependency ratio (2000) is high at 59.77 per 100, with an aged dependency of 5.9 per 100. References (1) 2003 ESCAP Population Dam Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific, 2003. (2) World Population Prospects: The 2000 Revision. New York, United Nations, 2001. (3) Health ofOlder Persons in the Western Pacific Region: Country Profiles. Manila, WHO Western Pacific Regional Office, 1998.
21
t<o-N4 ~N4 (C~INA) HOW MANY OLDER PERSONS (2000) Total Population 6 860 000 (7 028 000 in 2003) Age Groups 60+ Total 982000 477000 M•le Female 505000 DEPENDENCY RATIOS Year DeDendencv ratio 60+ cut-off (Der 100) DeDendenc:v ratio 65+ cut-off (Der 100)
MORTALITY DATA Leading causes of mortality are predominantly noncommunicable diseases. The elderly as a group have a higher prevalence of health problems, including many chronic and degenerative diseases like hypertension and diabetes. Some non-fatal diseases can also adversely affect the quality of life of the elderly significantly. Outstanding examples are cataract and arthritis. About 7% of elderly persons suffer from depression and elderly suicide is also an important issue. According to local studies,4% of the elderly aged 65 or above, around 25 000 people, suffer from dementia. In 1997, the most common causes of mortality for both sexes were: malignant neoplasms6576 (28.3 %of deaths), heart disease, including hypertensive heart disease- 3928 (16.9 %}, all forms of pneumonia - 3703 (15.9 %), nephrotic syndrome and nephrosis - 829 (3.6 %), and septicaemia- 559 (2.4 %).
65+ 726000 340000 386000
80+ 137000 52000 85000
Total Dep. Ratio 46.01 42.07
Old Dep. Ratio 20.78 20.93 At birth 77.3 82.8
Total Dep. Ratio 38.53 35.56
Old Dep. Ratio 1459 15.39
2000 2005
LIFE EXPECTANCY Male Female TOTAL FERTILITY RATE URBAN 100% 2.4
At 60Jrs (1997) 20.3 243
/'JA-ti.,-,.M, rwl-tmu AM-A rv~YIMM-w..tJ Policies pertaining to the elderly have been formulated and updated through a range of administrative and legislative actions over the past decade. National legislation has also been passed in support of initiatives to improve the welfare of the elderly. These tnclude laws whlch provtde subsidies to the poor for medical expenses, and laws which regulate residential homes for the aged. A three-year "Healthy Ageing Campaign" was launched in September 2000.
MEDIAN AGE 37
Hong Kong is an ageing society. Of the total population of 6 860 100 in 2000, 143% were aged 60 years and above and 10.5 % were 65 and above. In the general population, there were approximately equal proportions of males and remales. In the older population, however, there were significantly more remales than males. The country is highly urbanized (1 00% urban}. Life expectancy at birth is among the highest In the world, at 77.3 years for males and 82.8 years for females In 1996. Life expectancy at 60 years Is also high for both sexes (203 years for males and 243 years for females). The dependency rat!o (2000) is comparatively low at 38.53 per 100, with a relatively high aged dependency rat10 of 14.59 per 100, reflecting the growing significance of older persons in Hong Kong society.
~./-vYWCt:J [vr t~ ~£A~rf:j In Hong Kong, the major source of tnformal support for the elderly Is the family. However, the family system in Hong Kong has undergone significant changes in the last two decades. Though Chinese culture favours the extended family, nuclear families have become the dominant family type. The percentage of elderly in Hong Kong who are residing with their children is still high compared with Western countries (80%), but there is a decreasing trend. The female elderly get less support from the famtly than the male elderly. The process of modernization and urbanization is slowly eroding the support system for the elder1y so that alternative or complementary systems are gradually bring developed.
22
About 43% of the elderly live in government-aided rental blocks and 5.6% in government home-ownership estates. About 1.8% live in institutions. Community support services are also provided, such as home-help services and day care centres. Geriatric services are provided in major hospitals. Eighty per cent (80%) of hospital care provided by public hospitals is run by the statutory Hospital Authority and 15% of primary consultations are obtained from general outpatient clinics of the Department of Health Community Nursing Services. There are 455 geriatric day places provided for elderly patients in public hospitals. Community nursing service, outreach community geriatric and rehabilitation teams of the Hospital Authority, as well as the elderly health centres and visiting health teams of the Department of Health, cater to the health needs ofthe elderly living in the community. Community geriatric assessment teams provide health assessment, counselling, curative treatment and health promotion activities for elderly using family medicine and multi-disciplinary team approach. Community psychogeriatrics teams provide outreach care and rehabilitation services for the elderly with psychiatric diseases/dementia. For public services, the medical fees are highly subsidized. Those who cannot afford the fees can apply for a waiver. Income security is maintained through a comprehensive social security assistance scheme and special needs allowance (including old age and disability allowances).
{1) 2003 ESCAP Population Data Shm. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific.2003. {2) World Populotfon Prospects: 1he 200() Revision. New York. United Nations, 2001 . {3) Demographic Yearbook
1998. New York, United Natlons,2001 .
{4) Country report: Hong Kong. China. Paper submitted at the Workshop on Development of Programmes for Health of Older Persons:Seoui,South Korea,4 • 7 June 1999.
{5) Health and ageing:Hong Kong, China. Paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice: Adelaide.Australia,26 · 30 October 2000. (6) Guidelines for National Pol/des and Programme Development for Health ofOlder Persons In the Western Pacific Region. Manila, WHO Western Pacific Regional Office. 1998.
23
MORTALITY DATA
HOW MANY OLDER PERSONS (2000) Total Population 127 310 000 (127 524 000 in 2003) Age Groups
60+ Total Male Female 31 420 000 13 740000 17 670 000
65+ 23 370000 9840000 13 530 000
80+ 5300000 1690000 3 610000
The leading causes of mortality for the general population are mostly chronic noncommunicable diseases. The leading cause was malignant neoplasms in 1994. In 1990, mortality rates for Japanese males were higher than for Japanese females for cancer, heart disease and cirrhosis. On the other hand, more females than males died from stroke in the same year.
t-tAtf-v~tJ rq-licr t;.J AM-A rY9J YA#t-m-t;.J In 1983, the Health Service Law for the Aged was enacted, providing free health care services for the elderly. In 1989, a more comprehensive approach to providing services for the elderly was drawn up. This was the Ten-Year Strategy to Promote Health Care and Welfare for the Elderly (Gold Plan).lts main objective was to develop the infrastructure for public health care and welfare services for the elderly. The New Gold Plan was established in 1994 to respond to the growing number of older persons needing aged-care services. The latest government plan is the Active 80 Health Plan for National Health Promotion.
DEPENDENCY RATIOS Year Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off (per 100)
2000 2005
Total Dep. Ratio 61.09 67.50
Old Dep. Ratio 37.23 43.91
Total Dep. Ratio 46.77 50.79 20.9 26.1
Old Dep. Ratio 25.04 29.55
LIFE EXPECTANCY Male Female TOTAL FERTILITY RATE URBAN 73% 1.3
At birth 77.8 85.0
At60yrs
~q-u-YCt;./
fvy
~
e;lJ{t;y0
MEDIAN AGE 37
.P~y'/"ft-ic
AM-A ~tit- ryq-flle;
Japan is an ageing society. Of the estimated total population of127 310 000 in 2002,24% or 31 420 000 were aged 60 years and over, while 18.3% or 23 370 000 were aged 65 and over. This makes Japan the country with the highest percentage of older persons in the Western Pacific Region. There were more females than males in the general population and among the older population. The country is 79% urban. Life expectancy at birth is the highest in the Region. Japanese males could expect to live up to 77.8 years and Japanese females to 85.0 years in 2002. Life expectancy at 65 years is also the highest in the Region. When a Japanese male reaches 65 years old, as of 1994, he could expect to live an additional20.9 years and the Japanese female, an additional26.1 years. The dependency ratio for 2000 was 46.77 per 100 and the old age dependency ratio was estimated at 25.04 per 100.
The family is still the major caregiver for the elderly, though this role is being undermined by socioeconomic changes necessitating most adult members of the family to work outside the home. Voluntary organizations in the community also provide welfare services such as home-help services. The Government is the major provider of formal health and welfare services. All citizens have access to health care due to the national health insurance scheme. The health insurance plan can be divided into three parts: employees' health insurance, community health insurance and health services for the aged. For the elderly, the scope of benefits includes medical and dental care, hospitalization, nursing, pharmaceuticals, home-based care and transportation. Health care is provided through a network of public health centeres, municipal health centres and social welfare offices. Geriatric health care is provided on an outpatient basis through day and short care health facilities and home visits, while geriatric wards and wards for medical care for senile dementia are available for inpatients.
24
JA'f>Af'J
(can't.)
The government pension system helps promote income security for the elderly. Presently, the Government is rebuilding the social security system to make it more cost-effective and relevant to the times. According to the document Welfare Vision for the 21st CenturyProspects Regarding Benefits and Burdens, the Government plans to establish an employment system in which elderly people with disabilities and women can fully use their abilities. It will also promote education for these groups to foster independence and creativity
Ret.nrncu (1) 2003 ESCAP Population Data Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific, 2003. (2) World Population Prospectt:The 2000 Revision. New York, United Nations,.2001. (3) Demographic Yearbook 1998. New York, United Nations,2001. (4) Health ofOlder Persons in the Western Pacific Region: Country Profiles. Manila,WHO Western Pacific Regional Office, 1998. (5) Kolnuma N. Long Term Core Insurance Put Into l'r!lctla for the Adv<JncedAge Society. Paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice:Adelaide,Australia,26- 30 October 2000. (6) Endo H. Health Policy and Research Trends in Japan. Paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice: Adelaide, Australia, 26 - 30 October 2000. (7) Ministry of Health, Labor and Welfare Website (www.mhlw.go.jplenglishlorg/policylp.32.htmi/J, 2002. (8) Japan Statistics Website (www.stat.go.]p/engllshldota/]lnsuV2uhyou115k2.1.xls),2002. (9) Guidelines for National Policies ond Programme Development for Health ofOlder Persons in the Wtitem Pacific Region. Manila, WHO Western Pacific Regional Office, 1998.
25
HOW MANY OLDER PERSONS (2002) Total Population 92 000 (93,000 in 2003) Age Groups (1 996)
/JA-tiiT,.,AJ riTlici t;J AM-A rYij rAMi.m.t;J 65+ 3178 1325 1842
60+ Total Male Female DEPENDENCY RATIOS Year Dependency ratio 60+ cut-off (per 100)
80+
48975 23888 25087
-
A policy statement made by the President during the inaugural First Meeting of the House Parliament stated that the general welfare, position and status of older people will be promoted and improved. To carry out this policy, the Government created the Ministry of Environment and Social Development. While to date there are no national programmes for the elderly, a National Ageing Symposium has been held to plan strategies and programmes to address their needs.
Dependency ratio 65+ cut-off (per 100)
Total Dep. Ratio
Old Dep. Ratio
Total Dep. Ratio
Old Dep. Ratio
2000 2005
87.07 85.54
10.09 9.78
80.52 79.31
6.23 6.09
LIFE EXPECTANCY (1995-97) Male Female TOTAL FERTILITY RATE URBAN 40% 4.5
At birth 61.0 67.0
MEDIAN AGE 20
t>~,.wrk-ic
AM-A kMJtk. r,.iT[fl~; '/Zt;J-.ru.-YCt;.f
Of a population of 82 000 in 2002, only 4% were 65 years old and over. Females outnumbered males, especially in the older age groups. The country is 60% rural. In 2000, life expectancy for females was 67 years while males had a life expectancy of 61 years. The dependency ratio in 2000 was 80.52 per 100, with an aged dependency ratio of6.23 per 100. MORTALITY DATA The leading causes of mortality include cardiovascular conditions, gastrointestinal diseases and liver diseases. Other causes are "general debility" and noncommunicable diseases.
~y
tk t;[At;y':!J
Health care and the maintenance of the well-being of the elderly person is the primary responsibility of the family. In this traditional society, the family brings honour to itself by providing quality care to its elderly members, as older people have a high status in the family and in the community. There are indications, however, that economic conditions which are transforming the society from a subsistence to a cash economy are undermining the traditional role of the family as the major caregiver of the elderly.
26
~11ZI$ATr (con't.) Aside from the family, informal sources of care hardly exist. Sometimes, church members make visits to older people's homes to say prayers with them. The Red Cross can be called to provide assistance in crisis situations. The Government provides no special services for the elderly. Medical attention is regarded as a right of the individual and is, therefore, provided free of charge. Health workers conduct home visits periodically and stress the importance of health promotion and early detection of disease. Income security is provided through retirement benefits for the previously employed. There are, however, no pension funds for the needy elderly.
R.,._s (1) 2002 ESCAP Popu/alion Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific. (2) Country Heoltlr lnformalion Ptollles,200l Revision. Manila,WHO Westem Padflc Regional Office. (3) Heolth ofOlder Persons in the Western Pacific Region: Country Profiles. Manila, WHO Western Padfic Regional Office, 1998.
27
f'J Ati-cr~Ntvt r_t1 c1 t'4 HOW MANY OLDER PERSONS (2000) Total Population 5 279 ooo (5 657 ooo in 2003) Age Groups Total Male Female DEPENDENCY RATIOS 60+ 297000 138000 159000 65+ 185 000 85000 100000 80+ 26000 11 000 15000
AM-A rY<j YAMi-m.N
There is no national policy, programme or legislation enacted specifically for the elderly.
~-cru-YCt;.!
fvy tJw, ~tA ~y1:1
Health care for the general population is provided at primary health clinics/centres and hospitals by medical workers such as physicians, nurses, midwives, etc. Medical consultation, hospitalization and medicines are free of charge to the poor. There is no specific health care programme for the elderly. However, the Ministry of Public Health has organized a 10-bed geriatric unit at the Mahosot Hospital. The unit provides consultation to sick older persons and provides treatment in cases of serious illness. There is a plan to establish an Elderly Clinic in the hospital to provide health education and promotion of healthy ageing. A government organization, the Front of Lao National Contraction, provides social and welfare assistance to older people with its network of provincial and district level units. Social and other services for the elderly are still limited and focus mainly on retired members of Government.
Year 2000
Dependency ratio 60+ cut-off (per 100)
Dependency ratio 65+ cut-off (per 100)
:zoos Male Female
Total Dep. Ratio 96.94 85.55
Old Dep. Ratio 10.35 9.85
Total Dep. Ratio 89.62 80.03
Old Dep. Ratio 6.25 6.58
LIFE EXPECTANCY (::Z000-05)
At birth 53.3 55.8
TOTAL FERTILITY RATE URBAN 25%
4.7
MEDIAN AGE 19
P~Y'1k-1c AM-A ~tit- r~fit~ Estimates by the Government and the United Nations put the country's population at 5 279 000 in 2000. Approximately 5.6% are 60 years old and over and 3.5% 65 and over. There are more females than males in all the older age groups. Indicators show a relatively short life expectancy at birth, the lowest in the Region, at 53.3 years for males and 55.8 years for females, and a high total dependency ratio (2000) of 89.62 per 100, with an aged dependency ratio of 6.25 per 100.
MORTALITY DATA Leading causes of deaths are predominantly infectious diseases, such as malaria, pneumonia, meningitis, diarrhea and tuberculosis.
(1 I 2002 ESCAP Popul.tlon Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific,2002. (2) World Popul.tlon Prospects:The 2000 Revlslon.NewYortc,Unlted N.tlons,2001 . (3) Health of Older Persons in the W5tem Pacific Region: Country Profiles. Manila, WHO Western Paclftc Regional Office, 1998. (4) Key lndicMors 2002: Population and Human ResounceTrends and Challenges. From lhe website of the Asian Developmem Bank from the website of Asian Development Bank (http://www.adb.org/docummttlboo/cslkry-lndimlorJ/2002/rtDs}
28
lvt-ACAll (C~tfJA) HOW MANY OLDER PERSONS (2000) Total Population 444 000 (464 000 in 2003) AgeGroups (1196) Total Mille Female DEPENDENCY RATIOS Year DeDendencv ratio 60+ cut-off tDer 100) DeDendencv ratio 65+ cut-off (Der 100)
60+ 44000
65+ 33000
80+
20000 24000
14000 19000
7000 2000 5000
2000 2005
Total Dep. Ratio 47.12 37.80
Old Dep. Ratio 13.43 14.60
Total Dep. Ratio 4237 3235
Old Dep. Ratio 9.77 10.08
MORTALITY DATA The leading causes of mortality are predominantly noncommunicable diseases, such as diseases of the circulatory system, neoplasms, diseases of the respiratory system, Injuries, poisonings and other Illdefined conditions. Infectious diseases, though still claiming many lives, do not figure as prominently as chronic, noncommunicable conditions In causing death In the general population. Because of the continued increase in the number of older persons and the emergence of chronic. noncommunicable diseases as the main causes of mortality, it can be said that Macao is now experiencing both a demographic and an epidemiological transition.
LIFE EXPECTANCY (2000.05) Male Female TOTAL FERTILITY RATE URBAN
At birth 76.9 81.6
!'JAtf~,.,tJ -,wl-tc1tAt ~w+J( rYijYMM.u..t;J The 18 fundamental principles of rights of aged persons, adopted by the United Nations General Assembly, are used as the guiding policy framework for provision of services for the elderly. These principles Include access to adequate food, water, education, health services, clothing, accommodation and family and community support. National legislation has been passed for the improvement of the welfare of the elderly. Law No. 24/86/M gives access to primary health care, with free medical services, medicines and laboratory examinations, to all residents over 64 years of age. Law No. 68/89/M provides free medical services, including hospitalization in government hospitals for all persons of 65 years and above. In 1993, a 'Care for the Elderly' programme was developed with the following objectives: • to promote better quality of health services; • to identify the dependent elderly and those considered high risk; • to develop home health services in cooperation with the Social Welfare Department, families, neighbours and friends to prevent premature institutionalization of the elderly.
1.1
99%
MEDIAN AGE 35
-1>~~4-;c ;u..A ~t~t- ry~fi~ Macao had an estimated population of 444 000 persons in 2000. Of that number, 44 000, or 9.9%, were 60 years of age and above and 33 000, or 7.4%, 65 years and older, making Macao an ageing society. The gender balance is skewed in the older population, especially in the 60+ age group, where females significantly outnumber men. Macao is virtually 100% urban. Life expectancy at birth {2000) is high at 76.9 years for males and 81.6 for females. The total dependency ratio for 2000 was comparatively low at 42.37 per 100. However, the aged dependency ratio was high at 9.77 per 100.
As yet, there Is no coordinating body to link various government efforts as well as private sector initiatives to provide comprehensive and integrated services to the elderly.
29
(con't.)
~v~rctAJ
fvr tk ~tA~rlj
The family provides for the care and support of its elderly members. However, there is already a noticeable change in the structure of the family towards nuclearization. This has been attributed to the emigration of family members, leading to many older persons living alone or being placed in hostels or nursing homes. Day care centers, hostels, nursing homes and hospice services are available to a limited extent, and are handled by religious groups. Some private groups also provide "meals on wheels", home help and shopping assistance, with government financial support. The Social Welfare Department issues a senior citizen card providing free travel by public transportation and special discounts in some shopping stores and theatres. An array of domiciliary services and day centres are provided free by the State to those over 60 years of age. Women are the major beneficiaries of home help services. Health care for the elderly is provided free at the nine district health centres and covers medical services, medication and laboratory examinations. Likewise, at the Centro Hospitalar Conde S. Januario government hospital, services are provided free for the elderly. The hospital provides acute care, rehabilitation and psychiatric care.
R.,.,.._ (1) 2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Paclflc,2003. (2) (3)
World Populatian Prmpecfs:The 2000 Revision. New York. United Nations.2001.
Heolth ofOlder Persans in the Western PGcific Region: Counlly Profiles. Manila, WHO Western Pacific Regional Office, 1998
30
HOW MANY OLDER PERSONS (2000) Total Population 22 218 000 (24 537 000 in 2003) Age Groups 60+ Total Male Female DEPENDENCY RATIOS Year 2000 2005 Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off (per 100) 65+ 80+
1-/Atfv~r-vl
rlici t;.[ AM-A rvi7J VAM1.-m.t.[
1466000 694000 722000
920000 424000 496000
135 000 59000 76000
A National Policy on Aging was announced in 1996 under the Ministry of National Unity and Community Development. The policy seeks to develop an elderly community that is harmonious, has dignity, high self esteem and respect, optimizes the self-potential of older people, and ensures they enj oy all chances and are provided with care and protection as members of the family, community and nation. National plans of action were developed by government agencies in accordance with the stated policy. The Ministry of Health included health care of older people as part of its Seventh Malaysia Plan, a five-year plan running from 1996 to 2000. A National Elderly Health Council was established under the Ministry of Health in 1997 and is chaired by the Honourable Minister of Health. The Council acts as the main body w hich looks into the policies pertaining to health of the elderly, as well as other health standards and norms. The national health promotion programme on Healthy Lifestyles includes the elderly as one of the target groups for its campaign.
Tota I Dep. Ratio 68.36 65.49
Old Dep. Ratio 11.10 14.79 At birth
Total Dep. Ratio 61.67 59.11 At60yrs
Old Dep. Ratio 6.69 7.48
LIFE EXPECTANCY (2000-05) Male Female TOTAL FERTILITY RATE URBAN
70.6 75.5
16.2 (1997) 18.6 (1997)
1.1
59%
MEDIAN AGE 24
f>~v'/"h-ic
AM-A ktJth- rvvfilt '/<.e;.[vu,vce;.r [vv tk e;[Ae;vl:J
Malaysia is still a young society. In 2000,6.5 % of its population of 22 218 000 million persons were aged 60 years and over, while 4.1% were aged 65 and over. There were more males than females in the general population. Among the elderly population, there were more females than males for all age groups. Malaysia is 59% urban and the dependency ratio was 61 .67 per 100 in 2000, with an aged dependency of 6.69 per 100. MORTALITY DATA Chronic and non-communicable diseases, such as heart and pulmonary diseases, septicaemia, accidents and cerebrovascular diseases, top the list of causes of mortality. Malignant neoplasm was the fifth leading cause of mortality.
Traditionally, particularly in rural areas, the family takes care of t he elderly. However, rural-urban migration and the increasing participation of women in the workforce are slowly making it difficult for the family to discharge this function, increasing the chances of institutionalization of the elderly. Presently, there are nine government-run old people's homes in the country, with a total of 2550 residents (1997). The demographic and socioeconomic changes in
31
Malaysia, as well as inadequate home support services in the community by government or nongovernmental organizations, contribute to the difficulties faced by the family in taking care of the elderly. These factors may increase the number of elderly placed in homes. There is, therefore, a need for government regulation and standard pre-placement screening to prevent overuse ofthe facilities. Homes for the aged are also run by nongovernmental organizations, the oldest of which is the Central Welfare Council. Welfare services for the elderly are provided by these organizations but their services are limited in scope and coverage. The elderly are given the same health and medical care privileges as other age groups. Primary health care services (including treatment medication and others) are provided free in health clinics in rural areas. However, a minimal registration fee is required for medical care in urban polyclinics and government hospitals. At present, comprehensive health services for the elderly, including health screening programmes, treatment, referral and rehabilitation (at health clinics and homes), has been piloted in four health clinics in the country. These services will be made available at primary health care clinics and in the community in stages by the year 2000. Under welfare services, the following are provided, although limited in actual fact: visiting nurses, allied health professional advice and home alteration services, aids to daily living and day care programmes. Welfare services also provide free shelter, food and RM70 (approximately US$ 18) as a monthly allowance for destitute or poor elderly persons. R.m.nca (1) 2003 ESCAP Population Data Sheet Bangkok, United Nations Economic and Social Commission for Asia and the Pacific, 2003. (2) World Population Prmpects:The 2000 Revision. New York, United Nations, 2001. (3) Demographic Yearbook 1998. New York. United Nations, 2001 . (4) Health ofOlder Persons in the Western Pacific Region: CountJy Profiles. Manila,WHO Western Pacific Regional Office, 1998. (5) Price M. Mission report. Kuala Lumpur, Malaysia, 3 - 20 March 1999.WHOWestem Paclftc Regional Office (MR/1 999/0063). (6) Tyler CJ.Misslon report, Malaysia, 12-20 July 1999. WHO Western Paclflc Regional Office (MR/19991041 1). (7) Awin N. Health andAgeing· Research, Education, Policy and Prac:ticl!. Paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice: Adelaide,Austrlllia,26- 30 October 2000. (8) Guidelines for National Policies and Programme Development for Health of Older Pflrsons in the Western Pacific Region. Manila,WHO Western Pacific Regional Office, 1998. (9) Eye Care for the Elderly: Counoy Report Malaysia. Paper submitted at the WHO Workshop on Prevention of Blindness, Fukuoka,26- 29 October 1998. (1 0) Key lndiartD!s 2002: Population and Human Resaurr;e Trends and Challenges. From the website of the Asian Development Bank (http://www.adb.org/documentslbookslkey-indicalofS/2002/rtol.xls)
32
Co~~otJmA1-Tl-< 1rf tk fJ 01ZT~~1Zf4 J.ft.-ARIAfJA IS1-AtJ:Pf HOW MANY OLDER PERSONS (2002) Total Population 73 000 (76 000 in 2003) Age Groups Total Male Female 60+ 2144 1148 998 65+ 1700 608 629 80+
1Jvvtfvl+Al rvlicie;J AM-;( rV17jVAM1,m,t;J Policies to improve the health and welfare of the elderly have been adopted, but specific programmes for them are still limited. There is, as yet, no coordinating body to implement and plan services for the elderly. The United States Older Americans Act of 1965 mandates that comprehensive services for the elderly be provided through State plans and programmes. Public Law 9-21, also known as the the Commonwealth Man-Amko Physical Abuse and Mental Cruelty Act, seeks to ensure that an abused member of the man-amko receives such care as will serve the emotional, mental and physical welfare of the man-amko and the best interests of the Commonwealth, and also requires the reporting of physical abuse and mental cruelty incidents against the man-amko. Persons committing such acts shall be imprisoned for not more than one year or fined not more than US$ 1000.
-
-
DEPENDENCY RATIOS Dependency ratio 60+ cut-off (per 100) Year Tota I Dep. Ratio Old Dep. Ratio 2000 36.99 3.69 2005 44.61 4.86 LIFE EXPECTANCY (2000-05) Male Female TOTALFERTILITYRATE URBAN 90% 2.1 At birth 68.0 74.0
Dependency ratio 65+ cut-off (per 100) Total Dep. Ratio Old Dep. Ratio 34.95 2.15 41.59 2.67 At60yrs
NA NA
MEDIAN AGE 29
'/Zt;Jv~NvCt;J fvv
-&k e;[;(e;vlj
The majority of the elderly are taken care of by family members. Home nursing assistance is available, but most families cannot afford it. Of the total population of 73 000 persons in 2002, persons aged 65 years and older comprised only 2 %. There were more females than males in the general population and among the older population, especially in the age group 65 years old and over. The great majority (90%) of the population live in urban areas. Average life expectancy at birth was 68 years for males and 74 years for females in 2000. For the same year, the total dependency ratio was 40.28 per 100, a comparatively low ratio. The aged dependency ratio (2000) was 2.1 5 per 100 , reflecting the youthful composition of the country. There are no data on the existence of specific health and medical services for the elderly. Health care for the general population is provided by both public and private medical professionals. To better address the health problems of the elderly, which are mostly chronic conditions, programmes on the promotion of healthy ageing should be included in t he existing health care system. The majority of older persons seek care at their local hospital (CHC). A large number of t he elderly have medicare (health insurance for the previously employed) and/or medic-aid (government aid for health care to low-income elderly persons) t o pay for medical expenses. The Public Health Department conducts monthly visits to the homes of the elderly.
MORTALITY DATA The leading causes of death are a mix of chronic and infectious diseases, with cancer as the number one cause.
33
(con't.) Nutritional meals are available for the elderly in senior citizen centres. Meals are delivered to the homes of the disabled and frail elderly. Transportation services are also provided to those who qualify. Socioeconomic benefits and other services are also available. The US Social Security Law provides for retirement benefits for the qualified elderly. The elderly are given senior citizen discount cards which give them discounts at some stores and restaurants. The Office on Aging has three Senior Citizen Community Centers- one for each of the islands of Saipan, Tinian and Rota. At the centres, the elderly are able to socialize and enjoy recreational activities. The elderly are also given the opportunity to teach the younger generation about their culture and history.
(1) 2003 ESCAP Ptlpulalion Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific,2003. (2) Counll)' Heolt#llnformalion Prollle1, 2001 Revision. Manila,WHO Western Pacific Regional Office. (3) Heolth ofOlder Persons in the Wesll!m Pacific ~ion: Country Profiles. Manila,WHO Western Pacific Regional Office. 1998.
34
HOW MANY OLDER PERSONS (2002) Total Population S4 000 (75 000 In 2003) Age Groups Total Mala Female DEPENDENCY RAnOS 60+ 1737
65+ 1116
80+
845
892
530 587
-
v..r 2008 2005
Tctal Dep. Ratio as.2:t
3.36
nado 60+ cut-offTDtr100) I DetM:nclent.Y nrtlo 65+ cut-off (oer 100) Old Dep. Ratio Total Dep. Ratio Old Dep. Ratio If\, 3.94 82.23 5.80 80.30 3.36
LIFE EXPECI'ANCY (ZOOD-05)
-=-I• TOTAL FERTILITY RATE URBAN 7396 5.7 MEDIAN AGE 18
Male
At birth 67.0 71.0
:J>~YAff.-'c ~
kWtt.. rYlVfil,; f'JAMv~ JWlicit;t AM-A r"9J"AM1-m-t;t There is, as yet. no national policy or programme for the elderly.
The Republic of the Marshall Islands Is still a young society. Persons 65 years and over comprised only 2% of the total population of 54 000 persons in 2002. More than half of the elderly are women. The country is 73% urban. Life expectancy at birth is 67.0 years for males and 71.06 years for females. The total dependency ratio In 2000 was 82.23 per 100, with an aged dependency of just 3.94 per 100.
Rl:.tvu-r&t;t {v.- th,; ~/Atwl:J Family members and other relatives provide care and support for the elderly. Primary health care and preventive medical care strategies have been institutionalized. Health education and promotion activities, as well as traditional care, are provided by the Ministry of Social Services at Ageing Centers in Majuro, Ebeye and the outer islands. Weekly outreach programmes are conducted by the Ministry of Health.
MORTALITY DATA Leading causes of mortality are still infectious diseases, such as pneumonia and sepsis. Noncommunicable diseases, such as cancer, myocardial infraction, cerebrovascular diseases and suicide, make up the rest of the list.
35
(con't.)
A National Elderly Health Council was established under the Ministry of Health in 1997, chaired by the Honourable Minister of Health. The Council acts as the main body which looks into the policies pertaining to health of the elderly as well as other health standards and norms. The national health promotion programme on Healthy Lifestyle includes the elderly as one of its target groups.
{1) 2003 ESCAP Population Doto Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific, 2003. {2) Counly ~lth Information Profi/eJ, 2001 Revision. Manila, WHO Western Pacific Regional Office. (3) ~lth ofOidf!rPer3ons in the W1!mm Pacific Region: Counlry Profiles. Manila, WHO Western Pacific Regional Office,1998.
36
HOW MANY OLDER PERSONS (2002) Total Population 124 000 (125 000 in 2003) Age Groups 60+ 65+ 80+
/'JN/fiv,._M rwlicJt<J AA+A rY'VJYAA#m.t;J The United States Older Americans Act provides for federal funds to be made available for programmes geared towards the promotion of the welfare of older persons. However, no funds from the United States Federal Program are presently available for the Government to implement such legislation. The Government's emphasis is to provide support to the family members of older persons who could provide adequate health care services to their elderly relatives. The State Plan on Aging was formulated to comply with this law. The Plan, administered by the State Unit on Aging {SUA), provides for the development of comprehensive and coordinated systems for the delivery of supportive services and to serve as the effective and visible advocate for the elderly.
Total Male Female DEPENDENCY RATIOS Year
6616 3137 3479
4425 2028 2397
-
DeDendeney ratio 60+ cut-off (Der 100)
DeDendencv ratio 65+ cut-off (Der 100)
Total Dep. Ratio 96.13 86.66
Old Dep. Ratio 10.74 9.49 At birth 67.0 69.0
Total Dep. Ratio 89.15 81.23
Old Dep. Ratio 6.80 631
2000 2005
LIFE EXPECTANCY (2000.05) Male Female
At 450Jrs (90/91) 15.9 175
TOTAL FERTILITY RATE URBAN 29%
5.7
MEDIAN AGE 20
p~Yilfh..lC ~ ~tit- rYv[i~ The population of Micronesia was estimated at 124 000 in 2002, with persons 65 years old and older comprising 4%. There is a significant difference in the proportion of males and females, with significantly more females than males among the older population The country is approximately 30% urban. Life expectancy was higher for females {69.0) than males {67.0) in 2000. The total dependency ratio in 2000 was 89.15 per 100, with an aged dependency of 6.80 per 100.
MORTALITY DATA The leading causes of mortality were predominantly non-communicable diseases, with diseases ofthe circulatory system as the leading cause of death in 1994.
37
(can't.)
~t;.!?t+YCt;.! ~y b~ e;[A
t;yl:J
The family is the major provider of care and support of the elderly, but the rapidly changing society has diminished family support. Many older persons now live by themselves and receive little support from family and relatives. To address this situation, community-based services should be established to help the family carry out its traditional role. Primary, secondary and tertiary health care services are provided to the general population. When needed, off-island medical referrals are available. There is still a lack of medical specialists, as well as allied health workers, in the country. Because of limited funds, the Government is placing greater emphasis on primary and preventive care. The State Plan on Aging provides for geriatric home health and nutrition services, housing, and establishment of senior citizens' centres, as well as information , referral and legal assistance services.
(1) (2) (3) (4) (5)
2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific. 2003. Counly Hf!Oith Information Profile5,200 I Rmsian. Manila, WHO Western Pacific Regional Office. Health of Older P'l!rsans in the Wesrern Pac:ific: Region:Country Profiles. Manila, WHO Western Pacific Regional Office, 1998. Demographic Yearbook 1998. New York, United Nations,2001. Key lndlcotors 2002: Population and Humon Resource Trends and Challenges. From the website of the Asian Development Bank (http://www.adb.org/documentslbookslkey-lndlcatars/2002/rtol.xls)
38
HOW MANY OLDER PERSONS (2000) Total Population 2 533 000 (2 594 000 in 2003} Age Groups Total Male Female DEPENDENCY RATIOS Year 2000 2005 Dependency ratio 60+ cut-off (per 1DO) Dependency ratio 65+ cut-off (per 1DO}
During the last five years deaths of those aged 55 and older have comprised 47.2% of total mortality. Ofthose,45.1 %were caused by cardiovascular diseases,27.8% by cancer, 7.5% by respiratory diseases, 6.5% by diseases of digestive organs and 1.5 % by accidents and other external causes. (1999) 65+ 95000 41000 56000 80+ 14000 5000 9000
60+ 140 000 63000 77000
fJ ttii1r~tvt -r'"lici t41 AM-A rY'9j JrAMi.Ut.t41 The Population Policy of Mongolia for the Period 2000-2015 lists the following plan for the elderly: • To provide the elderly with opportunities to enjoy their contribution to the development of the country and satisfy their cultural and economic needs, creating conditions for their social security and protecting their rights and interests; • Develop an infrastructure ensuring a guaranteed livelihood for the elderly and providing them with medical, social and cultural services and expand the range of subsidized services.
Total Dep. Ratio 67.9 56.07
Old Dep. Ratio 9.80 8.97 At birth 61.9 65.9
Total Dep. Ratio 62.83 51.44
Old Dep. Ratio 6.48 5.73
LIFE EXPECTANCY (2000-05) Male Female TOTAL FERTILITY RATE URBAN
2.4
57%
MEDIAN AGE 23
• To support the aspiration of the elderly to live an active life and contribute to the country development. • To promote and perpetuate the long-standing traditional ove and respect for the elderly and to strengthen the bonds of affinity between generations.
1:>~,.'1-~ic
AM-A Wt~ r,.?fle;
Mongolia had a population of 2 533 000 in 2000. Persons 60 years old and older comprised 5.52% of the total population, while only 3.75% of the population were 65 years of age or older. The majority were females. In 2000, life expectancy at birth was higher for females (65.9 years) than males (61.9 years). The total dependency ratio was computed at 62.83 per 100 in 2000, with an aged dependency ratio of 6.48 per 100.
MORTALITY DATA The first two leading causes of mortality in 1995 were diseases of the circulatory system and malignant neoplasms, both chronic, noncommunicable diseases. The next leading cause of death was diseases of the respiratory system, generally attributed to the harsh winter. This was followed by injury and poisoning and diseases of the digestive system.
39
/vt-of-1401-IA 'fZtJq-u-YCt;./
(con't.)
[vr- b~ t:tAt;r-':!J
It is traditional for children to care for their elderly parents. Children are the main source of financial support for the elderly. In a survey of older persons in Ulaanbatar, the majority of caregivers (spouses or children) thought that the elderly should be cared for in the family home even when they became dependent and required a substantial amount of assistance. The same survey showed 100% of the respondents received a pension from the Government. This source was supplemented by financial support from their children, income from paid employment and, for the old elderly unable to work, from personal savings. For those who have no relatives, volunteers of the Red Cross and other community groups help in caring for the elderly. Organized programmes for prevention, health promotion and curative care for the elderly have not yet been developed. Health services for the general population are provided at the primary, secondary and tertiary levels of care. Allied health workers provide primary care, especially among scattered populations.The current policy is to strengthen public health and primary health care to develop general practitioner health services in the future. The elderly are provided free medical services if they are admitted to hospital. For outpatient services, if doctors prescribe essential drugs, the elderly pay only 50% of the cost. Other benefits available to the elderly include free communal transport services, and housing loans on soft terms. The National Ageing Health and Social care Program intends to improve the health and social care of the elderly through improved quality of life, provision of health increase in active lifestyles within the community. Program objectives include: • • • • • to improve community-based services for the elderly; to improve the quality and accessibility of health services for the elderly; to expand the IEC on ageing-related issues; to improve education of the elderly and promote their social activity and roles; and to activate government efforts and NGO collaboration in promoting health of the elderly.
(1) (2) (3)
(4) (5) (6)
<n
United Nations ESCAP Population Data Sheet. 2003 United Nations World Population Prospects.2000 Revision Health of Older Persons in the Western Pacific Region, Country Profiles: World Health Organization, 1998 National Programme on Health and Social Protection ofthf! Elderly, Ulaanbaatar, Mongolia. March 11199 Ageing and Health in Mongolia by Dr. Dulamsuren Samdan, paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice: Adelaide, Australia, 26- 30 October 2000 Mission Report of Prof. Gary R.Andrews and Ms.Janette Marie Gay, Health Promotion for Older Population, Mongolia, 13 September- 5 October 2001, MOGJHSE/001 ,MR/2001/0530 Country Report: Mongolia, paper submitted at the WHO Workshop on PRM!ntion of Blindness, Fukuoka. 26- 211 October 1998
40
HOW MANY OLDER PERSONS (2000) Total Population 12 000 (13 000 in 2003) Age Groups Total Male Female DEPENDENCY RATIOS
fJNti17~+M -,wlicitJ AM-A rY9jYAMi-n...trJ 65+ 80+
60+ 363
183 179
189 81 108
-
The Government has indicated commitment to initiating and maintaining health promotion activities and healthy lifestyles for all Nauruans
Year
The family Is the major caregiver to the elderly. There are no specific services for the elderly. Health care is provided for the general population free of charge. Two well-equipped hospitals cater to the health needs of the population, although specialist treatment is restricted and usually has to be obtained in Australia.
LIFE EXPEOANCY (2000)
At birth
Male Female TOTAL FERTILITY RATE URBAN(%)
57.0 64.0 4.4
100%
MEDIAN AGE 21
f>tMwJ "'1k--tc AM-A ~tit- rr11'f1 t~ Nauru has a young population. Of the total population of 12 000 persons In 2002, only 2%, or 240 persons, were 6S years of age or older. The country is 100% urban. Life expectancy at birth was relatively low in 2000, at 57.0 years for males and 64.0 years for females. The total dependency ratio in 2000 was 78:27 per 100, with an aged dependency ratio of 2.49 per 100.
MORTALITY DATA Leading causes of mortality were a mix of communicable and noncommunicable diseases, with cardiovascular diseases as the number one cause. (1) 2003 ESCAP Population Datu SIH!et. BangkDk, United Nalions Economic and Soci1l Commission for Asi11nd the Plcific,200J. (2) Collntty Hellfttllnf'om!Cition Ptofiles.2001 Revision. Manila.WHO western hcific Rtgional Office. (3) HI!CIIth ofOlder Pmons tn tiM! western P«Jflcllegton:Counrry Proftlfs. Manila. WHO western P.tclfle Regional Offlce. 1998.
41
HOW MANY OLDER PERSONS (2000) Total Population 215 000 (228 000 in 2003) Age Groups Total Male Female DEPENDENCY RA110S Year 2000 2005 De_pandancy ratio 60+ cut-off (per 1 DO) Total Dep. Ratio Old Dep. Ratio 61.40 12.12 13.63 61.17 Da_pandancy ratio 65+ cut-off (par 100) Total Dep. Ratio Old Dep. Ratio 7.60 54.89 53.66 8.33
60+ 1000 8000 10000
65+ 12000 5000 7000
80+ 2000 0 2000
LIFE EXPECTANCY (2000-05) Male Female TOTAL FERTILITY RATE URBAN 79% 2.4
AI birth 72.5
77.7
At &Oyrs (1 994) 15.8 19.5
fJ MfivwiJ rrl1Ci t;J ~ rl"f1J YAM1.1#t'4 There is, as yet, no specific policy or programme for older people.
MEDIAN AGE 28
.P~,.ric ~ ~w:tJt~ ry.vfitt In 2000,thetotal population of New Caledonia was estimated at215 000. Ofthis,8.3 %,or 18 000, were aged 60 years and over and 5.6 %, or 12 000, 65 years and over. There was no significant difference in the proportion of males and females in the general population. In the older population, however, there were more females in the 65+ and 80+ age bands. The country is 79% urban. Life expectancy is comparatively high, at 72.5 years for males and 77.7 years for females. At 60 years old, males could expect another 15.8 years while 60-year old females could expect 19.5 more years (in 1994). The dependency ratio is comparatively low in 2000, at 54.89 per 100, with an aged dependency ratio of 7.60 per 100.
~v~t-4
[v,. (;k e;[Ae;,.f:j
care for older people is mainly provided by the family. In Noumea, the bulk of health care providers are private physicians, with 45 dental surgeons, 23 physiotherapists and 29 pharmacists. The territory has a pension scheme for retirees. The vast majority of citizens, including the elderly, are comprehensively covered for their health needs through a national insurance scheme. Public hospitals are well staffed, with adequate and up-tcrdate equipment.
MORTALITY DATA The leading causes of mortality are predominantly noncommunicable diseases and conditions such as tumours, diseases of the circulatory and respiratory systems, and trauma.
(1) 2003 ESCAP PopC~Ir:rtion Dcml Sheet. Bangkok, United Nations Economic and Social Com mi$sion for Asill and the Pacific. 2003. (2) World Populotion Prospects: The 2000 Revision. New York. United Nlltions, 2001. (3) Demogrophic Yeorl>ook 1998. New York, United Nations,2001. (4) Health ofOlder Persons in the 'Nat.em f'Gcilic Region: Country Prtlfiles. Manila,WHO Western Pacific: Regional Office, 1998.
42
HOW MANY OLDER PERSONS (2000) Total Population 3 737 100 (3 933,000 in 2003) Age Groups 60+ Total Male Female DEPENDENCY RATIOS 65+ 80+
MORTALITY DATA The leading causes of death among those 65 and over are ischaemic heart disease, stroke, other circulatory diseases, lung cancer and respiratory diseases. 450300 196 600 25 700 109 700 37300 72400
604800 272400 332400
f'JNtivwM rvlici~.r tvwA rY11JYAM411K-N As yet, there is no legislation enacted specifically for the elderly. However, 1995 amendments to the Health and Disability Services Act of 1993 require the Ministry of Health to improve, promote and protect the health of the public. The Public Health Group of the Ministry is also required to consult with the public, those involved in the provision of public health services and other appropriate persons. An issues-based paper on the well-being of older people and Kaumatua has been developed by the Ministry of Health to set outcome targets and identify the policies, programmes, research and information issues to achieve desired outcomes. The first review of public health activities and the setting up of outcome monitoring systems is now complete. To ensure that the needs of older persons are considered in policy development and decision-making, inputs from the Minister for Senior Citizens, the Minister of Health (health and disability support), and the Minister of Social Welfare (income support} are solicited before any policy or decision is formulated.
Year 2000 2005
Dependency ratio 60+ cut-off (per 100)
Dependency ratio 65+ cut-off (per 100)
Total Dep. Ratio 62.06 61.84
Old Dep. Ratio 12.12 13.63 At birth
Total Dep. Ratio 25.33 26.62
Old Dep. Ratio 17.73 18.311
LIFE EXPECTANCY (1995-97) Male Female TOTAL FERTILITY RATE URBAN
At 60yrs (1994)
75.3 80.7
16.1 19.5
2.0
86%
MEDIAN AGE 35
'TZ~.rv~YCt;.J'
fvY tk ~tl(~yl.!J
Pt:#wJPfJ'-{1,-Jc AM-A Wt~ rviTfit~ People of 60 years and over comprised 16.1% of the total population of about 3.7 million in 2001, while those 65 years and over comprised 12.0% in the same year. This makes New Zealand the country with the third largest proportion of older people after Japan and Australia. There were more females in the general population as well as among the elderly population. New Zealand is predominantly urban. (86%} Life expectancy at birth was 75.3 for males and 80.7 for females in 2001. At age 65, males could expect to live 16.5 more years in 2001, while females could expect an additional19.1 years. The total dependency ratio was 52.24 in 2000, with a comparatively high old dependency ratio of 17.73.
The family is the predominant provider of care for its older members. The Government complements this role by funding a variety of home support services such as domestic assistance, meals on wheels, and services to assist the elderly in personal care. Comprehensive information is lacking on the coverage of community-based services, as well as housing and educational programmes for the elderly. Residential care is funded by the Government for those eligible for such services. Private nursing homes are also available. Social security measures are also available for older persons.
43
The Social Welfare (Transitions Provisions) Act of 1964 and amendments provide pensions for older people who meet age and residential qualifications. Other welfare benefits are also available. As for health care, general practitioners are the main providers of primary health care. Qualified nurses and other health professionals provide an array of primary, secondary and tertiary health services in many settings. However, data on health programmes for the elderly and how these are integrated into mainstream services are lacking.
llmrwncu (1) (2)
ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific.2003.
World Popu/alion Prospects: The 2000 Revision. New York. United Nations, 2001. Heolth ofOitkr Pfmons in the Western Pacific Region: Country Profiles. Manila, WHO Western Pacific Regional Office, 1998. Letter of Dr. Karen Poutasi, Director-General of Health, New Zealand to Dr. Shichuo Li redntemational YearofOiderPenons dated 10 September 1999.
(3)
(4) (S) (6) (7) (8) (9) (1 0)
Older People and DisabiUty: An Analysis of Data from the 1996 and 1997 Disability Survey, June 1999. Glackin J.Agelng In NewZealand. Paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice: Adelaide.Australia.26- 30 October 2000. New Zealand Health Information Service Website (Www.nzhls.govt.nzlstats/sulcldestats-p.htmi/J.
Heolth ofOitkr People Strategy. Paper (published April2002) from New Zealand Ministry of Health Website (www.moh.govt.nz)
Heolth of0/d6 People In New Zealand: A Statistical Reference. Paper published 2002 by the Ministry of Health from the New Zealand Ministry of Health Website (www.moh.govt.nz) Andrews GR. Mission report, 11 February -11 March 1998.WHO Western Pacific Regional Office (RS/98/0053).
44
HOW MANY OLDER PERSONS (2002) Total Population 2300 Age Groups Total Male Female
60+ 260 117 143
65+ 165 73 93
80+
-
/Jil-t19"M-M f""limu AM-A rYijYMH-u..t;J There is, as yet, no policy or programme specifically for the elderly
The family provides care and support to the elderly. Pensions are provided to those who qualify. All medical and dental services are rendered free of charge to patients. There Is only one hospital In the country, the Lord Liverpool Hospital, which provides secondary and tertiary levels of care. Health promotion activities, such as the Diet and Healthy Lifestyle workshops, are conducted in response to the increasing number of people suffering from lifestyle diseases. 17.73 15.13
DEPENDENCY' RATIOS
Year 2000 2005
DeMndeney ratio ao+ cut-off (Mr 1 00)
DeDendeney ratio 65+ cut-off (Mr 1 00)
Total Dep. Ratio 84.47 74.87
Old Dep. Ratio 24.17 24.34 At birth 71.0 72.0
Total Dep. Ratio 69.34 61.92
Old Dep. Ratio
LIFE EXPECTANCY (2000.05)
Male Fenwle TOTAL FERTILITY RATE URBAN 35.0%
3.0
MEDIAN AGE 27
t>~~i& IW+I( ~tit- rrvfi~ Niue Is the largest raised coral atoll in the South Paclflc Ocean, with a total population of 2300.1n 2000, persons aged 60 years and over comprised 11.0% of the population and those 65 and over 7.2%.1n the general population there were slightly more males than females. In the older population, however, females outnumbered males in all age groups. The country Is mostly rural. Life expectancy for females Is 72 years and 71 yrs for males. The total dependency ratio for 2000 was 69.34 per 100 working population, with an aged dependency of 17.73 per 100. MORTALITY DATA lbd&a:.-
The leading causes of deaths are a mix of communicable and noncommunicable diseases, with diseases of the circulatory and respiratory systems the two leading causes.
II>
2CIJ3ESCAP~D«tt/ShHt. llingkolr.Un~ N11lons Econoll'llcand SociAl Commwlon for Alia llllld ~ l'llcl1!c:.2003. (2) Coun!ryHI!Q/th tnlormatlott PtoiiJes,100111evirkln. Mllnlla, WHO lM!stem Pildftc ilegloMI Olllc:e.. (3) HtiWiofO#dfrl'llnonsln tilt MstMI P«<ffclllglon:Counrryl'rofllts. Manila.WHO \Yft1fm Plld1lc Rf!IIONI ott'a. 1M
45
HOW MANY OLDER PERSONS (2000) Total Population 20 000 (21 000 in 2003) Age Groups
f'lAt;-v,.,Al .,-t1c1 t;J AM-A rY9J Y~i#~ On 5 May each year, the country celebrates Old Age People's Day. This day is a national holiday and all states hold activities honouring older persons.
Total Male Female
60+ 1557 674 883
65+ 1115 457 658
80+
-
-
Old Dep. Ratio
The Older Americans Act of 1965, which enables the United States of America to provide Federal funds to help support services for the elderly in Palau, is a major source of funds and policy direction for services for the elderly. A bill has been filed in the Senate giving senior and disabled citizens 50% discount on all medical expenses.
DEPENDENCY RATIOS Year 2000 2005 Dependency rldlo 60+ cut-off (per 100) Dependency ratio 65+ cut-off (par 1DO)
Total Dep. Ratio
Old Dep. Ratio
Total Dep. Ratio
55.96 53.95
12.13 11.45 At birth
51.02 48.57
8.58 7.56
LIFE EXPECTANCY (2000) Male Female TOTAL FERTILITY RATE URBAN 73.0%
67.0 71.0 2.6
MEDIAN AGE 30
i>~Yr1c AM-A~~ rr-v[i~ Palau had an estimated total population of 20 000 persons in 2000, 5% of them 65 years of age and older . There were slightly more males than females in the general population. However, in the older age groups, females significantly outnumbered males. The country is 73% urban. In 2000, life expectancy at birth was 71 years for females and 67 years for males. The dependency ratio of 51.03 per 100 was comparatively low, with an aged dependency of 8.58 per 100.
MORTALITY DATA The leading causes of mortality in the general population are chronic, noncommunicable diseases, with diseases of the circulatory system as the leading cause of death.
46
1Zt:Jvu-YCN [vy
f;ke, ~u
ew0
fA1-A1A
(con't.)
The family is the primary caregiver for the elderly. Most caregivers are immediate female family members. There is no long-term institutional care. The Ministry of Health provides inpatient, outpatient and dental services to older people. Dispensary services and trained nurses serve rural areas which do not have access to central care. Public health and geriatric nurses provide periodic home visits for older people when necessary. The Ministry of Health subsidizes 80% of medical and dental care of elderly people receiving less than US$ 400 a month; hence no one is denied service because of inability to pay. Private clinics also provide health care to the elderly, with subsidies from the Government. The Ministry of Community and Cultural Affairs has programmes for the elderly which include congregate meals, home meal delivery, transportation, information and referral, legal services, community service employment and education. The elderly also act as trainers of young people in major cultural and traditional activities.
(2)
(1 J 2003 ESCAP Population Data Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific. 2003. Health ofOlderPer:sons in the Western Pacific Region: Country Profiles. Manila, WHO Western Padfic Regional Office, 1998
47
HOW MANY OLDER PERSONS (2000) Total Population 4 809 000 (5 564 000 in 2003) Age Groups Total Male Female
60+ 200000 100 000 100000
65+ 118 000 58000 60000
80+ 11 000 5000 6000
The country is predominantly rural, with only 18% of the population living in urban areas in 1995. Life expectancy at birth is comparatively low at 56.8 years for males and 58.7 years for females in 2000. The dependency ratio is high, with a total dependency ratio of 79.23 per 100 and an aged dependency ratio of 4.24 per 100 in 2000.
MORTALITY DATA DEPENDENCY RATIOS Year Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off (per 1 00)
2000 2005
Total Dep. Ratio 85.36 84.04
Old Dep. Ratio 7.80 7.59
Total Dep. Ratio 79.23 78.8
Old Dep. Ratio 4.24 4.53
The leading causes of mortality for the general population are predominantly infectious diseases such as pneumonia, perinatal conditions, malaria, meningitis and tuberculosis.
fJ A-ti..,...;J r..,.li ci t;J A-#A rrry YAMi-u-t.t/J There is, as yet, no national policy or plan of action for the promotion of the welfare of the elderly. At present, the National Social Development Policy, as formulated in 1993, provides for the development of services for all disadvantaged groups, including the elderly. The published National Health Plan (2001-201 0) addresses broad health issues relevant to the elderly, especially rehabilitation and the provision of other health aids. A National Policy Development Committee was set up during the Workshop on National Policy Development in July 2000 to facilitate the development of a policy for older persons. A national committee with intersectoral representation was formed and was later renamed the Working Group on Research on Elderly.
LIFE EXPECTANCY (2000) Male Female TOTAL FERTILITY RATE URBAN 18% 4.0
At birth 56.8 58.7
MEDIAN AGE 19
In 2000, Papua New Guinea had a total population of 4 809 000 persons,4.1% of whom were 60 years of age and older and 2.4% 65 and older. Males outnumbered females in the general population as well as in the elderly population.
48
(can't.)
'!ZtJv~A--YCf:J
fvr t~ t;[Atrf:J
Traditionally, families provide for the welfare of their elderly members. Health care for the general population is provided through a network of hospitals, health centres, subcenteres and aid posts. The National Welfare Section of the Department of Home Affairs and Youth provides general welfare services for disadvantaged groups, including the elderly. To date, there are no specific health care or social welfare programmes for the elderly. Within the health delivery network, there are no curative services particular to older persons and no specialists in geriatrics. Preventive health services are provided, but only within the broadbased services available to all citizens.
(1 J 2002 ESCAP Population Data Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific, 2002. (2) World Population Prospedl':The 2000 Revision. New York, United Nations, 2001 . (3) ~lth of Older Pl!nons in the Western Pacific Region:Country Profiles. Manila, WHO Western Pacific Regional Office. 1998. (4) Papua New Guinea Country Report Paper submitted at the Workshop on Health and Ageing - Research, Education, Polley and Practlce:Adelalde,Australla,26- 30 October 2000 (5) Plange N. Mission report Papua New Guinea, October4- 18/December 2 -14,2001. WHO Western Pacific Regional Office (MR/ 2001/ EDITOR'S NOTE: PLEASE ADD MR NUMBER). (6) Plange N. Mission report Papua New Guinea,April1 -11, 2002. WHO Western Pacific Regional Office (MR/2002/ EDilOR'S NOTE: PLEASE ADD MR NUMBER). (7) ~/th ond Wellbeing of the Elderly In Papua NewGulneo: A Sun~ey Report December 2001 - Mo1th 2002
49
HOW MANY OLDER PERSONS (2000) Total Population 75 653 000 (80 731 000 in 2003) Age Groups
Total Male Female DEPENDENCY RATIOS Year
60+ 4197000 1904000 2293000
65+ 2671000 1175000 1496000
80+ 333000 127000 206000
The total dependency ratio for 2000 was comparatively high at 6755 per 100, with an aged dependency of 6.08 per 100.
MORTALITY DATA The elderly population suffers from the double burden of both degenerative and infectious diseases. The leading causes of death are noncommunicable or degenerative diseases, including diseases of the heart diseases of the vascular system and cancer.
DeiN!ndencv ratio 60+ cut-off (IN!r 100)
Dependencv ratio 65+ cut-off (IN!r 1 00)
2000 2.005
Total Dep. Ratio 73.54 70A1
Old Dep. Ratio 9.88 10.33 At birth
Total Dep. Ratio 67.55 64.30
Old Dep. Ratio 6.08 6.37
LIFE EXPECTANCY (2.000.05) Male Female TOTALFERTILITYRATE URBAN 60%
At 65yrs (1991) 155
68.0 72.0
17.3
3.1
MEDIAN AGE 22
Pt7WwJY'1h,-rc AM-J{ W,fk, rY?ftt~ The Philippines is still a young society. In 2000 the total population was estimated at 75 653 000 persons. Of that number, 554% were aged 60 years of age or older and 3.53% were 65 or older. There were more females than males in this older population. Approximately 40% of the population lived in rural areas. Life expectancy continues to improve in the Philippines. In 2000,1ife expectancy at birth for males was 68 years and 72 years for females. Life expectancy at 65 years has also been improving. In 1991, a 65 year-old male could expect to live 15.5 additional years while females can expect 17.3 more years. Females outlive males in all age groups in the older population.
so
f>t< I1--IPPI J'-1 f;f f'JtvlivlNM rvlicit;.t AM-A rY9JvM-k-U1-t;.t
(con't.> The National Health Insurance scheme provides for medical insurance to every citizen, including the poor and the unemployed. At present, only the employed or previously employed enjoy such benefits. The Department of Social Welfare and Development provides assistance for physical restoration; self and social enhancement services; substitute family care in group homes for the neglected; livelihood service; and after care and follow-up service for those discharged from homes for the aged. At present, there are three governmentrun residential homes for the elderly. Community-based social, health and livelihood development services are being provided by a number of nongovernmental organizations. A social security system covers all employed persons in both the government and private sectors. There are also benefits for veterans. Benefits include retirement benefits, death or survivorship benefits, funeral benefits and hospitalization benefits for dependent parents and children.
The Constitution provides that the needs of the underprivileged, the sick, the elderly, women and children are given priority in the delivery of essential goods, health and development. Two recent laws have been passed to carry out this mandate.
• RA 7432 grants, among others, discounts to all senior citizens in the use of transport services, hotels and other establishments, as well as purchase of medicine. · RA 7876 provides for the establishment of senior citizen's centres in every city and municipality in the Philippines. These centres are tasked to develop and implement productive activities and work schemes for senior citizens.
The Philippine Plan of Action for Older Persons (1999-2004) was formulated by the Department of Social Welfare and Development, with the support of NGOs and other sectors, in 2000. However, there is, as yet, no national health plan for the elderly, and health services for the elderly are still vertically implemented, with little coordination between government units and between the government and the private sectors.
'/<..t;Jv~+Y'Ct;.f
[vv b~ e;[,Aewlj R.,.,._ (1) 2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific. 2003. (2)
The family is the main provider and caregiver for the elderly. Children provide financial support to their parents without prompting. In general, the elderly live with their families. Only a small percentage (3%) live alone. However, because of migration to urban centres, the elderly in rural areas are increasingly being left behind in nuclear households. There are no specific health services for the elderly, but the Department of Health and local government units provide preventive, curative and rehabilitative services to the general population (including the elderly) through a nationwide network of village health stations, rural health units and government hospitals. However, most government hospitals do not have geriatrics departments and only a few institutions offer comprehensive geriatric services (Veterans Memorial Medical Centre, St. Luke's Medical Centre and Granada Health Centre).
WorldPopulatlonl'rospect5;7he2000RevlsJon.NewYork.Unlted Natlons,2001 . Demographic Yearbook 1!198. New York, United Nations,2001.
(3) (4) (5)
Health ofOlder Persons in the Western Pacific Region: Counoy Profiles. Manila,WHO Westem Pacific Regional Office, 1998. RP's Elderly Need Insurance. TheJoumat8Aprll1999. Workshop on Health and Ageing· Research,Educatlon,Pollcy and Practlce:Adelalde.Australla,26- 30 October 2000.
(6) Narvaez DM.Hea/th and Ageing- Resean::h, Education, Policy and Practice: The Philippine Experience. Paper submitted at the (n Department of Social Welfare and Development Website (www.dswd.go~.ph/older.htm), 1002.
(8) Ollvar-Santos E. Philippines Counoy Report. Paper submitted at the WHO Workshop on Prevention of Blindness, Fukuoka,21i- 29 October 1998.
(9) Key indica ton 2002: Population and Human Resource Trends and Challenges. From the website of the Asian Development Bank {http://www.adb.orgldocumentJ/booksllcey-indicators/2002/rtoJ.xls)
51
HOW MANY OLDER PERSONS (2000) Total Population 46 740 000 (48 020 000 in 2003) Age Groups
MORTALITY DATA The leading causes of mortality in the general population were mostly chronic, noncommunicable diseases.
60+ Total Male Female DEPENDENCY RATIOS Year Dependency ratio 60+ cut-oH (per 100)
65+ 3 305 000 1 278 000 2027000
80+ 453 000 133 000 320 000
5131000 2 149 000 2 982000
fJNti~~+M rlicie;.f AM-If rvryvAM-t-141-N The Elderly Welfare Law, enacted in 1981, established the legal basis for improving the welfare of the elderly. The Government has steadily developed policies to provide various services for the elderly through the following programmes: income maintenance; housing service; leisure activity; home care; and institutional care. The Social Welfare Law for the Aged, enacted in December 1992, also benefited the elderly through the establishment of domiciliary and institutional care. The latest legislation for the elderly is the National Health Promotion Act, which was enacted in January 1995 to establish the legal grounds for providing health promotion programmes. Acting as the coordinating body, the Elderly Welfare Division of the Ministry of Health and Welfare directs policy orientation, gives budgetary support for programmes to enhance the health status of the elderly and collects administrative information regarding older persons. At present, the Government intends to put more emphasis on community-based programmes for older persons by providing major budgetary support.
Dependency ratio 65+ cut-oH (per 100)
2000 2005
Total Dep. Ratio 47.02 47.71
Old Dep. Ratio 15.56 18.71 At birth 80
Total Dep. Ratio 39.32 39.48
Old Dep. Ratio 9.37 12.09
LIFE EXPECTANCY Male Female TOTAL FERTILITY RATE URBAN 83% 1.3
72
MEDIAN AGE 33
In 2002, the Republic of Korea's total population was 48 062 000, of whom 3 844 960 or 8% were 65 years old and over. Females outnumber males in the general population as well as in the older population. The country is 83% urban. In 2002, males had a life expectancy at birth of 72 years, while females had a life expectancy of 80 years. In 1995, a 60 year-old male could expect to live an additional 16.5 years, while a female of the same age could expect 21 more years. The total dependency ratio in 2000, at 39.32 per 100, was comparatively low, with an old age dependency ratio of 9.37 per 100.
52
'/Z~t>lA$1-IC CfF tiLOR~A ~~~+YCtA! ~y
(can't.) The need for income security in old age is addressed by the government social security schemes. There are three public pension schemes for retired government employees, military personnel and private school teachers. About 21% of the elderly are covered by these schemes. Another type of public pension scheme is the National Pension Scheme, which covers all workers who are not covered by the above-mentioned special pension schemes. Coverage under this scheme is still limited. Old age allowance was established to provide supplementary income for the elderly poor. Eligibility is limited to those persons who are not covered by any kind of public pension scheme. Beneficiaries must be 65 years old or over. For the elderly in the low-income bracket, the Government has introduced the 'non-contributory old-age pension'. It is expected that the non-contributory old-age pension benefit will be paid out in 1998 as a 'respect for the aged' pension.
/;k e;[;f t;rl:J
The role of the family as primary caregiver is being affected by social and economic conditions which have led to increasing nuclearization of the family. To foster respect and love for the aged, the Government rewards adult children who take care of their parents on Parents' Day, celebrated on 8 May every year. In addition, filial children are bestowed special entrance opportunities to universities. Residential care is the main form of aged care at present, but the actual number of facilities and places is small as a proportion of the aged population. Home-based care is largely volunteer-based and consists essentially of friendly visiting, insufficient to sustain a population with high levels of disability. Similarly, centre-based care tends to be offered as a service to residents of facilities rather than to the aged residing in the community. Clubhouses and senior schools, which are established by voluntary donations from local residents, provide organized leisure and educational programmes for the elderly. Private organizations also run home-help services and day and short-stay care centres, as well as homes for the aged. For the elderly who still want to work and remain productive, employment centres are available. The Government has instituted an 'elderly employment subsidy' which provides workplaces, with 90 000 won (approximately US$ 75) each quarter. This subsidy will be expanded gradually. The Government provides the elderly with discounts on public transportation and free admission to parks, and other recreational places. It also provides congregate housing arrangements for the elderly, and multipurpose senior centres have been established to serve their recreational needs. Health care is provided by hospitals and clinics in urban areas and by the health care network, such as health centres, subcentres and primary health careworkers, in rural areas. The cost of care is borne by medical insurance. Free health check-ups are available for the low-income elderly. The Government plans to establish 'dementia counselling centres' to address the growing number of elderly people with senile dementia.
Ref&anca
(1) (2) (3) (4) (5)
2003 ESCAP Population Data Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific,2003. World Population Prcspec:ts:The 2000 Revisioo.NewYork, United Nations, 2001 . Demographic Yearbook 19!18. New York, United Nations,2001. Health ofOlder Per.sons in the Western Pacific Region: Country Profiles. Manila, WHO Western Pacific Regional Office. 1998. Kim CK. National Policies and Directions for the Elderly. Paper submitted at the Workshop on
Health and Ageing- Research, Education, Policy and Practice:Adelaide,Australia,26- 30 October 2000. (6) Guidelines for National Policies and Programme Development for Health ofOlder Petsons in the Wesll!m Pacific Region. Manila, WHO Western Padfic Regional Office, 111!18. (7) Koo, BS.P~tion ofBlindness and E.)lt! Health Care in Korea. Paper submitted at the WHO Workshop on Prevention of Blindness, Fukuoka, 26- 211 October 111!18. (8) Key lndicatcm 2002: Population and Human Resoutce Trends and Challenge. From the website of the Asian Development Bank (http://www.adb.org/documents/boo/Wkl!y-indicators/2002/rtol.xls)
53
HOW MANY OLDER PERSONS (2000) Total Population 159 000 (173 000 in 2003) Age Groups
MORTALITY DATA The leading causes of death are circulatory diseases, respiratory diseases, Infectious and parasitic diseases, certain conditions originating during the perinatal period, diseases of the digestive system, injuries and poisonings and certain consequences of external causes. 65+ 8000
60+
10+ 1000
Total Male Femala DEPENDENCY' RATIOS
12000 5000 7000 De~H~nd1ncy ratio 60+ cut-off (per 100)
3000 5000
0
f'Jd-1v~ ]Wlic7~:.t AM-A f"i1J"MM-flk-t.t A national working committee was formed at the National Workshop on the Development of
1000
National Policies, 18-19June 1997.
Year 2000 2005
DIJM~ullncy miD 65+ cut-off (IHir 100)
Total Oep. Ratio 8531 83.60
Old Oep. Ratio 11.24 11.60 At birth 66.9
Total Oep. Ratio 76.26 76.26
Old Oep. Ratio 7.14 7.14
1<-I:Jv~+r&I:J {vr
t/t,e ~;tJ{~;r~
LIFE EXPECTANCY (2000·05) Mille Female TOTALFER11LITYRATE 4.1
Health care for older persons Is Integrated Into the role of every nurse. Community-based nursing services help families care for the elderly. However, such services are limited. Free medical care and medicines are provided. A home for the aged is operated by the Catholic Mission Little Sisters for the Poor.
73.5
URBAN
22.0%
MEDIANAGE 19
.p~"Af"-1c ~~tit- r..-vfile Samoa is a young population. Of the total estimated population of 159 000 in 2000, 754% were aged 60 years and over and 5% 65 and over There was no significant difference in the number of males and females In the general population or In the population of older people. In 2000,88% of the population lived In rural areas. Available data show females had longer life expectancy at birth than males (73.5 years vs. 66.9 years) in 2000.1n the same year, the dependency ratio was 78.14 per 100, with an aged dependency of 6.93 per 100 . . . .ICa
(I} 2/KIJESCN>Popu/GffonOatx:r Sheet. fllngkok. Untied Nlltfons Ealnomfc and SociiI CommiHionfat Atlaandthe Padllc. 2001. (2} 'MHfdl'opu/Qtfoltl'nllpectl:: Jhi!1«1011Mslon.NewYorlc.Unl!ed Nllloru,2001. (3} Hidrh ofOidrsPmotuln lflto Mfl!:l:!emPt:ldflr.Regton:Cotm~ryl'nlflles. Manllt.WHO\'IIe:nem Pacific Regional Ofllc:e. 1991. (4} 1'\'ia'M.Miafon reporn Al:lfa,s.no.,1S· 20 June 1!197.WHOWUII!m hdflc Reglonel Ofllce (IISI97/10429). (5} Kt!ytndiartorsJOII1:Popu/GffontiMHI.Imllnlll!:rotm:e lleldsondChollrnges. From lhe~ of the Atlan DeYI!Iopneflt Blink (lmp:i,._.adb.orgfdoaJme~lrd'Clllon12002/1101Jdl)
54
HOW MANY OLDER PERSONS (2000) Total Population 4 018 000 (4 369 000 in 2003) Age Groups (1 996) 60+ 65+ 80+
f'ltttiq~tJ rqlf ci t;.f AM-A rY9J YM-K-1!k-t;.f The Advisory Council for the Aged (ACA) was formed in 1988 to comprehensively review the status of ageing in Singapore. The Council appointed four committees to look into the specific areas of concern. These were the Committee on Community-based Programs for the Aged, the Committee on Attitudes toward the Aged, the Committee on Residential Care for the Aged and the Committee on Employment for the Aged. The recommendations of these committees formed the bases for a national policy on ageing. In August 1989, the National Advisory Council on the Family and the Aged (NACFA) was formed. It was composed of voluntary and private sector representatives, as well as government representatives. Its main task is to monitor the implementation of recommendations made by the ACA in 1988. In response to the changes in the disease profile in the country, where chronic, noncommunicable cases have become the leading causes of mortality and morbidity, the Ministry of Health has strengthened health promotion and health education. The National Healthy Lifestyle Program, launched in 1992, marked the start of a ten-year programme aimed at inculcating the right habits and attitudes towards a healthy lifestyle. It is a multisectoral, community-based programme involving employees and unions, community and volunteer organizations working together to provide information and skills training, and to support environments for healthy living.
Total Male Female DEPENDENCY RATIOS
423000 197000 226000
118 000 58000 60000
11 000 5000 6000
Year 2000 2005
Dependency ratio 60+ cut-off (per 100) Dependency ratio 65+ cut-off {per 1 00) Total Dep. Ratio Old Dep. Ratio Total Dep. Ratio Old Dep. Ratio 41.44 48.41 15.62 10.19 39.56 47.11 17.81 11.76 At birth 75.9 80.3 At 60yrs (1998) 18.9 21.8
LIFE EXPECTANCY (2000-05)
Male Female TOTAL FERTILITY RATE 1.4
URBAN
100%
MEDIAN AGE 36
p~y'f"Jt,fc
AM-A ~th, rY1r{fl~
Singapore had an estimated population of 4 018 000 persons in 2000. Persons 60 years of age and older comprised 10.5 % of the population, while those of 65 years and older comprised 2.9%. Life expectancy at birth (75.9 for males and 80.3 for females in 2000) and at 65 years (18.9 for males and 21.8forfemales in 1998) are some of the highest in the Region. The total dependency ratio in 2000 was comparatively low at 41.44 per 100, with an aged dependency ratio of 10.19 per 100.
MORTALITY DATA The principal causes of death are attributable to degenerative conditions such as heart disease and stroke, cancer, diabetes and injuries.
55
ftN4A?ORt '/<..t;J~u-YCt;J
(can't.)
fv-y {;k t;lJ/t;ylj
The family is the main caregiver for its aged members. In a 1995 survey on senior citizens aged 55 years and above, it was found that 86.2% of the elderly lived with their children. Within the household, the older person most often contributed to the family by giving advice and financial assistance, as well as assisting with household chores. Only 4.4% of senior citizens needed a principal carer, which is often a female child. Children were the most important financial support for the majority of the elderly. Housing is another important need of the elderly. There are various public housing schemes that encourage families of different generations to stay together. The Government is the principal source of funds for formal services for the elderly. The primary health care service in Singapore does not incorporate a specific component directed to health and care of older persons. Primary health care is provided by both the public and private sectors, which cater to the health care needs of the general population. About half of the elderly population consults private family practitioners. Acute hospital services are provided to serve the population in general, although the elderly utilize a disproportionately larger share of the services. Hospitals for the chronically sick cater for the elderly who require long-term medical and nursing care of a level higher than that provided in nursing homes. Care for the chronically sick is provided by two charitable organizations. Nursing homes and hospices are also available for the elderly sick who require long-term residential care and care for terminally ill conditions. Community and private sector organizations provide various community-based social and health services for the elderly. The operations of charitable organizations providing services for the elderly are subsidized by the Government in terms of financial assistance to capital and operating costs Community-based services include day rehabilitation centres for the frail and elderly sick, as well as the senile demented elderly, and home care services such as home medical care, home nursing and home help services which provide support to enable the families to cope with the care of the elderly.
(1) (2)
(3) (4) (5) (6) (7)
(8)
2003 ESCAP Popu/otlon Data Sheet. Bangkok, United Nations Economic and Social Commission for Asia and the Paclflc,2003. World Populallon Prospects: The 2000 Rellfslon. NewYork, United Nations, 2001. DemogrophlcYearboolc 1998. New York, United Natlons,2001 . Health ofOlder Persons In the Wesll!m PaciflcReglon:CountlyProflles. Manila,WHO Westem Pacific Regional Office, 1998. VIJaya K. Health Progrommes for tile Elderly In Singapore; Singapore Countly Report. Paper submitted at the Workshop on Development of Programmes for Health of Older Persons,Seoui,South Korea, 4-7 June 1999. LlkSY. Country Report on Health and Ageing: Slngopo~e. Paper submitted at the Workshop on Health and Ageing- Research, Education, Polley and Practice: Adelaide, Australia, 26- 30 October 2000. Updotlng Countty Profiles on Ageing and Health. WHO Westem Pacific Regional Office. Guidelines for National Policies and Progromme Development for Heoltll ofOlder Persons In tile Western Poclflc Region. Manila WHO Western Paclflc Regional Office,1998.
56
HOW MANY OLDER PERSONS (2000) Total Population 447 000 (477 000 in 2003) Age Groups (1tH)
f'JAJt;.,.,..M, rrli&1 t;J AM-A rY?J YM+l-1-M-b.t There is, as yet, no national policy or programme specifically for the elderly.
60+ Total Male Female DEPENDENCY RATIOS Year 2000 2.005 DeDendeney ratio 60+ cut-off (Der 100)
65+ 12000 6000 6000
80+ 1000 0 1000
19000 10000 9000
Family members and relatives are diredly responsible for the care and general well-being of the elderly. The Government provides no specific health services for the elderly. Health services are provided to the general population by village health workers, nurse aides, registered nurses and dodors through a network of health centres, clinics and hospitals. Health services are free. There are no nursing homes or hospices in the country.
DeDendencv ratio 65+ cut-off (Der 100)
Total Dep. Ratio 109.43 97.19
Old Dep. Ratio 10.29 9.38
Total Dep. Ratio 102.39 90.44
Old Dep. Ratio 6.58 5.63
LIFE EXPECTANCY (2000) Male Female TOTAL FERTILITY RATE URBAN 21%
At birth 67.9
70.7 4.4
MEDIAN AGE 19
The total population of Solomon Islands in 2000 was estimated at 447 000 persons, with those 60 years of age and above comprising 4.3% and those 65 and over comprising 2.7%. The country is predominantly rural, with only 21% of the population living in urban areas. Life expectancy was 67.9 years for males and 70.7 years for females In 2000. The dependency ratio (2000) is high at 10239 per 100, with a young dependency ratio of 95.81 per 100 and an aged dependency ratio of only 6.58 per 100. MORTALITY DATA
The leading causes of mortality in 1995 were a mix of communicable and noncommunicable diseases, with communicable diseases predominating. Heart diseases and cancer are the leading noncommunicable causes of mortality.
.,-.,.,.ca (1) 2003 ESCAPI'!Opukrllon Data Sh«t Bangkok,Unlll!d Nations Economic and SOCial Commission for Asia and llu~ Paclflc,200:i. (2) Wi:lJ1d Populot/on 1'/'osp«U:7fte 2000 Rl!fifJioll. New Yort, United Nat10nf,2001. (3) H«lhhoiO/Mrhnons in~ Wl!Jtt!m Pdcifit Rl!gion:Cow!ttyProlifu Manila, WHOWestem Pacific Regiollal Offi~ 1998
57
T ty£{_f5.l-A1A HOW MANY OLDER PERSONS (2000) Total Population 15 000 Age Groups
fJAM.,.,..,;J r'l-Jcit;:J ~ rVVjrMH-u..~ There is, as yet, no policy or programme specifically for the elderly.
Total Male Female DEPENDENCY RATIOS Year
60+ 129 57 71 DeDendeney ratio 60+ cut·oH {Der 100)
65+ 93 42 51
-
80+ Family members and neighbours provide care and attend to the needs of the elderly. NZ$ 50 (approximately US$ 32) per month from the Tokelau community services budget is given to elderly persons of 60 years and above. The elderly are also allowed to stay overnight on islets for their rest and recreation. Health workers conduct monthly visits to look Into the health of the elderly.
Dependency ratio 65+ cut-off (per 100)
2000 2005
Total Dep. Ratio 102.25 66.29
Old Dep. Ratio 17.75 16.39 At birth 68.0 70.0
Total Dep. Ratio 93.53 87.64
Old Dep. Ratio 12.67 10.53
LIFE EXPECTANCY (1996) Male Female URBAN
41.0%
P~~ic AM-A ~~ rrv£1~ The population ofTokelau was estimated at 1500 persons in 2002. Tokelau is one ofthe few Pacific Islands which has a comparatively large percentage of older persons. Of the total population in 2002, 6.6% were 65 years of age or over. The majority of the older people are females. The country is 41% urban. Life expectancy at birth for males was 68 years and 70 for females in 2002. The total dependency ratio in 2000 was a high 95.53 per 100, with a comparatively high old dependency ratio of 12.67 per 1OO,showing the increasing importance of the elderly sector In terms of their role In society as well as the resources that may be needed to address their needs. MORTALITY DATA
Chronic and noncommunciable diseases are among the leading causes of death, together with diseases of the respiratory system, ill-defined conditions and congenital anomalies.
(I) Co11ntry Hslth lnf'o!rnatfon Plof!les, 2001 RIMslon. M;~nlli,WHO Wl!stl!m Pi&Ciflc Reglorlill ~ (2) Hslth of Older Pel!ons In the Wl!stl!m Pi&Ciflc Reglon:Counll'y Plotl'le.s. M1nlla, WHO We.item Padllc Regional Otllce,. 1998
58
Tof'J4A HOW MANY OLDER PERSONS (2002) Total Populiltion 101 000 Age Groups
60+ Total Male Female DEPENDENCY RATIOS Year DesMndency ratio 60+ art·oH {per 100)
65+ 5243
80+
7808 3879 4019
2553 2690
-
-
Dependency ratio 65+ cut-off (per 100)
Total Dep. Ratio
2.000 2005
88.35 85.37
Old Dep. Ratio 14.66 14.93
Total Dep. Ratio 79.49 76.41
Old Dep. Ratio 9.27 9.38
LIFE EXPECJANCY (1996) Male Female
At birth
66.0 72.0
TOTAL FERTILI'IY RATE URBAN 54.0% MEDIAN AGE 20
4.2
P~Y~ic AM-A kNJt/t, rYVfi~ The population ofTonga was estimated at 101 000 persons in 2002. Of the total population, 6.6% are 65 years of age or older.The majority of older people are females. The country is 54% urban. Life expectancy at birth for males was 66 years and 72 for females in 2002. The total dependency ratio in 2000 was 79.49 per 100, with an aged dependency ratio of 9.27 per 1oo
tJAti?~+M JW"licit;.t Data unavailable.
AA+A rY17JYMK-u-t-t'J (II (2) CountryHe~lth lnformlt!ofl Proflles.2001 ReY!slon. M1nlhtWHOWestern PldflcReglon11 Ofllte. HN!th of Older Persons lr1 tile Western Pldflc Region: Country Proflles. Manila.WHOWestem Plldllc Regional Of!la=. 1998
'Rafiru.-YCt:J
fvy tk ~lAIW~
Data unavailable.
59
HOW MANY OLDER PERSONS {2003) Total Population 11 000 Age Groups
fJAt;g,.,M- rt1c1t;J AA+A rYijYM#i+t-Al' 10+ 15+ 671 258
80+
Total
Male Female DEPENDENCY RATIOS
951 372 578
412
-
There is, as yet, no policy or programme specifically for the elderly.
~iTINYC~
fiTY
~ ~tA~yt:t
Year
Dependency natto 60+ cut-off {per 100)
Dependency natto 65+ cut-off {per 100)
Traditional culture and values fonn the basis of care in the family. Community health care servtces for the elderly are given In the context of primary health care.
2000 2005
Total Dep. Ratio 76.08 66.29
Old Dep. Ratio 16.79 59.52
Total Dep. Ratio 67.34 59.52
Old Dep. Ratio 10.99 10.45
LIFE EXPECTANCY (1996) Male
Atblnh 66.0 72.0
Female TOTAL FER11LITY RATE URBAN 55.0% 3.4
f>~~1cM+A ~th-rrvfi~ Tuvalu, fonnerly known as the Ellice Island, has a total population of 11 000 in 2003. Persons 65 years of age or older comprise 7% of the population.There are more females than males in the general population, as well as in the elderly population. The country is 55 % urban. Males had longer life expectancy than females in 2002 (72 years vs. 66 years). The dependency ratio was 67.34 per 100 in 2000, with an aged dependency ratio of 10.99 per 100.
MORTALITY DATA The leading causes of mortality in 1994 were heart disease and cerebrovascular accidents, both chronic and noncommunicable diseases; pulmonary tuberculosis; infant deaths; and senility. (I CoumryHc!llllftlllfom!CII1on~.l'OOI AMslon.
(2) HeGiriJ INOlder PIHsDns tn !MWII!mm Pot:Hic llilglot1:Coum7yPtofflt!s.Mantla, WHOWeslem P.adflc Regional Olllm, 19911.
Mmlla,WHO Western Plldfk Rcglon;~l 0111«-.
60
HOW MANY OLDER PERSONS (2000) Total Population 197 000 (212 000 in 2003) Age Groups Total Male Female
fJAtJ1r.,..M- r1rt1 c1 t;J AM-A r~ YAM-t.-141.-t;./ Data unavailable.
60+ 10000 5000 5000
65+ 6000 3000 3000
80+ 1000 0 1000
~ir~YCt;J
fry tk tlAtwf1
Data unavailable.
DEPENDENCY RATIOS Year DependencY ratio &0+ cut-off (per 100) DependencY ratio &5+ cut-off (per 100)
2000 2005 Male Female
Total Dep. Ratio 89.60 86.44
Old Dep. Ratio 9.63 8.97 At birth
Total Dep. Ratio 83.64 80.56
Old Dep. Ratio 6.19 5.53
LIFE EXPECTANCY (2000)
67.5 70.5
TOTAL FERTILITY RATE 4.1
URBAN
21% 19
MEDIAN AGE
t>~ y"rh,-rc AM-A ~th,
rYirF lt
Vanuatu is a young society. Persons 60 years of age and older comprised only 5% of the total population of 197 000 persons in 2000, while those 65 and over comprised 3%. Females had longer a life expectancy at birth than males in 2000 (70.5 yrs. vs.67.5 yrs). The dependency ratio in 2000 was 83.64 per 100, with an aged dependency of 6.19 per 100. MORTALITY DATA The leading causes of mortality are predominantly chronic, noncommunicable diseases, except for respiratory infection, which is the second leading cause of death in the country. (1) 2110.3 ESCAP PopultJtion Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Pacific, 2003. (2) WorldPopu/ationl'ro5p«ts:The2000Revision. New York, United Nations,2001.
(3) Health ofOlder hrwns in the Wemm Pocific Region: Country Profila. Manila,WHO Westem Pacific Regional Office, 1998.
61
HOW MANY OLDER PERSONS (2000) Total Population 78 137 000 (81 377 000 in 2003) Age Groups 60+ 65+ 4178000 1 926 000 2252000
MORTALITY DATA The leading causes of mortality are fetal deaths from maternal complications, chemical toxicosis, pneumonia, respiratory tuberculosis, crushing injuries, essential hypertension, traffic accidents, viral encephalitis, malaria and dengue. The main causes of mortality are apparently still communicable/ infectious diseases. However, morbidity and mortality from noncommunicable diseases continue to increase. Viet Nam can be said to be experiencing the early stages of epidemiological transition.
80+ 650000 278000 372000
Total Male Female
5 827000 2 722000 3105 000
DEPENDENCY RATIOS DependenCY ratio 60+ cut-off (per 1 00) Year Total Dep. Ratio Old Dep. Ratio 2000 68.48 12.53 11.71 2005 57.84 LIFE EXPECTANCY (2000) At birth 66.9 71.6 2.3
DependenCY ratio 65+ cut-off (per 100) Total Dep. Ratio Old Dep. Ratio 62.64 8.63 52.97 8.26
Male Female TOTAL FERTILITY RATE URBAN 20% 24
fJtvtiir.....tvl .,..,-tici~ («.,A r~rM#i#t-4 The rights of the elderly are protected by a section of the state Constitution of Viet Nam. The Constitution contains various provisions which pertain to the care and protection ofthe elderly. It gives priority to the elderly in medical treatment, provides them with social insurance and various services to assist them in their needs, provides them with protection in the workplace, mandates children and grandchildren to take care of them, makes maltreatment of the elderly a criminal offense, and gives lighter sentences to old people who commit crimes. The Law on the Elderly (12 May 2000) provides the legal base for all activities which care for the elderly. The Law includes 34 articles defining the general status of the elderly in society, including provisions for environment, housing, social and health assurance. From time to time, the Prime Minister issues instructions for the welfare of the elderly. Instruction 132/CT ordered organizations at all levels to provide assistance to the elderly, and Instruction No. 117m ordered assistance and support to be given to the Association of the Elderly of Viet Nam.
MEDIAN AGE
t>~r~~ic ~ Wt~ ri'"1Tfilt Viet Nam had a total population of 78 137 000 in 2000. Of that number, 5 827 00,0 or 7.5%, were 60 years of age or older and 4 178 000, or 5.3 %, were 65 years or older. There were slightly more males than females in the general population. The country is predominantly rural, with only 20% of the population living in urban areas.
Life expectancy at birth was 66.9 years for males and 71.6 years for females in 2000. The dependency ratio in 2000 was 62.64 per 100, with an aged dependency ratio of 8.63 per 100.
62
Vlf3TfJA~ (con't.J The Ministry of Health, Department of Sports and the Ministry of Labor, Invalid and Social Affairs have the responsibility to take care of the elderly, particularly homeless old people.
~frH-YCt;J
fo-r tk e;lAewlj
Vietnamese society maintains its tradition of respecting and taking care of the elderly, especially in rural areas. In urban centres, however, this tradition is slowly being affected by the "new lifestyle", which is in pursuit of material advantages. The Association of the Elderly of Viet Nam is a voluntary social organization which promotes the welfare of the elderly at the central, commune, village and hamlet levels. Various organizations, cooperatives and trade unions coordinate with state organizations to provide services for the elderly. A pension is provided for those who have retired from work (55 years of age for women and 60 years for men ). Primary health care is provided to the general population, including the elderly, through a network of medical service units in villages, communes and precincts. Secondary and tertiary care is provided at hospitals and sanitariums. In large cities, there are hospitals for the elderly, especially for retired people; in provincial hospitals, there are sections for sick old people. Institutional care is provided for homeless old people, orphans and patients with mental disorders. There are also rehabilitation centres for the elderly, war victims and victims of traffic accidents. There is a gerontology department in Hanoi Medical College. Viet Nam National Institute of Gerontology (VNIG) organizes training courses on geriatrics for doctors who work with the elderly throughout the country, and training courses on nursing the elderly for nurses in Hanoi.
(1) (2) (3) (4) (S) (6) (7)
(8) (9)
2003 ESCAP Population Data Sheet. Bangkok. United Nations Economic and Social Commission for Asia and the Paclflc,2003. World Population Prospects; The 2000 Revision. New York, United Nations,2001. Health ofO/derl'r!rsons in the Westl!m Pacific Region: Country Profiles. Manila,WHO Western Pacific Regional Office, 1998. Price MA. Mission ll!port Ha Noi, VietNam, 17 November- 7 December 1999. WHO Western Pacific Regional Office Tran Due Tho. CountryReparr: VIetNam. Workshop on the Development of Programmes for Health of Older Persons, Seoul, South Korea,4- 7 June 1999. Pham Thang. Health and Ageing- Research,EdiJCCition, Policy and Practice. Paper submitted at the Workshop on Health and Ageing- Research, Education, Policy and Practice: Adelaide, Australia,26- 30 October 2000. Guidelines for National Policies and Programme Development for Health ofOlder Persons in the Western Pacific Region. Manila, WHO Western Pacltlc Regional Office, 1998. Ton Thi Kim Thanh. The Situation ofBlindness Prevention in V"let Nom. Paper submitted atthe WHO Workshop on Prevention of Blindness, Fukuoka,26- 29 October 1998. Key lndica!Drs2002: Population and Human Resource Trends and Challenges. From the website of the Asian Development Bank (http:I/Www.adb.org/documentl/boola/lcey-indicators/2002/rta/.xls)
63
HOW MANY OLDER PERSONS (2002) Total Population 14400 Age Groups
'Rt:.lv~t'.! [vr ~ ~tA"l:J In this traditional society, the family is still the primary care giver for the elderly.
IE. DEPENDENCY RA110S
65+ 1165 517
T/6 336 440
The Health Department of Wallis conducts visits the home-bound elderly periodically. There are, however, no special assistance programmes for the elderly unless they are disabled. A pension is available for persons 55 years and above who have previously been employed. Those who are not eligible to receive a pension receive a social benefit from the Territory.
647
Y.ar 2000
D111eru:llnc:w r.tlo 60+ c:ut-off U..r 100) Total Dep. Ratio Old Dep. Ratio 83.93 13.8
De
raefo65+cut-«f(DW 100)
Total Dep. Ratio 76.51 65.15
Old Dep. Ratio 9.21 8.97
2005
74.12
14.89
Ll FE EXPECTANCY (1991-95) Male
Atlbirth 66.7
Female TOTAL FER'IIUTY RATE
70.8 est2.85 0%
URBAN
:J>~,.~ic ~ Wt/..- rY'lrfi~ The self-governing French Overseas Territory of the Wallis and Futuna Islands had an estimated total population of 14 400 in 2002. Of this number, 776,or 5.4%, were 65 years old and older. There is no significant difference in the proportion of males and females In the older population. The country is 100% rural. Life expectancy at birth in 1991-1995 was 66.7years for males and 70.8 years for females.
JJMfiv,...M, rvlkit'.! ~ r"'9j~"MM.Ut.I;J There is, as yet. no specific policy or programme for the elderly. (1)
..., (2,)
COI.OII!yHHJth lnfomtatJolt~:IOOt lliMdM. Manila,WHOwatem Patltlc Regional om ca.
....
Hr!tdlltG!OidB1'f!rJ:Dra In ~~flacJflcRllgloll:CO<DI!Iyl'rofl14 Man... WHOWetUm Pad1lc: Regional~ 1991.
64