Abstract
BackgroundLow and middle income countries are ageing at a much faster rate than richer countries, especially in Asia. This is happening at a time of globalisation, migration, urbanisation, and smaller families. Older people make significant contributions to their families and communities, but this is often undermined by chronic disease and preventable disability. Social participation can help to protect against morbidity and mortality. We argue that social participation deserves much greater attention as a protective factor, and that older people can play a useful role in the prevention and management of chronic conditions. We present, as an example, a low-cost, sustainable strategy that has increased social participation among elders in Sri Lanka.DiscussionCurrent international policy initiatives to address the increasing prevalence of non-communicable chronic diseases are focused on cardiovascular disease, diabetes, respiratory disease and cancers, responsible for much premature mortality. Interventions to modify their shared risk factors of high salt and fat diets, inactivity, smoking and alcohol use are advocated. But older people also suffer chronic conditions that primarily affect quality of life, and have a wider range of risk factors. There is strong epidemiological and physiological evidence that social isolation, in particular, is as important a risk factor for chronic diseases as the 'lifestyle' risk factors, yet it is currently neglected. There are useful experiences of inexpensive and sustainable strategies to improve social participation among older people in low and lower middle income countries. Our experience with forming Elders' Clubs with retired tea estate workers in Sri Lanka suggests many benefits, including social support and participation, inter-generational contact, a collective voice, and facilitated access to health promotion activities, and to health care and social welfare services.SummaryPolicies to address the increase in chronic non-communicable diseases should include consideration of healthy ageing, conditions that affect quality of life, and strategies to increase social participation. There are useful examples showing that it is feasible to catalyse the formation of Elders' Clubs or older people's associations which become self-sustaining, promote social participation, and improve health and well-being of elders and their families.
Highlights
Low and middle income countries are ageing at a much faster rate than richer countries, especially in Asia
Summary: Policies to address the increase in chronic non-communicable diseases should include consideration of healthy ageing, conditions that affect quality of life, and strategies to increase social participation
WHO focuses on four conditions responsible for most premature mortality, and four ‘lifestyle’ risk factors [2]
Summary
Social isolation a significant risk factor Since the 1970s there has been a growing understanding of the influence of social relationships on the prevention and management of chronic conditions [9]. Case study - addressing social participation of elders in tea estate communities in Sri Lanka Sri Lanka is a lower middle income country with one of the fastest growing populations of older people in the world due to early gains in life expectancy and reduction in fertility rates [35] Those over 60 years make up about 12% of the population, and this is expected to increase to over 20% of the population by 2030 [35]. The process of establishing self-sustaining Elders’ Clubs described in this case study provides useful lessons for the National Secretariat for Elders in implementing this goal, and for other low income settings It has shown the valuable role local non-government organisations can play in linking with different government sectors to provide more appropriate services and in assisting older people to access services. When in good health older people can be of great benefit to their families and communities
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