The Active Aging Concept

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When considering the demographic inversion and assocaited challenges, it becomes evident that investments in aging and health are necessary to ensure human rights and sustaniable development. Given that people are living longer and the proportion of older adults in our society is higher, understanding the aging process and facilitating healthy aging is and will be critically important. Unless vigorous measures are taken to prevent non-communicable diseases commonly associated with the aging process and to promote health during old age, the aging of the population will place new and perhaps impossible demands on health care systems and younger generations. Meeting these challenges requires a clear understanding of the health needs of older adults, innovative planning to develop programs, systems and structures which will support the health and welfare of the aging population, and substantial reforms and policies at global, national, and local levels. Recently, the WHO’s discussion paper on health and aging indicated that “we can afford to get old if countries, regions and international organisations enact ‘active aging’ policies and programmes that enhance the health, independence, and productivity of older women and men. The time to plan and to act is now” (WHO, 2001). Active aging is the process of optimising opportunities for physical, social and mental well-being throughout the life course in order to extend healthy life expectancy, productivity and quality of life in old age. Active refers not only to physical activity but also to continuing involvement in social, economic, spiritual, cultural and civic affairs. Similar sentiments have been conveyed in the 2002 International Strategy for Action on Aging (United Nations, 2002a). In addition to the call for awareness of aging issues and challenges, WHO and UN has issued policy framework and priority directions for action and research, which identify health and independence/ autonomy, productivity and protection of the aging population as the three critical pillars essential for active aging (United Nations, 2002a; WHO, 2001).

Active aging promotes the level of health required for the elderly to continue as productive members of society, and saves them from the position of being mere recipients of care and services. In turn, this will benefit India’s younger population who often take on the burden of caring for the elderly. Indeed, the country as a whole benefits from a healthy elderly population, a fact that high-income countries have recognised; they have been adjusting for some time to meet the needs of their older citizerns. The governments of low-income countries are only just beginning to recognise the long-term socio-economic implications of their aging populations. Economic facts to consider regarding active aging :

        •   It is often less costly to prevent disease than to treat it. In Canada, it has been estimated that a reduction of $ 150 million a year in health care expenditures is possible if the prevalence of physical inactivty was lowered by 10% (Katzmarzyk, Gledhill and Shephard, 2000).

        •   Old age itself is not assocaited with increased medical spending. Rather, it is the disability and poor health often associated with old age that are costly.

In order to provide research, program and policy direction, WHO has created a comprehensive list of factors that affect the health of the elderly pouplation across the globe. These include :

        •   Culture and gender : Social status, which affects access to nutritious foods, education, meaningful work, and access to quality health care.

        •   Health and social service systems : Access to quality health care throughout the lifecycle, disease prevention, equitable access, long-term care availability, curative services, affordability of medication and care services, availability of mental health services.

        •   Behavioural determinants : Tobacco use, alcohol use, level and type of physical activity, healthy eating, oral health, medication usage and adherence.

        •   Personal factors : Biology and genetics, cognitive capacity.

        •   Physical environment : Physical safety (falls), adequate housing, social support, clean water, clean air, and safe foods.

        •   Social environment : Violence and abuse (including physical, sexual, psychological, and financial) level of education and literacy.

        •   Economic environment : Income, social protection, work.

While considerable research is available on the determinants of health and active aging in developed countries (Johnson, 2000; Johnson 2002), there is limited research on healthy aging and the determinants of autonomy among older adults in developing countries such as India (Johnson, Rajan and McLeod, 2003). Research indicates that social, personal, economic, environmental and behavioural factors as well as health and social services are all considered determinants of active (WHO,  2001). In addition, culture has been identified as a critical role in how these determinants are translated within population groups. While population statistics, such as census data, are useful in identifying the size and socio-economic characteristics of the older cohort, limited research is available on the determinants of health among older adults in India.