Get Real
Aging
By Solita Collas-Monsod
Philippine Daily Inquirer
First Posted 04:21:00 11/22/2008
Filed Under: Senior Citizens, Demographics
A growing number of the world’s population are attaining not only old age but advanced old age—almost by leaps and bounds.
In Hong Kong, for example, people who were 65 years old or older constituted 4.5 percent of the population in 1971, but their number jumped to 11.1 percent in 2001. In South Korea, while these “olds” comprised 5.9 percent in 1970, this proportion increased to 14.8 percent in 2000. While Europe has the highest proportion of the “old/elderly,” it is expected that the combination of rapid declines in fertility and increases in life expectancy in Asia, Latin America and the Caribbean, the Near East and North Africa, will result in the proportions of elderly in these regions more than tripling by 2050—so much so that the “old” are now subdivided by demographers and economists into the “young old” (65 to 74 years old), the “middle old” (75 to 84,) and the “oldest old” (85 and over), with the last subgroup growing much faster than the other two.
This phenomenon, however, seems not to have hit the Philippines: In 1970, 3.5 percent of our people were “old,” and in 2000, that proportion went up, but only to 3.8 percent (compared to the doubling experienced in other countries). Why such a weak demographic transformation? Possibly because the combination of rapid declines in fertility and increases in life expectancy experienced in those countries did not take place in the Philippines. Nevertheless, it is still accurate to say that the proportion of the old/elderly to the total population in the Philippines has been growing, albeit not by leaps and bounds.
The research on the aging phenomenon makes for fascinating reading. For example, a theory was proposed in the early 1980s (by James Fries) that there is a biologically fixed maximum human life span. This would imply, says a study, that death rates at very old ages should be relatively stable, since “virtually all death at advanced ages is due not to accident or unlucky chance but the wearing out of organ systems as the maximum life span is approached.” It would also imply that genetically identical individuals should have identical maximum potential life spans. It would further imply that the death rates should increase with age.
But apparently the data do not support those implications: A US study shows that death rates at older ages have in fact declined substantially over the last century, and work on twin registries showed no evidence of twins sharing a maximum potential life span.
More recently, a new theory has been proposed (by Fogel and Costa) to explain the phenomenon of advanced old age, which they call the theory of “technophysio evolution.” The theory says that increased human control of the environment due to technology advances has allowed human populations to greatly improve the capacity and robustness of vital organ systems, “such that later birth cohorts have much greater health capital and much lower rates of depreciation of that capital than earlier birth cohorts”—which means that the age of onset of chronic diseases and disability will occur later, meaning in turn that life expectancy will rise.
Not surprisingly, the research also shows that health and therefore life expectancy is significantly better as one moves up the socioeconomic ladder. There is a statistically significant link between income and health, and education and health.
Whatever is the cause of increased life expectancy, the inescapable conclusion from all this is that geriatrics, that branch of medicine that focuses on the health care of the elderly, is definitely a sunrise industry. Because that care is what stands between the elderly (and I am one of them, being a “young old”) and the so-called “geriatric giants,” which is how symptoms common to a number of diseases of old age are called: confusion (impaired intellect/memory), falls, incontinence, immobility, impaired vision, hearing loss, and the issues involved in being subjected to multiple medications (called polypharmacy). The prospects are not pleasant, and the only ones we oldies can depend on to mitigate its effects are the geriatricians.
Why geriatric medicine, and why not just plain adult medicine? Because, apparently, the body of an elderly is substantially different physiologically from that of an adult. One has to differentiate between disease and aging effects. Also, it seems that the decline in physiological reserve in organs makes the elderly not only more vulnerable to diseases but more likely to have complications from mild problems. Plus, functional ability, dependence and quality of life issues are of greater concern to geriatricians than to adult physicians. Plus, sometimes an elderly cannot make decisions for himself. Etc.
So what is the state of geriatric medicine in the Philippines? It is hard to tell. But the fact that the Philippine Society of Geriatric Medicine is only eight years old may give us a clue. I am told it has 168 members, half of whom are physicians, and the other half made up of nurses and other medical practitioners. Among the physicians, about 35 are certified geriatricians (meaning, they either took a fellowship course in geriatrics, and/or passed an exam that gives them a Certificate of Added Qualifications in Geriatric Medicine). The bad news is that only 20 of the 35 are still in the Philippines, the rest having moved to greener pastures.
Twenty geriatricians for 2.9 million people, the population 65 years old and older, as per the 2000 census: mind-boggling.
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