Issues Magazine

The Longevity Revolution: The Need to Develop a Culture of Care

By By Ina Voelcker, Louise Plouffe, Silvia M.M. Costa and Alexandre Kalache

International Longevity Centre Brazil

Increasing longevity is one of the benefits of a modern age, but with it comes the responsibility to properly care for our ageing citizens.

Population ageing, the demographic trend occurring as fewer people are born and people live longer, is one of the biggest triumphs of the past century. By 2050, for the first time ever there will be a higher proportion of older people than of people aged below 15 in the world. By then, the proportion of older people (60 years and over) will have doubled from 11% to 22%. Even more dramatic than this unprecedented global increase in the proportion of people aged over 60 is the fact that, worldwide, those older than 80 are the fastest growing population subgroup: from 14 million in 1950 to 379 million by 2050.

As life expectancy increases, the longevity revolution is underway throughout the world. Globally, over the past century we gained more than 30 years of life expectancy. Just in the past two decades life expectancy increased by 6 years worldwide. While today’s boomers could, when they were born, expect to live for, on average, 70 years, now at age 60 they have a remaining life expectancy of about 25 years.

Rethinking Life Courses

Increasingly long lives have profound implications at individual and societal level. Traditional life courses in most Western societies still assume that one retires between 60 and 65, and indeed the majority leave the formal labour market around that time. When retirement age was set at 70 years by the German Chancellor Bismarck more than

100 years ago, average life expectancy for a German was around 40 years. Today, life expectancy in many countries (including Germany) has already doubled. Yet retirement ages have actually decreased.

Although we need to work longer, our life courses should also become more flexible. There should be increased periods of learning throughout the life course, and allowances should be made for those with caring responsibilities for ageing parents. In addition, we now expect to have more time for leisure activities than people did at the beginning of the 20th century.

Unsustainable Care Systems

Living longer requires rethinking our life course and prevailing paradigms. Current life course models are no longer sustainable, and neither are health and social care systems in many places around the world. The demand for care is increasing rapidly as populations age. As people age, their functional capacity decreases, they become frailer and, even though many are healthy and active, an increasing number of older people become dependent and in need of care. Formal care systems, where they exist, become unsustainable in their current form. Family caregiving, where it is still the norm, is becoming more and more challenging due to global trends such as urbanisation, migration and globalisation, as well as increased female education and labour force participation, which lead to more complex and geographically dispersed family networks.

As more and more people live longer, a larger number of people will experience disability and frailty. Health patterns have changed from communicable diseases to non-communicable diseases, which are now the leading cause of not only deaths in the developed world but also of disability in both developing and developed countries.

Despite the changing epidemiology, health care systems still remain largely focused on cure and are not sufficiently orientated to provide care. Also, despite the changing demographics, we continue to obstinately train doctors for the 20th century through an emphasis on child development and reproductive health, with little attention given to older adult development and senescence. The 21st century imperative is the acquisition of specialist knowledge by all health care providers to respond to the needs of those who are increasingly going to be their patients.

As a first step to achieve such change, it is crucial to identify and uproot all beliefs, attitudes and behaviours that lead to abuse and neglect and to recognise the right to independence, dignity, self-fulfillment, participation and care according to the United Nations Principles of the Older Person of 1999. A rights-based approach to developing a culture of care provides the best opportunity for delivery in a non-discriminatory and equality-promoting manner. Services have to be not only available and affordable but also accessible, appropriate and of quality.

Developing a Culture of Care

The Rio Declaration “Beyond Prevention and Treatment: Developing a Culture of Care”, produced by the International Longevity Centre Brazil (ILC-BR), together with partners from United Nations agencies, international and national non-government organisations, Bradesco Seguros (a major Brazilian financial corporation) and academic institutions, was developed as a response to the longevity revolution. The Declaration’s core concern is that “however much is achieved in prevention and treatment, the longevity revolution comes with an added imperative: to develop a culture of care that is sustainable, affordable, compassionate and universal”.

To advance this debate on a global culture of care, two connected international forums were held in Brazil in October last year under the leadership of the ILC-BR in partnership with the World Demographic Association and Bradesco Seguros. Participating experts included representatives from other centres in the ILC Global Alliance (Argentina, Brazil, Dominican Republic, France and South Africa), United Nations agencies, international and national non-government organisations and academic institutions.

The Rio Declaration, approved unanimously, highlights the need for inclusive, person-focused care firmly grounded on human rights. It calls for a fresh perspective on gendered dimensions of care in policy and in society. Policy targets on care in the United Nations Post-2015 Development agenda are recommended. Emphasis is given to achieving a care system spanning health promotion to end of life care that is characterised by communication, continuity, coordination, comprehensiveness and community linkages. The Rio Declaration further calls for specific actions addressing respect for the rights of older persons; care services; planning and delivery of care; education and training; and age-friendly environments for a culture of care.

Ageing as a Lifelong Process

This paradigm shift towards a culture of care requires a holistic look at ageing and one that understands ageing as a lifelong process. The Active Ageing Policy Framework, a core reference for developing policies on ageing developed by the World Health Organization in 2002, recommends this. It defines active ageing as “the process of optimizing opportunities for health, participation and security, in order to enhance quality of life and wellbeing as people age”. Lifelong learning has recently been added as a fourth pillar.

These four central pillars provide a framework for individuals and societies to respond to the longevity revolution in a way that they can “realize their potential for physical, social, and mental wellbeing throughout the life course”.

In addition to thinking about ageing in relation to the life course, it is important to look at the functional capacity trend along the overall life course. While prevention and treatment are important throughout the life course to maintain a person above the disability threshold, it is becoming more and more important for societies and individuals to also prepare for a time when individuals may fall below that threshold. When that happens, it is impossible to care for oneself and one needs physical, psychological and emotional assistance.

However much we achieve in preventing or postponing age-related diseases and frailties there is a time in our lives when most of us will need care. Thus we have an imperative to develop a culture of care as expressed in the Rio Declaration – a response to the “longevity revolution” occurring throughout the world.

The International Longevity Centre Brazil (ILC-BR) is an independent think tank created in 2012 and situated in Rio de Janeiro. Its mission is to propose ideas and guidance for policies addressing population ageing based on international research and practice with a view to advance active ageing. The Centre does this through knowledge development and exchange, recommendation of evidence-based policies, social mobilisation and international networking with a focus on Brazil and the State of Rio de Janeiro. The ILC-BR is a member of the Global Alliance of International Longevity Centres, an international consortium with current member organisations in 14 countries.