How to protect Asia’s rapidly aging population from COVID-19
The COVID-19 pandemic highlights the need to strengthen programs and policies affecting older persons both in times of crisis and afterward.
COVID-19 has become a global health crisis with significant human costs that are rising at an alarming rate. The risks of this virus for older persons have been amply highlighted, with mortality rates increasing rapidly with age, especially for those with underlying chronic conditions. An early study from the National Health Commission, in the People’s Republic of China, suggested that about 80% of people who died from the virus in the country were over the age of 60, and 75% had pre-existing conditions.
Asia and the Pacific are rapidly aging. Fifty-eight percent of the global population, or 614 million persons over the age of 60 years old live in the region. In many countries, more than half of older people are affected by underlying conditions, with the prevalence rising sharply with age. Many conditions, such as hypertension and diabetes, which increase complications of COVID-19, are undiagnosed. It is estimated over 60% of hypertensive cases and 30% of diabetic cases in India are not diagnosed, and poverty is strongly associated with a lack of diagnosis and treatment, increasing risks and complications in dealing with this pandemic.
Overstretched health services and nascent care systems in most Asian countries create substantial challenges for governments to address the needs of the at-risk populations in the region. Understanding the circumstances of older persons and designing specific actions in Covid-19 responses will be critical.
The design of Covid-19 response programs must recognize the situations and diversity of the older population. In the rush to protect older people we can overlook this. There is significant diversity in health status across all age groups, in the range of contributions made on a daily basis to their own families and the multiple roles they have in society as workers, carers, volunteers, and community leaders; and in the ability of older men and women to be resilient and withstand shocks. This heterogeneity needs to be recognized to ensure older persons are not discouraged from contributing to the collective response as well as ensuring that specific individual vulnerabilities are reduced.
Participation in the informal labor force for many older people is a necessity with approximately 40% of persons over 60 years old working in countries such as Bangladesh, the Philippines and Viet Nam, increasing to 66% in Nepal. The widespread economic impact of the COVID-19 pandemic will also affect them. Social protection programs must recognize this and ensure initiatives to protect against economic shocks for informal workers include older people.
Fifty-five per cent of persons over the statutory retirement age in Asia Pacific currently receive either a pension although the value of these pensions is comparatively small compared with other regions. Countries without social pensions tend to have old-age poverty rates higher than average poverty rates. Expanding coverage of social pension schemes to reach older persons and injecting additional cash through these programs in response to this crisis can help.
Such social protection measures for older persons have been taken in in India, Sri Lanka, Thailand and Viet Nam. It particularly helps older women who are less likely to have other sources of income to take better preventative precautions, access healthcare if needed, and mitigate against a loss of income for themselves and those in their care. Often pensions are collected at designated communal pension points; now is the time to ensure appropriate and safe distancing measures are implemented or alternative distribution channels are in place to facilitate older persons receiving their pensions.
Beyond the urgent strengthening of health systems and measures to ensure income security, aged care including social and community services serving older persons needs to be included in the response plans. The importance of focusing on these services is vividly demonstrated by the tragic infection cluster spikes in residents and staff in nursing homes reported in Australia, Italy and the United States, and reports of older people dying unattended in care homes in Spain.
Strong infection control protocols, testing and personal protective equipment and other supplies are needed to protect staff and those in care. This needs to target residential facilities, such as nursing homes, care homes and social welfare institutions, and organizations providing home and community services on which people rely on. Agencies responsible for overseeing care and other social services need to be supported and not overlooked in the response so they can ensure appropriate services are provided.
In Asia-Pacific, as across the globe, most day to day care is provided by family members, often spouses and daughters. This makes up a significant portion of the care burden in households. Self-isolation is not an option when providing personal care, and even less so in larger households. Education on how to protect family care-givers and those they care for must be disseminated quickly and widely as well as access to testing, hygiene kits and personal protective equipment secured. Additional financial support to allow family care-givers to stay home should be considered. Global practitioners and academics are pooling technical expertise and resources as well.
Every day we hear inspiring stories of how communities are rallying together to ensure the well-being of all their members and governments from the Thailand to India are starting to call on armies of volunteers to support over-stretched services. In the Asia-Pacific region there are already many networks of community health workers and social and community-based organizations, such as older people’s associations, often led by older persons themselves, which can be mobilized to support these efforts.
Over the past months older peoples associations in Shaanxi Province, in the People’s Republic of China, have been involved in enforcing community quarantine measures and providing cleaning supplies and personal protective equipment to older persons; and in Viet Nam and Cambodia they have been delivering public health messages, especially those living alone, or who are illiterate
Now these organizations are establishing systems to provide members of their community with basic needs, psycho-social assistance and support plans if they fall ill. These and other community groups and organizations have a key role to play in ensuring communities stay socially connected, safe, and ensure no one is left behind. Resources to build on their capacities, networks and skills will help strengthen responses at the community level for those who are ill but not in need of hospital care.
Governments in the region are gradually adapting as they transition to aging societies. The COVID-19 crisis highlights the urgent need to strengthen programs and policies affecting older persons, the importance of developing targeted approaches in the areas of health, care systems, income and building on the strengths and assets of the community organizations which are already operating on the ground and serving this population.