January 2014, Volume 64, Issue 1

Special Communication

Active ageing in Pakistan: challenges and opportunities

Samina Subzali Vertejee  ( Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi. )
Noureen Nasruddin Karamali  ( Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi. )

Abstract

The increasing number of ageing population is a signpost for re-directing the resources to ensure quality of life for elderly thus promoting active ageing. However, the challenges to achieve the goal outweigh the opportunities due to scarcity of resources.
Several factors including, brain drain, poverty, lack of knowledge of elderly to protect their rights in association with poor state laws determines the poor quality of life for elderly in Pakistan. Although, the apparent scenario is quite unpleasant yet there are several opportunities such as improved crude birth and death rates, increased awareness about gerontology as a specialty care area and constitutions of Pakistan can be significant to ensure the well being of elderly and overcome the challenges to achieve active ageing in Pakistan.
It is important to make best use of opportunities at hand by redirecting the resources to improve the quality of life to promote active ageing in Pakistan.
Keywords: Active ageing, Brain drain, Caregiver, Quality of life, Elderly, Challenges and opportunities.

Walking through the streets elderly are found either sitting idle, helpless or engaged in laborious work. Moreover, most of them are even deprived of basic necessities including food, shelter and clothing. Contrary to this, elderly in elite society may be considered blessed and are fortunate to have someone caring for them; however this is not true in most cases. It is witnessed that most elderly are found left under the care of a lay workers usually the maid or house boy; while in some cases this is not practiced due to security reasons. The ageing individuals regardless of their social status are overlooked and live in misery and social isolation.1,2 The situation may be degraded with the increasing number of ageing population.1,2
Pakistan like many other developing countries is going through the demographic transition. The continuous improvement in life expectancy and low fertility rate has resulted in population boom, with nearly 180 million dwellers, which further may reach to 210 million by 2020.3 The overpopulation compounded with poverty, and lack of awareness has resulted in compromised quality of life for elderly in the society.1 Consequently, it is imperative to advocate for the rights of elderly; equity in health care and other services. This can be achieved through prudent resource allocation to meet the needs of ageing population in managing their health and wellbeing.4
This paper will discuss the opportunities and challenges in cultural and economic context for elderly to attain quality of life for active ageing. The demographic transition evidenced by growing number of ageing population; signposts the need for strategies to improve the quality of life as one of the key targets. It is therefore important to examine the opportunities and challenges responsible for active ageing in Pakistan. World Health Organization, (WHO) defines active ageing as the "process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age".5 Though the opportunities determine active ageing;6 however the challenges including the vicious cycle of poverty and illiteracy outnumber the opportunities.7
Challenges to Active Ageing in Pakistan
Maslow\'s Hierarchy of Needs states various needs of individuals that he/she attains throughout the life span; however due to certain factors the needs are unmet or are "deficit needs "which can be impacting the quality of life.8 Amongst the elderly it is governed by three elements including, the ageing individuals, the caregiver and the state laws; each complements the other to ensure quality of life. Likewise, the relationship of each can be a rich living experience or vice versa for elderly individuals.7 The family caregiver\'s role is hampered by rapid urbanization and brain drain due to economic crisis.4 Thus, the diverse expectations promote social isolation and disengagement from social machinery.9 People age 60 years and above are stereotyped to be less active compared to what they have been doing in their prior life.10 Alongside, the least favouring state law, frailty, lack of knowledge of self-protection of rights and poverty leads to poor quality of life and thus hinders active ageing.11 It is also reported that many elderly verbalise the ageing process and declining culture of reverence as one of the leading causes of distress and anxiety amongst them.9,11
A survey report by Pakistan National Centre for Ageing (PNCA), revelead 47% of the elderly do not have the payment capacity for health care, safe housing, food and clean water. Eighteen percent of the survey respondents reported that things were not in their favour. The survey findings highlighted poor governmental role in providing bank loans for small business to elderly for self-sustainability and self-reliance.1,2,12
Opportunities and Way Forward for Active Ageing
Demographic transition with low birth and death rate; itself is an opportunity that demonstrates the effectiveness of the system in improving crude birth and death rates. Secondly, the field of gerontology and geriatrics is an emerging specialty care area in Pakistan that exhibits the promising sign to address the needs of elderly. Additionally, community support groups including the non-profit organizations working for improvement in quality of life for elderly population shows significant trends in society.4 Beside these the Old Age Benefit Scheme 1976; was launched for the financial maintenance of elderly in their later life for both the formal sector employee and self-employed individuals.13 Further, the government schemes for senior citizens, nevertheless very few but can be established to facilitate provision of shelter, income support programme and medical services.
Above all "Ageing in Place" can also play a significant role in health and well-being of the ageing population,14 though the concept theoretically may not be known, but people may be practicing it and giving the freedom to ageing individuals to decide their preference of living. Article I of Universal Declaration of Human Rights deliberates on the concepts of freedom, equality, dignity and rights for all; if human rights declare the word "All"; elderly are also inclusive. Moreover article 25 of Universal Declaration of Human Rights also emphasizes that everyone has a right to live quality of life and so does the ageing individual.15 Therefore, practicing the "Ageing in Place" strategy will allow both caregivers and the ageing individuals to consciously decide the preference of dwelling for elderly.14

Conclusion

Pakistan is a welfare state which is also reflected in the Constitution of Pakistan. Article 38D promises the social safety net and endorses provision of basic necessities of life; without any discrimination. Likewise the article 14 of constitution of Pakistan also claims the "inviolability of dignity of men".16,17 These confirm that no one is subjected to violation, wether young or old. Despite the well written constitutions, the rights of elderly are ignored resulting in poor quality of life due to heightening number of challenges. However there are opportunities although scarce but not absent.4 Therefore, it is important to make best use of opportunities at hand by redirecting the resources to improve the quality of life of ageing population. Hence, the realization of care of elderly or gerontology as specialized field by governmental and non- governmental organization will be a significant asset to address the needs of the ageing population.

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