AGEING WITH DIGNITY: BALANCING HEALTHCARE AND SOCIAL SUPPORT FOR

THE ELDERLY

INTRODUCTION

People worldwide are living longer. Today most people can expect to live into their sixties
and beyond. Every country in the world is experiencing growth in both the size and the
proportion of older persons in the population. By 2030, 1 in 6 people in the world will be
aged 60 years or over. At this time the share of the population aged 60 years and over will
increase from 1 billion in 2020 to 1.4 billion. By 2050, the world’s population of people aged
60 years and older will double (2.1 billion). The number of persons aged 80 years or older is
expected to triple between 2020 and 2050 to reach 426 million. While this shift in distribution
of a country's population towards older ages – known as population ageing – started in high-
income countries (for example in Japan 30% of the population is already over 60 years old),
it is now low- and middle-income countries that are experiencing the greatest change. By
2050, two-thirds of the world’s population over 60 years will live in low- and middle-income
countries. Older people are often assumed to be frail or dependent and a burden to society.
Public health professionals, and society as a whole, need to address these and other ageist
attitudes, which can lead to discrimination, affect the way policies are developed and the
opportunities older people have to experience healthy aging. [1]

AGEING WITH DIGNITY

Social support includes real or perceived resources provided by others that enable a person to
feel cared for, valued, and part of a network of communication and mutual obligation. Studies
have demonstrated an association between increased levels of social support and reduced risk
for physical disease, mental illness, and mortality. Social support can be critical for those
older adults who rely on family, friends, or organizations to assist them with daily activities,
provide companionship, and care for their well-being. [2]

Most public policy debates are concerned with the physical issues of aging, whereas social
issues, such as social support, tend to be ignored. Older people are faced with greater losses,
given fewer social resources and less adequate social support, in both subjectively perceived
support and the frequency of contact. Physical activity also plays a key role in maintaining
health and mobility in old age; the evidence for the health benefits of physical activity is
stronger for adults 65 years and older than for any other age group because the consequences
of inactivity are more severe for this age group. Furthermore, older people with a high-level
social support may achieve the recommended physical activity more easily than those with
lower social support levels, thereby maintaining health and physical function. [3]

From a public health perspective, it is important to note that greater amounts of time engaged
in physical activity, even at low intensity, would provide important benefits for maintaining
physical function in old age. In addition, appropriate environment may increase outdoor
mobility in older people. Many studies have demonstrated that attractive and friendly
environments, such as greens spaces, safe road crossings, and sidewalks, are closely related
with higher physical activity among older individuals. [4] Families throughout history have
provided care to older adults with serious illnesses living in the community; this is the case
before, currently, and will be into the future. Family involvement is a global phenomenon
occurring across all socioeconomic levels, within all race and ethnic groups, and in low-,
middle-, and high-income countries. [5]

Following are some ideas that would contribute to social-support improvement in the elderly:

First, government could participate in or learn from the WHO Healthy Cities project to
protect and promote their citizens’ health and well-being. Inequality in health and urban
poverty, vulnerable groups, and participatory governance as well as social determinants of
health should be emphasized in the comprehensive health planning. [6]

Second, health promotion may reduce the disparity in health status to help people to achieve
their fullest health potential. Public health policy, supportive environment, community
participation, personal ability, accessible health service, and moving into the future are the
significant elements of health promotion action. In addition, different social, cultural, and
economic systems should be taken into account while formulating any health promotion
strategy and programme. [7]

Third, developing social systems that provide support for the elderly through various
economic, service, and mental health projects; this should be a focus of future work on aging.
[8]

Fourth, encouraging participatory activities may improve support utilization levels. Pathways
linking activities and individual well-being often include social support from social
interactions, physical benefits from body movement, and the consequent positive
psychological benefits. [9]

Social support protects the elderly against the adverse effects of stressful life events, such as
diseases and bereavement. The presence of someone to assist in later life protects individuals
from aging losses. Assessing social support relies on the conceptualization of this concept.
Most of the studies measure social support in terms of its functional component. Accordingly,
social support constitutes emotional support (caring and love), instrumental support (tangible
support), informational support (guidance and providing solution), appraisal support (help for
self-evaluation), and social companionship (spending time for recreation). Some studies have
measured social support based on the number of supportive people in their social network.
These theories focus on being loved and valued by others but do not address the person's
perception of helping others. Socio-demographic groups discuss the direct and indirect effects
of social support on health. Older women receive more support due to a more extensive
network than men. Older men receive more support from their wives and report more
satisfaction. In contrast, older women receive support from their children or friends.
Receiving social support is important among older patients as it helps them recover from
illness, injury, and health maintenance. Moreover, social support helps manage diseases and
promotes adherence to treatment or medicine. However, some studies revealed the negative
effect of receiving too much social support on well-being. Thus, the quantity and quality of
the received support are challenging and questionable. Many factors such as low income,
loneliness, disease, or dependency on daily activities can affect the quantity and quality of the
received support. [10]

Physical frailty can quadruple the probability of depression; patients in their later years who
suffer ailments such as chronic lung disease, arthritis, and coronary heart disease have been
shown to have elevated levels of low mood as well as diminished hedonic and eudemonic
well-being. Older adults experience depression, frustration, or restlessness due to physical
pain and impairment. [11]

Frailty is a core concept developed in the 2000s by multiple researchers. Though there is no
single definition of frailty, it is universally accepted that it leads to future disability, multiple
comorbidities, low quality of life and mortality. Frailty results in deregulation of the innate
body system with lower internal reserve for external stressful events, causing great damage in
frail older adults. Currently, the known risk factors of frailty are age, physical inactivity,
malnutrition, impaired cognitive function, unemployment and poor self-rated health. Social
support is also associated with frailty. Several studies reported that perceived social support
from family or community is associated with low prevalence of frailty. However, most of
these studies were cross-sectional and the effect of different spectrum of social support, like
positive or negative support, or whether the support was from within or outside family
members, had not been explored therein. [12]

Social support from family members is essential to health, especially for older adults in Asia.
Different from Western countries, older adults in Asia usually have support not only from the
spouse, but also from children and grandchildren. A systemic review stated that family
support has a greater influence on depression among community-dwelling older adults in
Asia, compared with those from Western countries. A previous study discovered that
intergenerational relationship and family social support are negatively correlated with an
older adults’ depression level, while family social support also play a mediating role between
intergenerational relationship and depression. On the other hand, support from spouse is also
important. A past study revealed that older adults in Korea who lived with their spouses had a
larger number of network members than those who did not live with spouses, and social
support satisfaction and family function are significant predictors of loneliness. A previous
study in Taiwan focusing on older adults who lost their spouse also demonstrated poor
psychological outcome. Besides the psychological profile, family support is also associated
with physical activity. A study reported that spouse-specific emotion-related social support
and household size are associated with less sedentary behaviour, especially for men. [13]

Most studies have demonstrated the negative impact on health of negative supports, including
negative emotions like anxiety, anger, and depression. Negative support and negative
interactions were also associated with poor mental health and poor quality of life. The
mechanism between those interactions could be metabolic change. One study demonstrated
that participants with negative social support showed higher levels of cortisol in the hair. The
reason why negative support was not significantly associated with physical frailty could be
that negative interaction could be alleviated by multiple socioeconomic factors. One study in
Korea showed that level of income and positive social support determined the relationship
between level of negative social support and depressive symptoms. [14]

Keeping in view the recommendations made in the “National Policy on Older Persons” as
well as the State’s obligation under the “Maintenance & Welfare of Parents & Senior Citizens
Act 2007”, the Ministry of Health & Family Welfare, Government of India launched the
“National Programme for the Health Care of Elderly” (NPHCE) during the year 2010, in the
11th Plan period, to address various health related problems of elderly people. [15]

Following strategies will be adopted to achieve the above mentioned objectives:

Preventive and promotive care: The preventive and promotive health care services such as
regular physical exercise, balanced diet, vegetarianism, stress management, avoidance of
smoking or tobacco products and prevention of fall, etc. are provided by expanding access to
health practices through domiciliary visits by trained health workers. They will impart health
education to old persons as well as their family members on care of older persons. Besides,
regular monitoring and assessment of old persons are carried out for any infirmity or illness
by organizing weekly clinic at PHCs. [16]

Management of Illness: Dedicated outdoor and indoor patients services will be developed at
PHCs, CHCs, District Hospitals and Regional Geriatric Centres for management of chronic
and disabling diseases by providing central assistance to the State Governments. [17]

Health Man Power Development for Geriatric Services : To overcome the shortage of trained
medical and paramedical professionals in geriatric medicine, in service training will be
imparted to the health manpower using standard training modules prepared with the help of
medical colleges and regional institutions. The post graduate courses in geriatric medicine
will be introduced in Regional Geriatric Centres for which additional teaching and supportive
faculties are provided to these institutions. [18]

Medical Rehabilitation & Therapeutic Intervention: By arranging therapeutic modalities like

therapeutic exercises, training in activities of daily life (ADL) & treatment of pain and
inflammation through physiotherapy unit at CHC, district hospital and Regional Geriatric
Centre levels for which necessary infrastructure, medicine and equipment are provided to
these identified units. [19]

Information, Education & Communication (IEC): Health education programmes using mass
media, folk media and other communication channels are being promoted to reach out to the
target community for promoting the concept of healthy ageing, importance of physical
exercise, healthy habits, and reduction of stress. Camps for regular medical check-up are
being organised at various levels where IEC activities are also specifically promoted. [20]

CONCLUSION

Providing social support is more important than receiving it for the well-being of older adults.
So, facilitating the intergenerational social support exchange or volunteering in social
activities could help older adults maintain their authority and independence in their social
relationships and consequently feel well in later life.

To enhance the well-being of older individuals, the focus should be on improving social
support through continuous enhancements to social security and medical insurance systems.
Advocacy for active participation in society, fostering interpersonal relationships, and
facilitating group support can solve problems like lack of mental comfort, insufficient
financial support, and life care. Additionally, prioritizing mental health services for older
individuals is vital. Governments and societies should provide targeted interventions, care,
and positive psychological support for those at higher mental health risks and develop
community-based social activities to further enrich their lives and improve mental health.

Emotional and instrumental social support from within and outside family members can
reduce future physical frailty among older adults. It is important for healthcare professionals
to understand the need for social support by older adults to appreciate the risk of physical
frailty. Future research should be focused on the effectiveness of social interventions for
older adults who lack social support.

REFERENCES

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[2] Social Support and Health-Related Quality of Life among Older Adults --- Missouri,
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[11] Zhang Y, Sun L. The health status, social support, and subjective well-being of older
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[12-14] Wei-Min Chu, Chikako Tange, Yukiko Nishita, Makiko Tomida, Hiroshi Shimokata,
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[15-20] National Programme for Healthcare of Elderly (NPHCE). Available at

https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1046&lid=605