“I see old people” is how this chapter begins. I’m reading “The new North – The World in 2050” by Laurence Smith. Without having finished the book, I’m excited to share some of the thoughts. This chapter really struck me.
Smith is a young professor in geography and earth and space sciences at UCLA. In his book, he analyzes four key “megatrends” – population growth and migration, natural resource demand, climate change and globalization – and projects how our world could look like in 2050.
The world is filling up with old people. Smith begins by describing the four stages of the demographic transition, which is happening everywhere in the world: 1. High and similar rates of birth and death (e.g., the preindustrial era, with a small and relatively stable total human population); followed by 2. Falling deaths but not births (initiating a population explosion); followed by 3. Falling births (still exploding, but decelerating); and finally 4. Low and similar rates of birth and death (population stabilization at a new, higher total number.
He states that most OECD countries have now passed through these stages – except for those allowing high levels of immigration like the USA – and have stabilizing or even falling populations. Most low- and middle-income countries are still in stage 2 or 3 though.
Smith summarizes that urbanization, modernization, and the empowerment of women push fertility rates downward. In other words, the urbanization of society (if associated with modernization and women’s rights) helps slow the rate of growth (with exceptions). In low-immigration developed countries like Italy and Japan, and regions like Eastern Europe, populations are falling. Consequently, if fertility rates continue to drop as they are now, the world population might be around 9.2 billion in 2050 – the population will still be growing, but about half as fast as today.
One of the most profound long-term effects of women having fewer babies is to skew societal age structure toward the elderly. Of course, improving healthcare also extends our life spans. This aging will hit some places faster and harder than others. Today, Japan is the world’s most elderly country with a median age of 44.6 years. In Pakistan, in contrast, the median age is just 22.1 years. Korea, Russia and China will join Japan as the world’s geriatric nations. Korea, Vietnam, Mexico and Iran will age radically by fifteen years or more. Countries like Afghanistan, Somalia and the Democratic Republic of Congo will still have youthful populations in 2050.
Smith asks: Is an elderly population a good thing or bad? He describes a possibly wiser and less violent society, which at the same time strains healthcare systems, and raises the economic burden on younger workers. The whole concept of “retirement” is about to undergo a major overhaul – people will have to work later in life. Big cultural shifts will be needed in the way we treat and value our elderly. Society must learn that aging and youth should be valued equally.
As the world grays, skilled young people will become a more and more craved resource, Smith concludes. Thus, those countries best able to attract skilled foreign workers will fare best. These young workers might come from Somalia, Afghanistan, Yemen, the West Bank and Gaza, Ethiopia, and much of sub-Saharan Africa, which will offer our world’s youth in 2050 based on current population structures.
Finally, the critical but open question that Smith poses is whether our poorest countries will be able to turn their forthcoming demographic advantages into the new skilled workforces needed to help care for an elderly world. This would require enormous improvements in education, governance and security. Women would have to start attending school and working in places where this is uncommon today. Terrorism would have to be sufficiently quelled. The countries that need young workers would have to accept immigrants from the countries that have them.
Hopefully, these things can be achieved.
PS: Check out Laurence Smith on Vimeo: http://vimeo.com/15715690
I came across this article from the UK about elderly people spending their merry Christmas on their own. I found it interesting, depressing, and even discovered a link to health in the whole dilemma.
While for many people Christmas is the only time in the year when they actually meet family and friends, others are not cared for by anybody or do not care for anybody (anymore). Thus, they spend the celebration of love alone, like a quarter of all people in the UK that are older than 75 and live by themselves – even though the majority of them have children.
Experts say that “family breakdown is fuelling an epidemic of loneliness in old age” and that the fact that two in five marriages fail has serious impacts for the elderly. Young people have to divide their time between parents and step-parents. Besides, ‘silver separations’ are also becoming more common, with latest figures showing that more than 11,500 over-60s were granted a divorce in 2009.
In one of the largest surveys of its kind, the think-tank polled 2,000 over-75s to test how isolated the elderly truly are. ‘I’m 88 and I have nobody at all. I’m on my own’, said one, and ‘some days the only person I speak to is the boy in the shop when I pick up my paper.’
Growing isolation and loneliness makes elderly people particularly vulnerable – also in terms of health. Related mental and physical health conditions include a weakened immune system, sleep deprivation, higher blood pressure, a higher risk of dementia and depression. What to do?
In the UK there is an initiative that involves the police, fire officers conducting home safety checks, as well as social workers who see “warning signs” to connect people to local voluntary groups that can provide companionship. But is that a solution of the problem really?
Chapman J (2011): 250,000 elderly people who’ll be spending their Christmas alone. Available: http://www.dailymail.co.uk/news/article-2078261/250-000-elderly-people-ll-spending-Christmas-alone.html#ixzz2FXDlyfWT
In 1983, the World Health Organization put cancer as a leading cause of death in South Korea. It has an immense impact with 64,000 people dying every year in Korea due to the disease. Luckily, the latest development in cancer treatment is available in Korea: Cyber Knife Radio Surgery. There are currently some hundred cyber knife systems installed in only few countries in the world. Korea was among the first to implement it and today, it has one of the most numbers of installed systems. Compared to UK and US, a cyber knife treatment costs less in Korea.
Cyber knife systems have been used to treat tumors in upper spine, head and neck since 1999 and in the rest of the body since 2001. John Adler invented the system for cancer treatment. It is made to deliver radiotherapy for malign and benign cancer tumors at all stages in specific parts of the body in a non-invasive way. It uses a real-time image guide to find tumors even if the patient is moving, and to deliver radiation with highest accuracy. It eliminates the need for invasive surgeries.
There are various benefits of the technique, e.g. faster procedures in comparison to other radiation methods, no requirement for hospitalization, no need for anesthesia and almost no post-operative care. Cyber knife surgery can even be used for tumors that have already received the maximum dose of radiation. There are no incisions or cuts, and recovery time is not needed. It can even be used for tumors in the spine, which are hard to treat because they are moving while the patient is breathing. The cyber knife can pinpoint the exact location of the tumor and beam into it without damaging other surrounding tissues. That leads to a shorter treatment period and a quick recovery. Treatment can be finished in less than five days on an outpatient basis, without spending a single night at the hospital.
One hospital in Korea is specialized in treating spine cancer. The oncology experts in Korea are highly trained and have years of experience in radiology and cyber knife cancer treatment. Medical staff in Korean hospitals are English speaking and communication will not be a problem when getting medical treatment there.
Cyber knife surgery abroad:
Cyber knife Treatment for Spine Cancer
There seems to be one single, simple best thing to keep our lives healthy and to prevent especially non-communicable diseases: a small, but regular dose of physical activity. This is especially relevant for elderly people as they often suffer from multi-morbidity, but could potentially stay more healthy by changing their lifestyles just a little bit.
Wouldn’t it be easy to put eating and sleeping in 23 and 1/2 hours and keep 30 minutes for physical activit? It doesn’t even have to be on a daily basis, but e.g. going for a 30 minutes walk three times a week has already proven to reduce the risk for arthritis by 47%, for dementia by 50% and for diabetes by 58%.
So how about prescribing physical activity? If doctors did that for their patients – do you think it would have an impact on people’s health?
Check out this video by Michael Evans and Mercury Films Inc. http://www.youtube.com/watch?v=aUaInS6HIGo. It has also been posted by the Swedish Professional Association for Physical Activity. http://www.yfa.se/
Also check out Michael Evans’ blog: http://www.myfavouritemedicine.com/23-and-a-half-hours/
Our teacher once accused us: “You’re incredible! What you guys don’t find on Wikipedia does not exist in your world – or what?”
Trying to find out more about “u-health”, I remembered that and it made me smile. U-health or u-health care cannot be found on Wikipedia (yet) and on the first sight it does not seem to be on many peoples’ minds in today’s world, but dig a little deeper!
U-health stands for ubiquitous health – omnipresent, universal, ever-present health. Sounds big! And there you go with your online-search… [Small note: I found so many interesting aspects that I don’t know where to start now – so let me just give you a basic idea with this blog post and let’s explore the topic further within the following ones.]
On the Congress on Nursing Informatics 2006 in Korea, u-health did cause lively discussions. The Korean Government had started a project on u-health services for the provision of health care services in the country’s rural areas using the advanced broadband infrastructure (NI 2006).
U-health care is a developing area of technology to monitor and improve a patient’s health status. It uses different environmental and patient sensors to gather data on almost any physiological characteristic to diagnose health problems (Brown et al. 2007). U-health should stand out through availability, transparency, seamlessness, awareness and trustworthiness – anytime and anywhere (Cha 2008).
Many industrialized countries are sitting on a demographic time bomb – facing problems in health care that are related to the growing number of elderly. Their limited resources in health need to be used more efficiently and effectively. So especially these societies could benefit from u-health care and its innovations to reach better diagnosis and treatment. It also has a lot of potential in improving hospital administration and patient management with reduction of medical errors, and in enhancing service quality, communication and collaboration. (Chang) However, at the same time, u-health care confronts ethical issues, e.g. when it comes to trust, privacy and liability, or in combining computer and information ethics with medical ethics (Brown 2007).
Hence, the bottom line is that yes, u-health is and will increasingly be on peoples’ minds (and it will probably soon appear on Wikipedia).
Societies as well as individuals will have to make difficult choices in the future.
1 Korea IT Times offers a variety of more interesting articles by Cha Joo-hak on the topic: http://www.koreaittimes.com/source/cha-joo-hak
2 Brown I and Adams A A 2007. The ethical challenges of ubiquitous healthcare. International Review of Information Ethics Vol. 8. www.i-r-i-e.net/inhalt/008/008_9.pdf
3 Cha J-H (2008). Defining the Perfect Ubiquitous Healthcare Information System. Korea IT Times. http://www.koreaittimes.com/story/56/defining-perfect-ubiquitous-healthcare-information-system
4 Cha J-H (2010)Who Shall Live Better? – Health Care and Socioeconomic Choice. Korea IT Times. http://www.koreaittimes.com/story/8559/who-shall-live-better-health-care-and-socioeconomic-choice
5 Chang B-C ().Ubiquitous-Healthcare Changed paradigm after introduction of EHR. Yonsei University. www.health-informatics.kk.usm.my/resources/2_Chang.pdf
6 NI 2006. The 9th International Congress on Nursing Informatics. Seoul, Korea June 2006. http://differance-engine.net/ni2006blog/?p=22
I went Friday night to see a movie just released here, Robot & Frank. I knew I would love it just based on the premise, but it may just be my favorite movie in the last couple years.
Set in the “near future”, it tells the story of Frank, an older man suffering from early dementia, who is given a robot by his children to help take care of him. The man, bored and isolated in a country town, gradually comes to enjoy the company and stimulation the robot provides. The story gets moving when you learn that before his retirement he was a professional jewelry thief and now, with the encouragement the robot provides to be active, he realizes he can get back in the game and teach the robot to help him steal. It’s a movie, so inevitably they get into trouble.
I am a sucker for movies about dementia because it is complex and a hard topic to do sensitively and well. But Robot & Frank is about more than the vanishing mind. It is about the person Frank was, is and always will be, and how dementia is just a part of that. The movie and the actor, Frank Langella, make him shine as a character. It is also about the stress that an aging and vulnerable parent puts on children, especially in the US, who live far away and have their own families or geographically distant careers. In this way it touches on the way Americans in particular are dealing with dementia.
But it went from good to great because it got how we treat dementia right (Sadly, in the near future we still don’t have better medication to treat dementia it seems). Now we largely treat dementia with lifestyle changes and support via caregivers and adult day programs. The robot is basically a lifestyle manager– he gets Frank on a routine; he makes sure he sleeps enough; he keeps the house clean and orderly; he cooks and serves him well-balanced meals at regular times. He endlessly proposes activites: let’s garden, let’s go for a walk, let’s play a game. He knows that to keep Frank well he needs to keep him as physically and mentally as active as possible and keep a routine. And then when Frank gets upset or angry, naturally he does not take it personally and can continue to work with Frank. He does not get upset or burnt out — an unfortunate reality for many human caregivers. By the end I was intrigued on how robots could be the perfect treatment to help people with dementia have the best functioning possible.
I would even suggest that Frank gets the idea to have the robot help him with burglaries because his brain is working better at this point, after the robot’s interventions have made him sharper. This is not unusual. When someone with dementia starts getting good care, they start doing better in many ways– mentally, socially and physically.
No matter, it’s all a movie anyway and such sophisticated technologies, while present in small ways– eg. alerts installed at home to help family monitor their loved ones from afar, small fuzzy robots to help demented patients with behavior issues (see this prior post)— are a long way from being fully autonomous beings that can live with otherwise independent elders. But I was impressed with how the screenplay and the movie treated the tangled issues of dementia, aging, and family tension and made it fun and funny. Like anyone with dementia, Frank never stops surprising everyone, even the robot, who he reminds that “the human brain, it’s a lovely piece of hardware.” Indeed.
See other reviews:
Including all generations may be best for some
While I had high hopes for a scientific blog today, I find myself more reflective on a wonderful experience I had this weekend and its impact on the work I do.
I was lucky to attend the wedding of a close friend and his new bride. It was under the relentless but magnificent sun in the scenic foot hills of Mt. Hood, Oregon. We were hot, some of us even burning, but we joyfully celebrated with the graceful couple, twice– once with her family’s religious traditions, and once with his family’s religious traditions (welcome to the US!). Beautiful, inclusive, rowdy and sweet, it was a wonderful series of events over two days.
I noticed, too, that the couple was fortunate to have, along with nephews and nieces and friends and parents, many of their grandparents and older relatives there. I couldn’t help but notice one older gentleman who attended every event. He walked formidable distances to the meals and the ceremonies, but often one or two relatives would help him. He walked slowly but deliberately. And if anyone looked over at him, he smiled from ear to ear. Despite clear difficulty, he was an undeniably positive force and seemed to spread cheer. The groom acknowledged this man, his grandfather, in his wedding speech. He said despite a recent broken bone in back and being 95 years old, he got up every morning and declared, “I’m going.” And he was very grateful that his grandfather had come. And I was amazed that, as far as I could tell, his grandfather stayed later than I did at the party!
As I watched the groom’s grandfather enjoy and take part in the exhaustive events of the weekend, I had a couple thoughts.
- Many of my patients, when faced with difficulties that come with aging– pain, mobility issues, health problems– will talk about what they look forward to as what keeps them going, and it is commonly a grandchild’s graduation or wedding. I thought I understood this, but it was beautiful to see. And many of the other bloggers on this site have written about how having things to look forward to maintains psychological health and well-being. That was clear to me this weekend.
- For so many reasons– physical and cognitive function among the most important– I routinely try to identify and encourage patients to stay as socially engaged as possible. Watching the engagement and joy of the groom’s grandfather, I thought about the recent and influential article by a colleague of mine at University of California, San Francisco, Dr. Carla Perissinotto. She found that feelings of loneliness led to a higher rate of death and functional decline in a cohort of elderly US adults, independent of whether or not these adults actually lived alone. This finding means that for us as geriatricians, knowing that our patients live alone is one thing, but actually asking them if they feel lonely and trying to find ways to help them feel less lonely is just as important.
At this spectacular wedding it was wonderful to see everyone of all ages celebrate and be together, but for one person, the groom’s grandfather, it may have actually prolonged his life.
Why do people stay together and why don’t they? Why marry or why break up/divorce? Those are common questions for people to ask themselves at some point during their lifetime. While the act of getting married is seeing a boost in eg. Sweden (with the number of new marriages up with 33% in the past 10 years (due to among other things a larger cultural popularity, more kids being born etc – see embedded article (in Swedish))) we also live in a time when many countries have statistics where one out of two marriages end in divorce (Sweden, US, Spain, Germany, Russia, Belarus, Cuba (even more) etc*). Something that might seem strange to the generation of pensioners and grand-parents around today that married in a time when divorces where not as common and the view on marriage was quite different from what it is today. (See an interesting interview on the topic with sociologist Dr Paul Amato, who has conducted extensive research on marital quality and stability, under the paragraph ‘The 1950s and “companionate marriage”‘ in this blog post where he argues that marriages today have more individualistic/psychological/existential reasons (find one’s soul mate, help each other fulfil one another’s lives and grow as persons) as opposed to the more pragmatic/companionate approach of the 50s and 60s.)
While the view on life-long love and marriage as an institution obviously gets a lot of influences from the trends and tides of the society around it, there are those that argue that there are few things that makes us as happy as being in a relationship. Anders Sandberg, philosopher and computational neuroscientist working for Future of Humanity Institute at Oxford University, means that people in a relationship live longer, are less ill and generally feel more content with life than those that don’t. Money or intelligence doesn’t even come close in comparison for the importance for our well-being. Thus, as the human enhancement scientist that he is, Dr Sandberg looks to biology to find ways to increase the likelihood of people forming and staying in relationships. According to Dr Sandberg, even though much of society has changed around us in the past 1000s of years, the same is not true for our psychology. The average life time of a person did for a very long time not pass 35 years, meaning that we seldom would be in relationships for more than 15 years – ironically close to the median duration of marriage today – 11 years. In a recent article co-written with Julian Savulescu and published in the New Scientist, Dr Sandberg argues that in order to increase the chances of people’s well-being caused by being in a relationship, while sparing them the pain break-ups can often inflict, we can look to some recent findings from another research article published in The Journal of Neuroscience with experiments on voles in order to find new ways forward.
The results published in The Journal of Neuroscience show that introducing vasopressin (known as one of the ‘love hormones’ together with eg. oxytocin) by gene modification in polygamous male meadow voles made them more monogamous and similar to their cousin, the prairie vole, that is already monogamous as a species (and that also has more receptors for oxytocin and vasopressin in their brains from a start). Given their other argument that helping humans stay in relationships would generally imply more happiness for them, Sandberg and Savulescu thus argue that it would be ethically correct to develop methods that would make possible the same biological alterations in humans. Of course, Sandberg admits such methods would have to be used with caution not to have people entrapped in bad relationships. One of the authors of the article in The Journal of Neuroscience, Dr Larry Young, along with Dr Hasse Valum at Karolinska Institutet (who in a recent PhD thesis proved that the same correlations between pair bonding and vasopressin (in males) and oxytocin (in females) could be found in humans), however argue that they don’t believe in creating medicinal treatment based on those findings, especially since there are also potential negative side effects by eg. increased vasopressin in males such as that they become more aggressive and defendant of their partner with higher rates of this hormone.
Even though convention, rather than biology, is more likely to be the reason for the lower divorce rates on a macro scale among pensioners and grand-parents back in their day (and maybe, as a result of holding true to that convention, even today) I think it is still interesting to see how we can unlock some of the secrets of the world around us through science. Let’s see what the future holds. (Apart from being love hormones both vasopressin and oxytocin has shown potential of treating both autism, social anxiety disorder, borderline personality disorder and schizophrenia.)
On a final note, when researching for this blog post I came across another very interesting study showing that friends, rather than family, are more important to help people live longer after the age of 70 according to a recent Australian study (in a way contradicting, or at least weakening, Dr Sandberg’s argumentation above). I think I will have to save that topic for my next blog post.
Sources: http://www.dn.se/nyheter/vetenskap/livslang-romans-med-hjalp-av-medicin (in Swedish, including short interview with Dr Sandberg)
http://www.practicalethics.ox.ac.uk/latest_news/love_machine_engineering_lifelong_romance (abstract of Dr Sandberg’s research article)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768419/ (full research article in The Journal of Neuroscience)
Image source: http://www.flickr.com/photos/aneesprince/7202772588/
*Statistics sources: Sweden: SCB – Central Bureau of Statistics (see above embedded link – in Swedish), US, Spain, Germany (and some other countries): United States Census Bureau – Table 1336 (see above embedded link), Russia, Belarus, Cuba (and many other countries): United Nations Demographic Yearbook 2009-2010 comparing tables 23 and 24 per country (see above embedded link)
Today gives rise to a new state of mind for the baby boomers. As our elderly are expected to retire during ages 60-65; start playing golf, cleaning the garage and priming up the garden, it brings forth question: Do they want to do this for the rest of their years?
According to Global Action on Aging (GAA) of New York, the elderly appear to have a strong incentive to contribute to society by having a will to stay in the workforce. Trends have shown that working men between ages 62 and 74 in the past decade have risen by about 40%, whereas working women in these ages and in this same time period have risen by 60%. A large proportion of elderly in the States report low amounts of savings, and though while financial reasons are a large contributor to the elderly staying in the workforce, apparently it is not the only one. “All the research we’ve done shows that, even when the money issue is put aside, people don’t want to do nothing.” - Tammy Erickson, author of “Retire Retirement: Career Strategies for the Boomer Generation” (Harvard Business School Press, 2008)
“Call it a second phase, an encore, a reinvention. Just don’t call it retirement. More people are entering their mid-60s — stuck, perhaps, with dismayingly skimpy savings accounts, but blessed with sound health and many years ahead of them — and deciding that retirement doesn’t top their agenda.” - Katy Read, The Courier-Journal
“My speculation is that the more mature the individual, the more self-reflective or self-aware they are, the more likely to recognize that they need to retool, to kind of reinvent themselves.” – Jeff Hudson, program director for continuing education and customized training at Normandale Community College in Bloomington, Minnesota
Perhaps the wave of baby boomers caused a silver evolution and revolution in and of itself; consciously, or unconsciously, as a self-protective mechanism by our elders themselves, to help contribute to the aging world. If it be conscious, however — striven with willpower — it will probably make the outcome much more successful. Willpower is the tool needed to reinvent yourself for a reinventing future, whether is it re-educating yourself, taking on a new initiative, or quite simply charting out a new path to meet your dreams.
People Don’t Want to Retire: Many Seniors Prefer Reinventing Themselves
Former Seattlites are Reinventing Themselves in the Hills of San Miguel
Graph description further down.
When my little brother was a kid he used to answer the question of what he wanted to be when he grew up with a firm and certain: ‘a pensioner’. Quite insightful, I must say, for a 5 year-old, but I guess he’d simply realized what so many pensioners-to-be are starting to realize as the day of retirement draws nearer. According to a recent study of the state of the elderly and elderly-to-be in Sweden, the UK and the US, life satisfaction increases steadily from the age of 47 and four out of five in this age group have a positive view of their coming years in ‘life’s third act’. This all the while two thirds of the same respondents fear that the care system for senior citizens will not be able to look after them when their time comes.
The study, presented by Kairos Future in cooperation with a number of Swedish companies and institutions*, is Kairos Future’s fourth in line of studies of attitudes among the baby boom generation. Previous studies being carried out in 1999, 2004 and 2008, they have all followed the same baby boom generation born in 1945-1954. It was first in the third one that the scope was expanded to include also the UK and the US.
Below I share a couple of highlights from the study:
1. Contentedness of life in general increases steadily from the age of 47. Graph above depicting contentedness of life. On the y-axis the scale of contentedness and on the x-axis year of birth of respondent. The arrow points at respondents of 50 years of age. As graph shows contentedness of life increases steadily from just before this point in time (and has a bottom low between age 35-45 (youngest respondents of study were of 30 years of age)).
2. The primary focus of most to-be pensioners is to stay healthy, both physically and mentally. To keep the brain alert and maintain an active lifestyle are top priorities for most baby-boomers. Many also say that they want to keep contributing to society to a larger extent than in earlier studies and statistics also reflect this fact showing that the number of 66-year olds that are still working have increased from 19% (1997) to 36% (2009). This is also reflected in that few of the already retired wish that they would have retired earlier (only 7%), whereas a larger group wish they would have retired later (20%). Which leads me to the last of the interesting findings I have chosen to highlight.
3. Many suspect that society’s elderly care won’t be able to support them, when they reach the later stage of the Third Age. As many as 37% of the baby boomers, and 35% of the 30-55 year-olds doubt this. Kairos Future have created an interesting graph depicting how society’s changing demography in the past century puts a lot more pressure on the working generation in order to sustain those not working, since we both start working later in life, and live longer after retirement today, than 90 years ago. Question is – will society be economically sustainable with people only working one third of their lifetime (as suggested will be the case if the demographic development continues til 2040, without changes to the number of working years)? Or will things have to change, and in that case, how? Is the current debt crisis around the world maybe even an early reflection of society’s debts to its people that is simply running out of hand due to the demographic changes with people living longer and longer? Interesting questions asked by Kairos Future and visualized through the following graph:
So, to sum it up, an interesting read.
On a final note, I just loved the introduction of the report where they presented a number of the new names that people have started to give to the people living in this new active Third Age: Such as Silver surfers, Passionists, Passioners, SALLIES (Senior Affluent Life Lovers Enjoying a Second Spring), OPALS (Old People Active Lifestyle) and MAPPIES, (Mature Attractive Pioneers). Now that’s some granny!
* For the curious: SEB, SPV, Micasa Fastigheter in Stockholm AB, Apotek Hjärtat, Pensionsmyndigheten and Friskis&Svettis.
Source (where you can also find the report for download (unfortunately only available in Swedish)): http://www.kairosfuture.com/publikationer/framtidens-%C3%A4ldre?pub=Framtidens-%C3%A4ldre
”There are no children on the streets. No pregnant women. Of course you notice it!” Nhat Vuong, social entrepreneur and Founder of i-kifu shakes his head. Japan is not an aging society, in many aspects it has already aged. But as Nhat points out, the elderly still have money. They get care. A report from the Japanese Research Institute, 2008, on Household Expenditures supports his statement. The household spending power is redistributed from the young to the elderly. But the question is how long the economy can cope with a hastily declining number of workers in the national work force.
As Nhat points out, people are not that engaged in giving for the cause of the well-being of the elderly. If they give to society, they prefer to look at investments for the future, supporting children, education, the environment. The elderly will need support but they are not seen as investments.
The reason to why we meet with Nhat, a social entrepreneur based out of Tokyo since 5 years back, is to learn about the mentality of the young in Japan. The mentality of the entrepreneurs, the shakers and movers. Nhat himself is the founder of the i-kifu, meaning ”I donate” in Japanese. He has been working on the crowd funding venture since 2007, to give people the opportunity to achieve a social impact through their social engagements. His venture hands out karma points that can be exchanged for rewards to people that do good; either by donations or volunteering.
Nhat’s personal story is fascinating. Following the end of the Vietnam war, Nhat’s parents fled Vietnam in a boat and he was born in a refugee camp in Malaysia. From there his family was given asylum in Switzerland, with the help of the Red Cross, and Nhat enjoyed a safe upbringing just like any other child in the stable economy of the Swiss. His parents would mention to him how lucky he was that he could just go to school, not having to work, but the concept of poverty was hard to grasp. The only comparison he had was with his Swiss peers and just like them he desired the latest toys and the nicest gadgets. It was when Nhat for the first time visited Vietnam, 15 years old, that he was confronted with social injustice and extreme poverty. It was then that he realized that he wanted to make a positive social contribution to the world.
After finalizing his studies in Switzerland Nhat moved to Japan (mostly for love), started looking for job opportunities in the digital sphere and soon saw the opportunity to connect his skills in IT, marketing and gamification (peoples’ addiction to games and the reward systems these offer) with his social impact aspirations. The idea of i-kifu was born and now, some time and a lot of hard work later, Nhat has 25 Non-for-profits that share their projects through his site. Several socially minded businesses support the platform. The traffic to the site is growing even though the concept of crowd funding and donations is much less common than in other markets. In the US, for example, there are over 1 Million Not-for-profits whereas Japan only has 60 000. After the earth quake and the Fukushima disaster this is slowly starting to change, both in the social scene and in Japan’s orientation towards entrepreneurial ventures.
”Japan is waiting for an awakening. Some people were hoping that the earth quake would have the effect but that still remains to be seen. People live in invisible prisons, entrepreneurs and innovators are held back by social expectations- you are not solely responsible for your own success or failure, your family and friends share the shame if you don’t succeed. The circle of responsibility is strong and rigid. That is why it is difficult for Japanese people to try something new. The risk is too big”.
“When you approach someone with a really great idea the first question is: Has this been done before? Not? Well, please come back when a large corporation has tried it and it became really succesful. The entrepreneur scene is not easy. There is a lack of role models and the school system still focuses on training workers for long-term positions at large corporations”. But Nhat is optimistic. And determined to work the system. He says: “If I can make it work here, then I can succeed anywhere. Plus, as we learned from Steve Jobs, if you only ask people what they want and give it to them you will never reach the really groundbreaking innovation.”
Nhat also mentions the island effect; “Everything is so easy and accessible to the Japanese, they don’t really need to travel overseas or to learn English. Even if Japan was heavily dependent on technology export for a long time, cars and electronics, they themselves did not embrace technology at the same rate. Despite high-tech innovation in some Japanese corporations, there are still offices in japan that use their fax machine actively.” A country of contrasts, as Nhat describes it.
And the vision for the future? “The era when Japan thrived is gone. There is no longer time for time-consuming, hierarchical decision-making and deeply anchored decisions. Now the speed of technical development requires that companies try, fail, succeed, iterate faster. In previous times it could take a Japanese company six months to reach a decision, now, in six months, innovators from China and India would have rolled out the product already, succeeded or failed and moved on. That’s how innovation is achieved nowadays. Trial and error. Fast. Not processes with full internal consensus. Japan needs to embrace this. Iterate faster.”
Nhat pauses and formulates his conviction: “Japan has a huge potential. The people here are extra-ordinary. I have seen people achieve here what I didn’t think was humanly possible. They can do it. They truly can. With the right support they can achieve anything.”
In times when all of Europe (and some of its neighbouring countries) are preparing for the musical get-together of the year, The Eurovision Song Contest (ESC), Russia is generally a country to look out for. With a track record of ending among the top three in five of the past 11 years and a general strong voting base in the former Soviet Union they often bring an important contribution that’s considered an odds-on from the start. (Eurotechno or grand ballads with figure ice-skaters or ballet dancers usually being the winning concepts.) Nothing saying that that would have changed for this year, and many still saying they’re just as much of a favourite this year as other years, but you could definitely say they surprised many when bringing forth this year’s contribution.
Timely enough for the European Year for Active Ageing and Solidarity between Generations (that I blogged about here), they’ve namely selected a group of 8 grand-mothers called the Buranovskiye Babushki (literally ‘Grandmothers from Buranovo’) that with their ethno-pop style out-performed former ESC winners Dima Bilan and T.A.T.u with almost 10 points by the public vote in the Russian national song selection. With most of the group being 70-80 years of age, only 6 out of the 8 grannies will be performing in Baku, Azerbadjzan next week when the competition starts with the semifinals.
However it ends up going for Russia’s new grannie stars, I still think their initiative is admirable and the fact that Russia ended up voting them winners a true mark of Solidarity between Generations, in its very own special way.
See them perform their winning song here:
As American baby-boomers start retiring, new career opportunities are appearing for the stars they grew up with. Actors such as Sally Field and Alex Trebek (Jeopardy host, aged 71) have started advertising products including hearing aids and joint pain medication. These advertising campaigns reflect several realities facing the American and other global populations: the desire for spokespeople that represent this important consumer group and the possibility for continuing your career past retirement age, even in a sector that is as age-conscious as Hollywood.
Marketing researchers suggest that advertisements using older, familiar faces give customers an added confidence in the product being sold because they imagine that these people do not need the money and would not be endorsing products or services they did not believe in.
As with most successful marketing campaigns, the companies started by identifying their target audience and then researching what kind of spokesperson they would respond to. Interestingly, they found that women of the baby-boom generation were, despite having lived through the sexual revolution, more likely to trust a male spokesperson. They also found that these women were more responsive to someone older than them, thus leading to the decision to hire actors such as Robert Wagner (aged 82) and Pat Boone (aged 77). Focus groups also showed that people may rank a celebrity highly when asked if they would like to have them over as dinner guests, but at the same time rank them as untrustworthy – ranking entirely others as very trustworthy.
It seems celebrities are responding to the confidence placed in them, with Fred Thompson of Law and Order fame acknowledging that he did his research before endorsing the American Advisers Group and that his 91-year-old mother is now one of their customers. Sally Field has been advertising bone-loss drug Boniva since 2006 and has stated that she is happy to talk about a drug she uses and benefits from.
It seems so far the focus groups have been fairly accurate, and that the celebrities endorsing these very important products and services feel a responsibility not only towards the companies but especially towards the customers, who are very much like themselves!
Some people argue that the youth world-wide is too focused on their own dreams and ambitions to engage for the elderly. These people have not met the youth of Singapore.
Following recent discussions about the location of new elderly facilities in Singapore, where certain residents of the Woodlands neighbourhood opposed the construction of an eldercare day centre to avoid a loss of community space and a possible drop in property prices, the students at the Nanyang Polytechnic wanted to make an active stand for embracing ageing. The students organized a movement, spread by Facebook, which aims to create awareness and promote social inclusion and acceptance of the elderly in Singapore.
The supporters of the cause are asked to either change their Facebook profile picture to a photo of an elderly person or to post on their Facebook status the number of years and days they have before they turn 65. To mark the first month of the “Embrace Ageing” movement on March 10, supporters are asked to wear either gray clothing or accesories. The movement has already received around 700 likes on Facebook and is still gaining in popularity.
To support the youth movement, you can contribute by “liking” the Facebook page here: https://www.facebook.com/EmbraceAgeing
Picture Source: https://www.facebook.com/photo.php?fbid=317967148255840&set=a.317617651624123.86690.317616621624226&type=3&theater
What do you think about when I say grandparent?
Cinnamon roles, a warm smile, a friendly voice and some amazing stories told and songs sung before going to bed on a summer’s eve? A prankish friend with a childlike mind inventing new games, adventures and setting up family shows starring you as the main act anytime the family got together? A strict head of family, speaking slow and only when necessary, that sets all the rules and expects you to pay your respect and loyalty?
Whichever is your personal memory of a grandparent I’m sure it’s a special one, which is why I felt a particular warmth inside when I came across a particular news article when preparing for my latest blogpost on Active Ageing. The article was about a new research project on grand-parenting, reported by the European Union’s initiative of focusing the year of 2012 on the topic of Active Ageing and Solidarity Between Generations (the former part of that focus being one that I particularly feel about).
Launched in October 2011 by the organization Grandparents plus, the research project, or International Study of Grandparenting, set out to examine the role of grand-parenting across Europe, and answer the questions of how grand-parenting differs from family to family and from country to country and how family policy frameworks shape the role of grandparents.
One thing that the pre-study, launched in 2010, found is that grandparents’ role in family life is likely to become more important as populations age. Parents of tomorrow are both more likely to have parents that are alive, but also healthy and financially stable, and thus can take a bigger part in their grandchildren’s lives. Therefore it is also increasingly interesting to look at how legislation and social policies across different countries have dealt with the inclusion of grandparents in family life, where examples such as transferable parental leave in Germany, basic state pension credits for taking care of grandchildren in the UK or financial support for grandparents of teenage parents in Portugal are a couple of the forerunners.
While looking forward to the results of the newly launched research project maybe you have your own good grandparent story to share? What is your best grandparent memory? For me, my viking grandpa has provided me with a couple of good ones for sure. Maybe that could be the topic of another blog post?
Til then, Happy (soon) Grandparents Day Poland! (21st of January) (First country in the world to start celebrating the tradition of a National Grandparents Day.)
Swedish paper conglomerate SCA recently announced an investment in the Chinese elderly care market. SCA produces a wide array of products including a large range of incontinence products under the brand Tena, SCA is in part motivated by the fast growth that the incontinence product market is expected to have in China: estimated at 20% annually compared to the overall market growth rate of 4%. But the incontinence market is not the only market experiencing rapid growth in China, the General Secretary of the Standing Committee of the NPC Li Jianguo recently announced that another 3.4 million beds in eldercare facilities will need to be added in the next five years.
SCA is partnering with Singaporean company ECON Healthcare Group to start the care company Jiahu, and aim to have 1000 nurses in Shanghai within a couple of years and then expand to the rest of Asia. Today ECON operates eight nursing homes and a hospital in Singapore as well as a maternity hospital ward in Malaysia.
However, the Swedish and Singaporean companies are not the first foreign companies to enter the promising Chinese market. Last year American Cascade Healthcare announced plans to build a eldercare facility in Shanghai. Other international companies have entered joint ventures with Chinese healthcare providers in an attempt to bypass some of the difficulties that come with entering a country where cultural traditions suggest that care for elders stays within the family.
http://di.se/ “Svenska Skogsjätten startar hemtjänst i Kina”
As we enter into the year of 2012 there are lots of exciting things going on on the scene of demographic ageing and the ‘silver evolution’. As it seems, more and more people, organizations and governments are becoming aware of the enormous potential in the growing 65+ generation and keeping them actively involved in society. In this blog post I set out to outline five things, all related to the topic of Active Ageing, that I believe to become important during the year of 2012.
But first a quick break for terminology: What is actually meant by Active Ageing? According to the European Union it’s defined as:
“Giving the baby boom generation and tomorrow’s older adults the opportunity to:
- stay in the workforce and share their experience
- keep playing an active role in society
- live as healthy and fulfilling lives as possible.”
Or as the World Health Organization (WHO) put it: “Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.”
1. One initiative along those lines is that of the European Union (EU) who has designated the year of 2012 as the European Year for Active Ageing and Solidarity between Generations. The European Union has a tradition since 1983 of dedicating every year to a specific cause important for society. On the 14th of September 2011 the European Parliament decided that the turn had come to the cause of Active Ageing and Solidarity Between Generations. In practice, this means that since that day a number of organizations, both public and private, have been invited to take part in or lead initiatives with tangible, measureable results to be followed up upon during 2012 related to those two topics. This includes everything from research projects on Information and Communication Technologies (ICT) for ageing, and making use of participative web 2.0 tools in caregiving for frail older people, to facilitating the creation of new business opportunities for products and services related to the ageing challenge, promoting better inclusion of elders in the labour market and showing photo exhibitions picturing the intergenerational dialogue within Europe, to mention a few initiatives. In other words a very interesting agenda, that we are all looking forward to be following.
2. Meanwhile, at the other side of the Atlantic, Harvard Business Review Blogger and MIT Sloan School research fellow Michael Schrage, recently pointed out the business opportunity of adapting apps, devices and tablets to the growing senior customer base as one of six ‘Innovative Ideas to Watch in 2012′. All as the silver generation grows and becomes more active and technologically savvy.
3. And as one multilateral organization prepares for its year of Active Ageing another one under the United Nations (UN) umbrella, namely WHO, enjoys an increased awareness around their related programme of creating age-friendly cities. After arranging the programme’s first international age-friendly cities conference in late September 2011, now WHO’s intitiative is an integrated part of the EU’s year of Active Ageing, encouraging more European cities to apply to the network.
4. For 2012, the UN is also looking forward to get on with the the second quinquennial review of the outcome of the Second UN World Assembly on Ageing that took place in Madrid in 2002, also known as The Madrid International Plan of Action on Ageing (MIPAA), a document that marked a sort of turning point in how the world has seen the challenge of population ageing. This was the conference where the WHO presented their well-known Active Ageing Policy Framework that has served as a basis for the definition ever since.
5. Last but not least, as one of the pioneer organizations in advocating the rights of older people, also the International Federation on Ageing (IFA) will make their important contribution to the active ageing discourse next year. One way that they’ll be doing this is through their 11th bi-annual Global Conference on Ageing, which this year goes under the theme of ‘Ageing Connects’ – covering topics from work and the access to knowledge/education to advancing health and well-being and the possibilities within innovative products and connected technologies such as twitter, blogs and social networks.
In other words – a lot to look forward to during the coming year. So while we wait eagerly for all the good blog post material that the above mentioned happenings will generate, let us take the opportunity to wish you all:
A Happy New Year of Active Ageing!
With a growing ‘silver’ population in Singapore, it is substantially necessary for the country to develop its healthcare and eldercare system to meet the demands. In addition, there is a need to not only construct a dense network of community-based services, but also to ensure long-term sustainability in the provision of these services. The blueprint for a holistic and affordable eldercare must also incorporate the concept of ageing-in-place, where seniors can continue residing in the community which they are familiar with. Altogether, the Committee on Ageing Issues (CAI) has proposed 4 key approaches towards achieving this;
Develop support services within the community
In terms of the management of elderly healthcare needs, a holistic Family Physicians (FPs)-centered approach should be adopted. This is because of the close proximity the FPs are to provide primary prevention, maintenance of health and screening of diseases to the elderly in the community. The increasing presence of Community Health Centres (CHCs) also help to supplement the FPs with support services. In addition, there is a need to establish a variety of community-based nursing services for the elderly who would prefer to continue living in the community. Caregiver Centres on the other hand will offer an alternate support to families by providing care for the elderly.
Facilitate integrated service planning and delivery
There are plenty of rooms for improvement in this aspect. Follow-up care for discharged elderly patients can be enhanced via the closer integration between hospital systems and the community. The CAI also believe that the integrated service models of day care and day rehabilitation centres for the elderly must be flexible against market changes in order to be cost-efficient. More importantly, data requirements across all agencies must be streamlined to ensure that medical information is exchangeable between step-down healthcare facilities and community-based elder-care facilities.
Expand diversity and capability development within the health and eldercare sector
With the growing complexity of needs and expectations of the elderly, it is increasingly important to enhance healthcare capabilities and tailor social and personal care services to suit their range of requirements. The CAI is of the belief that in order to spur private sector participation and innovation in health and eldercare, the government should revise its policies and undertake a facilitating role in the industry. Essentially, certain aspects such as manpower and service standards must also be improvised to meet the rising demands of an ageing population.
Ensure affordability of health and eldercare services
This is achieved through a flexible multi-tiered safety net consisting of government subsidy for Class B2 / C wards, Medisave, MediShield, Medifund and ElderShield. As much as 80% of actual medical expenditures at Class B2 and C wards of public hospitals are being subsidized by the government while the remaining schemes provide greater financial protection for the elderly against huge medical bills.
As we can see, the Government’s role goes beyond financing the use of services. It also has an essential role to play with regards to manpower development, regulations and the establishment of standards for the sector. More importantly, it must facilitate the planning and development of the sector in order to achieve a holistic and affordable eldercare for our future seniors.
(Image source: Khoo Chai Ling)