Ageing in Latin America:

Five Facts, Ten Comm

andments

and Four steps for an Action Plan

Luis Miguel Gutiérrez Robledo, M

D, PhD

5 FACTS ABOU

T AGING AN

D OLD AGE IN

LATIN

AMERICA

TEN CO

MAN

DMEN

TS FOR HEALTHY AGIN

G

4 STEPS TO FO

LLOW

FACT 1|DEM

OGRAPHIC CHAN

GE

Percentageof

populationaged

65 and over: 2015 and 2050

“An Aging World: 2015,” by W

an He, D

aniel Goodkind, and P

aul Kow

al(P95/16-1, M

arch 2016, )

Population Aged 65 and over by region: 2015, 2030 and 2050

Countries with percentage of population aged 80 and over

projected to quadruple: 2010 -2050

“An Aging World: 2015,” by W

an He, D

aniel Goodkind, and P

aul Kow

al(P95/16-1, M

arch 2016, )

FACT 2|RAISIN

G TRENDS IN

CHRO

NIC DISEASE BU

RDEN :

FRAILTY AND GERIATRIC

SYNDRO

MES

Less Deaths, More O

ld People, New

Issues

Medical

progress

Improved living

standards

Reduced mortality

•Increased survival•Increased prevalence of

age-related diseases•M

ultimorbidity

•Longer duration of disease•Frailty•Disability•Dependence

J Am Geriatr Soc 2005;53:S308

Life expectancy at 60 years, several countries

Mexicans older than 60 still enjoy a lifespan of 22 years, but a healthspan

of 17.3

Source: Roberto Ham-Chande (2003) Esperanzas de vida y expectativas de salud Reunión Regional sobre Envejecim

iento y Salud.

Thereis

a growing

gap between

thehealthspan

and thelifespan

in Mexico thatw

illcontinueto

expand

Global burden of disease by region and incom

e

“An Aging World: 2015,” by W

an He, D

aniel Goodkind, and P

aul Kow

al(P95/16-1, M

arch 2016, )

Drivers of changein life

expectancyat age

60 by

sex, región and income, and risk

factors

“An Aging World: 2015,” by W

an He, D

aniel Goodkind, and P

aul Kow

al(P95/16-1, M

arch 2016, )

+

THE HEALTH PROFILE O

F MEXICAN

S OLDER THAN

60 GERIATRIC SYN

DROM

ESAN

D DISABILITY, FALLSM

alnutrition/ Sarcopenia

Sensoryim

pairment

Painand Depression

NCD

HTA. DIABETESCVD

CARDIAC DISEASEDEM

ENTIA

MU

LTIM

ORBIDITY

+FRAILTY

TOTALY

DISABLED AN

D DEPEN

DENT

ESSENTIALLY

HEALTHY AND

FUN

CTION

AL

5%20%

20%55%

Source: ENSAN

UT, 2012.

+

11,510,196 millions

Country distributionof share of

populationw

ithoutlegal H

ealth coverage

byregion

Financialimpactof having

anold

householdm

emberin six

middle

income

countries.

“An Aging World: 2015,” by W

an He, D

aniel Goodkind, and P

aul Kow

al(P95/16-1, M

arch 2016, )

Health and H

ealth care•

The leading causes of death have been shifting in part due to increasing longevity, w

ith the share due to non-comm

unicable diseases (NCDs) on the rise. N

CDs often occur together and this m

ultimorbidity increases w

ith age. Low and low

er-middle

income countries continue to face a considerable burden from

comm

unicable diseases as w

ell.•

People continue to live longer. A portion of one’s expected years of life will not be

healthy ones. •

A cluster of risk factors are responsible for the global burden of disease. The m

ajority of smokers now

live in low-and m

iddle-income countries. Increasing

obesity, in addition to being underweight, has been associated w

ith increased m

ortality at older ages. •

Older population has different health care needs than younger adults due to

increasing chronic diseases and disability at older ages.

FACT 3|DISABILTY TREN

DS AND

NEED FO

R CARE

Care Dependence (needs for care)

•Neglected public

health topic•

Preva

lence 3

-16

%

•Associated with

•com

orbidity•

socioeconomic

disadvantage•

high health costs

•4 x increase among

older people in LMIC

forecast to 2050

Characteristics of caregivers and care arrangements (%

) for comm

unity-based care dependent older people, China, M

exico, Nigeria and Peru, 2003–2008

World report on ageing and health. W

HO 2015

Global estim

ates of deficits in long-term care protection for older persons / Xenia Scheil-Adlung;

International LabourOffice. -G

eneva: ILO, 2015 (Extension of Social Security series; N

o. 50)

Global estim

ates of deficits in long-term care protection for older persons / Xenia Scheil-Adlung;

International LabourOffice. -G

eneva: ILO, 2015 (Extension of Social Security series; N

o. 50)

Global estim

ates of deficits in long-term care protection for older persons / Xenia Scheil-Adlung;

International LabourOffice. -G

eneva: ILO, 2015 (Extension of Social Security series; N

o. 50)

Thesituation

in LatinAm

erica

Global estim

ates of deficits in long-term care protection for older persons / Xenia Scheil-Adlung;

International LabourOffice. -G

eneva: ILO, 2015 (Extension of Social Security series; N

o. 50)

Non-P

aid Work

19%

Hospital services

21%

Prim

ary care services

28%

Health care goods

9%

Public health adm

in.7%

Com

merce/Trade8%

Other goods

4%

Other services

4%

Role of n

on-p

aidh

ealthcare

(inform

al care)

Source: Sistema de Cuentas Nacionales de

México: Cuenta satélite del sector salud de

México, 2008-2010 / Instituto Nacional de

Estadística y Geografía.--M

éxico: INEGI,

c2011.

Structure of GDP in Health, 2010%

GDP in Health by type of goods or services, 2010

Public37%

Private44% N

on-Paid w

ork19%

Long term care

•The increasing size and share of the older population drives its long-term

care costs. •W

ide range of funding sources, mainly out of pocket.

•Care provided differs in coverage, degree of cost-sharing, the scope and depth of coverage, and providers’ qualifications.

•Unpaid caregiving by family m

embers and friends rem

ains the main

source of long-term care for older people in the region.

•Informal care m

ay substitute for formal long-term

care in some

circumstances, particularly w

hen low levels of unskilled care are

needed

FACT 4|N

EED FOR A

COM

PREHENSIVE PU

BLIC POLICY

MO

NTEVIDEO

CON

SENSU

SIncludes 15 priority m

easures dealing with the issue of

population ageing and social protection (priority m

easures 18 to 32):Participation, social insurance, education, health, care, dignified death, w

ork, violence, discrimination,

savings, and public policies, among other m

atters. These topics form

part of a range of international hum

an rights instruments, declarations and United

Nations General Assem

bly resolutions, conventions of the International LabourO

rganization (ILO), reports

and standards prepared for the special proceedings of the Hum

an Rights Council, and the jurisprudence of treaty bodies, am

ong other sources, including some

instruments adopted w

ithin ECLAC.

Inter-American Convention on protecting the hum

an rights of older personsIs the m

ost recent international instrument and w

as adopted by the General Assembly of the

Organization of Am

erican States (OAS) on 15 June 2015,

Signed by Argentina, Brazil, Chile, Costa Rica and Uruguay.A

im: to

pro

mo

te, pro

tect an

d en

sure th

e recog

nitio

n a

nd

full en

joym

ent a

nd

exercise, on

an

eq

ua

l ba

sis, of a

ll the h

um

an

righ

ts an

d fu

nd

am

enta

l freedo

ms o

f old

er perso

ns, in

ord

er to

con

tribu

te to th

eir full in

clusio

n, in

tegra

tion

, an

d p

articip

atio

n in

society.

The Convention is based on the recognition that all existing human rights and fundam

ental freedom

s apply to older persons and that they should be fully and equally enjoyed on an equal footing w

ith the rest of society. It also provides an interpretation of human rights as they relate to

ageing and standardizes very important rights that have not been explicitly addressed in any other

international human rights instrum

ent, including the right to life and dignity in old age, the right to independence and autonom

y and the rights of persons receiving care.

FACT 5|DISADVAN

TAGE AND

AGE DISCRIMIN

ATION

HECHO 5| PREVALECEN

LOS ESTEREO

TIPOS N

EGATIVOS, LA

DISCRIMIN

ACIÓN

Y EL MALTRATO

Abuse and neglect in Mexico

31.6

19.0

13.711.8

2.2

37.3

PicológicoFísico

NegligenciaEconóm

icoSexual

Algún tipo dem

altrato

Older people have the right to live a life w

ithout violence and abuse.

Povertyrate

fortotal populationand

populationaged

65 and overforLatinAm

erica 2005-2007

THE GO

OD N

EWS: CHAN

GE IS PO

SSIBLE

A Model for Successful Aging

Precedents

•Decline of functional reserve

•Loss of specific functions

Adaptive Processes

•Selection

•O

ptimization

•Com

pensation

Result

•Reduced and m

odified but effective life

•Acceptable level of w

ell-being

Baltes& Baltes. SuccesfulAging: Perspectives from

the Behavioral Sciences. Cambridge University Press, 1993

PublicHealth care

expenditure2005-2050

increasein %

pointsof GDP (O

ECD)

TEN CO

MAN

DMEN

TSFO

R HEALTHY AGEIN

G

In 35 years, latinamericansolderthan

65 willgo

from7 to

20%

of total population. In Mexico today

livem

ore olderadults(>60) (12.7 m

illions) tan children(<5) (10.2 m

illions)1

Demographic change opens new

opportunities for progress in Health Policy

2

Becauseof the

publicHealth Policy

progressin theregion, w

ehave

a greatchance toprom

otehealthy

agingof latin

americans

3

20% of olderadultsin región becom

efrailand up to

10% becom

etotally

dependent4

Healthyold

peopleare evenlesscostly

tan middle

agedpeople

5

Thechallenge

isnotoldage

butdisease. Universal coverage

isa must.

6

Gerosciencew

illimprove

ourchances toprevent

disease, prolonghealthspan

and preventdependence7

Thedevelopm

entof a new person

centeredand

personalizedm

odelof careand training of the

ad hoc professionalsisa priority.

8

TheStrategy

and ActionPlan on

Agingand Health

focusonresearch, hum

an ressourcesdevelopment, a

new m

odelof careand com

prehensivepublic

policydevelopm

enttoface

thechallenge

of populationaging

9

With

a succesfulstrategyand action

plan forhealthyaging

we

can envisona decade

of healthyageing

following.

10

4STEPS TO

FOLLO

W

Presenter’s name if needed

4 STEPS TOW

ARD

S H

EALTH

Y AG

EING

Four areas for action

AN

STRATEG

Y AN

D

AC

TION

PLAN

FOR

H

EALTH

Y AG

EING

Policy com

mitm

ents to Healthy

Ageing

•Strategic Objective 1 includes overall

policy comm

itments to H

ealthy Ageing

and fundamental approaches, such as

Healthy A

geing in all policies and com

bating ageism. Three proposed

approaches are relevant across governm

ent policies.

Policy com

mitm

ents to Healthy

Ageing

1.E

nable autonomy

2.E

mpow

er older adults and their fam

ilies, and organizations that represent them

3.S

upport Healthy A

geing interventions (m

ulti-sector and intersectoral) and at all levels of governm

ent.

To achieve success

We w

ill require clear com

mitm

ents to specific actions by each stakeholder, to support the translation of the

GS

AP into actions and results in

every country.

Country -led A

ctions Mem

ber S

tates

•Multi-sector and Intersectoral

Com

mitm

ent•A

dvocacyand Im

plementation

•Health and Long term

care•R

esearchand Innovation

Multi-sector and Intersectoral

Com

mitm

ent

•Em

powerolder persons to participate in developing

and evaluating policies.•

Develop, strengthen and im

plement policies and

legislation to protect the rights of older people.•

Prom

ote and support multi-sectoraland

intersectoralcollaborationw

ith diverse stakeholders to design and im

plement actions to

address healthy ageing.•

Prom

ote transformation of social, econom

ic, and environm

ent sectors to meet the needs of different

age groups including older adults through multi-

sectoraland intersectoralactions that require w

orking across sectors.

Advocacy and Im

plementation

•Increase national aw

areness and competencies on

healthy ageing as a priority topic through comm

unication strategies aim

ed at the general population and those w

ithin governmental sectors.

•Enable m

edia to increase knowledge, aw

areness and understanding of the rights and needs of ageing populations, including all form

s of entertainment.

•D

evelop, strengthen and implem

ent national and sub-regional plans and policies to address the health needs of an ageing population, ensuring that vulnerable groups are addressed and inequities identified and reduced, that are properly resourced and w

ith clear lines of institutional accountability

•Foster the developm

ent of age-friendly environments.

Health and Long term

care•

Engage private sector tow

ards national standards and regulations for form

al and informal care, to increase coverage,

quality and equity in service •

Ensure access to essential m

edicines.•

Develop national long term

care systems that are properly

resourced and with clear lines of accountability

•C

onnect to other relevant national strategies, for prevention, m

anagement and treatm

ent as well as m

ore effective care for older populations

•In line w

ith services identified, ensure health and long term

care workforce is trained, deployed and m

anaged, with

appropriate, qualifications and diversity, to provide integrated older people centred

services.•

Ensure gerontologicaland geriatric com

petences,are included in all health related curricula.

Research and Innovation

•Encourage and support research, m

onitoring and evaluation system

s related to healthy ageing, including periodic national surveys inclusive of older persons.

•E

nsure national vital registration and statistics are disaggregated by age and sex throughout the

life-course.•

Reflecting older persons’ needs and expectations,

allocate resources to support research, knowledge

generation and translation, and design of interventions and technologies.

•C

reate incentives to develop, test, adapt and scale technological and social innovations for hom

e and com

munity-based services for older populations

HECHO 2| EL DRAM

ÁTICO CAM

BIO EN

LA CARGA DE LA EN

FERMEDAD

1. Adequatehealth

servicesto

the em

ergingneeds

of the aging

population

2. Train the necesaryhealth

workforce

tosatisfy

the emerging

needs

3. Generate

information

in orderto

developand

monitor program

sand interventions

4. Create

longterm

caresystem

coordinationinstrum

ent

5. Position the healthand aging

issuein

the Nationalagenda

Multi-sector and Inter-sectoral

Com

mitm

ent in Mexico

•D

evelop, strengthen and implem

ent policies and legislation to protect the rights of older people.Law

on the rights of older persons (2002) C

onvention on the H

uman R

ights of Older Persons (2015)

•P

romote and support m

ulti-sectoraland intersectoralcollaboration w

ith diverse stakeholders to design and im

plement actions to address healthy ageing.

National C

omm

ittee for Care of Older Persons

(Ministry of H

ealth 1999)•

Prom

ote transformation of social, econom

ic, and environm

ent sectors through multi-sectoraland

intersectoralactions. National A

ging Strategy (C

ON

APO

-ING

ER 2016)

Advocacy and Im

plementation in

Mexico

•Increase national aw

areness and competencies on

healthy ageing as a priority topic through com

munication strategies. W

orking with N

GO

’s to develop an aw

areness campaign and dedicated

website (Tagle

Foundation), Healthy A

ging Forum

(JICA M

etropolitan Institute of G

erontology Tokyo)•

Develop, strengthen and im

plement national and

sub-regional plans and policies to address the health needs of an ageing population, D

evelopment of an

Action Plan on A

geing and Health (N

AM-IN

GER)

Health and Long term

care in M

exico•

Free access to medication through universal coverage

efforts.•

Develop national long term

care systems First R

eport on care dependence by the N

ational Institute (2014)•

Developm

ent of a new com

munity based, liaison

geriatrics, model of care (2015)

•W

orking to ensure health and long term care w

orkforce is trained. FO

RH

UM

web based LTC

training programm

e, (2012)

•M

exico-US w

orking group on comm

unity care (2014-ongoing)

•Functional com

petency mapping for care of older persons,

Aim

ing to all health related curricula •

Medicine, nursing specialty program

s.

Research and Innovation in

Mexico

•C

reation of the National Institute of G

eriatric M

edicine (2012). •

Periodic surveys: MH

AS (2001), SA

GE and M

exican H

ealth and Nutrition exam

ination survey (2012)•

Our national vital registration and statistics are

disaggregated by age and sex throughout thelife-course.

•W

e have allocated resources to support research, know

ledge generation and translation, through the creation of a M

exicanR

esearch Netw

ork on Ageing

•A

t the Institute and through the network, w

e develop, technological and social innovations for hom

e and com

munity-based services for older populations

RESEAR

CHN

ETWO

RK

ON

AGEING

Health and Aging PolicyTim

elinein M

exico

FIRST

SPECIFIC

ACTIO

NPLAN

O

N AG

EING

LAW O

N TH

E R

IGH

TS OF

OLD

ER AD

ULTS70 AND M

OR

E SO

CIAL

PENSIO

N

CO

NSTITU

TION

AL R

EFOR

M O

N

RIG

HTS

TOAC

CESSTO

HEALTHCARE

NAM

POSITIO

N

STATEMEN

T ON

H

EALTH AND

AGIN

G

FIRST U

NIVERSAL

SOC

IAL PENSIO

N

PRO

GR

AM IN

MEXIC

O

CITY (B

ECAM

EA

RIG

HT

IN 2003)

NATIO

NAL

UNIVER

SAL SO

CIAL PEN

SION

65 AN

D +

CREATIO

NO

F SEGU

RO

PO

PULAR

ANAG

END

A FO

RR

ESEARCH

ON

AGEIN

G

FISCAL R

EFOR

MTO

FINAN

CEIT

ALL

MH

AS2001-2013 B

EGIN

S

CREATIO

NO

F THE N

ATION

ALC

OM

ITEEO

N

AGIN

GAN

D H

EALTH

PAHO

SABE

SURVEY

FIRST

EVIDEN

CE B

ASED AC

TION

PLAN O

N AG

EING

PRO

POSAL

NEW

G

ERIATRIC

SPECIALTY

PRO

GR

AM

•Comprehensive aging services policies are needed aim

ed to an integrated system

of care•Financing, still an unsolved issue•Ultim

ate challenge: functional integration of planning and im

plementation across dom

ains that historically have had only incidental connections: social developm

ent and health•N

eed to establish initiatives that foster comm

unity participation, and advocacy, to prom

ote effectiveness and successful implem

entation of healthy aging initiatives

Public Policy and AgingClosing rem

arks

Thankyou…

..

Total fertility rate by region 2015, 2030 and 2050

Median age by sex and region 2015, 2030 and 2050

Life expectancy at birth by region 2015 and 2050

Living Longer, But Not N

ecessarily Better

About 30% of the burden of disease in older

adults results from years lived w

ith disability

Age Groups

Source: IHME, 2012

YLDYL L

BurdenProjections: Hip fracture incidence

forMexico until2050

Clark P Epidemiology, costs and burden of osteoporosis in M

exico (2008) ArchO

steoporosDOI 10.1007/s11657-010-0042-8

+ 431 %

Burden Projections: N

umber of Subjects

Afflicted w

ith Dem

entia in Mexico

Sosa AL Epidemiology, costs and burden of Dem

entia in Mexico (2013) 10/66 group

Multim

orbidity increases with Age

Lancet 2012;380:37

Frailty, Sarcopenia