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9 November 2009

Ageing population: the problem, the challenge and the opportunities

delivered at Lingnan University

Speech by Dr. C.H. Leong

         May I begin by thanking Lingnan University and President Chan Yuk Shee for the honour to address this Assembly. When I first received the invitation, I asked Prof Alfred Chan who actually taught me the issues of elderly care what kind of audience will I be facing. Prof Chan said that it would be a majority of students and some staffs. I therefore hesitate. Could an old man address a group of very young. Perhaps it is exactly for the same reason that I took the challenge to address you, because I believe that this is a step forward in intergeneration harmony, which underpins elderly well being.

        The topic I have chosen today is ¡§Ageing population: the problems, the challenge and the opportunities¡¨. I choose this topic for 3 reasons: „P

¡E Ageing population is global and this is a fact and an issue. „P

¡E Lingnan University has a well-established record and a framework of Liberal Art Education. Under the leadership of your former president. Prof K Y Chen and your current President Prof Y. S. Chan you have a most enviable Institute of Ageing studies. Speaking on ageing in your University will I am sure attract many useful and contributive feedbacks.

¡E I am elderly myself.

        Ageing population is a fact, the percentage of people aged 65 and above has reached from 7.6 % in 1986 to 13.9% in 2009. This amount to about 900 500 of our 7 million people in mid-2009. The Census and Statistics Department of HK estimates that by 2026, the population of people aged 65 and above will be 21.9% - HK now has the second highest population of older people in Asia after Japan. Ageing population is a global issue. It is estimated globally that by 2050, people aged 60 or over will outnumber those below 15.

        In the same score, the ¡§elderly dependency ratio¡¦ rose from 124 in 1991 to 168 in 2006 and is expected to reach 425 by the year 2036.

        The reasons are simple; better sanitation, better health care, better medical treatment has extended dramatically our life expectancy at birth. To HK, it was 79.4 years for males and 85.5 for female in 2007. This is compounded by the background of decreased fertility in Hong Kong. The datas are that there is less than 1 birth per couple. I once had the chance of talking to a group of university students from different Universities. I went round the group to ask them how many children they would like to produce. I was surprise that a high percentage say 0, and only one venture bravely to say 3.

¡EProblems

        Such are the facts and issue. Will these bring about problems? Looking at it superficially, the answer would be an emphatic yes!

     Let me elaborate:

¡E Financial Burden

¡E Health and Medical Burden

¡E Social Burden

  Just to mention a few.

Financial Burden: It could be said that any person who has retired are not contributing to the society. They do not have any income and thus not contributing to the tax pot . Worse the society will have to support them in some aspects. In 2006, when the % of age 65 and above is 12.4%, it means 8 working person will be supporting 1 elderly. When it come to 2026, by which time it is 22%, then 4-5 people will have to support one elderly. The financial burden is thus obvious.

¡E Health and Medical Burden

        It is a well-know fact that elderlies do consume much more health care support. They are more prone to be sick and when they are sick, they usually have major illnesses or chronic illnesses which require a long term and expensive care. Facts taken from the Hospital Authority showed that 49 % of their hospital beds are occupied by person 60 and above. Elderly persons are prone to fall and to them even minor falls may end up in fractures. Fixing fractures entail cost not to say the burden of long term physiotherapy and rehabilitation to get them back to be able to take care of themselves.

        Old age is also associated with degenerative changes. In the case of degeneration of the brain, it will lead to dementia presenting as loss of cognitive functions. A typical example is Alzheimer Disease. Most will need specialized care and in severe cases institutionalized special care. Local studies revealed that 4% of elderly people aged 65 or above will haves some degree of dementia and 6% among those aged 70 or above. The prevalence doubled every 5 years after the aged of 65. At 2006, it is estimated that some 70,000 community dwelling older people suffer from some forms of dementia.

Social Burden

        Whether you like it or not, elderlies are different from the younger age and their differences could be considered as a social burden. As a start, elderlies are slower in their movements. They thus delay traffic getting in and out of cars and other public transports. They delay elevators in housing estates. They are clumsy and often drop objects. As a joke, elderlies need to go to the toilet more and take a longer time. In a crowed household as Hong Kong, such construe a genuine burden. Elderlies tend to be demanding and dominating. They often exert their paternalistic behaviors which today may be unacceptable to the younger age. Family and social disharmonies may result. Worse the elderlies may conceive themselves useless, a burden to the family, become a recluse and in extremely cases even develop suicidal tendencies.

        It may sound alarming but elderly suicides are on the rise. Worse elderly suicidal are very determined, if they fail they will try again.

        It may be a surprise to most of you, but in Hong Kong, elderly discrimination do exist in no small way. Tenants in public housing are know to have oppose, sometimes in very militant ways, the establishment of elderly homes in their buildings.

        Unfortunate too many issues that are created to show care to the elderly often give impression that elderlies are a burden.

        On a personal basis, I am somewhat upset by the general public¡¦s image of elderlies. The common symbol of a senior citizen is a white hair, wrinkled face person partially bald, with a bent back holding a walking stick being assisted on crossing a road. I think I do not need that yet. Elderlies are thus portrayed as weak, frail, perhaps a burden, which by today¡¦s standard they are NOT.

        While the communities in general do somewhat consider the ageing population therefore as a burden, Government behaviours have not alleviate the misconceptions. The overall elderly care policy is often interpreted as a welfare policy.

¡E The Challenge

        But all these are, and should be, different. The elderlies of today and definitely those 10 years along the line will be different. They will be healthier, more active, more participative, better educated, and perhaps more financially independent.

        With these as background, the challenges are to shake off the gloom associated with an ageing population and turn the elderlies into opportunities ¡V producing ¡§successful ageing¡¨.

        I believe that some major factors for successful ageing should includes:

¡E Proper pre-retirement preparations;

¡E Change the image of the seniors themselves;

¡E Promote Active Ageing;

¡E Promote an elderly-friendly community;

¡E Promote intergenerational harmony, so as to reestablish the care roles of a family, and

¡E Involve the elderlies and not ¡§Ignore Them¡¨

        To those far away from retirement age, retirement could be something to cherish.  It means a long drawn much needed holiday, it means time for you to do so many things that you were unable to do but could not find the time.

        Yet for those who stepped into retirement, they are entirely different. It is NOT a long holiday, rather it is a permanent holiday. You have unlimited time because you have nothing to do. You feel completely lose because your usual crowds of friends have to rush back to work and you have no schedule. The end result is you feel you are not wanted, you feel you are useless, you don¡¦t feel needed in the society.

        This is utterly unacceptable and the elders themselves are to be blame. They become completely withdrawn and retreat into a ¡§cocoon¡¨. They refuse to join anything or activities that the society produces for them and they even shun from their usually friendship gatherings. The seniors must change their image and their mindset. Remember they should feel proud as they are responsible for building the society into its success today. They have the biggest accumulative of knowledge and expertise which are vital to nurture the young. To the seniors, the word to them is ¡§get up and go¡¨, ¡§change into something decent every morning to involve in what the community has arrange for you. Don¡¦t let your wife see you in pajamas even at 11:00am in the morning.¡¨ The human body and the human brain is like a computer circuit, the more you use it, the better will be the brain circuit and thus the functions. Leaving it to stall, it will degenerate and deteriorate. Medical evidence has shown that if you keep on stimulate your brains even if you have Alzheimer, it will not deteriorate so fast. It has been said that it is playing mahjong that lower the incidence of Alzheimer and arthritic changes in the fingers among Chinese. Playing mahjong requires quite a lot of brainwork. Shuffling your mahjong is a continuous exercise for your fingers. There is of course an added advantage of social interaction. A mahjong game involves at least 4 persons.

         What can the society and the community do to help our elders to be engaged in active ageing?

         We have started an Elderly Academy. This is a school based learning allowing our seniors not only a chance to really learn but a sense of going ¡§back to school¡¨. Participating primary and secondary schools will be contributing their premises after regular school hours and during weekends. The students of these schools will become ¡§teachers¡¨ teaching elders enrolled either directly or through elderly institutions and non-governmental welfare organizations. The curricula will consist of a mandatory session on health education and healthy living. Other subjects are discussed and agreed by the ¡§ students¡¨ the ¡§teachers¡¨ together. It might be a surprise to note that working with computer, personal health care are the most commonly chosen topics. This scheme thus has achieved a few objectives.

¡E „P Ensure that our elders remain active;

¡E „P Promote their social relationship by enlarging their social circle and thus enhance their confidence and images;

¡E „P Promote across sectional cooperation between the education sector and welfare sector;

¡E „PInduce better understanding between the old and young ¡V in short promote intergeneration harmony, leading to appreciation of core family values

        Starting off with 32 schools, we have now 98 schools. The tertiary institutes have also showed their enthusiasm. Some 8 out of 11 local universities are involved. They provide wide spectra of programmes ranging from specifically organized interest class to elders, to proper sub degree courses; to formally allowing the elders to sit in at regular university degree sessions. As of today, there should be over 10,000 elders in the primary and secondary schools and about 1,000 who yearn to taste university life. When they were young they were deprived, and are now proud to be enrolled as university students. Let me take this opportunity to thank the Lingnan Education Institute for your support in these issue. You have a one stop learning services for our elders, starting with primary schools to secondary schools and the University.

        I am aware that the concept of the university of the 3 rd Age, which is essentially a peer learning group, has been well established in many parts of the world, in particular Australia. Ours is perhaps unique in that other there offering a university life for our elders, we have also instilled a real sense of cooperation between the generations, where elder students study side by side with the younger regulars. This would no doubt promote inter-generation understanding and harmony in the long run.

         Nothing is more effective than peer inducement and peer support. This applies particularly to the elderlies. It is on these understanding that the Elderly Commission has started pilot project in all the districts in Hong Kong ¡V Pilot Neighborhood Active Ageing Project. Using the neighborhood as platforms, nongovernmental organization enter into partnership with different sectors to train up volunteers of all age and sectors in particular the elders to organize activities regularly for the elderly and to pay visits to singletons elders to strengthen neighborhood support and as sense of belonging in a neighborhood setting. Today such neighbourhood projects are across the whole territory reaching out to every sector of the community, including private and public estates, old tenement buildings and rural areas. We have witness examples of formerly ¡§shut off elderlies¡¨ opening up to neighbors, joining peer groups and even taking a lead to induce others to participate. The project is extended to a ¡§Caring for Elders¡¨ concept aiming to promote care for elders and abuse prevention through neighbor support networks. Elderly abuse, of which we have no exact figures, are by no means rare, this project will tackle elderly abuse through a three prong approach, namely education (through the Elder Academy Network) prevent and support (through setting up elder caring group). We have further extended this Pilot Neighbourhood project to prevent, and attempt early discovery of elders with suicide tendency, hopefully to minimize if not arrest such unnecessary tragedies. All in all, the elders play the active role answering to the concept of ¡§utilize¡¨ them and do not ¡§ignore¡¨ them.

         For those in the audience, who belong to a more mature age, the project might bring back the nostalgia of ¡§under the lion rock¡¨ culture where filial piety reigns supreme; where respect of the elders is a convention; where neighbourhood harmony, and friendship is the norm. As an elder myself, let me say this to you, it was this culture and spirit that bound Hong Kong together to emerge a winner from the doldrums of the 50¡¦s and the 60¡¦s to become what we are today.

        All this times, we are talking about elderlies who are or can be active. What about the old olds, the frail elders? What are the problems and challenges?

        The issue that concerns is ¡V long term care. Should they be ageing at home? Or should they be institutionalized in Old Age Home that provides different degrees of nursing services? What are the problems and challenges?

        All research studies will tell you that elderlies prefer to age at home. When I visit elderly home as a chairperson of the Elderly Commission, I like ask the boarders, as a means of assessing standard of the elderly institutions, is whether they are happy and satisfied. Most of the time their answers are positive, but would always add, that they would still prefer to age at home with or near their children and grandchildren.

        Paradoxically, Hong Kong has the highest rate of elderlies living in institutions. Our data showed that 7% of elders aged 65 or above are living in elderly home compared with other countries which were roughly in the range of 1-5%.

The problem is that with such a high rate of institutionalization and with the rapid growth of the elderly population, any amount of increase in elderly places in elderly home will never be able to meet with the demand.

         The challenge is how to assist our elderly to aged at home in dignity and in the company of their loved one.

        Are our family homes well equipped for our slightly disabled and less active elderlies? Is the community providing adequate services and home help to allow the elderlies to be at home and the younger member of the family to feel secure leaving their elders at home? The answers to both of these questions are in the negative. Less than ideal living conditions in Hong Kong, especially in less well to do sectors are never elderly friendly enough. There may be no elevators for elders to move about, sharp corners and obstructive objects are all over the place considering the small size of the apartments. Handrails etc are not available to assist the elderly in their movements.

         In the same score, while the Department of Health and Social Welfare Department do produce a comprehensive list of home help, they may not be ¡§elderly friendly¡¨. In short facilities are there, but does not match the elder needs. The challenge is how to pair these facilities to the requirements of the elderly users. Here is where challenges can turn to opportunities.

¡E „P The Opportunities

         Alan Greenspan once said that ¡§Ageing population is not only a fact, it is a destiny¡¨. We cannot run away from it, we should therefore welcome it and turn problems into opportunities.

        I can think of 3 opportunities at least and I like to share them with you:

¡E „P ¡§Re use¡¨ our Elderlies

¡E „P Overwhelming ¡§Elderly Market¡¨

¡E „P Opening new ¡§job and professional opportunities¡¨

¡E „P Creating an Elderly Social Enterprise

¡ERe use our Elders

        At the outset of this address, I mentioned that the elderlies of today and tomorrow are and will be healthier, more active and financial independent. To force these people to surrender their works when their expertise and knowledge is at the peak is a waste of modern human resources. At the same time, of course, extending their retirement age would have the read across effect of hampering our young from climbing up the job ladder. There is no reason however that the following ways could not be considered.

¡E „P Flexible retirement age;

¡E „P Change the nature of the job of the elderly after retirement and consequently has a salary cut

¡E „P Revise the role of elderlies in the Elderly Academy to become mentor to the school children.

        When all elderly CEO is moved sideways to a position - an advisor, the employer will enjoy the comfort of having an experienced personnel to advise any younger CEO. Furthermore, the elder will have a pension, he will not need a full salary, decreasing the extra financial burden of the employers. It is thus a win - win situation.

¡E Silver market

        It is paradoxical that in most major cities, there are fabulous toyshops, shops that specialized in children¡¦s products and these shops are still mushrooming, despite decreases in the young population. Yet though there are more elders, there is hardly any corresponding increase in shops selling products for the seniors and entrepreneurs coming up with products that our senior citizen needs.

        The future elderlies because they are and will be active will need products to give them quality life despite being slightly hamper by mild degenerative change as a result of age. Yet very few are available.

         Do not under estimate the spending power of our future elderlies. Even today, before the financial tsunami, in the US, data have shown that some 50% of new cars are bought by people 50 year or above and some 50% of luxury care are own by elderlies.

        Yes new products for the elderlies could never be labeled as such for fear of stigmatization. Elderlies especially female do not want others to look at them as old.

New Jobs and new opportunities

        More eldelries means the need for more people to look after them. Most of the time, these jobs were taken up by volunteers - family members who willingly give up their own jobs and social life to look after a close elderly family member. When unfortunately the day comes, that the elderly pass away, such relative will feel relief. They will eagerly discard their baggage and along with it all the years of expertise of caring for the elderly. All is thus lose!

        The future elderlies because they are and will be active will need products to give them quality life despite being slightly hamper by mild degenerative change as a result of age. Yet very few are available.

        In the face of increasing demand, there will be a call for a new job career, a new profession ¡V elderly carers. People who are willing to join the team of elderly carer with training opportunities and promotion jobs prospects. Hopefully even young people could be enticed to be interested to make it as a life long career, opening new job markets.

        Of late, we are very much concern with drug abuses in schools, the elderlies in the Elderly Academy setting can act as mentors to install morality and family core values for the young students to prevent them from being led astray.

¡E Creating an Elderly Social Enterprise

         Many of our elderly have special skills, some have managerial expertise. Together there is no reason that they could not form social enterprises. A while ago, I was commenting on a lack of ¡§Elderly Orientated¡¨ home help services in the community. Working on a bases of a cross sectional, intergeneration cooperation, we have all the require elements from our retirees to form caring companies to supply the very much needed customized home help services, to allow the comfort of our elderlies to age at home. Ladies and gentleman, for the last 30 minutes or so I have dwell on the problems of an ageing population, the challenge that lies ahead for the Government and community to consider and the possible opportunities it will bring. These are in no way complete and I will defer to this very learned audience to put in your words of wisdom.

Ladies and gentleman, for the last 30 minutes or so I have dwell on the problems of an ageing population, the challenge that lies ahead for the Government and community to consider and the possible opportunities it will bring. These are in no way complete and I will defer to this very learned audience to put in your words of wisdom.

        To the younger members of the audience, you may consider what I said to be boring and perhaps even of no significances. For to you old age, retirements are something 40 years or so away.

         On this, I beg to differ. Any policy on elderly care affects you as much as the elderly and the whole society at large. Let me elaborate.

         Like it or not anyone of us will get old, one of these days. By then, you will need a good elderly policy to give you a dignify way to grow old without being a burden to the society and your family.

        A good elderly policy also means the elders are proper cared for, they will be given the best chance to enjoy their ¡§golden year¡¨ without being a burden to the family. Therefore as a young person you benefit, you do not have to shoulder all the burdens of care for your elderly family members.

        Many decades ago, when life expectancy is relatively short, a family usually consists of 2 generations, the parents and the siblings. At worse, the siblings have care for only one generation, the parents.

        The future elderlies because they are and will be active will need products to give them quality life despite being slightly hamper by mild degenerative change as a result of age. Yet very few are available.

         Not too long ago, this family becomes somewhat extended, you includes the grandparents through longer life expectancy. The burden is to have to look after 3 generations.

         In the days to come, 4 generations or even 5 could exist at the same time. You will then have not only the grandparents, but also the great grandparents to take care of. The burden will be to look after 4 generations.

        Yes, no one would deny that the family would be a major pillar for elderly care, yet a properly designed and implemented elderly policy will ensure that even with 4 or 5 generations living together, the family will always be a happy and loving one, without the threat of an ageing burden.

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