Dr. Shyam P Lohani

OUR environment is an important determinant of health. It can either favour for healthy living or have adverse effect on health. Every country throughout the world should provide an opportunity to its citizens for leading a healthy and long life.
The World Health Organisation (WHO) defines healthy Ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. All people should be functionally able to meet their basic needs, make independent decisions, learn and grow, maintain and have relationships, remain mobile and contribute to society.
The demographics are changing rapidly worldwide and the population comprises increased proportions of older people than a few decades ago. Overall increase in life expectancy has raised several issues on every country’s socio-political, economic and scientific front. Issues such as “why we grow old”, “how long can we live”, “how to maintain good health”, “how to prevent and treat diseases among elderly”, “what are the future perspectives for healthy ageing and longevity” have been discussed increasingly among academia, social and political arena. The need for healthy ageing is a challenge to all countries throughout the world. Health is also an important determinant of overall economic growth of the country and investing in healthy ageing contributes significantly to the economic growth.

Changing demographics
In 2017, the population aged 60 and above was 962 million across the world. This number is projected to reach nearly 2.1 billion by 2050. In 2030, older persons are expected to outnumber children under age 10 (1.41 billion versus 1.35 billion); in 2050, projections indicate that there will be greater number of older persons aged 60 or over than adolescents and youth at ages 10-24 (2.1 billion versus 2.0 billion) (UN, 2017). By 2050, some 80 per cent of all the older people will be living in low- and middle-income countries.
Asia is also expected to experience a twofold increase in the number of older persons, with the population aged 60 or over projected to increase from 549 million in 2017 to nearly 1.3 billion in 2050 (61.2 per cent total world population of older people). Nepal’s population aged 65 and higher is projected to reach seven per cent by 2028 and 14 per cent by 2054 (CBS, 2019).
Majority of disability and deaths in older age may result from loss of movement, sight, hearing, and non-communicable diseases such as heart diseases, chronic respiratory disease, diabetes, cancer, depression and dementia. Ageing is also associated with an increased risk of a person having more than one disorder at the same time. Multimorbidity can lead to interactions between disorders; between one disorder and treatment recommendations for another; and between drugs prescribed for different disorders. Polypharmacy (use of four or more drugs by the same person) is frequent in older people, which may result in drug interactions and longer hospital stay and increased treatment cost.
The consequence of demographic change with the continuously growing older population is a huge challenge. It is, therefore, imperative to have knowledge about how to promote healthy ageing so as to promote health and quality of life among older people and to prevent costly and negative impacts on the population as a whole.
The most important component of a healthy lifestyle is healthy eating. Although dietary needs change as people age, we need enough nutrients. Fruits and vegetables, whole grains, lean meats, low-fat dairy, nuts, and seeds give enough nutrients with fewer calories. Avoiding processed food and alcohol is equally important as eating foods that are low in cholesterol and fat. Similarly, drinking enough liquids helps prevent dehydration. Another important aspect of healthy lifestyle is to remain physically active which in turn helps maintain a healthy weight and reduces chances of chronic health problems. However, the amount of exercise depends on age and current health.
Healthy ageing warrants maintaining mind active which in turn improve memory such as reading, playing games and learning new skills. Yoga, meditation and relaxation technique improves mental health. Social and leisure activities lower the chances of some health problems. Activities that result in happiness should be carried out which in turn help improve thinking abilities.
Quitting smoking and giving heavy alcohol use help in healthy ageing. Similarly, older age people should try to take active role in his/her healthcare with regular health checkup and adequate information on the dose, duration and timing of any medications. Falls is the leading cause of injury among elderly. Old people are also more likely to fracture a bone when they fall. Getting regular eye checkups, involving in physical activities, and making house safer can lower the risk of falling.

Quality health services
Adequate access to good-quality health services for older people need considerable attention of the government. The provision of geriatric wards in hospitals having more than 100 beds should strictly be implemented. The family members, society, and the country should now pay due attention to the health promotion of elderly people as population is ageing rapidly due to improved understanding of healthy habits, better healthcare facilities and preventive measures. There is urgent need to initiate the provisions to improve the physical environment and social support for older people in the form of safety, mobility, transport, recreation, lifestyles, and social relationships besides availability of good quality healthcare services for treatment and rehabilitation.

(A Professor, Lohani
is the founder and academic director of Nobel College. lohanis@gmail.com)