International Day of Older Persons - a reflection on today and tomorrow!

Author: Sofia Duque

Affiliations: Internal Medicine Specialist with Geriatrics Competence – Hospital Cuf Descobertas – Internal Medicine Department Invited Lecturer of Geriatrics – Faculty of Medicine, University of Lisbon Direction Board Member - College of Geriatrics, Ordem dos Médicos Coordinator of the Geriatrics Study Group of the Portuguese Society of Internal Medicine Executive Board Member – Website and Communications Director - European Geriatric Medicine Society Member of European Academy for Medicine of Ageing

Commemorative days are opportunities to draw society's attention to problems that urgently need to be solved and require effort from the scientific community and society to improve the situation.

This year, as coordinator of the Geriatric Studies Group of the Portuguese Society of Internal Medicine, I was asked to reflect on the International Day of Older Persons in an article published in a highly visible online journal. I share it here because older persons' problems in Portugal are identical to those of many other countries.

“The 1st of October marks the International Day of Older Persons, as established by the United Nations (UN) in 1991, with the aim of raising awareness of the issues of aging and the need to protect and care for the older population. The UN intends to draw the attention of several member countries to the stereotypes associated with chronological age and myths related to aging.

In Portugal, aging is often associated with dependence, cognitive impairment and social devaluation. It is not uncommon to hear family members and even healthcare professionals comment "for his /her age it's not bad!", regarding older persons and their physical or cognitive ability, as if functional and cognitive deterioration were inevitable consequences of aging.

These myths can be overcome by promoting successful aging, maintaining physical capacity, and not interrupting the participation of older people in society despite their older age. The experience acquired throughout their lives allows them to be more competent and balanced in their role as citizens, workers, family members, caregivers, or even volunteers and consumers. For all this, we must always remember that older persons are valuable.

However, few older people receive the appropriate and personalized health care they deserve. The development of specialized health services in geriatrics is urgent, and Portugal is one of the few countries in Western Europe where the National Health Service does not consider its existence as a structural feature. Why do Portuguese older persons not have the same accessibility to geriatric consultations as other Europeans? Why is there a lack of inpatient departments targeting the specificities of older patients (i.e. geriatric wards)? Why are there no geriatric clinical departments where healthcare professionals can improve their skills in the clinical management of older patients? Sooner or later, one of us will need such departments and clinical expertise ourselves…. If we start "tomorrow" it will be too late, but it will still be possible! At this stage of change in the Portuguese National Health Service (NHS) (new Minister of Health and new NHS CEO), we hope it will be reasonable to restore our hope in the correction of this iniquity between Portuguese older persons and other Europeans.

This year, the UN chose the resilience of older persons, with a greater focus on women as the theme for the International Day of Older Persons. This emphasis on women comes from a paradox: despite women having relevant roles in the social, civil, cultural, economic and even political spheres, their recognition and visibility are just residual. Likewise, it is realistic to consider that their needs are also unnoticed and therefore never satisfied, not only at the individual level, but also at the level of social and health policies. This discrimination against women occurs throughout their life course, possibly cumulatively and exponentially. However, their intrinsic resilience allows them to continue to overcome adversities, reaching the same goals as men, even with invisible or nonexistent rewards. But what is the price to pay for this superhuman resilience that makes women take care of everyone, from the youngest to the oldest, in an intrinsic and altruistic way? Could this explain that in Portugal, women live longer than men, but live fewer years with health and independence? Is the “resilience” of women applied almost exclusively to others and never to themselves? Is this the explanation for the accelerated and unsuccessful aging of women, accumulating disadvantages throughout their lives?

If being older in Portugal is a challenge due to insufficient social, economic and health policies, being an older woman is an even greater challenge. Often, older women are the caregivers of their husbands, surviving more years, but fated to live the following years alone and in poor health. Social and health policies starting from the beginning of the life course may be able to reverse this trend and provide a healthier and more equitable aging process. Geriatrics can also contribute to this goal, but we really must start working today.”