Older adults comprise a growing proportion of the global population. This population shift has far-reaching socioeconomic and political implications for people of all ages. Older adults make valuable contributions to society, both material and immaterial, and younger generations benefit from their experience (1). Increased longevity and the growing presence of older adults create new opportunities for both individual and societal development. At the same time, social and economic policies, services, and research are needed to enhance the well-being of older adults and to eliminate the ageism that prevents older people from living with dignity, realizing their full potential, and accessing resources (2). Social workers are well positioned to collaborate with older adults in creating and advocating for ageing-friendly policies and programmes, and to provide culturally competent services to older adults.
Global Trends in Ageing
The global population is ageing at a rapid rate. In 1950, just over five percent of the world’s population was 65 years or older. By 2006, that number had jumped to eight percent. By 2030, experts anticipate that older adults will comprise 13 percent of the total population—one in eight people will be 65 or older (3). While developing countries will experience the most rapid growth in ageing, with increases of up to 140 percent, developed countries will experience increases averaging 51 percent. (Women, who tend to outlive men, will comprise the bulk of the older adult population [4, 5].) Simultaneously, overall population is declining in many countries due to low fertility rates, HIV/AIDS, and international migration (6). The United Nations estimates that the number of adults 60 years and older will outnumber children under the age of 15—an historical first—by 2045 (7).
Not only is the world ageing, but it is also ageing differently. Life expectancy is increasing, with people 85 years and older—especially women—comprising the fastest growing segment of the population in many countries. Notable exceptions include South Africa, where life expectancy dropped from 60 to 43 years in the last decade, primarily due to HIV/AIDS (6). Globally, more people are dying from noncommunicable diseases and chronic, degenerative conditions than from infectious and parasitic diseases, a trend expected to grow in the next couple of decades. (Whether increased life expectancy will be associated with increases or decreases in disability status remains an open question.) At the same time, communicable diseases—especially HIV/AIDS—remain prevalent, particularly in low- and middle-income countries (3). In considering the benefits and consequences of population ageing, therefore, it is essential to consider not only longevity but also healthy life expectancy, or expected years of life free of illness, disease, and disability (8).
These demographic and epidemiological shifts, combined with increasing urbanization, modernization, and rural-to-urban and international migration, profoundly affect family structures, health and long-term care provision, work and retirement patterns, and financial security (9). In revising the international policy on older persons, IFSW has drawn upon the Madrid International Plan of Action on Ageing (MIPAA), a product of the Second World Assembly on Ageing in Madrid (2002). Approved by the 151 countries participating in the Assembly, MIPAA outlines three priority directions for policymakers: (a) older persons and development; (b) advancing health and well-being into old age; and (c) ensuring and enabling supportive environments (10).
Older Adults and Development
Although older adults serve as essential resources to their communities, they face a great risk of marginalization. Older adults often experience both social devaluation and poverty upon leaving the labour market; financial market fluctuations contribute to income and social insecurity regardless of employment history, especially in countries with developing and transitioning economies. Groups particularly vulnerable to poverty and social devaluation in old age, due to cultural and institutional biases which affect people throughout the lifespan, include women, people with disabilities, people with a migration background, and people who do not belong to the majority racial or ethnic group of any given society. Moreover, older adults seeking support to maintain independence and quality of life frequently encounter either a lack of social services, especially in rural and remote areas, or services that are poor in quality or unresponsive to linguistic and cultural diversity.
Participation of older adults in societal development enhances the well-being both of older adults and of communities as a whole and depends on multiple factors, as outlined in MIPAA. Implementation of country-specific human rights legislation and international human rights instruments, such as the Convention on the International Protection of Adults (11), the Convention on the Elimination of All Forms of Discrimination against Women (12), and the Convention on the Rights of Persons with Disabilities (13), benefits older adults and society at large. Social workers advocate for older adults’ human rights and fundamental freedoms by promoting older adults’ dignity and working to end all forms of discrimination. Social workers also support the full integration of older adults by promoting their social, economic, and intellectual contributions to society and their inclusion in decision-making at all levels. In particular, older adults with a migration background need support and advocacy to access the social, cultural, political, and economic opportunities the older majority population enjoys (14).
An ageing-friendly labour market requires increased recruitment of older adults and elimination of promotion barriers and retirement regulations that neglect older adults’ wishes and competencies. Other components needed to enhance older adults’ participation in the labour market include health-promoting, disability-accommodating work environments; work-related health and rehabilitation services, including industrial social work; institutional support for self-employment and microenterprise, particularly in rural areas; promotion of workplace equality with respect to gender, race or ethnicity, and other diversity factors by monitoring and enforcement mechanisms regarding employment standards, equal opportunity policies, bridging programs, and training programs; and increased participation of the working age population, especially women, people with disabilities, and chronically unemployed individuals.
Irrespective of employment history, access to literacy, numeracy, and lifelong learning—adapted as needed to changing cognitive capacities in old age—also facilitates older adults’ participation in societal development and enjoyment of cultural life. Intergenerational activities, such as service-learning programmes in which younger generations tutor older adults in computer skills, enhance social cohesion and older adults’ knowledge. Equally importantly, older adults serve as mentors, mediators, and advisers, passing on their social, cultural, and educational knowledge to younger generations.
Improving poor living conditions and infrastructure in rural areas, and eradicating poverty in all geographic areas, is critical. In several countries, hyperinflation has rendered pensions, disability insurance, health benefits, and savings almost worthless (10). Poverty among older adults, as among other age groups, exacerbates social marginalization, contributes to poor health and mental health, and erodes the ability to live and function both independently and interdependently—all factors related to quality of life. Labour market reforms and adequate pension or pension-equivalent systems (indexed to each society’s standard of living and available to both formal and informal sectors) are essential to ensure social and economic security in old age. This is especially true for women, who are disproportionately poor due to lower degrees of formal education, social security measures structured around men’s labour market experiences, interrupted participation in the labour market due to caregiving for children and others, and patriarchal family structures.
WHO identifies older adults, particularly in resource-poor countries, as particularly vulnerable in emergencies (such as natural disasters, war, and terrorism) due to isolation, disability or lack of physical stamina, loss of family caregivers, and institutionalization (15). Rehabilitation projects, social services, and legal counselling, which must be responsive to the needs and contributions of older adults, are critical to facilitate coping with crises such as displacement, land dispossession, and loss of property.
Advancing Health and Well-Being into Old Age
MIPAA and IFSW affirm WHO’s definition of health: “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (16). IFSW and MIPAA also uphold WHO’s life course perspective on ageing, which recognizes that (a) health promotion and disease, disability, and injury prevention contribute to health in old age, especially for women, and (b) the health of older adults must be considered in the context of events throughout the lifespan (17). Furthermore, MIPAA asserts, and IFSW supports, that advancing health and well-being in old age requires not only individual efforts but also governmental commitment to creating—in partnership with nongovernmental organizations and the private sector—a social, physical, and economic environment conducive to healthy ageing.
These perspectives, which correspond to the social work value of self-determination and person-in-environment framework, provide the foundation for all efforts to advance health and well-being into old age. Social workers play a critical role in advocating for and providing for health care that centers on older adults’ goals, needs, and strengths and in creating societal conditions favourable to health and well-being in old age (18).
Health promotion initiatives provide older adults and people of all ages with the knowledge and tools to manage and improve their own health. Among other factors, WHO advocates smoking cessation, moderation in alcohol use, a balanced diet, regular exercise, and social integration over the lifespan as essential to healthy ageing (19). For people living with disabilities, preservation of maximum functional capacity and full societal integration are crucial.
Well-being in old age also requires universal and equal access to a full continuum of health care services that are tailored to each community’s needs and meet appropriate legal, regulatory, and professional standards. Lack of services and unaffordability are primary barriers to access, especially in low- and middle-income countries. Regardless of location or cost, many older adults cannot access services due to discriminatory attitudes and practices based on age, gender, race, ethnicity, language, sexual orientation, gender identity and expression, physical, psychological, or cognitive disability, or other diversity factors—or forego using available services that are not culturally appropriate or physically accessible.
While preventive and primary care present the best hope for healthy ageing (5), mental health care is also essential (though frequently overlooked). The stress of disease and disability can contribute to mental health problems; likewise, mental health problems can exacerbate, or slow recovery from, disease and disability (20). Emotional and mental health problems are also associated with decreased utilization of preventive health care services (21), diminished immune functioning, nonadherence to prescribed medical regimes, and risky behavior (20).
Sexual health care, though similarly disregarded by many health providers and older adults (22), is becoming increasingly critical as the prevalence of HIV/AIDS—both existing and new cases—grows among older adults. Older women, who frequently do not have the power to negotiate safe sexual practices (23), or who do not perceive the need for safe sex beyond their childbearing years (24), are particularly at risk.
Specialized care is essential for Alzheimer’s disease and other dementias, which primarily affect older adults (especially those 80 years and older and people of all ages in developing countries ) and now rank among the top 20 leading causes of global burden of disease (3). Experts project the number of people with dementia worldwide will increase about 30 percent by 2040, with sharp rises in populous, rapidly developing regions such as Latin America, China, and India (25).
A strong workforce knowledgeable in geriatrics and gerontology—including paraprofessionals and informal caregivers such as family and other community members—is essential to advance the health and well-being of older adults. While medical advances have increased not only the lifespan but also the quality of life for many older adults, the psychosocial aspects of aging—and the crucial role of social work in supporting the well-being of older adults—must not be neglected. Social workers are uniquely prepared to help both formal and informal caregivers understand and provide the social aspects of care so critical to quality of life in old age.
Ensuring and Enabling Supportive Environments
Ensuring and enabling supportive environments for older adults requires attention to five factors: safe, accessible, and affordable housing; support and relief of family and other informal caregivers; prevention and reduction of elder mistreatment; participation and empowerment of older people; and elimination of ageism.
The immediate living environment significantly affects the well-being of older people. Safe, accessible, affordable housing remains a pressing need for many older adults worldwide, especially in urban parts of developing countries and countries with economies in transition. In developing and developed countries alike, affordable public housing—when available—is frequently inaccessible to persons with disabilities or is not linked with the supportive services necessary to maintain independence. Even among older adults who own their own homes, financial and physical maintenance of property frequently poses challenges. Universal home design and the availability of assistive technologies and home maintenance, repair, and modification greatly enhance the potential for ageing in place. In many developed countries, the ageing-in-place movement has helped to shift resources from institutional care to home and community-based care. The availability of both in-home services (such as personal care, housekeeping, meal preparation, care management, and home health care) and community services (such as day programs, congregate meals, and social centers) enables a growing percentage of older adults to delay or even avoid institutional care (26).
Although most older adults lead independent, productive lives and do not need a great deal of care as they age, families and communities face increasing challenges to caring for their aging members. In many countries, coresidence of older and younger family members has been an important component of lifelong intergenerational caring, in which adult children have cared for their ageing parents in exchange for parental support at earlier stages of their lives. Changing family structures—exemplified by increasing divorce rates, decreasing marriage and birth rates, and blended families resulting from divorce and remarriage—together with demographic ageing, present formidable challenges to the provision of care across generations. These challenges particularly affect transitional and developing countries, which have experienced both demographic ageing and modernization in comparatively short periods of time and have not had the opportunity to develop formal support systems such as state-run social security programs (27). At the same time, in developing countries fewer adult children are available to care for growing numbers of older people.
Another trend in family structure affecting older adults, particularly in the developing world and countries with high rates of HIV/AIDS, is the increasing number of older adults serving as primary caregivers for grandchildren or other young family members (28). Other factors such as violence, substance abuse, and incarceration also contribute to the increase of childrearing responsibilities among older generations.
Despite these trends, families—especially women—continue to provide most of the care for older people, primarily in home settings. Increasingly, older adults themselves care for other older adults of the same or different generation. Family caregivers in the home and community often face the task of balancing caregiving and job responsibilities. Multiple demands on family caregivers create physical, emotional, and financial stress. Caregiver support programmes, such as respite care, financial support, and flexible labour market policies, are critical to alleviate role conflicts and ameliorate the resulting stress (10). Integration and support of other informal caregivers such as friends and neighbors is also essential and requires strong intergenerational solidarity throughout communities.
Action to prevent and reduce all forms of elder neglect and abuse, along with the creation of support services to address these problems, is another major objective of MIPAA. WHO identifies a number of risk factors for elder abuse: social isolation; the societal depiction of older people as frail, weak, and dependent; and the erosion of bonds between family generations (29). Older, widowed women, for example, face the risk of abandonment and property seizure in many countries. Although countries around the world vary considerably in their responses to elder abuse and neglect, existing health and social service networks generally provide services such as emergency shelters and support groups. Educational programmes to raise awareness of the growing problem of elder mistreatment and to reduce stereotyping of older people are essential to prevent increased abuse, neglect, and exploitation of older adults.
As the numbers of older people increase worldwide, older adults have the potential of becoming more influential in society. Empowerment and political participation of older generations varies significantly across countries. Older adults in some countries actively and effectively produce and promote policies and programmes that improve their quality of life; in many countries, however, older adults are not organized and struggle to have their interests incorporated in public debate and social policy. Negative images of aging, to which social workers themselves are not immune, also contribute to older adults’ marginalization. Nongovernmental organizations often take the lead in promoting the empowerment of older people through social development projects (30). By examining and countering their own ageism, social workers and other professionals also play a key role in empowering older adults.
Progress in realizing the goals of MIPAA must be evaluated in the context of each country’s capacity, and international cooperation is essential. Social workers play a crucial role both in monitoring progress toward, and achieving, these goals and in facilitating collaboration across borders. With grounding in cultural competence, social workers are also well equipped to ensure that ageing-related policies, programmes, and research reflect and are responsive to the wide diversity of older adults, as well as to counter the various forms of oppression that contribute to the challenges of ageing.
Policy Position Statement
Social workers are in a unique position to create, implement, and advocate for policies, programmes, services, and research benefiting older adults. Recognizing that population ageing profoundly affects all sectors of society, IFSW encourages the consideration of older adults in all policies and specifically supports the following policy principles that promote the well-being of all older adults.
- Participation of older adults in the design, implementation, and evaluation of ageing programmes, policies, and research
- Respect for older adults’ quality of life (physical, psychological, social, intellectual, and financial) and self-determination
- Support, protection, and strengthening of human rights for older adults, including elimination of physical, emotional, and sexual abuse, financial and material exploitation, and neglect, abandonment, and self-neglect; implementation of human rights legislation and conventions
- Universal and equal access of older adults to affordable, comprehensive, and coordinated services in all sectors of society, regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religious or political belief or affiliation, migration background or civil status, physical, psychological, or cognitive ability, geographic location, or other diversity factors
- Elimination of socioeconomic and health disparities and discriminatory attitudes, practices, and policies that hinder older adults’ participation in society
- Promotion of full societal integration of older adults—including people with physical, psychological, and cognitive disabilities, illnesses, and diseases, as well as intra- and international migrants—through lifelong learning, political participation, intergenerational relationships, cultural, social, and voluntary activities, and paid employment
- Safe, accessible housing for older adults in community and institutional settings; physical accessibility of public and widely used commercial spaces and services
- Introduction, preservation, and strengthening of public, private, and commercial pension systems that ensure adequate income to meet older adults’ personal needs; eradication of poverty among older adults, especially older women
- Health and mental health care, including promotion initiatives to prevent and ameliorate physical, psychological, and cognitive disability and disease, substance use disorders, and suicide among older adults; primary and acute care, including effective medications and sexual health care; rehabilitative services and assistive technology; psychotherapy and substance abuse treatment; palliative and hospice care; and specialized geriatric and gerontological health and mental health services
- Long-term services and supports—available in home, community, and facility settings, and including specialized services for older adults with Alzheimer’s disease and other cognitive disorders—that maximize older adults’ quality of life and facilitate ongoing participation in the community
- Labour market, economic, psychosocial, and respite support for family caregivers of all ages
- Specialized attention to the needs and contributions of older adults in emergencies such as natural disasters and humanitarian crises
- Promotion and expansion of gerontological, geriatric, and cultural competency education and training for all social workers and other health, mental health, and social service providers; recruitment and retention of gerontological and geriatric specialists; safe working environments, fair conditions, and just compensation for all workers in the field of ageing
- Promotion and strengthening of the social work role in meeting the biopsychosocial needs of older adults through practice, policy, research, and advocacy
This Policy Statement was approved by the IFSW General Meeting in Salvador de Bahia, Brazil August 14, 2008.
1) International Federation of Social Workers. (1999). International policy on older persons. Retrieved May 11, 2007, from www.ifsw.org/p38001808.html
2) National Association of Social Workers—U.S. (2006). Senior health, safety, and vitality. In Social Work Speaks (7th ed., pp. 341-347). Washington, DC: NASW Press.
3) Lopez, A.D., Mathers, C.D., Ezzati, M., Jamison, D.T., & Murray, C.J.L. (Eds.) (2006). Global Burden of Disease and Risk Factors. Retrieved January 24, 2008, from www.dcp2.org/pubs/GBD
4) World Health Organization. (2003). Gender, health and ageing. Retrieved March 13, 2008, from whqlibdoc.who.int/gender/2003/a85586.pdf
5) Chan Cheung Ming, A., Cheng, S-T., and Phillips, D. (2007). The aging of Asia: Policy lessons, challenges. Retrieved March 17, 2007, from globalasia.org/articles/issue3/iss3_11.html
6) National Institute on Aging (National Institutes of Health, U.S. Department of Health and Human Services) and U.S. Department State. (2007). Why population aging matters: A global perspective (DHHS Publication No. 07-6134). Bethesda, MD: Author. Also available online at www.nia.nih.gov/ResearchInformation/ExtramuralPrograms/BehavioralAndSocialResearch/GlobalAging.htm
7) United Nations. (2007). World population prospects: The 2006 revision. Retrieved January 24, 2008, from www.un.org/esa/population/publications/wpp2006/FS_ageing.pdf
8) World Health Organization. (2008). Healthy life expectancy (HALE) at birth (years). Retrieved March 13, 2008, from www.who.int/whosis/indicators/2007HALE0/en/index.html
9) Hokenstad, M. C. T. (2003, March). Ageing international style: United Nations international plan of action on ageing. Paper presented to the Federation for Community Planning Human Services Institute.
10) United Nations. (2002). Report of the Second World Assembly on Ageing: Madrid, 8-12 April 2002. Retrieved September 13, 2007, from www.un-ngls.org/pdf/MIPAA.pdf
11) Hague Conference on Private International Law. (2000). Convention on the international protection of adults. Retrieved July 14, 2008, from hcch.e-vision.nl/index_en.php?act=conventions.text&cid=71
12) Office of the United Nations High Commissioner for Human Rights. (2008). Convention on the elimination of all forms of discrimination against women. Retrieved March 19, 2008, from www2.ohchr.org/english/law/cedaw.htm
13) United Nations. (2008). Convention on the rights of persons with disabilities. Retrieved March 19, 2008, from www.un.org/disabilities/default.asp?navid=12&pid=150
14) Niessen, J., & Schibel,Y. (Migration Policy Group), on behalf of the European Commission (Directorate General for Justice, Freedom and Security). (2007). Handbook on integration for policy-makers and practitioners (2nd ed.). Retrieved March 23, 2008, from ec.europa.eu/justice_home/doc_centre/immigration/integration/doc/2007/handbook_2007_en.pdf
15) World Health Organization. (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Retrieved January 31, 2008, from www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdf
16) World Health Organization. (1998). Health promotion glossary. Retrieved January 31, 2008, from www.who.int/healthpromotion/about/HPR%20Glossary%201998.pdfDefinition originated in the Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June – 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. See www.who.int/suggestions/faq/en/ for more information.
17) World Health Organization. (2002). Active ageing: A policy framework. Retrieved January 31, 2008, from www.euro.who.int/document/hea/eactagepolframe.pdf
18) National Association of Social Workers—U.S. (2005). NASW standards for social work practice in health care settings. Washington, DC: NASW Press. Also available online at www.socialworkers.org/practice/standards/NASWHealthCareStandards.pdf
19) Stein, C., & Moritz, I., on behalf of the World Health Organization. (1999). A life course perspective of maintaining independence in older age. Retrieved March 14, 2008, from whqlibdoc.who.int/hq/1999/WHO_HSC_AHE_99.2_life.pdf
20) World Health Organization. (2008). Mental health: WHO urges more investments, services for mental health. Retrieved January 31, 2008, from www.who.int/mental_health/en/
21) Thorpe, J. M., Kalinowski, C. T., Patterson, M. E., & Sleath, B. L. (2006). Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States. Medical Care 44 (2), pp. 187-191.
22) Huffstutter, P. J. (2007, November 26). Older but wiser? Safe sex after 50; Experts and an aging population battle a risky HIV generation gap. Los Angeles Times, p. A1.
23) International Federation of Social Workers. (2006). International policy on HIV/AIDS. Retrieved December 10, 2007, from www.ifsw.org/en/p38001031.html
24) AVERT. (2007). Older people, HIV and AIDS. Retrieved January 31, 2008, from www.avert.org/older-people.htm
25) Alzheimer’s Disease International (2007). About Alzheimer’s: Common questions. Retrieved January 31, 2008, from www.alz.co.uk/alzheimers/faq.html
26) Hokenstad, M. C. (2006, December). Older persons in a changing society: Report to the United Nations Department of Economic and Social Affairs Division for Social Policy and Development.
27) United Nations. (2005). Living arrangements of older persons around the world. New York: Author.
28) Apt, N. A. (2007). Health and ageing in Africa. In Robinson, M., Novelli, W., Pearson, C., & Norris, L. (Eds.), Global health and global ageing (pp. 187-196). San Francisco, CA: Jossey-Bass/John Wiley & Sons, Inc.
29) World Health Organization. (2002). Abuse of the elderly. Retrieved December 4, 2006, from who.int/violence_injury_prevention/violence/world_report/factsheets/en/elderabusefacts.pdf
30) United Nations. (2007). World economic and social survey: Development in an ageing world. New York: Author.