Adding life to years: the promise of active ageing

Whilst by the year 2025 the number of Maltese persons aged 65 years and over is projected to increase by 72% compared to 2010 figures, by 2060 the population of children and youth under 20 will decrease by 35%.

This will increasingly make our demographic pyramid - the figurative description wherein the young at the base support the old at the top - more square, as the number of young people at its base is no longer greater than the number of older people at the top.

For Marvin Formosa, who chairs the newly appointed National Commission for Active Ageing, this poses a demographic challenge which policy makers can no longer afford to ignore.

"As this century continues to unfold, Maltese society will experience unprecedented changes in its demographic fabric... Unfortunately, Malta has dragged its feet in the setting up of a long-term policy on active ageing."

But according to Formosa this warrants innovative approaches to public policy, since what works now will not necessarily meet the concerns and issues in population structures in the future.

The Commission, appointed in May by the Parliamentary Secretary for the Rights of Persons with Disability and Active Ageing, Franco Mercieca, plans to finalise and present a national policy on active ageing by the end of this year. The strategy will cover a 16-year span between 2014 and 2020.

"The Maltese government is urgently required to move on from providing lip-service to the concept of active ageing and express its strong commitment to promoting higher levels of positive, successful and productive ageing," says Formosa.

But this requires clear policy visions and strategies, which will permit older people to achieve more independence and allow them to take better charge of their own lives and contribute to society.

"This requires a balanced distribution of resources and opportunities between generations that safeguard the rights of older persons to live a life of dignity and independence and to participate in social, economic, cultural and civic life."

Presently 10,171 pensioners work on either a full-time or part-time basis, without any reductions to their pensions. The Commission hopes that this number will increase as the result of a national policy for active ageing.

But is the labour market accommodating the needs of elderly workers - who will be expected to work till age 65 - and are they being expected to deliver in the same way as younger workers?

"It is important that older and ageing workers enjoy exactly the same conditions of service and equal opportunities as their younger peers."

The National Commission believes that in order for Malta to reap the economic benefits of full labour participation, all stakeholders must work together to build and test new models of employment for people in the second half of life.

But it is crucial to bring about "a change in our attitudes to retirement and working longer," encouraging employers to take the initiative in leading innovation, and ensuring that age-friendly measures are seriously considered when discussing employment-related agendas.

One key issue is whether current pensions can provide for a decent living standard, as this could well create a risk that people end up working longer - not to fulfil their aspirations but simply because they have no other choice.

According to a recent reply to a parliamentary question 52,533 persons live on a pension of less than €700 a month. Does this suggest that a large segment of the elderly are living in relative poverty? What can be done to address this problem?

Furthermore NSO statistics, show that in 2010, the percentage of persons aged 65 and over at risk of poverty was 18.1%, slightly less than that for children, which stood at 21.1%. As far as material deprivation is concerned the rate for older persons was 11.7%.

"This means that, yes, at least one in ten older persons is facing difficulties in meeting unexpected financial expenses and may also be in arrears on mortgage or rent payments, utility bills, purchase installments or other loan payments."

Formosa contends that in view of these statistics it is imperative for the government to enact a 'social justice' agenda that mitigates against the disadvantages and lack of opportunities faced by older persons from working-class backgrounds, whilst continuing to support other persons in middle- and upper-class sectors to reach their aspirations.

I refer to studies abroad included in publications like 'The Spirit Level,' which suggest inequalities in life expectancy based on social class. Does a correlation between life expectancy and social class exist in Malta?

Interestingly, Formosa's own PhD thesis, 'Social Class Dynamics in Malta Amongst Older Persons,' which was also published in 2009, suggests that this is also the case in Malta.

"Taking education as a proxy for class position, as it is well evidenced that class and educational attainment holds a positive relationship, statistics published by Eurostat show a clear and systematic relationship between educational attainment on one hand and mortality on the other. At any age, life expectancy is less among persons with the lowest educational attainment."

One key question facing policy makers is whether there should be a mandatory retirement age at all.

Some argue that this concept on its own militates against the idea of active ageing. On the other hand, is there a risk that by abandoning this concept we end up having a more exploited working class, which is increasingly being expected to work beyond what it once was?

Formosa immediately points out that a significant percentage of older persons, especially older persons from working-class backgrounds, find that they have no choice but to exit the labour force, since manual labour does take an extensive toll on one's physical capital.

"The principle of social justice prescribes continuing support, in terms of free or subsidised social or healthcare services to vulnerable sectors of the older population."

Formosa explains that even in countries such as the United States and New Zealand, which have legislation that prohibits mandatory retirement, one still finds that the majority of older persons retire from the labour market at some point of their lives.

The Maltese government has also made it amply clear that it is not in favour of raising the retirement age.

Although the definition of retirement is historically and culturally relative, retirement is a socioeconomic process that will always remain a key transition in the development of human lives.

"As people grow older, their priorities in life change, with many consciously opting to shift their time and energy towards non-economic activities such as family and leisure. Moreover, many older persons who continue working do so for the social and emotional benefits that work brings to their lives, rather than career-oriented goals as such."

Therefore policy can never abandon the concept of retirement.

"Active ageing is not simply about working longer but also about more participation in society and better levels of independent living."

But is the current stress on active participation in the labour market militating against the participation of the elderly in other areas?

For Formosa, associating active ageing with participation in the labour market is a restricted way to look at the concept. He acknowledges that this association was highly prevalent amongst policy makers in the European Union until the mid-2000s and, admittedly, still dominates the agenda during OECD meetings on active ageing.

However, the National Commission will follow more recent developments in the concept, which look at active ageing from a multidisciplinary perspective. This is also the current position adopted by the EU, one that emphasises longer working lives, participation in society and independent living.

"Active ageing demands that older persons remain active in all spheres of life as much as younger peers."

Demographic change also poses challenges to the Maltese health system.

According to a study by Anthony Scerri and Charles Scerri published in the Malta Medical journal, the number of persons over 60 suffering from dementia is projected to be close to 10,000 by 2030, or 2.3% of the Maltese population. How well equipped are we to deal with this condition?

Unfortunately according to Formosa, Malta is ill equipped to provide optimal quality of care for the current 1.2% prevalence rate of dementia (5,200 persons) in the local population. "Unfortunately, there is a lack of awareness and understanding of dementia, and it is often considered to be a normal part of ageing or a condition for which nothing can be done."

This false perception is having a negative impact on individuals with dementia, their caregivers and families and their support structure in a number of ways. Low awareness levels are also contributing to stigmatisation and social isolation.

"Poor understanding creates barriers to timely diagnosis and to accessing ongoing medical and social care, leading to a large gap in treatment."

Formosa refers to a recent newspaper interview by Malta Dementia Society co-founder Charles Scerri, who claimed that Malta not only lacks qualified carers to take care of people with dementia, but many healthcare professionals - including doctors and nurses - still do not fully understand the condition.

"The Commission subscribes to his view that experience is not enough of a qualification to be fully equipped to care for dementia patients.

The key is training on the various facets of dementia, social and health related, complemented by rigorous research to keep abreast of wider and specific developments. I am confident that the national policy for active ageing will act as a catalyst for the further promotion of good practices in dementia care."

Formosa also challenges the idea that one only enters a residential and nursing home as a last resort.

"This step should be seen as another, normal phase of the life course... it is a fact that physical capital tends to decline with increasing age and this is natural part of the human developmental process."

Therefore it is only logical that society includes residential and nursing home services to meet such a state of affairs. In fact when joining a residential or nursing home is justifiable, such a transition results in an improvement of the quality of life for older persons.

The national policy for active ageing will aim to bridge community and residential-nursing living by ensuring that the latter settings include optimal opportunities for residents to live "positive, successful and productive lives".

Although the setting and maintenance of standards of care homes does not fall under the remit of the National Commission, it is important that basic benchmarks of good quality care are in place.

"Only so society can ensure that older persons, irrespective of their spending power, receive optimal social and health services in residential and nursing homes."