Across the world and the WHO Western Pacific Region, the population of adults over 60 years is the fastest growing age group (111). More than 290 million people aged 60 years and older live in the Region. While populations differ across the Region, all countries will face the challenges of an ageing population and meeting their needs will require rapid changes to many areas of society. Within the Region, 80% of older people live in middle- income countries (111). These challenges will be most significant in developing economies, where rates of ageing are fastest. The pace of ageing for example in the fifteen Pacific Island countries has accelerated and is projected to increase from 512,000 people aged 60+ years in 2014 to 2 million in 2050 with people aged 80+ years increasing from 34,000 in 2014 to 205,000 in 2050 (137).
While both men and women are living longer, the majority of these older people will be women because women live longer than men (see Figure 4). The level of education, literacy, and opportunities for workforce participation for women will determine the resources they have for healthy ageing, including whether they can age in place and the suitability of their housing, and whether they live alone. In the Pacific Island countries, the impact of climate change may potentially reduce the availability of suitable accommodation and safe environmental conditions e.g. reduced availability of safe drinking water. In addition, most older women in PI countries are widowed and can expect to live about 6.5 years as widows (137). Women in Kiribati, the Solomon Islands and Tuvalu experience widowhood for more than 10 years. This is further compounded by international migration with Niue, the Cook Islands and Tokelau the countries with the highest proportion of persons aged 60+ years in 2014, also the most affected by international migration (of children and other family members) (137). This has important implications in terms of poverty and access to resources given in the Pacific the majority of the population who are now old have spent their working lives in the rural village economy or the urban informal sector and are unlikely to have a pension or other regular sources of income.
Older women and men, but particularly older women may face obstacles in either continuing to work (for physical health reasons as well as ageism) and or in obtaining other work due to low literacy, low levels of education, lack of job experience, skills and qualifications (137). Inequities in older age reflect inequities in previous life stages particularly limited participation in the paid workforce for women (47,138,139). The impact of this is magnified by time out of the workforce in raising children and or older people in an unpaid capacity affecting not only opportunities for income but also women’s employment opportunities and career progression as well as reduced access to contributory pensions (138).
Adding years to life is good, but for many people they are not always healthy years. As people grow older, many do so with functional impairments and one or more chronic conditions – some of which are caused by NCDs. Ageing populations will also lead to changes in the disease burden in countries (5). For example, approximately 16 million people in the Western Pacific Region were estimated to live with dementia in 2016; it is projected that in at least 10 countries in the Region, the burden of Alzheimer’s disease and other forms of dementia will have increased 100% by 2040.
Sex and age-disaggregated data for DALYs provides important insights into meeting the challenge of ageing and enabling healthy ageing for both women and men (109). Table 3 illustrates some of the important differences in exposure, risk and potential outcomes for women and men aged 70 years and over e.g. neoplasms for men aged 70+ years are double that for women. Data for females and males aged 80+ years in the Region show some minor variations e.g. a decrease in neoplasms and an increase in chronic respiratory diseases for both groups (109).
References
| Females | Males | |
|---|---|---|
| Cardiovascular Diseases | 28.9 | 30.48 |
| Neoplasms | 5.34 | 12.65 |
| Chronic Respiratory Diseases | 5.99 | 9.25 |
| Diabetes and Chronic Kidney Disease | 4.97 | 4.06 |
| Neurological disorders | 1.76 | 1.94 |
| Respiratory Infections and TB | 0.99 | 1.87 |
| Unintentional injuries | 1.15 | 0.74 |
Metabolic causes (such as high blood pressure and high fasting plasma glucose) make the greatest contribution to DALYs among women followed by behavioral and environmental, and for men behavioral causes make the greatest contribution followed by metabolic and environmental causes (109). For women dietary risks, high blood pressure and high fasting plasma glucose are the top three causes of DALYs; and for men tobacco, dietary risks and high blood pressure are the top three causes of DALYs. At 80+ years, tobacco use is a significant risk factor and cause of DALYs, with high blood pressure becoming more important than dietary risks. By contrast, high blood pressure replaces dietary risks as the number one risk for women aged 80+ years (109).
Older women may also experience the double disadvantage of discrimination arising from both gender inequality/sexism and ageism leading to barriers and inequities in health (see Box 6).
Other conditions such as infectious diseases can also impact older people significantly. For example, age is an important consideration for AMR, with adults over 70 years more likely to develop a resistant infection (93). AMR surveillance in Japan, for example, showed that 80% of the cases with carbapenem resistance are among people 65 years of age and older. Furthermore, there are important differences in UTIs between females and males over the life-course in terms of sex/biology and mortality and morbidity. For example, while UTI prevalence is generally higher in females than males overall, at older ages, UTI prevalence in males increases and can be higher than in females (140–142). Women however are more likely to have community-acquired rather than healthcare-associated UTIs. Healthcare-related acquisition is found to be associated with higher frequency of AMR and multidrug resistant E. coli and a higher mortality rate and length of hospital stay (143,144). Provider knowledge, attitudes and practice together with older people’s embarrassment or fear of stigma about UTIs may affect diagnosis, appropriate treatment and outcomes for both older women and men.
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