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The Health Plight of Older Refugees in Australia

Since World War II, Australia has taken in an estimated 675,000 refugees and is ranked among the world’s top countries for refugee resettlement. As of 2015, there were 35,582 refugees living in Australia.

Photo Credit: migrationmuseum
Photo Credit: migrationmuseum

Classified by the United Nations as someone who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable, or owing to such fear, is unwilling to avail himself of the protection of that country,” a refugee faces a plethora of stresses – many even after resettlement – that adversely affect his health and well-being.

Increased risks for infectious and chronic diseases, post-traumatic stress disorder, and difficulties accessing necessary health-related services are some of the widespread effects of living in refugee settlements, being exposed to war or persecution and learning to navigate foreign cultural contexts. These effects are significantly exacerbated in older refugees.

In Australia, there are two categories of older refugees – individuals who were over the age of 60 upon resettlement, and individuals who resettled as young people and aged in Australia. While data is limited, some studies have shown that older refugee populations fare worse than their native counterparts.

Specific health conditions identified as a concern for older refugees include age-related memory problems, psychological health status, physical health needs, and social isolation. While these problems may seem related to elders in general, their effects are particularly pronounced among refugees.

To add to this issue, the health needs of the elderly in times of conflict are also often overlooked. The United Nations High Commissioner for Refugees explains that “lack of mobility, weakened vision and chronic illnesses such as arthritis and rheumatism (issues typically face by older adults) can make access to support difficult, and aid services often do not take these issues into consideration.”

The crisis that compels individuals to seek asylum and resettlement in other countries are often physically, mentally, and emotionally traumatic. Elderly individuals often suffer great upheaval and are at greater risk of experiencing social isolation and separation from family upon their displacement.

We are at a point in history where we are seeing the largest number of refugees ever since World War II. In order to address the needs of older refugees in Australia as well as elsewhere in the world, it is crucial that policy makers consider refugees as a distinct group in need of specific services that are unique from the rest of the population. It is also important to consider the needs of refugees across their entire lifespans and across stages of resettlement.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at Kent State University College of Public Health.


Battling Beauty Stereotypes in Brazil’s Older Women

If you have ever watched a Brazilian telenovela, you might notice that older women look unrealistically younger than the characters they portray, with the help of botox or other “medical miracles”. Older women in Brazil face pressure to look young, not gain weight, and maintain top physical appearance. As women age, their metabolism slows down and wrinkles tend to appear on their faces. This can lead to body image dissatisfaction, which is a distorted perception of appearance that leads an individual to unhealthy lifestyle, weight issues, and/or depression. Such distortion is common among older women in Brazil and having a negative impact on the mental and physical health of this population.

Photo Credit: CarolinaAURO
Photo Credit: CarolinaAURO

Body image dissatisfaction is often discussed in the context of teenage girls. It may cause eating disorders where girls may choose to eat less or vomit after eating, in an effort to maintain a certain physique. Thus, the choices made in adolescence can have a lifelong impact on the health of an individual. Anorexia nervosa and bulimia nervosa are eating disorders that have been linked to low bone mineral density and osteoporosis in teenage years. Both disorders also impact older women. In fact, anorexia nervosa is more likely to cause death in women over 65 than girls or women under 65.

Body image dissatisfaction is a direct result of ageism in society, and the fear of getting older. Older adults may feel less relevant or unwanted if they do not maintain youthful appearances. In a population-based study in southern Brazil, researchers found that women over the age of 50 were most likely to be concerned that they weighed too much. Older men were also more likely to be dissatisfied with their weight than younger men, but the magnitude of the dissatisfaction was smaller than women.

The need to look young in aging women has its roots in an ageist society, where older women are not valued as much as their younger counterparts. Changes in skin and weight are a natural part of aging but in Brazil, many women fear any weight gain. While the solution to this problem is unclear, the media can play a great role by portraying older women who have aged naturally. This population should be able to feel comfortable with their appearance as this may challenge beauty stereotypes and reduce the stigma of growing older. Media, however, is only a small part of the problem and it is clear that older women need to be valued for their contributions to society.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.


Microneedles: A New Innovation in Medical Care for the Elderly

Photo Credit: Peter DeMuth, Wellcome Images
Photo Credit: Peter DeMuth, Wellcome Images


Rita Barrock is an 84-year-old Alzheimer’s patient. She lives in a nursing home, where she has to be under constant supervision. One of the daily challenges that the nurses who care for her face, is getting her to take her medication. As an Alzheimer’s patient, Barrock is not always compliant with her medication – she often forgets why she needs to take the several multicolored pills that she is given three times a day and throws a fuss that is both disruptive to the home as well as detrimental to her own well-being. [1]

One in three senior citizens in the USA dies with Alzheimer’s disease or dementia. In sub-Saharan Africa, the current population of older adults is 46 million and is estimated to reach 157 million by 2050. A number of these people have HIV and yet another portion contract a whole host of other diseases on a regular basis. By 2050, India’s aging population is set to be 323 million, 45 percent of whom will carry the entire country’s disease burden, the most prevalent of which is diabetes. There are currently 197 million elderly living in poverty, 40 percent of whom live alone.

Anyone who has spent time with grandparents or other elderly folk have been privy at some point or another to their daily intake of medication. However, research proves that for a number of different reasons, older populations tend to be less regimented than younger ones when it comes to swallowing the pill. In a study of 34,501 coronary heart disease patients aged 65 or older, for example, only 26 percent continued to use their medication five years into their regimen.

Common reasons for abandoning the intake of medication include the number of pills prescribed and the stigma of taking oral or injectable medication. Apart from not wanting to take medication, and medical conditions that prevent older folk from making coherent decisions regarding their health; poverty, lack of access to medication and inadequate health literacy – for instance, the inability to correctly inject oneself with insulin – also deter seniors from following their medical routine.

With so many barriers, it is time to rethink the way people ingest medication. Some progress being made in this field includes extended-release tablets that minimize the daily dosage one needs to take. Over the last few years, there has been another technology that has the potential to revolutionize the way people medicate. Microneedle technology is a new drug delivery system that relies on a transdermal release of medication. Imagine a small patch of biodegradable polymeric protein or silicone with several microscopic needles embedded in it. The needles are coated with medication and are applied in the same way one would apply a nicotine patch. Their small size makes them a minimally invasive, easily applicable, pain-free way to medicate, that is also devoid of the stigma of the pill.

Microneedles are still in the testing stages. They are currently being developed for use in insulin for diabetes, quantum dots for cancer, TB testing, gene delivery and several immunizations, including HIV, tetanus, polio, and influenza (plasmid DNA). In addition, it is primarily universities such as Georgia Tech, UNC-Chapel Hill, MIT, and some international institutes such as the Indian Institute of Technology Kharagpur and Tokai University of Japan, that are developing this technology, with a view to disseminating more effective vaccines in developing countries. There are, however, a handful of private enterprises investing in the technology for mass production such as California-based TheraJect.

Medical technology is a dynamic field that has the potential to significantly change the quality of life for older adults. This population should be recognized as a vital market for technologies like microneedles.

[1] This particular story is fictional. It is based on the experiences of older adults in nursing homes.

Sachi Shah is a recent graduate with a degree in International Development and Economics from Sarah Lawrence College, New York.

India is Diabetes Capital of the World

Photo Credit: Pixabay
Photo Credit: Pixabay

P Pushpam, a resident of Chennai, India, was denied her job appointment with the Indian Railways on the grounds that she was a chronic diabetic. The court ruled in her favor and pointed out the impracticality of discriminating against people suffering from diabetes in a country that has over 40 million diabetics.

As India makes its demographic transition toward lower birth rates and higher life expectancy, the prevalence of non-communicable diseases is on the rise. India is the “Diabetes Capital of the World” with over 60 million diabetics in the country, that is projected to at least double by 2030. The country ranks second, between China with 90 million and USA with 24 million diabetics. About 17% of the country has diabetes and about 77 million are considered to be pre-diabetic, which refers to those individuals who have higher than normal blood glucose levels, but not high enough to categorize them as diabetic.

Disability-adjusted life years (DALYs) is a measure of the burden of a specific disease in a population. A study shows that the DALYs attributed to communicable diseases in India such as malaria and TB will decrease. However, the DALYs associated with diabetes and other non-communicable diseases will increase. When compared to China, another country with a large and rapidly aging population, one sees a decrease in the DALYs for both communicable and non-communicable diseases.

Smoking, poor physical activity and alcohol use are some pertinent risk factors of diabetes in India. A survey revealed that close to 40% of Indian men are daily smokers and approximately 18% of the study respondents had poor physical activity levels. The survey also suggested that in addition to these individual level risk factors, environmental factors, specifically indoor air pollution contributes to the increasing prevalence of diabetes. The incidence of solid fuel use, contributing to air pollution in India is 83.5%. An urban lifestyle, and increasing strength of the food, fertilizer, pharmaceutical and beverage industries in the past decades, also contributes to a higher prevalence of diabetes.

A major obstacle to diabetes in elderly health is the lack of awareness of one’s status. A study in the urban slum of New Delhi reported that only 36% of their respondents were aware of their diabetic status. Low awareness among the elderly is linked with difficulties in screening, diagnosis and treatment abilities. Elderly patients tend to have lower mobility and are more likely to be dependent on their family members, delaying their ability to seek care.

The increasing prevalence of diabetes management among the elderly places a huge burden on the Indian health care system. While lifestyle modification is the most cost-effective solution to this growing epidemic, a more intense plan of management and care for elderly diabetics is needed.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

The Green Revolution – Care Delivery Redesigned

A growing trend in long-term care delivery has sparked the redesign and re-engineering of senior living centers. This trend includes the integration of plants, gardens, and greenhouses within communities. For instance, assisted living homes and skilled nursing facilities nationwide have adopted horticultural programs in order to improve psychological health and serve as a therapeutic comfort for older adults. Mere exposure to living plants and flowers have also shown to increase activity levels in the elderly as well as influence health outcomes for seriously ill patients.

                                                                      Photo Credit: mksfca

Redesigning homes range from developing community plots or atria that encourage active teamwork and participation through gardening to “meditative labyrinths” or aromatherapy gardens. In fact, the Robert Wood Johnson Foundation-supported “Green House Project” takes advantage of greeneries, natural light, gardens, and therapeutic outdoor spaces that drastically improve the environment and ambience of care settings. The Foundation has called the project a “catalyst for significant social change in how frail older adults are cared for in this country” and the initiative is being adopted at sites nationwide.

Green House Project homes may qualify as assisted living centers or nursing homes and can be funded through Medicaid or Medicare. Medicaid provides free or low-cost health coverage for families and individuals with low income and limited resources in the United States. Medicare is the federal health insurance program for Americans age 65 and older, certain younger people with disabilities, and people with end stage renal disease and amyotrophic lateral sclerosis (ALS). The widespread growth of the Green House Project and other pilot programs represent a movement towards person-centered, comfort-based care. These programs also reflect a broader paradigm shift in the delivery system towards non-medical needs, personal comfort and well-being.

Raca Banerjee works in health care policy and consulting. She has conducted research on a wide variety of policy and legislative issues related to the Affordable Care Act, Medicare, long-term care, health IT, and more. Raca is an active participant of Rotary Club International. In her free time, she enjoys volunteering, performing music, playing tennis, and learning new languages.

Old and Forgotten: The Crisis of Africa’s Elderly

Africa is currently the most youthful continent in the world. At least 35 per cent of its more than one billion population is between the ages of 15 and 35. While investing in the youth is a priority for the continent’s transformation, the elderly should not be forgotten. As Africa’s population grows, the number of older people also increases therefore it is important to highlight the issues that affect this population.

Traditionally, extended families have taken care of elderly members but since that is changing, aging Africans are now facing new problems. The United Nations Population Fund estimates that around 50 million people above the age of 60 account for around five percent of Sub-Saharan Africa’s population. In the past, most of them turned to families for help but the practice is becoming less widespread. It is difficult to convince people that the elderly in Africa are in need of help. Issues affecting this population are not popular because either everyone is just focusing on children, which is important, or they are under the notion that the elderly live happily with their extended families. It becomes more difficult when even development policy debates marginalize issues related to the elderly. For example, the Millennium Development Goals (MDGs) focuses only on women and children.

Despite these issues, society should not give up on the elderly because they need our assistance. There are many ways to help the elderly in Africa such as organizations can partner with local hospitals to train volunteer healthcare assistants who will visit the elderly in their homes and ensure that they receiving the care they need. Other complex issues can be tackled efficiently. For instance, there are at present senior citizens who cannot afford sufficient medical care in South Africa. The situation is more problematic because advocates for the elderly state that the services for senior citizens have dramatically decreased in the last two decades.

According to Anita Powell, Southern Africa reporter for Voice of America, few among South Africa’s rapidly growing elderly population are faring well, health wise, due to economic insecurity which is linked with worse health outcomes. Elderly advocates insist that Nelson Mandela, South Africa’s most famous senior citizen, is not the standard by which South Africa’s treatment of its weakest members should be judged. Unlike other aging South Africans, Mandela spent nearly two weeks in a Pretoria hospital for a lung infection, and received the best possible medical care. The nation’s growing elderly population is increasingly marginalized by a government that has focused its health care on young people and women. While child health is very important, the health care needs of the elderly should not be overlooked especially in a nation with only eight registered geriatric doctors. Despite these issues, it is good to know that South Africa’s pension system was the second most distributed of the African countries in the Global AgeWatch Index, the first-ever overview of the well-being of older people around the world. Without a formal pension system, the prevalence of poverty among older persons will likely increase. Currently, there are no formal systems in most other African countries.

It is critical to provide proper assistance and support to combat poverty and economic security for today and tomorrow’s seniors. Africa’s elderly still contribute to development, civic life, and the economy in many ways including caring for grandchildren when the middle generation has died or become very sick from HIV/AIDS. Ultimately, they need to be rewarded. This video portrays the work of the Ikaheng Daycare Centre for the Aged in the South African Township of Ikaheng.

Sophie Okolo is the Founder of Global Health Aging.