Population Aging and Urbanization in Europe

Cities are seeing a rise in ageing populations. In the European Union (EU), 75 percent of residents live in urban areas. As urban populations continue to rise, more and more people will grow into old age. For instance, the over age 65 group makes up 20-27 percent of the population in cities inside Portugal, Italy, and Spain. Since population aging will influence health, social exchanges, and well-being of older adults, hundreds of cities are designing urban environments to foster active and healthy aging.


Urbanization affects many areas including the health and well-being of society. As a result, many sectors are collaborating to keep populations engaged and healthy. Adapting cities to demographic trends accommodates residents, allowing for independent living and participation in society. The European Commission estimates that over 75 percent of housing in the EU is not suitable for independent living. Other aspects of physical environments including adequate sidewalks, transportation, and functional green spaces can increase physical activity and improve mobility, which reduces the risk and effects of chronic disease. Social issues, such as employment discrimination, negative stereotypes, and ageism, also play a role in the health of aging populations. It is important to involve older adults’ perspectives on urban planning to identify issues and barriers which prevent participation in society.

To help cities adjust to demographic trends and support healthy ageing, the World Health Organization (WHO) created a Global Network of Age Friendly Cities and Communities and Affiliated Programs, as well as a guide for policy and action in fostering age-friendly urban environments. Over 300 cities in 33 countries are currently involved in the Global Network, including 19 Member States in the European Region. The WHO guide advises on eight areas¹ considered the most influential, which also reflect the UN Principles for Older Persons. Through the work of the European Innovation Partnership on Healthy and Active Ageing (which has a dedicated Action Group on Innovation for age friendly buildings, cities and environments) the European Commission has published a guide on innovation for aging, with examples from 12 countries in Europe.

EuroHealthNet’s Healthy Ageing website also highlights examples of initiatives and key resources on healthy and active aging throughout the European Union. Arup, Help Age International, Intel, and Systematica have produced an overview² of aging in 10 European cities with comparative data on both urbanization and aging. AGE Platform Europe published a guide³ aimed at helping European cities to use the Urban Agenda to become more age-friendly and as a repository of innovative solutions for age-friendly environments. These networks and initiatives encourage cities to be health-promoting environments as they adjust to population aging, and share innovative ideas, experiences, and lessons learned along the way.

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By 2020, more than 50 percent of the global population over 60 years old will be living in urban areas. Planning now can stimulate active and healthy aging both for current and future generations.

1. The WHO guide addresses: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community support and health services.
2. The ”Shaping Ageing Cities” publication examines: society; mobility; built and digital environments; politics; planning; and aging.
3. The AGE Platform Europe guide addresses the eight areas in the WHO guide as well as eight themes corresponding to the Urban Agenda: inclusion of migrants and refugees; jobs and skills in the local economy; urban poverty; housing; air quality; urban mobility; digital transition; and innovative and responsible public procurement.

Carrie Peterson covers Europe for Global Health Aging. She is a Gerontologist and Consultant in eHealth and Innovation.

Under-Diagnosed and Often Overlooked: Elder Abuse in South Africa

This article is the first part of a two-part series on elder abuse in South Africa. Click here to read Part 2.


This year marks the tenth anniversary of World Elder Abuse Awareness Day (WEAAD). The United Nations established WEAAD to bring communities around the globe together in raising awareness about elder abuse. Although this problem is considered a public health issue, the World Health Organization has recognized that elder abuse remains a taboo which is often underestimated and ignored by many societies. This problem is perpetuated by societal attitudes and a lack of public knowledge about elder abuse. The abuse of older people is often viewed as a personal matter – it is not openly discussed. As a result, the prevalence of elder abuse is under-reported worldwide.

In South Africa, organizations like the Saartje Baartman Centre in Cape Town are helping those affected by elder abuse.  Dorothy Gertse the head Social Worker at the center reports that a growing number of elderly women are seeking assistance due to abuse by younger relatives. Elder abuse is a broad term that is comprised of various acts such as physical, sexual, emotional, and verbal abuse, neglect, exploitation, abandonment, and financial/economic abuse.

South Africa is currently experiencing a rise in economic abuse– individuals are seeking access to financial resources such as pensions and the homes of vulnerable older adults. Gertse states that family members are escorting the elderly to pension pay points and confiscating their finances. The rate of abuse has increased within the last 6 years; Femada Shamam, Chief Operating Officer for the Association for the Aged reports that in the 2010-2011 there were 1458 reported cases; this rose to 2497 cases in the 2012-2013 financial year.

The Older Person’s Act exists within South Africa’s Constitution and outlines the government’s obligation to protect the rights and uphold the safety of older persons. However, Shamam reports that many are unfamiliar with the act, and their role in upholding it. He states, “If you go to the police to report an incident, they wouldn’t know they have the authority to remove the alleged perpetrators.” Thankfully organizations like the Saartje Baartman Centre and The Go Turquoise for the Elderly are creating awareness surrounding issues faced by older persons in South Africa.

Andria Reta covers Africa for Global Health Aging. She is a Gerontologist and Professor of Health Administration.

Australia: Integrating Mental Health Services at the Primary Care Level

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In many developed countries, the aging populations are on the rise and Australia is no exception. Currently, 13% of Australia’s population is over 65 years and this is projected to grow 19-21% by 2031 and 26% by 2051. The experience of aging can range from a positive, fulfilling one to an anxiety filled, negative experience. In Australia, mental health disorders are highly prevalent among the elderly.

Existing mental health services are provided at the primary care level, with the general practitioner. In 1992, Australia changed its mental health services policy from an institutional to a community-oriented set up. When it comes to health, one’s General Practitioner (GP) is usually the first point of contact for an elderly patient. By integrating mental health services at the primary care level, the Australian government places mental health as a mainstream agenda in the health system.

An example of a model is the case of St. Vincent’s District in the inner city of Sydney. This district had a heterogeneous elderly population, comprising of Holocaust survivors, people who are homeless, or in hostels among others. Less than 1% of the population surveyed went directly to a hospital for mental health services, and a significantly larger proportion went to their GP. Since the elderly have the freedom to choose their GP, they place a high level of trust with these health professionals. The model encouraged collaboration across primary care, community services and specialist services such as geriatric medicine and geriatric psychiatry. An impact evaluation of this program suggested that general practitioners and other primary health care workers became more skilled in assessing and managing elderly mental health, requiring less support. Additionally, there has been better outcomes with regards to maintaining continuity of care.

This model was applauded for not only improving access to mental health services, but also in the collaboration it achieved. However, stigma against mental health issues is a concern. Elderly patients are often victims of the existing stigma around mental health and this is a significant barrier to engaging in dialogue on mental health issues with one’s General Practitioner. Another critique of this program is that care and treatment can be ‘fragmented, piece meal and sometimes non-existent,’ and that there is no nationally consistent protocol.

It is estimated that 10-15% of the elderly population have experienced depression. If one looks specifically at the elderly population in residential care homes, this population has more than twice the rate of the depression, at 35%. Additionally, about 10% have experienced problems with anxiety. Suicide rates among the elderly are also a cause for concern as men over 85 years have the highest likelihood of dying by suicide than any other age group. This age group’s suicide rate  is three times higher than the national rate, at 37.6 deaths per 100,000 people. Some of the key reasons for depression include loss of a partner and deterioration of health.

These figures look grim. Perhaps there is a need for the re-evaluation of this model, looking at health systems factors as well as sociocultural factors affecting access and use of mental health services.

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.

How Robot Technology is Caring for the Elderly

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Japan faces a rapidly aging population. As more and more of the population greys, fewer and fewer young people are available to care for the elderly. There is a particular shortage of health care workers who work with the elderly therefore the demand for elderly health care is not being met. Among health care workers, there is a high turnover rate which was close to 17% in 2013. Japan’s answer to this shortage is research in robot technology to assist in elderly health care.

A prototype robot, Robear, has been developed. Designed by Riken, a Japanese research institute, this robot is a polar bear cub look-alike that aids health care workers. The Robear is the successor of two previous heavier robots, RIBA and RIBA-II. Robear helps in lifting patients from beds and supporting them in walking. Apart from research in the robot’s abilities, research into understanding the needs of the elderly has also been done, especially in the appearance of the robot. Researcher Mukai says, “The polar cub-like look is aimed at radiating an atmosphere of strength, geniality and cleanliness at the same time.”

Another robot being developed in the country is the ChihiraAico, a 32-year-old Japanese woman look-alike that is supposed to ease communication between humans and non-humans. The creators at Toshiba are aiming to use ChihiraAico with patients with dementia to help them connect with counselors and medical staff with ease. On the other side of the Pacific, the USA is developing PARO, a robotic pet. There is evidence to show that pets can effectively combat loneliness among the elderly and PARO currently shows promising results. A pilot test in a home suggested that elderly residents feel calmer and less anxious after interacting with these robotic pets.

Robotic technology in Japan is not limited to health care, and has expanded to a range of end-of-life services. As more and more elderly people take charge of their funerals, Japan’s end-of-life industry has come up with ‘skyscraper graveyards’. Traditionally, the Japanese cremate the dead and store the ashes in the family crypts in cemeteries. Due to the space constraints, ‘skyscraper graveyards’ have become increasingly popular. Relatives are given identity cards and robotic arms assist them in retrieving the urns stored in vaults deep underground.

Using robots for elderly health care has advantages and disadvantages. On the one hand, robots can effectively aid in the under-staffed health care system in Japan by assisting in hospitals and elder care units. It can also be placed in individual homes and provide remote monitoring of the individual. Moreover, it can help combat loneliness. On the other hand, the use of such expensive technology raises questions on the lack of human relationships and its impact on family dynamics.

Is robot technology the future of elderly health care? What is the scope for robots outside of high income countries like Japan and USA? What, if any, impact will the high dependability on robots have on human-to-human interaction? Only time can answer these questions. Japan’s experiments with robots are promising, and if this technology proves to decrease the burden of aging on Japan’s health care, there will only be more demand and a greater space for robotic technology.

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 Need to Address Chronic Conditions in Timor-Leste

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Timor-Leste or East Timor is a small low income country in Southeast Asia with a population of 1,114,000. It has years of conflict, violence and brutality, and a tumultuous past with Portuguese and Indonesian forces. The conflict and political upheaval have left its marks on all aspects of development in the country. In 2002, Timor-Leste became an independent nation.

Being one of the newest countries in the world, Timor-Leste’s current WHO Country Cooperation Strategic Agenda 2009-2014 is primarily focused on developing a robust health system and improving capacity building. Key health issue focus areas are infectious diseases, maternal and child health and nutrition. There is an immediate need for data and adequate focus on chronic conditions, especially among the adult and elderly population. Although Timor-Leste has the lowest number of publications in medicine, available preliminary data particularly on cardiovascular diseases and diabetes highlights the growing burden of chronic conditions among the elderly. With increased urbanization and improved economic conditions, there is a need to address this growing burden among the elderly population.

Among the 50-96 year population, cardiovascular and circulatory diseases account for approximately a 25% of the total disability adjusted life years (DALYs). For the population aged 70 years and above, these diseases account for approximately 36% of the total DALYs. Specifically, ischemic heart disease in 2010 accounted for approximately 12% and 16% of the total DALYs for 50-69 year and 70+ year population respectively. The disease burden of diabetes mellitus (in terms of DALYs) among the 50-69 and 70+ year population has also increased from 3.6% to 4% of the total disease burden affecting this population. The overall diabetes prevalence in Timor-Leste is currently low at 2.9%. Available data indicates that 7 out of 10 cases occur in those over 40 years. Furthermore, there is very low awareness of diabetes in the country which is a risk factor for increased diabetes prevalence. Urbanization and economic development have the potential to rapidly increase the prevalence rate. Currently, Timor-Leste does not have a national strategy in place to address the diabetes.

As Timor-Leste works on creating a robust and comprehensive health system, it will be imprudent if chronic conditions affecting older populations are not taken into account. With increased economic growth, access to health services and urbanization, the rising burden of chronic conditions can lead to the high prevalence of communicable and non-communicable diseases i.e. the double burden of disease. Collection of valuable data and surveillance, and strategies to improve awareness and reduce the current burden of chronic diseases are ideas for sustainable good health in Timor-Leste.

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.