Tag Archives: Namratha Rao

Japan Confronts Crime Wave With Aging Population

“It wasn’t great to get caught, but I just didn’t give a damn…” Fumio Kageyama

A crime wave among older people is underway in the world’s greyest nation. Just last year in Japan, the number of criminals over 65 overtook the number of teenage criminals for the first time since the country started publishing age-related crime statistics in 1989. Over a third of shoplifting crimes are committed by those over 60, and 40 percent are repeat offenders. Criminal offenses by those age 60 and over have also quadrupled between 1994 and 2014.

Photo Credit: Geoff Stearns
Photo Credit: Geoff Stearns

This curious phenomenon has its roots in the age-old problem of poverty and loneliness. Japan is an expensive place to live in, with even a frugal lifestyle costing 25 percent higher than the basic state pension. The cost of living simply does not match the pension rates of the elderly. Hence older people are committing crimes that result in imprisonment but assure them of food, shelter and healthcare. Loneliness is another factor that encourages crime among older people. About 40 percent of the elderly population live alone. Once released from prison, many do not have access to money, food or shelter, which perpetuates the vicious cycle of crime.

The rise in elderly crime is set against the gloomy national economy of the country. ‘Abenomics’ is a set of economic policies that are currently in place to revive Japan’s stagnant economy, and provide much-needed context to this crime wave. The impetus for these economic policies has been the two decade long stagnant national economy. Japan’s stock market and property bubble burst in the early 1990s, leading to long-term stagnant wages and markedly reduced spending. For the past two decades, the country has not seen any major economic improvement. Worsening the situation were the nuclear meltdown and natural disasters of 2011. Now Japan is caught between reducing the national debt and dealing with roughly 30 percent pensioner population.

‘Abenomics’ is a three-pronged strategy, encouraging monetary easing, government spending, and business deregulation. So far, critics remain unconvinced about the impact of these regulations, and current crime cases reiterate the ineffectiveness of these policies regarding the elderly population. The Japanese government has responded to the crime wave among older people with a short-sighted measure to increase prison capacity by a whopping 70 percent. This does little to address the crime spree that is embedded in poverty and lack of economic security. Furthermore, it takes a huge amount of resources to maintain a prison full of pensioners. A 2-year prison sentence can cost as much as USD 74,700 in a Japanese prison, compared to USD 6,900 on pension annually.

Inmates with health problems can even increase prison costs. In fact, a 2012 Justice Ministry report found that two-thirds of inmates had at least one health condition, including cardiovascular diseases, mental health illnesses, and behavioral disorders. This has resulted in prison guards often going above their disciplinary duties by changing diapers, cleaning inmates and helping them to walk. Japan can respond with long-term measures, such as prison reform, to prevent prisons from turning into dysfunctional nursing homes.

Namratha Rao recently graduated with a Master of Science in Public Health in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.

The Not-so-Novel Concept of Elderly Homes in Asia

Photo Credit: elvisinchina
Photo Credit: elvisinchina

Old age homes are no longer a taboo! The waiting lists of nursing homes in Korea are at three times their capacity and the number of elder care homes in Nanjing, China has increased from 27 in 1990 and 52 in 2000 to 148 in 2009!

In Asia, people are seeing a shift in the traditional roles for elderly care. Changes in family structure, urbanization, and other factors of contemporary lifestyles often compel older members to seek care outside of the family. Elderly residential facilities, such as old age homes, retirement villages, and other forms of institutionalized care for the elderly, have become increasingly popular in Asia. Given the high demand for such facilities, there is a need to monitor its growth and the quality of care provided.

Thailand, Malaysia, and Sri Lanka are among the Asian countries that offer renewable visas to older expatriates. Private companies and developers in India and Malaysia are investing in senior citizen villages and assisted living infrastructure such as temples, spas and golf courses to attract the wealthy older population. There are some financially well-off older adults who choose to retire in such elderly villages. However, not many can afford this kind of lifestyle.

Two cross-sectional studies from India surveyed elderly residents of old-age homes to understand their reasons for opting to live in one. It is interesting to note that poor health was not cited as a reason explicitly. The cross-sectional study in Madhya Pradesh, India reported that the top reasons for the elderly to opt for old age homes are because there was no one to look after them (68.2 percent), they did not have a place to live (56.4 percent) and to meet like-minded people (53.8 percent). The other cross-sectional study in Uttar Pradesh, India found that the two most common reasons were misbehavior by son and/or daughter-in-law (29.8 percent) and poverty (29.3 percent). This survey data hints that moving to an old age home was more a necessity than a voluntary life choice.

In addition to lifestyle changes, the surge in dementia and other health conditions among the elderly is driving the need for high quality care. Caring for such long-term conditions places huge emotional, physical and financial burdens on families. For instance, the symptoms of dementia can include hallucinations and depression which require swift and expert medical care. Many institutions are hence better able and equipped to provide timely care and rehabilitation.

Asian countries can learn a lot from studying trends in elderly residential facilities in developed nations of the Western world. A study in the UK reported that the overall standard of care in both nursing and residential homes was highly deficient when judging against quality indicators. This study serves as a warning to the rapidly aging countries in Asia: Provide adequate regulation to ensure a high standard of quality care in elderly residential facilities.

Namratha Rao recently graduated with a MSPH in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.

Technology for the Tech-Shy: Designing New Applications for Older Adults

In the digital and connected world, older adults are seemingly left behind. Tech companies continue to design products that cater to young adults, even in the generation of social media. As phone calls and snail mail are dangerously slow and outdated, why should the elderly not benefit from advances in communication? Fortunately there is a growing number of mobile and tablet applications that cater to the elderly population. These apps help to improve quality of life and communication channels with family, friends and healthcare providers.

For example, Oscar aims to enhance the lives of seniors as well as help seniors keep in touch with their family, friends or caregivers. Oscar is an easy-to-use, remotely managed communication tablet app that allows tech-shy elderly known as the ‘seniors’  to remain connected with family, friends and healthcare professionals known as the ‘juniors’. The app boasts of a simple interface which allows users to communicate via text, pictures, voice and video calls. Additionally, it provides a ‘Live View’ of the application on the elder’s tablet and allows the ‘junior’ to fix or update relevant items remotely. The technology also provides reminders, weather alerts and games. Apart from communication, Oscar is a platform for apps with the possibility of adding or removing applications depending on the user’s proficiency and interest. Keep your eyes peeled for the iOS version that is coming soon!

Photo Credit: Pixabay
Photo Credit: Pixabay

Two finance applications that target the elderly are Mint and Check. Like Oscar, both apps boast of simple interfaces which present relevant financial data in one simplified format. Both applications also provide reminders for paying bills, tracking payments, and helping with creating and managing budgets. A primary difference is that Check is only available on Apple iPads, while Mint is available on both Android and Apple operating systems.

In addition to communication and finances, healthcare is another important consideration with the elderly population. WebMD and Blood Pressure Monitor are great applications, allowing seniors to monitor and learn more about their health. Finally, there are a whole host of games apps to improve cognition and memory such as Luminosity and Elevate. Luminosity focuses on cognitive abilities, while Elevate focuses on reading, writing and mathematics. Both are fun, and we encourage everyone to check them out!

While being acutely aware that some of these apps are only accessible to people with adequate financial resources, such people can invest in mobile applications to remain connected, enlightened and lead an improved quality of life.

Seniors are part of the digital world, hence they should benefit from advances in communication than be left behind. The goal is to design products, free or cost-effective, which will improve the quality of life of older adults. It is, therefore, encouraging to see a number of companies collaborating with seniors to design great products. Since technology can also benefit this population, corporations are recognizing the value and contribution of older adults.

Oscar, Mint, WebMD, etc., have great potential to improve health outcomes among the elderly as well as provide a comfortable and healthy life. The video below shows more useful apps for the elderly.

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

Elderly Refugees: The Experiences of Cambodian populations under the Khmer Rouge

Photo Credit: Extraordinary Chambers in the Courts of Cambodia
Photo Credit: Extraordinary Chambers in the Courts of Cambodia

War, natural disaster and fear of persecution often result in the tragic displacement of people far away from their homes. These people, refugees, live in uncertainty and under significant psychological and physical stress. Among these refugees are the elderly who are a particularly vulnerable group. Aging is not limited to disease and disability, but also the sudden change and a loss of belonging. The experiences of Cambodian elderly refugee populations is a clear example.

The Khmer Rouge took over Cambodia in the 1970s, prompting several years of genocide and a mass exodus of Cambodians into Thailand, US and other countries. By 1979, there were 160,000 Cambodians in refugee camps in Thailand.

A 10 year study sought to capture the experiences of Cambodian Americans in Northern California. Most Cambodian Americans lived in run down neighborhoods with a high prevalence of criminal activity. Elderly immigrants were at high risk of occupying poor housing conditions. Despite this fact, some refugees chose to move back into inner city neighborhoods as they aged to be a part of the community they once were as recent immigrants. In the case of this refugee population, many elderly people did not want to return to Cambodia given the turmoil which influenced their flight. Of those who did, they were constantly reminded of the differences in living conditions between the two countries.

Many Cambodian refugees in the US had poor education. With low income and little to non-existent English skills, elderly refugees constantly needed support from other immigrant populations, their children, and resources from the government. One woman says, “At my age, I’ve nothing to do, but pray for my children. I know that now I am their pillar, but later when they all grow up and leave, I will be alone with only myself to rely on.”

The past experiences with the hardships of the Khmer Rouge are constantly woven into their current narratives. For instance, many elderly complain of diseases such as high blood pressure or sleeplessness, and attribute such ailments to the harsh lives under the the Khmer regime. Post-traumatic stress disorder and depression are also common among Cambodian refugees. According to one study, family-related anger is prevalent among refugee families because of the cultural gap between refugees and the general population, as well as between refugees and their children who are much better adjusted to American lifestyle.

There are many organizations working towards improving the lives of elderly immigrants. The International Rescue Committee (IRC), one of the world’s leading organizations for refugees, has an Elderly Refugee Program. This program provides English as a Second Language classes, and assists in part-time employment and obtaining citizenship.

Yet the question remains – What can be done about the sense of loss of loved ones, one’s home, country and citizenship?

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.

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.

Healthcare and Aging in the UAE

They think they are elderly and it is a normal consequence of ageing to be in bed,” says Dr Al Suwaidi.

The United Arab Emirates (UAE) is a small country in the Middle East, nestled between Saudi Arabia to the West, Oman to the East and Iran to the North. A cross-sectional study reported that 95% of its participants, all adults over the age of 65 years, rated their health as satisfactory or higher. There is a general perception of good health among the elderly. Despite this fact, the UAE has the 2nd highest incidence of diabetes in the world, and 4th highest rate of glucose intolerance in its population. Very little in known about elderly health in the UAE and even less is known about elderly health beliefs in this population.

Dubai, United Arab Emirates. Photo by Paolo Margari.

Dr. Al Suwaidi, Director of Geriatrics at Dubai Health Authority, provides insight into what elderly health could be. She suggests the norm to be a passive acceptance of poor health during aging. Religion also plays a significant role in health care seeking behavior. A recurrent theme is the idea that ‘Health is from God‘, discouraging individuals to take action for better health which can imply going against the will of God. Another factor influencing health care seeking behavior is the presence of symptoms. Good health is equated with lack of visible disease, making it less likely to seek care for silent or underlying cases such as diabetes and hypertension.

There is a high regard for elders within the family structure. Common features of the family structure include a practice of traditional values, religion and high economic resources. Understanding the role of elders within the family is essential to providing adequate geriatric care. Dr. Al Suwaidi suggests that there is a greater need for day care centres than long term nursing homes since families would not be receptive to placing their elders in old-age living facilities. This shows the importance of encouraging families and increasing geriatric care that focuses on home-based elderly care.

Geriatric care is a relatively new branch of medicine in the UAE. There is a high disparity of geriatric care provided between the seven emirates, or regions, of the country. The emirates of Umm Al Quwain and Fujairah have relatively poor geriatric care facilities. This is because different governmental bodies govern and offer different services to their respective elderly population. In addition to disparity by location, there is also disparity by citizenship. UAE has one of the world’s highest proportions of an expatriate population, accounting for close to 90% of the country’s total population. This vast majority have limited access to health insurance and social welfare programs.

Current government initiatives include the Elderly Happiness Initiative (EHI) and Weleef. EHI aims to improve the quality of life of elders living alone by providing funding for health care workers to visit and provide home-based care. Weleef is a program that imparts knowledge on best practices to health care providers on a regular basis. Both programs operate in the Emirate of Dubai and are accessible only to UAE nationals or Emiratis. In Dubai, the elderly population, constituting 0.5% of the total population, accounts for 5% of out-patient visits. In addition to improving health, revisiting the current situation of elderly health can also help defray the costs of aging. The UAE needs an inclusive geriatric care model that incorporates local ideas on elderly health. The UAE needs an inclusive geriatric care model that takes local models of elderly health into account

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.

Australia: Integrating Mental Health Services at the Primary Care Level

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

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. 

Why China Needs More Skilled Health Workers for the Aging Population

China’s workforce is aging. Of special relevance here, and a pressing issue for the country, is the aging of its healthcare workforce. These include China’s barefoot doctors who are rapidly aging. Barefoot doctors are farmers who receive basic and minimal medical training and work as health care providers in the rural areas of China.

Xu et al.
highlights three main implications of aging barefoot doctors. The first implication is a high risk of healthcare workforce shortage in the immediate future, leaving many rural residents without basic healthcare. This will create a huge burden on China’s healthcare system, hindering any plans for health reform. The second implication is that aging barefoot doctors currently have lower education levels, are less susceptible to change and technology and lack the formal training of younger counterparts, which might deter rural residents to seek care from them. The third implication is that the very same characteristics of aging barefoot doctors can lead to poor treatment and provision of facilities, especially for non-communicable diseases. While data on urban health care providers and other types of health personnel such as nurses is scarce, the general trend toward a graying population in China tends to suggest that these types of workforce are also aging.

China has one of the highest proportion of aging population at over 9%. At the current rate, this proportion is expected to increase to 25% by 2050. The aging population is a result of population control strategies in the 1970s and 80s as the government promoted the “later, longer, fewer” lifestyle. Moreover, the government instated the controversial one-child policy which restricted families to having only one child. There are several consequences and impacts of an aging population that require a focus on chronic, non-communicable diseases. Close to two-thirds (60%) of the disease burden in China is non-communicable diseases such as cardiovascular diseases and diabetes, among those of 45 years and older.

The healthcare industry is not alone in facing an aging workforce. The increasing age of the workforce decreases productivity, while raising the average wage level. On a global level, this will make a dent in China’s manufacturing might and other labor-intensive industries, threatening the country’s economic growth rate. At the current rate, India and Indonesia are poised to overtake China in terms of economic growth by 2020. The trends are also seen in the Chinese migrant workforce, a population of about 245 million migrant workers at the end of 2013. The average age increased from 33.1 years in 2011 to 33.7 years in 2013.

However, the situation is not all bleak. An aging population provides great potential for a booming healthcare industry that needs to account for chronic diseases as well as elderly living options due to rapid urbanization and changing family dynamics. There is documented need and much scope for growth in China’s healthcare industry, particularly catering toward the elderly. However, the needs for the younger generations who may be facing lack of adequate healthcare should not be ignored.

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.