Many adults eagerly look forward to their “Golden Years” and one of the key features of this period is retirement. It is easy to imagine golf courses, beaches and time to catch up on reading lists. In reality, many older adults continue to work after age 65. The entirety of South America is undergoing a demographic shift due to an aging population. Thus, many countries are re-examining their existing government pension systems. While it is important to provide economic security in old age, it is also crucial to allow continued avenues of employment and meaningful engagement with society for older adults.
The quality of life in retirement is dependent on the financial resources of the individual. Adults aged 65 and over generally have income from four sources including government funded pensions, private pensions from employers, savings and employment. In the United States, adults with higher education and income potential will often remain in the workforce past age 65. In contrast, adults with lower income levels in low- and middle-income countries remain employed past age 65 to stay out of poverty.
There is a huge variability in percent of the aging population that is working in Latin America. Some Latin American countries, such as Brazil, Argentina and Columbia, have relatively low participation of older adults in the workforce. Such countries are similar to the United States, with only 10-15% of adults past age 65 engaged in paid work. In other countries, such as Peru, Paraguay and Ecuador, 40-50% of adults age 65 and older are still participating in paid work. These countries also have relatively low coverage levels by government and private pension plans, but the correlation between working and government funded pensions is not perfect.
Many countries in South America are re-examining government pension programs to accommodate the aging population. Recent reforms in Paraguay have instituted new rules that prevent individuals collecting government pensions from participating in paid work. Better pension systems may provide more security for older adults, but preventing work has problematic implications for the future role of older adults in society. Social engagement is correlated with improved health and employment can be a meaningful avenue of engagement.
Building strong government and private pensions that will allow a retirement free from financial hardships or poverty is important. However, building systems that prevent older adults from working is equally problematic. Older adults in countries with strong pension systems, such as the United States and Britain, are fighting to re-enter the workforce and be productively engaged in society. It is important that South American countries do not build a pension system that prevents older adults from contributing paid work to the economy.
Grace Mandel is a Masters of Public Health student in Health Policy and Systems at Johns Hopkins University Bloomberg School of Public Health.
In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 2 in this series. Part 1 focused on the aquatic therapy marketplace. Click here to read Part 3.
Over the last thirty years, the field of aquatic therapy has steadily grown in US allied healthcare. Insurance companies that reimburse for aquatic therapy ONLY reimburse for a licensed physical therapist or maybe a physical therapy assistant. Depending on the state, there are some workarounds like a certified instructor being employed by a physical therapy practice or hospital. All too often, though, the employers err on the side of legal caution, fearful of liabilities which may be inherent in land-based physical therapy but seem almost non-existent in aquatic therapy.
Out of respect for those licensed in physical therapy, Aquatic Therapy Rehab Institute (ATRI) certified instructors, who do not have a degree and license in physical therapy, are discouraged from calling themselves “aquatic therapists”. Physical therapists, however, are not required to have aquatic certification to bill for aquatic therapy. So, if you are in need of aquatic therapy, perhaps as pre-operative conditioning or after your insurance allowable coverage for physical therapy has been exhausted, what can you look for in an aquatic professional?
Many reputable organizations either post or offer access to staff biographies. Like they do in the physician offices, those practicing aquatic therapy should specifically display their credentials. A certificate, license or degree from a bona fide organization can be a first tier requirement. Certifications usually require professionals to obtain continuing education hours to maintain credentials. This must be done every two years or less, and professionals should display the one that is relatively current.
Certifications from organizations like ATRI, Aquatic Exercise Association (AEA) and Aquatic Therapy University (ATU) may give an indication that your practitioner has met certain stringent requirements to authenticate their expertise. ATU has more recently been established specifically to target degreed professionals in both physical and occupational therapy. In some instances, even speech pathologists are obtaining certifications as evidence is now emerging on warm water activities. The soothing effects of such activities can advance progress in remediating stroke, traumatic brain injury (TBI) deficits or other speech pathologies, including some oral cancers.
Across all three certifying organizations, a broad and sometimes intensive proficiency needs to be demonstrated. This includes sufficiently answering test questions governing anatomy, physiology, kinetics and some physics as it pertains to water properties, as well as skill demonstration, especially when performing physical manipulations in the water.
Even when a licensed physical therapist is practicing aquatic therapy, it is important to know what additional training and credentials the aquatic professional may have by a certifying organization. All the knowledge of anatomy, physiology and kinesiology may not be as helpful if the practitioner has not spent a significant amount of time in water experiencing how the body works differently on land and in waist or shoulder deep water. It is more important that the aquatic practitioner have a deep understanding of how the properties of the water can be used to best achieve the functional goals or milestones of the participant.
Thus, beyond finding credentials, seeing is believing. Take time to observe your aquatic practitioner and ask permission to observe – perhaps make a video with your cell phone or take notes. Compare one practitioner to another or better yet several others! Look to find many of the following qualities:
Clearly defined milestones and functional goals/expectations of outcome;
Workload progression that supports goals: meaning variances in
time to accomplish an exercise;
range of motion;
effort or exertion;
depth of water used;
length of extremity in activating a particular joint;
exercises performed where extremities are operating in different depths;
exercises performed where extremities are operating in different planes;
use of equipment such as drag and buoyancy equipment;
breath cueing and control (when to inhale and exhale; diaphragmatic breath);
Attentive observation of and note-taking about the patient (some PTs bring their laptops poolside and pay more attention to their computer than their client);
Apparent knowledge of how to make modifications of exercises to insure progress without pain or injury;
Cheerful disposition and encouragement based upon progress toward goals.
With all or most of these objectives meeting your approval, ask to speak with the professional and ask for referrals. In some cases, aquatic practitioners are award winners in their fields. They may have published research articles or been written up in a local paper or support group newsletter. Be sure to contact references and add their comments to your observation notes. It is best to have a conversation with a prospective aquatic specialist to make sure you communicate easily and understand their instructions. Sometimes, communication disconnects can derail the most qualified professional’s efforts to guide you toward your functional goals.
This kind of upfront investment in your self care may prove the best return for not just your dollar, but more importantly your well-being. After all, your health is your greatest wealth!
Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.
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.
As many already know, Japan has the largest population of people over 65 in the world at 25 percent in 2013. Since the Japanese are known for their longevity, this number may seem like an isolated phenomenon but the rest of the world is catching up. Almost every major country went through a birthing boom after World War II and people are starting to wonder how they are going to take care of the large number of elderly citizens. Italy already has a 65 and over population at 21 percent and by 2050, Americans aged 65 and above are expected to make up at least 21 percent of the population. As soon as 2025, the U.S. spending on Medicare, Social Security, and Medicaid is projected to double, which means there will be yet more strain on state and federal budgets.
If that is not food for thought, birth rates in Japan are at an all-time low. With decreased birth rates, there will be a hole in the future workforce when it comes time to take care of the elderly. Japan owns the second largest amount of U.S. debt, and with two economies so intimately connected, both can decline at the same time. The Japanese media has begun dubbing the citizenry’s lack of interest in the opposite sex as “celibacy syndrome.” While choosing a lifestyle outside of traditional marriage is a personal decision, so many people making this choice will eventually cause an economic downturn when it comes to needing resources for the elderly. Fewer babies were born in 2012 than any other year on Japanese record and not so funnily, adult diapers outsold baby diapers.
In Italy, there is a similar picture, not in terms of birth rates, but in terms of young adult employment. Unemployment is at a staggering 44.2 percent for people ages 15 to 24. An alarming statistic by itself, it is compounded by the fact that Italian pensions take up 15.6 percent of the country’s Gross Domestic Product. This rate is the highest in all of Europe and with jobs so scarce, young Italians are either moving abroad with their college degrees or have given up the job search entirely. Even those who are lucky enough to find jobs are not faring much better. The average salary for a person born post-1980s is a mere $1,375 a month, making it nearly impossible to afford home payments, car payments, and child payments. In addition, people are living in their parents’ homes longer and using their parents’ money as well. This postpones starting a family of one’s own and prevents the older generation from saving for retirement. With smaller retirement savings, older people are staying in jobs longer.
The only economies with less growth than Italy’s since 2001 are Haiti and Zimbabwe. Italy has the oldest working population out of any European nation and when that population retires, it puts enormous strain on the government because their tax base is exceedingly diminished with so many young people unemployed.
Jacob Edward is the Manager of Prime Medical Alert and Senior Planning in Phoenix, Arizona, USA. Jacob founded both companies in 2007 and has helped many Arizona seniors and their families navigate the process of long-term care planning. Senior Planning provides assistance to seniors and people with disabilities in finding and arranging assisted living in Phoenix, as well as applying for state and federal benefits.
As the American population continues to age, there is an opportunity and a need to adequately respond to the unique needs of older adults. Ensuring a social structure that considers the needs of the aging is important, particularly as it is projected that by 2030, the number of Americans 65 and older will double and comprise nearly 20% of the total population. Comprehensively responding to the needs of the aging should include measures that protect the health, well being, and quality of life of older adults.
There are benefits to older adults remaining in the workforce – both individually and occupationally. It has been noted that among older adults who remain employed, their cognitive capacity is less likely to diminish as compared to their non-employed peers due to mental engagement within the workplace. Additionally, research has shown that employers value the presence, contribution, and input of older workers and report that older employees exhibit knowledge related to job tasks, respond resiliently to job-related stressors and changes, and are willing to learn new tasks quickly. Added financial resources are also a significant benefit for older Americans who remain employed beyond retirement age.
Recent economic crises, however, have left few immune to financial loss. For older adults, financial loss as a result of the “Great Recession” have led to this need to continue working and raise enough money on which to live after retirement. For older adults who lost their jobs during the recent economic downturn, many reported that they continued searching for employment with little luck due to hiring preferences in many industries for younger employees. This represents a persistent area of vulnerability for the aging, as financial uncertainty after retirement remains a reality for many.
Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.