The condition of the elderly today: common problems and assistance projects

Getting older is not always easy and it has become even less so in the time of COVID-19. But what exactly marks the age when a person becomes elderly? How many senior citizens are there in Italy today? What are the main issues linked to old age and which services and projects can help overcome them?Who is considered “elderly”? What we mean by “elderly” is a concept that cannot be defined in absolute terms, as it has different meanings across societies and historical time periods. It is often associated with becoming grandparents, with retirement or a reduction in employment. However, while the United Nations refer to those aged 60 and over as “older persons”, ISTAT and the Ministry of Health talk about people over 65. In 2018, however, during the National Congress of the Italian Society of Gerontology and Geriatrics (SIGG - Congresso Nazionale della Società Italiana di Gerontologia e Geriatria), an adjustment to 75 years was proposed. Given increased average life expectancy at birth (85 for women, 82 for men in Italy), SIGG argues for a distinction among people over 65, between those in the so-called third age (characterised by good health, social inclusion and access to resources) and those in the fourth (marked by dependency on others and physical decline). In essence, this proposal aims to update the concept of old age by making it more dynamic and raising it by 10 years. Why? “A 65-year-old today has the same physical and cognitive fitness as a 40- or 45-year-old did 30 years ago, while a 75-year-old today is like someone who was 55 in 1980. We should raise the level of old age to a threshold that is more appropriate to real life expectancy in countries of advanced development”. How many senior citizens are there in Italy today? According to ISTAT data, there were 13,946,954 people aged 65 and over living in Italy (residents only) at the start of 2020. This is more than 23% of the country’s entire population. Italy’s age index in 2020 was 179: this means there were more than 178 elderly people for every 100 children. This statistic confirms an overall improvement in residents’ health on one hand, but creates new socioeconomic and healthcare-related problems on the other. These are issues that should be addressed considering the elderly not simply as a cost, but as a resource.The social importance of the elderly According to the ISTAT Annual Country Report for 2020 (Rapporto Annuale 2020. La situazione del Paese dell’Istat), presented on 3 July 2020, the increase in the older population is both a burden and a resource. “A burden because of the implications of age-related illnesses, in terms of need for assistance; and a resource because older people are an excellent support system for families, whom they often provide with childcare help, while their pensions create intergenerational redistribution of monetary resources in cases of unemployment or job loss in the younger generations, thereby countering the risk of poverty, especially in the regions of southern Italy.” Data relative to the 2016-2019 period collected by PASSI d’Argento, a system that surveys the elderly population coordinated by the Italian National Institute of Health (ISS - Istituto Superiore di Sanità), suggest that almost one in three elderly people (29%) is a resource for their family members or the wider community; 19% take care of partners, 14% take care of non-cohabiting family members or friends, and 5% participate in voluntary work. The ability or desire to be a resource for others is more common in women (32% compared to 24% of men) and drops notably with increasing age (from 37% of people aged 65-74 to just 9% of those over 85); it is less frequent in people with lower levels of education and those experiencing economic difficulty. Paid employment is fairly rare (6%) and the prerogative of people with a higher level of education who are resident in the center and north of the country. According to the ISTAT study on active aging and conditions for the elderly in Italy, more than one in 4 people (26.8%) report providing assistance to children and grandchildren and 13.2% to non-cohabiting adults.The problems of the elderly The unstoppable advance of age, now extended thanks to medicine and an average improvement in the quality of life, brings an inevitable decline in health, even if the most insidious problems are often not physical. Physical problems Over 14 million people in Italy live with chronic disease; of these, 8.4 million are over 65. More than half the population aged between 65 and 75 has one or more chronic illnesses, a quota that increases with age to 3 out of 4 people aged 85 and over. This was the setting for the spread of the SARS-Cov-2 epidemic: in Italy, the death rates increase with age and appear somehow to be associated with the presence of chronic disease, which explains why the over-65 population was the most affected, especially in confined areas such as care homes. Psychological problems The most hidden problems, which have important repercussions on the physical front, are psychological, linked to loneliness and the lack of a sense of purpose. In the past, the elderly played an important role in family life and society but relationships within present-day family units, i.e. those composed of parents and children alone, risk becoming more sporadic: after the death of a spouse in particular, there is a danger of becoming isolated from children, grandchildren and younger family members, especially when families are scattered across different cities. This can cause a loss of social and emotional standing. PASSI d’Argento data for 2016-2019 estimate that about 2 in 10 people aged 65 and over live in social isolation: in particular, 20% of the elderly population reports having no contact (not even on the telephone) with other people during an ordinary week, while 70% does not participate in social gatherings in places like recreational centers, clubs, parishes, political party headquarters or association offices. Solitude and social isolation are closely related to feelings of vulnerability and anxiety, which can lead to depression and a serious decline in physical health. Depression Depression is a bona-fide illness to which the elderly are particularly prone: living alone, infrequent social contact, health problems, loss of autonomy and/or of a loved one are all events associated with this stage in life and with this psychological disorder. PASSI d’Argento estimates that approximately 13 in 100 people over the age of 65 suffer the symptoms of depression. The link with physical health is very strong: people with these symptoms reported poor physical health for an average of 15 days in the last month (compared to 2 days in people with no symptoms of depression) and limitations in their daily habits for about 12 days (compared to less than 1 day in people with no symptoms of depression). Symptoms of depression become more frequent: with advancing age (reaching 22% after age 85); in the female population (17% compared to 9% in men); in groups that are socially disadvantaged through economic hardship (31% in those who report great economic hardship compared to 8% who do not); in groups that are socially disadvantaged through lower education levels (17% in those who completed primary school at the most, compared to 8% of university graduates); in those living alone (16% compared to 12%). A significant share of people with symptoms of depression do not seek help (26%), those who do turn to family members/friends (23%) or doctors/health professionals (17%) and in most cases (34%) to both. One of the most serious problems is that the condition is often underestimated and goes undiagnosed in the majority of cases: one suicide in three in Italy is an elderly person. Symptoms of depression, furthermore, worsen the progression and complicate the treatment of chronic disease, which in turn leads to an increase in medical appointments and emergency room visits, in the consumption of medicines and the length of hospital stays.Services and projects for the elderly While there are numerous services and projects for the elderly, even if unevenly distributed across the country, those which offer distance support or support for the difficulties caused by the limitations imposed by the pandemic appear to be the most significant today. PASSI d’Argento (Progressi delle Aziende Sanitarie per la Salute in Italia) is a surveillance system that monitors the health of the population over 65. Following the establishment of PASSI (which began in 2006 and targets the entire adult population), Passi d’Argento (which means “Silver Steps”) was tested for the first time in 2009 and rolled out continuously from 2016, gathering data from all the Regions and Autonomous Provinces with the exception of Lombardy and Val d’Aosta (excluding, however, the institutionalized elderly, in hospitals, residential long-stay care homes, nursing homes or hospices). This is a National Health System tool which is coordinated by Italy’s National Institute of Health (Istituto Superiore di Sanità) and carried out by the Local Health Authority offices and Regions, to measure the three pillars identified in the World Health Organization’s “Active Ageing” strategy: health, participation and safety. A more informed idea of the quality of life, social inequalities in health and safeguarding and assistance needs will help in guiding preventative actions and in evaluating their efficacy over time. “Viva gli Anziani!” (“Long live the Elderly!”) is a project we support in partnership with the Comunità di Sant’Egidio: it provides home help and active monitoring, support and training initiatives for people taking care of elderly relatives, and promotes new structural solutions such as cohousing. The project works to make sure that elderly people do not lose their homes, even in situations of economic or logistical difficulty, and, in particular, so that they don’t feel alone. During the Covid-19 emergency, our Group earmarked further funding ( €2 million for a total of 5 different initiatives) to support the elderly with services to provide assistance at home and take care of daily needs (food shopping and meal delivery, medical prescriptions and medicine, distribution of basic necessities, transport and accompaniment services for urgent and unavoidable medical appointments) to limit the times they have to leave their homes. Then there are the incredible 1,402,755 volunteer hours, provided by the almost 7,000 Auser volunteers during the Covid-19 emergency: these included home visits to deliver food, medicine and meals, plus protected transport for cancer patients, dialysis patients and those with other illnesses requiring urgent attention and following therapy cycles. And most of all, a great amount of telephone support to provide company and reassurance to elderly people who are lonely. Time banks assist people in the reciprocal exchange of activities, services and skills: for example, an elderly person could tutor students or look after a pet in exchange for someone who does their shopping or keeps them company. Keeping active and learning is possible at every age: folk schools for popular education, universities for the elderly and courses of any type can help senior citizens keep mentally active, make new friends and build a social network. SIGG (Società Italiana di Gerontologia e Geriatria) has translated a booklet of simple exercises to do at home, especially important at a time like this. Keeping physically healthy can also help the mind.