How communities can step up to provide long-term care for the world’s ageing population

All over the world, people are leading longer lives. This increased life expectancy is one of the great success stories of human development.

Advancements in medical sciences and public health services, socio-economic development, and rising literacy levels have all contributed to prevention, disease control, and management, which in turn has reduced premature mortality.

Declining fertility has also led to an increase in the number of older people in many countries. In 2019, the 65+ age group outnumbered children younger than five for the first time in human history. The proportion of the world's population aged over 60 years old is predicted to nearly double between 2015 and 2050, from 12% to 22%.

While the increase in the number and proportion of older persons is visible across all regions of the world, this demographic change may not be entirely uniform. In more developed regions, for example, the share of older people will increase from 26% in 2022 to 34% in 2050. In less developed regions, on the other hand, this age group will increase from 11.5% to 20% during the same period. It is also estimated that by 2050, 80% of older people will live in low- and middle-income countries.

Living for longer allows older people to constructively contribute to human development, acting as a knowledge resource for families and communities. However, older people tend to have a higher prevalence of chronic diseases, physical disabilities, mental illnesses and other co-morbidities. They are also disproportionately impacted by the double burden of disease – the coexistence of communicable and non-communicable diseases, particularly in resource-strained settings.

Further, supporting an ageing population tends to be more challenging in resource-strained settings. Taking on the care needs of an ageing population may jeopardise some countries’ already overburdened healthcare systems.

So, a more robust, integrated and cost-efficient healthcare system is needed to support the older members of our communities, with services focused on the vulnerabilities linked to ageing.

To age healthily, older people may need long-term care services to meet their daily needs, maintain functional ability and improve their overall well-being. Long-term care encompasses a broad range of personal, social, and medical services and support that ensure people with, or at risk of, a significant loss of intrinsic capacity can live consistent with their basic rights and human dignity.

Long-term care can be provided informally by family members or relatives, or formally via trained caregivers at home or in institutional settings. Regardless of how it happens, however, all forms of long-term care must form part of a continuum of services that delivers person-centred care.

Institutional long-term care can support people with terminal illnesses or no family support. However, community-based long-term care can help a larger segment of older people with manageable medical conditions and with available family support.

Community-based long-term care is led by local groups or organizations that are ideally placed to fully adapt to local contexts and ensure community ownership and sustainability. But there are several reasons it hasn't received enough attention, and remains under-utilized within healthy ageing programmes around the world.

Although it’s generally more cost-effective than institutional care, little attention has been given to community-based long-term care financing. This makes it difficult for such programmes to scale up and serve more people. Data and evidence about community-based long-term care are also very limited, again preventing the replication or scaling up of successful programmes.

The lack of understanding and knowledge about how these services work has also led to limited capacity and skills development among service providers.

GRAVIS, an India-based non-profit, focuses on supporting healthy ageing in remote rural areas. It has organised a holistic community-based long-term care programme that has benefitted nearly 250,000 people.

This programme uses a multi-pronged approach to community-based long-term care. The first component focuses on educating communities on health needs, self-care and preventative care. Another part involves developing local cadres by training family caregivers, formal health workers and peer educators. The third component is meeting people’s diagnostic, curative and referral needs by providing outreach medical services in remote areas.

All three components are interconnected and further integrated with other GRAVIS schemes on food and water security. Our advocacy and research on community-based long-term care also generate evidence for replicating and scaling up successful programmes.

Community-based long-term care can address the unmet needs of older people around the world, even as this population segment continues to grow. In addition to being more cost-effective, care provided by families and the community is more likely to be based on bonding and empathy, creating a more person-centred approach. This means older people receiving community-based long-term care are also less likely to be lonely or isolated, further boosting their mental health and overall well-being.

An ageing society means we need more research and investment into how to create successful community-based long-term care programmes. This will help us to protect the health, well-being and dignity of older generations, while continuing to benefit from their skills and experience.