BY GLORIA LANGAT
October 1, 2024, marked the 34th commemoration of the United Nations International Day of Older Persons (IDOP), a day dedicated to raising awareness, celebrating older persons, and highlighting opportunities and challenges associated with ageing.
The theme for 2024 is ‘Ageing with Dignity: The Importance of Strengthening Care and Support Systems for Older Persons Worldwide.’ Having age-related physical and cognitive impairments and difficulties performing typical day-to-day activities can significantly impact the quality of life and, thus, affect the ability to age with dignity.
Such issues include the gradual decline in functionality and ability to perform daily activities, generally referred to as functional limitation(s). The onset of the decline and the number of functions affected varies from one individual to another and across population sub-groups due to various factors such as poverty, disadvantages across the life course, or the environment we live in.
This is especially true if social and health structures and support systems are insufficient or are entirely missing to help affected people cope with living with impairment. To age with dignity under such conditions becomes increasingly more challenging, especially for the poor in society.
Analysis conducted in 2024 by researchers from the African Population and Health Research Center (APHRC) shows that people aged 50 years and above in West Africa fare better in terms of functionality than those of the same age in the East African region.
In Kenya, data shows that more than half (56%) of the population aged 50 years and above have some form of functional limitations, compared to 33% in Nigeria and 30% in Senegal.
The most commonly reported functional limitations are sight and mobility, followed by concentration (cognitive abilities). Within Kenya, low socioeconomic status is significantly associated with having functional limitations.
While the population in the richer and richest wealth quantiles report fewer functional limitations, those of the same age in the poorer and poorest wealth quintiles report significantly higher limitations. In the Kenyan context, there is a significant disparity across counties.
Homabay (87%), Migori (82%), and Siaya (73%) counties report the highest proportion of functional limitations, whereas Taita Taveta (29%), Kilifi (37%), and Nairobi (37%) counties report the lowest proportion as shown below. However, the numbers differ between the rich and poor in these Kenyan counties.
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How was Functionality Measured?
The data comes from the 2022 Kenya Demographic and Health Survey.
The most assessed age-related functionality indicators in population surveys and censuses are vision, hearing, mobility, cognitive function, and ability to self-care.
For the first time, functional impairment data is collected in a nationally representative survey following the introduction of the Washington Group Short Set on Functioning (WG-SS) in the Demographic and Health Surveys (DHS).
Participants in the survey were asked to share information on whether they have difficulties with (i) seeing, (ii) hearing, (iii) walking or climbing stairs, (iv) remembering or concentrating, (v) self-care, and (vi) communication.
The rating for each question was whether they had no difficulty, some difficulty, a lot of difficulty, or could not perform each of these six domains. Subsequent surveys will be helpful to show trends over time and if there are any cohort differences.
Why it Matters to Address Functional Limitations Among Older People
In 2024, the population aged 50 years and older in Kenya is estimated to be around six million.
This figure is projected to reach nine million over the next ten years, representing a 50% increase. The increase in life expectancy at birth from 59 years in 1980 to 64 years reflects a reduction in contagious or infectious diseases, which previously caused a higher disease burden and mortality at younger ages.
Although an increase in life expectancy is to be celebrated, a large majority of older people in Africa spend a better part of old age with poor health and functional impairment.
While ageing is associated with gradual losses in functionality due to biological changes, prolonged exposure to behavioural, social, and environmental risk factors accelerates the onset and trajectory of these functional impairments.
When these risk factors are addressed early, their onset and impacts can be delayed, thus contributing to improved quality of life. Functional limitations impact the quality of life and have social and financial consequences on the individual and society.
The healthcare costs to manage and address functional impairments are huge; similarly, having an impairment, if not addressed, hinders the ability of the person to participate in livelihood activities. Living with impairment can be isolating if the environment is not conducive to enabling older persons with functional limitations to operate, leading to disengagement from social activities and loneliness.
What Needs to be Done?
Outside of the African continent, several countries have seen a decline in the prevalence and early onset of functional limitations among older people due to improvements in medical services, access to appropriate healthcare, and management of risk factors, particularly for debilitating diseases.
In Kenya, improved medical technologies and better access to healthcare can reduce the impact of functional limitations and the negative consequences associated with loss of functionality. Functional impairment can be a risk factor for various diseases and a symptom of underlying disease.
However, modifying behavioural risk factors and medical interventions can offset the onset of loss of functionality and slow the rate of decline or progression.
Persons with severe functional limitations require long-term care to manage and adapt to their limitations. Kenya needs to strengthen its long-term care systems for older people to allow them an opportunity to age with dignity. In addition, interventions to improve the social, health, and environmental determinants of functional limitations across the life course are essential to enable ageing in dignity. APHRC has been building long-term, trust-based strategic collaborations with various partners to address research gaps in ageing.
As the world commemorates the 34th anniversary of the IDOP, it is essential to reaffirm the commitment to strengthening the care and support systems for older persons in a rapidly changing world, especially as the world approaches the midway point of the UN Decade of Healthy Aging (2021-2030). We call on policymakers to prioritize an integrated continuum of care that delivers person-centred, affordable, and accessible care. In addition, all systems need accountability to integrate health and social care for older people and their caregivers to ensure long-term, equitable, and sustainable care.
Gloria Langat, Research Scientist, Aging and Development Unit, William Mawia, Communications Manager, Visibility Unit, and Erick Muhuyi, Intern, Aging and Development Unit of the African Population and Health Research Center (APHRC).