Aging population: Prosperity or disaster?

By Rita A. Widiadana

KUTA, Bali (JP): What would happen if the Indonesian population were dominated by senior citizens? According to a noted medical professor, it could be a sign either of prosperity or human disaster.

University of Indonesia professor of urology Djoko Rahardjo has said that Indonesia and other countries in Southeast Asia are currently facing serious problems in dealing with the rocketing numbers of their graying population.

"Indonesia faces the greatest risk, with a 414 percent annual increase in the total of its aging population," the professor told participants at the three-day International meeting of the Federation of ASEAN Urological Associations at Discovery Kartika Plaza hotel in Kuta.

The annual meeting, which ended on Sept. 1, was attended by more than 300 urologists from Indonesia, ASEAN countries, Australia, Austria, Britain, Ireland, the United States and the Netherlands. The meeting discussed various urological problems, such as kidney-related diseases, prostate cancer, bladder cancer, male and female infertility, female and male sexual dysfunction and issues relating to geriatrics (the aging of the population).

Rahardjo said Indonesia is now in danger because the country is not yet ready to properly accommodate an aging population.

"We have frequently warned the government to start preparing all the necessary facilities, otherwise it could become a huge burden, both for the government as well as society in general," Djoko said.

Recent advances in medical technology and socioeconomic conditions have raised the life expectancy of Indonesians from around 65 years to between 70 years and 80 years of age.

"Socially, Indonesia has not yet developed adequate infrastructure to help the aging male population continue productive lives," the expert said.

The retirement age of local workers both in government and private institutions is set at between 55 years and 65 years of age.

"What will happen to 66-year-olds who are still healthy and active? Should they stay at home, doing nothing?" he asked.

Some companies, private ones in particular, still employ these senior workers. But in many government agencies, thousands of fresh candidates desperately hope that these old officials will quit their jobs.

Tan Hui Meng, a urologist at Subang Jaya Medical Center in Malaysia said that in his country the number of elderly (aged above 65) would increase over the next 25 years by 82 percent, whereas the new-born population will rise by only three percent and the working-age population by 46 percent.

The United Nations projects that by 2050, the proportion of people above 60 will exceed for the first time the proportion of children below 15, and 13 countries will have proportions greater than 10 percent of the most elderly (aged above 80) in their population.

Southeast Asia will not be spared from this phenomenon.

The aging world, particularly in Asia, where the majority of the countries are still in the developing stage, is heading toward a bleak future if prompt measures and advice are not heeded or implemented immediately on both national and international levels.

Besides demographic problems, Asia also has to meet the challenges of rapid urbanization, lack of natural resources and degradation of the environment and ecosystem.

"The aging population is an important resource to society and it is vital to sustain the productivity of this segment of the population in many of the rapidly aging Asian nations," said Hui Meng.

Male problems

However, he admitted that in most of the Asian countries, it is quite difficult to deal with, in particular, the problems of aging males.

"Due to biological differences and socially constructed roles of males throughout their lives, aging males require a gender- specific approach to deal with their associated problems," the doctor commented.

Professor Djoko had a similar view. Indonesia and most Asian countries informally adopt a patriarchal family system in which male members are socially and culturally placed in higher positions compared with their female counterparts, he explained.

When a man reaches retiring age, he may lose his job as well as suffer from a deteriorating physical condition, which can lead to various emotional problems, he said.

"The majority of men associate work and health with power. If they are jobless and sick, they will feel powerless and useless," the professor said.

Physically, aging males may suffer from various geriatric diseases such as heart-related problems, prostate cancer, genitorurinary-oncological diseases, erectile dysfunction and incontinence.

"Aging males also face the andropause period, which is similar to the menopausal period for elderly women," Djoko said.

Medical attention to aging females, however, is already well- established, such as the development of hormone replacement therapy, which is now recognized as slowing the progression of diseases.

The aging process in men may cause detrimental effects on bone, muscle, body composition, sexual function and psychological well-being.

A recent cross-sectional study conducted on male visitors at Cipto Mangunkusumo hospital in Jakarta showed that out of 501 respondents between 40 years and 90 years of age, 71 percent had symptoms of andropause -- categorized as mild (39 percent), moderate (27.5 percent) and severe (4.6 percent).

The study found a high prevalence of andropause in Indonesian aging males, with 40 years of age as the cut-off point. More objective studies, with measurements of testosterone and other risk factors, are currently under way.

"It is hard for men to accept the dismaying reality that they are aging and the potency of their physical (mostly sexual) organs has started to lessen. Worst of all, most of them are reluctant or are probably too embarrassed to seek professional help," said the professor, adding that overall, men's preventive healthcare is generally neglected.

He warned the government to provide medical facilities for elderly males and to encourage them to receive proper medical attention. "If the majority of these senior people are sick, it will be burdensome to their families, society and the government too," Djoko said.

Medical intervention for elderly males is urgently needed. It could include hormonal replacement therapy, which may be necessary to alleviate problems, prevent disability and improve the quality of life of aging males.

"The problem is whether the government and society are ready to provide the necessary facilities and proper places for aging men," he said.