Aging population: Prosperity or disaster?

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.