Lecture 11: Liveable Cities for elderly

Question 1

Explain about the elderly

Answer 1

• The elderly represent one of most rapidly increasing grp in society & majority live in cities
• UN Def n of elderly generally refer to ppl aged 65 yrs or older

Question 2

How is world’s pop n of elderly changing?

Answer 2

According to UN’s World Social Report 2023,
- growing at fastest ever rate, abt 761 million as of 2021
- expected increase > twice by 2050, to 1.6 billion, >16% of total global pop n
=> 1/6 ppl in world will b elderly (silver tsunami = silver cities)

Question 3

What are 2 primary reasons for ageing pop n in cities?

Answer 3

• Declining fertility rate
• Increase in life expectancy

Question 4

What are issues faced by elderly in urban cities?

Answer 4

1. Econ well-being
   - financial needs to support oneself (to retire, age gracefully)
   - (socio-econ) accessibility/affordability to medical care
2. Social well-being
   - social segragat n/exclus n, loneliness in cities
   - physical environ, transport mobility
3. Psycholo well-being
   - dealing w depress n at old age
   - need for security (overcome fear, crime in city)

Question 5

Explain economic issues of elderly

Answer 5

financial needs to support oneself (to retire, age gracefully)
- need regular income to pay for daily needs
- btr to hv pension, or allowance fr children, otherwise must seek re-employmt (for menial tasks eg guard, cleaner)
- many feel need continuous savings
- thus, many elderly are poor
eg In SG, poverty rate among working elderly rose fr 13% in 1995 to 41% in 2011
fr Manpwr Ministry figures, 23% of ppl in 2016 above 65 y/o in formal workforce earn < $1000, which is lower than 57% in 2003, shd indicate rising earnings
BUT, rising cost of living may not b offset by marginal % increase in earning
- so if elderly cnt make ends meet, urban liveability is worsened

Question 6

Explain socio-economic issues of elderly

Answer 6

accessibility/affordability to medical care
- lack of phy/econ access to medical care plagues elderly in cities in world
- hc can b for phy, bodily ailment but must oso b for psycholo ailments eg depress n
- loneliness can cause depress n in elderly, so hc must b equipped to deal w this need
- elderly w finance issue r embarrassed, reluctant to seek medical help
eg In SG, hc system may not hv capacity to deal w ageing pop n. Ministry of Health report now 58 000 staff (nurses, support care staff), which must grow to 82 000 by 2030 to operate hospitals, clinics, eldercare centres (to include more health, community care svc) to support projected increase in no of elderly bcos by 2030, 1/4 S’porean will b 65 y/o & above

Question 7

Explain social issues of elderly

Answer 7

1. social segragat n/exclus n, loneliness in cities
   - elderly hv strong need for social interact n
   - family is impt source of emotional support
   eg
   Fr SG General Household Survey in 2016
   41200 elderly currently live alone (projected reach 83000 by 2030)
   => spatial exclus n of elderly (physical, mental)
   - spatial exclus n:
   physical - exclude elderly eg isolate them w language barrier (dialect vs english in cities)
   mental - eldelry may feel not belonged in cities as fac, amenities look ‘young’
   => discourage elderly fr explore far fr familar home, neighbourhood
   - spatial exclus n
   idea that elderly oni belong to particular place
   eg retirement home (but not all can afford), older low rent high density housing in inner cities
   => limit social interact n, isolate elderly fr majority of pop n
2. physical environ & transport mobility
   - elderly need accessible svc eg food (markets, hawker centre), hc (polyclinics, hospitals), jobs, leisure (parks, green spaces to foster community activities)
   - SG govt try make more elderly friendly environ by upgrade lift, build ramp, ensure there r day activity centre, fitness corner, parks, etc.
   - oso need to dvlop elderly friendly public transport network (easy access, navigate, comfortable, affordable) help keep elderly active, reduce social isolat n, prevent social exclus n & help keep job
3. rising need to protect elderly fr scam
   - need to educate elderly to be digitally vigilant

Question 8

Explain psychological issues of elderly

Answer 8

• how elderly perceive day-to-day existence
• a +ve sense of psycholo well-being enable elderly function effectively, b more resilient in overcome challenges

1. dealing w depress n
   eg
   Fr Centre for Urban Design and Mental Health in India, cities r associated w higher rate mental health problem vs rural area; loneliness among older ppl related to life situat n (death, declining health) can lead to depress n
   - important to maintain good health, as elderly can be more independent in daily activities, not feel like burden to family
   - oso impt offer strong social support so elderly no feel ‘needed’, help strengthen sense of self-worth, foster inter-generational bonding
   => this is done thru provis n easy access to both physical, mental hc, social care
2. overcoming fear, crime in city
   - elderly need live in safe, secure environ
   eg in USA, where suburb n, counterurban n is a trend for the rich, elderly house themselves in special purpose retiremt community w many facilities but high cost
   - BUT, some elderly may want/can oni retire in same area
   - seen as more vulnerable social grp, esp in city due to physical frailty, dependence on others, limited econ capacity, seeming defenceless, so easier target of crimes
   eg In USA, most likely victim of crime is male elderly living alone in public housing esp inner city
   => create stress, disrupt daily routine, restrict activities esp during night
   In SG, crimes r less worrying but elderly oso prone to scammers usually door-to-door salesmen who target elderly living alone & phone scams

Question 9

What’s the diff btw social & psychological well-being of elderly?

Answer 9

• Social well-being
  (Me w Others concept)
  sense of belonging to community, b able to establish +ve r/s w others, contribute to society
• Psycholo well-being
  (Me concept)
  self-acceptance, feeling of purpose, meaning in life, personal growth, dvlopment, environ mastery/control (ie hv sense of independence)

Question 10

What is the meaning of top down and bottom up approaches?

Answer 10

1. top down approach - implement by govt
2. bottom up approach - implement by community/NGOs

Question 11

What are some top-down approaches to meet elderly’s econ needs?

Answer 11

• implement central provident fund
• implement laws eg Maintenance of Parents act
• re-employ, retrain skills to help elderly support themselves

Question 12

What are some approaches to meet elderly’s social needs?

Answer 12

• family bonding and social integrate in workforce
• govt, Volunteer Welfare Organisations (VWOs) set up elderly homes, day-activity centres to encourage social interact n

Question 13

What are some approaches to meet elderly’s socio-econ needs? (Hint: hc)

Answer 13

• Promote healthy lifestyle, regular screening
• (top-down) Insurance; eg in SG, Medishield

Question 14

What are some approaches to meet elderly’s psychological needs?

Answer 14

• Set up elderly homes, day-activity centres to encourage social interactions
• make physical environ more liveable for elderly (eg within their homes, outdoors)

Question 15

How do needs of elderly in LDCs compare to elderly in DCs?

Answer 15

essentially, same needs, but experience more severe problems in terms of:
- lack of retirement savings
LDCs lack financial means to support elderly in terms of pensions
=>regulatory means to establish mandatory national savings for all need strategic planning, resources)
=>LDCs face challenge in manage rapid pop n growth, econ dvlopment

• poor access or lack of hc amenities, svcs
• lack of retire, nursing homes, professional hc workers, edu n

Question 16

Elaborate on effectiveness of Central Provident Fund in meeting elderly’s econ need

Answer 16

• Central Provident Fund (CPF), compulsory social security system, enables working S’pore citizen set aside portion of work income as funds for retirement
  =>cater to future elderly needs as it emphasise idea of personal responsibility in saving for retirement
  => their children oso encouraged top-up CPF amt for them

LIMITATION
- might not be in time for current gen; elderly unhappy w late age withdrawal at 55 yrs old
- income inequality - some elderly may hv insufficient CPF retirement savings to last them till old age
- some elderly even spent all CPF withdrawals

Question 17

Explain effectiveness of old age allowance in Nepal in meeting elderly’s socio-econ need

Answer 17

schemes are out of reach (only 20 percent of eligible individuals receive old-age allowances, and less than seven percent of eligible recipients receive government service pensions).
This lack of financial security is further compounded by the fact that Nepal’s social security system is primarily focused on younger demographics, with maternal and child health taking precedence.

Question 18

Elaborate on effectiveness of implementing laws to meet elderly’s econ needs

Answer 18

• Laws eg Maintenance of Parents Act 1995 make provision for maintain parents by their children
  ->elderly entitled to sue their child for maintenance in form of monthly allowances or lump-sum payment

LIMITATION
- create social tension, implicat n, -vely affect family ties
- elderly may find suing their child for monthly allowance embarrassing
- elderly w/o children or CPF wld not receive any support

Question 19

Elaborate on effectiveness of re-employ, retrain skills in meeting econ needs of elderly

Answer 19

• re-employment is re-contracting employees who hv reached retirement age, allow them continue work if willing & can
  eg as of 1 July 2022 in SG, re-employment age (max age employee can be re-employed until) is 68 yrs. So, employers must offer to eligible employees who have reach retirement age (63 yrs), re-employment until 68 yrs old. Otherwise, employer fine up to $5 000 and/or term of imprison of up to 6 months

eg In city of Phoenix, Arizona, USA, senior citizens eligible for reduced tuition rate. At Arizona State University, oni pay 50% of standard rate for undergraduate classes, 25% of standard rate for graduate class

eg
Oslo, Norway
- generous universal pension system w financial security, and elderly oso benefit fr hc system supporting all Norwegians fr birth
- pension, work income can b combined
- attracted more eldelry to continue working, keep them meaningfully engaged in job
- ppl voluntarily work longer as life expectancy increase to make up for lower yearly pens n paymt

LIMITATION
- elderly citizens w limited edu n in workforce often forced to conduct hard manual labour w/o enough income

eg study by Economic Policy Institute show older workers aged 50-70 experience difficult work condit n; 50.3% fr physical demand, 54.2% environ hazard, 53.7% difficult schedule, 46.1% high-pressure job -> shows older workers not in ideal work environ

eg SG senior forced work late into their life, cnt still make ends meet

eg 2015 study on elderly poverty by AP Ng Kok Hoe of LKY Sch of Public Policy found that: relative poverty rising dramatic amg elderly in workforce, w poverty rate amg working elderly rising significant fr 13% in 1995 to high 41% in 2011
- too many targeted help schemes, each w diff criteria, limiting condit n attached
=> challenging for elderly to seek help
=> confusion, misunderstand cause some to fall thru bureaucratic cracks

Question 20

Elaborate on effectiveness of family bonding and social integrate in workforce in meeting elderly’s social needs with DC example

Answer 20

• Promote elderly’s contribut n
  Fosters inter-generational/family bonding thru many public edu n program since 1999
  eg In Italy, care homes r rare; elderly care in city is seen to b family’s responsibility. Majority of older ppl continue live at home for rest of life, supported, cared for by family members
  eg In SG, govt policies towards seniors based on ‘Many Helping Hands’ approach, w principle of personal responsibility to secure well-being at old age, w family as key pillar of support
• there are public edu n efforts to reshape values, attitudes, views towards ageing & that elderly can still contribute to family & society
• Social integrate in workforce:
  ads used to promote social construct that elderly can oso contribute +vely in urban (working) environ, to b valued for wealth of knowledge, life experience

LIMITATION
- intergenerational family bonding - such initiatives may isolate elderly living alone or those w lost connections or in conflict w family members
- at work place: poorly skilled, educated elderly may not feel socially inclusive in workforce; cnt perform too physically, mentally demanding jobs compared to younger counterparts
- hard to integrate w younger workers, meet potential employers’ expectations

Question 21

Elaborate on effectiveness of family bonding and social integrate in workforce in meeting elderly’s social needs with LDC example

Answer 21

1. (success) The Cooperative Elderly Care Program in Bangladesh

Bangladesh has implemented community-run programs, such as by Young Power in Social Action (YPSA) that integrate elderly care within workforce activities, providing avenues for older people to stay engaged economically and socially. Elders participate in skill-sharing and mentorship programs, allowing them to remain valuable contributors to their communities and engage socially, thus enhancing their sense of fulfillment and connectedness.

2. (limit) Fragmentation of Family Support in Rural Nepal

In rural Nepal, rapid urban migration has weakened traditional family support systems. Many young people move to cities or abroad for work, leaving elderly relatives behind with limited social contact or care. Attempts to reintegrate the elderly into social programs through limited government initiatives have been inconsistent and underfunded. Despite free healthcare for older adults in Nepal, limited access due to socioeconomic factors and changing societal roles contributes to health, social challenges, exacerbated by ageism, demographic shifts. Migration and a shrinking youth workforce raise concerns about social security sustainability. This highlights the challenges in meeting the elderly’s social needs without the support of traditional family structures.

Question 22

Elaborate on effectiveness of govt, Volunteer Welfare Organisations (VWOs) set up elderly homes, day-activity centres to encourage social interact n in meeting elderly’s social needs

Answer 22

• eg Willing Hearts programme, which aim provide daily meals to beneficiaries eg elderly, esp those living in one room flats

LIMITATIONS
- current shortage of spaces, daycare svcs for elderly
=> govt must work w VWOs (top down + bottom up approaches) to create these adequately to meet ageing pop n’s needs
- some elderly may fall thru cracks, especially those living alone, restricted in mobility to go to centres
=> elderly care centre, mainly those w medical support, cost ~$250 to $600/month b4 subsidies (too high cost for some elderly)

Question 23

Elaborate on effectiveness of promote healthy lifestyle, regular health screening and insurance in meeting elderly’s socio-econ needs

Answer 23

• Promote healthy lifestyle, regular health screening
  ->for the early detection of illnesses to lessen the risk of major illnesses.
  In SG:
  -an Eldercare Masterplan to offer residential, centre-based, home-based care services for seniors is implemented
• Insurance (top-down approach)
  *SG not welfare state (no national pension scheme)

eg
- In SG, Medshield is co-payment, low cost insurance scheme, help meet medic expense for major, prolonged illnesses
From 2016, oso implement Medshield Life, lifelong insurance plan, made mandatory for all S’porean to hv

eg Oslo Norway will hv 50 000 more seniors by 2040, to address concerns over qlty of svc, Oslo changed its approach fr institutional, stop-watch based care of elderly to active ageing where seniors r in charge of own lives. City employed more home care staff, introducing acitivty time w more nursing care provided and amenities for social interact n

LIMITATIONS
- confuse, challenging for isolated elderly/ elderly w/o family. May not oso be aware of such schemes
- serious shortage of hc workers

Question 24

Elaborate on effectiveness of setting up elderly homes, day-activity centres in meeting elderly’s psychological needs

Answer 24

• Widening community network strives to ease loneliness, ensure elderly are looked after
  eg
  ‘Action Plan for an Age-friendly City’ & ‘Plan for safe & diversified care of older ppl’ initiative in Oslo will involve more residential care homes (Care+) specially adapted for elderly seeking safety, activities; facilities hv 24h staff, cafes, various hc svc & activities

LIMITATION
- (in some countries eg SG) Inadequate elderly homes, day-care centres for elderly
- huge shortage of social, hc workers
- may not totally address root cause of loneliness (lack love, care). Social well-being affected. May meet physical, social needs but not psycholo well-being

eg2 Senior Citizen Care Initiative by SOS Children’s Villages – Uganda
SOS Children’s Villages Uganda attempted to provide holistic care to elderly people through community centers that offered social engagement and health services. However, the initiative faced major hurdles due to lack of adequate funding, understaffing, and difficulties in accessing remote areas. The centers struggled to maintain regular programming, leaving many older adults without meaningful activities, contributing to their isolation and mental distress.

Question 25

Elaborate on effectiveness of making physical environ more liveable in meeting elderly’s psychological needs

Answer 25

• allow elderly gain environ mastery/control
  –>boost their sense of independence, encourage them venture out of their house, interact w others in community
  => prevent them fr suffer loneliness & even depression
  eg
• at home, senior-friendly feature, surveillance systems (cameras, etc.)
• low-floor step-free buses
• Green Man+ (allow longer green man time fr 3 up to 13 seconds) cross road w more time
• silver zone signs (reduce speed)

eg
‘Action Plan for an Age-friendly City’ & ‘Plan for safe & diversified care of older ppl’ initiative in Oslo will involve active ageing programmes where elderly r in charge of own lives;, age-friendly transport solut n

LIMITATIONS
- CCTV at home may intrude elderly’s privacy
- some elderly may not be aware of features like Green Man+; continue to jaywalk, etc.

Question 26

Explain needs of elderly in LDCs. How are they addressed?

Answer 26

eg China
- pop of ppl over 60 y/o projected reach 28% by 2040
=> problematic due to lack of retiremt, nursing homes, esp in rural areas
- more alarming is the fiscal costs of having more elderly, fewer young ppl, starting w expense of creating first modern national pension system (bcome too costly)

strategies
- open more care centre
=> to support elderly ppl, which is lacking currently

• involve private sector & tech to help look after elderly
  => broden reach of health insurance, increase spending on training nurse, & invite public sector to build private hospitals, collab on innovat n, etc.
• promote pro-natal policies
  => relax one child policy, allow 2 children, to reverse fertility rate decline

Question 27

What can be concluded from elderly problems and strategies

Answer 27

• w rapidly ageing pop n in many societies, need create age-friendly cities where older ppl btr thrive, continue make meaningful contribut n to society
• can explore innovative approach to improve access to integrated care, community-based social, hc system, strengthen svc, chronic disease control & prevention
• older ppl shd oni work voluntarily not b obliged to work just to make ends meet
• w flexible retiremt policies, btr integrat n into workforce, support learning, skills dvlopmt thruout life will ensure income security for all