The session on the topic of ‘Embracing an ageing society’ took place on the second day at the beautifully designed Hong Kong Palace Museum.

Ageing populations are sharply on the rise, and more than half of the world’s population aged 65+ will be living in Asia by 2025. Individuals who require long-term care for both chronic diseases and daily activity are also forecast to quadruple in number by 2050.

The session explored the opportunities for and challenges in addressing an ageing society, and discussed areas where philanthropy can plug in.

While the three speakers represented different sectors — foundations, government and academia — they also shared something in common: they were all health professionals (doctors and nurses) earlier in their careers. Etsuko Kita, Chair of the Sasakawa Health Foundation, was the first medical doctor sent by the Japanese government to work in conflict areas of Peshawar, Pakistan in the 1980s. Donald Li, Chairman of the Elderly Commission of the Labour and Welfare Bureau of the Hong Kong Special Administrative Region Government, is a specialist in family medicine. And Jill White, Professor Emerita at the University of Sydney and University of Technology Sydney, has been a registered nurse for 50 years.

Moderator Marla E. Salmon, Professor of Nursing and Global Health, University of Washington, started the panel by asking everyone in the room to spend a minute in reflection on their feelings when they heard the word ‘ageing’, asking if they were positive, ‘Oh No’, or a problem we have to solve?

She used the question to initiate the subsequent discussion: when we think about how to embrace an ageing society, the first thing to bear in mind is a demographic profile that has changed dramatically, and requires us to look at the challenge differently. As White pointed out, the age of 65, once considered the magic number for retirement, is now an outdated concept. It originated when life expectancy was around 50, but today, people are living many decades longer.

The notion of ‘old’

‘One of the concepts that a colleague espouses is that we think of ‘young old’ as from 65 to 85, and ‘old old’, which is 85 plus,’ explained White. ‘There is a real difference: only 10 percent of people around 65 to 80-ish really require any assistance. But it raises to 80 percent for 85+, and that is where the notion of ‘frailty’ comes in. Frailty is a better indicator of care requirements than is chronology.’ White provided examples of ‘system failure’ in response to the changing demographics, including mandatory retirement policies in certain countries and strict pension regulations that prevent fully capable retirees from remaining engaged. In contrast, Li highlighted positive examples from Hong Kong, such as lifelong learning opportunities and part-time employment options for the elderly, emphasising that ‘age is just a number’. He noted that numerous institutes in Hong Kong welcome older individuals, and there is even an ‘elders academy’.

The power of nurses

One of the core discussions at the session was the importance of acknowledging the power of nurses as the key to the spread of primary health care in today’s ageing society. Japan is a good example, which Kita from Sasakawa Health Foundation refers to as ‘an aged society’. With growing generational and regional disparities, it is no longer feasible to see a doctor anytime in rural areas, where many Japanese old people live alone.

Kita started to recognise the power of nurses during her time working in conflict areas and rural villages in the global south, where no well-established health system exists. ‘I witnessed the fact that skilled nurses can protect the health of the entire community. Nurses are involved not only in medical care, but also in lifestyle support. Our foundation has a very powerful motto: Nurses change society. We provide training courses for nurses in Japan to learn how to run home-care nursing centres in their communities. Today, our graduates are operating around 150 home-care nursing centres all over the country.’

Kita’s comment was echoed by White, who further pointed out that reform of medical professional training is needed so that nurses have greater understanding of the value of ageing care. Li, on the other hand, thinks training for all caregivers is important. ‘A holistic approach is needed that requires teamwork: doctors, nurses, social workers and family members to provide coordinated care. The key is trust. Do you trust what they are doing?’

How technology and philanthropy can help

Speakers provided different answers to a question raised by Salmon: How important is technology?

White thinks technology has enormous potential to assist the elderly and prevent them from falling off the cliff. ‘The only thing I use on my Apple Watch is the health monitoring function. The data collected from watch users can be really valuable. There are many other simple things, such as smart houses that turn on automatically’. Kita and Li, however, both emphasised that while technology is important, a community caring system is most important, and nothing can replace human care. ‘In the Chinese traditional medical practice, the first thing a doctor does is check your pulse. What nurses and family members can provide as caregivers is the human touch, people to be cared for by people they can trust,’ said Li.

All speakers agreed that philanthropy plays a vital role. Li pointed out that Hong Kong is privileged because there are many philanthropic organisations that partner with government in operating care facilities, providing financial support and other initiatives that promote active ageing. ‘It will be difficult for government to fund all of them.’ Other areas that philanthropy can plug in, recommended by speakers, included advocating for nurses and supporting unpaid caregiving work, which is predominantly performed by women; fostering careers in the ageing care system, and organising activities to engage the younger generation and embrace the ageing society. As Salmon concluded at the end the session: ‘When we think of ageing as part of life instead of part of the problem, we are all in this together.’

Fan Li is the East Asia Regional Representative at Alliance magazine