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Aging Society and Sustainable Health Systems

Aging Society and Sustainable Health Systems
Her Royal Highness Princess Maha Chakri Sirindhorn
At The WCPT-AWP & PTAT Congress 2017
On Moving towards Health, Longevity and Sustainability
On June 28, 2017
At BITEC Exhibition & Convention Center, Bangkok, Thailand
Distinguished Physical Therapists,
 Ladies and Gentlemen,
       I am pleased to be here among so many physical therapy experts from Thailand and also from other countries. I am not a physical therapist, and so I can only share with you from the point of view of a patient.
Aging Society
       As you all know, many countries, Thailand included, have become a part of the aging society. In Thailand, according to the World Bank report, as of 2016, 11% of its population or about 7.5 million people were 65 years or older, compared to 5% in 1995.  In about 20 years from now, more than a quarter of the Thai population will be 65 years or older, and the working age people will drop about 11%.  We are among the countries of which the population ages very quickly. The main driver of this phenomenon is the advancement of medical technology and the sharp decline of birthrates, as a result of economic and education development and the success of the National Family Planning Program launched in 1970. 
We can witness the rapidness of this change in our lifetime.  Over 40 years ago when I started working in rural areas, I was only 20 years old or even younger. At that time many families had 14-15 children, very big families. For example, one couple I met had 20 children! Now most couples want only 2 or 3 children or even fewer. The trend of declining birthrate continues, and we will end up having fewer working age people to pay taxes to support a lot of retirees like me.  With the tax money, the government can pay for our pension, subsistence allowances, health-care and long-term care systems. This has become or will soon become an important economic and financial issue in any aging society at the global as well as national levels.
In Thailand the Ministry of Social Development and Human Security and the Ministry of Health take care of the wellbeing of the elderly. At present the government provides progressive subsistence allowances for all senior citizens, 60 years and older, who do not have pension, free health services for all, shelters and centers for the elderly, etc. The Thailand’s Elderly Persons Act of 2003 protects, promotes and supports the rights and benefits of the elderly, including social welfare, medical services, education, occupation, occupational training and social activities.    
We may live longer nowadays, but we cannot be sure whether we will live well and stay healthy to enjoy life, to be able to help ourselves, and to be useful for our country and our global community.  So the big issue now is for the aging society to prepare good health systems to assure a healthy aging society. If we succeed, we can then benefit a lot from the wisdom and experience of those healthy elderly people. In other words, if we can turn the burden of dependency of elderly people into the benefit from the elderly as valuable human resources, then the aging society will be an advantage.
I think together we can do something to make our aging society a healthy, happy and productive society.
Sustainable Health Systems
       Aging society and declining working age population is the reason why we have to talk about sustainable health systems today. “Sustainable” means being able to maintain thing as it is. Here it means that we have to find the ways to maintain health of the elderly, as there will be more and more of them. If not, so many of them will overload the services provided by the government and the support from smaller families. There might not be enough governmental budgets to treat them.
I think every government tries their best to take care of their senior citizens. For example, in Thailand there are different kinds of health insurance to cover everyone, progressive subsistence allowances for the pension-less people, elderly care services by governmental and non-governmental organizations, housing for senior people, hospital and nursing cares, etc.
Education is the Best Policy
The best policy is to provide sufficient and necessary education for senior people to take good care of themselves to maintain independent living as long as possible. They should know about physical and mental health care, including memory care.  A public health professor said that many habits in childhood or youth, like smoking, drinking, over-eating can cause problems later in life. Therefore to start health education when people are getting old is much too late, but better late than never.  For example, everyday one needs balanced nutrition, that is, adequate but not too much proteins, carbohydrates and fats, sufficient amount of micronutrients, I mean minerals, and vitamins. We also need fibers and water. Movement or exercise is necessary. Don’t forget about enough sleep and rest, which I always forget. Recreation is much required. It is good for our mental health. This is the general health education for wellbeing that must be stressed throughout life.
       Old people like me are prone to have high cholesterol, diabetes, problems with blood vessels and cardiac system, respiratory system, orthopedic problems, problems in the digestive tract, muscle ache, and memory loss, etc. Senior people should know how to maintain good health and good living despite all these old age problems.
       Since I was very little, I was allergic to some kinds of food, pollen, dust and many others. Apart from the doctor’s treatment, exercise has helped me a great deal. I have noticed that when I could not exercise due to feeling sick or having no time, allergies and gastric symptoms come back. Fortunately I do not have much muscle problems and so I don’t need any massage. I find massaging boring.  At one time there was an advertisement at the shopping mall near my house about a self-massaging course. I was curious, but I didn’t want to take the course by myself. So I sent a spy to register for it. However, my spy could not get in, because there was a long queue.  So up to now, I still don’t know what self-massaging is!
Physical Therapy and the Elderly
       My works at the Thai Red Cross and the Saijai Thai Foundation and in my own capacity are to help the veterans, the disabled, senior people and other disadvantaged groups. They have something do with physical therapy and rehabilitation. I have to look after sick and bed-ridden patients, wounded military personnel, and people with disabilities. I find physical therapy very useful in retaining and rehabilitating those people to maintain, improve or restore mobility and body function, and also to reduce pain. The physical therapists use their hands or some equipments with computer programs. It works very well for muscle, bone, stomach, lung and brain, etc. The therapists can also advise and educate their patients, the patients’ relatives and caregivers about the ways to improve their houses to suit their conditions.  They can also suggest easy therapy that non-experts can apply.  Physical therapy plays an important role when senior people reach the point that they need assisted living, memory care, home care and hospice care. The kinds of therapy that I have seen are speech therapy and occupational therapy or OT. 
Besides, there are many other activities that are good for the elderly, for example, singing, playing music, cooking, gardening, etc.  One gardening activity that old people used to do was picking a kind of grass, called หญ้าแห้วหมู in Thai, or Gyperus rotundus, in the lawn.  This was a popular pass-time activity, because they could sell it to the herb shops.  But I tend to advise against it because it may make our backs bend.  Some people may like story-telling and reading.  I saw some novels with big prints abroad, for elderly and low-vision people.  I haven’t seen this kind of books in Thailand.  Handicraft activity is also an ideal form of therapy. It’s a good exercise for fine motor. 
I would like to suggest a few more things.  When I was young, we used old newspaper or pages from used exercise books to make paper-bags and got additional income.  No one makes this kind of bags anymore.  But as many organizations do not want us to use plastic bags, these paper-bags can be useful again, against the climate change.  Here is the bag I made yesterday.  This one is rather big.  The smaller sizes could be sold for about a quarter of one bath per 100 bags.  Here is another example, Dok Mai Chan, or sandal wood flower, that everyone is preparing to take part in the cremation and to pay homage to His Majesty the Late King.  Now instead of using wood we use paper or banana leaf or other materials, and here are the flowers someone just made for today demonstration.  Another activity for the elderly is to use coconut leaves to make into fish, prawns and grasshoppers, etc.  My late nanny liked to make these.  The last example is making jumping ropes from rubber bands.

Paper-bag (Left) and Dok Mai Chan (Right)
Health of the elderly or aging people deteriorates according to the law of nature, the Four Inescapable Realities of life: birth, aging, sickness, and at the end, death. Nevertheless, the physical therapists can give elderly patients better quality of life, for example, delaying muscular atrophy and improving other health systems making them capable of independent living as much and as long as possible.
So, Physical Therapists, please accept my heartfelt appreciation for your work in helping me and my fellow patients all along.
Suggestions and Conclusion
       I would like to conclude that nowadays sustainable health systems should be a priority for health development strategy, not just in Thailand but all over the world.  Here are some points that I would like to stress:
  • Education
I emphasize that education is the best policy to reduce the preventable health problems later on in lifeEducation should begin early and continue lifelong  It should cover not only physical health, but also mental and emotional healthPhysical therapists should take part in the education for good health and wellbeing, at all levels and in all forms
  • Mental Health and Social Life
Most budget and support are for the promotion of good physical healthIn fact, of equal importance is mental healthSenior peoples mental health and social life should be guided by professional personnelBut we do not have enough professionals in this areaSo we need more training, research and development to improve elderly peoples mental health and social life
  • Work Opportunity for the Elderly
The government and the society should improvemore work opportunities for senior people, because wisdom and experience of senior peoplecan be utilized more fully for a longer period of time  Working is good in both economic and health aspects
  • Research and Technology Innovation
We need more rehabilitative and assistive technology to help the elderly, both in quantity and qualityIn many cases the technology has to be customized to fit each individual with different disabilityAbout 10 years ago we, Thailand and Singapore, have initiated iCREATe which stands for the International Convention on Rehabilitation Engineering and Assistive Technology to promote and improve innovation, research and development of technology that can assist the disabled and the elderlyI would like to invite all of you to take part in this annual conferenceThis year is the 11thiCREATe, which will be held in August in Kobe, Japan Next year it will be held in July in Shanghai
  • Personnel Development
We needformal education to develop sufficient professionals both at the vocational and the college levels to take care of the elderlyWe also need a lot of shortcourse trainings to develop skillful personnel and also to train thefamily members how to take care of the sick and bedridden elderly Again physical therapists play an important role in this aspect
  • Home-based Care
Most hospitals are likely to promote more homebased care for chronicallyill senior people, as there are not enough hospital beds and rooms to accommodate the growing number of sick peopleSo we, especially the physical therapists and technologists, must findthe ways to develop effective and efficient homebased health care systems, by using all available resources and technologies, to assist or rehabilitate the elderly at home
Thank you very much for your attention, and I wish all of you success in your life and work.