elder population in sri lanka

ELDER POPULATION IN SRI
LANKA : CURRENT STATUS
Dr. Achala Balasuriya
Consultant Physician
General Hospital
Nuwara Eliya

Topics
• Introduction
• Demography
• Factors affecting the demographic trend
• National survey findings
• Services available for elders in SL
• Problems face by the elders
• Proposals for the future

Introduction
• Population ageing is a universal phenomenon , but it
looms particularly large for Sri Lanka .It’s population
is the oldest among the developing world and it is
one of the fastest ageing populations in the world.
Definition of ageing
• Refers to increase in the relative proportion of elderly in
population.
• Western world age over 65 and above is regarded as the
demarcation age.
• Developing world age 6o and above is considered to be
the cutoff point.

Demography
Population in Sri Lanka at present 20,450,000.
Elders over 60 - 11%
Projected figure for 2030- 22%
In 2030, one in 5 people will be over the age of
60 years.
Among elders female numbers are higher than
males due to increase in life expectancy.

Ageing in Sri Lanka – South and Central
Asian perspective
Country Percentage of 60+
2000
Afghanistan
4.7
Percentage of 60+
2030
5.5
Bangladesh
Bhutan
India
Nepal
Pakistan
Sri Lanka
4.9
6.5
7.6
5.9
5.8
9.8
9.7
7.6
14.0
7.8
7.8
21.5

Number and percentage of elders 60+ years
1946-2031, Sri Lanka
Year Total population Percentage age 60+ years
(‘000) (%)
1946 6,657 5.4
1953 8,098 5.4
1971 12,690 6.3
1991 17,259 8.1
2002 19,015 10.8
2011 20,873 13.1
2021 22,324 17.8
2031 23,129 21.9

Young and old age dependency ratio
Year Under 15 65 and older Total
1991
49.2
8.5
57.7
1996
42.4
9.3
51.7
2001
37.0
10.1
47.1
2006
34.7
11.1
45.8
2011
33.1
12.7
45.8
2016
31.4
15.1
46.4
2021
29.3
18.1
47.4
2026
27.5
21.4
49.0
2031
26.1
24.4
50.5

District variation in elderly population

Demographic trends and factors
affecting Population Ageing
• 1. Decline in fertility
The main driver of the slowing momentum of population growth has
rapid fertility decline since the 1950s.
been
Total fertility rate
Crude birth rate
• 1953 - 5.3 1946 - 36.6
• 1993 -2.3 1970 - 29.4
• 2001 -2.1 2009 - 18.4
Increasing life expectancy is the next most important driver of SriLanka’s
population ageing: lower mortality prolongs the survival of older persons. The
proportion of oldest – old is 12% which is
highest in south-Asia.

Demographic trend continued…..
2.Increased life expectancy – low mortality
Crude death rate
1945 - 21.9
1971 - 7.7
1995 - 5.8
Life expectancy
1920 1946 1953 1962 1967 1971 1981 1991 2001
M
F
32.7
30.7
43.9
41.6
58.8
57.5
61.9
61.4
64.8
66.9
64.2
67.1
67.7
72.1
69.5
74.2
70.7
75.4
3.Improved health care
4.Population migration

National Survey on Elders: 2003-2004
• Carried out to obtain reliable information on elderly population
of Sri Lanka.
• Covered rural ,urban and estate sectors in all districts.
• Survey covered 11,663 and based on this total estimated
elders in the country was 1,661,000.
• Objectives
• Ascertaining the specific distribution of the elderly population
• Obtaining details of the demographic, economic, health and
social characteristics of the elderly population.
• Identifying the social needs of the elderly, difficulties faced in
domestic and social environment.
• Generating other ancillary information helpful to make policies
and services for the well being of the elderly.

Summary findings of this survey
Distribution of elders by sector
• 83.9- rural
• 12.3-urban
• 3.8-estate

Distribution of Elders by gender according to
sector

Distribution of elders according to age

Distribution of elders according to Seeing ability

Distribution of elders according to hearing ability

Elders according to illness

Other
4.1
3.4
3.8
Distribution of elders by main source of
income and by sector ( percentage)
Source All(%) Urban (%) Rural (%) Estate (%)
Salary
8.6
6.9
16.9
Pension
25.1
11.8
2.6
Property
2.2
8.8
0.8
Bank Interest
1.3
0.4
0.4
Business/Agri
4.4
11.5
3.9
Children
44.6
45.9
61.8
Samurdhi
2.6
5.9
3.3
Relatives
6.2
4.8
6.2

Socio- economic characteristics of the elderly
• Among elderly there is a large share of women and
widows.
• The female share increases with advancing age.
60-64 years 70- 74 years 80 and above
53% 60% 70%
• Poverty does not affect elderly disproportionately more
than the population as a whole. But incidence of poverty
among the old old (75+)is very high.
• Nearly 60% were economically dependent- 46% on their
children
• Majority of elders (71%) reside in houses owned by them
or rented by them and co residence rates are very high-
80%.Only 6% of elders live alone.

Services available for elders
through GOSL
• 1.National Council for Elders - established under
Protection of Rights of Elders Act No 9 of 2000.
• Council comprises 15 members chaired by the
secretary of Ministry of Social Services and Welfare.
Objectives
• Protecting and promoting rights of elders
• Identifying problems faced by elders and making and implementing
policies accordingly
• Implementing various types of programmes by using their knowledge
and experience
• Conducting awareness programmes for elders
• Providing guidance and various types of welfare assistance for low
level income group of elders
• Updating data related to elders

Services continued ………
• 2. National Secretariat for elders - Established under the
Elderly Act 9 of 2000
Maintenance board for elders- to look into claims for
maintenance by parents who are neglected by their children
• Elderly Identity cards- which enables the >6o group to obtain
priority services from Gov and private sector institutions ;
higher interest rates for FDs; 5 % discount when obtaining
medicines from Osusala outlets.
• So far 625,000 identity cards have been issued.
• Issue of eye lenses- for low income (Rs < 5000/=) group
• Day care centers- Provides financial assistance up to Rs
25,000 for each day care centre for purchase of equipment
and also provides of Rs 10,000 for needy elders to start self
employment activities

Distribution of day centers for the elderly
Distribution of day centers for elderly, by province
• Western 31
• Southern 21
• Central 27
• North-Western 12
• North-Central 32
• North-Eastern 5
• Sabaragamuwa 15
• Uva 4
Total 147

Continued..
• Establishment of village committees- both at village level
and district level- for social , economic cultural an d
spiritual development of elders ( National Secretariat
provides financial assistance of Rs 5000 for a village)
• Provision of funds to establish and maintain elderly
homes
• Provision of a old age pension to elders over 70 years
• Doing surveys among elders
• Arranging home care services
• Conducting pre retirement seminars for both State and
private sector employees
• Sponsorship programme for elders established
• Elders desk has been opened at the legal aids commission to
help the needy elders.

Services by NGOs
• Helpage Sri Lanka-
Established in 1986 guided by
the 1 st World Assembly on Ageing
Initiatives
• Volunteer home care programme
• Conducting mobile medical camps
• Provision of assistive devices for the elderly
• Training home carers
• Livelihood assistance
• Paid care facility
• Psychosocial intervention programmes
• Eye care centre

Problems faced by the elderly in SL
In hospital care
• Elderly patients receive no priority in hospitals and
are managed in a common ward.
(No designated geriatric wards in both Gov and
private sector hospitals)
• No specialist geriatricians
• Junior doctors lack knowledge and skills to manage
geriatric complaints- eg: delirium, dementia
,depression are often overlooked
• Lack of properly trained allied healthcare supportphysiotherapists,
occupational therapists , speech
therapists and social workers .

Continued
• Lack of geriatric rehabilitation facilities in the State
hospitals; equipment, trained manpower, space and
other facilities
• Community Services
• No community geriatric services
• Lack of trained nurses and healthcare workers who
can start up such a service
• Inadequate number of nursing homes and elderly
homes to look after the very old, frail, and sick
• Lack of respite services to help of care -givers

Proposals for future
Re orienting the health system to respond to an
ageing population
Integrate primary prevention and primary healthcare
for elderly using PHC network of the MOH for
geriatric assessment , prevention and rehabilitation.
Cadre creation of Geriatricians and Para medical
personnel to provincial hospitals
To develop and design the hospital healthcare
system with geriatrics as a sub-specialty so that
properly planned wards, gymnasium , and
rehabilitation devices can be installed.
Introduce geriatrics in to the medical curriculum
at the undergraduate and postgraduate streams.

Continued….
In the short term-
‣ Improve health service delivery at primary,
secondary, tertiary levels with preference for elders
at OPD, Pharmacy and a referral system from
community physicians.
‣ Nursing officers’ trained to help in the community to
visit patients’ , homes, elderly homes and to run
community geriatric clinics .
‣ For minor ailments a geriatric day hospital service at
MOH areas , using the same premises, with
supervision of diploma holders(DEM).

Proposals for future ……….
Supporting informal care arrangements
• Introduce / expand social welfare and care services
targeted to the most vulnerable.
• Provide community and home based support
services for sick and frail old people.
• Improve income support programmes for elderly so
that they can contribute to household welfare.
• Increase capacity of nursing homes to care for the
elderly .

Ensuring income security
• Provide opportunities and start facilities to assist
elders to use their knowledge ,experience and skills
to earn an income.
• Extend the statutory age of retirement from 55 years
to 65 years in view of increasing life expectancy and
good health.
• Convert unfunded pension schemes to funded ones
to facilitate sustainable pension payments for the
retirees.
• Ensure adequate income security and social
protection of needy senior citizens by expanding
social assistance .

Thank you for your
undivided attention.