The aging of the population is the result of medical successes, although it also responds to other factors, such as the fall in the birth rate and the increase in the labor exodus
The high Life expectancy that registers Spain has placed it for years among the countries in the world with a older population. According to the population projections for the period 2022-2072 from the National Statistics Institute (INE), if current demographic trends continue, in 2037 the Spanish population aged 65 and over will account for 26.0% of the total. By autonomous communities, according to the projection of the European Statistical Office (Eurostat), Asturias, Castile and Leon Y Galicia will be the oldest regions of the entire EU from 2030 and, above all, between 2040 and 2050. In this period, the average age of the population could reach 56.8 years in Galicia.
Returning to the projections of the INE for the period 2022-2072, life expectancy at birth would reach 86 years in men and 90 in women in 2071, with a gain of 5.8 and 4.2 years, respectively, compared to current values. For its part, life expectancy for people aged 65 in 2071 would be 22.7 years for men (3.7 more than currently) and 26.3 for women (3.2 more years).
The high life expectancy registered by Spain and the decrease in mortality and morbidity can be interpreted as a success of the National Health System (SNS) for the care provided. However, the health parameter is not the only one that explains demographic aging. The low birth rates and the exodus labor towards other regions with more employment have a direct impact on the investment of the population pyramid in Spain.
“The pandemic has oriented the health model towards immediate care”
According to Francisco José Saéz Martínez, coordinator of the Chronicity Working Group of the Spanish Society of General and Family Physicians (SEMG), these causes, and especially migratory flows, both internal and external, are what determine which autonomous communities are more aged. “The health successes and population displacement They are the ones that point out, within emptied Spain, the high degree of aging and, above all, its progressive increase until 2050, the year in which national aging is expected to decrease, especially due to the decrease in population, as reported by the INE & rdquor ;, exposes.
For his part, José María Faílde, president of the Galician Society of Gerontology and Geriatrics (SGXX), recalls that in just over a century life expectancy has gone from 34 years (at the beginning of the 20th century) to almost 84 years (80.42 for men and 85.86 for women) at present. As for Galicia, he adds, however, that there are other factors that influence the fact that it is one of the three oldest communities in Spain and one of the oldest in Europe. “Beyond the possible influence of genetics, our eating style (Atlantic and Mediterranean diet), the lifestyles and living conditions (social and environmental environment) are variables that undoubtedly influence this process. However, it is necessary to go deeper into its study, since we know very little about ‘overaging’ and why Galicia is one of the places in the world with the highest rates of centenarians,” he says.
For the experts, the fact that people live longer is positive. However, they understand that the inversion of the population pyramid is not only due to medical advances, but is also the result of demographic and birth policies. “The birth promotion It’s on everyone’s lips, but what facilities do women have to reconcile their work with having children? What help is given to families? None& rdquor ;, criticizes Jesús Sueiro, spokesman for the Galician Association of Family and Community Medicine (AGAMFEC).
“To guarantee a quality life in old age, more resources are needed& rdquor;
Likewise, demographic aging brings with it a series of challenges for which the health system is not prepared. In this sense, Sáez assures that if the National Health System (SNS) is to be sustainable, a more prepared health model is necessary for face prevention and the management of conditions of chronic health and that immediacy does not prevail. “But the pandemic and the political orientation towards the shortness of the actions, not beyond four electoral years, have broken this orientation and at this moment the only thing that stands out is the digitization of the public health system and the empowerment of emergencies and hospitals as sources of immediate care for pathologies, obtaining an increase in votes. This is generating a picture of a major crisis in the SNS, which is becoming a increase in patients in the private healthcare system and in concepts of ‘supermarket’ health carewith an increase in mortality and a significant decrease in life expectancy in 2020 and 2021 (almost two years less, from 87 to 85 in women and from 79 to 80 in men, according to INE data )”, he argues.
In this sense, Sueiro adds that, parallel to the population, also age templates sanitary and that a replacement has not been prepared to attend to the increase in older patients, most of them multipathological. “We live longer, but many times the last years are of a tremendous loss of function and questionable quality of life. There is no medicine that cures frailty. In order to guarantee a quality life in old age, it is necessary to put more resources into the socio-health field and to better coordinate health and social policies. It is not about adding years to life, but life to years & rdquor ;, she affirms.
Likewise, the Galician doctor points out that aging is not exclusively a medical issue and that many older patients have associated social problems, such as unwanted loneliness, for which reason active socio-sanitary policies are required.
A political and social pact for health
According to José María Faílde, one of the greatest challenges of gerontology is to ensure that aging and its impacts are included in the priority agenda of public policies with specific lines of intervention. “It is important that both from a health, economic and social point of view, we act proactively and not as we are doing in many cases ‘with inaction’, reacting late or reactively to the problems that arise & rdquor ; he affirms. Likewise, it advocates protecting the rights of the elderly, combating stereotypes, prejudices and ‘old age’ discrimination and detecting, preventing and eradicating unwanted loneliness. “Ageism and unwanted loneliness have serious impacts on the health of older people & rdquor ;, he warns.
For his part, Francisco José Sáez speaks of a political and social pact to preserve the health system. An agreement that goes through the “redesign of the system and its empowerment so that health professionals do not ‘flee’ to other countries& rdquor;, for the compensation of the increase in retirement, the update of the Chronicity Strategy -after ten years there are important changes in pathologies that are not included– and due to the assessment of new ones, such as persistent COVID, among other aspects.
The demographic transition also requires, according to Jesús Sueiro, healthier cities, with fewer barriers and more pedestrian areas, and actions aimed at improving the quality of the last years of life.
“Hospitals should have Geriatrics & rdquor;
For José María Faílde, president of the Galician Society of Gerontology and Geriatrics (SGXX) since last June, the level and projections of aging in the Galician community are a opportunity to test “brave and pioneering” public policies & rdquor; to be at the forefront of tackling the aging population of the European Union.
Longevity is a success of medical advances and of the health system, but is it prepared to face the aging of the population?Population aging, insofar as it means that individuals live longer, is undoubtedly a success of public health policies and socioeconomic development . However, this situation brings with it a series of challenges that must be addressed proactively, in order to prevent this situation from becoming a situation that puts welfare system at risk and reduce the quality of care in the health system.
How should healthcare face the challenge of aging?I insist that a proactive approach. For example, it is required, among many other aspects, that all Galician hospitals have geriatric services, that intermediate care units be set up, geriatric rehabilitation services, that community services be strengthened to promote active aging, that they increase Resources for people to age in their own environment as much as possible and, when necessary, in residential centers that allow interaction with the immediate environment and are as similar as possible to homes and habitual ways of living. of individuals.
“It is positive that people live longer, but it is necessary to promote the birth rate”
Would you be ready today?Honestly, in my humble opinion, although I recognize that important steps are being taken, I believe that we are still a long way from the desired situation. For this reason, from the Galician Society of Gerontology and Geriatrics we want to introduce the need to increase geriatric care resources, since currently only two provinces have specialized geriatric services, one located at the Meixoeiro Hospital in Vigo and the other at the Lucus Augusti University Hospital (HULA) in Lugo. The current level of aging of the Galician population and its future aging process are an opportunity for courageous and pioneering public policies to be tested, which are the cutting edge to face the aging population that the whole of the European Union will suffer in the coming four decades.
How to slow down aging?I think we must differentiate two aspects. On the one hand, it is very positive that people live longer, and especially with a better quality of life and lower dependency rates. That is to say, that the healthy life expectancy is increased. On the other hand, it is necessary to adopt measures to balance population aging, as this can cause malfunctions in the system. Among other measures, it is necessary to promote the birth rate, which implies betting on policies that increase socioeconomic development, improve opportunities for young people and family reconciliation, among many others.