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Aging Well: Who Will Be There to Walk beside You?

This year’s World Health Day, celebrated on April 7, will focus on aging and health. The older I get, the better I understand that old truism: ‘old age is not for wimps.’ Not that I consider myself old by any means—but I am definitely well into middle age! The motivation and effort required to work out at the gym seems to have increased with my age, while my capacity to party all night definitely hasn’t. But all in all, I consider myself to be aging well, and I realize that I am one of the lucky ones, being physically and mentally active and happy.  For all of us, as we age, we are more likely to have restricted mobility or to be living with a chronic condition, such as cancer, heart disease, or dementia. For some of us, the grief of bereavement, consequent loneliness, and perhaps poverty can lead to depression and despair.

The World Health Organization’s statistics remind us that older people are the fastest-growing age group worldwide. By 2050, two billion people—or nearly one out of every four people—will be older than 60 years, and 80% of them will be living in low-income countries where underdeveloped health systems have little in place to help people to age well. How can we support health workers to take on this growing need for care, and what type of care should it be?

I have to confess a bias: my first career was as a nurse, and later a teacher and researcher of nursing. I know there are more nurses in the global health workforce than any other cadre1, and I know, too, that they are often undervalued—both in terms of recognition and pay—for the care they give. As we look toward a world where there will be a need for continuous care and support for conditions that will not be cured but managed for many years, it seems to me that it is high time for nurses to take center stage.

Much has been written about nursing ever since Florence Nightingale put pen to paper. My personal theory is that nursing is so many things to people in different circumstances that it can sometimes defy description. The model that I like best, that conjures up to me the essence of what nurses do, is that they “walk alongside their patients.”2  This image tells me that nurses do not necessarily interfere with what their patients and clients want, but nurses facilitate their patients being able to function well enough to attain their own life and health goals. In the process of walking alongside their patients, nurses build relationships of trust and empathy, so that patients can return to them again and again for advice, health screening, and when it is required, clinical nursing care.

On what is now becoming a much longer journey through life for many people, the need for ongoing care—care that promotes health, prevents illness, and sometimes needs to cure disease—will be apparent. And for many, there will not be enough nurses to go around.

Nurses are aging too. The average age of a nurse in the US is now 48 years, as fewer young people choose nursing as a career. Nursing used to be one of two likely careers for women; the other was teaching. Now, thank goodness, many more doors are open to women, but there is a gap of entry into nursing that has not yet been filled in the US. It is not a high-paying career for most, it is emotionally taxing work (though very rewarding too), and it does not enjoy a high status in the hierarchy of professions. In many low-income countries, these phenomena are magnified a thousand times, with low pay, few incentives, and a paucity of supplies and equipment that is hard to imagine. It can be a challenge to attract young people into nursing in these situations, and even more difficult to keep them in the places where they are most needed, such as in rural areas.

What’s to be done? World Health Day reminds us this year that for all of us the clock is ticking. For us to age well, we need support to prevent disease and to maintain a healthy life for as long as we live—which is now getting longer. For all of us to have access to the range of care that helps us to do this, we need more health workers—and especially, I would contend, nurses, because of their holistic training and approach to care. IntraHealth works to advocate with governments and our partners for health workers to be supported, to be trained, paid and respected, so that there are enough for all of us, young and old.

But as we contemplate the changing demands on health systems from the rapidly aging global population, we can see that this quiet plea of ours is in fact an emergency. Without health workers, without nurses, our chances of aging well diminish, and when that happens, the burden on society increases to care for those who are no longer able to care for themselves.

This year, cherish those around you who are aging and the health workers who are walking beside them; let them know how much they are appreciated.

1. World Health Organization, The World Health Report, 2006

2. Montgomery Dossey B. and Keegan L. Holistic Nursing: A Handbook for Practice. American Holistic Nurses' Association