Focus on Disability: Support for the elderly is missing
- Disability is common among older people, and most disabled people are elderly
- But aid efforts focus more on disabled children than disabled older people
- Disability programmes must aim their services at the elderly too
Although children remain the most common age group in developing countries, population ageing is now happening even in the poorest areas of the world, including Sub-Saharan Africa, according to a new report.  It estimates that, by 2050, there will be as many people over 60 as there are children under 15. Reporting the news, the BBC asked whether growing old in developing nations is always a positive experience. 
Population ageing will profoundly affect economies and health needs. For instance, the report notes that only one in four people over 65 living in low- and middle-income countries receives a pension, which needs to change.
One important thing the report doesn’t fully consider is disability among older people. I asked Eppu Mikkonen-Jeanneret, the head of policy at HelpAge International, the NGO that wrote the report, why this was the case. She told me that HelpAge understands the importance of disability in measuring the wellbeing of older people. Two indicators were used in the report to account for disability (healthy life expectancy at 60 and relative psychological wellbeing), but she hopes improved data will allow more explicit inclusion of disability indicators in future.
I agree that more information is always useful. However, there are already enough data to know that disability is an important issue among older people.
The best data available on how many older people have disabilities are from the WHO. It estimates that, on average (the figures vary between nations) around 38 per cent of people older than 60 around the world have a disability.  This compares with nine per cent of 18- to 49-year-olds. One in 13 older people experiences significant difficulties. Disability is therefore common among older people, and most people with disabilities are elderly.
As a result, older people may need specific services because of disability. Medical care and rehabilitation fall into this category. So does social support. And, importantly, services for older people must be accessible to people with disabilities and match their needs. This is not always the case. For example, health insurance schemes for older people often exclude items such as walking frames or hearing aids, although people with disabilities may need these.
Addressing the needs of older people with disabilities is about more than social justice. It can also help economies grow. My research group studied the impact of cataract surgery in Bangladesh, Kenya and the Philippines.  We showed that treating older people’s cataracts lessened their families’ poverty because they could work again and no longer needed constant care. The financial improvement was still apparent six years later.
Aid programmes targeted at disabled people in poor nations also need to focus more on older people. I agree with Allen Foster, former head of disability NGO CBM, who said: “Most international NGOs working with persons with disabilities still focus on children rather than the elderly because children have potentially more years of life ahead of them.”
At least two changes are needed to prepare for global population ageing. First, policies and programmes addressing ageing must consider disability to ensure that services are accessible to people with disabilities and meet their additional needs. One way to ensure policies achieve this is to involve disabled people in their design. Disabled people’s organisations are often powerful lobbyists, and so engaging them from the start will help make policymakers more accountable and raise their awareness of disability issues. Second, aid agencies’ disability programmes must stop focusing chiefly on young people and aim services at the elderly too.
Hannah Kuper is the co-director of the International Centre for Evidence in Disability at the London School of Hygiene & Tropical Medicine, United Kingdom. She can be contacted on [email protected]
 Global AgeWatch Index 2014: Insight report (HelpAge International, 2014)
 Global AgeWatch Index: Norway best for older people (BBC News, 1 October 2014)
 World Report on Disability (WHO, 2011)
 Cataract Impact Study (London School of Hygiene and Tropical Medicine)