Perubahan Struktur Demografi Kesehatan dan Kesejahteraan lansia

Jumlah young, middle & old-old people, Indonesia, 1950-2050 Sumber : World Population Projection, 2006 revision Pertambahan dari UHH dari 45.7 tahun in 1970, to 65.4 in 2000, 69.9 in 2015, 76.9 in 2050, (SP 2010, UHH menjadi 72 tahun) Jumlah penduduk ‘old ‘ 60+, dari 4.9 juta (1950), menjadi 21.4 juta (2010) dan diperkirakan menjadi 79.8 juta (2050). Bagaimana konsekuensi di aspek sosial, ekonomi dan kesehatan? Perbedaan usia perbedaan kebutuhan untuk layanan kesehatan dan perawatan

Age dependency ratio; old (% of working-age population) in Indonesia Sumber: World Bank Indicators

Gender dan Situasi saat ini Sumber data Susenas 2005 Laki-laki + Wanita: 10,4 juta ‘young old’, 4,8 juta ‘middle old’, dan 1,4 juta ‘old-old’ Young old: 5.0 juta laki-laki dibanding 5.4 juta wanita Middle old: 2.3 juta laki-laki dibanding 2.6 juta wanita Old-old: 0.65 juta laki-laki dibanding 0.81 juta wanita

Pendidikan dan Tempat tinggal, Susenas 2006 Sebagian besar berpendidikan rendah dan tinggal di pedesaan Kurang dari 30% lansia tinggal di kota dengan pendidikan rendah Layanan khusus dibutuhkan untuk lansia khususnya mereka yang berpendidikan rendah atau yang jauh dari fasilitas kesehatan (seperti di pedesaan)

Bekerja untuk menghasilkan ‘INCOME’ Table1. Lansia yang bekerja untuk menghasilkan penghasilan Lansia Kota Pedesaan Total n % Bekerja untuk menghasilkan ‘income’ Ya 293 36.0 250 30.0 543 33.0 Tidak 522 64.0 582 70.0 1104 67.0 815 100.0 832 1647 Memiliki ‘Income’ utama 307 37.9 236 28.5 33.2 503 62.0 591 71.5 1094 66.8 811 827 1638

FINANCIAL SUPPORT Table 2. Source of Financial Support Received by the Elderly, based on Location Source of Support from Urban Rural Total N % n Spouse 58 4.35 50 3.75 108 8.11 Son 217 16.29 236 17.72 453 34.01 Daughter 211 15.84 187 14.04 398 29.88 Son/Daughter In-Law 100 7.51 70 5.26 170 12.76 Grandchildren 27 2.03 29 2.18 56 4.20 Brother 15 1.13 10 0.75 25 1.88 Sister 13 0.98 7 0.53 20 1.50 Other 42 3.15 60 4.50 102 7.66 683 51.28 649 48.72 1332

SOCIAL SECURITY Social Security Urban Rural Total n % Pension Yes 188 23.53 111 13.37 299 18.35 No 611 76.47 719 86.63 1330 81.65 799 100 830 1629 Savings 87 10.88 34 4.09 121 7.42 713 89.13 797 95.91 1510 92.58 800 831 1631 Insurance 27 3.38 28 3.37 55 772 96.62 803 96.63 1575 1630 Others 25 3.18 15 1.82 40 2.49 762 96.82 807 98.18 1569 97.51 787 822 1609

Productive Ageing

Madrid International Plan of Action on Ageing ( Second World Assembly 2002) Three main streams: Older persons and development Advancing health and wellbeing into old age Ensuring appropriate and enabling environments

Ageing Policy Indonesia ‘s Law number 13 year 1998 On Older People Welfare . The Policy of Older People Well Being is also mentioned in Indonesia ‘s National Plan of Action for Older Welfare Guidelines, 2003.

Indonesia ‘s Law number 13 year 1998 On Older People Welfare (1) Older persons who are healthy and productive still can contribute their wisdom and experience for themselves and to their social economy, they are able to support themselves ; and (2) Older persons who are dependent , sick and non – productive have to be protected and adequately cared by the public

National Plan of Action for Older Welfare Guidelines,2003 There were seven startegic steps : Strengthtening institutions Coordination among institutions Improving management Empowering family and community Reinforcing health services Increasing older persons quality of life and Increasing availability of facilities.

HEALTH FOR ALL (WHO, 1980) PENDUDUK AKAN MENJADI: LANSIA MEMILIKI KEKUATAN DALAM KEHIDUPAN BEBAS DARI BEBAN PENYAKIT WASPADA BAHWA PENCEGAHAN LEBIH BAIK UNTUK MENCEGAH PENYAKIT MEMILIKI CARA MENJADI DEWASA, MENUA serta MENINGGAL DENGAN BAIK

Wellness in ageing Human Right Fulfillment for Older Persons will affect to Welness in Ageing as follows: Social Emotional Vocational Spritual Physical Intelectual Avoiding abuse in above mentioned aspects Council for Third Age,Singapore 2007; WHO, 2002

OLDER PERSONS AND DEVELOPMENT ACTIVE PARTICIPATION IN SOCIETY AND DEVELOPMENT INTERGENERATIONAL SOLIDARITY INCOME SECURITY , SOCIAL PROTECTION AND POVERTY PREVENTION EMERGENCY SITUATION

OLDER PERSONS EPIDEMIOLOGICAL CHALLENCE MORBIDITY AND MORTALITY HEALTH RISKS ACCIDENT MORE SPESIFIC FOR ELDERLY WOMEN

Geriatric Problems in Indonesia Nutrition problem Osteoarthritis and Osteoporosis Deppresion and dementia Incontinence DM Cardiovascular Cancer Hearing impairment Visual impairment Oral health problem and medically compromised Delirium Immobility and Falls ( MOH, 2003, Household Survey 2003, Rahardjo et al 2007)

Status Kesehatan dan Perilaku Kesehatan Good ADL Score: 70% ( independent) Feeling to have a good health : 81% Chronic disease : 74% Physical activity/exercise : 30% Medical check up: 27% ( Tribudi, 2006)

Status Kesehatan Lansia Sumber IFLS 2007

Status Kesehatan Lansia Sumber IFLS 2007

Status Kesehatan Lansia Sumber IFLS 2007

Status Kesehatan Lansia Sumber IFLS 2007

CONCLUSION: REGARDLESS OF THE OVERALL LEVEL OF OLDER PEOPLE’S FINANCIAL CONDITIONS BEING RELATIVELY LOW, MANY OLDER PEOPLE REPORTED STILL BEING ACTIVE , HAVING LOW PHYSICAL ACTIVITIES ACTIVITIES FINANCIAL LIMITED INCOME LIMITED SUPPORT LIMITED INSURANCE SOCIAL ACTIVITES HOUSEHOLD ACTIVITIES WORKING TO EARN INCOME HEALTH BEHAVIOUR Low Physical activities, Good Spiritual activities, High NCD Prevalence

HEALTH POLICY FOR OLDER PERSONS PROVIDING BASIC SERVICES IN PRIMARY, SECONDARY AND TERTIARY CARE FOCUS ON PROMOTION AND PREVENTION INTEGRATED APPROACH: GOVERNMENT, COMMUNITY, NGOs, OTHER STAKE HOLDERS PROFESSIONALISM , SKILLED HEALTH WORKERS LOCAL GOVERNMENT SUPPORT ENSURING HEALTH FINANCING AS A SUB SYSTEM OF NATIONAL HEALTH SYSTEM ( DONALD PARDEDE, MOH RI 2007)