Hong Kong’s ageing time bomb a cause for concern
A look at how the city’s demographics have changed over the past 20 years and the dangers that lurk going forward
People have been spending their whole lives trying to live longer, but to 93-year-old Sum Shuet longevity is nothing but a curse.
“I hope my son will fall asleep soon so I can also sleep,” Sum said, referring to the Chinese metaphor which essentially means death. “I do not want to live any more.”
The nightmare dates back 13 years when Sum’s then 55-year-old son, an electronics repairman and the breadwinner of the family, had a stroke which left him staying in a care home.
Instead of being taken care of, the nonagenarian, who suffers from diabetes and hearing problems, has since resumed her role as her son’s caretaker. She has been visiting him every day, rain or shine, with the help of walking equipment.
“I once asked the doctor why other patients passed away soon after they were admitted to hospital but not my son,” Sum told the Post in a weak voice.
“I just want him to sleep soon so I can follow him ... Life is too painful for me.”
Sum’s sad case is not an isolated one.
It highlights a few problems arising from the fast greying population – the growing trend of elderly people taking care of their older family members, as well as the lack of community-based services and an age-friendly environment that encourage active ageing.
Hong Kong’s men and women also enjoy the longest life expectancy in the world – 87 years for women and 81 for men – implying that more people will be relying on social services paid by a shrinking workforce.
THE AGEING TREND
In just two decades, the percentage of residents aged 65 or over rose from just 10.3 per cent of the population in 1997 to 16 per cent in 2016. This is expected to balloon to 24 per cent by 2025.
By 2041, it is projected that almost one in three will be aged 65 or above.
Meanwhile, the median age climbed from 34.7 the year the city’s first chief executive, Tung Chee-hwa, took office to 40 by the time his successor, Donald Tsang Yam-kuen, was re-elected in 2007.
But Hong Kong has aged in a multitude of ways. With more grey-haired people on the streets, the number of elderly involved in traffic accidents is also increasing. From just 21 per cent of road traffic pedestrian casualties in 1997, those aged 60 and above now comprise 32 per cent of accident victims.
When the first census after the handover was conducted in 2001, the proportion of elderly people in about half of the city’s 18 districts was still below 10 per cent. Fast forward to the 2016 by-census and more than a tenth of people in each district were elderly. The main areas were Wong Tai Sin, Kwun Tong, Southern and Eastern.
In the absence of a universal pension scheme, a significant number of the elderly residents, particularly those living alone, are also struggling to make ends meet. In 2015, 30.1 per cent of elderly people were living in poverty, more than double the overall poverty rate in Hong Kong.
Demand for care services, such as membership of neighbourhood elderly centres, almost doubled from 77,000 in 2003 to more than 143,000 in 2015.
The severe shortage of subsidised nursing home places means the elderly have to wait an average of 26 months. In 2015, 5,881 people on the waiting list died, up 73 per cent from 2005.
“AGEING IN PLACE”
In 2014, the government tasked the Elderly Commission with formulating an Elderly Services Programme Plan aimed at achieving “ageing in place”, or moving towards community-based support services as opposed to care homes. As a result, the elderly have been given vouchers to choose the types of services that best suit their needs.
However, veteran social worker Ng Wai-tung, who has been following Sum’s case, slammed government for not doing enough. “No senior resident would like to give up their freedom and stay in residential care centres,” he said. “But the fact is they are not safe at home.”
The residential respite service also required advance booking for up to 14 days, meaning people were unable to seek immediate relief when they could not take care of elderly family members.
Ng recalled the case of a 70-year-old woman who refused to go into hospital because she could not find her 80-year-old husband, a dementia sufferer,temporary accommodation at short notice.
“The respite service amounted to nothing in the end.”
In contrast, Taiwan provided a hotline for families in need of immediate temporary residential services for the elderly, he added.
“Senior residents in other countries can go on carefree trips following their retirement with their monthly pension,” Ng said. “Yet in Hong Kong, there are many barriers that bar elderly people from getting subsidies and support. The government has always been saying they would respect the seniors, but what have they done?”
Dr Lam Ching-choi, chairman of the Elderly Commission, said the clear goal of “ageing in place” had put the city on the right policy path, although he admitted huge hurdles remained.
“The volume of community care services is indeed insufficient and the quality of many private nursing homes is questionable,” he said.
Lam attributed the problem to staff shortages in nursing homes and difficulty in finding land for day care and nursing facilities.
“I sincerely hope the next administration can make a change,” he said, referring to incoming chief executive Carrie Lam Cheng Yuet-ngor, who officially takes the helm on July 1.
RISE OF DEMENTIA
An ageing city has also brought about a big increase in dementia rates, which are expected to worsen over the next decade. Dementia is already the eighth leading cause of death here.
Studies show that in 1995, two years before the handover, just 4.5 per cent of those aged 70 or above had dementia. According to the Elderly Services Programme Plan, one in 10 of those over 65 now suffers from dementia, most commonly Alzheimer’s disease.
“To reduce dementia rates, we need to develop effective therapies to help reverse degeneration [of the brain]. But a major obstacle is the lack of understanding of the pathophysiology of Alzheimer’s,” said Professor Nancy Ip Yuk-yu, an internationally renowned expert on neurodegenerative diseases at the University of Science and Technology.
This year the government launched a two-year pilot scheme to provide support for sufferers through the dementia community support via the Community Care Fund.
Though more residents now suffer from dementia compared to 20 years ago, Ip said the good news was that the neuroscience field in Hong Kong had also grown in tandem over the same period.
“The neuroscience community in Hong Kong has established a strong foundation for basic research, and much of the work being conducted is at the forefront of the field,” she said.
“We have elucidated disease mechanisms and identified signal pathways involved in disease progression, through which we have not only shed new light on disease pathophysiologies, but have also identified new drug targets, which are essential in developing effective therapeutic drugs.”
In April last year, the university announced that Ip and her team had made a potential breakthrough in the fight against Alzheimer’s by restoring the memory of mice with dementia by injecting them with a protein.
But while, the government has provided additional support for research in recent years, lawmaker Fernando Cheung Chiu-hung said there are still inadequacies in terms of support for dementia patients and their caregivers
One example, Cheung said, was that government initiatives on dementia were tied to its elderly policy meaning early onset sufferers below the age of 65 – especially if they are not physically disabled – were often not eligible for any of the government’s assistance schemes such as medical vouchers or day care services.
“There are still many policy blind spots,” Cheung said. He also pointed to there being no subsidised elderly care facilities that had specialised services catering to dementia sufferers and even fewer support services provided to help families taking care of family members with dementia.
The number of dementia patients in Hong Kong is estimated to be about 100,000, about 28,000 of whom are receiving care services under the Hospital Authority.
A SHRINKING LABOUR FORCE
The growing number of elderly people requiring assistance is however relying on a shrinking labour force, with the city on track to losing 14 per cent of its labour force over the next 50 years.
Chou Kee-lee, chair professor of social policy at Education University, said the top end of the population pyramid would fatten even more over the next 20 years as more baby boomers – those born between 1946 and 1964 – retired from the workforce.
“The pace of ageing will rapidly increase as more people born in the two decades after the war reach retirement age,” he said. “Society really needs to think about the situation, and whether it should be doing more to help the elderly continue contributing to the economy.”
Chou said it helped that the concept of old age had changed. “Twenty years ago 60 was already quite old and bodies at 60 were quite weak. Nowadays, as education, incomes and health standards increase, 60 is not really considered that old. Sixty will probably be the new 40.”
Professor Paul Yip Siu-fai, a population expert at the University of Hong Kong, said apart from trying to lure quality migrants, the city must provide choices for older people in the job market.
“Hong Kong is not an age-friendly city but instead a place full of age discrimination,” he said, citing its low elderly employment rate of less than 40 per cent compared to more than 50 per cent in Japan.
The city, he said, had already missed the golden opportunity to tackle the ageing issue during the demographic window – the time when there was a relatively high proportion of people of working age and the government had more resources available.
“If we do not work on it today, it will be almost impossible to do so in future,” Yip warned.
CHEUNG SUET-LING’S GOLDEN YEARS
Cheung Suet-ling is widely regarded as the perfect example of active ageing after winning a gold medal in athletics at 93.
She made the headlines in March at the World Masters Athletics championships in South Korea when, as the sole competitor in her age group, she crossed the finishing line of the women’s 60 metres in 25.73 seconds.
“I have become more cheerful and happier [after training] and people no longer treat me as an old lady,” says Cheung, who can easily touch her toes in her colourful sports outfits.
She was somewhat reluctantly introduced to sporting circles last year by daughter Lai Yin-mei, 58, a retired athlete who was moved to tears some time ago by the pride and confidence shown by elderly competitors at a regional championships.
Lai says her mother, the city’s first such gold medallist, is lucky compared to many others of her age, having a cheerful personality and no need to worry about money.
Yet she says it is care from family members that has made her mother’s active ageing possible.
“I am not saying the government should not do anything, but the fact is everyone should also think whether they have done enough [to take care of their elderly family members],” Lai says.
She put her words into action by bringing Cheung into her own social group because many of her mother’s friends died more than 20 years ago.
“My friends have been very acceptive of her and she keeps making new ones,” Lai says.
“Her training does not actually mean huge changes to her life – it is just a new hobby that further occupies her time.”
Lai laments the social trend that has seen young people move away from families and distance themselves from the elderly.
“The happiness brought to the elderly by their family members cannot be compared with the extra subsidised nursing homes built by the government,” she says.
“Society should not put the whole burden [of taking care of the elderly] on the administration.”