Written by Irene Meier, scientific advisor for swissnex Brazil
When I first arrived in Rio de Janeiro, I was struck by the treadmills, elliptical machines, and stationary bicycles on every major plaza and on many street corners. These free open air “gyms for the third age”, invitingly colorful and populated at all times, day and night, are geared towards the elderly population and serve equally as sports facility and neighborhood gossip central. Along with the vigorously enforced special queues for over-sixty-year-olds in every supermarket, bank or post office, they stand as symbols of Brazilians’ respect for their seniors. But is Brazil ready to absorb and care for a rapidly aging society?
According to the Brazilian Institute on Geography and Statistics (IBGE), there are currently 22 million people (=10.7%) above age 60 living in Brazil. Until 2050, they are supposed to make up almost one-fourth of the population. In low- and middle-income countries, such a rapid growth is largely the result of reductions in mortality at younger ages, particularly during childhood and childbirth, as well as infectious diseases. Furthermore, the World Report on Aging and Health from 2015 (WHO Library Cataloguing-in-Publication Data: ISBN 978 92 4 156504 2) states that a child born in Brazil in 2015 can expect to live 20 years longer than one born just 50 years ago. However, the pace of the aging population is much greater than in the past, indicating that Brazil will only have slightly more than 20 years to make the same adaptions as France made in almost 150 years to adapt to a change from 10 to 20% in the proportion of the population older than 60.
In a personal communication from March 2015, the city public health manager of Pernambuco, Eduardo Augusto Duque Bezerra, emphasized that, while the national aging and health policy only recently called attention to the overlooked needs of the country’s aging population, the policy has since facilitated better care for the elderly thanks to universal health coverage and a robust family health. As one of the key features of the program, he names the multidisciplinary teams made up of doctors, psychologists, physical educators and physiotherapists, nutritionists and others, providing social services, community outreach and home visits. All health workers are trained to assess frailty and functioning, and maintain a strong referral link established with primary health-care clinics (However, no results of this case study have been documented until today). Beyond that, newer interventions target the establishment of self-help groups, classes to encourage healthy behavior, exercise, and dance classes – including the public gyms mentioned above. The program seems to excel in engagement and participation of communities. Additionally, it ensures free supply of five essential medicines to older people receiving treatment through its public-health system, including medicines for chronic diseases (WHO Report, 2015).
However, the implementation of such an effort is rather difficult in an economically unstable country such as Brazil, and the progress is only slowly made. In addition, demographic aging indicators from Fiocruz point at a disequilibrium and regional differences in health access for older people, which seems to be easiest in the Southeast of the country, followed by the South, and more difficult in the Northeast, Central-West, and finally the North of the country. Researchers attribute these differences mostly to income and education.
Taken together, this means that there are barely any facilities available for older individuals, nursing homes are a rarity, and care usually lies in the hands of relatives. The lack of memory clinics for cognitive assessment of the aging brain, and minimal coursework in neuropsychology and geriatric areas further reveal that there are also not enough trained specialists around. Professionals as well as economists agree that the current public health politics are not enough to increase the quality of life of the elderly, and that it will indeed be more expensive to take care of a sick and demented population than implementing preventative measures in a healthy one. And while there are in fact a few promising government-funded multi-site, multi-ethnic research initiatives under way, funds are often uncertain, funding may unexpectedly end, and studies may have to be supported out of the principal investigators’ own pockets, which has already led to the emigration of talented and renowned researchers lately.
A further deterrence in providing health services and in the introduction of new products and inventions in Brazil is the national agency for sanitary vigilance (ANVISA), which is chronically understaffed and takes at least 12 months for approval of new proposals, considerably and unnecessarily slowing down the process, implying high costs and risks.
The private sector seems to be more promising in providing support for the elderly: businessman and medical doctor Benjamin Apter from São Paulo opened up the first conceptualized and staffed ‘gym for older individuals’ (Academia B-Active) about a decade ago. And while he reports a continuously increasing number of enrolled ‘students’, he says that it was a very slow growth process. Similarly, another local entrepreneur saw a market niche in building a supermarket specialized in products of health and wellbeing, that stocks about 500 different articles, of which 70% are particularly valuable for older adults, and that is staffed with specifically trained employees.
In an interview with the psychiatrist and head of the memory clinic of Instituto D’Or of Research and Education in Rio de Janeiro, Dr. Paulo Mattos further points out that the elderly population requires a wide range of different strategies, from infrastructure to personnel, and that different age-related diseases call for attention different from the ones of the rest of the population, as they bear the load of chronic disease, more frequent medical attention, higher consume of medicine, medical tests, and hospitalizations. Hence, he criticizes that it is unwise not to plan for all those needs in advance and confirms that Brazil is not ready for this change in population growth.
From the point of view of a clinician, he explains that Brazilians do not have the ingrained ‘perspective’ of getting old and do not prepare adequately for this period of life in the same way as other countries do, which means: from planning and organization of financial life until making living adjustments at home. He calls this the main reason for why one can see autonomous American and European elderly people living in a protected specialized home, while in Brazil, they are only referred to such institutions once they are very ill, too frail, or when the family cannot deal with the burden of caretaking any longer.
Dr. Paulo Mattos leads one of these few memory clinics (Center of Applied Neuropsychology) in Brazil and calls it different, as it is both, a research center and outpatient facility for specialized diagnoses. The vast majority of patients are referred by geriatricians, neurologists, and psychiatrists for memory deficit investigation, where clinical, neuropsychological, neuroimaging, and blood work up is done, as well as various lines of research carried out related to aging diseases. Based on his experience, he considers the next pressing steps related to aging research in Brazil to be the implementation of more efficacious diagnostic strategies, but also to deepen our understanding of risk factors, in order to reduce morbidity and mortality through early interventions. He sees the strength of Brazilian research in the field in highly productive research centers with myriad collaborations nationally and internationally, and that dementia is among the three main topics in Brazilian’s scientific output in medicine. These facts and opportunities render Brazil an attractive and competitive – yet often underestimated – research place.
Taken together, it seems that Brazil is getting aware, is already scientifically savvy and on the forefront, but practically still unprepared for the increasing number of older individuals. Where information remains meager is the area of (geronto-)technology and startups in the field. Efforts and investments are rather sparse and call for more private initiatives, and the increasingly aging population – whether healthy or sick – promises an interesting market for investments in this area in Brazil.