Southeast Asia is home to some of the world's most rapidly ageing countries. This is the result of increased life expectancy and falling fertility rates.
In 1970, women in Southeast Asia had an average of 5.5 children. By 2017, that number was down to 2.1, and the total fertility rate dropped below the replacement level in Brunei, Malaysia, Singapore and Thailand. [i]
Countries with slow population growth tend to be ageing ones. This has held true throughout the ASEAN region as every nation has experienced an increase in median age since 1970. By 2035, it is projected that 26.6 percent of Singapore's population will be 65 or older, while the same group is expected to reach 22.8 percent in Thailand. In Vietnam, the proportion of those over 80 will rise to 20 percent by 2038. [ii]
An ageing population shifts the narrative for the region's economic growth prospects, as a declining working-age population pairs with an increasing old-age dependency ratio.
On a cultural scale, two factors tend to make a society more ageist -- scarce resources and a growing percentage of older people in the population. More older people will need health and social care and financial security for retirement needs.
The term "ageism" was coined by gerontologist and author Robert Butler, MD. According to him, ageism has three elements - prejudicial attitudes towards older people and the ageing process, discriminatory practices against older people, and institutional practices and policies that perpetuate stereotypes about the elderly. [iii]
The World Health Organization's Global Report on Ageism[iv] states that one out of every two people on earth may harbor ageist attitudes. Ageism is everywhere and it impacts everyone. We need to recognize it in our part of the world and take measures to reduce it. Compared to racism and sexism, ageism is the most socially normalized "prejudice." Its consequences affect us deeply as individuals and the societies we live in.
Like the racist and the sexist, the ageist relies on the concept of "othering" -- where we see a group of people as being unlike ourselves. That perceived difference leads to bias and prejudice.
Ageism exists because of fear and denial that we will become the other person -- the older person whom we see as an unwelcome stereotype. All of us are exposed to negative images and messages about older people from society at large, the media, movies and negative stories about older people. Through these experiences, our brains become wired to implicitly believe that becoming old means going downhill both cognitively and physically. Thus, we might consider ageism to be a coping mechanism that allows people to avoid thinking about their own mortality.
All "isms" are socially constructed ideas that pit us against one another, but ageism's target makes it a singular and strange phenomenon. Of the three categories of 'isms' -- sex, race and age -- age is the only one in which the members of the in-group (the young) are destined to join the out-group (the old). Ageism is therefore prejudiced against our future self -- our feared future self. That is why I find it strange that although ageism can compromise the quality of our own life into old age, many of us become ageists.
Ageism in the Workplace
Data from ADP's Global Workforce View 2020 report shows that Singaporean workplaces have some of the highest incidences of age discrimination in the Asia-Pacific region, with 17 percent of workers saying they have experienced such discrimination in their current role. The survey found the regional average to be 12 percent and Asia-Pacific has the highest regional incidence of perceived discrimination. [v]
Embracing today's greater longevity requires policymakers and employers to reject yesterday's preconceptions about ageing. Chronological age does not equate with function and does not equate with cognition. Ageing is also very heterogenous and so it should not be used as a proxy for capability. As such, we should do away with our policies of fixed retirement and re-employment age, as is the practice in Singapore.
Despite reported ageism in the workplace, the Philippines is the only country in our region that has any legislation which expressly prohibits age discrimination. In Singapore, there are only guidelines regarding fair treatment in the workplace by the Tripartite Alliance for Fair & Progressive Employment Practices (TAFEP). This is not enough. Fortunately, Singapore is working to codify the current workplace anti-discrimination guidelines into law. Employers have to face the reality that the workforce is ageing, and it would be to their benefit to continue to upskill and retain their older workers. Practicing ageism is not a productive way to go.
Companies must ensure that their employees -- including their leadership -- attend sessions to be aware of unconscious biases directed towards older workers. This needs to be part of their diversity, equality and inclusion (DEI) agenda. We are living longer, so each new cohort of the older population is effectively younger and should not be discriminated against because of chronological age. Their ability to do the work is what is important. Leaders must recognize the value of the experience and institutional memory of older workers. They should also organize the transfer of skills between generations and teach younger leaders about reverse mentoring.
In addition, older workers have to rid themselves of the negative perceptions of ageing. They should engage in lifelong learning and try to build allies with younger co-workers throughout their working careers. Doing so will deliver individual and collective benefits.
Ageism and Gender
Outside of the workplace, ageism also impacts our daily lives and the gender dimension of ageism is a double blow for women. For some women, ageism is worse than the ageing process itself. In our culture and elsewhere, youth and beauty are greatly prized, especially for women. Women become "older earlier" and are more often judged by their physical appearance, rather than their accomplishments.
Grey hair and facial lines are seen as making men look distinguished and experienced whereas they merely make women look "old." Therefore, women often disguise the fact that they are ageing. That is one reason why many women do not like to tell their age. Old age seems to make women invisible and therefore, many women want to avoid looking old so that they are not overlooked in their attempt to remain socially and professionally engaged. This is one reason why the aesthetic industry is so successful and so many of its clients are women. We should work toward a genderless outlook on ageing in which everyone is recognized and appreciated for the experience their years have given them.
Ageism and COVID-19
The COVID-19 pandemic has helped expose ageism and age discrimination in society. In a statement published during the pandemic, Claudia Mahler, the United Nations Independent Expert on the enjoyment of all human rights by older persons, called for urgent action against ageism. As she noted, "Ageist comments and hate speech were ripe with older persons being blamed as the reasons for lockdowns and labelled as vulnerable and burdens to societies." [vi] In reality, society placed greater burdens on older people during that time as our ageist assumptions made it "more difficult for older persons to get equal access to medical care." [vii]
One study found the pandemic compounded the impact of ageism and that those effects might outlast the challenging circumstances in which they arose.
As the researchers noted, "Being the target of ageism during the crisis negatively affects older adults' self-perceptions of ageing and this impact may be felt beyond the current crisis." [viii] The same study noted that while we develop subjective perceptions of ageing early in life, they "can change over the life span as a function of experiences."
Internalization of Ageism by Older People
One of the most insidious effects of ageism is that older people internalize negative attitudes which become self-relevant and self-fulfilling prophesies. The older person then feels that it is not worth trying to age actively, not worth doing routine health screening, not worth living a healthy lifestyle and that nothing can be done about frailty and disease as they are part of getting old. It is crucial that we consider the effects of ageism as we develop and enact policies to keep older people healthy via beneficial efforts like age-friendly housing, affordable health care and senior centers.
It is interesting to note that credible scientific research has shown that negative and positive self-perceptions of ageing can have profound effects on health and longevity.
One study found that older people with more positive self-perceptions of ageing, measured up to twenty-three years earlier, lived 7.5 years longer than those with less positive self-perceptions of ageing. This advantage remained after age, gender, socioeconomic status, loneliness, and functional health were included as covariates. [ix]
The results of another study suggest that positive age beliefs -- which are modifiable and have been found to reduce stress -- can act as a protective factor. It further found that these benefits occur even for older individuals at high risk of dementia. This is the first study to link the brain changes related to Alzheimer's disease -- a devastating neurodegenerative disorder that causes dementia in millions of people worldwide -- to a culturally-based psychosocial risk factor. This last study suggests that combatting negative beliefs about ageing could potentially offer a way to reduce the rapidly rising rate of Alzheimer's disease. [x]
In Singapore, the statistics for dementia are worrying -- one in ten people over the age of sixty and one in two over the age of 85 have dementia. Over 100,000 are estimated to be diagnosed with dementia in Singapore. [xi] Therefore, our health strategy must prioritize combatting negative beliefs about ageing.
Managing Ageism
Ageism exists in our institutions, our relationships and ourselves, and so we have to work at all these levels to reduce ageism.
On an individual level, we should explore and explode our own unconscious biases. A common example is when an older person forgets something, he or she will say apologetically, "I'm having a senior moment?" Younger people also forget things, but they do not say, "I am having a junior moment."
Ageism can change us in many ways. It can alter our perceptions of ourselves and negatively impact our health, longevity and well-being. It can create generational divides, thereby limiting the benefits of interaction between those groups. Ageism can also foster serious economic consequences. [xii]
On the family level, some young people here and
in other Asian societies have a misplaced sense of filial piety. They show their love and devotion by putting too many restraints on their elderly parents.
While moderate shows of affection elevate the mood of the older person, too much support can reinforce feelings of inadequacy. This can make older people feel powerless and vulnerable, which can lead to depression.
Tough love is a concept that is familiar to many. The phrase commonly applies to raising youth. However, older people can also benefit when adult children allow their elderly parents to live as independently as possible and accomplish certain activities by themselves. In the long run, tough love tactics can help the older person.
On the societal level, we have to work towards building age-integrated societies. Such age-integration could bring about positive changes in our thinking, behavior, policies and institutions.
Singapore is one of the fastest ageing countries in the world and is going through an unprecedented demographic transition. For Singapore to cope effectively with this demographic challenge, it needs to convert its ageing society into a longevity society. Andrew J. Scott offers this wisdom: "An ageing society focuses on changes in the age structure of the population, whereas a longevity society seeks to exploit the advantages of longer lives through changes in how we age. Achieving a longevity society requires substantial changes in the life course and social norms and involves an epidemiological transition towards a focus on delaying the negative effects of ageing." [xiii]
Ageism is a major barrier to achieving an age-integrated longevity society.
The media plays a major role in perpetuating stereotypes of age. The ways in which older people are represented in the media can have a lasting impact on attitudes, reinforcing stereotypes held both by the young and by older people themselves.
Dr Becca Levy and her colleagues estimate that age discrimination, negative age stereotypes, and negative self-perceptions of ageing lead to billions of dollars in excess annual spending in the US on common health conditions like cardiovascular and respiratory disease, diabetes, and injuries.
We need data like this in Southeast Asia to spur us to take action against ageism instead of wringing our hands about how the ageing population is pushing up health care costs.
To say the least, ageism is hardly benign --- it can foster serious economic, social and health consequences. It can have a direct effect on people's livelihoods, health and function.
A wide-ranging public conversation is essential, as the ageing of the population is one of the biggest demographic and socio-economic challenges in our recorded history. Whether this challenge will be a boon or bane depends on each nation's policy response. If we make the appropriate adjustments to become an age-integrated longevity society, then we can benefit from the "longevity dividend."
How can we become an age-integrated longevity society?
An age-integrated society builds on the complementarity of qualities and skills of both younger and older people. We must more vigorously create the conditions for the old and the young to study, work, and live together. Older people want to age and die in the community and not in old age homes. We can adapt our built environment to create more spaces where old and young interact and support and learn from each other. For example, why not build senior care centers that are also student care centers, with opportunities for the different generations to bond over common interests? The Aconchego program in Portugal aims to increase intergenerational contact by arranging for older people to provide housing to university students. In exchange, the students help alleviate older people's loneliness and isolation. [xiv]
Why not ensure that all working spaces are multigenerational? Why not do away with policies that have fixed retirement ages? Because age is not a reliable indicator for judging workers potential productivity or employability -- chronological age does not equate with function and does not equate with cognition. To bring about this shift will require changes to the way we run businesses, as well as the outlooks and actions of individuals and society as a whole.
It is worth pointing out that the establishment of an age-integrated society will spur the formation of an inclusive society. Older people are from different genders, ethnic groups, religions and abilities, and if we accept them for themselves and feel no prejudice against them and our future selves, then other "isms" will also melt away from our consciousness and we will be on our way towards universal human solidarity.
* This is an edited version of the article of the author in Digest, 18 August 2023, entitled "The Story of Ageism in the Southeast Asian Region," https://digest.headfoundation.org/2023/08/18/the-story-of-ageism-in-the-southeast-asian-region/#easy-footnote-3-40502.
Dr Kanwaljit Soin is a well-respected orthopaedic and hand surgeon. She is also a former and Singapore's first female Nominated Member of Parliament, from 1992-1996. Dr Soin, who was inducted into the Singapore Women's Hall of Fame in 2014, is actively involved in welfare and advocacy organizations. She is also the author of Silver Shades of Grey: Memos for Successful Ageing in the 21st Century.
For further information, please contact: The Head Foundation, 20 Upper Circular Road The Riverwalk #02-21 Singapore 058416; ph (65) 6672 6160; fax (65) 6672 6189; e-mail: info@headfoundation.org
[i] Fertility, OECD logoSociety at a Glance: Asia/Pacific 2022, OECD iLibrary, www.oecd-ilibrary.org/sites/c416afed-en/index.html?itemId=/content/component/c416afed-en; The ASEAN Post Team, Declining fertility rates in ASEAN, The ASEAN Post, 29 March 2020, https://theaseanpost.com/article/declining-fertility-rates-asean. https://theaseanpost.com/article/declining-fertility-rates-asean
[ii] The ASEAN Post Team, Southeast Asia's rapidly ageing population, The ASEAN Post, 16 February 2020, https://theaseanpost.com/article/southeast-asias-rapidly-ageing-population.
[iii] See Sheldon Ornstein, Ageism and Aging, American College of Health Care Administrators, www.achca.org/index.php?option=com_dailyplanetblog&view=entry&category=aging&id=50:ageism-and-aging. Read also Robert N. Butler, MD, "Age-Ism: Another Form of Bigotry," The Gerontologist, Volume 9, Issue 4_Part_1, Winter 1969, pages 243-246, available at http://agisme.eu/wp-content/uploads/2018/02/Butler-Ageism.pdf.
[iv] Global report on ageism, WHO, www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism/ global-report-on-ageism.
[v] Mint Kang, Singapore has most age discrimination in APAC, People Matters, www.peoplemattersglobal.com/news/diversity/singapore-has-most-age-discrimination-in-apac-27840.
[vi] Pandemic exposes ageism and age discrimination in society, says UN expert, United Nations, 30 September 2021, www.ohchr.org/en/press-releases/2021/09/pandemic-exposes-ageism-and-age-discrimination-society-says-un-expert.
[vii] Pandemic exposes ageism and age discrimination in society, says UN expert, United Nations, ibid.
[viii] Anna E. Kornadt, Isabelle Albert, Martine Hoffmann, Elke Murdock, Josepha Nell, "Perceived Ageism During the Covid-19-Crisis Is Longitudinally Related to Subjective Perceptions of Aging," Frontiers Public Health, Volume 9, 13 July 2021, www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.679711/full.
[ix] Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V., "Longevity increased by positive self-perceptions of aging," Journal of Personality and Social Psychology, 83(2), 261-270, 2002. https://doi.org/10.1037/0022-3514.83.2.261.
[x] Becca R Levy, Martin D Slade, Robert H Pietrzak, and Luigi Ferrucci, "When Culture Influences Genes: Positive Age Beliefs Amplify the Cognitive-Aging Benefit of APOE ε2," J Gerontol B Psychol Sci Soc Sci. 2020 Oct; 75(8): e198-e203, www.ncbi.nlm.nih.gov/pmc/articles/PMC7489069/.
[xi] Understanding Dementia, Dementia Singapore, https://dementia.org.sg/dementia/singapore/.
[xii] Questions and answers/Ageing: Ageism, WHO, 18 March 2021, www.who.int/ageing/features/faq-ageism/en/.
[xiii] See Andrew J. Scott, "The longevity society," The Lancet, www.thelancet.com/journals/lanhl/article/PIIS2666-7568(21)00247-6/fulltext.
[xiv] For more information on the Aconchego Program, read Age-friendly World, https://extranet.who.int/agefriendlyworld/afp/aconchego-program/.