Different Approaches to Combatting Ageism

### **Chapter 1**

### Contemporary Human Rights Law and Ageism

*Barbara Mikołajczyk*

### **Abstract**

The continuously and dynamically growing number of older persons worldwide experience various types of exclusion, negligence, isolation, degrading treatment, elder abuse and the deprivation of a long list of their human rights. Regardless of residence and standard of living in a given country, older adults are the most excluded from the mainstream. Just as racism or sexism leads to a violation of the dignity and rights of people of a different race or gender, so ageism has a similar effect. Therefore, combating ageism is a challenge to international human rights law. This chapter is based on the core human rights treaties and the latest developments of the international community in combating ageism. Selected human universal and regional rights treaties along with soft law documents are analysed. The activities of the human rights bodies, including the independent expert on the enjoyment of all human rights by older persons, are also reviewed as the author focuses on human rights law in action. The author intends to indicate the untapped potential of states' current international obligations, international mechanisms and gaps in addressing ageism at the international forum.

**Keywords:** older persons, ageism, human rights, age discrimination, international human rights bodies

### **1. Introduction**

Like the phenomena of sexism, racism and ableism, it is clear that ageism also existed before it was given a name and analysed by scholars from various scientific disciplines and perspectives. However, we usually count the 'history of ageism' from the time when Robert N. Butler used the term 'age-ism' during a Washington Post interview in 1969 [1]. He coined it as the 'prejudice of one age towards other age groups' [2]. Later, when relating to ageism against older adults, he described it as 'a process of systematic stereotyping and discrimination against people because they are old, just like racism and sexism' [3]. He aligned ageism with negligence, ignorance and the damaging assumption that older adults are old-fashioned, unproductive, incompetent, slow-thinking, inflexible, unattractive, sexless, etc. [4].

Ageism manifests itself in various individual and institutionalised forms, ranging from elder speak, disregard and mockery, through neglect, segregation, social isolation and financial and corporal abuse, to extermination, defined as a conscious attempt to shorten the 'worthless' or suffering-ridden life of an older person [5].

Moreover, new forms of ageism are constantly being identified, for example, those that include the introduction of policies and strategies that are designed to meet the needs of older people but which, in fact, stigmatise them or require them to be constantly active, regardless of their capabilities [6, 7]. Regardless of the gravity of the manifestation of ageism, its form and scale, ageism always leads to a violation of human dignity. For this reason, ageism should be a concern of international human rights law, as human dignity is the essence and source of all human rights. That is why states' and societies' awareness of ageism is a preliminary condition for the effective protection of older persons' rights.

Along with ongoing research, the concept of ageism has been evolving. It has appeared, for example, that ageism should not be put into the same box as sexism and racism, as the group of older adults exposed to ageism is heterogeneous and, therefore, unlike sexism and racism, is much more difficult to identify [8]. Paradoxically, age lacks a clear threshold and is not a connecting factor for older persons, as they are people of different ages, living conditions, health and needs [9]. Indeed, the older population is much more similar to people with disabilities, who are also of various ages, types of disability and with diverse needs.

This chapter is a study in human rights law, so the newest analysis of 'ageism' proposed at the international forum should be presented here. In March 2021 the World Health Organisation (WHO) published 'Kicking Off a Global Conversation about Ageism: the Launch of the First UN Global Report on Ageism' (Global Report on Ageism). This report brings together the global output in identifying ageism and its determinants and explores three levels of manifestation of ageism – institutional, interpersonal and self-directed. Explicit [conscious] and implicit [unconscious] forms of expression of ageism are also addressed in the report [10]. Finally, it proposes interventions to reduce this phenomenon.

However, what is particularly relevant to this study, the report contains a comprehensive description of ageism. It is defined as a multifaceted social phenomenon that has stereotypes, prejudice and discrimination directed towards others or oneself based on age. The first relates to human thoughts, prejudices towards feelings, and finally, discrimination of actions or behaviours. Age stereotypes [positive or negative] tend to differ by context and culture. Prejudice is an emotional reaction or feeling (positive or negative) that is directed towards a person based on their perceived (age) group membership, and it contributes to creating or maintaining hierarchical status relations between groups. Age discrimination is the easiest to identify as it relates to behaviours – including actions, practices and policies – that are directed towards people based on their age [10].

This conception of ageism seems to unite previous proposals for definitions, which often assumed that ageism is a unique form of age discrimination [11–13], or conversely treated ageism as a source of discrimination and other negative behaviours towards older adults, and have usually qualified it as a feeling, idea or belief, or even an ideology [5, 14].

Over the years, the phenomenon of ageism, its determinants, aspects, consequences and scale have been the subject of diverse multidisciplinary studies, analyses and meta-analyses on ageism, provided by gerontologists, psychologists, psychiatrists, sociologists, medics and researchers from other disciplines [11, 12, 15–28]. This phenomenon is also the subject of research from the perspective of the international protection of human rights and the obligations of states in this area [29–38]. However, as the world's population is ageing, and the global treaty on the rights of older persons is constantly 'under construction', the research in this area needs further development.

*Contemporary Human Rights Law and Ageism DOI: http://dx.doi.org/10.5772/intechopen.106541*

Therefore, the formal dogmatic method in legal science is applied in this chapter. The primary research material is act of international law (hard and soft) and the output of human rights bodies in identifying, condemning, and redressing ageism. Moreover, a review of human rights literature supports the analysis of legal acts. The contributions from other scientific disciplines are used only as auxiliary.

Such an approach should help confirm the hypothesis that international law has the potential, currently untapped, to counter ageism affecting older persons, especially those belonging to vulnerable groups. That is why the main goal of this chapter is to assess the progress in the visibility of 'ageism' in international documents that are able to (at least potentially) affect states' policies and laws to reduce ageism at domestic levels. Another goal of this chapter is to identify new or still underestimated areas in which the international community's action against ageism is desirable.

### **2. Blindness of the treaties**

Any discourse on the elimination of ageism in international human rights treaties should begin with the Universal Declaration of Human Rights (UDHR), even though it is not a treaty. This is primarily because it is ascribed the force of customary international law, and because it gave rise to all presently binding international human rights treaties. According to its Preamble, 'recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world'. Its Article 1 states that 'Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status [39]'*.*

The recognition of human dignity and non-discrimination, as stipulated in the UDHR, became an inspiration for the whole human rights system. Thus, human dignity is invoked in various international acts, including the International Covenant on Civil and Political Rights [40] and the International Covenant on Economic, Social and Cultural Rights [41] adopted in 1966. In addition, the concept of dignity has been introduced into treaties protecting particular groups of people, such as children, women, migrant workers, disabled persons and victims of involuntary disappearances, as well as into treaties protecting specific human rights and freedoms, especially freedom from torture and racial discrimination. We can also find some references to human dignity in the international labour and environmental and humanitarian laws [42–46].

Indeed, the protection of human dignity underpins protection against phenomena such as sexism, racism, ableism and ageism, but it would be naive to believe that general references to dignity in international law are sufficient to protect older adults from ageism. First of all, 'human dignity' is not defined in international acts and, in spite of a common appreciation, it is unclear, disputable and causes many interpretive difficulties [8, 10, 14, 38]. Usually, understanding a violation of human dignity requires an in-depth case study and sensitivity to various nuances. As indicated above, seemingly beneficial solutions can conceal ageist attitudes against older persons, which is why ageism needs targeted, legal and extra-legal actions to combat it. General references to human dignity are simply starting points for further developments.

Unfortunately, there is no universal, sectoral convention on the protection of human rights in old age that could play an educative role among the international community and raise awareness of decision makers on the rights of older persons and the harmful effects of ageism.

Surprisingly, two treaties that are considered milestone achievements of regional communities – the Inter-American Convention on Protecting the Human Rights of Older Persons of 2015 [47] and the Protocol on the Rights of Older Persons to the African Charter on Human and Peoples' Rights of 2016 [48] – do not mention ageism' at all. On the other hand, they contain provisions obliging the state parties, to take steps towards eradicating prejudices, stereotypes, stigmatisation and marginalisation resulting in preventing older persons from fully enjoying their human rights.

In addition, these particular treaties recognise the prohibition on age discrimination as one of their main principles. The clear recognition of the prohibition on (old) age discrimination in international law is an important step, as the anti-discrimination clauses contained in the core international human rights treaties, following the UDHR, usually do not contain such a prohibition. The International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families of 1990 [49] is an exception. Moreover, the Convention on the Rights of Persons with Disabilities of 2006 mentions age as one of the reasons for multiple or aggravated forms of discrimination [50].

Certainly, the premise of 'other status/circumstances/conditions' should be recognized as the premise covering young and old age. However, it took years before the Committee on the Economic, Social and Cultural Rights (CESCR) and the Human Rights Committee (HCR) finally confirmed in their general comments and case law that both covenants prohibit age discrimination [34].

It may be also observed that the international community and the human rights bodies providing the interpretation of relevant treaties were more willing to oblige states to take measures against stereotypes, prejudices and stigmatisation than to address age discrimination. For example, already in 1995, the Committee on Economic, Social and Cultural Rights, in its general comment No. 6 on the Economic, Social and Cultural Rights of older persons, called on governments, non-governmental organisations and older persons themselves to make efforts to overcome negative stereotyped images of older persons as suffering from physical and psychological disabilities, incapable of functioning independently and having neither a role nor a status in society [51].

Moreover, the human rights treaties dedicated to the protection of women and people with disabilities, who are particularly exposed to stereotypes and prejudices, contain provisions to counter these phenomena and could become a model of solutions applicable to older persons.

The Convention on the Rights of Persons with Disabilities (2006) should be considered the most advanced in combating stereotypes and prejudices, including those based on sex and age, in all areas of life [Article 8]. What is particularly important, the CRPD promotes an approach to people with disabilities, not through the prism of the assistance they receive, but through the prism of human rights [human rightsbased approach –HRBA]. HRBA is also the best way to prevent ageism and protect older persons' rights [52].

Meanwhile, Article 5 of the Convention on the Elimination of All Forms of Discrimination against Women of 1979 obliges states to take all appropriate measures to modify social and cultural patterns and eliminate stereotypes and prejudices about the roles and behaviours of men and women [53]. Interpreting this provision, the Committee on the Elimination of Discrimination against Women (CEDAW), in its General Recommendation on the Rights of Older Women [No. 27 of 2010], stressed

### *Contemporary Human Rights Law and Ageism DOI: http://dx.doi.org/10.5772/intechopen.106541*

the states' obligation to 'eliminate negative stereotyping and modify social and cultural patterns of conduct that are prejudicial and harmful to older women…' [54]. The transformation of incumbent social and cultural patterns of older persons into intergenerational solidarity is another factor in the elimination of ageism.

It is also worth noting that the protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa, the Maputo Protocol of 2003 [55] obliges states to ensure the right of older women to freedom from discrimination based on age, and the right to be treated with dignity. The protocol also refers to various kinds of stereotyping and prejudices against women in general.

However, similarly to both covenants, the regional human rights treaties of general character, including the European Convention for the Protection of Human Rights and Fundamental Freedoms [56], do not indicate an age premise in their anti-discrimination clauses. It appears that age discrimination has not been deeply examined by the international tribunals, and the evident cases of ageism may not be addressed. The best example is *the case Carvalho Pinto de Morais v. Portugal considered by the* European Court of Human Rights (ECtHR) [57]. This case referred to the Portuguese court's decision to reduce compensation for medical errors during gynaecological surgery. The national judges justified their judgement arguing that sexuality was not important for a 50-year-old woman and that she did not need any substantial compensation to cover the costs of employing a domestic helper because, with the children grown up, the applicant's domestic duties were mainly looking after her husband.

The ECtHR found that Portugal had violated the convention, but the majority of the ECtHR judges focused more on gender discrimination, comparing judgements of the Portuguese courts in cases referred to male victims of medical malpractice with the applicants' situation, and did not deeply analyse age discrimination, ageism and evident stereotyping. The ECtHR did not give a more in-depth interpretation of the premise of age, which was as important to the applicant as that gender. The ECtHR admitted that age could fall within the criterion of 'other status' within the meaning of Article 14 of the Convention, but did not confirm that age discrimination had 'the same force' as the other grounds for discrimination. Above all, the Court decided not to compare the situation of younger and older women with regard to the stereotype concerning their sexual life. In this respect, the Court seems to have passed over the chance to establish a line of case law on stereotyping [33].

Unlike the international human rights law, the prohibition on age discrimination is present in the European Union [EU] framework, in its primary law, including the Charter of Fundamental Rights [58], in the EU secondary law, as well as in the jurisprudence of the Court of Justice of the European Union [59]. However, ageism, age stereotyping and prejudices are not directly indicated there [30, 60, 61].

It is easy to note that general references to human dignity, and imprecise 'other status/condition/circumstances' permissions of non-discrimination, are not sufficient to protect older persons' rights and prevent them against all aspects of ageism.

With this in mind, the United Nations General Assembly established the Open-Ended Working Group on Ageing [OEWGA] in December 2010 [62]. The first task of this body, composed of delegations from states and civil society organisations, was to analyse the existing international framework for the protection of the human rights of older persons and identify possible legal gaps and propose the best possible solutions for the future. In 2012, the UN General Assembly commissioned OEWGA to draft a treaty to protect the rights and dignity of older persons [63].

Over the course of 12 sessions, OEWGA considered the scope of the future convention, addressing the issues of autonomy, independence, non-discrimination, long-term and palliative care, elder abuse, social protection, education and lifelong learning, capacity building, access to justice and the labour market, economic security, and older persons' right to contribute to sustainable development. Calls to combat ageism have certainly been present at the OEWGA sessions, especially at the third and sixth, though perhaps surprisingly, ageism has not been the principal, separate topic of any of the sessions.

### **3. Outside the treaties**

The first milestone, though not legally binding, acts on older persons' rights adopted on the international forum did not refer to ageism. The first complex international instrument on ageing – the Vienna International Plan of Action on Ageing – adopted at the World Assembly on Ageing in 1982 [64], does not mention 'ageism' itself, but certainly refers to various symptoms of ageism, especially on the labour market and in the media. Another crucial UN document is the United Nations Principles for Older Persons of 1991 this does not address ageism either, though it does contain important guidelines on older persons' dignity. It states that: 'Older persons should be able to live in dignity and security and be free from exploitation and physical or mental abuse. Older persons should be treated fairly regardless of age, gender, racial or ethnic background, disability or another status and be valued independently of their economic contribution' [65].

Finally, the Madrid International Plan of Action on Ageing (MIPAA) and the Political Declaration adopted at the Second World Assembly on Ageing in April 2002, being a milestone in addressing the key challenge of 'building a society for all ages [66]', indicated 'ageism'. However, it happens only once, when calling on the media and the private and public sectors to avoid ageism in the workplace and to present positive images of older persons as wise, productive and experienced. Certainly, there are many recommendations in the MIPAA encouraging states to combat stereotypes and prejudices, including intersectional, in various spheres of life, especially in employment.

However, the MIPAA is not a one-off event, as it has its continuity. Every year since 2002, the UN Secretary-General has been submitting to the UN General Assembly reports entitled 'follow-up to the Second World Assembly on Ageing'. The notion of 'ageism' was mentioned for the first time in the report of 2009. The secretary-general argued at that time that 'systematic stereotyping and discrimination against people because they have reached a certain chronological point and are considered 'old', has come to be known as 'ageism'. Ageism reinforces a negative image of older persons as dependent people with declines in intellect, cognitive and physical performance, as well as other areas required for autonomous, daily functioning. As a result, older persons are often perceived as a burden, a drain on resources and persons in need of care. 'These perceptions contribute to their vulnerability, which puts their rights at risk [67]'.

Since 2009, 'ageism', its harmful consequences and calls to counteract them have been developed in the subsequent reports. For example, in the report of 2011, the secretary-general noted that, despite older persons playing an important role as custodians of culture and history, paradoxically, they are victims of ageism which is broadly tolerated in societies around the world [68]. In the report of 2012, he devoted an entire subsection to ageism in various spheres of life, arguing that, ten years after the adoption of the MIPAA, prejudicial attitudes and discriminatory practices on the part of individuals and institutions towards older persons continue to undermine their

### *Contemporary Human Rights Law and Ageism DOI: http://dx.doi.org/10.5772/intechopen.106541*

participation in society. He also referred to the findings presented at the European Union forum on the occasion of the European Year for Active Ageing and Solidarity between Generations 2012, which reached the conclusion that ageist attitudes were not only the source of discrimination experienced by older persons but also served to justify that discrimination and, in many countries, a number of existing institutional and policy practices tended to create a 'culture of ageism' that reinforced ageist views and led to the further marginalisation and exclusion of older persons [69]. In 2014, the UN Secretary-General raised concerns that ageism is still a roadblock to the full implementation of the Madrid International Plan of Action on Ageing [70].

New aspects of ageism emerged in the 2021 report. The COVID-19 pandemic sharpened ageist attitudes towards older people. According to the report, data gathered before the crisis revealed that one in two people held ageist attitudes towards older persons globally, but the crisis amplified and exacerbated the widespread practice of discrimination against older persons, especially in the area of provision of health and other critical services and resources, and in long-term care facilities [71]. That is why the UN Secretary-General called to build stronger legal frameworks at the national and international levels to protect the human rights of older persons, including accelerated efforts to develop proposals for a convention that would be key to promoting and protecting the rights and dignity of older persons. He also called to combat ageism and age discrimination and address the intersectional discrimination that affects older persons, in particular women and persons with disabilities [71].

The MIPAA process within the UN framework is the most universal in promoting the rights of older people and in campaigning against ageism as a threat to human dignity. However, it is also worth referring to other international forums where the issue of ageism is or can be raised.

Potentially, this could happen at the International Labour Organisation [ILO] forum. The ILO's conventions do not address ageism, but ILO Recommendation No 162 of 1980 contains a whole chapter dedicated to the equality of opportunity and treatment of older workers [72]. However, since the adoption of this recommendation, the labour market has changed considerably, with the concept of ageism spreading beyond academic considerations. It, therefore, seems appropriate to include the problem of ageism in employment in the ILO's legal framework, as the negative multidimensional consequences and costs of ageism and age discrimination on the labour market are today well known and analysed [73]. For example, the European Commission's recent 'Green Paper on Ageing Fostering Solidarity and Responsibility Between Generations' mentions ageism specifically as a potential barrier to the economic activity of older adults [74].

At a regional level, the resolutions and recommendations drawn up on the Council of Europe forum should be mentioned here, as the states gathered on this forum, unlike the American and African states, have not yet decided on the adoption of a treaty on older persons' rights. The Parliamentary Assembly resolution entitled 'Promoting Active Ageing—Capitalising on Older People's Working Potential' of 2011 refers to 'ageism' and defines it as 'a harmful prejudice that results in a widespread lack of respect for older people… [75]'. Another resolution –'Combating Discrimination Against Older Persons on the Labour Market' – of 2013, also explicitly refers to ageism and age discrimination. It encourages states to start campaigns to change beliefs and attitudes in order to eliminate stereotypes and build a positive and accurate image of workers in all age groups [76].

The terms 'ageism', 'stereotypes' and 'prejudices' are not present in the most complex Council of Europe document on older persons – the Committee of Ministers Recommendation on the Promotion of Human Rights of Older Persons. On the other hand, the recommendation aims to eliminate barriers denying older adults and their human rights, so potentially covers ageism [77].

The impact of this recommendation was revised after five years from its adoption, in 2019. It turned out that only one of the 21 reporting states – Austria – had addressed ageism in its report on the assessment of implementation of the recommendation. The Austrian authorities declared 'in light of the recommendation, we continue to mainstream these rights in all policies and programmes, in order to actively combat ageism, the marginalisation and social exclusion of older persons' [78].

Therefore, it may be stated that the states are not 'used to' addressing ageism. This dearth of references proves that, if a given notion is not introduced into a document, there is no further action, or this action is severely limited.

It seems clear that ageism has not become a 'popular' notion, either in human rights treaties or in the soft international law. However, we may expect changes in this area, as, on 7 October 2021, the Human Rights Council adopted a resolution on the rights of older persons. It goes hand in hand with the WHO Report adopted in the same year and recognises that ageism 'can be associated with stereotypes, prejudice and/or discriminatory actions or practices, including hate speech, against older persons based on their chronological age or on a perception that a person is "old", and that ageism can be implicit or explicit and be expressed at different levels [79]'. Among various recommendations to states and international bodies, the Human Rights Council calls to make the situation of older persons more visible in the international forum, including human rights procedures and reports of international bodies.

Therefore, attention should also be paid to reports, working papers, thematic studies and other analyses prepared and presented at the UN forum. Their publication may become a turning point in negotiations on a new document or a given issue, or at least may contribute to raising awareness among the international community. For example, Amnesty International's 1972 report on torture [80] launched a campaign that culminated in the adoption of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in 1984 [81]. Gerard Quinn and Theresa Degener's 2002 report identifying gaps in the protection of the human rights of people with disabilities [82] provided the impetus for the adoption of the Convention on the Rights of Persons with Disabilities in 2006 [50].

Therefore, particular attention should be drawn to the working paper, 'The necessity of a human rights approach and effective United Nations mechanism for the human rights of older persons' (known as the Chung Report) of 2009 [83], which contributed significantly to the establishment of OEWGA and initiating the work on the treaty on the rights of older persons. We can read in this study that 'ageism or stereotyping and prejudice against older people that can lead to age discrimination, ranges from negative stereotyping to witch-hunting'; 'ageism seems to be increasing over time, despite our growing awareness of the issue'; 'ageing is a double whammy for women, who get hit with more ageism and sexism' and 'ageism is more prevalent in America than racism [83]'.

Another important voice on ageism can be heard in the 'Normative Standards in International Human Rights Law in Relation to Older Persons. Analytical Outcome Paper' drawn up by the Office of the UN High Commissioner for Human Rights in 2012 [84] and in the study 'update to the 2012 Analytical Outcome Study on the Normative Standards in International Human Rights Law in Relation to Older Persons' provided in March 2021. It is easy to observe that in the study of 2012 there is just one passage on defining ageism and related concepts. Meanwhile, its updated version contains a depth analysis of ageism and its harmful consequences. Ageism

### *Contemporary Human Rights Law and Ageism DOI: http://dx.doi.org/10.5772/intechopen.106541*

is not only barely noticed here, but it constitutes a starting point for all of the High Commissioner's further recommendations on the rights of older persons [85].

Finally, the mandate of the independent expert on the enjoyment of all human rights by older persons, established as a new UN Human Rights Council Special Procedure in 2013 [86], has introduced a new quality to the protection of older persons' rights. The two independent experts appointed so far – Rosa Kornfeld-Matte and Claudia Mahler – contributed significantly to raising awareness of the harmful effects of ageism in their annual reports, statements and observations on their country visits. Special attention should be drawn to the annual thematic report dedicated exclusively to ageism and age discrimination that Claudia Mahler presented in 2021 [87]. Following an in-depth analysis of ageism and age discrimination, Claudia Mahler called on states to take legislative and organisational steps against ageism and age discrimination and to simultaneously target the root causes of ageism. She stressed that working towards a cultural and societal transformation of how society sees ageing and older people is indispensable. Older persons and their organisations must be active actors in this transformation. She stressed the importance of awareness-raising efforts coupled with strategies to empower older persons, build up their skills and capacities and reduce internalised and self-directed ageism. She also called on states and other stakeholders to take measures to encourage the media to avoid stereotypical portrayals of older persons and promote a culture of tolerance, empathy, diversity and intergenerational solidarity, which are essential for anti-discrimination measures to be effective. She concluded her report with a message that ageism 'is largely invisible in treaty provisions and interpretations by monitoring treaty bodies. To address this gap in international and regional human rights law, age as a ground of discrimination must be explicitly recognised, including in a comprehensive binding legal instrument on the human rights of older persons [87].

### **4. The UN human rights machinery**

As ageism and age discrimination are often not visible in the international treaties, condemning ageism by the international courts or the human rights treaty bodies in their judgements or views is more a matter for the future. However, it does not mean that there is no space for other actions against ageism in the current international human rights law.

The United Nations human rights machinery, under the auspices of the Human Rights Council, has at its disposal procedures that have the potential to shape the international community's awareness of the harmful effect of ageism, even in a situation when there is no sectoral treaty on older persons' rights. This is possible as the special procedures mandate holders are guided in their actions by the Universal Declaration of Human Rights and soft law documents. Moreover, states participate in this system not because treaties bind them, but because they belong to an international community within the framework of the UN.

The mandate holders act as independent experts, operate in dialogue with the relevant government authorities and cooperate with civil society organisations and other stakeholders [35]. Therefore, the mandate of the independent expert on the enjoyment of all human rights by older persons should be indicated here. The mandate covers, among other things, country visits allowing experts to examine and evaluate the situation of older people on the spot and make targeted recommendations to governments and other actors, for example, business and civil society.

The independent expert's recommendations are sometimes very practical. For example, in a report on a visit to China in 2020, the independent expert noted that there is no semantic and linguistic equivalent of 'ageism' in many languages and dialects used in China. Insufficient awareness and appreciation of this phenomenon were observed in China, so the independent expert recommended the translation and mainstreaming of the term 'ageism', along with its notional conception and the adoption of specifically targeted policies and a dedicated normative anti-ageism response. She also encouraged the authorities to establish an independent national equality body to monitor and report discrimination issues, including discrimination against older persons or ageism [88].

In the reports on visits to China, Mozambique and Montenegro, the independent experts noted the concern about ageism mixed with gender-based discrimination arising from patriarchal attitudes and stereotypes regarding the roles and responsibilities of women and men, placing women at a disadvantage [88–90].

In Mozambique, the independent expert also observed ageism and age discrimination in many spheres and contexts, from household decision-making about scarce resources to ageist attitudes of health professionals towards older persons. She noted that older adults are frequently refused treatment or are treated with disrespect due to their age [90]. The reports on the visits to Montenegro and Uruguay focused on ageism leading to violence against older persons, maltreatment and elder abuse [89–91].

In 2015, the independent expert encouraged the Austrian authorities to continue mainstreaming the rights of older persons in all policies and programmes, which should actively combat ageism as well as the marginalisation and social exclusion of older persons, thereby reducing their vulnerability, including abuse and violence [92].

In addition to governments, the private sector is also the addressee of the independent expert's recommendations. In the reports on visits to Montenegro and Uruguay, she expressed her concern about ageism and the stereotyping of older persons, which goes hand in hand with certain forms of discrimination. She reminded businesses that they should comply with the guiding principles on Business and Human Rights [89, 91].

Ageism against older women was also of interest under another thematic mandate within the Human Rights Council – the special rapporteur on violence against women, its causes and consequences. The reference to ageism can be found in the special rapporteur's report on her visit to Australia in 2018. The Australian government was advised to develop a national plan to promote the autonomy and agency of older people by addressing ageism and promoting community understanding of elder abuse, achieving national consistency in standards, safeguarding at-risk adults and improving responses, as well as building the evidence base for responding to elder abuse [93].

Apart from the Human Rights Council Special Procedures, the Universal Periodic Review [UPR] is another mechanism that can be taken into account. It is a review of the achievements and shortcomings in a state's respect for human rights and fulfilment of its obligations. It is carried out periodically and is a form of the inter-state dialogue. While it is certainly flawed and vulnerable to politicisation, due to its universal coverage it has the potential to disclose ageism as a harmful phenomenon internationally. During recent UPR cycles, older persons' rights and dignity and the dangers of age discrimination are more and more frequent topics of this dialogue. However, states rarely address ageism *expressis verbis* in their recommendations to other states. Therefore, Vietnam's call on Singapore to enhance measures to ensure the protection of the rights and well-being of older persons, including efforts to reduce ageism, is unique. It is possible that the Vietnamese recommendation formulated during the UPR cycle of 2021 may become a model for other states in subsequent reviews [94].

Finally, it should be noted that today it is difficult to imagine a system of international human rights protection without NGOs in the reporting procedure in all human rights treaty bodies, or in the course of the Universal Periodic Review and the special

procedures of the Human Rights Council. Moreover, NGOs act as *amicus curiae* before international tribunals, as well as before quasi-judicial bodies, reviewing notifications of violations of human rights treaties. They can play a crucial role within the framework of these diverse procedures, providing expertise on ageism and all its aspects.

### **5. Conclusions**

Although many years have passed since ageism was first identified, and although there is no doubt that this phenomenon lies at the root of social exclusion, it was hardly visible in the international forum just a decade ago. Today, this notion is present mainly in reports and observations of specialised human rights bodies, though it is not widely used in legal and law-related language. The notion of ageism does not appear *expressis verbis* in the core human rights treaties, nor even in the regional treaties on older persons' rights. It is true that stereotypes, prejudices and age discrimination are frequently referred to in sectoral treaties [mainly referring to women and persons with disabilities], but it is rare that all these aspects are equally stigmatised there, and certainly, they are not directly linked with older persons.

Consequently, ageism is not addressed in the general conclusions and recommendations provided by the human rights treaty bodies when interpreting the states' obligations under human rights treaties. Moreover, this notion is not as widely used as expected in resolutions and recommendations issued by international organs. Generally speaking, international hard and soft human rights laws are still dragging their heels in naming 'ageism', which severely weakens combating it on international and, consequently, national levels.

Hence, introducing this concept into international hard law as a 'keyword' covering age discrimination, stereotypes and prejudices would be a clear message to the whole international community. Therefore, a global treaty on the rights of older people or human rights in old age condemning ageism and all ageism's dimensions is desirable. Such a treaty would impose positive obligations on states to eliminate various obstacles, including ageism, to older people's enjoyment of human rights. Human rights can only be achieved when states are legally obliged to respect them and where monitoring mechanisms are thoughtfully operationalised [95].

However, one cannot be naïve and assume that merely introducing a call to combat ageism into hard international law will prove sufficient. It is clear that raising awareness of the international community is a long-term effort and requires dealing with new challenges.

It, therefore, seems worth using hitherto unused or rarely used mechanisms such as the UPR to raise awareness of this phenomenon. Above all, however, new varieties and forms of ageism, especially the hidden ones, should be analysed and revealed to the international community. Thus, any extra-legal action by international bodies, states, NGOs and other stakeholders, should also be appreciated.

It seems essential to bring new areas and aspects of ageism to the attention of both scholarship and international bodies. It is clear that life and the political situation in the world constantly pose new challenges, with ageism during emergencies being one such challenge. The best recent example of this is the COVID-19 pandemic when older adults were blamed for being the reason for lockdowns and other restrictions [96, 97]. As a result, in May 2020, 146 states at the United Nations forum signed a statement expressing their deep concern over the escalation of ageism, including age discrimination and the stigmatisation of older persons, which aggravates their vulnerabilities [97].

Another issue to be explored is conscious and unconscious ageism against older persons during armed conflicts. In February 2022, Human Rights Watch published a report revealing older persons' vulnerability in recent international and war conflicts, both those who remained in their homes and those who became war refugees or internally displaced persons [98]. The report does not cover the war in Ukraine, where the situation of older adults, regardless of whether people left their homes or stayed, is dramatic. HelpAge International, referring to this humanitarian crisis, noted that 'while war does not discriminate, the international response does. Time and again, the toll of war on older people is overlooked as they struggle to survive and piece together a new normal [99]'.

Finally, it also seems that the fight against ageism internationally should become 'more specialised' and more attentive to the combination of ageism and other inequalities. The double standards concerning ageing between man and woman are best known and described in the doctrine and in international reports [100]. The stigma, stereotyping and discrimination of older adults with disabilities are also wellexplored [101]. However, international law does not address all disadvantaged groups. Various groups, like LGBTQ people, similarly to older persons, do not enjoy 'their own' treaty. Others, like indigenous peoples, are selectively protected by international regulations. This leaves the older members of such groups 'doubly invisible'. It appears that addressing ageism against older adults belonging to diverse, disadvantaged populations is another challenge to the international community.

This chapter had its limitations and focused on legal issues; however, the non-legal initiatives that have been taken internationally cannot be underestimated in the fight against ageism. Thus, one of the goals of the global campaign, the UN Decade of Healthy Ageing [102], which is compatible with the Sustainable Development Goals (SDG), is to prevent an older population from ageism in order to improve the lives of older people, their families and the communities in which they live. In turn, the central message of the 2030 SDG Agenda, 'to leave no one behind [103]', is critical to changing attitudes toward older persons and protecting people of all ages.

### **Conflict of interest**

The author declares no conflict of interest.

### **Author details**

Barbara Mikołajczyk Faculty of Law and Administration, Institute of Law, University of Silesia, Katowice, Poland

\*Address all correspondence to: barbara.mikolajczyk@us.edu.pl

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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### **Chapter 2**

## Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions of Underdevelopment and Extreme Poverty

*Ntobeko Bambeni*

### **Abstract**

Ageing is a crucial era at the last stage in the lifespan of human beings, particularly for those who survive and pass through other stages of the life cycle. There has been a considerable increase in the number of people who reach this stage and live longer across the globe. The rampant increase of this population group has yielded unprecedented challenges to the both the developed and underdeveloped world due to the psychological, health, economic and social needs of this population cohort. In most developing countries, these social challenges faced by older the older persons are to a certain extent mitigated by the cohesive structure within the community. However, the social, living arrangements from families and communities that are available to the older population are under threat due ongoing demise in the traditional forms of care is as a result of families having suffered from the impact of social change, including urbanisation, geographical spread, migration, the trend towards nuclear families, and participation of women in the workforce. Ageism as a concept is viewed as the theoretical, policy and practical underpinning for how ageism is perceived and dealt with. The negative stereotypes that often shape the theoretical framework with regard to ageism is the root cause of negative attributes associated with ageing. This chapter therefore, concludes with the key recommendation that governments from the developing economies should strive towards development of policies for the protection of advancement of the wellbeing of older population and make resources available for the implementation of the policies.

**Keywords:** ageing population, developing countries, social challenges, older persons, ageism

### **1. Introduction**

Ageing is one of the essential element of the life cycle of a human being. it is regarded as the last stage in the lifespan of human beings, particularly for those who survive and pass through other stages of the life cycle. There has been a noticeable increase in the number of people who reach this stage and live longer across the globe. The phenomenon of continued increase in the population ageing is prevalent in both developed and developing parts of the world. The rampant increase of this population group has yielded unprecedented challenges to the both the developed and underdeveloped world due to the psychological, health, economic and social needs of this population cohort. Therefore, this may have serious implications for the social policies of governments from both the developed and developing countries as they may find themselves compelled to devise means to secure more resources to meet the increasing needs associated with the growing ageing population. The increase in the population ageing has created many challenges for older persons, especially in developing countries as they are mainly characterised by underdevelopment and poverty. However, there are convergent challenges besetting the ageing population which are detrimental to their well-being and these may range from inadequate healthcare and discrimination as a result of ageism. Despite all the challenges, the population ageing is faced the increase in their numbers has become a global phenomenon.

### **2. Methods for data collection and analysis**

The data used for the writing of this chapter was collected through a literature review. The purpose of this section is to describe the data collection and analysis methods applied during the review of the literature by getting into details about the exact procedures and processes that were followed during data collection and analysis.

### **2.1 Data collection**

The type of data review that was utilised is narrative review. Sylvester et al. [1] describe narrative review as the 'traditional' way of reviewing knowledge. On the one hand, the purpose of the narrative review is to summarise or synthesise what has been written on a particular topic, and on other hand, does not see seek to make a generalisation or cumulative from what it is reviewed [2]. It can be helpful in gathering together a volume in a specific subject area and synthesising it [3]. To achieve the objectives of this study, the author utilised the narrative review in order to summarise the literature pertaining to the social challenges faced by the older adults in developing countries. Through the narrative review, the researcher's undertaking is to accumulate and synthesise the literature to demonstrate the value of a particular point of view [4]. The narrative review was used to summarise the assembled data from the literature to demonstrate social challenges of older adults across the world and in the developing countries. Lastly, the narrative review can be used for writing of educational articles for practitioners to be updated with certain topical issues [2]. The data collection process was implemented through different stages, namely, literature review design and conducting of the review.

### *2.1.1 Review design*

The process of data collection began with the designing of the literature review. This stage of designing literature was implemented by searching the internet for appropriate

### *Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

articles. Mainly, this stage is devoted to searching for the literature and making decisions about the suitability of material to be considered in the review [5]. The appropriate articles were searched by using the phrase 'population ageing in developing countries' and challenges of ageing in developing countries. According to Snyder [6], a search strategy for identifying relevant literature must be developed by selecting search terms and appropriate data base that assist in deciding on the criteria to use about which elements of data to be included and excluded. The search terms for identifying the appropriate data could be words or phrases used to identify articles, books and reports and these words, terms and concepts should be related to the research question [6]. Out of the various sources derived out from the search, the author selected those that under the search phrase had words or concepts that relate to healthcare, social protection, socio-economic situations and challenges faces by ageing population in the developing countries. The reason for the author to identify certain sources is that some of the sources were not relevant answering the research question. Snyder [6] asserts that because the initial search almost yields many articles, a strategy may be needed to identify, which are actually relevant and, therefore, inclusion in the literature review should be guided by the research question. As a consequence, the quality of the literature is dependent on, among other aspects, what literature is included and on how it was selected [7].

### *2.1.2 Conducting review*

This stage of data collection refers to the process of how the data was extracted by the author from the literature sources that were selected for review. This stage of data collection involves extracting applicable information from each primary source included in the sample and deciding what is relevant to the problem of interest [8]. In the case of journal articles, the author would first read the abstracts of the journal articles in order to determine whether were there any summary of the literature review, findings and discussions that are related to the healthcare, social protection, socio-economic and challenges faced by older adults in developing countries. With regard to the reports of the international organisations such as the United Nation's Agencies, the author would first read through the executive summaries and within the table of content to identify the most relevant titles and subtitles for review. The author also made use of the lists of references from some of the journal articles to identify other articles that because of their titles were considered valuable for the review. To avoid reading each piece of extracted literature in full, the author selected to read the abstracts first, made selection of the relevant literature to be reviewed based on the abstracts read and subsequently read the full articles that he finally selected [6]. The nature of data that is recorded from extracted sources depends on the research question [9].

### **2.2 Data analysis**

The data analysis is conducted after literature review was conducted and the decision is taken about the final sample and which standardised means of extracting appropriate information from the literature sources to be used [6]. The data were analysed through identification of key concepts and themes that persistently featured prominently in the literature sources. The concepts identified showed significant relevance to the research question of the chapter. Webster and Watson [10] suggest that when the reading is complete, it must be followed by synthesis of the literature, develop a logical approach to grouping to representing the key

concepts that have been identified and followed by discussion of each identified concept. The reciprocal translation analysis was applied as a data analysis technique to identify key metaphors, themes or concepts in each study or literature source [11]. Some of the concepts derived from different literature sources that share common relationship were brought together and discussed under one broad theme. The identified concepts were subsequently discussed as broad themes and sub-themes. The reciprocal translation analysis involves the translation of concepts from individual studies into one another and in the process evolves overarching concepts or metaphors [12].

### **3. Population ageing: a global phenomenon**

The proportion of the world's population aged 60 and above is increasing more rapidly than in any previous era [13]. This growing trend among this cohort of the world population disregards borders including developed, developing and underdeveloped regions [14]. Population ageing in developing countries is growing at three times the speed of population than in developed countries [15]. This rapid increase even transcends to the world's poor countries wherein those who survive the disease of infancy and childhood have a very good chance of reaching ageing [13]. The United Nations Population Division has estimated that the number of older adults over the age of 60 years will rise from 800 million (11% of the world's population) in 2011 to over 2 billion (22% of the world's population) in 2050 [16]. The number of older adults aged 80 and above is estimated to increase by 270% over the same period and with the greatest increase of older persons expected to occur in low and middleincome countries.

The contributing factors to the increase in the ageing population are declining fertility and increased life expectancy [17, 18]. The improved increased understanding of medicine, major developments in medical technology in recent years [19] and prevention of diseases previously responsible for huge numbers of premature deaths [13] are attributed to the increased life expectancy. While life expectancy has substantially increased, the total fertility has fallen below the stable rate level [19]. The steady increase in the ageing population has enormous implications for population demographics, which may have a direct bearing on already over-burdened global healthcare and social services systems. Population ageing will have a profound impact, especially as many governments around the world have yet to put in place the policy framework to respond to the challenges brought by the ageing of their populations [20]. Bennet and Zaidi [20] further argue that there is a disparity between advances in longevity and in the development of policies that protect and empower older persons. There is a deficiency in the awareness of the potential of older persons in being net contributors to the development process, especially in sub-Saharan, Middle Eastern and Asian countries.

### **4. Overall social challenges facing older persons**

The increasing ageing population indicates that the society may have a large number of people who require special needs due to disability as a result of chronic illness and physical immobility due to old age and mental-related illnesses. These conditions may have a direct impact on the health care and social protection systems.

*Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

### **4.1 Physical immobility and impaired mental ability**

Older persons are likely to experience chronic conditions, physical degeneration and frailty as a result of the ageing process [21]. It is also noted by Nabalamba and Chikoko [22] that population ageing is highly correlated with physical and mental disability and an increase in the number of health conditions. According to the 2006 World Health Organisation's projections, the diseases associated with the ageing such as Alzheimer and other forms of dementia accounted for 6.3% of disabilityadjusted years. This percentage is proportionately higher than the contribution to the disability-adjusted years of HIV and AIDS (5.5%), all cancers (5.3%), heart disease (4.2%) and respiratory diseases (4.0%) [22]. Most notably, it is the contribution of Alzheimer and other forms of dementia alone as it accounts for 12% of other neurological disorders [22]. There is a likelihood also to see an increase in other chronic conditions such as strokes, chronic obstructive pulmonary disease and diabetes mellitus [23]. The increase in the number of older persons with chronic conditions will account for greater disability [23]. Physical limitations that older persons endure may lead to functional decline and the inability to care for themselves in addition to increasing risks for falls, a decline in physical activity, depression, loneliness and hospitalisation [24]. Both the increase in physical disability and chronic illness may necessitate the need to provide increased health care and social care as the management of long-term chronic conditions, and related disabilities require a substantial amount of resources (both human and financial) from governments, communities and families [22].

### **4.2 Inadequate provision of healthcare services**

Despite the poor quality of life experienced by many older persons and the challenges faced by the planners and professionals in providing the much-needed health and welfare services for the growing number of frail older persons, it is disturbing to notice the lack of enthusiasm in promoting the joys and triumphs of older persons in the latter part of the twentieth century [13]. The poor quality of life experienced by older persons is characterised by challenges such as inadequate retirement pension, social exclusion, lack of access to basic services, health care, food insecurity and a lack of affordable accommodation [17]. Inouye [25] points out at ageism to be a fundamental causal factor for the inadequate and inappropriate health care services to older persons. Inouye [25] criticises ageism for its adverse impact on the healthcare system by leading to inequities in healthcare delivery and poor clinical outcomes. In the context of healthcare, ageism is defined as age-related discrimination, including explicit age cut-offs for treatment or resource allocation or implicit age-related biases, which limit access or create a barrier to healthcare [25]. The above assertion about ageism is confirmed by a landmark study on COVID-19 whereby healthcare professionals were found to have been significantly more likely to withhold life-sustaining treatments for older persons compared with younger persons even after controlling for prognosis and patient preferences, a practice that is claimed to have persisted to date [26]. Ageism has also led to inadequate or inappropriate care and decreased or delayed access to health care services, resulting in decreased survival, power quality of life, increased cognitive and functional impairment, emergency visits and hospitalisation [27].

The older persons also suffer depleted welfare services and a lack of family and community-based care support. This contributes towards making the older persons consistently becoming the poorest in all societies and material security is one of their greatest preoccupations [13]. Despite experiencing the same lack of physical essentials, assets and income suffered by other people, they are without the resources that younger, fitter and more active adults can use to compensate [13]. The problem of poverty among older persons is not only restricted to material needs. Their inability to participate effectively in economic, social and political life finds them socially excluded and isolated from decision-making processes and thus, not only affecting their income and wealth but also contributing to poor housing, ill-health and personal insecurity [13].

The lack of community and family-based care, which used to be rooted in traditional family and community-based care, also negatively impacted the psycho-social and economic well-being of many of the older persons. Ferreira [28] points out that diminishing care that used to be provided to older persons by family members is a result of changes in family structures ushered in by modernisation and urbanisation, particularly in developing countries. Globalisation is also considered to have contribution to the reduction of the family into a non-viable economic institution for older persons as it promotes values of individualism and the pursuit of self-interests [29]. Sen [30] also observes from a vantage point the challenge of strain experienced by families due to chronic and complex problems associated with ageing as they would put pressure on authorities to put their older persons who require more extensive care in residential institutions. The broad overview of the adverse situation of the increasing ageing population as described above has also specific features peculiar to the context of the developing countries.

### **5. Ageing in the developing countries**

It is estimated that the number of older persons in developing countries will be more than double over the next century reaching 850 million by 2025, which will be 12% of the total population [13]. The number of older persons aged 80 years and above is expected to increase by 270% in 2050 with the greatest increase of older persons in the developing countries [16]. Patel [17] attests that the majority of the world's population of older persons (60%) live in developing countries. In Africa, alone projections show that the older adults could account for 4.5% of the total population by 2030 and nearly 10% by 2050 [22]. Sen [30] argues that though population ageing is a feature in all countries, its consequences are more devastating in poor countries where it is occurring at a very fast pace. This growth in the ageing population in the developing countries presents significant challenges to economic resources and other significant competing health and social challenges [31, 32]. The population ageing poses great challenges to society concerning for example health care, caregiving and a suitable pension system especially for developing and underdeveloped countries that often have limited resources [33]. The Madrid Plan of 2002 provides the framework to incorporate discussions of population ageing into the international debates on development and the implementation of national policies to respond to the challenges of building societies for all ages [34]. The Madrid Plan of 2002 gives priority to ensuring that ageing is made an integral part of the international development agenda; to advanced health and wellbeing into old age and to creating enabling and supportive environments for older persons [34].

*Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

### **5.1 Poverty**

The probability of being poor at old age does not only depend on being covered by a pension scheme [34]. The degree of poverty among older persons varies with the level of educational attainment, gender and living arrangements [34]. Nabalamba and Chikoko [22] argue that the efforts to understand poverty have dominated much of the debate on development in recent years, however, the poverty experienced by the majority of older persons, particularly in developing countries, has been largely ignored as a result of competing interests such as education, health, housing, sanitation and water as they were considered as pressing. Hutton [35, 36] affirms that the older persons in developing countries experience disproportional high levels of poverty as it is estimated that about 80% of older adults have no regular income. The poverty facing the population of older persons is exacerbated by a plethora of other urgent and pressing demographic problems such as rapid population growth, high youth population and high unemployment; high infant and child mortality rate and high maternal mortality rates [22]. The increasing population ageing in developing countries has significant implications for poverty reduction strategies [37]. Nabalamba and Chikoko [22] affirm that these urgent and pressing challenges have resulted in governments and societies deprioritising older persons in favour of other more vocal age groups. Nabalamba and Chikoko [22] further aver that government development policies tend to favour expenditure that invests in the long-term productive potential of the younger adults because of high levels of unemployment among this age group and being also aware of their potential to create social and political unrest if their demands and life chances are not fulfilled. The undervaluing of the contribution of older persons by policy makers and planners marginalises them from development thinking and policy and thus contributes to the persistence of the poverty among older adults [38].

Barrientos et al. [38] identified a number of trends in developing countries that could make matters worse regarding old age poverty. Barrientos et al. [38] point out at the economic adjustments brought by globalisation, changes in labour markets and especially social sector reforms have in different manners adversely affected the livelihoods of older persons. The absence of formal pension coverage causes the majority of older persons in developing countries to face considerable income insecurity [34]. The poverty situation worsens for the unprotected who are often small farmers, rural labourers and informal sector workers as for them, the notion of retirement does not exist [34]. As they had not held any formal jobs, they do not qualify for a pension and if they were unable to accumulate enough assets, they have no choice but to work on their own [34]. The situation of poverty often persists for those who were already poor during their working years as they are likely to remain poor in old age [34]. Lastly, those who might have lived above the poverty line but were unable to build up precautionary savings to finance consumption during their old age face the risk of poverty as they grow older [34].

### **5.2 Healthcare**

Despite few studies that have been conducted, there is a general consensus in the literature that access to care and health system responsiveness in developing countries is poor and the healthcare system frequently fails to meet the needs of older persons [32, 39]. Developing countries experience high incidents of communicable diseases such as hypertension, obesity, heart disease and diabetes [40]. Boutayeb

[41] describes the combined effect of chronic communicable and non-communicable diseases as a burden for developing countries.

Older adults in developing countries have limited resources to access healthcare [34]. Access to health becomes a major challenge for those who reside in rural areas as the hospital resources are concentrated in urban areas [40]. The lack of access to healthcare is aggravated by the inadequate healthcare workers in rural areas and such workers are difficult to recruit and retain [40]. Henriques-Camacho et al*.* [40] identify the lack of literacy among older persons in rural areas to have a significant role to decrease access to health and similarly, large geographical areas and distant villages are a challenge to providing access to healthcare in developing countries.

### **5.3 Social protection**

In developing countries, alone about 342 million older adults lacked adequate income security and the number would rise to 1.2 billion by 2050 if the coverage current mechanism design to provide old age income security is not expanded [34]. The case in point is the African continent, which is not well prepared for a major increase in its ageing population with regard to expanding social pension coverage [22]. The bigger challenge for Africa is the decline of informal systems of social protection in the form of cash and support from both extended family and community sources [22]. Until recent, contributory pension schemes cover very few older persons due to the informality of most livelihood activities and employment and most of the older persons' societies are pre-dominantly rural and much of the population operates outside the formal social security sector and wage-dependent markets.

Traditionally, especially among African people, the informal social protection has been effective for generations as it provided a major share of support to the older parents and the most vulnerable [22, 42]. Shetty [42] asserts that depending on various cultural practices, in countries where it is expected for children to look after their older parents, the evidence shows that they do better when living with their families. The provision of social protection by family members is still the basis for determining the nature of social protection policies aimed at older persons in many developing countries. This increasingly filial responsibility of family members to care for the older persons in developing countries is not just culturally expected, it is often legally mandated [42]. Shetty [42] refers to the Maintenance and Welfare of Parents and Senior Citizens Act of 2007 in India, which requires that adult children who neglect their parents either by refusing to make provisions for their care, or by inadequately caring for their older parents in their homes, can be imprisoned up to 3 months or fined an amount of US\$10 or both. Through the established tribunals older persons can take their own children to court to demand maintenance of up to US\$220 a month and similar laws exist in countries, such as Singapore and China [42]. Despite the harsh nature of these laws, there could be an argument in favour of them given the severe lack of social security and pension schemes as well as government-funded infrastructure for older adults such as old age homes and geriatric clinics [42]. In Southern Africa, the care for older persons is a shared responsibility of the nuclear family, government and voluntary organisations [29]. For example in Lesotho, the government through the Department of Social Development has the responsibility for administering welfare programmes, including personal social services for older persons and it is separated from the old age pension scheme as it is administered by a different Ministry, the

*Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

Department of Pensions within the Ministry of Finance [29]. Lesotho's universal old age pension scheme caters exclusively for older persons who are 70 years and above [29]. There is also a public assistance scheme for vulnerable groups in the population including older persons that are administered by the Ministry of Social Development in Lesotho [29]. The public assistance scheme is also means-tested and as a result, not all applicants qualify for it and this inadvertently excludes many older persons as it is operated under very strict eligibility criteria and is always poorly funded [29].

### **5.4 Ageism**

Despite the contributions, many older adults have made to society and their diversity, negative attitudes about older persons continue to persist across societies and are rarely challenged [43]. Ageism is one barrier that prevents older persons from acquiring the essential care and services and it also discourages older persons from active ageing as if often undervalues their active role in society. Ayalon and Tesch-Romer [44] define ageism as stereotypes, prejudice or discrimination against (but also in favour of) people because of their chronological age or on the basis of a perception of them as being old [45]. Barrientos et al*.* [38] affirm that for individuals, the ageing process is an inescapable biological reality but is the social construction of individual ageing that generates both constraints and opportunities. Ageism can be implicit or explicit and can be expressed on a micro, mezzo or macro or macro level and thus underlines the individual, social and institutional significance of the phenomenon [46].

Chang et al. [27] argue about the rising prejudices over the years that have been spread concerning the older persons who are seen as thwarting productivity and social dynamism. Ageism creates stereotypes about ageing, which go beyond influencing behaviour and ways of managing the care for older persons' population, but can also impact personal experiences of ageing [46]. The negative self-perceptions of ageing involve reduced self-efficacy, which may directly result in depression [26] along with repercussions for physical illness due to effects on immune system [47]. Ageism tends to reinforce social inequalities as it is more pronounced towards older women, poor people or those with dementia [48]. Ageism as it relates to older persons is most prevalent in the health care sector [49]. This could be attributed to the fact that healthcare utilisation and whereby costs are higher among older persons compared with younger adults and are expected to increase further with the life-span [50]. The ageism phenomenon has led to argument by some philosophers that older adults pose a huge burden on the healthcare system [51]. Harrigan et al. [52] regard healthcare professionals as being more likely to communicate in patronising and disrespectful ways with older persons as compared to younger adults.

### **5.5 Gender**

By 2050, most of the 80 years old will live in rural areas and most of them will be women [42]. This is due to women living longer than men worldwide and this gender bias is not specific to low-income countries, but in developing countries, there can be less autonomy and less financial independence than in the developed countries [42]. According to Srivastava et al. [53] globally, there are about 90 million older persons who are estimated to be living alone of which about 60 million are females. In addition, a great majority have only been in one union and often decide not to marry after the spousal bereavement at older age [54].

The process of ageing affects males and females differently due to economic, social and cultural factors. The study conducted in five countries (China; Ghana; India; Russia and South Africa) showed that the male participants across generally reported a better quality of life as compared to their female counterparts across all five countries [33]. The study results indicate that gender inequality regarding the quality of life exists and that gender may play a critical role in the quality of life among older adults in low and middle-income countries [33]. According to Denton et al. [55], previous studies have also argued that men and women are exposed to different cultural norms and social factors. Lee et al*.* [33] assert that female participants' overall social status was found to be lower than that of their male counterparts and they were likely to have a more limited income, more barriers concerning access to health care and more responsibilities regarding household chores and these factors could affect their perceived quality of life.

### **5.6 Widowhood**

Intrinsic to the exposure of adult women in relation to cultural and social factors is the phenomenon of widowhood, which has a direct effect on inequality regarding the quality of life among older persons. Widowhood is described by Wilcox et al. [56] as a catastrophic event at any stage of life for the surviving partner with serious repercussions on their physical, economic and emotional well-being, particularly in the first year of the loss or for a longer term in some cases. In spite of that, the emotional response as a result of the loss of a spouse is considered to be different depending on various socio-economic demographic characteristics such as age, gender, widowhood duration, living arrangements, functional ability to perform activities, health status and other factors such as community involvement and economic conditions of the survivor [57]. There is also an assertion that differences between two sexes in depression due to the loss of a spouse are argued to differ according to gender roles as women are found to invest less in their financial security and more in familial relationships as compared to their men counterparts [53]. In many instances, after the bereavement of the spouse, their only source of income diminishes, which increases their economic hardship in old age leading to an adverse impact on their psychological well-being [58, 59].

Widowhood plays a significant role in the poverty of older widows especially in developing countries [60]. Hurd [61] argues that the issue of poverty is particularly trouble-some for the population segment of widows since they have fewer possibilities to recover from a drop in income. In the traditional African society, poverty, deprivation, malnutrition, neglect or isolation among older persons were not common as children, members of the extended family and community members provided care and support for them [62]. The care and support for older persons were seen as collective responsibility and expectation of the entire society [62]. Consequently, upon the death of a husband, a widow relied on her children and members of the extended family for her wellbeing [60]. This responsibility for care and support for older persons was premised on the social relationship and structure of the extended family since it promoted closeness among members, thus reducing the problems of poverty and deprivation.

Nowadays as a result of intergenerational relationships, older widows are currently the most vulnerable and marginalised groups in the rural areas [60]. In contrast to the traditional practice, they are now faced with what Eboiyehi [60] describes as a quadruple danger of being old, poor, widowed and alone. Eboiyehi [60] argues that

*Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

in some cases the customs that were used to protect them in the past are now used to oppress and exploit them. For example, the poverty experienced by older adult widows can be linked to discrimination in inheritance customs, the patriarchal nature of society and the supremacy of the repressive traditional practices and customary rules [60], which take precedence over constitutional guarantees of equality, modern laws and international women's human rights [63]. This is often characterised in the rural communities by "chasing off' and 'property grabbing', which become the common features orchestrated by brothers of widow's husband being driven by greed and deceitfulness as they deprive the older widows of their homes, agricultural land and assets [60]. Therefore, the passing of a husband means a loss of income and property that the deceased spouse owned and left for the widow [63]. The psychological maltreatment of older widows exposed them to become more likely to be in poor health conditions and they are either childless or do not have a son or daughter nearby to provide assistance when needed [62]. Another challenge faced by older widows in Africa and in some parts of Asia is traditional mourning and burial rites involving harmful and degrading treatment that constitutes gender-based violence and they are coerced to participate in these rites through their fear of losing status and protection against being evicted from the family home [63].

### **5.7 Witchcraft accusations**

The witchcraft accusation often laid against older women is rife, particularly in Africa. Witchcraft is defined as the ability of a person or group of people to cause harm to others [64]. Those accused of witchcraft are believed to have the evil propensity to harm innocent persons in an inexplicable concealed manner [65]. They are believed to possess the magical powers to fly at night and travel far and wide to kill innocent people, cause diseases in humans, sudden death, impotence, sickness in animals, bad luck and other misfortunes [65]. It is believed that during the process of harming their victims they are able to transform from human beings into animals, birds, reptiles and insects [66]. They are sometimes blamed and punished for being responsible for strong winds, drought, hunger, misery and all other disasters [67]. In many communities, people who have suffered misfortune, illness or death often utilise the services of soothsayers or traditional healers (sangomas) to identify who in the community has been bewitching them [67]. Unfortunately, in most cases, the fingers are often pointed at older women who then have to suffer the consequences [68, 69].

The rise in accusations of witchcraft and counter-killing of alleged witches is associated with illiteracy [70], poverty, diseases and ignorance [71]. Meels [68] argues that sometimes even rational and literate people do believe in witchcraft especially when events cannot be explained or when people fail to establish causes of complex issues, such as regular misfortunes and failure to succeed in life*.* The accusations of witchcraft are also associated with demographic, socio-economic, psychological and cultural factors [65]. Mencej [72] points out at factors such as economic well-being and strained relationships among community members play a major role in accusing older women as witches. The challenge of witchcraft accusations represents a serious violation of the human rights of the victims, more particularly in Africa [73]. As a consequence, people accused of witchcraft are subjected to physical and psychological abuse by their respective communities [74]. This witchcraft accusation is the source of unacceptable levels of mistreatment perpetrated against older women in Africa [73]. The older persons that are prone to be accused of witchcraft

are those that are too old, have bad health, have red or yellow eyes, wrinkled skin, missing teeth or have a hunchback stance [75, 76].

### **5.8 Abuse**

The abuse of older persons features prominently in the current literature on ageing as it is becoming one of the significant challenges facing the ever-increasing ageing population. The concern about older person abusers increases as the global population ages [77]. It is recognised internationally as an extensive and serious problem, which urgently requires the attention of health care system, social welfare agencies, policymakers, and the general public [78]. The World Health Organisation (WHO) [43] reveals that in a 2017 review of 52 studies conducted in 28 countries from diverse regions across the world is estimated that 15.7% of people aged 60 years and older are subjected to forms of abuse. Rates of older person abuse are reported to be high in institutions such as nursing homes and other long-term care facilities [43] with up to 64% of staff admitting to elder abuse based on self-report. The abuse of older persons is reported to have increased during the COVID-19 pandemic [43].

The definition of older person abuse sometimes often rests upon various professionals to fit the purpose of the specific disciplines, such as legal, law enforcement, medical and welfare. [79]. Chalise [79] adds that as a result of these disconnected viewpoints about the phenomenon of older person abuse, it is a notion that is also understood differently by older persons themselves and caregivers. Wallace and Bonnie [80] argue that the use of widely varying and sometimes poorly constructed definitions of the older person abuse phenomenon is a major barrier to improving the understanding of older person abuse. To mitigate the misunderstanding as a result of this shortcoming, Wallace and Bonnie [80] proposed a widely accepted definition of older person abuse whereby they define it as intentional actions that cause harm or create a serious risk of harm (whether harm is intended or not) to a vulnerable older person by a caregiver or other person who stands in a trust relationship, or a failure by a caregiver to satisfy the older person's basic needs or to protect the older person from harm. However, the international accepted definition among scholars is the one that refers to older person abuse as a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person [43]. According to Chalise [79], the definition of older person abuse implies that an abusive act perpetrated against an older person could be either an act of commission or omission by any person in a position of trust such as a family member, friend or neighbour.

The older person's abuse constitutes a violation of human rights and includes physical, sexual, psychological and emotional abuse, financial and material abuse and abandonment, neglect and serious loss of dignity and respect [43]. WHO [43] adds that older person abuse has serious physical and mental health, financial and social consequences, including, for instance, physical injuries, premature mortality, depression, cognitive decline, financial devastation and placement in nursing homes. According to Ayalon [81], the consequences of older person abuse can be especially serious and recovery may take longer. Albeit there are various categories of older person abuse, for wider use the international scholars reached a consensus on five categories of older person abuse, namely, physical abuse, psychological abuse, financial abuse, sexual abuse and neglect [82]. The older person's abuse may be manifested by various signs depending on the category of abuse. The types and signs of abuse are demonstrated in **Table 1**.

*Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*


### **Table 1.**

*Signs of older person abuse.*

There are various risk factors that lead to the abuse. The main risk factors that lead older persons to become victims of abuse include the following: being a female, presence of cognitive impairment and being single or living in an older person or couple family, living in rural areas, having a poor self-perception of health and having a disability [83]. According to Pilleemer et al*.* [78] and WHO [43], these risk factors can be identified at an individual level, thus, both as a victim and perpetrator, victimperpetrator relationship, community and societal level. The summary of older person abuse at the individual, community and societal levels and the associated risk factors are summarised in **Table 2**.

At an individual victim level, the risk factor is often functional dependency or disability, which generally becomes a challenge across all countries and has been consistently found to be associated with greater risks of older person abuse [78]. Other risk factors at individual victim level identified by [78] are poor physical health, cognitive impairment through dementia, poor mental health, low income and gender. The individual perpetrator risk factors include mental illness, which is viewed as a strong risk factor, substance misuse and abuser dependency whereby the studies have shown that abusers are likely to be depended on their victims for emotional support, financial help, housing and other forms of assistance [78]. At the level of the victim-perpetrator relationship, the older person's abuse is determined by marital status and varies from country to country [78] and through partner/spouse or child–parent relationships [43]. At community level, the risk factors are likely to be determined by geographical location thus whether it is rural or urban areas and varies with country [78]. In other


### **Table 2.**

*Risk factors associated with older person abuse.*

countries, older person abuse may become prevalent in rural areas while in other countries it may become more prevalent in urban areas. The societal risk factors identified are negative views on ageism and ageism may be attributed as a contributing phenomenon [78]. Negative attitudes and stereotypes associated with ageism may contribute to societal acceptance of older person abuse. The last risk factor for older person abuse is social and cultural norms that normalise violence as acceptable behaviour and may further perpetuate violent behaviour towards older persons [78]. In the South African context, Kotze [77] argues that older persons view poverty, unemployment and the subsequent use of alcohol and drugs as contributing factors to abuse. Kotze [77] also points out the breakdown of family structures, loss of respect for older persons, beliefs in witchcraft and high crime rates, including domestic violence and socio-economic inequalities.

Albeit the high prevalence of older person abuse, even today it continues to be a taboo, mostly underestimated and ignored by societies across the world [79]. The American Geriatrics Society's Foundation for Health in Ageing reveals that many cases of older person abuse are not reported. Even those who may consider reporting abuse often choose not to do so because they have been abused by a family member, a loved one, or a trusted caregiver [79]. The inability to report could be a result of extreme difficulty to reveal to others that someone trusted and loved by the victim is the one who is the perpetrator of abuse against the victim. Chalise [79] further argues that what makes matters worse is the blame that abusers often put on victims whereby they are told that it is their fault and also threatened if they reveal the abuse to anyone. The non-reporting of older person abuse also happens when the older person is dependent on the abuser for care, he or she may feel as if he or she has no option but to live in fear and pain [79].

### **5.9 Social care, living arrangements and social support**

In most developing countries, the difficulties in supporting older persons are to a certain extent mitigated by the cohesive structure within the community [84]. The inherent responsibility of children to support their parents later on in their life has been an intrinsic part of their culture for many centuries [85]. This conception is

### *Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

supported by United Nations [86] which asserts that in most developing countries a majority of older persons live with relatives and in many instances with their children. Traditionally, multigenerational households have provided the main social context for the sharing of family resources and the provision of mutual support as needs arise over the life course of the older persons [86]. The United Nations [86] further reveals that on average around three-quarters of the older persons over the age of 60 years in the developing countries live with children and or grandchildren as compared with about a quarter of the older population in the developed countries. Soni et al. [84] cite the examples of counties such as India, Nepal and China where family traditions and lineage are important with responsibility for the male children who are referred to as heads of households are expected to care for their parents, consequently creating a strong extended family unit. In Africa, family members are primarily responsible for providing care and support to older persons [87]. The caring by children of older adults is a reciprocated act, which is related to the African expression that roughly translates to 'Because you (i.e., one's older parent) have taken care of me (the child) to grow teeth, I will take care of you until your teeth fall out' [88]. In East and South sub-Saharan Africa, families provide most of the care for children, the sick and older persons due to few formal systems that exist [89]. According to the United Nations Population Fund [15], in East and South sub-Saharan formal care, where paid providers or governmental agencies provide assistance including day care centres, residential and care facilities, outside of urban centres, residential care facilities for older persons are rare and where present, they are generally financially accessible only to elite.

According to Kalache [90], these traditional forms of care available to the older population are under threat. The ongoing demise of the traditional forms of care is, as a result of families suffered from the impact of social change, including urbanisation, geographical spread, the trend towards nuclear families, and participation of women in the workforce [13]. The changes in the traditional forms of care have also been affected by migration whereby young people leave their country of birth searching for better opportunities and lifestyles [91]. The increased urbanisation and migration imply that people have to live a hundred miles away from their parents and simply cannot provide care and increased migration over the decades means that the younger generation may not even live in the same country as their parents [42]. The changes in the family structure have also been hugely affected by the effects of HIV and AIDS, particularly in the African continent.

There is a shift in the traditional form of caring, which is demonstrated by a change in the care responsibility. Instead of children taking care of their parents, older adults are the ones who take care of grandchildren and the sick in the household. Shetty [42] points out an uncertain employment environment whereby people are more likely to migrate for work or work much longer hours, therefore, meaning they can leave their children in the care of their grandparents. Therefore, this means that instead of older persons enjoying their retirement or being cared for, they have increasingly become care providers especially older women as they are becoming overwhelmed with care responsibilities and concern for their well-being and vulnerability is increasing [42]. The shift in care responsibility is also identified by the United Nations [86] when arguing that support typically flows in both directions and the nature and amount of support often varies or changes in response to individual needs. Very often, many older persons in multigenerational households are net providers of care and support for the younger generation instead of the other way around [86]. The United Nations [86] further adduces that even though they remain with the carrying and care responsibility, older persons are not recipients of material

and financial support from the child care and other households and community activities. In the developing countries, many older persons also remain active in the labour force and in the households, there are younger children and grandchildren who depend partially or entirely on the older persons for their livelihoods. Instead of being differentially waited upon by their children and children-in-law, older women are often involved in child care for grandchildren and in cooking for the ever busy dual wage earner couple [92].

There is also another developing trend of skipped-generation households, which is becoming a common phenomenon. The phenomenon of skipped-generation households consisting of grandparents and grandchildren is relatively common in many developing countries and older women are likely to live in this type of household [86]. The skipped-generation households become a reality when children may stay with grandparents when one or both of the parents have died and when parents have migrated for work or divorced [86]. The circumstance of the skipped-generation households varies in many ways depending on the situation that gave rise to the living arrangement. For example, parents who are working elsewhere often send money and return to visit and also grandparents who take care of orphaned children there may be one to help with support [86]. More often than not, skipped-generation households are likely to be found in rural areas, and these households tend to be poor [93]. The proportion of older persons living in skipped generation households has been going up in countries that were heavily affected by HIV and AIDS [86]. In those countries, many of the grandparents who support grandchildren are extremely poor [94].

Another aspect inherent to the lives of older persons who live with their children is household headship. In developing countries, on average, about 90% of older persons aged 60 years and over are identified as heads of households and over half of the men aged 80 or above are regarded as heads of households [93]. Women are much less likely than men to be identified as the head of the households, albeit there are distinct differences between countries in this respect [86]. On average about two third of older women in developing countries are either the heads of households or their spouses are heads of households [86]. While it is uncertain to what extent the household head leadership implies, it is about day-to-day control over resources and decision-making, and male older persons are usually regarded as playing a leading role in their households [86]. Older persons who live with their own children are far more likely to become heads of households than those residing with other relatives or non-relatives.

### **6. Implications for theory, policy and practice**

The theory undergirding the conceptualisation of ageing, policy formulation and practice is premised and influenced by ageism. The negative stereotypes that often shape the theoretical framework with regard to ageism are the root cause of negative attributes associated with ageing. The physical and mental deterioration associated with old age leads to devaluing of older persons and thus becoming isolated from active participation in social, economic and political activities. There is a need for a paradigm shift in theory that informs the current perspective about ageing. There is a need to modify the current theoretical paradigm on ageing by embracing the increasing longevity at old age, their strength with regard to life experience, the great contribution made by an ageing population in society and the active role that they still yet to play due to increasing levels of mental and physical health they still display.

### *Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

According to World Health Organisation (WHO) [95], the developing countries have much lower national income and infrastructure and capacity for health and social welfare than countries that developed earlier. This necessitates a reconsideration of the policy framework towards addressing the deficiencies in the provision of health and social welfare services. There is also a need to review policies relating to accessibility of labour markets and economic opportunities. The WHO [95] in the Decade of Healthy Ageing 2020–2030 suggests that appropriate laws, policies, national frameworks, financial resources and accountability mechanisms must be established in all sectors and all administrative levels to ensure that older persons experience health and wellbeing and enjoy the human rights. The WHO [95] further urges that national and international partners should also advocate for transforming social, economic and environmental policies for increasing longevity and optimising health ageing for development throughout the life course.

The WHO [96] argues that enhancing mental and physical wellbeing among older persons by delivering accessible, affordable, equitable and safe community-based care for older persons will require a competent workforce, appropriate legislation and regulation and funding. The precondition for having such competent staff is the elimination of ageism mentality among those entrusted with caring for older persons. Because of diminishing informal care in the developing countries, there is a need to think about other alternative models of care in contrast to institutional care. The financial capacity of the developing countries may not match the level of their developed counterparts that often utilised institutional care. The developing countries may consider designing family-based and community-based care models that will adhere to the acceptable norms and standards of providing care to older persons. The family and community-based care models may utilise formal caregivers that have undergone a transformation with regard to ageism mentality. Caring for older persons shall be conducted based on developmental perspective that will strengthen independent living and active participation of older persons in society.

### **7. Conclusion**

The increase in the population ageing seems to be an irreversible phenomenon, especially in the developing countries. There is a consensus in the literature about the perpetual increase in the number of older adults in developing nations. Older persons in developing nations are faced with challenges such as access to health care, social welfare system and social security. The challenges associated with their ageing such as deteriorating physical and mental health require adequate financial and human resources. The older persons are also exposed to high levels of poverty due to inadequate and lack of formal social security support measures. Older women are likely to become poorer than men due to their engendered social roles, which deprive them of participating in labour market when they are still eligible for employment. Older persons are victims of individual, community, institutional, societal and social abuse. Older women are the worse victims of older abuse as they are at the receiving end of older abuse due to patriarchal nature of society. The abuse of older women is perpetuated through cultural practices imposed during the process of bereavement and also after they have turned widows. The accusation of witchcraft laid against older women leads to many older women getting physically attacked and killed especially those who are very old and widowed. Ageism is viewed to have a fundamental effect on non-provision of essential services to older persons as it may determine the way

professionals, planners and policy and lawmakers respond to issues of ageing. As the population ageing is increasing, it implies that there will be more people that are going to become vulnerable to all forms of abuse and poverty. Therefore, governments from the developing economies should strive towards development of policies for the protection of advancement of the well-being of older population and make resources available for the implementation of the policies.

### **Author details**

Ntobeko Bambeni Independent Researcher, Pretoria, South Africa

\*Address all correspondence to: ntobeko.bambeni@webmail.co.za

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Perspective Chapter: Social Ageing Challenges Faced by Older Adults Exposed to Conditions… DOI: http://dx.doi.org/10.5772/intechopen.107116*

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Section 2
