The increasing population of older people has drawn attention to the need to revise\u00a0humanitarian policies to adequately serve this group\u2019s basic living and health requirements.\u00a0In 1999, the UNHCR announced the International Year of Older Persons with the observation\u00a0that \u201colder refugees have been invisible for too long\u201d. In a multi-country study of older\u00a0people in emergencies,2 HelpAge International concluded that \u201cif invisibility, exclusion
\nand powerlessness are common themes emerging from the experience of older people,\u00a0then consultation, inclusion and empowerment through partnership have emerged as the\u00a0primary indicators for best practice.\u201d<\/p>\n
From a health perspective, it is important to recognize the needs of older persons and to\u00a0develop appropriate policies to promote emergency health care. Yet it is equally critical to\u00a0assess and prepare for demographic and health trends that determine the shape of future\u00a0emergencies. By 2050, the prevalence of disability in some developing countries is projected\u00a0to rise by 400% as the population ages. An epidemiological transition also is shifting\u00a0the burden of disease from communicable to noncommunicable diseases. In 1996, deaths\u00a0in developing countries attributable to communicable and noncommunicable diseases were\u00a041.5% and 49.8%, respectively; yet this is expected to shift to 11.7% and 76.8% by 2020. Health planners must make allowances for the years of disability that accompany\u00a0many noncommunicable diseases (e.g. loss of mobility after a stroke). In developing countries,\u00a0the old-age dependency ratio in 2020 is expected to reach 11 (ratio of persons 65 and over to\u00a0persons aged 15\u201364), up from 7.6 in 1998.<\/p>\n
Emergency health policy and programming will also need to take into account probable\u00a0shifts in health care strategies. Modernization and urbanization, as well as shifting values\u00a0regarding family care for older people, has contributed to a marked breakdown of community\u00a0and intergenerational support mechanisms (14). As increasing numbers of frail older people\u00a0become both dependent and isolated, there is mounting pressure in some countries towards\u00a0their institutionalization. Emerging care and support models may take various forms,\u00a0including community-based care and health maintenance approaches, but all will require\u00a0strategies to protect older people during emergencies.<\/p>\n