Caring for the elderly

In the developing world less than 5 per cent of the population is more than 60 years old. By the turn of the century in the West one in five citizens will be elderly, and a high proportion will be over 75 years of age. The consequences for health care and accomodation are enormous; so is the problem of providing adequate pensions to support so many people who will no longer be involved in wealth-producing work. Family support of the elderly is becoming less and less common in the developed world. This is because of the decline of the extended family and the increased social and geographical mobility of modern life. In the past, most people spent their entire lives in their home town, taking care of their parents or other relatives in old age. Now, however, modern living dictates that smaller families are less able to care for elderly relatives; fewer grown-up children are willing or able to bear the responsibility. Formerly, it was not uncommon for an unmarried and unemployed daughter to look after aging parents, even to the extent of sacrificing her own chances of marrying young; or a woman widowed early might live with her son and housekeep for him. These social patterns are becoming increasingly rare. Daughters who traditionally looked after their parents after the birth of their own children now return to full-time work because it is often considered financially essential.

In the West, one-quarter of retired men and women live with one or more unmarried children; another quarter live with a married child. Of the remainder, many live with a spouse or sibling, or alone; only a relatively small proportion live in some kind of state or private institution. The proportion of the elderly living on their own is growing more noticeably among women, because they tend to outlive men. The consequences of living alone are serious for old people, their family and the state. A family house can become a considerable burden for one old person to maintain and heat on a limited income. At the same time, an old person may be slightly infirm and a worry to his immediate family but yet independent enough to be self-sufficient for much of the time. Or the only difficulty may be isolation. The answer to this growing problem may come from purpose-built sheltered housing. This groups together small one- or two-person flats or bungalows; a resident warden on site helps keep a watchful but not intrusive eye on the well-being of the residents. There is in most countries a shortage of such accomodation, and probably less than five per cent of all elderly people live in such schemes. In the future, however, this kind of housing could prevent the horror of old people dying alone in poorly heated homes with their bodies remaining undiscovered for many months.

Institutional care

The concept of institutional care brings fear to the hearts of many people. Fortunately the nineteenth-century hospitals and workhouses where the mentally disturbed, the old and the mentally disabled were placed together have disappeared to be replaced by modern old people’s homes.

However, many of the elderly still regard all forms of institutional care with suspicion.

Modern old people’s homes have a better ratio of staff to residents. Ideally a resident should have some degree of privacy, preferably his own room, although for the practical reasons of nursing and hard economics this is often not the case. Besides the social reasons, mentioned above, for the inability of the modern nuclear family to care for its elderly, there are medical factors that often make the ‘old folks’ home’ a necessity. The responsibility of looking after an aged parent suffering from Alzheimer’s disease, for example, may prove too much for some. The prevalence of chronic health problems associated with old age demands specialized nursing, beyond the strength and capabilities of families. Indeed, the problems of caring for elderly and sometimes difficult people have sometimes led to violent acts being committed against them even within their own family.

Loneliness in old age

The problem of loneliness in old age is widespread. A larger proportion of people have married this century than ever before, thus reducing the relative incidence of old people being left single without any family. Nevertheless, an increasing number of old women live on their own; disabilities and infirmities make social contact difficult and embarrassing. Old people’s attitudes to life partly determine how they deal with this problem. In this respect the elderly can be classified in different categories of personality. There are the elderly who can only with great difficulty cope with their increasing disabilities, not being able to come to terms with the inequalities of youth and old age. They react in a way that is either angry and bitter or withdrawn, not wanting to be a burden to anybody. On the other hand there is a category of elderly people who are independent and have a contented attitude towards the past and the future. In general this type of old person will be admired and loved by family and friends.

Closing the generation gap

A number of countries in the West are experimenting with projects that are designed to bring old and young members of the community into closer contact with each other – to the mutual benefit of both social groups.

Some nursery schools, for example, ask nearby elderly residents to help to look after one or two children for an afternoon or so a week as a way of not only dealing with congested classrooms, but also of giving pensioners a sense that they have a valuable social role to play. Particulary if their own grandchil- dren do not live locally (or if thay have none), most elderly people are more than happy to help to take care of young children, to read to them, and – if not too energetically – to join in their games. Children whose parents are both at work, and therefore would spend only a limited time with them, are the most likely to benefit from such surrogate ‘grandparenting’. Older children can provide practical help to old people who are unable to get about easily, doing shopping, digging gardens and mowing lawns, cleaning windows and helping with general domestic chores. In some districts, young offenders sentenced to do community service are employed to assist elderly people in this way.

A role for old age

Although it is impossible to replace the loss of friends and familiar things that elderly people cherished, it is definitely possible to at least make them feel they still have a part to play in life, rather than being relics of the past. This is perhaps easier said than done. In an extended family – and in many self-contained, non-Western societies this remains the rule – grandparents have an important role in bringing up the children of their own children. They hold a prominent position as ‘wise elders’ to the family.

The notion of ‘progress’ is perhaps partly to blame for the isolation of old people today. With its emphasis on the ‘new’, society often neglects the accumulated experience and wisdom of older people. Modern life tends to be stratified into specific age groups, so elderly people are isolated from the young and feel less at home with their culture and lifestyle. However, old people are a community resource; they have a contribution to make to help solve the problems of society that should be fully recognized.

The image of death has changed. Under the influence of the rapid progres made by medical science and the growing ‘individualisation’ of society, death has been ‘driven out’. People hardly dare face their own or someone else’s end, and parents often hesitate to confront their children with death. In the past most people died at home and the family could ‘part with’ the one who died within the family circle. Death was literally a part of everyday life. Nowadays, most people die in hospital, even though this is not always strictly necessary. In the hospital one is more occupied with ‘keeping alive’ than with dying, and someone whose end is near may feel extremely isolated.

Also, the corpse is removed to a mortuary; people seem to prefer to retain the image of the living person. Doctors are able to prolong ‘life’ with the aid of all sorts of technical equipment, often when the patient’s chance of recovery is almost down to nothing. This at one point raised the ethical question of how far medical science should maintain such a ‘life’. As the definition of death has nowadays been revised to a certain degree, the termination of’artificial life’ has been made somewhat easier. The question, however, of when someone is allowed to terminate hopeless suffering or – it is presumed – a ‘senseles’ existence, is still a controversial matter.