Caring for the Elderly: Global Perspectives
Declining birth rates and increasing longevity around the globe have made the care of the elderly an international concern. Developed countries struggle to take care of the rapidly increasing population of older adults. However, this problem is compounded in developing countries as industrialization and modernization bring with them major changes in culture and society. Contrary to modernization theory, however, these changes do not necessarily result in a marginalization of older people nor does every society and culture respond in the same way to the tension between modernization and the care of the elderly. Traditional values persist in some areas despite modernization, and private or government programs may be put in place to encourage familial care of the elderly.
Keywords Activities of Daily Living (ADL); Caregiver; Culture; Economic Development; Globalization; Industrialization; Marginalization; Modernization Theory; Social Role; Society; Status
When one thinks of elder care, one typically thinks of it in terms of one's own family or country. Questions of most concern typically center around issues of how to best take care of aging parents or other relatives and how to best plan for one's own future old age and the care that may or may not be needed at that time. These issues, of course, are not restricted to the United States. Across the globe, individuals grow old and require assistance from family, friends, the government, or charitable organizations to deal with changing mental and physical capabilities and increasing needs for health care or other support to meet the instrumental activities of daily living (e.g., going outside the home, light housework, preparing meals, taking medications in the manner prescribed, using the telephone, paying bills and keeping track of money) or even the activities of daily living (e.g., bathing, dressing, grooming, eating, using the toilet, transferring to or from the bed or chair, getting around the house). How such questions are answered and issues resolved often vary widely from country to country, society to society, and culture to culture.
Increasing Proportions of Elderly
As medical advances continue to bring about improvements in longevity, the proportion of elders not only in the United States but around the globe continues to rise. According to the United Nations, there is a continuing trend toward lower birth and death rates around the world. As a result, the proportion of elderly individuals in cultures and societies around the world is on the rise and is projected to continue to rise well into the coming centuries. For example, according to the United Nations, in 1950 there were 205 million persons aged sixty years or older worldwide, and only three countries had more than ten million people aged sixty or older: China, India, and the United States; by 2000, the number of persons aged sixty years and older increased approximately three times to 606 million and the number of countries with more than 10 million people over sixty increased to twelve. Over the first half of the twenty-first century, the global population of persons aged sixty or older is projected to expand to more than three times to two billion people in 2050. Further, longevity itself is increasing, with people aged eighty years or older being the fastest growing segment of the global population. The global population of individuals aged one hundred years or more is projected to increase fourteen-fold from 265,000 people in 2005 to 3.7 million by 2050. In addition, the tempo of aging is increasing more rapidly in developing countries than in developed countries, which means that along with the other issues of economic development, these countries will also have to quickly deal with the issue of their aging populations (UN Department of Economic and Social Affairs Population Division).
An International Issue
With increasing globalization, social issues such as the care of and provisions for the elderly within society are increasingly becoming international issues rather than merely local or national ones. For example, delegates of 160 governments, intergovernmental institutions, and nongovernmental organizations met in April 2002 at the United National Second World Assembly on Ageing in Madrid, Spain, in part to develop a long-term strategy for the aging population of the world. Among the outcomes of the Assembly was an emphasis on governments having the primary responsibility to promote, provide, and ensure access to basic social services including the specific needs of older persons (Article 13). However, this article also included the need to work with local authorities, civil society, nongovernmental organizations, the private sector, volunteers and voluntary agencies, and the elderly and their families and communities in realizing these goals. The Assembly also recognized the right of all persons, including the elderly, to realize the enjoyment of the highest attainable standard of physical and mental health (Article 14). The Assembly recognized the importance of family, volunteers, and communities in providing support and care to older persons in addition to the services provided by governments (Article 15) and the need to strengthen solidarity among generations to encourage mutually responsive relationships (Article 16).
Diverging Global Views of Elderly Care
While globalization and near-instantaneous communication contribute to the feeling that the world is getting smaller and the sense of a commonality of culture, this is not necessarily true. Even within Western societies, there are differences in the specifics of how the elderly are cared for. In fact, social policies and praxis regarding the care of the elderly vary across the globe. Even within broad cultural regions, there can be great variation. However, there are still areas in the world that have a different (or historically different) attitude toward the treatment and care of their society's elders.
It would be impossible to explore the details of attitudes toward and care of the elderly for every culture or country within the scope of this document. Therefore, this section will focus on two cultures that are distinctly different from Western culture: Africa and of South/Southeast Asia. The former is of interest because it is still to a great extent undergoing economic development. This allows one to observe the care received by elders in culturally traditional areas as well as the changes in that care and the concomitant attitudes with the incursion of modernization and industrialization. As recognized by the United Nations Assembly on Ageing, it is in such countries that the greatest attention needs to be given to elder care as elders no longer receive the respect and good care afforded them in traditional culture but do not yet have access to the government-funded and institutionalized care infrastructure provided by more developed countries. Similarly, many areas in South and Southeast Asia are still undergoing economic development and are finding it a challenge to switch from a traditional society in which there was intergenerational support and a cultural emphasis on taking care of the elderly to a modern society that does not prioritize these values. As a result of the modernization taking place in some countries in this area, the traditional support systems for elder care are breaking down whereas in other countries they are not.
Care of the Elderly in Africa
As with other places around the world, efforts to better provide for the need of the elderly need to be accelerated to meet the rising demand. In traditional African culture, the elderly are given high esteem and social status. Both as part of this traditional culture and as a natural outgrowth of the strong religious roots of the society (in particular, the kinship system, belief in spirits, and certain rites of passage), an expected part of traditional African culture has been to care for the elderly. Traditionally, mistreating the elderly was considered within the culture to be the equivalent of calling down a curse on oneself and the wrath of God and the ancestors on the entire community.
However, modernization in many parts of Africa has changed both expectations of status and care for the elderly. This is particularly true as many younger people move to urban areas, leaving behind elders in rural areas without family support or involvement in their care. Modernity has brought with it new religious attitudes and has changed traditional cultural norms. In much of African society today, traditional values and practices are routinely challenged. Mary Nyangweso (1998) investigated the effects...
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