All over the world, seniors are living and healthier lives. The scale on which it is occurring, its relative rapidity and newness in terms of human experience means we know relatively little about how to respond appropriately and effectively. In the past 50 years, more than previous 5,000 years, there have been greater gains in longevity. In Asia alone, the UN projects that the population aged 65 and older will more than quadruple by 2050, whereas the population aged below 15 years will decline. Each month another 800,000 people celebrate their 65th birthday.
Driving the trend towards older populations are gradual declines in fertility and increases in life span due to improved healthcare. Although more developed countries led this trend, the greatest ageing is now found in developing countries, which collectively comprise ¾ of the world's overall gain in those living beyond age 65. Singapore, for example, is expected to experience a nearly 4-fold increase in citizens aged 65 and older by 2030, with similar rates predicted for Malaysia and the Philippines which are expected a minimum tripling in their populations aged 65 and older (Kinsella and Velkoff, 2001). Throughout Asia, governments have to meet the challenges posed by aging populations, adopt policies encouraging savings and investments develop social and economic institutions and find new ways to tap the productive potential of older people (Mason, Lee and Russo, 2002).
Malaysia, like many other countries, is experiencing population ageing and this is indicated by a rise from in the percentage of older persons aged 65 and older from 3.5% in 1995 to 4.0% in 2000. By international standards, Malaysia's population of 23.3 million in the year 2000 cannot be regarded as 'old', since fewer than 10% of its population (4.0% in 2000 or about 932,000 persons) are older than 65 compared to 3.5% in 1995. By the year 2005, however, it is expected to increase to 4.3% (Government of Malaysia, 8th Malaysia Plan, p. 89).
But ageing in Malaysia is expected to accelerate in coming years because of improved longevity and also slowing fertility which can be linked to the impact of modernization on marriage, childbearing, family formation, value of children, increased education and participation of women in the workforce, etc. The modernization of Malaysian social norms can be expected to grow with globalisation. Globalisation promotes borderlessness or increasingly free flow across national boundaries of ideas, technology, people, goods, services and capital leading to integration and similarities between economies and societies.
Aim and scope of paper
This paper looks at some aspects of the elderly viewed in the context of population changes shaped by socio-cultural dynamics which also affect the contributions and care of the elderly. Reference is made to ageing and the aged in general and to Malaysia in particular.
In examining the care of the elderly, it should be emphasised that not all older persons need to be cared for. In fact, most elderly persons are capable of carrying on the activities of daily living or live independently.
General comments about the elderly
The elderly can be found, however defined, in virtually all societies. There is no universally acceptable definition of 'elderly' varies from society to society and from individual to individual depending on such factors as legal definitions, individual mental and physical functioning, self-concept, society's judgements and sometimes the individual's occupation.
Ageing as the process of becoming old affects different people differently. Some are less affected or affected more slowly than others by physical, psychological, and social processes which over time cause changes in the person's functional capacities
- Age stereotyping is unfortunately common - classifying individuals who are expected to become different persons once they reach a chronological benchmark which identifies them as 'old' or 'too old.' This stereotyping can broadly be classified as:
Positive stereotypes include older persons as the 'Golden Agers' and 'Perfect Grandparents.'
Negative stereotypes regard older people as ill or sickly, frail, useless, ugly, mentally declining, depressive, rigid/stubborn, etc. Negative stereotyping has adverse effects on both society and old people, reinforcing prejudice and discrimination or 'ageism'.
POSITIVE CONTRIBUTIONS OF THE SENIORS OR THE ELDERLY
- Against the backdrop of concerns about how ageing will affect individuals and societies, we must not ignore the positive contributions of the elderly to socio-economic and political development. Examples of leaders like Malaysian Prime Minister, Datuk Seri Dr. Mahatir Mohammad, the late former Prime Minister Tnuku Abdul Rahman, Royal Professor Ungku Aziz, captains of industry ex. Robert Kuok, Lim Goh Tong, Mr. David Boler, former Chairman-Founder of the NECF, etc.
- True that the foundations for a modern and prosperous and multi-cultural society like Malaysia would not have been possible without the diligence, sacrifice, and resourcefulness of previous generations, some members of which are still living and are contributing in their own way.
- Nevertheless, they can and do contribute in various ways, including:
- as an inter-generational 'bridge,' link between old and new;
- custodians of traditions, cultures and values which are being transformed, if not eroded by modernisation and globalisation.
- the interpersonal contributions of older people as care-providers. Increasingly, in many societies, older adults contribute significantly as care-providers (child-care, peer care, end-of-life care in families); yet, the frequency and the worth of this kind of contribution are generally overlooked and under-estimated (Wells, 1997).
- Besides care-giving, the elderly contribute to families by performing household tasks and other daily activities as a study of three Asian countries established (Andrews, and Hennink, 1992). Rather than producing goods and services, the older persons can and do contribute various socially valued products such as counselling, mentoring, community leadership, political involvement or role model figures. Such non-monetary efforts may have great economic and human benefits, but they are generally not widely recognised or appreciated.
CARE OF THE ELDERLY: SOME COMMENTS AND OBSERVATIONS
Elder Care - Whose Responsibility?
In general, the provision of care is primarily a responsibility of the family. However, society also has an obligation to assist the elderly who cannot care for themselves.
The role of government should be to provide a supportive environment for family- and community-based care and to provide direct elder care services when additional care is needed.
Care within the family includes support, providing security, reducing elderly stress, providing shelter and clothing, feeding and bathing, preventing and treating illness and showing affection and respect.
From a Christian perspective, caring for elderly family members is mandatory (cf. Exodus 20'12; Eph 6'1-2; 1 Tim 5'3-4). The concept of family surely applies to the church as a family of families or a living network. The church community also has a pastoral responsibility to look after the elderly within its midst.
Care facilities outside the family include curative and preventive health clinics, more specialised geriatric centres, traditional healers or members of extended family networks, community and government social and economic support systems and programmes for income generation.
There is indeed growing concern in Asia with how the elderly will be supported and cared for in the twenty-first century. Further economic growth and urbanization are likely to erode the family's ability or willingness to care for elderly members. Reduced availability of family caregivers clearly could affect the economic and physical well being of the elderly. There are already signs of this happening in Malaysia , as suggested by the author in a study 20 years earlier (Chan, 1982).
- Although caring for the elderly has traditionally been a family responsibility there is a progressive shift of the care-providing function away from the family. This shift is reflected in and related to the declining availability and quality of family elder care which in turn are affected by such processes as:-
- Modernization - changes in values, norms/expectations, attitudes towards the elderly, roles and behaviour, a shrinking pool of care providers related to declining family size, increased economic participation outside the home of traditional care providers, i.e., women who are now better educated than their counterparts in previous generations, and an increased divorce rate which means that more older people (men in particular) will have lost contact with their kin networks or will have such complex kin networks that they may be unable to receive care from their adult children;
- Urbanization - affecting availability and problems of congestion/unsafe, deteriorating macro and micro-environments affecting the elderly;
Increasing mobility - physically separating care-needers from family caregivers or providers. The mobility is not only internal (within Malaysia, e.g., from rural to urban areas, or between urban centres, within the same urban centre) but also externally oriented (out of the country, i.e., international migration).
The problem of obtaining adequate elder care is likely to be more acute for older women than men. This is because women usually outlive men, and men generally marry women younger than themselves. Thus, women are more likely than men to end their lives as widows. While older men can rely on their wives for care as they grow frail, older women, often after having first cared for an ageing parent or parent-in-law, then for an ageing husband, are themselves left without a spouse or grown children to provide the care they need as they age. The problems that elderly women face are, moreover, frequently compounded by their difficulties in obtaining sufficient income because of their limited access to pensions and rights to property. Governments in Asia, as well as elsewhere, need to pay special attention to the support and care needs of elderly women (Mason, 1992). Women being more affected as they tend to live longer than men do, and the challenges of ageing are likely be greater for women than men.
- Two basic individual needs - It should be noted that as more individuals live into very old age, two needs rise to the fore:
- income security and
In traditional societies, family and community provided both. As societies modernise (and their populations age), these responsibilities come to be shared by the society at large, through inter-generational transfers between working and retired populations, often facilitated by insurance and the savings elders accumulated in their earlier years.
Multi-generational mixing often becomes more difficult because of the large number of age-based and segregated institutions such as kindergartens, schools, adult work places, and retirement settlements as well as the phenomenon of urban/rural migration that often leaves elders to remain in rural areas.
Old-age support and care which can be provided by the family may be simplified into three categories:
- social/emotional and
Physical support - is required only when the elderly person is ill and/or is too frail and weak to attend to himself or herself. The spouse or any member of the family may provide such a function, either with or without external support, at home, or in institutions if constant medical attention is required.
Social/emotional support - from the family comes through the conjugal relationship as well as through adult children, although the former is likely to be more important for men than women. This is because men 65 or more years of age are more likely to be married -- usually to younger women -- whereas women are more likely to be widowed.
Economic support - Poverty in old age affects the ability of the elderly to provide for their needs, including health care which is increasingly becoming more expensive and not always easily accessible. In Malaysia, ensuring economic security for the elderly, as in other developing and even more developed countries, is becoming more challenging as only a very small proportion of the elderly population, and mainly those living in urban areas, are beneficiaries of pension or insurance schemes. Provident funds cover only workers in the formal sector; they are paid out in a lump-sum upon retirement, and are usually inadequate and quickly spent. Most elderly persons, therefore, work to advanced ages, if they can, and depend almost entirely upon family support during their later years. The care and support provided to parents are usually in the form of shared housing, food and other necessities and less often in the form of direct transfer of income. These transfers or remittances are, however, more likely for those children who live apart from their parents or who have migrated.
An important point to note is that living arrangements are not indicative of the care and support that is received by parents. For example, living in an extended family system with one's children is no guarantee that adequate care is being provided, and living independently does not mean that one's needs are not being met by family members. Evidence however indicates that family members are still important in providing emotional support and care to elderly persons living alone or away from their family members (Tan, 1992).
The Issue of Economic Security
- The economic well-being of the elderly is at great risk in societies where the elderly are unable to find gainful employment, and are marginalised by the absence of either strong family or state support. Poverty either of the elderly and/or their family support providers reduces the prospects of adequate elder care, especially expensive long-term medical attention is needed.
- In Malaysia, the effectiveness of national provident funds to provide an adequate income for the elderly has been questioned (Caraher, 2000). It has also been pointed out that the nature of the globalised economy reduces the opportunities for life long employment and working conditions (e.g., earlier retirements), affecting not only younger workers but also older workers who are particularly vulnerable. The globalisation of the economy can be expected to affect working lives will be characterised by uncertainty and unpredictability.
- With the growing trend towards privatisation of key public services, especially health, the economically vulnerable among the elderly (perhaps the majority) could be worsened.
Declining fertility and increased mobility will reduce the options of the elderly parents to live with their children. Furthermore, if parents are forced to move, in order to live with one of their adult children, this could disrupt local lifetime social networks. Increased longevity of females compared to males will also increase the proportion of elderly women living alone.
Most Malaysian families usually still take it upon themselves to care for the elderly in the family at home wherever possible, and this is reflected in a study which reported that over two-thirds of Malaysians aged 60 and older co-reside with their with an adult child (Chan and Da Vanzo, 1996; Schulz, 1997). Many elderly wish to be cared for in the familiar environment of their own home.
In Malaysia, it can be said that most seniors prefer to live by themselves as couples after all their children have left the home to start families of their own. Some choose to live by themselves alone even after they lose their spouses.
Some elderly still wish to live with the family of one of their children when they lose their spouses. If they cannot have one of the children move in with them, they seriously consider moving in with the family of one of their children. If this is not feasible, some even try relocating so that they can live closer to one of their children.
In Malaysia, like most Asian countries, only a small proportion of the elderly appear to be deserted or at least outside the conventional familial support system. Many elderly persons, who live alone or only with a spouse, are still receiving support or assistance from their children or other family members.
An important point to note is that living arrangements are not indicative of the care and support that is received by aged parents. For example, living in an extended family system with one's children is no guarantee that adequate care is being provided, and living independently does not mean that one's needs are not being met by family members. Evidence however indicates that family members are still important in providing emotional support and care to elderly persons living alone or away from their family members (Tan, 1992).
However, the strength of the family support system for the elderly is going to be increasingly tested with such interrelated developments as modernization, urbanization, increasing geographical dispersion related to increased physical mobility and shrinking pool of carers for the elderly.
The options of the elderly parents to live with their children are affected by socio-economic and demographic trends. Even if parents are forced to move, in order to live with one of their adult children, this could disrupt local lifetime social networks. Increased longevity of females compared to males will also increase the proportion of elderly women living alone.
Elder Abuse and Neglect
On the topic of caring for the elderly, the need to avoid elder abuse, a highly sensitive issue, arises. This problem may be hidden but is likely to surface with more older adults in our society and their unique problems. Already in Malaysia, there have been reported cases of children and women suffering from domestic abuse; and it is not unimaginable that the abuse and neglect of an elderly person (usually more frail and with least social support) by a relative or relatives in the household exists.
This scenario could be realised with mounting pressures and stresses associated with modernization, urbanization and economic uncertainties as national economies become increasingly interlinked and vulnerable through the effects of globalisation. To avert elder abuse, carers of the elderly particularly need help and support, just as much as the older persons they look after. Education of all carers into the nature of ageing and conditions associated with it minimise these as reasons for abuse.
WHAT COULD MALAYSIAN CHURCHES AND THE CHRISTIAN COMMUNITY OFFER?
- Caring for the vulnerable, needy and frail elderly is an integral part of Christian compassion and practical demonstration of the gospel.
- Offer services and facilities -
Churches and individuals could consider involvement in such areas of ministry as:
- Providing residential facilities for the elderly who are isolated from their families
- and residential nursing care facilities for the frail elderly;
- senior or adult day care centres or health programmes - an area of ministry with much scope since not all seniors need or want to be permanently sheltered;
- hospital or home visiting;
- home nursing;
- home help and maintenance;
- providing hospital transport;
- volunteer work at a hospice;
- ministry to support full-time care givers in the congregation: visit them, give them time-off, be a listening ear;
- other services which provide local elders with social connections and physical assistance to enable older people to be able to continue to live in the community and minimise the need for institutional care; and
- prayer for:
- i. those in particular need - elderly people, those who are left isolated by illness or care-giving, people suffering mental illness, people with terminal illness.
- for professionals and volunteers caring for the elderly - for strength, energy and recognition.
- Christians working in hospitals and the community - that they will have the wisdom and strength to live out their faith in their workplace.
THE UNITED NATIONS CHARTER FOR THE ELDERLY
Reflecting the diversity of needs of the elderly to ensure that older persons enjoy a satisfactory quality of life, the United Nations (1998) has set forth 5 important issues for:-
- Independence - have access to food, water, shelter, clothing, health care, work and other income generating opportunities, education, training, and a life in safer environment;
- Participation - should not be separated from community life and be able to participate actively in forming policies affecting their well-being
- Care - access to social and legal services and to health care so that they can maintain the best level of physical, mental and emotional well-being. This should include full respect for dignity, beliefs, needs and privacy.
- Self-fulfilment - access to educational, cultural, spiritual and recreational resources and to be able to develop their full potential
- Dignity - should be able to live in dignity and security, free of exploitation, physical and mental abuse and be treated fairly regardless of age, gender and ethnic background.
This paper highlights some of the many complex issues that must be confronted to ease the condition of the seniors in society. Ageing as a demographic process is inevitably growing and transforming the character of Malaysian society, putting on new pressures and challenges which will tax the capacity and adaptability of both the aged and the rest of the society.
There is much scope for Christian individuals and the Christian community at large to be involved in caring for the needy elderly.
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