ABSTRACT:
The number of old people, who are 60 years and above, is increasing in
the populations throughout the world. Even among the old population,
persons who are 80 years and above, called the ‘oldest old’ are growing
faster. Old age is associated with frailty, disability and disease.
Hearing and vision impairments, cardio vascular diseases, osteoporosis,
stroke and Alzheimer’s disease are some of the major diseases related
to old age. The growing number of older individuals in a society
necessitates the need for long term health care. The family is the
immediate caregiving institution and a sick elderly person increases
the burden of the family. Formal caregiving has not yet evolved in
India as in developed countries. This paper aims to analyze the needs
for elderly caregiving in the twenty first century, the availability of
formal and informal caregivers, the problems of the family caregivers
and the roles of communities and governments to enhance the level of
caregiving to growing elderly population.
Caregiving
Caregiving is a noble task but at the same time caring for a loved one
is always a stressful and frustrating one. Care may be needed for a
shorter or longer duration of time depending on the condition of the
care recipient. Short term care does not have much significance and
caregiving becomes a social issue when it is required for a long time
for a person who is chronically ill or disabled. The care recipient may
be anybody – a child, an adult or an elderly person of any gender.
Chronic illness or accident might have necessitated caregiving.
Caregiving to a child is different from that of providing care to a
middle aged or an elderly patient.
Caregiving includes helping the patient in the activity of daily living
like toileting, bathing, dressing, feeding, walking, administering
medicines, nursing and other related activities. The caregiver may also
be expected to assist the patient in financial and legal matters. There
are two types of caregiving – formal and informal. Formal caregiving is
a paid service provided by health professionals like doctors, nurses
and attendants of hospitals and some social welfare organizations.
Informal caregiving refers to unpaid services rendered by family
members, friends and relatives. Caregivers are falling under two
categories – primary and secondary. Primary caregivers are those who
are mainly responsible for providing care to the patient and those who
support the primary caregivers in their care giving activities are
called secondary caregivers. If the wife is a caregiver for her sick
husband, she is the primary caregiver and her sons, daughters-in-law,
grandchildren, friends and relatives who assist her are the secondary
caregivers.
Population Aging
People are living longer than their previous generations throughout the
world due to increase in life expectancy. The absolute number and
proportion of people who are aged 60 and above are increasing in the
world population. This is the result of demographic transition from
high birth rate, high death rate and shorter life expectancy to low
fertility rate, low mortality rate and longer life expectancy.
Fall in the birth rates increased the proportion of old people and
declining mortality rate increased the number of old persons in the
population. Developing countries have been aging for centuries but this
phenomenon is happening in developing countries recently and at a
faster pace.
The United Nations declares persons who are 60 years and above as old
and estimates that there will be around 2 billion old people in the
world by 2050, 80 percent of whom will live in developing countries.
The old population itself is aging and the persons who are 80 years and
above, called the ‘oldest old’ are aging faster than any other age
group. Major proportions of elderly persons comprise women in almost
all countries. The majority of them are widows and their numbers grow
as their age increases.
Old age and health
Old age is associated with chronic illness, frailty, disability and
dependence. All forms of functional impairments increase with age. The
major diseases relating to old age are cataract, hearing impairment,
arthritis, diabetes, osteoporosis, heart disease, cancer, stroke,
Alzheimer’s disease and neurological disorders. Depression, anxiety and
suicide tendencies are also found to be common among the oldest old.
With the increase in the old population, the chances of rise in the
dementia patients also increase. The health problems of the elderly are
different from those of younger persons and most of the diseases are
chronic (Sitaram Gupta, M S Rathore and S S Shekhawat, 2009). The old
persons require life long treatment and an elderly person with chronic
illness becomes the matter of financial and emotional burden on the
family.
Old persons have to depend on others due to poor health, disability and
economic situation. Old people have fear for their future and
dependency (Dias A and Patel V, 2009). More number of elderly persons
in a society puts pressure on the family and governments to provide for
their welfare.
Availability of formal care in the public health sector is very scarce
for elders and geriatric medicines and specialist health services for
old people are not well established in India.
Challenges of Caregiving to elders
The elders need more care when their vitality is reduced due to
weakness and sickness (Carol Bradley Bursack, 2009). Family plays an
important role in providing health care to the needy old persons.
Family remains the only source of care and support for the vast
majority of Indian elders (Dias A and Patel V, 2009). The caregivers
are normally the spouses and majority of the caregivers in our society
are women since women have the time, patience, tolerance, nursing
ability and helping tendency. The family members who provide caregiving
to ill or disabled relatives are great assets to the society (Richard
Schultz and Scott R. Beach, 1999). The illness of old people cannot be
cured and only palliative care can be provided. Due to frailty, the
dependence of old persons increases with age and caregiving to them
will not be so easy. When the old person is suffering from disability
or dementia, caregiving becomes very difficult and complicated.
Majority of dementia patients are cared at home by a family member and
the mental health of the care givers deteriorates in due course (Shaji
KS et al, 2009).
Poverty is one of the major problems for caregiving to elders.
Unavailability of affordable health care makes it difficult for poor
families to provide adequate care for old people. Poor elders who do
not have children will have to depend on relatives and friends for
survival and support.
If the caregiver is a spouse, child or somebody who loves the elderly
patient, witnessing the suffering of the patient will be a very sad
experience for the caregiver. The sorrow and the inability to mitigate
the suffering of the patient will increase the frustration and affect
the caregiver psychologically. The burden of woman caregiver will be
tremendous as she has to balance her time between the elderly person
and the rest of the family.
Providing assistance to the old person in the activities of daily
living like toileting, bathing, dressing etc, may be an unpleasant
experience affecting the self esteem of the caregiver. Caring an
elderly person is a very stressful job. Due to advanced age, the
cognitive abilities of the elders will be on decline and their demands
on the caregivers will be unbearable. At times they may abuse the
caregiver and behave irrationally which will add to the mental agony of
the caregiver. In some cases, the old couple may live alone and
caregiving by the elderly spouse will be very tiresome. Sleeplessness,
untimely intake of food, attending the visitors and providing timely
care will result in fatigue and depression.
The caregiver is likely to be affected psychologically and
physiologically due to pressure, exhaustion, stress and strain of
caregiving. Depression and anxiety are the outcomes of the stress faced
by the caregiver. The possibility of the caregiver suffering from
infectious sickness cannot be ruled out. In order to provide proper
caregiving, the caregiver has to take adequate measures to keep his
body and mind fit to meet the challenges of caregiving To be effective
caregiver, one has to understand the disease, the patient and manage
the time effectively. Regular well planned breaks from caregiving
activities will definitely ease the pressure. The caregiver also should
take the help of other family members, friends and relatives. By
ignoring his own health for the sake of caregiving, the caregiver is
likely to become patient himself.
Future of caregiving to elders
The average life expectancy of Indians is increasing steadily from 32
years at the time of independence to 63 years in 2001. As per the
estimate of United Nations, the life expectancy of males will be 68.8
years and females will be 72.1 in the period 2020-25. The population of
old persons in India was 12 million in 1901. It increased to 76 million
in 2001 and is expected to be 326 million in 2050.
Growing number of elderly persons will increase the demand for
caregiving dramatically in the coming decades. Joint family system is
disintegrating and one child families and nuclear families have become
common nowadays. Migration of younger generations, women employment,
modernization and globalization resulted in shortage of care givers to
the elderly. Informal or family caregiving cannot be sustained in
future and due to the social changes, it will be difficult to find
family members for caregiving except the living spouse.
Elder abuses and abandoning the parents are increasing and only a small
proportion of children consider it their duty to look after their old
parents. The relationship between parents and children deteriorates
over a period of time due to inter-personal conflicts and difference of
opinions. When the parents become old and sick, they are neglected and
insulted. The number of such neglected parents likely to increase
significantly in the future.
Interventions
Family is the prime social institution to care the elders. However,
when there will not be sufficient family members, it becomes imperative
to involve community members in caregiving activities. The family
members should change their negative attitude towards old people and
willingly offer their services in providing care to the needy elders.
Charity begins at home and if the families change for the better, then
the entire community in total is transformed.
The children who live away from their parents should make adequate
arrangements to provide formal care to their parents at the time of
need. Young children should be taught about Aging, the past
contributions of old people and the importance of
caring them. It is important to create positive image of elders in the
minds of the younger generations.
The number of caregivers, both formal and informal, will have to be
increased in future. It would be appropriate if the educational
institutions take initiatives to train students for voluntary care
giving. Arranging regular visits of students to old age homes will
enable the younger generations to understand the plight of old persons.
Educational institutes should organize seminars and conferences
regularly on the subject of elderly and caregiving needs to create
awareness among the students.
To reduce the financial burden of poor people, the governments should
provide free or subsidized medical care for old persons. Old age homes
are spreading throughout India, both in urban and rural areas. However,
they are not geared to provide long term care for old people.
Government agencies and NGOs who run old age homes may consider adding
caregiving facilities with suitable health care professionals.
Similar to old age homes, Caregiving Centres can be started throughout
India by government and NGOs. Leading private hospitals and corporate
companies can join together and establish care centres which can
provide long term care at affordable cost or free of charge for old
persons and other sections of the society.
Both government and private hospitals should have special geriatric
wards with professionals trained to treat old persons. Such wards
should have facilities to provide long term care for old patients
without the need for any family member to be with the patient.
Caregiving courses and trainings are offered by certain educational
institutions in some of the major cities at present. However, medical
colleges and similar institutions should introduce caregiving study
courses on a large scale and raise the quality of caregiving education
to the level of nursing by improving the standard of curriculum and
training. This will enable more young persons choose caregiving as
their career.
Old persons, as far as possible, can take care of themselves by forming
associations and clubs. Old people, especially ‘young old’, who are
aged between 60 and 70 and active, should take the lead to form
suitable networks to provide care to the fellow old persons.
In future, almost every household will have one or two old persons who
may require long term health care. When the caregiving need arises, the
caregivers from different families can form informal networks, assess
different needs of different patients, consolidate the requirements and
share the total care giving tasks among themselves. Such community
caregiving arrangements will avoid duplication of efforts, save time
and ease the pressure.
Conclusions
Caregiving is an act of a civilized and cultured human being.
Respecting elders and taking care of them is part of our tradition. By
doing so, we set an example for others to follow and also teach our
children about the importance of care giving. Caregiving is a rewarding
exercise and gives us an opportunity to pay back to the elders against
what they have given to us.
It is our duty to provide physical, emotional, social and economic
security to old people and ensure that they spend their last phase of
life happily with dignity and satisfaction. We have to commit ourselves
for this noble task and also guide the succeeding generations to follow
us.
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R. Narayanasamy
narayana91@yahoo.com
Caregiving to the elderly
