Caring for the Elderly: Global Perspectives

Caring for the elderly is becoming a pressing global issue due to declining birth rates and increasing life expectancy. This demographic shift is particularly challenging in developed nations where the aging population is rapidly growing, while developing countries face unique obstacles as cultural and societal changes arise from industrialization and modernization. Despite the common perception that these changes lead to the marginalization of older adults, many societies maintain traditional values that promote respect and care for their elders.

In some regions, such as Africa and parts of South and Southeast Asia, elders traditionally held a revered status within their communities, with family and societal norms emphasizing intergenerational support. However, as younger generations migrate to urban areas and modern values begin to take hold, these traditional support systems are often weakened. Government initiatives in various countries are attempting to adapt to these shifts by encouraging familial care and providing financial incentives, yet the effectiveness of such programs varies significantly across cultural contexts.

As the global population of older adults continues to rise, the need for comprehensive and culturally sensitive elder care systems becomes increasingly vital, reflecting the diverse ways societies approach the challenge of caring for their aging members.

Published in: 2021

By: Wienclaw, Ruth A.

Subject Terms

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

Perspectives

Overview

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).

Applications

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 of modernization on the care of the elderly in Kenya. She developed a survey to explore attitudes toward the elderly and possible reasons for these attitudes. Subjects in the study comprised 384 individuals (out of 425 individuals who were asked to participate) from several different categories: managers of elder care facilities, elders in these facilities, elders in rural areas, and other members of society.

The results of the study revealed a number of differences between traditional care of the elderly in African society and modern care. The traditional African society was structured in such a way that every individual had a function to fulfill. Kinship, for example, embraced all members of a community, giving them a sense of rootedness as well as a feeling of obligation to help the elders not only in one's family but in the community in general. Rites of passage also played an important role in traditional African culture. For example, once an individual fulfilled certain rites, he or she would be considered elderly. This shifted the individual's social role and functions, and brought with it a respect from others in the community and culture. Traditional religious beliefs in spirits and curses also helped shape the respect accorded to the elderly within traditional society. For example, it was traditionally believed that the elderly communed with the spirits of the dead and with the gods. The wrath of these beings could be evoked and elders were thought to be able to curse others or cause misfortune. Because of these and other factors, within traditional African society, elders were not only respected but well cared for by the community.

The modernization and industrialization of Africa, however, has brought with it changes in these traditional beliefs and practices. The gravitation of many individuals in younger generations to urban centers has stranded elders in rural areas without traditional support networks. In addition, the introduction of Western cultural values to Africa brought with it an emphasis on individuality and a shift in family considerations from the extended family (which traditionally emphasized taking care of one's elders) to the immediate nuclear family. The formalization and secularization of education in Africa, that is enabling the continent to economically develop on the one hand, has undermined the traditional wisdom associated with elders, on the other. Most Africans today question traditional beliefs in spirits and curses, resulting in less impetus for taking care of the community elders. Further, the infiltration of Western cultural values has in many ways undermined traditional African culture, leading to a diminution in the respect accorded elders in society and lessened community solidarity. As a result, older Africans tend to receive minimal care compared to what they have received in the past in a more traditional society and culture. As a result, many elderly Africans live in poverty, receiving little if any assistance from their immediate families. Further, there are few social services are available for the care of the elderly.

Care of the Elderly in South and Southeast Asia

As elsewhere around the globe, the growth of the elderly population is rising at an unprecedented rate in South and Southeast Asia. As in other parts of the world, these areas in Asia are experiencing economic development and its associated changes: urbanization, industrialization, migration, and globalization. Angelique Chan (2005) performed a study of the literature on the changes in formal and informal (i.e., family) support of elders in South and Southeast Asia and how these are being affected by modernization. She found that although these changes are resulting in concomitant changes in the traditional Asian family structure and intergenerational support of elders, the effects of these changes are not consistent. For example, although informal familial support of elders is breaking down in some countries such as China, other countries such as Thailand, Hong Kong, Malaysia, the Republic of Korea, Singapore, Taiwan, and Thailand are finding it possible to respond more positively to these changes. Part of this has to do with other values in the society. In those Asian cultures it is believed that elders are the gatekeepers of religious teachings and beliefs (e.g., Malays in Malaysia and Singapore), elders typically receive a concomitantly higher social status than in cultures that emphasize youth and economic success. The latter type of society is more likely to experience higher suicide rates, feelings of isolation, and other negative outcomes among older adults (e.g., China, Hong Kong, Singapore).

Asian societies have a long tradition of filial piety in which younger generations care for their elders. In contemporary Asian societies, state or formal care is provided to elders only in those situations where familial care is either insufficient or unavailable. The need for such care is likely to increase, however, with the trend toward smaller families (resulting in fewer members of the younger generation that can contribute to the care and support of their elders) and the increased longevity of many older adults. This informal care of elders can be divided into two categories, living arrangements and intergenerational transfers. Many Asian governments fear that there will be a decline of status for elders in the future, which will lead to a concomitant decline in the informal support that they receive from their families. In some Asian countries (e.g., Malaysia and Singapore), the governments have attempted to postpone the decline of intergenerational support of elders by instituting programs that support families in their traditional role as caregivers or other support providers for the elderly such as offering tax incentives for in-home care of invalid older persons or to provide financial support to their elders. Some Asian countries allow older parents to sue their children for economic neglect.

The majority of older adults in South and Southeast Asia co-reside with at least one of their adult children. However, this does not necessarily indicate that there is concomitant financial or other types of support for the elder in such arrangements or that such arrangements adequately take care of the physical, emotional, or financial needs of the elder. Some Asian countries such as Singapore and Malaysia, however, offer tax incentives to adult children who co-reside with their parents or offer them priority housing choices. These policies seem to be working: Both these countries have high co-residence rates, with over two-thirds of the older adults co-residing with at least one adult child. In fact, in Singapore, there is a co-residence rate of 85 percent. In general, Chan found that the current research indicates that family support of older adults within South and Southeast Asia is not declining as is predicted by the modernization of society, and traditional values and attitudes toward the care of the elderly remain intact, at least for the present.

Conclusion

The declining birth rates and increased life expectancies around the globe have made the care of the elderly an international concern. In addition, industrialization, economic development, and modernization bring with them major changes in culture and society, many of which have a negative impact on the care and treatment of elders within the society. Contrary to modernization theory, however, this does not necessarily result in a marginalization of older people. Traditional values persist in some areas despite modernization, and formal or government programs that provide service and care for the elderly are often supplemental to informal, familial care. In many cases, the best programs appear to be those that take into account the traditional values and expectations of the elders and that support and encourage familial care of elders.

Terms & Concepts

Activities of Daily Living (ADLs): Activities that are routinely performed in the course of a day for the purposes of self-care (bathing, dressing, grooming, cooking and eating, using the toilet, transferring to or from the bed or chair, getting around the house). Instrumental activities of daily living are non-self-care activities necessary for daily life (going outside the home, light housework, preparing meals, taking medications in the manner prescribed, using the telephone, paying bills and keeping track of money).

Caregiver: (a) A medical or services professional who assists in identifying, preventing, or treating a disability or illness. (b) An individual (e.g., adult child or other family member, friend, neighbor) who attends to the needs of a child or dependent adult and provides support and assistance. Support may be emotional, financial, or hands-on and may be done in person or long distance.

Culture: A complex system of meaning and behavior that is socially transmitted and that defines a common way of life for a group or society. Culture includes the totality of behavior patterns, arts, beliefs, institutions, and other products of human work and thought of the society or group

Economic Development: The sustainable increase in living standards for a nation, region, or society. More than mere economic growth (i.e., a rise in output), economic development is sustainable and positively affects the well-being of all members of the group through such things as increased per capita income, education, health, and environmental protection. Economic development is progressive in nature and positively impacts the socioeconomic structure of a society.

Globalization: Globalization is the process of businesses or technologies spreading across the world. This creates an interconnected, global marketplace operating outside constraints of time zones or national boundaries. Although globalization means an expanded marketplace, products are typically adapted to fit the specific needs or preferences of each locality or culture to which they are marketed.

Industrialization: The use of mechanization to produce the economic goods and services within a society. Historically, industrialization is a society's transition between farm production and manufacturing production. Industrialization is associated with factory production, division of labor, and the concentration of industries and populations within certain geographical areas and concomitant urbanization.

Marginalization: To relegate a person or subgroup to the outer edge of the group (i.e., margin) by demonstrating through word or action that the person or subgroup is less important and less powerful than the rest of the group.

Modernization Theory: A sociological perspective of globalization that posits that less developed countries will eventually industrialize in the manner of more developed countries and that the process of modernization will gradually improve the quality of life of its members due to political and economic forces. Modernization is thought to affect virtually all countries that have been affected by technological change.

Religion: A personal or institutional system grounded in the belief in and reverence for a supernatural power or powers considered to have created and to govern the universe.

Social Role: A set of expectations placed on members of a group of people with a given social position or status within society.

Society: A distinct group of people who live within the same territory, share a common culture and way of life, and are relatively independent from people outside the group. Society includes systems of social interactions that govern both culture and social organization.

Status: A socially established position within a society or other social structure that carries with it a recognized level of prestige.

Subject: A participant in a research study or experiment whose responses are observed, recorded, and analyzed.

Survey: (a) A data collection instrument used to acquire information on the opinions, attitudes, or reactions of people; (b) a research study in which members of a selected sample are asked questions concerning their opinions, attitudes, or reactions that are gathered using a survey instrument or questionnaire for purposes of scientific analysis; typically the results of this analysis are used to extrapolate the findings from the sample to the underlying population; (c) to conduct a survey on a sample.

Bibliography

Chan, A. (2005). Aging in Southeast and East Asia: Issues and policy directions. Journal of Cross Cultural Gerontology, 20 , 269-284. Retrieved July 22, 2008, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=23552400&site=ehost-live

Kwak, J., Kramer, B. J., Lang, J., & Ledger, M. (2013). Challenges in end-of-life care management for low-income frail elders: a case study of the Wisconsin family care program. Research on Aging, 35, 393–419. Retrieved November 14, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=88000044

Narknisorn, B. Gender, elder care, and care workers in Thai governmental home for the aged. Journal of Social and Development Sciences, 3, 254–263. Retrieved November 14, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=88011668

Nyangweso, M. A. (1998). Transformations of care of the aged among Africans - a study of the Kenyan situation. Aging and Mental Health, 2 , 181-185. Retrieved July 22, 2008, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=3954746&site=ehost-live

Pacala, J. T. (2014). Is Palliative Care the 'New' Geriatrics? Wrong Question-We're Better Together. Journal Of The American Geriatrics Society, 62, 1968-1970. Retrieved December 4, 2014, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=98999242

Segelman, M., Szydlowski, J., Kinosian, B., McNabney, M., Raziano, D. B., Eng, C., & ... Temkin-Greener, H. (2014). Hospitalizations in the Program of All-Inclusive Care for the Elderly. Journal Of The American Geriatrics Society, 62, 320-324. Retrieved December 4, 2014, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=94396703

United Nations. (2007). United Nations Programme on Ageing . Retrieved July 23, 2008 from http://www.un.org/esa/socdev/ageing/

UN Department of Economic and Social Affairs Population Division. (2002). World population aging: 1950–2050. Retrieved from http://www.un.org/esa/population/publications/worldageing19502050/

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Caring for the Elderly: Global Perspectives

On this Page

Subject Terms

Caring for the Elderly: Global Perspectives

Perspectives

Overview

Increasing Proportions of Elderly

An International Issue

Applications

Diverging Global Views of Elderly Care

Care of the Elderly in Africa

Care of the Elderly in South and Southeast Asia

Conclusion

Terms & Concepts

Bibliography

Suggested Reading