The challenges of aging

Lisandra Fariñas Acosta

A new challenge now has a place on world agendas. Population aging is a palpable phenomenon in societies, with consequent impacts on health, the family, economic activity and social security and assistance budgets.

Cuba, with 18.3% of its population over 60 years of age, according to statistics from the 2012 Population and Housing Census, has one of the highest rates of older adults in Latin America, and by 2050, will have one of the oldest populations in the world. With 2,410,392 older adults (over 60), how is Cuban society preparing to assume the challenges implied by aging?

Granma discussed this issue with Alberto Fernández Seco, head of the Older Adults, Social Assistance and Mental Health Department attached to the Ministry of Public Health, who identified the principal cause of this phenomenon as a low birth rate and increased life expectancy.

"Our country currently has a life expectancy of 78.97 years, 76 for men and 80 for women, although it’s interesting to note that the life expectancy of persons reaching 60 years is 22 more years, and for those reaching 80 years of age, 8.8 more," the specialist explained.

Fernández Seco added that, since 2010, Cuba has lacked replacement of its workforce, when the group of persons aged 0-14 years matched that of those reaching 60 years. From then onward those reaching the age of 60 have been increasing and the 0-4 group decreasing, which makes the demographic panorama more complex. Data from the 2012 Census revealed that the latter segment represents 17.3% of the population. "We are the first country in Latin America where this is occurring, combined with not having population replacement; in other words, being able to guarantee that each woman has a daughter."

Historically, health systems have been designed to treat maternal-infant problems, or illnesses of short duration which do not result in disability. With population aging, a new challenge has emerged: care. Developing and transforming care services to confront this is an urgent task, and, in this context, primary health care is vital.

Dr. Fernández Seco noted that in this aspect, Cuba has advantages as, since the 1980’s, it has been developing the family doctor and nurse program, a fundamental pillar for care of the older adult population in a local context.

With the current and future aging of the Cuban population, guaranteeing care for older adults is one of the principal difficulties confronting families, which causes people with full labor capacity to leave the workforce, the most affected being women who, in the majority of cases, assume care of the elderly.

"There are other care needs, in addition to health services, such as the casas de abuelas (community centers for the elderly) and senior citizens’ homes, both institutions within the public health system. In both of these, the centers and the homes, older adults are involved in cultural and rehabilitation activities which keep them socially active," the specialist noted.

"The community centers are a day-time option. In these older adults remain within their immediate environment and making it possible for family members to work. They are staffed by social workers, often specializing in social rehabilitation and occupational therapy.

Senior citizens’ homes are for people who cannot be guaranteed care in the community and for that reason, need to enter these institutions, although we always work on these persons returning to their environment if the conditions which prompted their admission should change. These latter institutions have multi-disciplinary medical teams; in this way the elderly have access to inter-consultations related to all necessary specialties."

The specialist called attention to population requests for these institutions which, in his opinion, do not represent real needs, while remaining higher than existing capacities, a problem which is more acute in the case of persons with disabilities. "20% of older adults are considered to be fragile or in need of care. Of these, 1% can be served in social centers, including an experimental model which is going to be implemented in 2014, for persons with disabilities.

"At this point, patients with dementia and other disorders cannot attend these institutions and family members must leave work to care for them, or take them to senior citizens’ homes. Currently 0.6% of the abovementioned 20% of elderly people in need are requesting entry into the homes, a figure which is rising," he commented.

According to the latest research, in Cuba approximately 130,000 persons are suffering from Alzheimer’s disease, a number that will more than double by 2040. There will be 300,000 persons with dementia, 2.7% of the Cuban population. According to recent studies, more than 50% of these people will need full or part-time care.

The country has 230 community centers, with a total of 7,398 locations, and it is estimated that 20,144 older adults are requesting this service. At the same time, there are 127 Senior Citizens Homes, with 9,287 beds, according to Dr. Alberto Fernández Seco.

"We are working on recovering beds deactivated as a result of construction problems in the homes, in order to raise capacity to the maximum, and it is proposed to increase the total number of these institutions by 13 through 2015. Equal priority is being given to the repair of community centers (to be increased to 140 in the same period) and the opening of centers for older adults with disabilities, depending on the aging pattern in each of the country’s provinces," he emphasized.

Dr Fernández Seco commented that maintenance and repair work has taken place this year in 65 centers and 85 homes, and they have been assigned equipment such as refrigerators, water tanks, ventilators, blenders, sewing machines, washing machines, stoves and laundry carts. Beds, mattresses and other furniture have also been provided. "Even if these are insufficient, they have helped to improve the service. We have had a better response in terms of linens, clothing, footwear and food."

Population aging is a phenomenon already occurring and confronting it is an evident need in the country; hence the implementation of immediate strategies in order to guarantee an adequate infrastructure and better quality of life for the elderly. However, the role of families in the education of the young, and of society as a whole, in the care of older adults is essential.

Reaching 60 years of age does not in any way signify limitations, in the context of feeling socially active. It is a new stage of life, with its own characteristics and in which people feel happy, emphasized the specialist, who highlighted the work of the Older Adults University and the older adult circles which involve more than 40% of the elderly population. "Their function is the socialization of older adults, to provide a time in the day for their recreation and distance from the burden of domestic chores and care of grandchildren," the interviewee stated.

The country’s public health system currently has 279 specialists in geriatrics and gerontology and 137 trainees in the specialty. In terms of the need to increase these figures, the specialist emphasized, "The important thing is to prepare all specialists, technical and service personnel working directly with older adults. Moreover, there is a need to prepare the population as a whole given that, on many occasions and out of ignorance, people mistreat the elderly. If we don’t know that they need to drink water frequently even if they don’t ask for it, if furniture within the house is placed in a way that it represents a threat to older adults, if we don’t take into account that continual space changes disorient them, we are mistreating them."

Dr Fernández Soto emphasized, "Society must increase its gerontology culture or, what amounts to the same thing, learn to live in harmony and health with the elderly. The media still places older adults in a disadvantaged social position, almost always as a dependent person incapable of taking initiatives and forming part of the development of society. On many occasions, we perceive old age as disabling, and it must be taken into account that aging is not an illness, that one can reach an advanced age without suffering any disability,"

Aging is a challenge which lies before Cuba, and in that preventative healthcare, education and sensitizing citizens is essential, in the context that living longer can also signify living better.