World Elder Abuse Awareness Day

Safe-Guarding the Elderly Persons, COVID-19 and Beyond

According to the UN Secretary General, “The COVID-19 pandemic is causing untold fear and suffering for older people across the world. Beyond its immediate health impact, the pandemic is putting older people at greater risk of poverty, discrimination and isolation. It is likely to have a particularly devastating impact on older people in developing countries.”

According to the Business Insider article, “the coronavirus doesn't infect all patients equally according to the Chinese Center for Disease Control and Prevention The study collected data from more than 44,000 confirmed patients in China through February 11, offering one of broadest depictions of how COVID-19 (the disease caused by the virus) operates in humans.”

COVID-19 has shown that there is need to establish social skills and life promoting factors that address the physical and mental status of the elderly in communities so that we are more in position to contribute to quality life of elderly persons and ensure they are not vulnerable to COVID-19. The elderly persons are at a higher risk of infection or severe illness from COVID-19. There is need to find out who may be at risk and how to protect them. Developing a care plan is vital during this crucial time of COVID-19 pandemic. A care plan is a form that summarizes a person’s needs, health conditions and current treatments.

We also need to understand how we have come to construct narratives around age. Age is a celebrated notion and a figure which features so highly in our lives.  We use age to mark patterns and stages which in turn require different care needs.  The patterns in turn are named differently such as new-born, child, preadolescent, adolescent, teenager, young adult, middle adult old adult and an elder. There are given functional expectations which we have attached and have drawn to our attention such as: nestling, crawling, walking, running, talking, independent action, expression and an age when we prefer less action but sedentary life. However, we have tended to assume that just because persons are more sedentary then they do not need so much external interference and perhaps this has led to abandonment of the elderly. Old age is not a definite biological stage, as the chronological age denoted as "old age" varies culturally and historically.

According to WHO "the ageing process is of course a biological reality which has its own dynamic, largely beyond human control. However, it is also subject to the constructions by which each society makes sense of old age. In the developed world, chronological time plays a paramount role. The age of 60 or 65, roughly equivalent to retirement ages in most developed countries is said to be the beginning of old age. In many parts of the developing world, chronological time has little or no importance in the meaning of old age. Other socially constructed meanings of age are more significant such as the roles assigned to older people; in some cases it is the loss of roles accompanying physical decline which is significant in defining old age. Thus, in contrast to the chronological milestones which mark life stages in the developed world, old age in many developing countries is seen to begin at the point when active contribution is no longer possible." (Gorman, 2000).

When is a person elderly? When we are dealing with the elderly we also need to be aware of the key concepts in social gerontology. According to sources, there are different dimensions of old age: chronological, biological, psychological, and social. Wattis and Curran add a fifth dimension: developmental. Chronological age may differ considerably from a person's functional age. The distinguishing marks of old age normally occur in all five senses at different times and different rates for different persons. In addition to chronological age, people can be considered old because of the other dimensions of old age. For example, people may be considered old when they become grandparents or when they begin to do less or different work in retirement.

According to many sources, old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle Terms and euphemisms include: Wazeeyi, abazeeyi, abakadde, abakulu, old people, the elderly (worldwide usage), Old Age Pensioners, seniors (American usage), senior citizens (American usage), older adults (in the social sciences, and the elders (in many cultures—including the cultures of aboriginal people). 

Elderly people often have limited regenerative abilities and are more susceptible to disease, syndromes, injuries and sickness than younger adults. The organic process of ageing is also called senescence. The medical study of the aging process is called gerontology and the study of diseases that afflict the elderly is called geriatrics. The elderly also face other social issues around retirement, loneliness and ageism.

Physical and mental state mark and make the characteristics of an elderly person.

Physical

Physical marks of old age include the following:

Bone and joint: Old bones are marked by "thinning and shrinkage". This might result in a loss of height (about two inches (5 cm) by age 80), a stooping posture in many people, and a greater susceptibility to bone and joint diseases such as arthritis. 

Chronic diseases: Some older persons have at least one or multiple conditions. In 2007–2009, the most frequently occurring conditions among older persons in the United States were uncontrolled hypertension (34%), diagnosed arthritis (50%), and heart disease (32%).

Chronic mucus hypersecretion (CMH): This is "defined as coughing and bringing up sputum is a common respiratory symptom in elderly persons.

Dental problems: May have less saliva and less ability for oral hygiene in old age which increases the chance of tooth decay.

Digestive system: About 40% of the time, old age is marked by digestive disorders such as difficulty in swallowing, inability to eat enough and to absorb nutrition, constipation and bleeding.

Mental

Mental marks of old age include the following:

Adaptability: This describes the "agreeable" and "accepting" nature of the elderly. But according to sources, old age is characterised by dependence but unfortunately this nature has been used to disparage older persons as incompetent and a worthlessness minority.

Cautious: This is antipathy toward "risk-taking" stems from the fact that old people have less to gain and more to lose by taking risks than younger people.

Depression: According to Cox et Al (2012), old age is a risk factor for depression caused by prejudice (i.e., "deprejudice"). When people are prejudiced against the elderly and then become old themselves, their anti-elderly prejudice turns inward, causing depression. "People with more negative age stereotypes will likely have higher rates of depression as they get older." Old age depression results in the over-65 population having the highest suicide rate.

Fear of crime: In old age, especially among the frail, fear weighs more heavily than concerns about finances or health and restricts what they do. The fear persists in spite of the fact that old people are victims of crime less often than younger people.

Increasing fear of health loss: Mental disorders afflict about 15% of people aged 60+ according to estimates by the World Health Organization. Another survey taken in 15 countries reported that mental disorders of adults interfered with their daily activities more than physical problems.

Reduced mental and cognitive ability may afflict old age: Memory loss is common in old age due to the decrease in speed of information being encoded, stored, and retrieved. It takes more time to learn the same amount of new information. Dementia is a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Its prevalence increases in old age from about 10% at age 65 to about 50% over age 85. Alzheimer's disease accounts for 50 to 80 percent of dementia cases. Demented behavior can include wandering, physical aggression, verbal outbursts, depression, and psychosis.

 Age and Africa:

The African traditional philanthropy and altruism networks are spaces within which the older persons are key-players. In such situations, they are able to communicate their needs even as they are provided opportunities to play social cohesive roles.

According to WHO, most developed world countries have accepted the chronological age of 65 years as a definition of 'elderly' or older person, but like many westernized concepts, this does not adapt well to the situation in Africa. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population. Although there are commonly used definitions of old age, there is no general agreement on the age at which a person becomes old. The common use of a calendar age to mark the threshold of old age assumes equivalence with biological age, yet at the same time, it is generally accepted that these two are not necessarily synonymous.

Age and the Western World:

The Western world perceives old persons differently from Africa. In the west there are structured service programmes catering to older persons. The African traditional philanthropy and altruism networks are spaces within which the older persons are key-players.

In the western world older persons are provided with assistive devices when they lose some or almost all the functional independence. It is possible to utilise censuses and statistics to know how many older persons there are. In USA, 8.5 million Americans needed personal assistance because of impaired basic activities of daily living required for personal care or impaired instrumental activities of daily living (IADL) required for independent living. Projections place this number at 21 million by 2030 when 40% of Americans over 70 will need assistance. There are many options for such long term care to those who require it. There is home care in which a family member, volunteer, or trained professional will aid the person in need and help with daily activities. Another option is community services which can provide the person with transportation, meal plans, or activities in senior centres. A third option is assisted living where 24-hour round-the-clock supervision is given with aid in eating, bathing, dressing, etc. A final option is a nursing home which provides professional nursing care.

Communities can provide the much needed care to the elderly if they are aware of numbers and needs. This will then be an opportunity to address COVID-19 pandemic related fears and suffering for the elderly, risk of poverty, discrimination and isolation. This approach is likely to reduce devastating impact on the elderly.