DETERMINANTS OF THE WELL-BEING OF THE JAMAICAN ELDERLY

By Paul Andrew Bourne




INTRODUCTION: CONTEXT OF THE STUDY


The issue of age and the aged has today taken center stage in development planning on a planetary scale. The elderly will constitute an increasingly larger percentage of total population and sub-populations than in previous centuries (UN 2005; WHO 2005; STATIN 2004; Apt 1999; US Census Bureau 1998). From 1998-2025, the world's aged population, ?'ages 65 and above', will more than double while the world's child population (under age 15) will increase by 6 percent compared to the number of children who are less than 5 years that will increase by less than 5 percent (United States Census 1998, 1-2). According to the United Nations population division by 2050 ?'1 in 5' persons will be 60 years moving from ?'1 to 12' in 2000, this speaks to a demographic transition and a future social change. This population dynamic speaks to an ageing population and not only to transformation in physiological changes of the organism of those people but also to the implications of ageing.

The physiological, socioeconomic and cultural changes occurring during ageing can modify structural and biochemical functioning in the elderly (Barker 1992; Costa 2000), resulting in changes in health status; thereby, health care issues will become an importance for the aged and the general populace. The progressive ageing of the world's population in the coming decades will have implication for services, programmes, activities and public expenditure (Miller 2000). In the Caribbean in particular Jamaica, with an extremely shortage of studies on the elderly, an understanding of their wellbeing is timely and this will offer a reservoir of knowledge for future social discourse and policy formulation.

In 2004, the life span of peoples 60 years and older in Trinidad and Tobago, Barbados and Jamaica increased by between 7.9 and 10 years (Gibbings 1999). Studies revealed that the elderly population accounts for 20 percent of the population of Trinidad and Tobago, 21.5 percent in Barbados and 14.6 percent in Jamaica (Gibbings 1999). STATIN (2004, iii) in "Demographic Statistics, 2004" reported that 10 percent of the Jamaica's population are 60 years and older; which opposed the viewpoint of Gibbings. Despite the indecisiveness in a general consensus on a definition of ageing, from the United Nations 183 perspective that ?'old age' begins at 60 years to demographers' usage of 65 years and older, there is a wholesale agreement that the aged come the next generation will be a real social happening. For this discourse, ?'old age' or the elderly will constitute individuals 65 years and older.

Statistics on the region showed that fertility and mortality have been gradually declining; this implies that the life expectancy is increasing and this reality will result in an increased demand for fastidious services; and this in keeping with the global trend (UN 2003).

Some writers revealed that an ageing population is a challenge to the world, as the major issues in ageing are social, medical, psychological and economic and not only mortality or morbidity. In general, improved nutrition and living standards were responsible for widespread mortality declines in the beginning of the 20th century. Death rates began to decline throughout the world because of better personal hygiene and public sanitation projects that removed garbage and sewage from city streets and provided safer drinking water. Improvements in health and medical breakthroughs also greatly contributed to gains in life expectancy at birth, mostly because of better infant and child survival and less maternal mortality. In Jamaica, the elderly population is growing at the fastest pace since the1970s.

Research on gerontology in the developing world suggest that the elderly have to face the increasing needs of medical, social and economic conditions (Eldermire 1997; Posner 1995; Palmore 1981; International Association of Gerontology 1955). The issue of well-being has become a popular area of discourse in the contemporary social sciences. This area of research is indeed multidimensional and spatio-temporal. Globally, regional and in particular in Jamaica, the most popular space in research is the biomedical approach; its popularity is fueled by the combination of the traditional operational definition of health and the dominance of the medical sciences in this field of enquiry. The number of studies on mortality, structural alterations and functional declines in body systems, genetic alterations induced by exogenous and endogenous factors, prevalence and incidence of diseases, and certain diseases as determinants of health clearly justify an established leniency to the medical science in the study of health. In addition to the dominance that is exhibited by the pharmaceutical industry on curative care.

There are numerous studies on hypertension, arthritis, diabetes, cancer, and sickle cell and their effect on health (Pedersen and Saltin 2006; Roberts 2006; Heuer and Lausch, 2006; McGinnis and Foege 1993). In addition, there is a causal relationship between cancer, HIV/AIDS infection, cardiovascular diseases, low birth weight and their resultant influence on health, diabetes and health, and in particular chronic diseases and mortality and by extension on health, and so on. Over the years, advances in medical technologies are easier explanation for health status than socio-cultural factors. Traditional studies on the various diseases and their influence on health were stressed in the medical research but the inconclusiveness of sociological and psychological determinants are responsible for the secondary nature of socioeconomic and psychological variables. One researcher places this perception squarely on the socialization of people when he wrote "…aging is widely regarded by professionals and the general public alike as a condition requiring medical intervention" (Cattell 1996). On the other hand, only a minute number of studies have analyzed chronic stressors (i.e. death of a family member or close friend, violence, joblessness, psychological disorders and sexual abuse) and wellbeing, social change and health, area of residence and wellbeing and perception of ageing and health. The post-1994 widened definition of health given by the World Health Organization, people are becoming increasingly cognizant that socio-cultural factors such as geographic location, income, household size and so on, as well as several psychological factors explain wellbeing; hence the new definition of health has coalesced biomedical variables and socio-cultural and psychological variables in the new thesis on wellbeing.

In many societies, there is an official age limit on retirement. Such a limit ranges between 60 and 65 years, and varies depending on gender, socioeconomic status, and the typologies of the industry. When one compares the difference in life expectancy of the sexes; age differential, perception, cultural factors and socialization, they provide an in-depth understanding of well-being. With social biases stocked against the elderly, retirement is another social change that takes some time being accustomed. The retirement is not the problem that the elderly faces but the social departure in particular the removal from the social setting. People who retire frequently are removed from the social setting of work to that of seclusion, and it is this situation that affects the wellbeing of those persons.

The unemployed aged is dependent on the state and the family; and prior self-investments are inadequate in catering for future existence. The situation is not any easier for the employed aged. With respect to the employed aged, with an average life expectancy post-age 60 years being 15 years (WHO 2004), they are having to borne the exorbitant cost of health care including preventative care sometimes at reduced salaries; and this is even more burdensome for the unemployed pensioner.

Coupled with cost of living, there is poverty within the various aged cohorts; social exclusion from the availability of scare resource allocations, perception of the various publics in regards their new roles and the increased dependency because of in affordability. Then there is the likelihood of insufficient planning for retirement; many old people face the daunting challenge of life in post-year retirement. Even with adequate preparation for retirement within the context of an additional fifteen years and the cost of care to maintain a particular quality of life, all planning for this stage in the life of the aged is very pathetic. This reality sometimes span more years that anticipated by the survivor.

Internationally, regionally and nationally life expectancy from birth (i.e. e0), 60 years (i.e. e60. . . ei) and beyond has been gradually increasing since 1900s (UN 2005) to which some academic attribute to biomedical advances in health-care services. Advances in computer technology, pharmaceutical drugs and techniques in detection and operation are responsible for quantitative change in years of life. Those who advocate within the context of biomedical advancements are implying that increased years of life is a qualitative change in survivability but a quantitative change in lifespan even though is not solely attributable to biomedical advancement is highly limited to understanding wellbeing of people given the multidimensional tenets of human's existence.

Additional years of life do not address the lifestyle or practices of the individuals. With the increased probability of survivorship, the aged await a number of conditions. There are voluminous research in biomedical sciences (cancer, hypertension, heart attach - cardiovascular diseases, mental disorder, arthritis, stroke, diabetes, esthma, genetics, and so on) that conclusively show that there are a number of diseases that arise with ageing. Eldemire (1997) forwarded a view expressed by the United Nations in 1992 that "life expectancy at age 60 years is now approximately 20 years", this indicates the additional years that the elderly will need to interface with the economic, health conditions, social, psychological and cultural variables of contemporary society. With the increased quantitative change in life expectancy for the elderly, they are now vulnerable to the ill health and disabilities, gradual deterioration in their social roles and consequently a reduction in wellbeing. Many research have revealed that there is a difference in the life expectancy of the sexes, where generally females outlive their male counterparts and social change in the life the elderly also affect their well-being.

The situation of social change that affects the elderly is not exclusively tied to mortality but adjustments concerning relocation from family households to nurses-care, the movement from living with self to residing with children, the change in lifestyle because of those transitions and so on also modifying the wellbeing of the aged-populace. The zeitgeist of this social change is a difficult one for many aged-folk; and the panacea is not to ameliorate obdurate typologies of severe illnesses but the enjoyment of life. In Jamaica, studies which examined the health of the elderly do so mostly from within the context of mortality and diseases and even so they are limited; this paper seeks to address the insufficient data on the subject as well as enriching body of knowledge that exist within the context to the World Health Organization's (WHO) new approach to health. This is recorded in WHO a press release in 2000 that stated:

For the first time, the WHO has calculated healthy life expectancy for babies born in 1999 based upon an indicator developed by WHO scientists, Disability Adjusted Life Expectancy (DALE). DALE summarizes the expected number of years to be lived in what might be termed the equivalent of "full health." To calculate DALE, the years of ill health are weighted according to severity and subtracted from the expected overall life expectancy to give the equivalent years of healthy life. (WHO 2000)


The World Health Organization and a plethora of research organizations have worked assiduously to develop and launch particular perspective on health and summary of measures of population health coalesce measures of population mortality, health conditions and morbidity. Prior to the slant taken by WHO on health, the conceptualization of this variable was focused on particular physiological state of the individual but with the introduction of new operational definition of the construct, health is now much more than the absences of diseases to include measures of healthy life expectancy and health-related quality of life. With this extension of population health, new genres of studies are forthcoming. Those studies highlight the space of population health in respect to socio-economic conditions of the elderly. This paper considers a number of the aspect within the multidimensional space of health. These are socioeconomic and psychological factors; and will provide answers to the question of what contribution these make to the measurement of well-being.

This study responds to the underlining concerns of the continuous increase in population ageing. As the fast ageing of populations, unless managed in a proactive manner, could impose serious challenges for policy makers in the Caribbean and Jamaica. In that, particular level of economic development is needed in order to deal with the challenges of this demographic transition. The demographic composition and structure of future world population and subpopulation must be understood within policy framework. The challenges that are likely to arise from an ageing population on public expenditure on pensions and health care, particularly in the absence of reforms in pensions and health services, could lead to a build-up of public debt in developing countries in particular Caribbean islands.

The United Nations projections indicate that the world's elderly populace is likely to be approximately 25 percent by 2050 of world population, and this manner has a number of socioeconomic and demographic consequences. With this impending demographic change in population structure and the limited number of studies on the non-biomedical perspective on the elderly within the Jamaican space, the researcher will analyze the ageing within the Jamaican population in an attempt to ascertain whether Jamaica is typical within the impending space of demographic transition.

Jamaica's old-aged population stood at 7.7 percent in 2004. This is not atypical as according to WHO/SEARC (1999), India's elderly population was 7.7 percent. During 2004-1991, the elderly population of Jamaica has risen by 3.28 percent (see Table 1). When the elderly is strictly operationalized within a demographer's space (65 and beyond), on an average the elderly population grew by 3.62 percent (see Table 2). The data in Table 2 reveal that for every 100 working-aged of the population approximately 13 elderly dependent on them. This is within approximately 30 percent of the population being children. Over the same period, the number of child-to-total-population grew by - 4.4 percent and by -10.08 percent for the youth. Without effective population planning for the elderly, come the next four decades, the old-aged population will become a burden to the working aged-populace in respect to medical care, nursing care, pension, other social insurance and survivability cost. With this impending social reality, there is a high probability that the old-aged will be called on to provide increasingly more of their needs for themselves within the construct limited resources from developing societies. The physiological changes with ageing such as loss of hair, wrinkling of the skin, decrease in height, and loss of teeth are not the only issue of old age but the various factors that affect their wellbeing.


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