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The culture of aging

Tomás Engler, a public health physician by training, has been a senior health specialist at the IDB since 1987. He coordinated the studies on older adults described on page 12, organized last June’s Inter-regional Consultation on Active Aging, and is now helping to develop the agenda produced by that meeting. In the 1970s, Engler established an adult health program in Panama’s Ministry of Health.

IDBAmérica : It’s been said that the industrialized nations got rich before they got old, while developing countries will get old before they get rich. What are the consequences?
Hopefully economic growth will increase in our countries, and the benefits will become available to all of society, including the elderly. But this is going to take some time. Meanwhile we are going to face a demographic phenomenon that is similar to that of the industrialized nations, but in a context of much greater poverty. Older adults, who have special needs, are likely to be affected by this more than other sectors of the population.

This is partly because retirement pensions are very low in Latin American and Caribbean countries, even for those who are fortunate enough to have them. In some countries a very large proportion of older adults is not even part of the formal pension system. As a result, people work hard to retire and then continue working until they can’t work anymore. These older adults are also going to need specialized housing, education, medical care and social services that in many cases are not available.

IDBAmérica : Do Latin American families do a better job of taking care of their elderly at home than those in industrialized countries?
I don’t think we know enough about the details to say so. Family unity is still a strong value in Latin America, but what has been working against it are the financial pressures on families and decreased family size. Unless older people can make contributions that are valued by the rest of the family, their presence can add to the tensions of poverty. Even in families that are better off, these situations create tensions. The studies we did in Argentina, Chile and Uruguay seem to show that older adults still depend on their families for help in covering medical expenses, clothing and food, even when they solve other things with their own income. Also, a lot of older people work to support themselves.

IDBAmérica : Why do proposals to raise the retirement age meet so much resistance?
Partly because of the theory that when the elderly remain employed longer, they can keep younger people from getting jobs, particularly when unemployment is high. But I’m not aware of any hard data that has shown this to be the case. It’s also a politically difficult issue, because many professional groups such as nurses or teachers view their early retirement ages as a conquest, and any politician attempting to take that away loses popularity quickly.

The irony is that the majority of people who retire early in these countries simply continue working. So we need to find out how long people actually are working, and then adjust employment policies to reflect reality. Once these issues are clearer in terms of empirical evidence, then we can start to promote dialogue between the young, the middle-aged and older adults, leading to a consensus on retirement policies and a new culture of aging.

IDBAmérica : Is the medical community in Latin America prepared to care for the needs of older adults?
Unfortunately we need a much stronger focus on preventive health care for the elderly and on improving the quality and coverage of specialized services for those who do need them. There is a tremendous shortage of geriatric training in Latin America, as there is in the United States and other wealthy countries. Very few medical schools even include geriatrics in the curriculum, despite the growing demand for these services. And the shortage extends past physicians to nurses, physical therapists and all other health professionals.

IDBAmérica : What is the situation with live-in facilities and nursing homes?
In the public sector there are a variety of institutions, but most of them are in deplorable condition. The resource shortages in public facilities are so acute that residents’ families often have to provide some basic things that are not there, like sheets or food. In the private sector we’re seeing the growth of medium-cost facilities for small groups of people, typically in former residences that have been adapted for this purpose.

However, there are serious concerns about the quality of care that is provided at these facilities, as there are in the United States, because the owners often cut corners to save on expenses. In several countries there are written regulations that are not being enforced, because the regulatory bodies charged with enforcing these rules do not have adequate resources or personnel. There is clearly a need to strengthen enforcement capabilities.

IDBAmérica : What can Latin American countries learn from industrialized countries that are already facing an aging crisis?
There are several lessons. One is the integration and coordination of services between health and social services, urban development, transportation and the like. It can sound obvious, but this can lead to construction of a new park, for example, that has park benches with higher seats, which make it easier for elderly or disabled people to get up. This only happens if the urban planners are talking to the gerontologists and the older adults as well. Well-coordinated services can also be centered on the person’s home, instead of having services that are fragmented and dispersed.

Finland and Japan have done a lot of research on productivity and the older worker. Since they have a labor shortage, they have an incentive to keep their workers on the job longer, and so they’ve put a lot of effort into studying things like ergonomics that can have an impact on productivity and job satisfaction. When strength starts to decline at a certain age, for example, things like making a lever longer can make it easier to exert more force. People who start to have eyesight problems can be helped by computer screens that display bigger letters. These are just examples of very simple, low-cost interventions that have a tremendous impact on productivity and the prevention of accidents.

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