The care of the elderly is a practice that has generated important debates in recent decades. This is so because, in the face of social transformations and the most recent economic crises, ageing has begun to be recognized as one of the stages most exposed to different conditions of vulnerability around the world.

Because of this, policy and theoretical debates on care practices have become critical in creating strategies to mitigate the vulnerability of older adults and to strengthen both support networks and social policies.

Is caring for the elderly a problem?

The term care comes from the Latin cogitare, which means to think; so it can be understood as “to think”, but also as “to have a concern”. Hence, its meaning can be transferred to having a concern that something undesirable may happen, a concern that translates into a concrete practice: protecting someone from an undesirable event, because that someone has difficulty doing it by himself .

Care is then a rational activity that connects with an emotional dimension (Left, 2003): it is centered on the fear for the other’s vulnerability awareness , a matter that human beings satisfy among ourselves through interpersonal relationships.

This is why care is now one of the central issues in the development of our societies. For example, a large part of social and health policies are organized around the question of who is the object of care, who can or should satisfy that need and what options are available for doing so.

Many challenges have been identified in this regard. Among others, there is a question that has recently worried the world’s population, especially those who have lived the “baby boom” after the Second World War: who is going to take care of us in our aging process?

Changes and Challenges in Aging Care

Old age is often understood as a problem, or at best, as a challenge. Far from old age itself having intrinsic conflictive qualities, the challenges have been the social and economic changes themselves that often leave some people on the sidelines of strategies aimed at covering basic needs; which, in turn, generates passive positions with little participation in social affairs .

For example, health in old age is a challenge, but not because of old age itself, but because health is increasingly expensive, there is a greater shortage of professionals and of material or economic resources, their distribution and access are inequitable; in addition, there have been major changes in the social and productive roles of those who have been the main caregivers over time: direct families.

As one of the alternatives to cushion this, the concept of “active aging” has emerged, which refers to the optimization of physical, social and intellectual opportunities centered on the autonomy and rights of the elderly .

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This concept has allowed some strategies to be developed, however, in some cases it has also served to make the elderly person themselves responsible for a problem that is social, political and economic; which makes us see that this is a more complex issue than it might seem.

Despite this, in many contexts ageing is no longer seen as a problem. There is a tendency to promote the social participation of older adults, and to rethink the concept and practices of care, more specifically those related to health and illness.

Who takes care of it?

The family support network (the family support ratio), which is the direct family, has constituted the vast majority of the caregivers. However, due to the socioeconomic changes of the last decades, the family support ratios are being drastically modified.

For example, in Spain it is estimated that the number of caregivers will increase from 6 caregivers for every adult aged 80 to only 3 by 2034. The consequence of this has been a considerable increase in the care needs of older people, as well as the groups or individuals who are responsible for meeting them.

In addition, the practice of care has a very important gender dimension : as it has been understood especially in relation to the private space, we have also been the women who have socialized in a greater identification with these values and tasks.

As a result, much of the caregiving practice is conducted by women, and there is even a widespread belief that caregiving is a ‘woman’s job’. Therefore, another major issue discussed has been the ‘feminization of care’.

Likewise, in many populations, the same political and socioeconomic conditions have promoted that care is also a semi-professional task for the migrant population , a population that has contained a large part of the problem of care shortage.

In other words, there is currently a significant lack of care for the elderly and other populations in vulnerable contexts, as well as the need to generate new political and socio-educational strategies at both the family and professional levels. In this context, the strengthening of strategies of intra-family solidarity in connection with social policies acquires relevance .

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5 proposals from the World Health Organization (WHO)

Although the care of older people is not a practice that is reduced solely to health, it is in this sector that some specific challenges have arisen. In response, WHO has begun to develop a programme called the Global Strategy and Plan of Action on Ageing and Health.

In this way, an important part of the care practices begin to be the responsibility of public organizations, beyond being centered in private and family spaces . Some of the proposals that make up this plan are the following:

1. Commitment to healthy aging

Closely related to the concept of active aging, it refers to a process of raising awareness in order to create sustainable measures and science-based policies that can promote the skills of older adults and their autonomy .

2. Aligning health systems with the needs of older people

It is a question of not dismissing the need for the health system to organise itself around the diversity of old age, towards detecting the preferences of the elderly and towards consolidating a good network of professional care .

3. Establishing systems to provide chronic care

The importance of promoting the timely detection of chronic and long-term care needs, including palliative care, is discussed, particularly in terms of strengthening infrastructure and staff capacity.

4. Creating environments adapted to older people

Due to the relationship between care and vulnerability, one of the most important issues in the topic is to extend the measures needed to avoid stigma and discrimination , as well as to empower and empower from the most basic and everyday levels.

5. Improving measurement, monitoring and understanding

Finally, WHO recognizes the need to strengthen research focused on ageing and to develop new and diverse mechanisms for measurement and analysis that will help to understand and address the complexity of care in old age.

Bibliographic references:

  • World Health Organization (2018). Ageing and health. Key facts. Retrieved 30 April 2018. Available at http://www.who.int/es/news-room/fact-sheets/detail/envejecimiento-y-salud.
  • Alfama, E., Ezquerra, S. & Cruells, M. (2014). Ageing in times of crisis. Recovered April 30th, 2018. Available at https://www.academia.edu/10729630/Envejecer_en_tiempos_de_crisis.
  • Abellan, A. & Pujol. A. (2013) Who will take care of us when we are eighty years old? Retrieved April 30, 2018. Available at https://envejecimientoenred.wordpress.com/2013/09/02/quien-cuidara-de-nosotros-cuando-seamos-octogenarios/.
  • Left, M. J. (2003). Caring for individuals and groups: who cares. Social organization and gender. Paper presented at the Catalan Congress on Mental Health. Working group on identity, gender and mental health. Retrieved April 30, 2018. Available at http://www.debatefeminista.cieg.unam.mx/wp-content/uploads/2016/03/articulos/030_08.pdf.