Mental health articles

Population aging in the developing world bear simplications for the mental health of the elderly bothin terms of organic and non-organic disorders. As already mentioned, since rates of certain dementiasincrease with age, there will be a greater percentage and absolute number of demented elders in populations as they become older. Also, as basic health technology reaches populations and as their standard of living improves, more frail elders are likely to survive, and for longer periods of time. Apossible consequence in many traditional societies is poor treatment of these growing groups of frail elderly and subsequent increases in their levels of minorpsychiatric morbidity. For example, Guillette explains that the Tswana of Botswana recognize adistinction between the economically/socially productive elder and the frail old and treat them differently. Specifically, they treat the frail old with less respect, and support for them is more uncertain. Intheir statistical analysis of coded ethnographic datafrom 57 non-industrial societies, Glascock andFeinman arrive at the same conclusion in explaining how the contrasting norms of supportive and death-hastening treatment of the elderly can co-existin so many of the societies in their sample:

While an aged individual is considered young or intact by theother members of the society, support for his or her existenceis provided. However, once this individual passes over intothe old or decrepit group of elderly, support is with drawndramatically, since the non-supportive treatment in all but one instance is death-hastening. Societies manage, therefore,to have both types of behavior without internal strain because the two types of behaviors are directed at differentpopulations. Individuals are selected as recipients for eachtype of behavior according to which group of old they belong.

Logue, through an extensive qualitative analysis of the anthropological literature, againconfirms the idea that the frail elderly are rarely valued by younger members of society. Thus, a rise in theproportion of frail elderly may correspond to increased minor psychiatric morbidity among the agedon the whole in some populations as a result of thewithdrawal of societal and family support for this subgroup.

Despite lack of consensus among researchers on the'old age security motive' of having many children,there is generally agreement that declining birth rates will equate to fewer potential caregivers for elders in many areas of the developing world. Most countries are observing lower birth rates,in comparison to former conditions of high fertility, asthey undergo the demographic transition.

Exceptions do exist in sub-Saharan Africa, and in Kenya where fertility levels and natural populationgrowth have recently reached all time highs of eightchildren per woman and 4% per year, respectively.High birth rates in developing countries have oftenbeen viewed partly as a consequence of people's needfor old age security. At least,many parents have used this motive to explain their desire for having more children. However,strong cultural norms associated with religion may bethe most important factor in maintaining high fertilityrates and even spurring increasing rates in the unusualcases of countries in sub-Saharan Africa. Currently, in most countries, the trendof having fewer children poses greater insecurity forthe elderly in terms of care and economic well-being.The few attempts that have been made to directlyassess the impact of decreasing fertility on family carefor the elderly indicate that it varies among countries.Using the 1986 percent distribution of elderlyaccording to actual number of living children andfertility preferences, Knodel, Chayovan and Siriboon modelled the future distribution of elderly inThailand according to their estimated number ofchildren and found that the future majority (57.5%)would have two children in comparison to the majorityin 1986 (59.8%) that had five or more children. They conclude that care for the elderly, especially in termsof material support, will decline moderately but that,since most elderly will still have at least two children,support through co-residence with one of them willremain a strong likelihood. In perhaps the mostextreme case, China's one-child family planning policyputs at risk the 'informal' social security system of thefamily, even though Chinese children are legallyresponsible to care for their parents in old age. Not only is it difficult for just one child ormarried couple to care for their parents, but if thechild is a girl, the parents can expect isolation in oldage due to patrilocal residence patterns. Elderlywho are childless in countries without strongalternative care systems to the family face particularlydifficult situations. Childless elderly among the Gendeof Papua New Guinea who have not been able toconstruct successful exchange relationships in theirsociety are frequently neglected and abused becausethey are perceived as a burden; with increasing de factochildlessness due to migration of the young away fromvillages, the plight of the elderly is likely to worsen.

 

Tags: aging, Health, health care