The impact of the institutionalisation of the elderly in Pakistan

In the 21st century, ageing of the population is a significant demographic occurrence and a distinctive trend seen universally (Ameh et al., 2014; Hermalin, Ofstedel, & Tesfai, 2006; Wandera, Kwagala, & Ntozi, 2015). Among the continents, Asia has the most rapidly increasing elderly population (Powell & Khan, 2013), with more and more people in the age group of 60 years and above. A United Nations report on World Population Prospects mentions that globally in 2017 there were 962 million elderly people 60 years and above, and  this number will rise up to 1.4 billion in 2030 (United Nation, Department of Economic and Social Affairs Population Division, 2015).  Another report by World Population Ageing reveals that the number of older persons 60 years and above will increase to 2.1 billion by 2050 and this figure is predicted to touch up to 3.1 billion by 2100 (United Nation, Department of Economic and Social Affairs Population Division, 2015).  This trend of ageing can be witnessed in many South Asian countries too. Pakistan is one of the South Asian countries currently comprising of more than 8 million elderly people, and this figure is expected to reach 27 million by 2050 (Ahmed, Owais, Siddiqui, Mamun, Rao, Yousufzai, 2013).  Life expectancy has been 68 years in the developing regions and is predicted to increase to 74 years by 2050 (UNFPA, 2012).   The paradigm shift Pakistan is a state where culture, traditions, values, and family bonding are given great importance. Globalisation has immensely impacted multiple spheres of life of the elderly population with considerable effect on transformation of the cultural values across the globe. The older population is exposed to the impact of globalisation in the form of challenges from family and society (Nair, 2014). Traditionally, the elderly have been cared for and their presence is cherished at home by their families, where they earn love, respect, and admiration from the families of their children. However, in recent years, the decline of the extended family system has deprived the elderly from the physical and emotional support provided by the family members (Chen Wu,White, & Cash, 2009; Gadit, 2010; Sabzwari &Azhar, 2010; Taqui, Itrat, Qidwai, & Qadri, 2007). As a result, they are left to spend their lives in isolation, with no physical, psychological, and emotional support. Because of this deprivation, large numbers of elderly people are ending up in shelter homes. Some of the significant factors behind this have been discussed below.  Contributing factors that influence the institutionalisation of the elderly Societies transform in response to globalisation and economic recession with substantial consequences for individuals, families, and communities. In Asian societies, the socio cultural impact of globalisation is surfacing on two significant domains: the family system and relationships. Some of the major factors of this paradigm shift are described below: Family systems in South Asian cultures Pakistan has a cultural tradition of strong family systems which are rooted in the life style of the people (Itrat et al., 2007). A joint family system is the fundamental and prevalent family structure in Pakistan (Itrat et al., 2007). This structure provides a feeling of identity and belongingness among the members, which closely knits them together in a bond of love, care, respect, and harmony. In Asian cultures, many of the socio-cultural values are grounded in the practice of the extended family system. The older members of the family are taken care of by the young generation and it is regarded as dishonorable if any elderly lives alone or in a shelter home. Weakening of the joint family system The elderly population in many South East Asian countries such as Taiwan, Korea, Singapore, Thailand, India, and Pakistan, are confronted with a decline in the traditional extended family system and the emergence of nuclear families (Chen Wu et al., 2009; Gadit, 2010; Sabzwari & Azhar, 2010; Taqui, Itrat, Qidwai, Qadri, 2007). The loss of the joint family structure is likely to have a substantial effect on the physical and mental health of the older population, who may consequently end up either living alone or in shelter homes. Migration of the younger generation Another substantial effect of globalisation is the relocation of the younger population from the rural to the urban areas, leaving the elderly without support (Chadha, n.d.; Pais, 2006). This escalating trend of migration of younger individuals is usually for better employment opportunities (Sabzwari & Azhar, 2010). All these factors have contributed in changing the filial piety values, resulting in the collapse of traditional caring by the extended family members. Family members are getting obsessively engaged in their personal lives and do not have sufficient time to spend with their parents, marginalising the elderly to the choice of either living alone, with social and financial dependence, or in shelter homes, where they might end up being ignored and unobserved (Chen Wu et al., 2009; Jamuna, 2003). Disengagement of women from caregiving roles   In the East, the caring role of a woman is a part of the cultural training from childhood. A female usually adopts a care giving role, while men provide active support in assisting the elderly family members financially (Jamuna, 2003). The care giving role of women consists of different obligations such as performing home chores, child rearing, and care of the elderly along with job. The above mentioned factors are leading to a decline in the decision making power, position and authority of the elderly. They are increasingly experiencing loneliness, depression, and ignorance. In addition to these factors, the demographic shift in Pakistan, along with several socio-economic challenges, such as economic recessions, low savings, lack of health insurance coverage, and weak pension system is badly impacting the lives of this vulnerable group (Jalal & Younis, 2012). Economic dependence The retirement age in Pakistan is 60 years for males and 55 years for females (Jalal & Younis, 2012). Pakistan has a weak and fragile system of pension distribution after retirement and the most important reason for this is the insufficiency of government funds (Jalal & Younis, 2012; Sabzwari & Azhar, 2010). Furthermore, the pension facility is limited to the people who are employed in the government sector (Sabzwari & Azhar, 2010). In a country with high inflation rates and other factors like abrupt decrease or loss of wages, meager retirement allowances and other fringe benefits (Itrat et al., 2007), and no other substitute supply of income, the elderly have to rely on their family members (Sabzwari & Azhar, 2010). Additionally, the unexpected transition from being the leader of the family to a passive member in decision making, coupled with the inability to contribute financially, often leads to decreased self-esteem and psychological distress (Itrat et al., 2007). Thus, due to these changes in society globally, the elderly are often forced to spend the last years of their lives suffering from pain, loneliness, and neglect. The emerging concept of institutionalisation in Pakistan The concept of institutionalisation of the elderly has emerged from the West, where it is a usual custom to keep parents and grandparents in old homes (Chen Wu et al., 2009). But, Rajan, Mishra, & Sarma (1999) state that, since the early 18th century old homes have been functioning in a developing country like India to provide shelter to the poor who have no family to care for them (as cited in Leibig, 2003). However, old age homes or shelter homes are an emerging phenomenon in Pakistan, which are becoming more and more common with the passage of time. Moreover, in Pakistan, empirical studies of the elderly population living in shelter homes are rare, primarily due to the traditional family framework. Shelter homes have become an alternative, where the fragile elderly population spends their remaining years waiting for love and emotional support from their children. According to a survey conducted by Ramamurti and Jamuna (1997), the aged who choose to live in institutions are the ones who are deprived, childless, untrained, or have less wish to live with their children (as cited in Jamuna, 2003). A qualitative study conducted in Taiwan revealed that the phenomenon of nursing home care for the elderly is a process of forced choice (Chen Wu et al., 2009). This relocation of the elderly into the shelter homes emerged because there was no choice left with those who could not provide sufficient care and support to their elderly during this period of their lives. Categories of shelter homes Traditionally, these homes served the poor who had no one to care for them or support them in their family. In recent years, however, some community-based services have been initiated by non-governmental organisations (NGOs). Institutions for the elderly are categorised into “free homes” and “pay and stay homes” (Jamuna, 2003). Voluntary organisations usually manage the free homes and provide accommodation and food free of cost. These homes usually register people who can independently look after their daily living (Jamuna, 2003). The pay and stay homes charge the aged according to the quality of services provided to them (Jamuna, 2003). The role of NGOs According to the Social Welfare Department of Sindh, six organisations are giving protection to more than 150 older people (Shah, 2010).The actual number, however, is much more than the reported figures. In Karachi, these homes are managed by private NGOs or faith-based organisations that are silently working for the older population. The Catholic Church governs three shelter homes in Karachi, where the residents pay minimal fees, while the rest is generated through the church (Sabzwari & Azhar, 2010). Some of the shelter homes are governed by other faith-based communities, functioning with the help of volunteers and donation support (Sabzwari & Azhar, 2010). The Edhi Foundation is one such example of a service where elderly people are housed (Gadit, 2009). Approximately, 417 residents at the Edhi old home are benefitting through this organisation, however, the actual number is under reported (Ali, 2011). Impact of institutionalisation on the elderly The causes which were discussed above are leading to harmful effects on the health of the elderly (Qidwai, 2009). So far there is no printed research finding on the physical and mental health of older people living in these homes (Subzwari & Azhar, 2010). However, the literature from the West specifies that elderly people living in these care homes are more inclined to develop depression as compared to those living with their families (Ron, 2004). Given the changes in sociocultural values globally, the elderly are forced to spend the last years of their lives either living alone or in shelter homes, leading to emotional pain, loneliness, and neglect. In addition to this, these factors are leading to a decline in the decision making power, position and authority of the elderly. They are increasingly experiencing loneliness, depression, and ignorance. Literature remarks that every fifth elderly person is experiencing depression (Ganatra, Zafar, Qidwai, & Rozi, 2008). Local studies were done in Karachi to identify the prevalence of these factors among the elderly. The prevalence of depression from these studies came out to be 22.9% and 19.5% respectively among the elderly population (Ganatra, Zafar, Qidwai, & Rozi, 2008; Taqui et al., 2007). Another study uncovered 60.6% and 69.7% as the prevalence of depression among the elderly residing in shelter homes assessed through the Geriatric Depression Scale (GDS) and the Centre of Epidemiological Studies Depression Scale (CED-D) (Qadir et al., 2014). Additionally, the elderly can experience loneliness and helplessness due to the non-presence of anyone caring for them, ignorance, lack of interaction with other residents and lack of emotional connection with the family. A study by Max et al. (2005) emphasises that loneliness is very closely related to depression in the elderly population. Conclusion The conception of old age homes is still in its infancy in Pakistan, and many South East Asian countries, including Pakistan, are diverting their attention towards researching the concept of shelter homes or old age homes. In recent years, shelter homes have been burgeoning. While they are offered to older people as an alternative place to spend their lives, the physical and psychosocial wellbeing of the elderly residents needs to be researched more in order to understand how this will impact their quality of life. References Ameh, S., Gómez-Olivé, F.X., Kahn, K., Tollman, S.M., & Klipstein-Grobusch, K. (2014). Predictors of health care use by adults 50 years and over in a rural South African setting. Global Health Action, 7 (24771). Retrieved from https://ift.tt/3oO9hM0. Hermalin, A.I., Ofstedal, M.B., & Tesfai, R. (2006). Future Characteristics of the Elderly in Developing Countries and Their Implications for Policy. Population Studies Center, University of Michigan, Institute of Social Research. Wandera, S.O., Kwagala, B., & Ntozi, J. (2015). Determinants of access to healthcare by older persons in Uganda: a cross-sectional study. International Journal for Equity in Health, 14(26), 1-10. Powell, J.L., & Khan, H.T.A. (2013). Ageing and Globalization: A Global Analysis. Journal of Globalization Studies, 4(1), 137-146. United Nations, Department of Economic and Social Affairs Population Division, (2015).World Population Ageing 2015, Retrieved from https://ift.tt/1TZ12aN United Nations, Department of Economic and Social Affairs Population Division. (2017).World Population Prospects: The 2017 Revision. Retrieved from https://ift.tt/2sUUcPc Ahmed, A., Owais, K., Siddiqui, M., Mamun, K., Rao, F., & Yousufzai, W. (2013). Dementia in Pakistan: National guideline for clinicians. Pakistan Journal of Neurological Sciences, 8 (3), 17- 27 United Nations Population Fund and Help Age International (2012). Ageing in the Twenty-First Century: A Celebration and A Challenge. New York. Retrieved from https://ift.tt/3oLwZrW Nair, L.V. (2014). Ageing in India: A conceptual Clarification in the background of Globalization. European Scientific Journal, 10(2), 379 - 392. Chen Wu, S., White, A., Cash, K., & Foster, S. (2008). Nursing home care for old people in  Taiwan: A process of forced choice. Journal of Clinical Nursing, 18, 1986 -1993 Gadit, A.A.M. (2010). Elderly Abuse: Tip of the Iceberg. Journal of Pakistan Medical Association, 60 (1), 1- 4. Sabzwari, S., & Azhar, G. (2010). Ageing in Pakistan—a new challenge. Ageing International, doi:10.1007/s12126-010-9082-z Taqui, A.M., Itrat, A., Qidwai, W., & Qadri, Z. (2007).  Depression in the elderly: Does family System Play a role? A cross - sectional study. BMC Psychiatry, 57(7), 1-12. Itrat, A., Taqai, A. M., Qazi, F., & Qidwai, W. (2007). Family systems: perceptions of elderly patients and their attendants presenting at a university hospital in Karachi, Pakistan. Journal of Pakistan Medical Association, 57(2), 106-109. Chadha, N.K. (n.d.). Intergenerational relationships: An Indian Perspectives. Retrieved from https://ift.tt/3bCUyQc Jamuna, D., (2003). Issues of Elder care and Elder Abuse in Indian context. Journal of Ageing & Social Policy,15 (2), 125 - 142. Jalal, S., &Younis, M.Z. (2012). Ageing and Elderly in Pakistan. Ageing International. doi 10.1007/s12126-012-9153-4 Gadit, A.A.M. (2010). Elderly Abuse: Tip of the Iceberg. Journal of Pakistan Medical Association, 60 (1), 1- 4. Ali, R. (2011, December 26). Abandonment and Anguish: Old homes no panacea for Karachi’s Elderly. The Express Tribune. Retrieved from https://ift.tt/tLEiKe. Qidwai, W. (2009). Ageing Population: Status, Challenges, and Opportunities for Health Care Providers in Pakistan. Journal of the College of Physicians and Surgeons Pakistan, 19 (7), 399 - 400. Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2/3):97–116. Ganatra, A.H., Zafar, S.N., Qidwai, W., & Shafquat, R. (2008). Prevalence and predictors of among an elderly population of Pakistan. Ageing &Mental Health, 12(3), 349 – 356. Qadir, F., Haqqani, S., Khalid, A., Huma, Z., Medhin, G. (2014). A pilot study of depression among older people in Rawalpindi, Pakistan. BMC Research Notes, 7(409). 1 – 9. Max, L.S., David, J.V., Jacobijn, G., Aartjan, T. F., Ross van der Mast & Rudi, G. J. (2005). Is depression in old age fatal only when people feel lonely? American Journal Psychiatry, 162, 178–180.

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