By Lisandra Fariñas Acosta
Cuba is one of the most aged Nations of Latin America and the Caribbean, and the predictions say that by 2050 it will be one of the most aged of the world. Success or problem? Both, without losing sight that high rates of human development in the field of health, for example, mean that we showcase today a 18.3% of the population above age 60, according to statistics from the last census of population and housing (2012).
It is a phenomenon that at present constitutes the major of the socioeconomic and demographic challenges of the country. It is not news the current and future scenario facing Cuba’s demographic almost zero growth, with rates of fertility below replacement level for more than 30 years, high life expectancy and a negative balance of external migration. Precisely, the combination of these factors has affected not only the size and the pace of the growth of the population, but also its structure by age, giving rise to a real process of aging.
Official health statistics put the average life expectancy at 78, 97 years, 76 for men and 80 for women. Also the life expectancy of people who reach the age of 60 is 22 years, and for those arriving in the eight decades, about 8.8 years more.
The national survey of population aging (ENEP-2010) warns that “a population without replacement is aged and then decreases, so that Cuba has begun to decrease in absolute terms. In this way, the decrease in a population intensifies their aging process”.
The panorama complicates if we bear in mind that, according to the mentioned research, has been considered the importance of defining the aging not only in relation to the increase in the proportion of elderly people compared to the rest of the population, but also as the inversion of the pyramid of ages, since the phenomenon is not only an increase in the proportion of elderly, but also a decrease in the proportion of children and young people aged 0-14 years (17.2% of the population, according to the results of the last census). In other words, the country does not have replacement of the productive forces either.
The challenges are already felt. The projections of the Cuban population dynamics demonstrate that it will increase the demand for geriatric services, gerontology, of safety and social assistance together with the picture of current health, where the cancer is, like hypertension, diabetes and diseases non-communicable chronic diseases cardiovascular brain, among the leading causes of morbidity and mortality.
Own national survey of aging shows that more than 80% of older adults suffer from chronic illness. This ratio, as you might expect, is increased for the Group of 75 years and more, from 60 to 74.
According to the study, women show disadvantage compared with men, regardless of age, which can be attributed to one better declaration of first or to their greater propensity attending the doctor. Most frequent chronic diseases among the elderly Cuban are blood hypertension, present in more than 55% of the total of this age group, and which reaches 63% of women. In addition, more than one-third suffers from arthritis, rheumatism or arthritis, also most frequent disease among women and adults aged 75 years and over. Diabetes, heart disease and nervous problems are the relatively common ailments among these people, even if they belong to the female sex.
The study presents results in terms of the type of daily diet and their frequency in older adults, which determines the nutritional risk which could be exposed. In this sense, evidence that food consumption survey almost generalized by older adults are eggs and grains or legumes, as it least opts for dairy products and fruit and vegetables. Not seen differences by sex or age in these findings, except for dairy products, which are part of a higher percentage of adults 75 and more, compared to the younger group. It was checked with the data of the survey that 93% of older adults consume at least two of these foods with the appropriate frequency, no differences between women and men.
Who cares who?
One of the biggest challenges faced by the society to the accelerated aging of the population is that of care, and a great responsibility falls on medical services. Historically, health systems are designed to meet children’s maternal problems or diseases of short duration, which caused not disability. With aging, the scenario changed and it complicates, which develop and transform the welfare services and to confront this phenomenon is urgent task. In Cuba, although it boasts a network of grandparent’s houses and nursing homes, the demand still exceeds capacities.
The Census of population and housing of the 2012 reflects that around 13% of homes have one single senior, which opens a challenge to security and welfare systems.
According to the national survey of aging, in relation to the marital status, the highest proportion of older adults are married or attached (45.6%), followed by widows, representing 30.2% of the population in the study. It was found that this proportion of widowers, joined the separated or divorced (17.5%) and unmarried (6.7%), 54.4 percent; that is, a considerable proportion of older adults that being without a partner may lack this important affective link in old age. These proportions are more pronounced in the Group of 75 and more.
This analysis denoted a significant difference by sex. Men who are without a partner represent 37.2%, compared with 69.7% among women, which stood at 68.2% after 74 years. This is due to the presence of a proportion considerably more women widows, primarily in the age group most advanced, in contrast with a much higher proportion of married and united men. In both cases, the explanation is given, on the one hand, by the higher male mortality, but also by more women to remain without a partner after a union, the same for widowhood than by separation or divorce.
Then emerges the dilemma of who cares who. Ensure the care of the elderly is one of the main difficulties the family is facing, resulting in the departure of the employment of persons with full working capabilities, being women the most affected, who generally assume the care of the elderly. In this way the tradition reproduces according to which they par excellence continue being the nursemaids.
The situation may be more sensitive for primary caregivers, if we take into account, in accordance with the latest research, in Cuba around 130 thousand people suffer from Alzheimer’s, number that will be increased by 2.3 times to the year 2040. It means, there will be 300,000 people with dementia, 2.7% of the Cuban population. According to updated studies, more than 50% of these people need permanent care or some of the time, that would be worthwhile to add that by each patient two family are psychologically affected and 40% of them have to stop working.
Women and old age
In Cuba, a higher proportion of women than men survive at more advanced ages – 53%-, with an index of 1 119 women for every thousand men. Therefore, it is essential to analyze subjective and construction of meanings revolving around being a woman, and live in an aged woman’s body. How experience the transition to old age Cuban women, before the so-called feminization of ageing?
Psychologist Laura Sánchez Pérez, who has researched gender identity in higher adult, concerned that it has been proven that “the paradigm of eternally young and beautiful woman is an almost unmovable content in gender identity of women, which is contradictory to the arrival of an age where the human body is visibly transformed, becoming a source of discomfort and dissatisfaction. The refusal is to live a full sexuality, thought from cultural to a young body. In addition, the contradiction between old age and wisdom and experience and fear to loneliness”.
The reality indicates that despite existing social policies seeking a gender equality, the Cuban women continue themselves perceiving overloaded in the domestic scope.
Research on population aging hardly incorporate the views of women, and about it alerts us sociologist Reina Fleitas in a recent article entitled “invisible speech of aging: the dilemma of gender”, included in the publication of the Chair of anthropology Luís Montane of the University of the Habana.
The researcher emphasizes that even though they have a longer life expectancy they also suffer a greater burden of disease that impairs their quality of life. “The female group in those ages often suffer degenerative dementia, Alzheimer’s disease and osteoporosis, and other chronic as ischemic diseases, diabetes and cardiovascular diseases,” she stressed.
In addition, Fleitas refers that “despite the notable progress that equal opportunities between men and women in education, health and employment since the second half of the century to the present, still inequalities in employment and wages are important”. In that sense, it emerges to researcher the care dilemma, since above inequities “are reflected in wage differences, as a result of a greater number of absences to work, determined by their role of caregivers in the family, or their important presence in occupations of lower grades which have a lower remuneration”.
At the end of life, indicates the researcher, they are those that tend to have an economic situation more difficult for these reasons, that many have no income because they never worked outside their homes. According to the census, the Cuban are 10% of the population occupationally employed in the ages 60 and older, while men constitute 27.3%.
There are many specialists, including Fleitas, who share the view that aging is “a matter of women” if you consider that about them lies with the heaviest burden of care for the elderly, both in public institutions and in the homes. In this sense, says the researcher, “numerous research on family shows that Cuban women remains the center of the family”, and those with public commitments live the conflict of trying to reconcile the demands of home and employment.
Men have a growing role in attention to family”, but still the shift shows no signs of parity,” said. “At this point we need policy monitor to assess the work of care of the elderly by a member of the family as a useful activity”, recommended the specialist, who proposes to also see the idea as a job change.”
It should not be seen retired to a person who takes in time full care of an old man by the fact that no longer work in a traditional public occupation”, she says.
“The lack of time and the overload of roles experienced by women caregivers in the ages of 50 and more, is a direct determinant of health problems that they live. These conflicts could be mitigated if you change the focus of policy towards families and women living those realities”, concludes the researcher.
Take the economy after 60
There are many seniors who continue to work after retirement age, proportion that is higher in men. The national survey of aging (2010) asked the major causes that they remained active in labor, and the majority of those surveyed responded that they felt useful and capable (70.8%). The second predominant reason was that the money was not enough (56%), and the third is that they had to help their children and others (22, 5%).
In general, the research showed as more important sources of income for women retirement or pension, the help of family resident inside or outside of the country (15 of every 100) and other sources not specified, while income of men comes mainly retirement or pension, wages and stimulus and work on their own.
In comparison with the other regions, retirement or pension and salary/incentive are sources of income of a greater percentage of older adults in Havana. Also in the capital, a higher percentage of older adults, regardless of their sex, benefit with the help of relatives residents in Cuba or outside the island. This concept also has a percentage weight relatively high in the eastern zone.
Of the total of responses on the sources of income, 9% said that did not receive income in the last month, with higher percentages for women. Concerning satisfaction with the level of revenues, the study reflected that four of every 10 older adults can live between good and a little tight with the money that they receive, as 60% done with hardships and deprivations. This may be reflecting that most of them only has income for retirement or pension. Women, according to this study, more than men tend to feel that living with hardship and shortages, probably because a higher proportion of them not perceived income and because perhaps they are in charge more of the economic aspects of the homes.
To the question of which economic resources have seniors for the future, the National Survey of Aging reflects that 75.5% mentioned the retirement or pension, in as much 13% related in addition other resources. Stresses that 15% of all older adults consider that they do not account with any economic resource for the future, a proportion that reaches 20% in the eastern region and which is emphasized much more for the female sex in the region, reaching 29%.
Also, every two elderly feels fear or uncertainty regarding their economic situation or health in the future, regardless of age. By sex, proportions not deviate much from this pattern, although the Group of 60 to 74 women tend more to express feelings of this nature than men of the same group. This seems to be in accordance with that more women than men reported not having any sustenance for the future.
Deprive society of stereotyped visions, that almost always placed to the elderly in a position of dependence and social disadvantage that is not able to take initiative and encourage social development, is still a pending subject in Cuba.
It is about winning in gerontological culture, i.e., learning to live together in harmony and health with the elders. The patterns of today’s modern society, reflect “to be old”, comparable to racism or sexism, consider that older adults have little or nothing to bring to the social group to which they belong. Nothing further from reality. Aging is one stage of life and as such have to understand it.
The labor retirement involves a risk of alienation from society. But it should not be considered an exile’s life, but we must not lose sight that arise other problems such as loneliness due to lack of social relations and the indifference towards the opportunity to develop new interests, situations that need to be resolved through appropriate social services and family support.
This demographic growing phenomenon in the world leads us to rethink the concept of old age, and imposes on us a change in attitude that is conducive to the actual location of the elderly in their family and social environment.
We must bear in mind that in the next decade our elders will be individuals with a high technical score, with a deep capacity for analysis and response to problems; a high percentage will have a university profession and a high level of information. Not to mention that the appropriation of the socio-cultural phenomena of this population group will not be it showing the newly-completed century adults.
Change our perception of aging, create conditions conducive to arrive with expectations at this stage of our existence and banish prejudices in lathe to it is essential in the determination of that to live more years will mean, additionally, live better.
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