Dr. Joan Porteous-Rawlins
I was talking to some of my former classmates the other day and we asked ourselves the question: Where did all the years go? It seemed not so long ago that we were in Form 1A at the school and here we are now, being referred to as “seniors” in whatever society we now find ourselves. Some of us of course, will argue that we are the “young old” which is a demographic term for those who are aged 60 -74. Some of our siblings are already in the category called the “old”, which is those who are 75-84 years and our parents if alive are certainly in the category the “old old”, which refers to those persons who are over the age of 85 years.
People are living longer! Throughout the English Speaking Caribbean, the elderly now represents 10-13 percent. I have an aunt who passed away in February (2016) who was 103 years old. My mother is already 95 years old. So some of us who are now the “young old“, have parents who are alive and if we are not already experiencing concerns we can expect to have challenges in relation to caring for our aged parent.
While we have a great deal for which we should be thankful, there are challenges none-the-less. A colleague of mine was telling me a few days ago that she recently took her mother with her on a cruise. They had been going on cruises periodically over the past several years. This year, my friend did not enjoy the cruise at all, and vowed not to ever take her mother again. She also complained that as the caregiver for her Mom she had in this past year been called away from work several times in relation to one or other health related issue with her Mom. It goes without saying that some of these younger seniors have not as yet retired from the workforce. The care-giving experiences of this particular friend of mine are not even major difficulties compared with that of others of my age group’s.
I have come to this “discussion” as a researcher and academic. My knowledge of older persons and their care is based on the research which I have done over time and still do, and the discussions I have had with older people I meet. As a researcher I have been able to look at this issue, not only in one place, for example, Jamaica, Trinidad or St.Kitts, places in which I have lived in recent times, but l am able to compare and contrast what I see and experience in other countries near and far. In so doing, I have come to know that individuals, social agencies and governments worldwide, spend a great deal of time and energy considering issues of the “Care of the Elderly parent”. This issue is now a major agenda matter internationally, mainly because of the demographic transition. The demographic transition refers to that shift in the population which has taken place worldwide in the past several decades, first in the developed countries and then in the developing countries, to one degree or the other.
This demographic transition refers specifically to the situation in which: there is a reduction in overall mortality and a reduction in fertility. This means that more persons get the opportunity to live into old age. A reduction in fertility means that fewer children are born to each woman; families are no longer ten (10) or thirteen (13) children, but 2- 4 children.What then happens the proportion of older persons in the society then increases significantly. However, because we are by then having fewer children, there will be a shift in the “dependency ratio”; this means that there will in theory be fewer younger persons to older persons and if we follow that logic; fewer persons to care for the older person when the time comes for such care to be given.
All of this then takes us to some of the very critical issues which must be raised in any discussion of “The Care of the Elderly Parent”. The first question we might ask might be: Whose responsibility is it to take care of the elderly parent? The first and logical answer, of course is, "It is the children"!
When I was a child (many decades ago), I used to frequently hear people say, “Children are an insurance for the future”. I very rarely hear people say that any more. Maybe, that has to do with the reality which now exists.
Writing from a Caribbean perspective, I know that many of us invest very heavily in our children. Responsible parents try to do the best for their children, by providing them with an education or a trade or a skill or whatever it is they believe will enable the children to become independent and so be able to contribute to the society and bring up a family. Unfortunately, this is not always the case and we see the negative outcome of this “less that good” child rearing raising its ugly head when the parents become elderly and sick. What goes round comes round!
Fortunately many children make good use of the investment which their parents made in them and indeed are ready and available when it is time to care for their elderly parents. However, despite the investment, and the “willingness in spirit” of these children, for reasons which we cannot readily understand, the care just does not seem to be there, and note that I have said “does not seem” and I will explain.
As Caribbean people we are very much a migratory people. We “move about”. Our children, also “move about” and when parents become elderly, they might find that they are in a different country/a different place,from that which their children reside. So when the time comes for the management/the care of the elderly; the parents are in one place and the children are elsewhere!
It is for this very reason that families need to discuss/need to plan what will be the care arrangements/the provisions for the care of the elderly parent. Who will do what? Where will this care take place? This has to be discussed long before the parent becomes ill or is in need of supervisory care. This discussion does not have to be “final” and complete, but it needs to take place. If it does not, quite likely there will be serious confusion and misunderstanding and “bad blood” among the children when the parent suddenly becomes ill or some other crisis occurs.
Throughout the Caribbean life expectancy is now in the 70s. By this I mean the average is about 70. Naturally many persons live on to the 80s and 90s and a large number of these persons stay reasonably healthy into the high 70s and are able to manage themselves well into these years.,
However, throughout the region we see significant number of cases of chronic diseases such as: diabetes, hypertension, heart disease, strokes and cancers. These conditions are the main cause of morbidity and mortality in the region and older Jamaicans have more than their fair share of cases of diabetes and hypertension.
Because older persons in the Caribbean are living longer, it means that they have more time for complications to set in, with for example, their diabetes, heart disease and hypertension. These conditions often lead to their disability, resulting in the need for more intensive interaction with the health care sources, expensive treatments, hospitalization and greater pressure on the family member who has taken on or who had been assigned the responsibility of care-giving. Once the older person becomes ill, the need for care becomes more urgent and the responsibilities more arduous.
In addition to the issue of serious ill health, there is something which we need to look at when we consider matters which relate to “the care of the elderly parent”. In a number of surveys which I have conducted over time in the Caribbean, elderly persons/elderly parents although not in serious ill health have complained of “being lonely”. Some have even stated “It is the loneliness which is killing us”. The loneliness was painful for them and even some of those who lived with family complained of feelings of loneliness.
This is where the family and indeed the community could “step in” and find ways of preventing our elderly parents/elderly persons from having to experience this “terrifying loneliness”. Imagine, in some situations, although only 16 % or so lived alone 33 % of the older persons complained bitterly about being lonely! As adults with children, we need to set the example. If we do not make time for our aged parents, how will our children know what is expected of them.
Clearly, we need, as family members, as community, to be more thoughtful and caring of out elderly parents/elderly citizens. We should seek to be more inclusive. We do not need to “park” our elderly citizens in a corner. Even young family members in the home could become more involved in ensuring that there is meaningful interaction with the elderly grandparent or other elderly person. School children could become involved with the elderly in their communities. This I believe is already happening in some of our Caribbean communities.
The ideal should be more intergenerational interaction. This is what we should be aiming for. Young family members could learn so much from their elders and elders could also learn about the new technologies/new issues in the society from younger persons.
Care giving for the chronically ill parent
I could not conclude this article without making some reference to the care of elderly parent/person for whom “cognitive changes” have become their reality. Here I’m making reference to Alzheimer’s disease and other dementias. Alzheimer’s disease is not something that any of us would wish for ourselves or for our elderly parents, but unfortunately “older age” is the “key risk” factor for these conditions, so I need to briefly say something about them.
Alzheimer’s disease and other dementias need to be recognized as of significance among the health concerns. As the population of older persons age even further, we will undoubtedly see more Alzheimer’s disease, vascular dementia and other dementias. Alzheimer’s disease is a slowly progressive disease of the brain. It is not a normal part of ageing but is more likely to be seen in persons over the age of 65 years. Vascular dementia is related to hypertension, strokes and high cholesterol, and these are common conditions in our populations 60 years and older. The important issue with these dementias is that they are extremely disruptive to the lives of the affected individuals and can be a great strain on caregivers especially those who have not been provided with adequate financial and other support.
Briefly put, Alzheimer’s disease is a disease of the brain.It is not a psychiatric or mental condition. Memory loss is usually the first notable sign. I should add immediately that not all cases of memory loss will be Alzheimer’s disease as memory loss might be an indication of other conditions such as: problems with the thyroid, anaemia and vitamin deficiency. It is therefore very important that the elderly relative seeks a proper diagnosis from a physician who is familiar with Alzheimer’s disease.
Finally, I need to stress that caring for an elderly parent, whether the person has dementia, severe diabetes, chronic heart disease or a stroke, is very difficult work! No matter how much we love or respect the chronically ill elderly parent, that need can become very difficult and even burdensome if the care has to be given by only one person. I would therefore like to conclude on this note, We need to “share the caring“ as caring for a sick aged parent, twenty-four hour daily, seven days a week ( 24/7) is much too much for one person.
Family members need to get-together and agree as to how such responsibilities will be met and share the “burden”. Some have “time” and some have “money”, but even those, with time will need a break. If those with money have absolutely no time then the money can be used to help to provide much needed relief for the main care giver; so she/he can have a weekend off or two weeks or some other “time off” as the need arise. Even those with no time should “make time” once in a while. Where necessary and where possible the elderly could be checked into “daycare”. This also gives the caregiver a break to “catch themselves” and recover somewhat from care-giving stress which could be a whole topic on its own. Therefore I will end by reminding us that we need to “share the care” when it comes to our elderly parents.
March 4, 2016
Dr. Joan Porteous-Rawlins is one of Manning's "Notable Alumni". Her biography is on this website at