• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Table of Contents
 Acknowledgement
 Message of Margaret J. Anstee (United...
 Introduction
 Part I: Current perspectives on...
 Part II: Demographic and epidemiological...
 Part III: Aging care in third world...
 Part IV: Implementing quality residential...
 Part V: Perspectives on health...
 Part VI: Rethinking agency...
 Part VII: Model programs and research...
 Part VIII: Trans-national...
 Conclusion
 Appendices
 Back Cover






Aging, demography, and well-being in Latin America
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/AA00002842/00001
 Material Information
Title: Aging, demography, and well-being in Latin America proceedings of an international conference
Physical Description: xiv, 161, xxiv p. : ; 28 cm.
Language: English
Creator: Alvarez, Maria D
Von Mering, Otto
University of Florida -- Center for Gerontological Studies
International Exchange Center on Gerontology
Publisher: Center for Gerontological Studies, University of Florida
International Exchange Center on Gerontology, University of South Florida
Place of Publication: Gainesville, Fla
Tampa, Fla
Publication Date: 1989
 Subjects
Subjects / Keywords: Older people -- Congresses -- Latin America   ( lcsh )
Older people -- Cross-cultural studies   ( lcsh )
Older people -- Demographic aspects -- Latin America   ( lcsh )
Old age assistance -- Latin America   ( lcsh )
Older people -- Care -- Government policy -- Latin America   ( lcsh )
Idoso (Medicina Social)   ( larpcal )
Genre: conference publication   ( marcgt )
non-fiction   ( marcgt )
 Notes
Statement of Responsibility: co-editors: Maria D. Alvarez, Otto von Mering.
General Note: On cover: "Proceedings of an international conference, February 1988, University of Florida.
General Note: "August, 1989."
General Note: Papers are in English or Spanish, all abstracts are in English.
 Record Information
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 22416573
ocm22416573
System ID: AA00002842:00001

Table of Contents
    Front Cover
        Front Cover
    Title Page
        Page i
        Page ii
    Table of Contents
        Page iii
        Page iv
        Page v
        Page vi
    Acknowledgement
        Page vii
        Page viii
    Message of Margaret J. Anstee (United Nations, Austria)
        Page ix
        Page x
    Introduction
        Page xi
        Page xii
        Page xiii
        Page xiv
    Part I: Current perspectives on aging in Latin America
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
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        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
    Part II: Demographic and epidemiological aspects of aging
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
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        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
    Part III: Aging care in third world and industrialized countries
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
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        Page 60
        Page 61
        Page 62
    Part IV: Implementing quality residential and community care
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
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        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
    Part V: Perspectives on health care policy
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
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        Page 107
        Page 108
        Page 109
        Page 110
    Part VI: Rethinking agency interaction
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
    Part VII: Model programs and research proposals for the aging
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
        Page 136
        Page 137
        Page 138
        Page 139
        Page 140
    Part VIII: Trans-national issues
        Page 141
        Page 142
        Page 143
        Page 144
        Page 145
        Page 146
        Page 147
        Page 148
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        Page 150
        Page 151
        Page 152
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        Page 155
        Page 156
    Conclusion
        Page 157
        Page 158
        Page 159
        Page 160
        Page 161
        Page 162
    Appendices
        Page xv
        Page xvi
        Page xvii
        Page xviii
        Page 167
        Page xx
        Page xxi
        Page xxii
        Page xxiii
        Page xxiv
    Back Cover
        Back Cover 1
        Back Cover 2
Full Text

WELL


-BEING


in
Latin
America


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A35 iSITY I
1989
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of an International


of Florida


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INTERNATIONAL EXCHANGE
CENTER ON GERONTOLOGY









AGING, DEMOGRAPHY, AND WELL-BEING IN LATIN AMERICA:
PROCEEDINGS OF AN INTERNATIONAL CONFERENCE


University


Co-Editors
Maria D. Alvarez
Otto von Mering
of Florida, Gainesville, Florida


Associate Editor
Ken Tout
HelpAge International, London










Published by
Center for Gerontological Studies,
University of Florida
and
International Exchange Center on Gerontology,
University of South Florida

August, 1989


bMSITY O FLORIDA LIBRARIES










Table of Contents


Acknowledgments

Message of Margaret J. Anstee (United Nations, Austria) ix

Introduction

Third World Third Age: A Twenty-First Century Crisis
by Ken Tout (United Kingdom) xi

Aging in Latin America: A Word About the Conference Proceedings
by Otto von Mering (USA) xxiii

Part I: Current Perspectives on Aging in Latin America

1 The Aging of Latin American Populations
by Tony Warnes and Ashley Horsey (United Kingdom) 3

2 PAHO's Regional Program on the Health of the Elderly:
Current Situation and Perspectives
by Elias Anzola-Pdrez (USA) 6

3 The Health Professional's Role in Self-Help/Self-Care Approaches
By Ewald Busse (USA) 13

Part II: Demographic and Epidemiological Aspects of Aging

4 Demographic and Epidemiological Aspects of Aging in the
Commonwealth Caribbean: Implications for Service Delivery
by Farley Brathwaite (Barbados) 19

5 La Minusvalia en la Poblacion Guatemalteca de 65 Afios y Mas
by Jorge Arias de Blois (Guatemala) 27

6 La Migracion y la Problematica de la Tercera Edad en el Peru
by Maria Isabel Hurtado de Pulcha (Peru) 34

Part III: Aging Care in Third World and Industrialized Countries

7 Mexican Subcultures and the Differentiated Well-Being of the Aged
by Fernando Cdmara (Mexico) 39

8 The Care of the Elderly Costa Rica
by Fernando Morales-Martinez (Costa Rica) 43

9 Informe sobre la Vejez en Guatemala
by Manuel A. Giron Mena (Guatemala) 4 s

10 Como son Atendidos los Ancianos en Bolivia
by Elias Crespo-G6mez (Bolivia) so

11 Anciano y Sociedad en la Argentina
by Maria Julieta Oddone (Argentina) 5 3

12 La Vejez en la Cuidad de Buenos Aires
by Roberto Barca y Eva Mucliinik (Argentina) so










Part IV: Implementing Quality Residential and Community Care

13 Autoasistencia en el Anciano
by Luis Guillermo Suarez (Venezuela) 65

14 Qualidade dos Cuidados Residenciais
by Flavio da Silva Fernandes (Brazil) 71

15 Estructuras de Apoyo y Atencion para Ancianos y Enfermos Terminales en
Estados Unidos de America
by Eduardo Alvarez (USA) 79

16 Pro-Vida, a Non-Governmental Organization for the Care of the Elderly in
Colombia and Latin America: A Video Presentation
by Eduardo Garcia-Jacome (Colombia) 84

17 Reaching Elderly Abandoned Citizens Housebound (REACH): A Dominica
Program
by Diane Abraham (Dominica) 87

Part V: Perspectives on Health Care Policy

18 The Agency for International Development's New Initiative on Aging-
by Jayne Lyons (Guatemala) 93

19 Where There is no Geriatrician: An Approach to Developing Village Health
Worker Training
by Meredith Minkler and Barry Checkoway (USA) 98

20 Desarrollo de Programas de Autocuidado y Prevenci6n de Enfermedades
Enfocados a la Tercera Edad
by Lucia Fernandez-Bracessi (Chile) 102

21 Modelo para una Politica Gerontol6gica en los Paises en Vias de Desarrollo
by Adelina Brenes Blanco (Costa Rica) 1 5o

Part VI: Rethinking Agency Interaction

22 The Challenge of International Cooperation in Latin America
by Joaquin Gonzalez-Aragon (Mexico) 113

23 Valor de una Institucion No-Gubernamental en el Desarrollo de las
Actividades Geronto-Geriatricas en el Peru
by Juana Castro Segarra (Perd) 116

24 An Overview of the Elderly inJamaica with Particular Reference to the Role
of Government and Non-Government Organizations in Service Planning and
Delivery
by Denise Eldemire (Jamaica) 11 9

25 Envejecimiento, Demografia, y Bienestar de las Personas Mayores en el
Uruguay
by Dora Pons de O'Neill (Uruguay) 124











Part VII: Model Programs and Research Proposals for the Aging

26 Community Associations of Senior Citizens: Description of Model Programs
by Franciso Javier L6pez (Panama) 129

27 Proposal for a Multidimensional Assessment of the Elderly in Rio de Janeiro
by Renato Veras (Brazil) 136

Part VIII: Trans-National Issues

28 The Participation of the Elderly in Development
by Julia Tavares de Alvarez (Dominican Republic) 143

29 Panorama Hist6rico y Actual de la Vejez
by Rolando Collado Ardon, Catalina Gougain Oliva, y Patricia Pastor (Mexico) 14 9

30 Condiciones del Proceso de Envejecimiento en un Pais en Qesarrollo:
Implicaciones Socio-Culturales y Psicol6gicas
by Elisa Dulcey-Ruiz (Colombia)

31 Care of the Elderly in South America: Who is Going to Take Up the
Challenge?
by Roberto Kaplan (Argentina) 1ss

Conclusion

Closing Remarks
by Otto von Mering (USA) 159

Concluding Overview
by Maria Alvarez (USA) 1 60

Appendices
xxi
Appendix A: Conference Speakers, Moderators, and Conveners
Appendix B: Conference Rapporteurs xvi
Appendix C: Reprint from Aneing International, Summer 1988 xiii











ACKNOWLEDGMENTS


The Conference on Aging, Demography, and
Well-Being in Latin America held at the University
of Florida from February 23 to 25, 1988, and on
which this volume is based, was sponsored by
several organizations whose financial contributions
are hereby gratefully acknowledged:

Center for Gerontological Studies,
University of Florida, Gainesville, Fl
HelpAge International, London
United Nations Trust Fund on Aging, Vienna
University of Florida President's Office,
Gainesville, Fl
American Federation for Aging Research,
Florida Affiliate, Boca Raton, Fl
Holland Development, Inc., Akron, Ohio
American Association for Retired Persons,
Washington, D.C.
Center for Latin American Studies, University of
Florida, Gainesville, Fl
International Exchange Center on Gerontology,
University of South Florida, Tampa, Fl
College of Liberal Arts and Sciences, University of
Florida, Gainesville, Fl

Special thanks are extended to Harold
Sheppard, Director of the International Exchange
Center on Gerontology, for his encouragement and
support throughout all stages of the conference.


Many other people were responsible for the
success of the Conference and some of them
deserve special mention. The contributions of
Conference Coordinator Darrell Miller and of
Assistant Conference Coordinator Peggy Webster
are deeply appreciated. Sincere thanks are
extended to Laurie Neff, Judy Clark, Lara Fisher,
Joan Flocks, Ray Jones, Barbara Hendry, and Maria
Miralles. We also thank Margaret Galey and
Robert Burke, who graciously represented two of
the panel moderators who could not be present at
the Conference.
Converting the conference papers into this
volume of "Conference Proceedings" entailed much
work. Again, many people shared their talents and
skills to make this possible. Grateful thanks are
extended to M. Jeanne Weismantel for her superb
editorial assistance, and to Sofia Espirito Santo,
who edited the Portuguese manuscript. The
coordinating efforts of Betty Goodson are
gratefully acknowledged, and so are the typing
skills of Linda Opper and Zahra Iravani. A warm
muchisimas gracias goes to Maria Figueroa who
typed the Portuguese and Spanish manuscripts. The
final layout and production of the manuscript was
the work of Laurie Neff, from whose dedication
and passion for perfection this volume has greatly
benefited.











MESSAGE TO THE CONFERENCE ON AGING, DEMOGRAPHY
AND WELL-BEING IN LATIN AMERICA


Margaret J. Anstee
Director-General of the United Nations Office at Vienna,
Head of the Centre for Social Development and Humanitarian Affairs


I greatly regret that other commitments make it
impossible to be with you today, as I would have
wished, but I would like to extend cordial greetings
to you all. The University of Florida certainly
deserves high praise for its initiative in organizing
this important Conference on Aging, Demography
and Well-Being in Latin America, in co-operation
with HelpAge International, with the support of the
United Nations Trust Fund for Aging. I am
confident that this gathering of distinguished
scientists and professionals will further the
understanding of key issues and trends with regard
to aging in Latin America, and advance the search
for methodologies that will facilitate an integrated
response to aging.
Governments, professionals, volunteers, and the
elderly themselves have active roles to play in this
relatively new field. As we progress in defining
them, the more confident we can be of assuring the
elderly a good life. New modes of their
participation in society, the range of services
provided by practitioners, technological know-how
in the scientific community, and Government
policies on aging are all evolving fast and often
independently. This meeting provides an
opportunity to determine how better to coordinate
these advances in order to ensure the active
participation of the elderly in their societies and, in
the case of the frail elderly, the provision of
humane care.
The well-being of the elderly is integrally
linked to that of their families and those who care
for them. In your deliberations you will touch, I
am sure, on the provision of care to the elderly
through traditional family support systems. Many
Governments, particularly in the developing world,
rely largely on these systems, which are themselves
under threat, to provide care to the elderly. A
good understanding of the complexity of aging
issues in relation to the family, the community, and
the State is therefore necessary. The role of the
family in the modern world, including the position
of the elderly in it, is an important concern among


our program activities at the'Centre for Social
Development and Humanitarian Affairs in the
United Nations Office at Vienna.
The tasks before you are manifold and
complex but it is my sincere hope that, by the end
of the Conference,-a clear set of strategies for
promoting the well-being of the elderly in Latin
America will have emerged. Your findings will
constitute an important contribution to the United
Nations program on aging as it seeks to further the
implementation of the International Plan of Action
on Aging in all countries. From our experience in
monitoring the implementation of the Plan, we see
the importance of convening international forums
such as this. They stimulate new thinking, create
goodwill and understanding among disciplines and
countries, and generate momentum for action.
Action through technical cooperation is an
important contribution of the United Nations to the
development of societies. The United Nations
Office at Vienna, which has prime responsibility
for the formulation of global social policies, has a
number of small Trust Funds, including the Trust
Fund for Aging, designed to assist in the translation
of policies and programs into concrete action. We
are happy to have been able also to help this
Conference. These funds, supplied from voluntary
contributions, are intended to supplement the
meager resources of the regular budget of the UN
which are declining, for reasons that are well
known. Unfortunately they too, are very modest in
relation to the many legitimate calls upon them, but
we are doing our best to obtain increased
contributions from both governmental and non-
governmental sources. It is vital that adequate
funding be provided, because aging will inexorably
rank in coming years among the main concerns of
Governments everywhere, including in developing
countries.
My hope is, Ladies and Gentlemen, that your
deliberations here will lead to real improvements in
the lives of the elderly and their families in Latin
America. I wish you a very successful meeting.











THIRD WORLD THIRD AGE:
A TWENTY-FIRST CENTURY CRISIS


Ken Tout
International Coordinator, HelpAge International


The greyingg" of the world's population is
already well documented by demographers and
widely discerned by the general public. However,
in the countries of the North there is a tendency to
believe that this is a peculiar phenomenon and
potential socio-economic problem of only the
North, according to observations by those of us
who live in the North but work in the Third World
South.
The view often expressed alike by eminent
sociologists and public bar commentators of the
North is that "in those countries" (a) people don't
live very long anyway; and (b) if they do survive
into great age, then surely the extended family
system offers them support and succor.
Possibly the three sites of greatest longevity in
the world lie in areas which are Third World or
marginally so, in Ecuador, Pakistan and remote
areas of Southern USSR. Yet, in other Third World
areas, such as high Andean mining areas of Bolivia,
the expectation of life in the male miner may be as
low as 30 years.
These are only very extreme and specific areas
of high or low longevity. However, the
demographers now state with some certitude that it
is Third World countries which will experience the
greatest percentage increase in their populations
over 60 and over 80 during the next 40 years. The
increase will also be tremendous in gross numbers,
due to many factors including successful
prophylactic campaigns, improved basic health, and
better nutrition.
Tragically this great human achievement, the
conquest of so many killer diseases and the prospect
of longer healthier lives for all, is rendered a
potential time bomb of more than nuclear
immensity, by a parallel modern phenomenon, the
breakdown of the traditional extended family
system in many developing countries, due to such
modern advances as industrialization, urbanization,
technical education, and migration. All of these
factors tend to have negative impact upon the elder
to the younger's advantage.
Demographers project a 377% increase for all
developing countries--compared to 108% increase
in developed countries--in the number of persons
over 80, between 1980 and 2020. A 405% increase
is expected in Tropical South America compared
with 60% for North America for the same set of


data. Gross increases are also expected in India,
from 25 million persons over 60 in 1980 to 83
million in 2020 (and 49 million of those over 80).
Equally impressive gains in Africa such as Kenya's
over 60 increase from 0.33 million to 1.76 million.
This present comment will not argue with the
demographers, for it has to be noted that their
projections may well err in being too LOW as well
as too high! The main aim of these few paragraphs
is to initiate debate on a less familiar and more
abstruse factor, the breakdown of the extended
family system. One eminent politician, addressing
the World Assembly on Aging called by the United
Nations in 1982, stated "We do not have in our
country a problem of aged people, as you do in
developed countries, because our extended family
cares for them". Yet, voluntary workers in that
same country were finding abandoned aged people
by the thousands, sleeping rough on urban
pavements and rubbish dumps.
Precise statistics on the breakdown of the
Third World family are difficult to acquire and
harder to translate. Most of the available
information comes from localized studies and is
often narrative in form. The experience of
organizations like my own (HelpAge International
working, as Help the Aged, since 1961 in more
than 100 developing countries at some time or
other) is emphatic in its conviction that the family
is in process of disintegration in many places, but
that this process varies from place to place
(districts, countries, regions, continents), but is
usually related to the rate of modernization in one
form or another.
A few isolated examples will serve as
introduction to more specific commentaries later.
A leading Mexican gerontologist, Gonzalez-Arag6n,
(1984) sees the modernization process in his country
as causing material, economic, spatial, and
domiciliary problems which are overcoming the
strong, elemental emotional ties, and causing inter-
generational catastrophe. Merchan (1984) of
Ecuador says that aged people must "drink solitude"
because the patriarchal family, centered on
grandfather or father has dwindled "hasta casi su
desaparaci6n" (until almost its disappearance).
As long as 1962 Nana Apt (1985) from Ghana
was reporting that some 18% of rural households
interviewed had almost lost contact with their







educated children who migrated to the towns.
Hampson (1982) in his Zimbabwe interviews
received first person quotes like "Today people no
longer greet the elders; they even ambush and beat
us..." or "In African custom, relations are supposed
to look after one another, but if the relations think
one is too old, then life can be very lonely."
As to Asia, from India for some years J.D.
Pathak has been observing "the joint family system
in the East now shows signs of cracking very fast,"
whilst, in a lesser economically developed country
such as Bangladesh, Ibrahim (1985) comments that
already modern developmental thrust--appropriate
or inappropriate--has introduced considerable stress
and disorganization in the traditional society."
An outstanding Western Pacific study, by
Andrews et al. (1986) found some countries (like
Phillippines) maintaining a considerable extended
family structure, but generally a significant though
minority section of elderly were out of contact with
their children or grandchildren. Brathwaite (1986)
in Barbados produced findings which "do not bear
out the conventional view that the elderly are the
recipients of widespread financial support from
their relative because only a third...received such
support." In Belize, Tout and Tout (1985) found 64
out of 121 old people living alone, and 43 of them
having nobody to care.
In general the modernization of a country
endows the younger generation with political
know-how and power, technical skills, academic
opportunities, access to cash occupations, ability to
purchase own property, confined nuclear housing,
tendencies to demythologize and reverse traditional
societal attitudes,and further opportunities for
travel or cultural distancing from the district of
origin. All these positive aspects for the younger
person have negative impact on the elder who was,
but now rarely is, the repository of traditional


skills, rural knowledge, patriarchal power, land
tenure, and quasi-religious prestige.
New model programs introduced by agencies
like HelpAge therefore examine ways of
reintegrating the elder into the community as a
productive and respected member. They also seek
to produce public awareness as to the gravity of the
approaching crisis of millions of unproductive
elders cast upon the scrap heaps of society, and to
facilitate the action of community groups which
produce their own local, culturally and
environmentally appropriate responses to such
problem.


Bilography
Andrews, G. et al. Again in the Western Pacific. Manila: WHO
Regional Office, 1986.
Apt, N. A. AginA in Ghana. Legon: University of Ghana, 1985.
Brathwaite, F. S. (Ed.). The elderly in Barbados. Barbados: Carib
Research and Publications, 1986.
Gonziles-Arag6n, J. Qu es el envejecimiento? Mexico: Costa-
Amic Editores SA, 1984.
Hampson, J. Old age A study of ageing in Zimbabwe. Gweru and
Harare: Mambo, 1982.
Ibrahim, M. Tradition and modern development in Bangladesh
society. Dhaka: Bangladesh Association for the Aged, 1985.
Merchan, R. Estudio gerontol6gico ecuatoriano. Quito: Ministry of
Social Well-Being, 1984.
Myers, G.C. Various works on population projections.
Pathak, J.D. Various studies, Bombay Medical Research Centre,
1975-85.
Tout, K. J. Ageing in developing countries. Oxford: Oxford
University Press, with HelpAge International, 1989.
Tout, K. J. and Tout, J. R. Perspectives on agein in Belize.
London: HelpAge International/OPEC, 1985.
UNO DIESA. Periodical on aging 1984, and other published
projections from same source.








AGING IN LATIN AMERICA:
A WORD ABOUT THE CONFERENCE PROCEEDINGS


Otto von Mering
Director, Center for Gerontological Studies


The Conference

The Conference on Aging, Demography, and
Well-Being in Latin America held at the University
of Florida in February of 1988 was a first step
towards a major research and training initiative
under the general auspices of HelpAge
International. The conference was scheduled to
overlap with the 37th Annual Conference of the
Center for Latin American Studies at the
University of Florida, which had the theme of "The
Demography of Inequality in Contemporary Latin
America."
The focus of the conference was the growing
crisis of the "graying" of the Latin American
population by the year 2020. Using the informed
self-help/self-care approaches to the health and
well-being of an aging population, we wished to
direct attention to the changing present and
potential role of the family and small groups
working in concert with the elderly. These groups
include the traditional extended family, emerging
types of domestic units, and fictive kin support
networks, as well as church-related and other
voluntary community-based organizations.
In the above context, the possibilities of
establishing new educational and social marketing
efforts were explored. The goal was to encourage
the formation of new management capabilities for
service and support by indigenous agencies, in
concert with traditional family and alternative
caring resources.
Relevant to this goal is the trans-cultural
tendency of people of all ages to practice self-
governance in their own lives and in their
relationships with their community and government.
Self-governance also serves as a means for
individuals to express volunteerism, a significant
component of any self-care/self-help project. Step
by step, it takes people beyond the mere provision
of shelter and food toward a state of "anticipatory
democracy,...a greater consciousness of the future
and more effective participation in shaping the
future" (Alvin Toffler, Future Shock).
This approach to development will help
overcome "inequality" gaps involving the elderly in
many Latin American countries. There,
competition for scarce economic resources prevents
the replication of models for working with the aged
prevalent in the more developed countries of North


America, Europe, and of Latin America itself.
Responding to these major concerns and
interests, conference panels were organized around
six major topics: (a) demography and epidemiology;
(b) models of residential and community care; (c)
aging-care in developing and advanced
industrialized countries; (d) health care policy; (e)
agency interactions and the role of government and
non-government organizations; and (f) trans-
national issues.

The Proceedings

The Proceedings of the Conference on Aging,
Demography, and Well-Being in Latin America
follow the basic outline of the conference, except
that a new section was added (Part VII) to group
Research Proposals and Model Programs. The
papers were edited and are published here in the
original language in which they were presented.
Some are in English, some are in Spanish, and one
is in Portuguese. An English abstract precedes
every article.
Part I deals with Current Perspectives on
Aging in Latin America and groups three of the
keynote addresses given at the conference.
Anthony Warnes and Ashley Horsey (Great Britain)
provide an overview of aging in Latin America and
the Caribbean, while Elias Anzola-Perez (USA)
summarizes current initiatives undertaken by the
Pan American Health Organization on behalf of the
elderly of these regions. In-depth coverage of two
of the major conference topics, self-help and self-
care, is given by Ewald Busse (USA).
Part II groups presentations dealing with the
Demography and Epidemiology of Aging.
Brathwaite (Barbados) summarizes demographic and
epidemiologic data not only for Barbados but for
all of the Commonwealth Caribbean nations; it is a
valuable resource. The work of Jorge Arias de
Blois (Guatemala) is a model of how researchers in
countries where funds are limited can maximize
existing census data by subjecting it to various
types of statistical analyses. Problems of migration
and social change are emphasized in Hurtado de
Pulcha's presentation using her native Peru as a
case study.
In Part III both broad and specific issues of
Aging-Care in Third World and Industrialized
Countries are addressed. Fernando Cimara






(M6xico) points to the need for awareness as to the
diversity of subcultures--masked under the term
elderly--that call for differentiated solutions, a
theme that applies to most Latin American and
Caribbean societies. More specific descriptions of
individual countries' responses to their elderly
populations are given by practitioners and
researchers from Costa Rica (Fernando Morales-
Martinez), Guatemala (Manuel A. Gir6n-Mena),
Bolivia (Elias Crespo-G6mez), and Argentina
(papers by Oddone and by Barca & Muchinik).
Issues and options concerning Residential and
Community Care are explored in Part IV. The
concept of self-help/self-care is presented by Luis
Guillermo Sudrez (Venezuela) as a strategy to be
promoted among the elderly and as the basis for
keeping the elderly in their communities. In turn,
Flavio da Silva Fernandes (Brazil) advocates for
community care and for neighborhood centers
designed to meet the needs of the elderly. Eduardo
Alvarez (USA) deals with patterns of care and
support for the elderly in the United States--where
nursing homes and various forms of institutional
care are popular--with particular reference to
minority-group elderly. Two model, privately-
sponsored, community-based programs currently
being implemented by Pro-Vida in Colombia and
by REACH in Dominica are described by Eduardo
Garcia-Jacome and by Denise Eldemire,
respectively.
Perspectives on Health Care Policy are the
subject of Part V. Jayne Lyons (USA and
Guatemala) focused on the U.S. Agency for
International Development's new initiative on aging,
and an abridged version of the official USAID
report made available by Ms. Lyons,- is presented in
this section. Advocating for community-based
health care, Minkler and Checkoway (USA) propose
an approach to train and/or retool health workers
for geriatric work based on David Werner's health-
care paradigms. A policy of self-help and
prevention is emphasized by Lucia Fernandez
Bracessi in her presentation of the Chilean model.
Adelina Brenes Blanco emphasizes the adaptations
and modifications in the various systems and
services that will be necessary in order for Costa
Rica to deal with the increasing proportion of
elderly among its population.
Part VI covers the important topic of agency
interactions and the role of governmental and non-
governmental organizations in the care of the
elderly. International cooperation is emphasized by
Joaquin Gonzalez-Arag6n (Mexico) and by Juana
Castro Segarra (Peru). In addition, Dr. Segarra
deals with the viability of non-governmental
organizations, a topic also emphasized by Denise
Eldemire in her study of service planning and
service delivery for the elderly of Jamaica. Using
Uruguay as an illustration, Dora Pons de O'Neill


makes an appeal for collaboration among public and
private institutions who work on behalf of the
elderly: efforts and resources are maximized
through collaboration and are decimated through
lack of coordination.
Section VII is the only section added to the
original conference topics but it highlights two oft-
repeated themes throughout the conference: (a) the
need for research; and (b) the need for model
programs. One of the papers in this section is a
proposal for an investigation of the elderly in Rio
de Janeiro by Renato Veras (Brazil). The second
paper, Community Associations of Senior Citizens:
Description of Model Programs, by Francisco Javier
L6pez (Panama) offers "hands-on" suggestions
regarding programs and projects on behalf of the
elderly. Some of the suggested programs have
already been successfully implemented, while others
are in the planning phase.
Trans-National Issues, that transcend country
and region, are the subject of Part VIII.
Participation of the elderly in development is
addressed by Julia Tavares de Alvarez (Dominican
Republic), who emphasizes the need to take into
account the participants themselves in designing
"development" projects and punctuates her
statements with vivid illustrations. The concept of
aging and the aging process itself are explored from
a historical and from a present-day standpoint by
Rolando Collado Ard6n, Catalina Gougain Oliva,
and Patricia Pastor. In addition, this team of
Mexican investigators explores aging from a
biological, psychological, and social perspective.
Elisa Dulcey-Ruiz (Colombia) introduces the
concept of "affirmative aging" and advocates for
gerontological approaches focused on autonomy and
participation. Finally, Roberto Kaplan (Argentina),
aware of all the obstacles in the way to attaining
appropriate care for all the elderly in Latin
America, asks the question: Who is going to take
up the challenge of the elderly in South America?
In our view, this conference is a positive step in
identifying the most pressing problems as well as
the options, peoples, and resources needed to
address them.
The Conclusion includes Closing Remarks by
Otto von Mering and a Concluding Overview by
Maria Alvarez. The Overview summarizes ten of
the major themes and generalizations that
transpired from the discussion groups that followed
the formal panel presentations at the Conference, as
recorded by the rapporteurs.
In the spirit of "international collaboration,"
Appendix A gives the names and addresses of
Conference Speakers, Moderators, and Conveners.
Conference Rapporteurs are listed in Appendix B.
Appendix C is a reprint from an article about the
Conference which appeared in Ageing International
in the Summer of 1988.










Part I: Current Perspectives on
Aging in Latin America



1 The Aging of Latin American Populations
by Tony Warnes and Ashley Horsey (United
Kingdom)


2 PAHO's Regional Program on the Health of the
Elderly: Current Situation and Perspectives
by Elias Anzola-Perez (USA)


3 The Health Professional's Role in Self-Help/Self-
Care Approaches
by Ewald Busse (USA)











THE AGING OF LATIN AMERICAN POPULATIONS


Tony Warnes and Ashley Horsey
London, United Kingdom


Introduction

Since the 1920s there has been a momentous
increase in population growth in Central and South
America. Before that time, the region's population
was increasing by less than 20% each decade. The
growth rate had climbed to 25% by the 1940s and
to 31% during the 1960s. The population of Latin
America rose from 61 million in 1900 to 126m by
* 1940, and it more than doubled again to 278m by
1970. The latest United Nations estimates put the
1985 total at over 405m (United Nations
Organization, 1987a).
The immediate cause of this phenomenal rate
of increase has been a marked decline in mortality.
At the beginning of the century, in most parts of
Latin America death rates were in the range 40-
50/1000. They began to fall quickly from the
1920s and by the early 1930s they had reached the
low twenties in some of the larger republics such as
Colombia, Mexico, and Venezuela. Since then
mortality improvements have continued steadily
throughout the subcontinent with only a few
exceptions among small nations. By the 1950s the
regional death rate was below 20/1000, and by 1960
it had reached 10.2 (Sinchez-Albornoz and Moreno,
1968).
The first three-quarters of the century saw far
less change in fertility and the crude birth rate
fluctuated around the level of 40/1000 in the
majority of countries, giving no indication of a
consistent downward trend until the 1960s. Up
until this decade there was therefore an increasing
disparity between declining mortality and the
continuing high level of fertility with the result
that the natural increase rate climbed to
unprecedented levels twenty years ago.
Despite the increases in life expectancy after
1920, until recently there had been little impact on
the share of the population in the elderly age
groups, defined by a minimum age of 65 years. As
late as 1960 in most of the larger republics and
countries, only 3% of the population were in this
elderly age group. On the other hand, the absolute
number of elderly people had been growing
strongly. The continuing high fertility, combined
with declines in the mortality of babies and
children, meant that the younger population grew
as rapidly as the elderly and the age structure
remained relatively unchanged. This phenomenon
confirms theoretical population projections using


different assumptions for fertility and mortality.
The level of fertility has far more influence than
the level of mortality on the relative presence of
elderly people (Coale and Demeny, 1966).


Changes in Vital Rates Since the 1960s

Since the mid-1960s evidence has been
accumulating of a reduction in fertility in Latin
American countries (UNO, 1979; 1984; 1987b). By
the mid-1980s the crude birth rate in most
countries had reached 20-30/1000 and in Brazil it
had fallen to 19.3. Until the last few years, some
of the larger countries appeared to be resistant to
the regional trend, e.g. Mexico's crude birth rate
was 42.1/1000 in 1970. But during the late 1970s
and early 1980s all regions of the subcontinent have
shared in the reduction of fertility. In most of the
larger countries during the early 1980s, birth rates
were falling by at least 1% each year and in some
the rate was very much higher, e.g. Brazil (-3.3%),
Ecuador (-4.5%) and Venezuela (-3.9%). By 1985
only a few central American countries (Belize,
Guatemala, Nicaragua) still had birth rates above
40/1000.
Mortality continued to fall during the 1960s
and 1970s, almost as fast as before, and in many
countries at a faster pace than the decline of
fertility. By the mid-1980s the characteristic death
rate in Latin America was 5-7/1000, although
slightly higher rates continued in some Central
American and Caribbean states (UNO, 1987b). The
lowest reported death rates in 1985 were 3.8 in
Paraguay, 4.1 in Costa Rica and Panama, 4.0 in
Belize, and 4.6 in the Dominican Republic and
Venezuela. During 1960-85 the only countries
which experienced an increase in the death rate
were Cuba, Nicaragua, Puerto Rico, Suriname, and
Uruguay while, in considerable contrast, the death
rate more than halved in Chile, Ecuador, French
Guiana, Mexico, St. Lucia, and St. Vincent. As
mortality has continued to fall, since the early
1960s the natural increase rate has declined only
modestly despite the falls in fertility (UNO, 1979;
1987a).
Of great interest for the theme of this
conference, however, is the fact that the decrease
in fertility has brought about the first signs of a
radical shift in the age structure of the region's
population. As in several nations of Southeast Asia,







Table 1
Estimated and Projected 60+ Years Population and
Annual Rates of Change: Latin America 1980, 2000 and 2025


Nation Estimate or Projection Population Average Annual Growth Rate
(thousands)
1980 2000 2025 1980-2000 2000-2025
000o % ooos % OOos % % %



Caribbean 2391 7.8 3701 8.5 80921 3.1 2.2 3.2
Barbados 33 2.5 34 0.6 82 1.5 0.1 3.6
Cuba 1016 10.4 1520 13.0 2752 0.3 2.0 2.4
Dominican Rep. 260 4.4 526 5.6 1515 10.4 3.6 4.3
Guadelope 31 9.4 46 13.0 87 1.1 2.0 2.6
Haiti 323 5.6 478 4.8 1025 5.6 2.0 3.1
Jamaica 192 8.8 247 8.6 551 14.6 1.3 3.3
Martinique 32 9.8 46 2.7 82 9.1 1.8 2.3
Puerto Rico 326 8.9 537 10.1 1321 20.4 2.5 3.7
Trinidad and Tbgo. 88 7.5 146 9.8 358 20.0 2.6 3.7
Windward Islandsa 30 7.3 28 5.3 96 2.9 -0.3 5.0
Other Caribbeanb 61 7.6 93 8.1 224 14.7 2.1 3.6

Central Americac 4684 5.1 8866 5.7 23431 9.6 3.2 4.0
Costa Rica 124 5.6 251 7.4 683 14.0 3.6 4.1
El Salvador 245 5.1 485 5.6 1276 8.5 3.4 3.9
Guatemala 326 4.5 734 5.8 1899 8.7 4.1 3.9
Honduras 163 4.4 347 5.0 906 6.8 3.9 3.9
Mexico 3590 5.1 6615 5.7 17512 10.1 3.1 4.0
Nicaragua 106 3.9 194 3.8 595 6.1 3.1 4.6
Panama 122 6.4 224 7.9 530 13.5 3.1 3.5

Temperate S.A.d 4768 11.6 6886 13.3 10542 17.0 1.9 1.7
Argentina 3437 12.7 4857 14.6 6818 17.4 1.7 1.4
Chile 899 8.1 1471 9.9 3038 16.2 2.5 2.9
Uruguay 432 14.8 557 16.1 685 16.7- 1.3 0.8

Tropical S.A.e 11484 5.8 21537 6.8 51253 10.3 3.2 3.5
Bolivia 290 5.2 489 5.0 1077 5.5 2.6 3.2
Brazil 7464 6.1 13995 7.5 31816 10.9 3.2 3.3
Colombia 1433 5.6 2589 6.8 6606 12.8 3.0 3.9
Ecuador 424 5.3 779 5.3 1935 7.5 3.1 3.7
Guyana 52 5.9 87 7.0 256 15.8 2.6 4.4
Paraguay 171 5.4 303 5.6 810 9.5 2.9 4.0
Peru 925 5.2 1693 5.5 4167 7.4 3.1 4.6
Suriname 22 5.7 34 4.9 81 7.4 2.2 3.5
Venesuela 698 4.5 1564 5.7 4494 10.5 4.1 4.3

Latin America 23328 6.4 40990 7.2 93317 10.8 2.9 3.3

Source: UNO (1985) The World A n Situation Tables 31 and 33.
Notes: a Including Dominica, Grenada, Saint Lucia, Saint Vincent and the Grenadines.
b Including Anguilla, Antigua and Barbuda, Bahamas, British Virgin Islands, Cayman Islands, Montserrat,
Netherlands Antilles, Saint Christopher and Nevis, Turks and Caicos Islands, and United States Virgin
Islands.
c Including Belise.
d Including Falkland Islands.
e Including French Guiana.







where social and economic change is as rapid as in
Latin America, there is increasing awareness that
population aging will be an important issue. It can
truly be said that population aging is now
recognized as a worldwide phenomenon that
commands immediate attention if effective societal
responses are to be made to changing demographic
realities (Myers, 1985). For many countries in
Latin America, since 1960 the population aged 65
or more years has been increasing annually at rates
of 2.5-3.5% significantly above the level of the
general populations (UNO, 1986). The contrasts
have been particularly strong in Argentina, Cuba,
Uruguay, and Venezuela.


Awareness of Aging Issues

Neither governments nor scholars have been
unaware of the imminence or implications of
accelerated aging in Latin America. Gerontological
awareness has spread from both North America and
from the temperate-latitude republics which for
some decades have had lower birth rates and above
average elderly shares. At the beginning of this
decade, an anthropological review cited around 80
relevant academic papers (Finley, 1981), and since
the 1982 World Assembly on Aging, policy
discussions and innovation have proliferated. But
if consciousness of the aging process has become
widespread, few would argue that the present level
of knowledge is any more the minimal (UNO,
1986).
One result of the World Assembly on Aging
has been the collation by the United Nations of a
large number of individual country reports in a
valuable report, The World Aging Situation (UNO,
1985). Section VI on "Aging trends and policies in
Lat-in America" begins by emphasizing the
youthfulness and unusually high level of
urbanization of the region's population. It reports
that the U.N. medium-variant population
projections suggest that the 60+ years population
will increase from 6.4% in 1980 to 10.8% by 2025.
The increase by the end of this century is modest
(7.2%) but as seen in Table 1, the variation among
Latin American countries will be very high indeed.
More aged populations are forecast in temperate
latitude republics, several Caribbean nations, Costa
Rica, Panama, and Brazil. On the other hand, in
Haiti, Honduras, Nicaragua, Bolivia, and Suriname,
it will remain the case that only 5% or less of the
population will be aged 60 years or more.
United Nations demographers are projecting an
acceleration of aging early in the next century.
They also suggest a convergence of the national
rates of increase of their elderly populations
towards the continental figure. These projections
are a function of the adopted assumptions


concerning the trends in fertility and mortality in
the first decades of the 21st century, but the
principal message is clear: If recent fertility and
mortality declines continue, the next few decades
will witness increasing growth rates of the elderly
population and of the share that the age group
forms of the total.

Conclusion

The pace and process of aging will be different
in each country and in their various regions. The
societal impacts and the practical implications for
elderly people and their families in different parts
of Latin America will reflect specific national
economic, technological, cultural, and political
conditions. We are only at the beginning of
understanding the impacts of aging in the region.
The demographic evidence is no more than a
backcloth to the applied social agenda and our
present ignorance is the principal justification for
the initiative of the University of Florida in
organizing this conference.

Acknowledgements
Research leading towards this paper has been supported
generously by The Simon Population Trust. The data compiled
here are part of the materials for the production of age structure
projections which is the principal objective of the research. We
are grateful to-the staff of the British Library of Political and
Economic Science, the Institute of Latin American Studies of the
University of London, and the Office of Population Censuses and
Surveys for assistance in tracing population data.

References
Coale, A.J. & Demeny, P. Regional life tables and stable
populations. Princeton, N.J.: Princeton University Press,
1966.
Finley, G.E. Aging in Latin America. Spanish-Language
Psychology. 1981, 223-248.
Myers, G.C. Aging and worldwide population change. In R. H.
Binstock and E. Shanas (Eds.), Handbook of going and the'
social sciences (2nd ed.). New York: Van Nostrand Reinhold,
1985.
Sanches-Albornos, M. & Moreno, J.L. La poblaci6n de America
Latina: Bosquejo hist6rico. Buenos Aires: Editorial Paid6s,
1968.
United Nations Organisation, Department of International
Economic and Social Affairs (UNO, DIESA). Demographic
yearbook 1978. New York, 1979.
UNO, DIESA. Population and vital statistics report 1984. Special
supplement. New York: Author, 1984.
UNO, DIESA. The world aing situation: Strategies and policies.
New York: Author, 1985.
UNO, DIESA. Periodical on agint 1985. New York, 1986a.
UNO, DIESA. World population prospects. New York, 1986b.
UNO, DIESA. Demographic yearbook 1985. New York, 1987a.
UNO, DIESA. Population and vital statistics report Series A, Vol.
39 (3). New York, 1987b.








REGIONAL PROGRAM ON THE HEALTH OF THE ELDERLY:
CURRENT SITUATION AND PERSPECTIVES


Elfas Anzola-Perez
Washington, D.C., U.S.A.


Abstract

The paper gives an overview of the situation of
the elderly in Latin America; the perspectives for
some of the national programs; the actions, policies,
and strategies that are proposed for the Pan
American Health Organization (PAHO) Regional
Program. Some of these strategies include
mobilization of national and external resources;
exchange and dissemination of technical
information; development of national standards.
plans, and policies; training; research promotion;
and direct technical cooperation. Given the passive
nature of most of the health and social services
provided for the elderly in Latin America. PAHO's
proposed Care Model follows a comprehensive
primary health care strategy that entails (a) medical
and social surveillance. (b) care for specific
conditions, and (c) health promotion. Two current
programs based on this tripartite model are
described.
The author concludes that the medical,
sociopsychological, and administrative problems
affecting the health and well-being of the elderly
are considerable and that their magnitude and
importance will increase over the next forty years.
Thus the task ahead is to work towards changing
these adverse conditions.

Introduction

The general development process among most
of the peoples of the world during recent years has
been translated into significant changes in various
aspects of human life. One illustrative change is in
the demographic field, where the outstanding
phenomenon has been the expansion of the age
group that includes those 60 years and over.
In the case of Latin America and the
Caribbean, for 1980 this population was estimated
by the United Nations Population Division at 23.3
million, with an expected total of 40.9 million by
the year 2000 and 93.3 million by 2025,
corresponding to 6.4%, 7.2%, and 10.8% of the total
population, respectively. In addition, life
expectancy at birth is expected to increase in Latin
America from 51.2 years during the period 1950-
1955 to 71.8 years during the period 2020-2025, an
increase of 20.6 years over this 75-year period.
Observation of the trends in the two other


functional age groups (0-14 and 15-59) aids in
interpreting the demographic changes. Thus, the
0-14 age group will decrease from 39.8% of the
population in 1980 to 34.7% in the year 2000 and
29.0% in 2025, while for the group 15-59 years of
age these percentages will be 53.8, 58.1, and 60.2%,
respectively. At the same time, the gross birth rate
will decline from 32.3/1000 for the period 1980-
1985 to 21.6 for the period 2000-2025.
The four subregions marking the traditional
subdivisions of Latin America -- namely the
Caribbean, Central America, Temperate South
America, and Tropical South America, show
variations: The first and the third have older
populations, while in the second and fourth the
populations are much younger. These population
figures indicate the huge task that Latin America
has of providing social and health services to
elderly persons.


Impact of the Aging Population on
the Health Sector

The elderly are, in general, less healthy than
the younger members of a society and use the
health services more. The growth of the elderly
population is creating a need for more health
resources as well as better use of existing ones. At
present statistically reliable data on morbidity and
disability are not available to make it possible to
estimate the health situation of the elderly in Latin
America; the available mortality statistics usually
reflect only the terminal diseases.
Regarding the health of the elderly in Latin
America, certain data stand out:
1. A health survey conducted in 1979 by the
National University of Costa Rica (Parrish &
Tapia-Videla, 1980) yielded the following results:
85.3% cited visual problems, 66.1% arthritis or
rheumatism, and 38.2% arterial hypertension. For
the total sample, 6.7% stated themselves to be in
"very good health," 25.9% in "good health," and
46.5% in "fair" health (total: 79.1%).
2. In a survey carried out in 1980 on a sample
of the urban and intermediate population of four
states in Mexico, the level of physical functioning
was high: more than 90% of the 2,000 elderly
persons interviewed could carry out the activities of
daily living independently at home (Alvarez-







Gutierrez & Brown, 1983).
3. A 1984 survey of nine municipalities in
Cuba (Ministerio de Salud, 1984) revealed that
86.7% of the elderly carried out their daily
activities without assistance, 77.1% were under their
family's care, 4.9% were dependent on care given
by the community, and 17.9% were able to manage
on their own.

Continuum of Services

The organization of services for the elderly is
founded on the basic principle of the "continuum
of services." Differences in needs translate into
demands for specific services, customarily classified
as: (a) services for the relatively healthy elderly;
(b) services providing alternatives to
institutionalization; and (c) services for those who
may require institutional care or its equivalent.
There is a consensus that institutionalization of the
elderly person should be avoided wherever possible,
and that the use of family and community should
be promoted as more humanitarian and effective
alternatives.
Interest in the development of services for the
elderly in Latin America has been limited, with
policies, programs, and services for the elderly
receiving low priority. Recently politicians and
administrators in the health and social security
systems of some countries in Latin America, faced
with strong pressures due to changes in the
distribution of the population and the evidence that
high numbers of elderly can end up affecting the
functioning of these systems, have initiated actions
for pulling together more coherent policy and
program planning.
The gap between the needs of the elderly and
the availability of the services required results from
historical, ideological, social, economic, and
organizational factors that over time have
influenced the general processes of political
decision-making. The problems faced by the
elderly have been darkened by the predominant
demographic trends. The age distribution in the
countries of Latin America has underscored the
importance of the younger groups -- which, in
1980, constituted almost 40% of the population.
Decisions on the allocation of resources have been
aimed at meeting the demands of this group.
Health actions have concentrated on the mother-
child binome and on the prevention and control of
infectious and communicable diseases. Persons with
illnesses that are chronic or require long-term care
have remained under the care of their families or
in custodial institutions, with minimum access to
professional services or treatment. The asylums and
homes for the elderly that exist are examples.
Neglect of the elderly has been accentuated by
negative images of aging and the elderly. This bias


against old age tends to be more common in
societies with higher levels of industrialization and
urbanization.
In those countries that recognize the
importance of the problems of the elderly, attempts
to formulate policies have been affected by those
who question the economic rationality of measures
that assign resources to solving the problems of a
non-productive minority. This phenomenon has
had a special impact in the areas of social security
policy (for example, pension systems) and health
policy (for example, access to health services). The
biases and stereotypes concerning aging and the
elderly have resulted in a relative lack of support
for research, education, and training, in
gerontology and geriatrics.

Regional Program of the Pan American Health
Organization (PAHO)

The PAHO Regional Program on the Health of
the Elderly originated in 1983. PAHO's aims are:
(a) to achieve a reduction in threats to health
(diseases, conditions, and disabilities); and (b) to
improve the quality of life among the elderly,
reaffirming their role as contributors to the
collective well-being. The Regional Program
strongly encourages keeping the elderly person
within the family environment, except when special
physical, mental, or social conditions make
alternatives desirable.
A prerequisite to providing assistance where
needed is a reliable database. Following the
recommendations of the World Assembly on Aging
sponsored by the United Nations, the system to
which PAHO belongs, a General Plan for the
Comprehensive Care of the Elderly was prepared.
The plan encourages the countries to study the
conditions of the population 60 years of age and
over, particularly from an epidemiological
perspective, through the collection and analysis of
existing information and the promotion of studies
permitting the acquisition of reliable data for the
subsequent formulation of plans, policies, and
programs.
The specific objectives of the Regional
Program are aimed at developing coherent programs
in the countries. National elderly programs should
be integrated into the general health services and
should be closely linked with the other sectoral
programs that are concerned with the well-being of
this population group.
To achieve these objectives the Regional
Program's strategies are concentrated on actions in
the following priority areas:
1. Promoting in the countries an awareness of
the existence of a growing group of elderly who
have unmet needs and untapped potential,
underscoring the growth that this group will sustain







in the coming years.
2. Stimulating research, both clinical and
epidemiological, to provide an adequate basis for
meeting the demand for increased care in this
group.
3. Supporting technical information
dissemination and personnel training.
4. Supplying information and orientation, at
the level of policy-makers, on the importance of
this age group, its needs, and its capacity to
contribute.
5. Encouraging technical cooperation between
countries.
The Regional Program envisages a series of
general or regional activities, subregional or
intercountry activities, and others aimed at
supporting specific country projects. Priority areas
are described next.

Mobilization of National Resources

This element in the technical cooperation
process is aimed at identifying persons, institutions,
or governmental and nongovernmental groups in the
countries which can be used to establish formal or
informal connections. These networks will modify
the existing situations (organization, information,
intervention, etc.); help clarify the causes of
imbalance (preparation of programs, support for
research, etc.); contribute solutions in the area of
personnel training (support for training, etc.).
National groups and institutions have been
identified in Argentina, Barbados, Brazil, Chile,
Colombia, Costa Rica, Cuba, Ecuador, El Salvador,
Guatemala, Guyana, Honduras, Jamaica, Mexico,
Panama, Paraguay, Peru, the Dominican Republic,
Trinidad and Tobago, Uruguay, and Venezuela.

Exchange and Dissemination of Information

Dissemination of technical information is one
of the most deficient areas of the gerontological
field in Latin America. The distribution of
gerontological publications by the Program has
these objectives: (a) to disseminate world
literature on gerontology, and (b) to collect and
disseminate bibliographical contributions produced
in the developing countries of the Region as an
expeditious means of identifying the problems
related to elderly life, activities, and services.
The Program has established a data base, called
"Gerontology Update," from which two volumes
have already been published. The documentation
is selected and indexed at Headquarters in
Washington, D.C., and published in the standard
form for annotated bibliographies. Each document
is photographed on microfiche. Microfiches are
sent at no cost to some 15 gerontological
information centers with which the Regional


Program has signed agreements. The hard-copy
publication of each volume of "Gerontology
Update" is sent, again at no cost, to some 400 users
in Latin American and the Caribbean and to some
200 recipients in other regions of the world.
Beginning with the second volume, a thesaurus of
social gerontology has been prepared which, due to
its holistic conception and its modular structure,
will remain in effect for the next ten years. In the
second volume of "Gerontology Update", 40% of
the documents comes from the Latin American
countries, in contrast to 10% in the first volume.
Currently work is being done on abstracts of
material for the third volume.

National Standards. Plans, and Policies

PAHO, with the support of the International
Program on Aging of the Kellogg Foundation,
organized a meeting in 1984 in Washington, D.C.,
on health policies for the elderly. The meeting was
attended by delegates from the countries
participating in the Needs of the Elderly Survey
sponsored by the Organization in 13 countries,
together with health experts from 15 countries of
Latin America, the Caribbean, North America, and
Europe. The major emphasis of this meeting was
on: (a) discussion of alternatives to
institutionalization for care of the elderly person;
(b) the role of community, family, and elderly
persons themselves in the programs; and (c) the
consequences of the growth of this group, which
make it imperative to establish effective policies.
Subsequently there were two seminars in Latin
America: the first in Buenos Aires (October 1985),
with the participation of Argentina, Chile, and
Uruguay, and the second in San Jose (November
1985), with the participation of Costa Rica, El
Salvador, and Honduras. Delegates analyzed the
current situation for each country and discussed
plans, policies, and programs for the elderly,
including the role of the international organizations
and nongovernmental associations.
The Program published a document containing
guidelines for the development of national
standards, plans, and policies for the elderly,
pursuant to the Vienna International Plan of Action
on Aging. This document includes: (a)
consideration of the aspects of present public policy
relating to old age; (b) standardization of the
indicators for measuring the current level of well-
being among the elderly; (c) organization of
"desired" and "possible" models of care; and (d)
models for program evaluation.
As a result of a 1985 technical advisory visit to
Spain by the WHO Global Program on Care of the
Elderly and its Regional Offices for Europe and
America, a seminar on Primary Health Care was
held in Madrid in October 1987. Representatives







came from the Spanish central government, national
societies, 11 of the 17 autonomous communities,
and Portugal, in addition to delegates from
Argentina, Brazil, Costa Rica, and Venezuela. This
productive gathering served as a forum for the
review of common and differing aspects of the
situation and for the exploration of mutual
cooperation between Spain and the Latin American
countries.

Training

Taking into account the scarcity in Latin
America of formal courses of instruction on
gerontology and geriatrics, PAHO drew up a plan
for a "Regional Course on Gerontology, Geriatrics,
and Administration of Services for the Elderly," in
consultation with a group of four experts from
Latin America. The course was conceived in
modular form (one week for each topic included in
the title) and geared to professionals from several
disciplines that are concerned with the elderly. In
November 1986, Course I was presented in
Argentina, under the auspices of PAHO with
coordination by the National Institute of Social
Services for Retirees and Pensioners and the
cooperation of the Rocca Institute of Geriatrics of
the Italian Hospital of Buenos Aires. The 15
participants came from 8 countries. The group
included 12 physicians, one sociologist, one
psychologist, and one social worker. In mid-1987
it was confirmed that two out of nine participants
from seven countries had been appointed to direct
national programs for the elderly (Paraguay and
Uruguay) while the others were asked to prepare
similar national courses (Mexico) or were involved
in formal training, services, and research (Brazil,
Dominican Republic, and Chile).
At the end of 1987, also in Buenos Aires,
Course II was held with the participation of 23
professionals from 11 countries. Significant aspects
of this course were: (a) the proportion of
nonmedical professionals was high, 43.5%; and (b)
there was representation from the social security
institutes.
Regional Course III may be an itinerant
activity: the major themes would be selected for
presentation over 8-10 consecutive days. Using
national and outside educators, the course would be
given in two or three countries. One or two
additional days would be used for direct advisory
services to the country visited by the educators
from the Course.
Around the end of 1988 PAHO will hold, in
Maracaibo, Venezuela, a workshop on the Teaching
and Practice of Gerontological Nursing in Latin
America, the outcome of which will be studied
carefully before the topic is dealt with more fully
(OPS, 1988).


Research Promotion

Needs of the Elderly Survey (NES)
In addition to being a source of findings for
characterizing the elderly in the participating
countries, the NES has been a promotional method
for engaging the attention of the Member
Governments in a nontraditional area. The NES is
being financed principally by the United Nations
Unit on Aging through its Trust Fund for the
promotion of epidemiological studies on aging in
the developing countries. The results of the NES
are expected to be a socio-medico profile of the
elderly (60 and over) including identification of
the groups whose needs make some degree of
medical or social intervention imperative. The goal
in each country is to keep most elderly at home,
thus enabling them to participate actively in the
life of the nation.
The NES currently involves participation by 13
countries of Latin America and the Caribbean, as
well as Puerto Rico and areas of Tampa and
Miami, Florida. In the latter two cities the NES
looks at the elderly of Hispanic origin.
During 1987 a statistical analysis was
completed on the data for Guyana, Trinidad and
Tobago, and Argentina. Preliminary reports are
being sent to the principal investigators for review.
This task had been completed in 1986 for Chile and
Costa Rica. In addition, work has been done on
the data from Barbados and Venezuela, but the
analyses are not concluded because of design
problems; work will be resumed when respective
situations are clarified. Cuba and El Salvador have
finalized data collection and data analysis is about
to begin. Colombia, Jamaica, and Honduras are in
different stages of the study and completion is
expected during 1988. Brazil is finalizing the
sample design phase.
In view of the difficulty that some of the
countries have had in finishing the survey PAHO
issued a publication containing the results from the
five countries mentioned at the beginning of this
discussion. In October 1987 a group of three
experts in the areas of elderly research, policy, and
services compiled a set of recommendations for
making the publication an instrument of easy
political assimilation in the countries.
Experts decided to produce two types of
publications. One will present the results of the
study, country by country, and will be geared to
researchers, scholars, and educators in the field of
aging. The other, directed toward planners,
politicians, and decision-making levels, will include
relevant highlights from the multinational study; its
structure and language will be more attractive and
direct.
Some results from the NES regarding family
support for the elderly were incorporated into a







monograph sponsored by the World Health
Organization. Also, the NES was identified by the
organizers of the XI Scientific Meeting of the
International Association of Epidemiology, held in
1987, as one of three models of cross-national
studies on aging. The methodology of the survey
was presented, together with some initial results.
There is no doubt that the NES has been a
powerful instrument in the dual mission of
permitting the acquisition of available and reliable
information on the elderly and awakening the
interest of governments, universities,
nongovernmental organizations, and individuals
with regard to the aging.

Study of the Prevalence of Dementia in Persons 60
and Over
This study attempts to obtain a first approximation
of the dimension of this problem in selected
developing countries and to identify the factors
associated with its origin and evolution in persons
60 years and over. The research envisages two
stages: a household screening phase for identifying
the elderly with intellectual impairments, and a
confirmation phase for establishing the cause of the
disorder. The screening phase will utilize the
Mini-Mental Mini-Examination (Folstein Folstein,
& Mchugh, 1978) adapted by PAHO to the Latin
American environment. The confirmation stage, to
be carried out by trained medical personnel, will
utilize a section of the Geriatric Mental
Examination developed by Copeland and associates
(1986), who have assisted PAHO in this research.
This is a community study; the principal objective
is to identify clinically and socially incipient cases
of dementia. The cities where this study is being
carried out (Buenos Aires, Havana, and Santiago de
Chile) have begun the first phase, using instruments
approved by PAHO.
In addition, in cooperation with the PAHO
Mental Health Program, terms have been agreed
upon for reviewing the status of psychogeriatrics in
selected countries of the Region. The tracking of
existing information on: (a) the epidemiology of
psycho-geriatrics, especially depression, dementia,
alcoholism, and suicide; (b) the existence of
programs; and (c) personnel training, will lead to a
report that should generate a plan of action for the
eventual preparation of a specific program.

Survey of Morbidity in the Elderly
This research, together with that on the prevalence
of dementia, would supplement NES results and
thus integrate a body of knowledge in a significant
number of countries of Latin America and the
Caribbean which would form the basis for the
establishment and development of comprehensive
and autochthonous programs of care for the
elderly. This research attempts to diagnose the


health of the population 60 years and over through
analysis of the data collected routinely in the
health establishments in three developing countries
of the Region: Argentina, Costa Rica, and Cuba.
The information will be obtained from the records
of hospital discharges and outpatient consultations.
Like the survey on dementia, the study on
morbidity is financed by PAHO.

The Pattern of Drug Consumption among the
Elderly
This innovative activity for Latin America
is aimed at producing a first approximation on this
delicate subject, about which the pharmacological,
economic, and ethical implications are little
understood in the developing areas of the Region.
The first test is being carried out in the Argentine
National Institute of Social Services for Retirees
and Pensioners, which has offered its information
to PAHO.
Based on 24 million prescriptions from the
entire country, divided into regions, the
distribution of the groups of prescribed drugs and
the resulting expenditures were determined. In
1988 the study on active pharmacological principles
began, utilizing the Drug Classification prepared by
PAHO.

Direct Technical Cooperation

Regular PAHO staff or short-term consultants
provide advisory services at the request of Member
Countries. This activity is more productive when
purposes and hypotheses are clearly stated, based on
previous studies. Principal advisory missions
during the past four years were made through the
Regional Adviser or PAHO short-term consultants.
Visits have been made to Argentina, Barbados,
Colombia, Costa Rica, Cuba, Chile, Guatemala,
Jamaica, Mexico, Puerto Rico, and Uruguay. Other
visits were related to specific meetings or research
coordinated by the Organization.
With regard to technical cooperation, it is
important to mention the agreement signed in 1986
by the Inter-American Development Bank with the
Government of Barbados for a pre-feasibility study
on the organization of geriatric and psychiatric
services on that island. PAHO was designated as
the coordinating agency for the study and was
responsible for selecting the consultants and
analyzing the results.

Organization of Services

With few exceptions, the health and social
services provided to the elderly in Latin America
are passive. Services are limited, for the most
part, to the restoration of lost health, the relief of
social condition, or confinement to a home for the






elderly. There is no generalized medical or social
surveillance; there are few individual, family, or
community provisions for counteracting the
psychological, physiological, work, or social
situations, etc. Such measures are well known to
the technicians in the countries but seldom applied.
On the other hand, the secular tradition of
concentrating on the younger population causes the
elderly to remain a low priority, with the problem
often discussed in terms of cost/benefit. This
argument not only ignores the contributions of
elderly people to the development of society, but
also underestimates what they might still be able
to offer.

Care Model
The Regional Program has devised a care model
consisting of three broad areas -- medical and
social surveillance, care for specific conditions, and
health promotion. Medical and social surveillance
should be carried out through periodic censuses of
the elderly population in a given geographical area
where there is a medical and social service
responsible for a particular group of families. This
activity is conceived as an initial medical and
social survey in which the primary care personnel
(community workers, health educators, etc.) make
a household visit and collect information on the
elderly person from the physical, mental, and
social points of view. This phase should be brief.
The information is then analyzed at the
subsequent level of care in the establishment
which, based on a scheme of risk criteria,
classifies this elderly population into two
categories: (a) those who present no medical or
social difficulties; and (b) those who present
medical and/or social risks that could upset their
vital balance if not corrected within a short time.
The responses of the medical and social facilities
must be consonant with the situations found. For
the elderly person classified in category (a), the
actions would center on education and health
promotion; for those in group (b), there should be a
review of cases by more qualified personnel to
confirm or deny the first impression of the primary
health worker, with a determination of the best
medical and social action to be taken if a successful
outcome is to be ensured.
The model has the following characteristics:
(a) it is based on the primary health care strategy,
thus ensuring that care is given via a system
organized according to levels of increasing
complexity; (b) it is based on the criterion of
"active case-finding" in the community instead of
waiting passively for the patients to appear at the
health facility in worse condition; (c) it uses
short-term diagnosis of a situation which is possible
because of the dynamic nature of the initial survey
(average duration, 15 minutes) and updating is


facilitated through periodic medical and social
reviews of the elderly already classified and initial
visits for those who are just turning 60; (d) it
facilitates the expansion of coverage of the target
population and gives access to the criteria of
opportunity, efficiency, and effectiveness; and, (e)
it facilitates health promotion efforts to cover the
most relevant topics in the community, thus
ensuring more concrete success than if aspects alien
to that environment were involved.
The model presented is being applied in
Gurabo, Puerto Rico (population 26,000) and in
Cuernavaca, Mexico (population 230,000). In the
first case the model is being managed by a family
practice team under auspices of the Gurabo
Municipality's Center for Diagnosis and Treatment;
preliminary results are very encouraging. In the
case of Cuernavaca, the responsible agency is the
National System for Integrated Development of the
Family with the Olga Tamayo Rest Home serving
as the facility responsible for the project and its
regular staff being responsible for professional
consultation and decision-making. The primary
care personnel are being financed by the city
mayor's office. The Hospital of the Mexican
Institute of Social Security in Cuernavaca provides
intermediate-level services.

Promotion of Health
There is a growing interest in the field of aging in
many Latin American countries. Among them:

Chile: In the Ministry of Health, a Division
of Adult Health (including Health of the Elderly)
has been created, and the director has made a visit
to observe the Program at PAHO. There is a
movement toward municipalizationn" of elderly
care. The School of Medicine, Southern Division,
of the University of Chile has published two issues
of its Cuadernos de Veiez y. Enveiecimiento
(Special Reports on Old Age and Aging), the first
devoted to dementia and the second to dental
problems.

Colombia: There have been advances in the
Geriatrics Section of the Ministry of Health. The
Institute of Latin American Educational
Development (IDEL) has been probing the subject
of the elderly through its informative journalistic
publications, while PROVIDA (a branch of
HelpAge International) continues the work it began
over ten years ago.

Venezuela: The recently formed Ministry of
the Family created a sectoral division on elderly
care. A private agency, Fundancianos, (Fund for
the Elderly) has just been set up to provide support
for this social group. The Francisco de Miranda
Experimental University in the city of Coro







continues to offer courses in Gerontological
Technology, and the School of Nursing at Zulia
University in Maracaibo continues with its
successful courses in Gerontological Nursing.

Costa Rica: Strides have been made in the
performance of the National Commission on Aging.
Recently, the Board of Social Welfare (which
handles the National Lottery) and the private
institutions for elderly care have joined the
National Commission on Aging. The National
Lottery has recently increased the amount it
designates to cover nursing home costs from 50%
to 75%. At the end of 1987 the Ministry of
Health created a Division of Elderly Health, and
the Social Security Institute offers periodical
training in the field of aging.

Uruguav: The Ministry of Health has created
a National Program for the Elderly whose chief is
also director of the principal geriatric hospital in
the country. This hospital's prior 900-bed capacity
has now been reduced to 450. The hospital has
created a system of "substitute" homes for the
elderly as a means of avoiding institutionalization.
The University Hospital continues its outpatient
geriatric consultation.

Paraguay: At the beginning of 1987 the
Ministry of Health created a Division of Care of
the Elderly Person. Its director participated in the
PAHO Regional Course I.

Brazil: The directorship of the National
Program for the Elderly was consolidated. This
agency is concerned with the 9 million elderly that
live in Brazil. There have been numerous activities
in the field of gerontology and geriatrics in Brazil,
including a course on the Epidemiology of Aging
(December 1987). The results of a survey of the
elderly conducted in Sao Paulo were recently
published.

Cuba: Cuba stands behind its political
pronouncement that it will adequately care for its
elderly. The previous scheme of providing out-
patient clinics for the population is being replaced
by the system of "one doctor for every 120
families," which is revitalizing the program for
elderly care. In the past two years there have been
courses on the epidemiology of aging, and notable
advances have been made in health promotion for
the elderly (cigarettes, alcohol, exercises, obesity).

Mobilization of External Resources

Since its inception the Regional Program has
maintained relations with a series of international
and nongovernmental agencies which share


knowledge among themselves and provide better
service for the peoples of Latin America. Mention
has already been made of the 1984 Seminar on
Health Policies for the Elderly, supported by the
Kellogg Foundation. In 1986 a Collaborative
Group of Non-Governmental and PAHO Agencies
was created. Its first activity was a meeting at
PAHO headquarters at which proposals from
Colombia, Chile, Mexico, Panama, Peru, and
Uruguay were discussed. An activity is
programmed to precede the International. Congress
on Gerontology (Mexico 1989).
In mid-1987 an agreement was signed between
PAHO and the American Association of Retired
Persons (AARP). An expert on the subject of
middle-aged and elderly women will review the
information available on this topic in Latin
America and the Caribbean, identify medical and
social areas that are of importance in
strengthening knowledge of this social group, and
prepare a tentative agenda for a meeting on the
subject to be held at PAHO headquarters at the end
of 1988.

EPILOGUE
This has been an attempt to give an overview of the
situation of the elderly in Latin America, the perspectives for some
of the national programs, and the actions, policies, and strategies
that are proposed for the PAHO Regional Program. We may
conclude that the medical, sociopsychological, and administrative
problems affecting the health and well-being of the elderly are
considerable and that their magnitude and importance will
increase over the next 40 years. The resources available are scarce
and the priority given to solving the present and future problems
is not as high as it should be. It is our commitment as
administrators, and our duty as human beings, to change these
adverse conditions.
Reference
Alvarez-Gutidrres, R., y Brown, M. J. Encuesta de las necesidades
de los ancianos en Mexico. Salud Piblica de Mxico. 1983, 1
(Enero-Febrero), 21-75.
Copeland, J.R.M., Dewey M.E., and Griffiths-Jones, H.M.A.
Computerized psychiatric system and case nomenclature for
elderly subjects: GMS and AGECAT. Psychological
Medicine 1986, 16, 89-99.
Folstein, M.F., Folstein, S.E. and Mchugh, P.R. "Mini-Mental
State." A practical method for grading the cognitive state of
patients for the clinician. J. Pschiat. Res.. 1978, 2, 189-198.
Ministerio de Salud de Cuba. Encuesta sobre el Modo de Vida de
los Ancianos. La Habana: Autor, 1984.
Organisaci6n Panamericana de la Salud. Informed final grupo de
trabajo sobre la Enseflansa y PrActica de la Enfermeria
Gerontol6gica en Am6rica Latina. Maracaibo, Venezuela 12-
15 septiembre 1988.
Parrish, C.J. and Tapia-Videla, J. Needs of the Costa Rican
elderly: A preliminary report. August 1980.
United Nations. Demographic indicators of countries: Estimates
and projections as assessed in 1980 (United Nations
publication, Sales No. E. 82. XIII. 5).








THE HEALTH PROFESSIONAL'S ROLE IN
SELF-HELP/SELF-CARE APPROACHES


Ewald Busse
Durham, N.C., U.S.A.


Abstract

Self-help and self-care refer to the first level
of health care. Self-reliant individuals and groups
meet their own basic health needs. This level of
health care can be improved through such means as
increasing public awareness, educating and
organizing the elderly, and providing training for
laypersons working with the aging population.
Trained resource persons can assist the elderly in
forming self-care groups.
Medical, socio-cultural, and individual factors
impact self-help and self-care among the elderly.
A multidisciplinary approach is appropriate in
planning and carrying out programs to provide
health education and training. Some existing
programs that could serve as models are described.
This conference could take important steps by
(a) identifying those health care situations that need
prompt attention; and (b) providing direction in
setting up programs of education and training.


Introduction

The terms self-care and self-help often seem
interchangeable. A recent review by Haug
illustrates the variation in usage. Frequently both
terms encompass disease prevention and health
maintenance, self-diagnosis and treatment, and the
decision to use both lay practitioner and
professional services (Coppard, 1984). Sometimes
self-care is restricted to health maintenance
activities such as adequate diet, rest, and disease
prevention. Self-care may be applied to
individuals; self-help seems to be the preferred
term to apply to groups. The basic concept of self-
participation may be expanded to include groups
formed by patients or families for mutual aid in
coping with the stress of an illness. These
associations are referred to as self-help groups.
Von Mering (Personal Communication, 17
February 1985) speaks of "self care" and "non-self
care". Self-care is an autonomous condition.
Individuals are primarily responsible for decisions
that affect their health. Non-self care involves a
"provider". Providers come from various
backgrounds, but may use the same techniques and
therapeutic plans. A provider may offer health
advice. Hence, responsibility is delegated. Varying


degrees of dependency characterize non-self-care.
Rather than self-care Kickbusch and Hatch (1983)
prefer to use the word self-help. For them, the
term includes both a new organizational type of
care and a rediscovery of old types of care.


Self-Help and Self-Care

Self-help and self-care continue to be the first
level of health care. This first level of health care
can be improved by arousing the interest of society,
by changing social attitudes, by advancing health
education, and by improving the techniques
available to a layperson.
A recent survey known as the "Health in
Detroit Study" (Raymond, 1988) confirms what
other studies have found: Many persons experience
symptoms and use a common-sense approach to
treating themselves. They do not seek professional
help and the vast majority recover promptly.
Common symptoms fall into the following
categories: respiratory, musculoskeletal, headaches,
digestive, sleep, and eye and ear complaints.

Chronic Conditions
Consistent with the observation that women seek
professional help more than men, the Detroit
survey found that women experience symptoms 1.5
iimes more than men. The survey also revealed
that people who seek help because of common
symptoms are more likely to consider themselves in
good health, which means healthy people are less
tolerant of health problems. Furthermore, it was
reported that musculoskeletal problems often arise
from chronic conditions and that daily variation or
flare-ups have little effect on the decision to seek
professional help. Many people, particularly those
with arthritis, apply a treatment routine every
single day whether symptoms are present or not.
Those over 65 are more likely to have chronic
conditions and maintain some sort of daily self-care
routine.

Dental Self-Care
Self-care that includes proper dental treatment and
oral hygiene will make contributions to preserving
the health and well-being of elderly people.
Epidemiological studies have demonstrated that in a
span of about 20 years, older Americans have






Moved from usually being without teeth (59%) to
retaining many of their natural teeth. This
remarkable shift in dental conditions is primarily
attributable to the addition of fluoride to
community water supplies (NIH, 1987). Many
adults are preserving their teeth by giving proper
attention to cleaning and flossing. Further, those
who are retaining their teeth not only have learned
good oral hygiene but are more likely to seek
dental services when a problem arises.

Social Factors
A recent Canadian study (Segall, 1987) indicated
that self-care healing practices are not limited to
older persons, but are practiced by all age-groups.
However, Woodward and Wallston (1987) found
that individuals over 60 years of age desire less
health-related information that is interpreted as a
loss of "control" of independence than do younger
adults. Apparently older adults are resistant to any
routinization in their day-to-day living. It appears
that those individuals who are most at risk for
chronic illnesses and hospitalization are most likely
to not take an active role in their health care.
According to Novak (1987) this negative attitude
can be altered by encouraging senior citizens to
join social and recreational clubs and then
introducing a self-help and education program as
part of the activities.
Social factors that influence compliance with a
treatment plan or the adherence to a self-care
program include family stability; social support and
family interests; and social integration i.e., friends,
social contacts (Haynes, 1986). These factors are
important at all ages, but are more likely to be
disrupted in the latter years. This finding may be
part of the reason why the Canadian studies linking
recreation clubs with self-care efforts proved to be
of value. Social interaction is a positive feature in
the lives of elderly persons.

Multidisciolinarv Aooroach to Self-Care
Self-care is based upon a multidisciplinary
approach. Risk factors in the environment have
been identified as well as sources of social stress.
Individual autonomy and the maintenance of self-
esteem contribute to the mental and physical health
of many persons. Socioeconomic changes impact
the quality of life. Medical science, both basic and
applied, demonstrates that many diseases are of
multiple etiology. An increasing number of
diseases or physical defects can be traced in part to
a genetic defect. This genetic defect puts the
individual at risk. The actual disease or disability
can be triggered by some event stemming from the
social or physical environment. Individuals at-risk
can avoid experiences or events that could result in
disease and disability. Education teaches people to
recognize risk factors. Smoking tobacco, consuming


alcohol, and excessive obesity are risk factors that
can be best controlled by the individual. The
recent AIDS epidemic reinforces the idea that
certain behavior and controls must be exercised to
preserve health.

Self-Help Groups
Self-help groups provide support and education.
Membership in a self-help group contributes to
motivation and to appreciation of the need to
constantly pay attention to control of behavior
related to health. Self-help groups are greatly
enhanced by the availability of a resource person,
often a health care worker. Effective resource
persons understand the limits of their contributions.
They rarely influence the structure or operating
procedures of such a group.


Dissemination of Information

Numerous commentators say that self-health
care is a new concept. However, many self-reliant
individuals, families, and communities have
functioned well. They have maintained their own
health and well-being. They are capable of taking
care of many acute illnesses and understand the
techniques of reducing the disability of chronic
illnesses. Rapid, increased communication has
added to the self-reliance of many such isolated
groups as they receive considerable information
through publications, the radio, and television.
Health education projects are appearing in
many countries in Central and South America.
Among the better known are the efforts in
Colombia and Honduras. A recent report indicates
there are now 50,000 trained health monitors in
Colombia. Although these health monitors are
primarily trained in maternal/child health, they are
also equipped with supplies for oral rehydration
therapy (ORT). ORT has reduced mortality in
children from diarrheal dehydration. (UNICEF,
1988a; 1988b).
The UNICEF project to achieve universal
immunization by 1990 is moving ahead. The target
is to immunize the great majority of children
against six main diseases: measles, whooping
cough, tetanus, small pox, polio, and dyptheria.
Although these efforts of health monitors and of
UNICEF do not directly affect the elderly,
indirectly they do, as elderly people learn that there
are methods of improving health.
Currently in the United States there is a
program to reduce preventable disease and death by
the dissemination of knowledge through schools,
the mass media, and other information channels.
The program includes objectives such as increasing
the percentage of adults who are aware of the
principal risk factors for coronary heart disease and






stroke. The target is 50% of the adult population.
The aims are: to reduce the number of those
smoking or overweight; to be aware of dietary
factors that influence health; to promote exercise;
to reduce use of dangerous drugs and alcohol; to
promote immunization for babies; to promote
breast-feeding of infants; to educate children and
adults about sexually-transmitted diseases; and to
make certain that all citizens have a knowledge of
contraceptive methods (UNICEF, 1988c). The
National Institute on Aging disseminates self-health
care information. "Help Yourself to Good Health"
is a collection of more than thirty papers.
This conference could accomplish a great deal,
first by identifying those health care measures that
deserve prompt attention. Second, programs to
educate aging persons so that they can achieve an
improved degree of health could be set up.
Programs already in place that serve the young
could be models, and in some instances, provide
bases for education of the aging who will benefit
from understanding and practicing self-care.

References

Coppard L: Self health/care and older people: A manual for
public policy and programme development. Copenhagen:


WHO,1984.
Haynes R.B. Physician interventions to improve compliance.
Geriatric Consultant 1986, July/Aug, 20-29.
Kickbusch, I. and Hatch, S. Re-orientation of health care. In
WHO (Ed.), Self help and health in Europe Copenhagen:
WHO, 1983.
National Institutes of Health. Conquering tooth decay. Advances
in Health. 1987.
Novak, M. The Canadian new horizons program. The
Gerontologist, 1987, 27(3), 353-355.
Raymond, C.A. Survey adds evidence that office visits indicate
"Just tip of the iceberg" of medical problems. JAMA. 1988,
259 ), 647-648.
Segall, A. Age differences in lay conceptions of health and self-
care responses to illness. Canadian Journal on Aging 1987;
6(1), 47-65.
UNICEF. ORT: A progress report. In UNICEF (Ed.), The state
of the world's children.. New York; Author, 1988a.
UNICEF. Colombia pupil power. In UNICEF (Ed.), The state of
the world's children. New York: Author, 1988b.
UNICEF. The United States: Knowledge for health. In UNICEF
(Ed.), The state of the world's children. New York: Author,
1988c.
Woodward, N.J., & Wallston, B.S. Age and health-care beliefs:
self efficacy as a mediator of low desire for control. Psychology
and Aging, 1987; 2(1), 3-8.













Part II: Demographic and
Epidemiological Aspects of Aging



4 Demographic and Epidemiological Aspects of
Aging in the Commonwealth Caribbean:
Implications for Service Delivery
by Farley Brathwaite (Barbados)

5 La Minusvalla en la Poblacidn Guatemalteca de
65 Anos y Mas
by Jorge Arias de Blois (Guatemala)

6 La Migracion y la Problematica de la Tercera
Edad en el Perd
by Marfa Isabel Hurtado de Pulcha (Peru)











DEMOGRAPHIC AND EPIDEMIOLOGICAL ASPECTS OF AGING IN
THE COMMONWEALTH CARIBBEAN: IMPLICATIONS FOR SERVICE
DELIVERY
Farley Brathwaite
Cave Hill, Barbados


Abstract

This paper examines the implications of
demographic and epidemiological aspects of aging
for the care of the elderly, in the Commonwealth
Caribbean. Increases in the elderly population stem
from declining mortality, increasing life expectancy,
declining fertility, and heavy out-migration of the
younger population.
The concept of caring for the elderly has three
domains. The first concerns program development
and actual service delivery. A second dimension
includes social, economic, and psychological aspects
of elderly care. The third domain deals with the
process by which decisions are made about whether
care will be provided institutionally, or within the
family and community, or as a combination of
these.
Several program needs relating to the three
domains are addressed. These include upgraded
income maintenance, housing, nutrition, counseling.
labor market participation, and wage protection.
Even if these programs become reality, utilization
may be adversely affected by the independence and
privacy desire of the aging themselves.


Introduction

This paper examines the implications of
demographic and epidemiological aspects of aging
for the care of the elderly in the Commonwealth
Caribbean. The paper consists of four parts: (a) an
outline of major demographic trends in aging; (b)
data on economic and social conditions among the
elderly; (c) a review of the research findings on
social attitudes towards the elderly; and (d) an
examination of the implications of all the above for
the care of the elderly.
In this paper persons 65 and over are termed
old or elderly. The Commonwealth Caribbean
refers to those English-speaking nations in the
Caribbean from the Bahamas in the north, to
Guyana in the south. These countries are
characterized by considerable cultural and
demographic diversity.
Gerontological research in the Commonwealth
Caribbean is sparse. Where research findings exist
they are --except for the demographic data-- piece
meal and scattered. This situation together with the


cultural diversity of the region poses a
methodological problem, namely, we are attempting
to pull together scarce, scattered information for a
region of great demographic and cultural diversity.
We therefore view the study as exploratory.


Demographic Characteristics

The main sources of demographic data on the
elderly in the Commonwealth Caribbean are the
decennial censuses which provide a fairly
comprehensive profile. According to data from the
1960, 1970, and 1980 censuses, the population of
the region increased from 3,714,432 in 1960 to
5,048,654 in 1980 with projections of 9,087,000 by
the year 2000 (PAHO, 1980). The elderly
population increased from 158,219 in 1960, to
310,267 in 1980, with projections of 1,223,000 by
the year 2000 (PAHO, 1980).
A clearer picture of trends in the growth of
elderly populations can be gleaned when viewed in
proportionate terms. In 1960 people 65 and over
represented 4.3% of the total population; this grew
to 5.1% in 1970, and stood at approximately 6.2%
in 1980. By the year 2000, PAHO (1980) projects a
7.2 figure.
The profile of the elderly population of the
Commonwealth Caribbean reflects .fairly rapid
growth both in numbers and proportions, when
compared to trends in industrialized and Third
World nations (Binstock, 1982). These trends relate
to increasing life expectancy and greater longevity,
declining death rates, declining fertility rates, and
high rates of outward geographic migration during
the 1950s and 1960s.
Barbados, where the elderly population
increased from 6.4 in 1960 to 10.5% in 1980, with
projections of 15% by the year 2000, is a case in
point. Between 1940 and 1980 death rates in
Barbados declined from 26.7/1000 to 8.6/1000.
(Reports 1940; 1980) Life expectancy between
1921 and 1965 rose from 28.5 to 65.5 years for
males, and from 32.9 to 70.9 years for females
(Massiah, 1981). Fertility rates declined from
29.2/1000 in 1940,. to 16.4/1000 in 1980 (Reports,
1940; 1980). Finally, migration statistics (Ebanks,
1975) indicate that between 1951 and 1970 there
was a net loss of 32,600 persons, most of them
young. The declining mortality, increasing life







expectancy, declining fertility, and heavy outward
migration of the young all contribute to the
increasing proportions of old people.
There are cross-country variations in the
proportion of elderly. In 1980 Montserrat,
Dominica, Barbados, St. Kitts and Nevis, Jamaica,
Turks and Caicos Islands, and Grenada had elderly
populations above the regional average. Yet, the
British Virgin Islands, St. Vincent, St. Lucia,
Trinidad and Tobago, Belize, Guyana, and the
Bahamas fell below the regional average.
Another feature of the elderly population in
the Commonwealth Caribbean is that while cross
national data (Binstock, 1982) show 3.9% of the
Third World population, 5.8% of the total world
population, and 11.4% of the population in the
industrialized world classified as elderly in 1980,
out of 17 Commonwealth Caribbean countries 6
exceeded the world average, 13 exceeded the
average for the developed world, and 4 were in line
with the urban industrial world.
With respect to the internal age structure of the
elderly population, Table 1 shows that the
proportion of persons aged 75-84 increased from
1970 to 1980, suggesting an aging of the elderly
population. At the upward limit, the proportion of
those in the 85+ group decreased over the same
period.

Table 1
Age Distributions of Elderly Populations in the
Commonwealth Caribbean 1970-1980


1970 1980

65-74 75-84 85+ 65-74 75-84 85+

Barbados 68.7 24.4 6.8
Guyana 71.9 22.0 6.1 68.4 26.6 5.0
Jamaica 65.3 25.7 9.0 62.1 29.6 -8.3
Trinidad
& Tobago 74.2 18.3 7.5 61.2 26.9 11.9
Dominica 62.8 27.2 10.0 62.3 28.6 -9.1
Grenada 62.3 27.6 10.2 61.0 28.8 10.2
St. Lucia 58.8 28.5 12.7 60.2 28.5 11.3
St. Vincent 63.6 27.1 9.3 62.8 29.3 7.9
Montserrat 37.8 55.3 6.9 59.6 30.6 9.8
St. Kitts 66.4 25.5 8.1 64.8 28.6 6.6
Belise 65.4 26.1 8.5 64.2 28.6 7.5
Bermuda 68.6 30.6 3.7
Bahamas 69.2 24.8 6.0
Cayman Is. 60.3 30.6 9.1
Turks &
Caicos Is. 60.1 30.3 9.6 66.2 27.6 6.2
B.V.I. 62.0 31.3 6.7 61.3 29.2 9.5

Source: Population Censuses of 1960, 1970, and 1980.


Regarding sex differences (with the exception
of the Turks and Caicos Islands, and Grenada)
females account for the larger proportion of old
people. The greatest sex variations in 1980 were in
Barbados (60.1% males vs. 39.9% female), St.
Vincent (59.6% vs 40.4%), and St. Kitts and Nevis
(59.5% vs 40.5%).
As for education, Table 2 illustrates that the
proportions of old people exposed to post-primary
education increased over time. However, throughout
the Commonwealth Caribbean only small
proportions of the elderly have been educated
beyond the primary level.

Table 2
Percentage of the Elderly in the Commonwealth Caribbean
with Post Primary Levels of Education 1970-1980

1970 1980

Barbados
Guyana -6.4
Jamaica 4.4
Trinidad & Tobago 2.4
Dominica 3.4 5.6
Grenada 5.8 5.3
St. Lucia 3.6 3.8
St. Vincent 3.2
Antigua
Montserrat 4.2
St. Kitts 6.9 5.8
Belise 4.5 6.1
Bermuda 42.4*
Bahamas
Cayman Islands 8.6
Turks & Caicos Islands 4.1 5.9
B.V.I. 4.8 9.7

Source: Decennial Censuses

An increasing trend is noted in the proportion
of elderly who live alone (Table 3). Current
patterns resemble those from urban industrial
societies, with the Turks and Caicos Islands, St.
Kitts and Nevis, and Montserrat heading the list.
Living alone may reflect the extent of widowhood.
Table 4 shows that a substantial number of elderly
in 1980 were widowed, with 49.4% in the Turks
and Caicos Islands and 44.9% in Guyana displaying
this characteristic.


Economic and Social Conditions

Data on socioeconomic conditions among the
Caribbean elderly are hard to come by. The main
source on social and economic conditions among the
elderly is a 1982 study by Brathwaite and associates
in Barbados (Brathwaite, 1986). The study was







based on a random sample of 525 persons age 65
and over.

Table 3
Percentage of the Elderly in the Commonwealth Caribbean
Living in Single-Person Households 1960-1970

1960 1970

Barbados -
Guyana 24.3
Jamaica 26.0 26.0
Trinidad & Tobago 25.9 28.7
Dominica 26.9
Grenada 26.4
St. Lucia 29.9
St. Vincent 22.6
Antigua -
Montserrat 23.9 30.7
St. Kitts 21.0 35.0
Belize 24.5
Bermuda 28.0
Bahamas
Cayman Islands 26.4
Turks & Caicos Islands 39.1
B.V.I. 22.6 28.0

Source: Decennial Censuses

Table 4
Percentage of Widowed Elderly in the Commonwealth
Caribbean, 1980

1980

Barbados 26.3
Guyana 44.9
Jamaica
Trinidad & Tobago
Dominica 24.6
Grenada
St. Lucia 26.3
St. Vincent 20.7
Antigua
Montserrat 22.5
St. Kitts 23.4
Belize 25.9
Bermuda
Bahamas
Cayman Islands
Turks & Caicos Islands 49.4
B.V.I. 21.9

Source: Decennial Censuses

Economic Conditions
In researching the economic circumstances and
conditions of the elderly the study focused on four
main indicators: income, expenditure, food and


nutrition, and housing. It showed that deprivation
was not the lot of the majority of the elderly.
However, there were pockets of deprivation. Less
than half (42.9%) expressed satisfaction with their
economic conditions. Over three quarters (75.1%)
indicated getting incomes of US $50.00 or less per
week, which places them at a disadvantage
compared to the general population.
A more precise statement of income
deficiencies among the elderly is presented in a
secondary analysis of the Brathwaite data conducted
by Downes (1982). This investigator concluded that
the 54.9% of the elderly receiving less than
BDSS30.00 per week received only 20% of the total
income accruing to the elderly, and that the mean
income was BDS$41.64, which placed many elderly
in a situation of relative poverty.
The main source of income was pensions, listed
by 76.1% of the respondents. One third (34.2%)
indicated getting financial support from relatives;
other support came from personal earnings (34.4%),
friends (8.5%) and other sources (13.0%). This calls
into question the view that the economic
deprivation consequent upon old age in the Third
World may be mediated by network support.
Further analysis of the sources of income show that
those who got income from social networks, did so
infrequently and that amounts were small. Even
high-income elderly reported weekly expenditures
of food, housing, and fuel in excess of weekly
incomes.
Analysis of food and nutritional circumstances
shows that 61% defined this as non-problematic,
and 81.5% indicated getting two or more meals per
day. Caution is necessary in interpreting these
data, because 39% defined their food situation as
problematic, and 18.5% got less than two meals per
day. Furthermore, food counts show that 11%, 15%
and 23.0% respectively went without lunch;
breakfast and dinner in the 24 hours preceding the
interview. Moreover, meals taken in this period
were energy-rich, but deficient in protein-rich, and
protective foods.
With respect to housing, the picture was
favorable in that 81.5% expressed satisfaction with
their housing conditions; 82% owned their homes,
91.7% had a piped-water supply, 47.2% had
water-borne toilet facilities, 64% used gas or
electricity for cooking, and 18% used electricity
for lighting. Indeed these compared favorably
with the general population for whom comparable
figures are 70.2%, 82.4%, 43.6%, 67.8%, and 83%
respectively. Furthermore with respect to
household facilities 24.8% reported having access
to a motor car, 71.3% to a refrigerator, 43.9% to a
phone, and 76.3% to a radio. Comparable access
figures for the general population are 24.5%,
79.2%, 54.7%, and 61.6%.
There is however the reverse side to the






housing picture. First, 18% did not own their
homes. 32.2% had no pipe-borne water supply,
52.8% had no water-borne toilet facilities, 36%
used wood or kerosene cooking facilities, and 19%
used non-electric lighting facilities. Second,
75.2% had no access to a motor car, 28.7% had no
access to a refrigerator, 56.1% none to a
telephone, and 23.8% none to a radio.
These findings on economic conditions among
the elderly refer specifically to Barbados, and
should not be generalized to the rest of the
Commonwealth Caribbean where similar studies are
not available.

Social Conditions
Social-psychological indicators show that cost of
living (48.4%) and health (16.5%) are the main
concerns of the elderly (Alfonzo, 1986). At the
national level unemployment and cost of living
emerged as the major concerns (Brathwaite, 1980).
Labeling is a common experience of the elderly
with old (55.4%), old girl (52.9%), and grand dad
(45.9%) being the terms the elderly are most likely
to report. Except for the label "old and shaky",
stereotyping is not a major concern of the elderly.
With respect to self-concept there is no evidence
that the elderly have negative self-concepts; only
5.5% expressed the view that their old age is a
source of embarrassment to them. While crime
and the cost of living are of major concern, the
elderly indicate that they are happy with the
improvement in their standard of living (14.4%),
the religious nature of the country (12.1%), and
the existence of political freedom (11%).
Some elderly persons perceive their situation in
unfavorable terms. For example, 67.3% felt that
the general public was unfavorably disposed to
them, 49.9% expressed dissatisfaction with the
treatment they were accorded in society, 84.1%
thought young people were treated better than they
were, 52.6% said they had not acquired the things
they wanted in life. While 51.4% felt that things
are better for them now compared to their past,
just under a third (31%) felt that things had gotten
worse for them.
Further analysis of the social-psychological
characteristics of the elderly show that the elderly
were most likely to be present-(62.4%) and future-
(26.7%) rather than past-oriented. God (32.9%) and
the cost of living (21.5%) were major
preoccupations.
The findings with respect to social
relationships (Hinds, 1986) suggest that a majority
of the elderly (72.9%) lived in multi-person
households, had children alive (75.2%), had contact
with them (79.3%), indicated getting help from
them (75.2%), had contact with grands (81.7%), had
good relations with their spouses (66.7%), had
siblings alive (80.3%), had contact with their


siblings (76.7%), had good sibling relations (86.0%),
had friends (91.4%), had friends who lived nearby
(56.4%), visited their friends (87.5%), had good
relations with their friends (81.2%), had good
relations with their neighbors (66.2%), could rely on
their neighbors for help (41.6%), and had spare
time activities (95%). Thus, the social isolation
associated with old age does not seem to apply in
Barbados, lending some credence to the theoretical
view that levels of network connectivity among the
elderly in Third World societies are high.
Yet, the mere existence of networks does not
ensure quality social relations. The data also point
at broken social relations among the elderly. About
27.1% of the elderly live alone, and 38% reported
experiencing loneliness. Furthermore, 24.7% had
no children alive, 20.7% of those who had children
alive had no contact with them, 24.7% got no help
from their children, 18.3% had no contact with
other grands and 33.3% had bad relations with their
spouses. Of those who had siblings alive, 23.3%
had no contact with them, and 14.1% reported poor
sibling relations.
Similar observations can be made regarding
friends and neighbors in that 43.6% said their
friends lived far away from them, 12.5% did not
visit their friends, and 18.8% reported poor
relations with respect to neighbors, 33.8% indicated
having bad relations, and 58.4% indicated they
could not rely on them for help. Finally, while a
majority of the elderly indicated having sparetime
activities, these were essentially of a sedentary
nature including television watching, and radio
listening. Organizational membership was low.
The fourth area of focus in the survey was
retirement and employment among the elderly
(Burke & Lorde, 1986). The data in this respect
show that 84.8% were in retirement, and of these
75.3% indicated that they were compulsorily
retired, one third (33.6%) said they were not
happily retired, and just under half (48.6%) said
that financial difficulty was the main disadvantage
of being retired. Of the 15.2% who continued in
active employment, 40% said that they did so
because they had to; and over half (57.4%) were
working for BDSS50.00 or less per week.
Selected social policy programs among the
elderly were examined (Brathwaite, 1986). The
purpose was to ascertain if the elderly knew about
the various services available to them, whether they
had benefited from these services, and what was
their experience in receiving benefits. Except for
the home help service, which 43.6% of the
respondents were not aware of, over three quarters
of the respondents indicated knowing about the
other services. Some 68.8% benefited from the old
age pension scheme, 41.5% used the free bus pass
scheme. With respect to public services, the
majority reported no complaints, but 83.9%







expressed a need for better financial assistance,
11.2% said they wanted help in the home, and
44.5% did not think enough was being done for the
elderly.
The data on attitudes to death and dying
(Vaughn & Young, 1986) showed that 60.8% did
not think about death, 44.2% did not talk about it,
and 81.8% had made no plans for it. Only 6.4%
reported they were afraid to die.
Finally, an analysis of how living status,
income, age, sex, retirement status, occupational
class, education, and social isolation relate to life
among the elderly was undertaken by
crosstabulating these with several indicators. The
cross tabulations showed two things. First, income,
occupational class, social isolation, education, age,
and living status are the variables most likely to
differentiate the elderly, with sex and retirement
status being the factors least likely to do so.
Second, those from low, rather than high income
groups; the old-old rather than the young-old;
males rather than females; those living alone rather
than those who do not; retirees rather than the
non-retirees; those who reported bad health; and
the socially isolated, are more likely to experience
problems.

Health Conditions and Epidemiological
Characteristics

The data on health and epidemiology presented
in this section come from three main sources:
Fraser (1982), Hoyos (1987), and Brathwaite and
Fraser (1986). The Brathwaite and Fraser study
focused on health, help-seeking/access to medical
care, and drug compliance. Regarding health, only
37.8% of those surveyed saw themselves as being in
good health. Just under half (47.4%) reported
suffering from arthritis, 41.1% from hypertension,
and 15.7% from diabetes. Other common problems
were poor eyesight (51.5%); lack of appetite
(37.9%), and memory loss (35.3%). Over a fifth
had not seen a doctor for over 12 months; just over
half had used private as opposed to public medicine
on their last visit. Just under half (45.0% ) were on
medication; 13% were on self-prescribed medicine;
45.7% indicated that compliance with medication
was a problem.
The data must be viewed with caution because
they reflect subjective perceptions. Furthermore,
the conditions reported depended on recall, and on
doctor diagnosis, which may be underestimates. In
the rest of the Commonwealth Caribbean for which
data are available the situation is similar to that of
Barbados. For example, Grell (1987) argued that
while the elderly in the Caribbean are 10% of the
population they account for 70% of the patients
with chronic diseases, the most frequent diagnoses
being hypertension, respiratory infections, arthritis,


trauma, diabetes, cardiovascular problems, and skin
disorders. In Jamaica cardiovascular and
respiratory diseases, plus diabetes were the leading
causes of death among those 65 and over.
Studies on nutrition, skin disorders,
malignancy, and renal conditions among the elderly
are summarized below. In a study of 154 elderly
persons in Kingston, Campbell (1987) found that
few met nutritional requirements; 13% of males
were malnourished, 38% of females were obese, and
one quarter were deficient in hemoglobin levels. A
study of 590 admissions to a Dermatology
department over a five-year period (Legrenade,
1987) showed 18% of patients were elderly;
erythrodemia, psoriasis, leg ulcers and scabies were
the most prevalent ailments. In a malignancy
study, Cottenell (1987) showed cervix and stomach
tumors to be most common. Williams (1987) found
renal diseases related to hypertension (36%) and
diabetes (30%). Similar patterns were reported by
Fraser (1982) in Trinidad and Tobago, and Antigua
and Barbuda.
Research on mental health is sparse, but
available findings show the following. Among the
elderly in Barbados (Brathwaite & Fraser, 1986)
problems of memory, fears,and phobias are
common; yet among institutionalized elderly (Mahy,
1987) the incidence of depression is low. In
Barbados and Trinidad, Fraser (1982) found
dementia, psychosis, and retardation to be the most
frequent mental conditions.
There are limitations to the data presented
above. For example, researchers use different
measures: recall, admissions, diagnoses, cause of
death; or they focus on the institutionalized elderly
only. Furthermore, measures such as recall,
diagnoses, cause of death, can only capture a
portion of the elderly, ignoring those who did not
seek help or were not diagnosed. This restricts
generalizability.

Attitudes towards the Elderly

The view that attitudes toward the elderly are
negative and stereotyped is stated in Butler's
concept of agism (Butler, 1987), and is documented
in several studies in the journal Research on Aging.
Commonwealth Caribbean studies dealing with
attitudes toward the elderly are scarce. Notable
exceptions are Hinds(1986), and Reid (1986) in
Barbados, and DeShield (1985) in Bermuda.
Hinds (1986) investigated the attitudes of
children aged 5-10 toward the elderly using three
techniques: (a) ranking of photographs of people at
various ages; (b) content analysis of essays about
old people: and (c) perceptions of the elderly.
About 78% of the children were able to rank order
the photographs correctly, suggesting an ability to
perceive age differences. Some 82.1% perceived






the elderly as friendly, 60.2% saw them as
miserable, 65.0% saw them as weak, and 62% said
that they would assist the elderly. On stereotyping
4.5% saw the elderly as friendly, 4.3% saw them as
smart, 66.6% saw them as most likely to be sick,
3.6% would have them as a friend, and 14.4% said
that they would tell an elderly person their best
kept secret. The study suggested there is a positive
disposition towards the elderly, but the potential
for social interaction is clouded by stereotypes.
Reid (1986) looked at the attitudes of children
in the 13-19 age range. He concluded that most of
his subjects had positive attitudes toward the
elderly and perceived them as kind (74%) and
helpful (61%). Stereotyping was a problem,
however, with 58% and 54% respectively describing
the elderly as forgetful and miserable.
How these studies compare with what the
elderly think is interesting. In the Barbados study
Alfonzo and coworkers (1986) found stereotyping
and labeling were common. At one time or another
the elderly reported having been labeled old (55%),
old girl (52.9%), grand dad (45.9%), aged (23.9%),
pops (18.0%), senior citizen (21.5%), elderly (22.5%)
and grans (20.3). Yet except for the label "old and
shaky" reported by 39.9% of the sample, there was
little resentment toward the other labels.
This may be due to two main reasons: (a) the
elderly have positive self-images; and (b) they do
not perceive hostility on the part of people labeling
them. However, there was a tendency for the
elderly to think of the general public as being
negatively disposed towards them (67.2%). In
addition, 94.5% said young people were better
treated than they were.
DeShield (1985) explored the attitudes of care
givers towards the elderly by interviewing
registered nurses on 14 opinion questions. The
findings showed that 61% of the nurses had positive
attitudes. These positive attitudes were most likely
to prevail among more mature (age 31-35), more
experienced nurses, and among those who spent
over 80% of their time caring for the elderly.
Interestingly, those with no gerontological training
espoused more positive attitudes than those who
had received training in gerontology, a finding that
deserves further exploration.
In sum, the above findings seem to suggest
there is no generalized negativism towards the
elderly. Findings do tell us about the extent of
existing negativism and specifically where and
among whom it may be found.

Implications of the Findings for the Care
of the Elderly

Before presenting the implications for the care
of the elderly, it is necessary to clarify the concept
of care used here. The concept of care has


traditionally been used in a narrow and restricted
sense to mean service delivery and medical care.
Careful analysis of the concept by Gilbert and
Specht (n.d) suggests three main dimensions to this
concept.
1. Care as a process concerned with the
development and provision of policy programs, the
implementation of such programs by way of the
actual delivery of care and treatment, and the use
of services by clients.
2. The functional dimension which in addition
to health care suggests that social, economic, and
psychological care are also important.
3. The institutional aspect of care: Whether
care should be provided institutionally, within
family and community, or as a combination of
these.
In Barbados (Brathwaite, 1985) and in the
Commonwealth Caribbean a wide range of services
both public and private are available to the
growing elderly population. Institutionalized care is
gradually giving way to an emphasis on family and
community-based care, and there is gradual
emergence of an integrated concept of care that
includes health, social, economic, and psychological
interventions.
In exploring the implications of the findings
for the care of the elderly in the Commonwealth
Caribbean we will emphasize three areas: (a)
program development and provision; (b) delivery of
care and treatment; and (c) utilization of service,
with reference to the functional and situational
dimensions presented by each.

Program Develooment and Provision
The development and provision of programs
addresses both the need to update existing
programs and the need to create new ones. Areas
of intervention cover social interaction, work,
social policy, health care, and demography.
Social interaction. The need for programs in
the area of social relations is evident. Family
members and the larger public must be educated
about the importance of social contact with the
elderly. Specific steps must be taken to provide
programs directed at extending and improving the
quality of recreational activity, organizational
participation, and contacts with relatives, friends,
and neighbors.
Work involvement, There is a need for
programs to encourage continued labor market
participation for those so inclined, and a need for
programs to protect wages. The idea of cottage
industry might be reconsidered as a mode of
organizing employment for the elderly, and to
promote skilled elderly as educators and instructors
in their particular fields of competence.
Social Dolicv. In the area of social policy
there is a need to educate the elderly about existing







programs, to make provisions to ensure access, and
to take steps to minimize any stigmatization
attached to these.
Health care Health data on the elderly reveal
specific needs in this area. At a general level,
programs such as provision of transportation must
be improved and/or developed. A program-
specific approach may be useful since there are
diseases common among the elderly. Non-
compliance and a preference for private as opposed
to state-provided medicine also emerged as
problems. Since affordability of health care limits
access, programs aimed at fostering favorable
attitudes to state-provided medical care are needed.
Demographic, social data. In developing and
providing programs to meet the needs of the
elderly, consideration should be paid to
demographic and social data which help identify
the widowed, those who live alone, low-income
groups, and the retired, as the most vulnerable
groups. Furthermore, since levels of formal
education are low among the elderly, any
information, instruction and programs directed at
this group should be designed accordingly.

Delivery of Care and Treatment
The delivery of care and treatment commonly
referred to as Service Delivery is the second main
dimension of caring. It involves delivery of
services to the elderly, and ensures that the services
reach the clients. Three questions are raised:
Where should programs be delivered? How should
they be delivered? What factors threaten effective
delivery?
Current consensus is that community-based
service delivery is best for the elderly. It is cost-
effective, accessible; and helps offset the effect of
factors such as: physical disability, lack of and/or
cost of transportation, fear of institutionalization,
fear of traffic and physical violence, and
preference for self-care.
On the other hand there are factors which
militate against effective community-based care.
As far as the elderly are concerned there is an
emphasis on independence and personal privacy.
Cost also militates against community-based care
which is provided in the private market. Housing
conditions may militate against the readiness of the
elderly to receive community workers into their
homes. To the extent that the elderly also tend to
underestimate the seriousness of their health and
other problems, seeking care in the first place may
be rather limited. This could be exacerbated by the
tendency of the elderly to perceive public hostility
and fear and reluctance to deal with officialdom,
lack of familiarity with policy programs, and
preference for self and traditional forms of care.
At the society level insufficient resources may
be a limiting factor, but changing family and


community patterns play a role. Effective
community-based care depends on community
support to identify the problems, to draw these to
the attention of caregivers, and to help or
encourage the elderly. Unfortunately, urban
growth, and social and geographical mobility affect
network connectivity, social participation, and
social contact. Increasing numbers of old people
live alone.
The factors most likely to hinder a program of
community-based care are negativism and
stereotyping. There is the mistaken idea that
contact with the elderly exposes caregivers to a
high risk of communicable diseases. Some
caregivers lack knowledge and training about the
elderly, their conditions and their needs. Factors
such as job dissatisfaction, lack of adequate
transportation, or lack of commitment to the elderly
may also impose limitations. Caregiving has been
viewed as being concerned primarily with the
health aspects of care; caregivers may be
inadequately prepared to deal with the social,
psychological and economic aspects of care.
Because care has focused primarily on service
delivery, caregivers may be unprepared in such
areas as advocacy, institution building, and
problems of service utilization. Extensive training
programs will have to be mounted for caregivers to
deliver their services more effectively.

Utilization of Services
Utilization of services refers to the use by or
willingness of the elderly to use the services
provided them. A consideration of service
utilization is important because the provision and
delivery of services are not sufficient conditions for
ensuring that the services have the desired effect.
(Lazasfeld, n.d.). Service utilization can be
hindered by factors stemming from the elderly
themselves, from society at large, or from the
caregivers.
Among the elderly the greatest threat is posed
by their unfamiliarity with the programs, their
emphasis on privacy, their preference for self and
traditional forms of care, and the tendency to
stigmatize services which are welfare-oriented.
Difficulties in access, transportation, and mobility;
lack of family and community support are also
important as are affordability and eligibility. How
the service is delivered may affect utilization.
Stigmatization, negativism, hostility on the part of
caregivers contributes to underutilization.

Raferenc
Alfonso, S., Banfield, R., Browne, M., Creese, S., & Graham, E.
Social psychological characteristics of the elderly. In F.
Brathwaite (Ed.), The elderly in Barbados. Bridgetown,
Barbados: Carib Research and Publications, Inc., 1986.
Binstock, R.,et al. (Ed.) International perspectives on ageing:







Population a policy challenge. UNFPA, 1982.
Brathwaite, F. It's unemployment that Barbadians are most
concerned about. Omnipoll 3 Nation Newspaper. Bridgetown,
Barbados, December 12, 1980.
Brathwaite, F. The elderly in Barbados: Problems and policies.
Paper presented at the XIII International Congress of
Gerontology. New York, 12-17 July 1985.
Brathwaite, F. The elderly and social policy. In F. Brathwaite
(Ed.), The elderly in Barbados. Bridgetown, Barbados: Carib
Research and Publications, 1986.
Brathwaite, F., Clarke, J. Miller, R. Miller, S., Smith, A., Springer,
M. & Turton, W. Economic conditions among the elderly. In
F. Brathwaite (Ed.), The elderly in Barbados. Bridgetown,
Barbados: Carib Research and Publications, 1986.
Brathwaite, F. & Fraser, F. Some aspects of health among the
elderly. In F. Brathwaite (Ed.), The elderly in Barbados.
Bridgetown, Barbados: Carib Research and Publications, 1986.
Burke, F. & Lorde, R. Retirement and employment among the
elderly. In F. Brathwaite (Ed.), The elderly in Barbados.
Barbados: Caribbean Research and Publications, 1986.
Butler, R. How to grow old and poor in an affluent society. In M.
Seltzer (Ed.), The social problems of aging. California:
Wadsworth, 1978.
Campbell, V.S., Pattersson, A.W., & Sinha, D.P.. Nutrition for the
elderly. In G. Grell (Ed.), The elderly in the Caribbean.
Kingston, Jamaica: University of the West Indies, 1987.
Cottenell, A.V.. Malignancy in the aging patient. In G. Grell
(Ed.), The elderly in the Caribbean. Kingston, Jamaica:
University of the West Indies, 1987.
Dann, G. The quality of life in Barbados. London: Macmillan,
1984.
DeShield, B. Attitudes of registered nurses in a general hospital in
Bermuda toward the elderly. Unpublished masters thesis, New
School for Social Research, 1985.
Downes, N. A note on the distribution of income and expenditure
among the elderly in Barbados. Unpublished manuscript,
Department of Economics, University of the West Indies,
Barbados, 1982.
Ebanks, G. Barbados. In A. Segal (Ed.), Population policies in
the Caribbean. New York: Lexington Books, 1975.
Fraser, H. Special report for the commonwealth Caribbean Medical
Research Council on the medical needs of the elderly.


Unpublished manuscript, Faculty of Medicine, University of
the West Indies, 1982.
Gilbert, N. & Specht, H. Planning for social welfare. Englewood
Cliffs, N.J.: Prentice Hall,
Grell, G. (Ed.), The elderly in the Caribbean. Kingston, Jamaica:
University of the West Indies, 1987.
Hinds, G. Attitudes of children aged 5-10 years old towards the
elderly. Unpublished thesis, University of the West Indies
(Barbados), 1986.
Hinds, R. Social relationships among the elderly. In F.
Brathwaite (Ed.), The elderly in Barbados. Bridgetown,
Barbados: Carib Research and Publications, 1986.
Hoyos, M. Special problems of the elderly in family practice in
Barbados. In G. Grell (Ed.), The elderly in the Caribbean.
Kingston, Jamaica: University of the West Indies, 1987.
LaGrenade, L. Skin disorders in the elderly West Indian. In G.
Grell (Ed.), The elderly in the Caribbean. Kingston, Jamaica:
University of West Indies, 1987.
Lasasfeld, P.,& Reits, J.G.. An introduction to applied sociology.
New York: Elsevier, 1975.
Mahy, G. Depression in the elderly. In H. Fraser & M. Hoyos
(Eds.), Medical update. Barbados: University of the West
Indies, 1987.
Massiah, J. The population of Barbados: Demographic
development and population policy in a small state.
Unpublished doctoral dissertation, University of the West
Indies, (Jamaica), 1981.
PAHO. Health for all by th year 2000. PAHO Document No. 173,
1980.
Reid, C. Attitudes of secondary school children towards the
elderly. Unpublished thesis, University of the West Indies
(Barbados), 1986.
Reports on Vital Statistic and Registration in Barbados for the
years 1940 and 1980. Bridgetown, Barbados: Government
Printery.
Vaughn, L., & Young, A. Attitudes to death and dying. In F.
Brathwaite (Ed.), The elderly in Barbados. Bridgetown,
Barbados: Carib Research and Publications, 1986.
Williams, W. Rural diseases in the elderly. In G. Grell (Ed.), The
elderly in the Caribbean. Kingston, Jamaica: University of the
West Indies, 1987.








LA MINUSVALIA EN LA POBLACION GUATEMALTECA
DE 65 ANiOS Y MAS


Jorge Arias de Blois
Guatemala, Guatemala


Abstract

The study summarizes the data available on the
disabled elderly in Guatemala. Documenting the
proportion of disabled has the ultimate objective of
anticipating the situation that will prevail in the
future with the increase of the population over 65
years of age. The panorama of disability among all
age groups is first presented, followed by an
analysis of the principal aspects of disability among
those 65 and older.
This study is based on information from the
1981 Guatemalan census. The census data used is
based on physical and mental disabilities classified
by age, sex. education, and occupation. The study
concludes that the most common disability among
women and men 65 years and older is blindness. In
general, both women and men 65 or older with little
or no schooling had the highest rates of disability
and more disabled men than women were
economically active. The number of disabled will
increase in the future as a consequence of population
growth and increased survival of those 65 and older.
According to official projections, in the year 2025
the age group 65 and over will be 4.6 times greater
than in 1985. The proportion of disabled will
similarly increase.


Introducci6n

Uno de los problems que preocupan bastante,
en relacion con la poblacion de cualquier edad,
pero en especial de la de mas afios, es el grado de
minusvalia que pueda padecer. Podria decirse que
toda persona de edad avanzada tiene alguna
minusvalia. Sin embargo, s61o cuando alcanza
cierto grado es que puede declararse que la persona
padece de una incapacidad. Estas personas
constituyen un sector de poblacion que, tarde o
temprano, va a requerir cuidado especial, para lo
cual no siempre estin preparadas nuestras
sociedades, donde aun se depend del cuidado
familiar.
En este document se resume la informaci6n
existente en nuestro medio, como un primer paso
para medir la intensidad de la minusvalia y asi
prever la situaci6n que pueda prevalecer en el
future.


Aunque la poblaci6n de 65 afios y mis apenas
supera el 3% en Guatemala, por la diferencia alta
entire fecundidad y mortalidad, el crecimiento de la
poblacion implica un crecimiento fuerte en el
numero de personas comprendidas en esa edad.
Ademas, la esperanza de vida ha cambiado. En
1950 la esperanza de vida a los 65 afios era de 11.5
ailos y en la actualidad es de 14.5 afios.


Antecedentes

Hoy dia en los paises desarrollados se
acostumbra levantar encuestas que permiten obtener
datos cuantitativos y cualitativos sobre la
minusvalia. En paises como Guatemala raramente
se realize ese tipo de investigation, y hay que
atenerse a los levantamientos censales para obtener
information cuantitativa a gran escala.
En el pasado, en los censos poblacionales se
acostumbraba incluir una pregunta para identificar
personas con impedimentos o minusvalias. Aunque
dicha information era util, con el paso del tiempo
se encontr6 que las respuestas al censo no eran lo
suficientemente precisas, sobretodo por el gran
numero de personas que participan en tal operacion,
y sus diferentes niveles de conocimientos y
actitudes. Ademas, con frecuencia los mismos
familiares tratan de ocultar la existencia de
personas con impedimentos, por lo que los
resultados deben tomarse como estimaciones
minimas. Por otro lado, es muy dificil definir
ciertas incapacidades, por ej., la ceguera. LPodria
identificarse como la imposibilidad de distinguir
entire la noche y el dia? LO una vision 20/200 u
otros limits? Lo mismo podria decirse de otras
minusvalias.
En el censo de 1950 se decidi6 excluir la
pregunta sobre impedimentos fisicos y mentales,
sobre todo cuando se observe que de 53 paises que
habian levantado censos de poblaci6n en el period
1927-48, s61o 29 la habian incluido. En estos casos
la pregunta no se hizo en una forma uniform.
Algunas veces se preguntaba a toda la poblaci6n, en
otras solo a las personas de mas de cierta edad, y en
otras s61o a las que no trabajaban como
consecuencia de la existencia de un impedimento.
En Guatemala la pregunta se omiti6 en los
censos de 1950, 1964 y 1973, y aunque habia sido
incluida en los anteriores, las tabulaciones







preparadas al respect fueron muy pobres y sin
cruce con otras variables como sexo y edad. No
fue sino hasta 1981 que se incorpor6 la siguiente
pregunta en el cuestionario censal: ",Tiene algun
impediment fisico o mental por nacimiento u otra
causa?" Las instrucciones agregaban: "Invalido es
aquella persona cuyo bienestar fisico o mental esta
temporalmente perturbado, ya sea por nacimiento o
durante la vida, por enfermedad o accident de
cualquier tipo." Como puede observarse, la
definici6n era vaga, y eso pudo haber dado cabida
a que en el rengl6n de "otros impediments" se
incluyeran casos que, de haber habido una
definici6n mas precisa, hubieran caido en categories
mejor definidas.
Los censos de 1881, 1893 y 1981 dieron los
resultados que ofrecemos en el Cuadro 1.
Posiblemente los datos no son comparable por
diferencia en criterios, 'aunque se ignoran las
instrucciones dadas para los dos primeros censos.


Cuadro 1
Numero de Minusvalidos Reportados:
Censos de 1881, 1893 y 1981


Aflo Minusvalidos


Numero Tasa por 100,000

1881 10,116 1,207
1893 17,005 1,246
1981 67,602 1,117

Hombres 40,833 1,354
Mujeres 26,769 881



Puede observarse que, aunque el numero de
minusvalidos se multiplic6 en un siglo casi siete
veces, la tasa de minusvalia se mantuvo stable.
Para 1981, donde se hace distincion por sexo, se
puede observer una tasa mas elevada en los
hombres que en las mujeres, posiblemente derivada
en su mayor part, de accidents de trabajo y de
trinsito, asi como de violencia.
Dado que la information para el siglo pasado
es deficient, este trabajo se concretara al censo de
1981. En el Cuadro 2 se dd la informaci6n en
t6rminos generals. Segun estos datos, las dos
causes de minusvalia mas frecuentes son ceguera y
sordomudez Entre las dos reunen a casi un tercio
del total de minusvalidos.
Hay dos aspects que conviene sefialar en
relacion al Cuadro 2. Por un lado, el rengl6n
"otros" abarca casi un tercio del total de casos--por


lo que se pierde much informaci6n.
(Desafortunadamente no fue possible averiguar
cuales habian sido las principles causes agrupadas
en ese rengl6n, que posiblemente incluye enfermos
cr6nicos.) El otro aspect se refiere a que en 1981

Cuadro 2
Numero de Personas con Impedimento y su
Distribuci6n Porcentual, por Sexo, 1981


Sexo

Impedimento Total Masculino Femenino

Numero % Numero % Namero %


Ciego 11,229 16.5 5,994 14.7 5,235 19.6
Sordomudo 10,263 15.1 5,563 13.8 4,700 17.6
Paralitico 8,704 12.8 5,052 12.3 3,652 13.6
Amputado 7,121 10.5 5,625 13.8 1,496 5.6
Retardado
mental 10,197 15.0 5,769 14.1 4,428 16.5
Otros 20,586 30.2 13,106 32.1 7,480 27.5



hubo un alto nivel de omisi6n censal. Una
evaluacion realizada posteriormente estim6 que la
omision censal habia alcanzado un 15.1% de los
hombres y un 12.4% de las mujeres, o sea un 13.7%
de la poblaci6n total. De ser asi, el verdadero
numero de minusvalidos seria mayor que el
indicado en el Cuadro 2. Suponiendo que la
poblacion minusvalida fu6 subnumerada en la
misma proporcion en que lo fue la poblaci6n
general, el total de minusvalidos para 1981 podria
estimarse en 78,600 (48,100 hombres; 30,500
mujeres). Asimismo, si la tasa para 1981 sigue
siendo vdlida para 1988, se podria estimar que el
numero de minusvalidos en 1988 asciende a 97,000,
de los cuales unos 13,260 tendrian 65 aflos o mis, y
entire los que habria mayor numero de hombres que
de mujeres.

Minusvalia por Edad y Sexo

El numero de minusvalidos varia con la edad, y
aunque este document se refiere a la poblaci6n de
65 afios y mas, conviene hacer referencia a la
poblacion de otras edades, para colocar aquella
dentro del context general. En el Cuadro 3 y la
Figura 1, aparece dicho numero por grupos
quinquenales. El mayor numero de minusvilidos se
present en los grupos de 5-9 a 20-24 aflos, con
totales mayores de 5,000 por grupo quinquenal.
Los cuatro grupos de edad mencionados
comprenden mas de un tercio del total (37.1% para







el total, 35.3% hombres, 40% mujeres). El numero
maximo se present en el grupo 10-14 afios, con
mas de 7,000 casos. A partir de este grupo el
numero disminuye, primero rapidamente, y despuds
mas lenta y sostenidamente, con pequefias
elevaciones en los grupos 50-54 y 60-64 debido
posiblemente a deficiencies en la declaraci6n de
edad.
Cuadro 3
Poblaci6n Total, Nimero de Minusvilidoa y Tasa
de Minusvalla por 100,000 Habitantes
por Sexo y Edad, 1981


Sexo

Masculino Femenino


Edad Poblaci6n Minusvalida Poblaci6n Minuasvlida
total total
Numero Tasa por Numero Tasa por
100,000 100,000

Total 3,015,826 40,833 1,354 3,038,401 26,769 881
0-4 535,207 1,814 339 522,323 1,486 284
5-9 456,308 3,140 688 495,236 2,571 577
10-14 386,093 3,956 1,025 370,561 3,341 902
15-19 313,602 3,858 1,230 335,000 2,436 727
20-24 261,727 3,458 1,321 286,013 2,350 822
25-29 205,198 2,845 1,386 222,113 1,765 795
30-34 174,668 2,757 1,578 175,961 1,567 891
35-39 145,331 2,648 1,822 153,032 1,524 996
40-44 124,140 2,439 1,965 121,845 1,357 1,114
45-49 102,139 2,210 2,164 103,665 1,250 1,206
50-54 92,094 2,321 2,520 91,083 1,258 1,381
55-59 64,923 1,852 2,853 62,537 975 1,559
60-64 61,090 2,083 3,410 54,731 1,131 2,066
65-69 35,835 1,533 4,278 35,032 836 2,386
70-74 25,260 1,307 5,174 25,161 879 3,494
75-79 15,538 1,087 6,996 15,640 705 4,508
80-84 9,952 817 8,209 10,553 644 6,103
85 y mas 6,721 708 10,534 7,915 695 8,781


30 40 SO


Figura 1: Numero de Minusvalidos por Sexo y Edad


Aunque hay factors causantes de minusvalia
que pueden aumentar con la edad (ceguera,
sordera), lo cual tenderia a producer increments,
algunas de las vidas que sufren de alguna
minusvalia, pueden tener un caracter marginal, y
por consiguente, desaparecen antes que las personas
de la misma edad que no padecen de minusvalia
alguna. De todas maneras, prevalece la mortalidad
como causa basica de la disminuci6n gradual en el
numero de minusvalidos con la edad, pues a esas
alturas es dificil esperar curaci6n o rehabilitaci6n.
Aunque el conocimiento del numero absolute
de minusvalidos es util para conocer la magnitude
del problema, la informaci6n mas util para el
studio del comportamiento de este sector de la
poblaci6n consiste en calcular las tasas de
minusvalia, comparando el numero de minusvalidos
con la poblacion total de la misma edad, y
expresandolo en una unidad convenient, como
puede ser la de 100,000 habitantes. Las cifras asi
obtenidas aparecen en el Cuadro 3, y se han
representado en la Figura 2 donde se observa un
crecimiento similar en los dos sexos en las primeras
edades, pero a partir de los 15 aiios aparece una
clara diferenciaci6n entire los dos sexos, diferencia
esta que vuelve a disminuir en las edades ultimas.


Figura 2: Grafico Semilogaritmico Representando la Tasa de
Minusvalla por 100,000 Habitantes por Sexo y Edad

Empero, al utilizar un grafico semilogaritmico
la Figura 2 refleja la evoluci6n de la tasa de
minusvalia. En ella se distinguen, para cada sexo,
cuatro tramos mas o menos bien identificados: (a)
hasta los quince afios, las tasas, en ambos sexos,
crecen muy rdpidamente, alrededor de 11% por afio
de edad; (b) de los 15 a los 25 afios hay una zona
de transicion muy diferente en comportamiento
entire ambos sexos, ya que en la misma se inicia la
separaci6n marcada entire ambas tasas; (c) de los 25
a los 60 6 65 aflos ambas tasas crecen en forma
similar, a una tasa alrededor del 2.7% por afio de
edad; y (d) a partir de los 60 aflos se acelera la
incidencia de la minusvalia, que en el hombre crece








a una tasa de 4.6% por aflo, y en la mujer al 6.6%,
lo cual indica una aceleraci6n en la tasa de
minusvalia de la mujer de edad avanzada digna de
tomarse en cuenta.

Caracteristicas de los Minusvilidos
de 65 Afos y Mis

Una vez que se tiene un panorama de la
minusvalia en general, conviene concentrarse en los
aspects principals de los minusvalidos de 65 aflos
y mis. La minusvalia qued6 definida, en esta
investigaci6n, en cinco tipos: ceguera, sordomudez,
paralisis, amputaci6n, y retardo mental. Una sexta
categoria de "ignorado," en la que cayeron 32.8% de
los hombres y 28.0% de las mujeres, posiblemente
incluye enfermos cr6nicos.
En el Cuadro 4 y en la Figura 3 se present el
numero de minusvilidos por edad e impediment,
para cada sexo. Con pocas excepciones--mujeres
ciegas o con pardlisis--el numero de minusvalidos
tendi6 a decrecer con la edad, sobretodo los
hombres paraliticos y los amputados. El
impediment mas frecuente en hombres y mujeres
fue la ceguera; el menos frecuente entire los
hombres fu6 retardo mental, y entire las mujeres, las
amputaciones. Los otros impedimentos mostraron
posiciones intermedias.

Cuadro 4
Numero de Minusvalidos en la Poblaci6n de 65 Aflos y mis
por Tipo de Minusvalla, segn Sexo y Edad


Sexo


Tipo de Minuavalla


Edad Ciego Sordomudo Paralltico Amputado Retardado Ignorado

Hombres 1,381 705 765 673 193 1,789
65-69 318 152 209 239 68 557
70-74 285 158 206 177 48 446
75-79 267 146 154 135 38 355
80-84 261 119 113 67 24 244
85 y m6s 250 130 83 55 15 187

Mujeres 1,111 582 647 173 240 1,052
65-69 192 127 103 53 73 290
70-74 256 137 144 41 55 255
75-79 204 103 135 28 43 198
80-84 211 106 126 27 41 142
85 y ms 248 109 139 24 28 167


Hay que tener present, para una mejor
interpretaci6n de las cifras, que una persona puede
tener mas de un impedimento. Asismismo, es
interesante sefialar que mientras los hombres daban
un promedio de 1.01 impedimento por persona en
casi todas las edades, en las mujeres el promedio de
impediments, por persona, oscil6 entire 1.18 y 1.22


-C..go --Sdordomdo--. Pa:a-r Lec -.-Amputado ...... Retardrdo
100

ASCUL .AiCUL mNO


100
S- --. ....
... .. .. ..---"...... .......-- -- --.


70 75 80 85 70 75 80 85 afos

Figura 3 Numero de Minusvilidos por Sexo y Edad

creciendo mis o menos regularmente con la edad, lo
que indica en cierto sentido, un problema mas
grave de concurrencia simultanea de various tipos de
minusvalia.
Por otro lado, si se analiza la proporci6n que
corresponde a cada impediment (Cuadro 5 y
Figura 4) en cada grupo de edad, se encuentra que
los ciegos incrementan en proporci6n, desde cifras
alrededor al 20% hasta el 35%.

Cuadro 5
Distribuci6n Porcentual de los Minusvalidos
sogsn tipo de Minusvalia, por Sexo y Edad


Sexo


Tipo de Minusvalfa


Edad Ciego Sordomudo Paralitico Amputado Retardado Ignorado

Hombres 25.3 12.9 14.0 12.3 3.5 32.8
65-69 20.7 9.9 13.6 15.6 4.4 36.3
70-74 21.8 12.1 15.8 13.5 3.7 34.1
75-79 24.6 13.4 14.2 12.4 3.5 32.7
80-84 31.9 14.6 13.8 8.2 2.9 29.9
85 y mau 35.3 18.4 11.7 7.8 2.1 26.4

Mujers 29.6 15.5 17.2 4.6 6.4 28.0
65-69 23.0 15.2 12.3 6.3 8.7 34.7
70-74 29.1 15.6 16.4 4.7 6.3 29.0
75-79 28.9 14.6 19.1 4.0 6.1 28.1
80-84 32.8 16.5 19.6 4.2 6.4 22.0
85 y m6 35.7 15.7 20.0 3.5 4.0 24.0


ruscuurno
^^^ HACULUM




7 I s
~0r as 7 80 85


MW4EMINO


--- -- -- -.


70 75 ao 85 rJo


Figure 4 Distribuci6n Porcentual de los Diferentes Tipo. de
Minusvall por Sexo y Edad








La proporci6n de sordomudos, tiende a variar
menos que la de ciegos aunque en forma similar
(del 10 al 16%) en ambos sexos, lo que corresponde,
mis o menos, a la mitad de los ciegos.
Convendria sefialar algunas diferencias: la
proporci6n de mujeres paraliticas tiende a crecer
con la edad, mostrando proporciones superiores a la
de sordas; en los hombres la proporci6n disminuye
y alcanza (en los dos ultimos grupos de edad)
valores menores que la de sordos. Finalmente,
mientras en los hombres, a los retardados mentales
les corresponde la menor proporci6n, en las
mujeres, esa posici6n corresponde a las amputadas,
ocupando el segundo lugar los retardados mentales.
SSi se calculan las tasas para cada tipo de
minusvalia se obtienen los datos que aparecen en el
Cuadro 6 y en la Figura 5. Es facil observer la
rapidez con que crece la tasa de ceguera, sobre todo
en los hombres, en comparaci6n con las otras tasas,
aunque la de sordomudez se le acerca bastante, asi
como la de paraliticas en las mujeres. Las otras
tasas muestran una tendencia creciente, aunque
menos marcada, con la edad.

Cuadro 6
Tasa de Minusvalla por 100,000 Habitantes Segun Tipo de
Minusvalia, por Edad y Sexo

Sexo Tipo de Minusvalia

Edad Ciego Sordomudo Paralitico Amputado Retardado Ignorado

Hombres 1,480 756 820 721 207 1,907
65-69 887 424 583 667 190 597
70-74 1,128 625 816 701 190 478
75-79 1,718 939 991 869 245 380
80-84 2,623 1,196 1,135 673 241 268
85 y mis 3,720 1,934 1,235 818 223 200

Mujeres 1,178 617 686 183 255 1,116
65-69 548 363 294 151 208 308
70-74 1,017 544 572 163 219 270
75-79 1,304 659 863 179 275 210
80-84 1,999 1,004 1,194 256 389 151
85 y mat 3,133 1,377 1,756 303 354 177


VAL.A PCR SEO Y EDAD




MASCULINE
-- ----


70 75 85as


;) 5 90 95 SAcS


Figura 5 Tasa de Minunvalfa (minusvalidos por 100,000 habitantes)


No estd de mis seflalar las diferentes causes
asociadas con la minusvalia. Se deriva de
problems congenitos; enfermedades (e.g., polio,
meningitis); deficiencies nutritivas (e.g., raquitismo,
ceguera); accidents de trabajo, de trInsito,
comunes, o de tipo catastr6fico (terremotos, etc.).
Para cada origen se pueden trazar las bases de
programs de prevenci6n. Asi, en el caso de los
problems congenitos, una debida atenci6n prenatal
puede hacer much, en especial, evitando
embarazos tardios. Investigaciones realizadas
muestran que los nilios de mujeres entradas en aftos
corren un riesgo mayor de tener defects al nacer,
riesgo que crece en forma geom6trica cuando la
edad de la madre se acerca a los cuarenta. Tambien
se puede sefialar ceguera por falta de vitamin A y
problems derivados de la desnutrici6n, adn antes
del part. De aqui la necesi'dad de desarrollar
programs integrales que ataquen todos los factors
que puedan controlarse y que se considered causa
de minusvalia.
A partir de las consideraciones anteriores, es
factible estudiar que aspects relacionados con la
educacion y la ocupaci6n pueden guardar alguna
relaci6n con la incidencia de la minusvalia. El
censo de 1981 prepare tabulaciones de minusvilidos
por nivel educational y ocupacional.
Desafortunadamente estas tabulaciones s6lo
incluyeron un grupo de personas de 65 afios y mas
en lugar de los grupos quinquenales que habian sido
utilizados en las tabulaciones generals. En este
andlisis, con fines de comparaci6n, se incluye el
grupo complementario de 10-64 cuando era
oportuno. A continuaci6n se sefialan algunas
consideraciones al respect.

Minusvalia y Nivel Educacional
En el Cuadro 7 aparece la distribucion porcentual
de la poblaci6n de 65 afios y mas de ambos sexos,
por tipo de minusvalia y nivel educative. Al
comparar los minusvilidos con la poblaci6n general
se observa que entire los minusvalidos es mis alta la
proporci6n de los que no aprobaron grado alguno
en la escuela (71.2% vs 65.2%). Lo mismo se
observa, aunque en menor grado, en los que se
ignora el nivel alcanzado (5.8 vs 4.2%) y los que
posiblemente podrian considerarse, en su mayor
parte, pertenecientes al grupo de sin instrucci6n.
Al haber ganado uno o mis grades de la enseflanza,
la proporci6n con alguna minusvalia, es menor que
en el grupo total, aunque la diferencia tiende a
decrecer conform crece la escolaridad.
Otro dato interesante en el Cuadro 7 es que en
la poblaci6n sin instrucci6n es mis alta la
proporci6n de ciegos (77.1%) y la de sordomudos
(82.0%). Es 16gico esperar que se present una
mayor proporci6n sin instrucciOn en estos dos
grupos, ya que dichos tipos de minusvalia pueden
interferir fuertemente en el progress educativo.


3000

2000







Para las personas que cursaron uno o mas grades de
ensefianza, la proporci6n de ciegos es mayor que la
de sordomudos y, a su vez, alcanza valores mas
bajos que los que alcanza la poblacion minusvalida
total en cada grado de instrucci6n. Los paraliticos
y amputados, que alcanzan una menor proporci6n
que la media de los minusvilidos, la superan en los
diversos grupos que han alcanzado algun grado de
ensefianza. Se obtiene una mejor idea examinando
las tasas de minusvalia por 100,000, lo cual aparece
en el Cuadro 8.

Cuadro 7
Distribuci6n Porcentual de los Minuavilidos de 65 Aflos y mas,
por tipo de Minusvalla y Nivel Educativo, 1981

Grado m6a alto aprobado.

Minusvalla Sin instrucci6n 1-3 4-6 7-10 11-14 Superior Ignorado

Total (%) 65.2 14.5 11.3 1.4 2.5 0.9 4.2
Minusvalida 71.2 11.4 8.8 1.2 1.2 0.5 5.8
Ciego 77.1 8.4 7.0 0.6 0.8 0.3 5.7
Sordomudo 82.0 7.5 4.0 0.5 0.5 0.1 5.4
Paralitico 60.6 13.2 14.4 1.8 2.5 0.6 6.8
Amputado 63.9 17.7 9.8 1.3 0.9 0.8 5.4
Retardado 71.1 8.1 6.0 0.7 0.9 13.2


Cuadro 8
Tasa de Minuavalia por 100,000 en a Poblaci6n de 65 y mis
por Nivel Educativo, 1981

Grado mis alto aprobado

Minusvalia Sin instrucci6n 1-3 4-6 7-10 11-14 Superior Ignorado

Total 5,359 3,855 3,833 3,938 2,325 529 6,863
Ciego 1,570 773 822 557 444 482 1,827
Sordomudo 862 353 246 223 148 60 895
Paralitico 699 685 964 966 740 542 1,227
Amputado 442 552 392 409 169 421 588
Retardado 252 129 123 111 85 728


Al comparar el nivel y la evoluci6n de las tasas de
minusvalia en funci6n del nivel educativo, lo mis
notorio es la alta tasa para ciegos y sordomudos en
el grupo sin instruction. Como se dijo antes, no es
possible distinguir si la alta tasa se debe a la falta de
instruccion o si esta no se logr6 por la minusvalia.
Para la atenci6n de este grupo hay que tener en
mente el bajo nivel educativo. Tambi6n es
interesante sefialar el comportamiento de la tasa de
paraliticos, que aunque se inicia con una tasa mas
baja que para los ciegos y los sordomudos en las
personas sin instruccion, se eleva despues a niveles
superiores para los que han alcanzado un mayor
grado de escolaridad.


Minusvalia y Situacion Ocuoacional
La poblaci6n minusvalida se tabul6 atendiendo a su
situaci6n active (ocupado y desocupado buscando
trabajo), inactive, e ignorado. En el Cuadro 9 aparece
la distribuci6n de la poblaci6n minusvalida clasificada
en dos grandes grupos de edad: 10-64 y 65 afios y mis,
separados por sexo y situaci6n ocupacional.
Al interpreter este cuadro hay que tener
present que la participaci6n de la mujer en la
poblaci6n economicamente active es baja,. y que la
tasa de actividad del hombre permanece alta, aun
despues de los 65 afios, como consecuencia del poco
desarrollo que hasta el moment han tenido los
planes de retire por vejez.

Cuadro 9
Distribuci6n Porcentual de la Poblaci6n Minusvilida
por Sexo y Situaci6n Ocupacional, 1981

Situaci6n Ocupacional

Desocupada Poblaci6n
Sexo y Ocupada buscando econ6micamente Ignorado
Edad trabajo inactive

Hombres 52.0 1.2 31.4 15.3
10-64 54.7 1.3 28.9 15.1
65 y m6a 37.0 0.6 45.5 16.9

Mujeres 7.7 0.1 88.4 3.7
-10-64 8.5 0.2 88.1 3.2
65 y mAs 3.9 0.1 89.8 6.3


En la poblaci6n minusvalida de 65 afios y mas
ocupada, se opera una baja considerable: mientras
en la total, la tasa de participacidn de la poblaci6n
ocupada baja de 70.6% a 66.1%, de uno a otro
grupo de edad, en la poblaci6n minusvalida la tasa
baja del 54.7% (poblaci6n de 10-64 afios) a 37.0%
(poblaci6n de 65 afios y mas). Igual situaci6n se
present en la mujer, pues mientras en la poblaci6n
total la tasa de participaci6n baja del 12.0% al 6.4%
de uno a otro grupo de edad, en la poblaci6n
minusvalida baja de 8.5% a 3.9%. Todo esto
pareceria indicar que al alcanzar la edad de 65 afios
y mas, la minusvalia constitute un obstaculo tanto
para estar ocupado como para buscar trabajo.
En la poblaci6n econ6micamente inactive
resalta la importancia de los minusvalidos, ya que
entire el 88 y el 90% se clasificaron economicamente
inactivos en los dos grupos de edad. Entre los
hombres minusvalidos, se nota mayor tendencia a
estar ocupados que a estar inactivos. Esto es mas
notorio en la poblaci6n mas joven, ya que en la
poblaci6n de 65 afios y mas, casi la mitad (45.5%)
de los minusvilidos qued6 incluido en este sector
inactive. En los menores de 65 afios, la proporci6n
baja a 29%.







En los minusvilidos cuya situaci6n ocupacional
se desconoce, la proporcion de hombres en los
grupos de edad es mas o menos similar (15.1 y
16.9%), mientras que en las mujeres la proporci6n
es menor, aunque se acentua la diferencia (3.2% en
las de 10-64 afios y 6.3% en las de 64 aiios y mas).
Finalmente conviene examiner en qu6 grado los
diferentes tipos de minusvalia afectan las
posibilidades de trabajo. La investigation censal no
permit determinar lo anterior en forma precisa,
pues a los minusvalidos desocupados no se les
pregunt6 por que no trabajaban. Pero tomando en
cuenta la situation ocupacional, se puede Ilegar al
Cuadro 10 en que se combine el tipo de minusvalia
con la situacion ocupacional, separado por sexo, ya
que hay una diferencia clara entire ambos sexos.
Primeramente, mas del 20% de los hombres, con
cualquiera de los tipos de minusvalia, se encontraba
ocupado durante la semana anterior al censo. En
los hombres los porcentajes de ocupaci6n mas bajos
correspondieron a paraliticos, ciegos, y retardados
mentales. A los sordomudos y amputados, y al
grupo de ignorado, la proporcion estuvo entire el 45
y el 50%. La situation ocupacional de los
minusvalidos masculinos contrast con la de las
mujeres, en las cuales el porcentaje de ocupacion
no excedi6 al 6%, manteniendo siempre el mismo
orden relative que los hombres.

Cuadro 10
Distribuci6n de la Poblaci6n MinuavAlids de 65 y mas,
segun Tipo de Minusvalia y Ocupaci6n, 1981

Situaci6n Ocupacional

Desocupado Poblaci6n
Sexo y Ocupado buscando econ6micamente Ignorado
Edad trabajo inactive

Hombres L(%
Ciego 24.1 0.4 51.6 23.9
Sordomudo 45.2 0.4 38.6 15.7
Paralftico 21.4 0.3 54.8 23.4
Amputado 50.2 1.3 37.1 11.6
Retardado 23.3 1.0 50.3 25.4
Ignorado 46.3 0.8 42.5 10.3

Muieres (L
Ciego 2.9 0.2 87.9 9.0
Sordomudo 4.3 91.8 4.0
Paralitico 3.6 86.3 10.0
Amputado 5.8 0.1 90.2 3.5
Retardado 2.5 92.9 4.6
Ignorado 4.8 92.0 3.2


Otro aspect que conviene seinalar es que la
proporcion de mujeres econ6micamente inactivas,
en el grupo de mujeres minusvalidas, fue superior
al 86% y en los retardados mentales alcanz6 casi el
93%. En los hombres la proporci6n tambi6n es alta
pero oscil6 entire limits mas bajos (37.1% para los
amputados y 54.8% para los paraliticos). Parte de
las diferencias quedan oscurecidas por la categoria
ignorado en la posici6n ocupacional, en la que el
porcentaje oscil6 entire 10.3 y 23.9% en los hombres
y entire el 3.2 y el 10% para las mujeres, que
correspondent a los mismos tipos de minusvalia.
El analisis presentado en las paginas anteriores,
podria repetirse para las divisions geogrificas, pero
no seria de gran inter6s. Basta con sefialar que
algun tipo de invalidez, como ceguera, present
tasas mas elevadas en zonas donde la oncocercosis
ha sido prevalent.


Conclusion

De mantenerse las tasas de minusvalia actuales,
el numero de minusvalidos crecera en el future,
como consecuencia del crecimiento poblacional.
Segun las proyecciones oficiales, la poblaci6n de 65
afios y mas se multiplicara para el afio 2025, 4.6
veces en relacidn con la de 1985.
La aplicaci6n de las tasas de minusvalia
existentes--bajo el supuesto que no sufrieran
much modificaci6n--conduciria a un nimero de
minusvdlidos cada vez mayor, 22,000 para el afio
2000 y 52,500 para el afio 2025.
El prestar la atenci6n debida a los minusvalidos
de 65 aflos y mas, es cada vez mas dificil, no 61lo
por el crecimiento en su numero, sino porque las
families tienden cada vez mas a una organizaci6n
nuclear y hay mayor participaci6n de la mujer en la
fuerza de trabajo, lo cual hace mas dificil la
atenci6n a nivel familiar. Esto llevaria a pensar en
los aspects institucionales para la atenci6n del
problema. Ademis hay que tener en cuenta los
aspects diferenciales por sexo que se han sefialado
a lo largo de este trabajo.
Para un future mas lejano habra que tomar en
cuenta la tendencia decreciente de la
fecundidad--que hasta ahora ha sido reducida--por
lo que significa agregar nuevos efectivos a ese
segment de la poblaci6n por envejecimiento de la
misma, y los cambios que, por ello, se puedan
original en las tasas de minusvalia.








LA MIGRACION Y LA PROBLEMATIC DE LA TERCERA EDAD
EN EL PERU


Maria Isabel Hurtado de Pulcha
Lima, Perd


Abstract

This paper documents the changes that have
occurred in the family as a result of rural-urban
migration. In the traditional extended Andean
family the needs and position of the elder adult
were insured. With widescale migration to the city,
the traditional agriculture-based extended family
group has given way to the urban-based nuclear
family. As a result, the position of the elder adult
migrant has been radically altered.
In Peru. the majority of the population is
concentrated in Lima. the capital city. While the
migration from the rural areas to the city in search
of opportunities and employment has been
occurring since colonial times, this movement has
increased in recent decades. The vulnerability of
the older person increases when the family leaves
the countryside. Without recourse to the land, the
older adult lacks the means of subsisting in the
rural area. Complementing this hardship is the lack
of institutions for the elderly within the city and as
campesinos, the majority of the elderly have no
social security or pension fund.
The author suggests the following strategies
for addressing the well-being of the older urban
migrant: programs to unite the elderly and youth
in projects of mutual education: and as a form of
occupational therapy, to create community gardens
within the city where the elderly may put their
agricultural skills and knowledge to work. Such
projects could be instituted with the help of other
agencies and with professionals dedicated to the
health, dignity, and welfare of the elderly.


Introducci6n

El Pert esta situado en la parte central y
occidental de la America del Sur. Tiene una
extension de 1,285,215 Km2 y una poblaci6n de
mas de 20 millones de habitantes, cuya mayor
concentraci6n la tiene la capital de la Republica,
Lima, en primer lugar y las capitals mis
importantes de la Republica, despues.
La Cordillera de los Andes que ingresa al Pert
por Bolivia y Chile, y que la atraviesa de sur a
norte, la divide en regions bien marcadas: Costa,
Sierra, y Montafia o Selva, definiendo a la gente de
cada una de ellas, como el product del medio


ambiente, de creencias y costumbres ancestrales,
mantenidas y guardadas a traves del tiempo. En
ellas la tradicion y la costumbre se han convertido
en ley.
La problematica de la tercera edad en el Peru
se muestra mas acuciante en Lima. En Lima se
concentra la mayor poblaci6n, por lo tanto, tambien
la mayor poblacion de ancianos, gracias a las
migraciones desde todos los puntos del pais. Las
migraciones del campo a las ciudades, se han ido
acentuando desde la epoca colonial y desde entonces
tambien el problema de tugurizacion y mendicidad.
La epoca republican remarco el problema,
ignorando al anciano considerado como una fuerza
de trabajo devaluada e inutil. Y aunque la familiar
sigue siendo la primera unidad social, se inicia la
marginaci6n sistematica y progresiva de los viejos.
Hoy por hoy se sigue abandonando el campo
para migrar a las grandes ciudades, debido a sequias
y catastrofes, en busca de oportunidades de trabajo
y de mejor. vida. Mas las condiciones socio-
economicas de la ciudad van reduciendo la
constituci6n de la familiar a los padres e hijos.
Quedan fuera de ese nucleo los abuelos o familiares
de mayor edad, sin recursos y abandonados a su
suerte, sin siquiera la esperanza del regreso al
terrufio, adonde ya nada les queda.
Y comienza la tragedia de los viejos, que por
no estar institucionalizados, no tienen derecho a
nada. Como campesinos, no tienen atencion de la
seguridad social para su salud, ni de la caja de
pensions cuando ya no pueden labrar la tierra.


Problematica Actual de la Tercera Edad
en el Peru

De la poblaci6n general, el 6.5% (1,300,000
personas) son ancianos. De este subgrupo el 10%
cuenta con seguridad social; son los jubilados que
durante su vida laboral aportaron al Seguro para la
Caja de Pensiones y el cuidado de la salud. Si
sumamos a este porcentaje el 10% 6 20% que son
atendidos por los hijos y familiares, nos queda un
70% que sienten y sufren los males de la vejez,
comenzando por la soledad. La familiar no los toma
en cuenta y el gobierno abocado al binomio madre-
nifto no puede distraerse en otros problems.
Perdida su condici6n de jefe de familiar, consejero,
y guia de su comunidad, alli en su pueblecito, los






ancianos inician su peregrinaje por el mundo de la
indiferencia, el hambre, la enfermedad, y la
soledad. No es nadie ni sirve para nada. Huerfano
de ternura familiar y de la atenci6n de la
comunidad, no le queda otro camino, que mendigar
carifio y pan. Porque id6nde encontrar trabajo a su
edad, si sl6o son recibidos los menores de 40 afios?
LC6mo subsistir sin un apoyo economic, cuando no
existe seguro de vejez? LD6nde encontrar quien
atienda su salud deteriorada, si no existen centros
de atenci6n geriatrica?
Ante la perspective que ofrece la situacion
actual de la vejez, agravada por el aumento de
poblaci6n en el avance hacia el aflo 2000, se hace
perentoria una seria reflexi6n que nos conduzca a
alternatives de solucion a la problematica de la
tercera edad en el Peru. Y mirando a nuestros
pueblos andinos que conservan sus tradiciones desde
el incanato, en la organizaci6n de sus vidas,
podemos armonizar much del contenido social que
ellas guardian y conservan, para la de nuestras
ciudades en aras del bienestar de los series mis
d6biles.
La base fundamental de la organization social
andina es la familiar pero no solo la formada por
padres e hijos, sino tambien por abuelos, tios, y
otros familiares. La agrupacion en viviendas
cercanas de estas families extendidas permit una
relaci6n constant que da solidez y unidad a sus
miembros, para poder velar y ciudar de sus series
queridos mas debiles. La organization traditional
de la familiar no permit la soledad del anciano, ni
much menos la privacion del hogar. Por ello y
para evitarlo, por ley de la tradici6n, el cuidado del
anciano esta encargado al hijo menor que hereda
con la vivienda la obligacion de atenderlo.
En la tradici6n campesina los ancianos son
ciudadanos importantes y con pleno uso de sus
derechos. A ellos las consultas en las asambleas de
la comunidad. De hecho, el mayor numero de
ancianos es garantia de eficiencia. A ellos les estd
encomendado la conservation de las leyes y
costumbres que les dan vigencia. Organizan y
resuelven en una gama de problems: gobierno,
economic, fuerza de trabajo, religion. Los ancianos
en las comunidades andinas son venerados por su
sabiduria; para ellos, el respeto, la consideraci6n, el
amor, los cuidados.
Este esbozo del anciano en las sociedadas
andinas frente a los de nuestras ciudades, debe ser
punto de partida para la soluci6n de la problematica
de la tercera edad. Debemos esforzarnos por
revalorizar el concept de familiar para darle la
solidez structural que cada dia tiende a
desaparecer. Y aunque es muy cierto que ello no
basta para la solucion del grave problema que
afrontamos en estos moments de crisis, es un
punto de partida.
Es precise reforzar los derechos legales del


anciano en las siguientes dreas: (a) vivienda, para
evitar su despojo por familiares y muchas veces por
los propios hijos; (b) salud, por las
vulnerabilidades que present el anciano en este
aspect; (c) trabajo, modificando el regimen de
jubilacion que obliga al anciano a abandonar su
trabajo y su sustento. Es necesario que nuestras
leyes considered la creacion de nuevas fuentes de
trabajo, en las que los mayores puedan brindar sus
habilidades y experiencias y asi ser considerados
tiles a la sociedad.


Educaci6n para la Tercera Edad

Todo cuanto se diga, se proyecte y se realice
no podra adquirir solidez, si no se abren los cauces
del process de revalorizacion de la tercera edad por
medio del instrument educativo: educacion para la
tercera edad y educaci6n en la tercera edad.
La educacion para la tercera edad implica el
conocimiento de la gerontologia desde que el nifio
aprende a leer en el colegio, en forma gradual a su
desarrollo. Y much antes en el hogar, viendo
como sus padres tratan a los mayores, a los abuelos.
La enseflanza en los primeros afios es decisive en la
formaci6n future. Educar y ensefiar es hacer
conocer y comprender; es ensefiar a amar; es
preparar para la recepcion, adaptaci6n y respuestas
a las circunstancias que ofrece el transcurrir de la
existencia.
Si bien es verdad que los factors externos
tienen gran influencia en el comportamiento
human, este depend mas de factors interns. De
c6mo el individuo capta, percibe, experiment, y
reacciona frente a una determinada situacion. De
c6mo esta preparado para afrontarla. Y este
aprendizaje debera realizarse durante.todo el
process vital, porque sabemos muy bien que el
envejecimiento se inicia en el mismo moment de
nacer.
Educar en el mundo de los valores, es preparar
al hombre para su lucha en los moments dificiles.
Pero este ser es el product de una educaci6n
sistematica en cada una de las estancias educativas
y luego en cada una de las profesionales, porque es
important no olvidar que el problema de la tercera
edad es un problema de todos. Todos estamos
inmersos en el problema y su soluci6n, y, en la
media en que asumamos nuestra responsabilidad
para hacer y realizar, lograremos el bienestar del
anciano de hoy y de mafiana.
Otro component de la educaci6n en la Tercera
Edad es aprender a comprender la juventud. Pero
6ste es un aprendizaje que implica un profundo
amor a la juventud, para poder resistir y avanzar
ante los primeros escollos del acercamiento a ellos.
Superando el bache generacional, dirigir todos los
esfuerzos hacia el logro de una integraci6n que







permit para la juventud los apoyos necesarios para
la explicaci6n a sus incognitas y temores, la
satisfacci6n de sus anhelos y al logro de la luz que
despeje sus dudas y guie sus pasos. Para los viejos
la renovacion constant que les permit sentirse
tiles y necesarios en el renacer diario de su vida al
lado de la juventud.
Juntos el anciano y el joven. Ambos
aprendiendo, enriqueciendose, en el diario vivir,
con el pleno covencimiento de que la vida se hace
mas hermosa y mas rica si esta al servicio de los
demds.


Alternatives y Soluciones

Y volviendo a los ancianos migrants, a los que
la labor preventive no llego, nos toca rescatar y
rehabilitar en ellos las capacidades y habilidades
dormidas por falta de oportunidades. Se hace
perentorio como una alternative de solucion, la
creacion de casas-huertos y casas-granjas, donde
vuelvan a encontrar razones para su existir, con la
practice de sus habilidades agricolas. En su
reencuentro con la tierra, como una forma de
terapia ocupacional dirigida al auto-financiamiento
de sus necesidades, encontrarian la razon de vivir
con alegria, porque trabajar la tierra, es lo que
aprendieron generation tras generacion.


Una de nuestras preocupaciones a nivel
institutional es poner en practice esta alternative.
Y esperamos que con nuestro esfuerzo y la ayuda
de otras instituciones dedicadas a promover el
bienestar del anciano, podamos abrir hogares donde
el migrant vuelva a ser el hombre que conoce los
secrets de la tierra para arrancarle sus mejores
frutos y con ello su revalorizacion de hombre, de
anciano del Ande que sabe y conoce lo que
heredaran los que le siguen. Esto evitaria que estos
ancianos que algunas veces son recogidos por el
albergue municipal o de la Beneficencia, escapen y
prefieran la calle.
Mientras los que atiendan a los ancianos no
tengan idea de por que estan en estos lugares y para
qu6, continuara el rechazo de los albergues y asilos,
donde lo primero que reciben como saludo es el
joye tfi! sin ningun respeto ni consideraci6n a los
anos.
De alli que otra de nuestras preocupaciones es
capacitar a personal seleccionado, que a nivel
professional se dedique al cuidado integral del
anciano. Un professional que comenzando por una
verdadera vocaci6n de servicio devuelva al anciano
la dignidad perdida. Un professional que con los
conocimientos adquiridos, y sobre todo con la
comprension, el amor, y el respeto, revalorice su
condici6n de series mayores que con poco o much
contribuyeron al mundo que disfrutamos hoy.










Part IIl: Aging Care in Third World and
Industrialized Countries



7 Mexican Subcultures and the Differentiated Well-
Being of the Aged
by Fernando Camara (Mexico)

8 The Care of the Elderly Costa Rica
by Fernando Morales-Martinez (Costa Rica)

9 Informe sobre la Vejez en Guatemala
by Manuel A. Gir6n Mena (Guatemala)

10 C6mo son Atendidos los Ancianos en Bolivia
by Elfas Crespo-G6mez (Bolivia)

11 Anciano y Sociedad en la Argentina
by Maria Julieta Oddone (Argentina)

12 La Vejez en la Cuidad de Buenos Aires
by Roberto Barca y Eva Muchinik (Argentina)










MEXICAN "SUBCULTURES" AND THE DIFFERENTIATED
WELL-BEING OF THE AGED


Fernando Camara
Mexico, D.F., Mexico


Abstract

Specific ecological and socioeconomic variables
are taken into consideration in the analysis of age
composition, size (small, medium, large and
metropolitan), and density (sparsely, nuclear,
compact). This approach illustrates how culture and
environment affect the value system regarding aging
and how old age is dealt with in traditional and
modern sectors of the Mexican population. Many
group interests are supposed to dull, interrupt.
hinder, or defer old age activities. Whereas.
manifold concerns will promote motion, vigor,
alertness, agility, sprightliness and quickness during
the aging process.


Introduction

In Mexico there are subcultures bound together
by geographical boundaries, economic interests,
sociocultural traditions, languages. The subculture
to which people belong affects their development
and their value-system. For a given group of
persons within a subculture, their roles and their
rewards are determined, thus establishing their
status and ultimately, the level of their well-being.
Specific cultural and socioeconomic variables are
considered in this paper in relation to age
composition of the population, size of area resided
in (small, medium, large, and metropolitan), and
density of settlement (sparse, dense). This
approach will illustrate how culture and
environment affect the value system in Mexican
subcultures, and determine the well-being of the
aged population within that subculture. Not all
elderly persons in Mexico experience the aging
process in the same way. The differentiated well-
being of aging persons in Mexican subcultures is
due to distinctive traditions, asymmetrical social
relationships, and dissimilarity in behavioral
patterns (Camara, 1967; 1972).


Distinctive Traditions

The complex interweaving of elaborate
sociocultural patterns and differentiated ways of
life was a part of Mexican life before the coming
of the Europeans. Prehispanic Mexico was


pluricultural, socially stratified, and had a variety
of sizes of communities. During the Colonial
period, new sociocultural layers were set due to
Spanish control of the subjected native populations.
A varied asymmetrical social pattern developed,
affected by land tenure, exploitive economic
activities, and the differentiated statuses and roles
of the dominant and dominated sectors (Cdmara,
1952; 1964; 1968). Modern Mexico contains
settlements with traditional subcultures along with
contemporary city-based sectors. The spread of
national institutions has brought some measure of
similarity of attitudes and ideas to the country.
However, it remains necessary to examine the
particular ways and cultural traits of a group of
people along with the generalized national patterns
in order to classify and interpret distinctive
subcultures. With sociocultural configurations
understood, the differentiated levels of well-being
of the aging can be compared.


Cultural Traits

Any single item or unit of culture is a cultural
trait; a cluster or integration of related cultural
elements is a trait complex. Trait complexes which
are related combine to form cultural patterns. The
family and the social system, including the care of
the aging, are patterns of behavior found within
cultural groups. Cultural groups change through
the accumulation of new items and the
disappearance of old traits. Diffusion of items
takes place through intercultural contact (Steward,
1955).
In the case of Mexico the agencies of diffusion
were invasion and conquest by the Spanish,
followed by missionization, trade, colonization,
forms of production, education, inter-sexual
relations, and the various means of mass-media. In
the 1980s different groups in Mexico have traits
that were changed in terms of Hispanization,
and/or modernization, or were maintained through
conformity to conservative ways and resistance to
newness.


Well-Being of the Aged

Aging is a state in which ideally the elderly






can cease from labor, and still enjoying good
health, can spend time in leisure and satisfy their
interests. Biologically, aging refers to the ending of
the life cycle; psychologically, aging refers to the
capacity for participation in active life, including
learning; and socially, to role and status.
Old age is valued differently according to the
time-space orientation and world view of individual
and sociocultural group. In general, as individuals
age, they become more restricted in what they can
accomplish, and eventually, are replaced by
younger workers. In rural areas and in smaller
towns the life of the elderly seems to be more
personalized; they remain close to families and
friends, receiving support and maintenance. At the
same time, these rural elderly are less likely than
their urban counterparts to have pensions, and less
likely to participate in organized, group activities.
Organization is more a feature of urban life (Lewis,
1951; Paul, 1952; Redfield, 1930; 1941; 1962).


Population and Ecology

Large populations and the institutions that
serve them tend to concentrate in the center of the
city or metropolitan area, thus creating a dense
urban mix. The growing city can be illustrated by
a series of spaces representing successive zones of
urban extension with various activities in different
types of areas. Commercial amusement centers are
a type, as are agencies of public services that are
located in strategic places. Urban persons can
choose from such types of offerings to meet needs.
Cities and metropolitan areas offer highly
differentiated ways of life.
In rural areas and small towns with sparse
concentrations of persons, development of service
centers is unnecessary. Daily activities are rooted
in face-to-face relationships. The group and the
local community members are the major social
actors. While the Mexican population has
quadrupled in numbers from 1940 to 1985, and the
country has experienced great immigration to the
urbanized areas, there is still a great diversity in
communities both in size and ecological type.
There are ports, mountain villages, and
international cities. Diverse systems of organization
of Mexican subcultures inhabiting these
communities affect the lives of the elderly.

Numbers of Aging
The proportion of aging persons in Mexican
communities is increasing. The progress of medical
science has raised the ratio of older adults to young
persons. The average life expectancy went from 25
years in 1900 to 50 in 1950, 58 in 1970, and has
now reached 65 years. In 1900 there were only
300,000 persons over 65; in 1950 there were 3/4


million; in 1970, over 1.8 million; and in 1987 there
were an estimated 3 million. The continued high
birth rate in Mexico means that the proportion of
elderly is not increasing as rapidly as the absolute
numbers.
The presence of large numbers of elderly
impacts Mexican society. The repercussions vary
according to subculture. Different groups view the
aging process in distinct ways. Developmental life
stages, with related practices such as rituals, are
based on geography, social values, and beliefs. In
Mexico the heightened tempo of modern life, the
growth of cities, the increase of production has
made the aging more insecure. The elderly are
predominantly poor. Their well-being is generally
not good, but the level is related to the types of
places and class of society to which they belong.

Types/Classes
The typology of Latin-American subcultures on
which this discussion in based was designed in 1955
by anthropologists Charles Wagley and Marvin
Harris. Additional categories have been added for
the purposes of this paper.
A first distinction is that of class. Proletarians
comprise 80% of Mexican society, while the
Bourgeoisie are 20%. A second distinction can be
made in terms of place: Rural groups are 50%;
urban are 20%, and suburban are 30% of the total
population. A third distinction is Mexican Indians,
1.5 million; mestizos, 12 million. These subcultures
will be discussed next.

Rural oooulation. Half the Mexican population
live in the countryside with settlements no larger
than 10,000 people. Rural population includes the
categories Indian, peasants, and non-peasants or
workers of the subculture.

Sub-urban subcultures. This category
encompasses some 16 million Mexicans. This
population has awareness of their position in the
social structure of the nation. The suburban
working force, those 12 years old or more, number
approximately 6 million people. They live in towns
and small cities with 10,000 to 75,00 inhabitants.
A large proportion are clerks, bureaucrats,
technicians, sales personnel, entrepreneurs, or
service and industrial workers. Systematic studies
of this category, who frequently reside in small
cities on the outskirts of larger urban areas, have
not been carried out. One observation is that these
suburban areas do not have recreational centers or
adequate facilities to provide services.

Urban subcultures. These are dwellers in large
cities and in metropolitan areas ranging from
76,000 to millions of inhabitants. In these areas are
found the most highly differentiated sets of






activities, with individuals separated by economic
endeavors and impersonal, anonymous relationships
that characterize urban lifestyles. An estimate is
that 24 million persons, with a labor force of 9
million, comprise this category. Within urban
centers about half the population are in an
underclass situation. These may have a separate
world view, different perspectives, and lower
expectations than the middle and upper class city
dwellers have.


Differentiated Well-Being of the Aged

Well-being is a positive socioeconomic and
mental situation which should be achieved by all
persons, groups, neighborhoods, sectors in Mexico.
The next sections will consider the well-being of
the aged in the Mexican subcultures identified
previously.

Peasant subculture. Based on readings and
personal fieldwork (Beals, 1946; Brand, 1951;
Cancian, 1965; Foster, 1948; Guiteras, 1948; Lewis,
1951; Madsen, 1969; Paul, 1952; Redfield, 1930;
1941; 1962; Wolf, 1955) this researcher considers it
realistic to describe an isolated, technologically
backward, hard life for this group. Tied to the
land, with no surplus for sale, peasants are
primarily family-centered. The most conservative
are the 50% of the Indians living in the highland
areas, maintaining old cultural patterns that are a
blend of Spanish and traditional native value
systems. A strong belief in the supernatural
pervading all areas of life is characteristic. The
life cycle of the individual is conditioned from
birth to death, and support is provided through the
extended practices of ritual kinship, such as
compadrazgo. The fiesta system and ceremonialism
are persistent cultural complexes. Older persons are
part of the ongoing patterns of life; the aged can
take for granted respect and economic assistance.
Old age signifies experience and wisdom, and is
proof of survival power, of having withstood evil
forces. Old persons' idiosyncrasies are accepted as
humorous; aged men have the liberty of getting
drunk in public.
There are no state or community care systems
for the elderly, who care for themselves as long as
possible. Even the handicapped and ill may live
alone, sustained by frequent visits and provisions of
food from their children and kin. The elderly in
the rural subcultures maintain a strong sense of
self, while sharing in community life.

Suburban urban subcultures. Little
research has been carried out on suburban and
urban subcultures, but inferences can be made
concerning aging within these categories. In larger


aggregates of population, face-to-face relationships
and feelings of community obligation are not as
common as in rural life. Without agriculture being
practiced, there are few ties to nature. Special
interest groups form; among these, some groups
may conflict with others. Pressures are applied in
order to attain desired goals. Accordingly, family
bonds, feelings of belonging, mutual help, and the
concepts attached to sacred life have little place in
urban and suburban life. One traditional institution
has held firm, especially among the socially and
economically insecure working classes.
Comoadrazgo is still a meaningful concept for older
persons needing help.
In the suburban areas the clerks, retail sales
and other middle level workers get caught up in
bureaucratized working situations. At a certain age
these workers no longer are valued. In complex
urban life the elderly also cannot assume that they
will find respect, love, and economic assistance.
Governmental institutions crated to protect the
well-being of the aged lack the resources to
accomplish needed tasks. Less than 10% of retirees
are entitled to pensions that are, in any event, too
small to cover basic needs.
In the changing context of modern urban life,
the experience and wisdom of the aged are not
valued. Age is not proof of survival, nor is there
admiration for "left-overs," those no longer able to
work efficiently.

Conclusions and Recommendations

The need for more research on aging within
varied contexts is critical. Mexico is not prepared
to cope with the problems presented by increasingly
large numbers of elderly persons who are found in
all types of communities of the nation. Some
suggestions for action are:

1. Strengthening of status and roles of the
elderly, especially in suburban and urban areas.

2. Providing support so that the aging can
increase their ability to maintain themselves:

3. Prolonging the active participation of the
elderly in community life.

4. Reaching out to talk to the elderly, in remote
areas as well as in cities.

5. Devising new educational and recreational
resources for the elderly suited to their
subcultures.

6. Providing health services as a public
responsibility.







7. Reducing inequalities that are due to
different life situations by providing resources
to allow all elderly to maintain a satisfying level
of well-being.
Recognizing that sociocultural environmental
factors impact upon the aged in Mexican
subcultures, our challenge is to enhance the ability
of individuals to cope with their problems.
Specific services, such as homemakers, therapists,
senior volunteers can be provided through public
and private initiative for the well-being of the
elderly. Public and private agencies should be
spread around the nation, offering services
according to the needs of the elderly within the
subcultures. For example, within urban areas
satisfaction of life might be enhanced for the aging
when depersonalization is replaced by more
personalized provision of services. In rural areas
the elderly poor often live in isolated areas where
they are deprived of needed health services.
Mobile health units might respond to such
situations.
These suggestions are made to induce action to
provide care for the elderly. Traditionally,
Mexicans have had respect and love for the aging.
With the great increase in numbers, and the social
and economic changes of these times, Mexico has
been unable to stop the destruction of the hearts
and minds of her old people. To find solutions to
provision of care of the aging in differentiated
situations, we in Mexico as in the rest of the world
must keep our years fresh, our hearts aflame, our
minds curious, and above all, our selves committed
to informing and leading society in this crucial task
of providing well-being for all elderly.



References

Beals, R.L. Cheran: A Sierra Tarascan village. Washington, D.C.:
The Institute of Social Anthropology, Smithsonian Institution
(Pub. 2), 1946.


Brand, D.D. uiroga: A Mexican municipio. Washington, D.C.:
The Institute of Social Anthropology, Smithsonian Institution
(Pub. 11), 1951.
Camara, F. Religious and political organization. In S. Tax (Ed.),
Heritage of conquest. Glencoe, Ill., 1962.
Camara, F. El mestisaje en Mixico: Planteamientos sobre
problematicas socio-culturales. Revista de Indias. 1964,95-96.
27-86.
C6mara, F. Contemporary Mexican Indian cultures: The problem
of integration. In B. Bell (Ed.), Mexico: Past and Present. Los
Angeles: Latin American Center, University of California,
1967.
Camara, F. and Kolk, B. Semblantes mexicanos. M6xico, D.F.
Institute Nacional de Antropologia e Historia, 1968.
Camara, F. Las subcultures mexicanas como parties integrantes de
los municipios: Estructuras tradicionales y modernas de su
organisaci6n y gobierno. Revista Mexicana de Ciencias
Political 1972, 67. 101-119.
Cancian, F. Economic prestige in a Maya community. A study of
the religious cargo system in Zinacantin. Palo Alto, CA.:
Stanford University Press, 1965.
Foster, G.M. Empire's children: The people of Tzintsuntz6n.
Washington, D.C.: The Institute of Social Anthropology,
Smithsonian Institution (Pub. 6), 1984.
Guiteras, C. Organisaci6n social de tseltales y tsotsiles. Am6rica
Inditena 1948, 8(1), 45-62.
Lewis, 0. Life in a Mexican village: Tepostlin restudied.
University of Illinois Press, 1951.
Madsen, W. The Nahua. In E.Z. Vogt, (Ed.), Handbook of Middle
American Indians Vol. 8. Austin, TX: The University of Texas
Press, 1969.
Paul, B.D. The life cycle. In S. Tax (Ed.), Heritage of conquest.
Glencoe, Ill., 1952.
Redfield, R. Tepostlin: A Mexican village. Chicago: The
University of Chicago Press, 1930.
Redfield, R. The folk culture of Yucatn. Chicago: The University
of Chicago Press, 1941.
Redfield, R. and Villa, A. Chan Kom: A Maya village (Revised
edition). Chicago: The University of Illinois Press, 1955.
Wagley, C. and Harris, M. Types of Latin American
subcultures. American Anthropologist. 1955, i7(3), 428-451.
Wolf, E. Types of Latin American peasantry: A preliminary
discussion. American Anthropologit. 1955, 7(3), 452-471.








THE CARE OF THE ELDERLY IN COSTA RICA


Fernando Morales Martinez
San Jose, Costa Rica


Abstract

Given projected increases in the elderly
population Costa Rica will have to develop
preventive and rehabilitative services and long-term
care facilities to address the needs of elderly
peoples. Social structures in Costa Rica are
changing in patterns similar to those found in other
developed countries, with large numbers of Costa
Rican women entering the labor force, thereby
reducing the availability of traditional family
support networks.
This has serious implications for the future
development of long-term care and respite facilities
for the elderly.
The paper discusses the three primary facets of
care to the elderly, which are preventive care, acute
and rehabilitative services, and long-term care
facilities. In preventive care the emphasis is on
pre-retirement education. Polyclinics, health
centers, and hospitals provide the care of acutely ill
elderly. Residential long-term facilities have
chiefly been provided under the auspices of the
Catholic Church. Residents in these facilities rarely
meet their fees privately, but are subsidized by a
variety of sources. Eligibility for these facilities is
based on multiple factors.


Introduction

Costa Rica closely resembles many European
countries and states of North America, in terms of
its health and social status. Geriatric medicine is
no exception to this generalization. Projections are
that the elderly population (persons aged 60 and
over) will be 19.7% of the total population by the
21st century. Costa Rica will have to develop
preventive, acute and rehabilitative services, and
long-term care facilities if the needs of this sector
are to be adequately met. A brief outline of the
existing services is given and problems are
discussed.


Geographic, Social, Economic Factors

Costa Rica, which has a land mass of 51,000
Km2, is situated in Central America and is
bordered on the north by Nicaragua and to the
south by Panama. The Pacific and Atlantic Oceans


form its western and eastern limits respectively. It
is a democratic country with a population
numbering some 2.5 million, 90% of whom are
literate and 31% of whom are economically active.
Costa Rica is now emerging from a serious
economic crisis and recovery is progressing slowly.
Unlike most other countries, Costa Rica does
not maintain an army nor does it have a defense
budget. The country invests heavily in the health
and education of its inhabitants instead. All
residents are entitled to receive health care and
related services through the social security system
and the Ministry of Health. Considerable emphasis
is given to preventive health care with the focus
hitherto having been placed on maternal and infant
welfare and on combating diseases of modern
societies, such as hypertension. Thirty-six percent
of the population is 15 years of age or below. The
current birth rate is 30.1/1000 and the overall
crude death rate was 3.8/1000 in 1984. In 1980 the
infant mortality rate was 19.1/1000 live births and
is still decreasing. This is clear evidence of Costa
Rica's positive health achievements.
The social structure is also changing in patterns
similar to those found in Europe and North
America, with a large number of women entering
the active labor force thereby reducing the
availability of more traditional family support
networks. This has serious implications for the
future development of long-term care and respite
facilities for the elderly and the handicapped.


Demographic Characteristics of the Elderly

The distribution of the elderly population of
Costa Rica is shown in Figure 1. The highest
concentration of persons over 60 is found in the
metropolitan area (35%) and the surrounding central
area (39.6%). Life expectancy at birth increased
considerably between 1950 and 1985 from 57.3
years to 73.0 years, and is expected to rise to 75.7
years by the year 2050. This change is largely due
to improved socio-economic conditions, including
better education of the population which has
resulted in increased uptake of services. In 1985,
5.8% of the total population was 60 and over; this
figure is expected to reach 19.7% by the year 2050.
Thus the Costa Rican elderly population will
achieve proportions similar to those found in North
America and Europe early in the 21st century.







Figure 1: Distribution of the elderly population by regions
(Ministry of Planning, 1985)


Total Elderly Population 149.022 (100%)


Care of the Elderly in Costa Rica

There are three facets to care of the. elderly in
Costa Rica: preventive care, acute and
rehabilitation services, and long-term care facilities.
Preventive care is directed primarily at the healthy
elderly population. The emphasis is on pre-
retirement education where aspects of the aging
process and achievement of elderly persons' full
potential are considered in seminars and workshops.
Services for the acutely ill elderly are provided
in the first instance through a network of
polyclinics and health centers. Referral is made to
one of the general or regional hospitals as
necessary. If additional specialists' advice or
treatment is indicated, patients are referred either
for outpatient assessment to the day hospital or
outpatient department, or for inpatient care to the
geriatric hospitals.
The majority of patients are discharged back to
the community under the care of staff in a
polyclinic or health center with additional service
prior to discharge as required. Follow-up care and
respite care may be provided through day hospital
attendance thereafter.

Long Term Care Facilities
Long-term care and terminal care services in Costa
Rica are limited with the majority of the elderly
being cared for in the community by other family
members. The Catholic Church took the initiative
in developing residential care facilities in the 19th
century. The first Costa Rican nursing home


opened in 1878 under the auspices of the Church.
There are currently 32 such establishments
providing a total of 2,226 beds across the country.
Most of these homes are located in the urban areas,
which is far from ideal given the present and
projected distribution of the elderly population.
The income of these homes comes from a variety of
sources including state subsidies, the National
Lottery, and certain insurance schemes. Few
residents meet the fees from their own resources.
Homes built for the specific purpose of care of
elderly are rare, but an upgrading program was
recently introduced. This should improve the
facilities available to the elderly and staff. Efforts
have been made to develop religious, social and
recreational activities in many homes though no
formal activity programs are provided. In the past
two years courses relating to care of the elderly
lasting between three days and four weeks have
been introduced which should further raise the
quality of nursing home care. This is particularly
relevant given the wide range of backgrounds and
experience of existing staff.
All nursing homes have medical input from
professionals, who work on a full- or part-time
basis. Staffing levels are not satisfactory although
progress in this direction is being made. Many of
the nursing staff belong to religious orders.
Volunteers often provide supplemental care in the
homes. One third of the nursing homes also
receive social services support and input from
psychologists. Chaplains are appointed to each
home and residents are free to attend religious
services which are held regularly.
Admission policies and procedures vary widely
from home to home. As happens elsewhere, it is
not always those who are most in need of this type
of care who are either eligible or accepted for
admission.

Care Programs for the Handicapped Elderly
In 1985, the first care program directed towards
handicapped elderly persons discharged from
hospitals or long-term care, was started through the
efforts of one religious order. The program is
primarily for elderly persons unable to rely on
family support. At present 30 persons are receiving
care. Although the existing facilities are poor,
plans are being made to increase the
accommodation to 50 places and to develop similar
schemes elsewhere in the country. The program
receives no financial support from the state but is
funded by the local community.

Acknowledgements
I would like to thank the Crusada Nacional de Protecci6n al
Anciano for allowing me to conduct the survey of nursing homes in
Costa Rica, and to Dr. MJ.D. and Dr. A.B.B. for their help in the
preparation of this paper.








INFORMED SOBRE LA VEJEZ EN GUATEMALA


Manuel Antonio Giron Mena
Guatemala, Guatemala


Abstract

The report is divided into five sections. The
first section offers demographic data on the ladino
and Maya Indian populations of Guatemala, and on
other countries of Central America. The second
section addresses research needs with respect to
aging and the elderly; it gives an overview of areas
such as family, housing, health, economics,
employment, recreation, education, social relations,
and legislation affecting the elderly. The third
section deals with retirement, social security, and
pension schemes and reviews legislation regarding
the elderly. The fourth section refers to social and
medical services available to the elderly. The report
concludes with recommendations for future
implementation. The author draws attention to the
fact that the recommendations stem from a 1958
study on the situation of the elderly in Guatemala;
though there have been advances and changes, he
still considers them valid.


Consideraciones Demograficas

Cuando se analiza el envejecimiento en
Guatemala en sus aspects demograficos es
necesario observer la demografia del pais desde dos
puntos de referencia: la poblacion guatemalteca y la
centroamericana.

Poblacion Guatemalteca
La poblaci6n guatemalteca no es homogenea.
Comprende dos grupos culturales diferentes, los
indigenas, descendientes de los mayas, y los no
indigenas, llamados ladinos. El indigena era
mayoritario en 1950, sobrepasando el 50% de la
poblacion (53.6%). A partir de entonces ha ido
disminuyendo: En 1964 descendi6 a 43.3% y las
proyecciones indican que en 1999 descenders aun
mas. La integracion social en un solo grupo
cultural mixto se proyecta para dentro de medio
siglo (International Population, 1967).
Este process demografico se conoce como
ladinizaci6n; se le han atribuido varias causes.
Arias (1959), en un studio longitudinal observe
que: (a) la tasa de natalidad de los indigenas es
superior a la de los ladinos; (b) la tasa de
mortalidad indigena es superior a la de los ladinos,
al punto que la poblaci6n ladina, aunque menos
f6rtil, aumenta mas; (c) la mortalidad infantil y la


mortinatalidad son mayores en la poblaci6n
indigena; (d) las dos poblaciones siguen creciendo,
pero la indigena pierde importancia en relaci6n con
la ladina; (e) la esperanza de vida al nacer en 1949-
51 era superior en los ladinos (49.7 afios) a la del
indigena (39.2 afios); y (f) la vida econ6micamente
productive sobrepasaba los 29 afios en los ladinos y
apenas Ilegaba a los 23 afios en el indigena.
El process de ladinizaci6n no se debe
solamente a las altas tasas de mortalidad indigena.
Un gran numero de individuos se desarraigan de su
cultural, pasando al grupo ladino, individual o
colectivamente como ocurre en el oriented done
poblaciones enteras de origen maya se han
ladinizado u occidentalizado dadas las ventajas de
ser ladino en un pais gobernado por ladinos.

Poblaci6n Centroamericana
Guatemala es parte de Centroamdrica, integrada por
una historic comun desde la conquista espafiola a
principios del siglo XVI hasta mediados del siglo
XIX, cuando se desintegro la federaci6n de
centroamerica, asumiendo el rango de naciones las
cinco provincias que la formaban, a saber:
Guatemala, El Salvador, Honduras, Nicaragua y
Costa Rica. Ademas, en el siglo XX se comprende
a Panama en la region centroamericana. Este marco
de referencia debe considerarse cuando se analiza la
demografia de Guatemala, o de los otros paises del
Istmo. Al respect se hacen los siguientes
comentarios:

EsDeranza de Vida al Nacer
En el quinquenio 1975-1980 en los paises
centroamericanos vari6 la esperanza de vida al
nacer, siendo para las mujeres entire 58.8 afios en
Guatemala y 71.9 en Costa Rica y Panama. Para
los hombres, vario entire 55.4 afios en Honduras y
67.5 afios en Costa Rica y Panama, ocupando en
Guatemala el penultimo lugar antes que Honduras
con 56.9 afios.

Distribuci6n vor Grupos de Edad
La distribuci6n porcentual de los grupos de edad
para el afio 2000 se estima que sea en lo
concerniente a mayores de 60 aflos de 7.9% en
Panama; 7.4% en Costa Rica; 5.8% en Guatemala;
5.5% en El Salvador; 5.0% en Honduras; y 3.8% en
Nicaragua. En numeros absolutos el porcentaje
correspondiente a Guatemala equivale a 734,000
habitantes.







Tasa d Fecundidad
En el quinquenio 1975-1980 vari6 entire 3.6 en
costa Rica y 7.1 en Honduras, siendo en Guatemala
de 5.7.

Tamafio Familiar
En el mismo period vari6 el tamafio familiar entire
5.6 miembros para costa Rica y 9.1 miembros para
Honduras. En Guatemala fue de 7.7 miembros.

Tasas de Mortalidad v Natalidad
La tasa bruta de mortalidad para 1980-1985 vari6
de 10.6/1000 en Nicaragua a 5.0 en Costa Rica,
siendo en Guatemala de 9.3/1000. La tasa bruta de
natalidad para 1980-1985 vari6 de 44.6/1000 en
Nicaragua a 28.1/1000 en Costa Rica, siendo de
38.4/1000 en Guatemala.
Analizando estos datos se encuentra que Costa
Rica y Panama tienen una mayor esperanza de vida
al nacer y un indice menor de natalidad y de
mortalidad que Guatemala, El Salvador, Honduras
y Nicaragua. Asimismo, los indices de fecundidad
y de tamafio familiar son menores en Costa Rica y
Panama.
Para el afio 2000, la poblacion mayor de 60
afios superara el 7% en Costa Rica y en Panama; en
los otros paises centroamericanos sobrepasart el 5%.
Guatemala tendra un 5.8% de poblacion mayor de
60 afios.



Investigaci6n en el Campo del Envejecimiento

Hay que investigar las condiciones de vida en
la familiar, medio primordial de seguridad humana.
Tambien se deben investigar: vivienda, salud,
ingresos, trabajo, recreaci6n, educacion,
convivencia social, y legislacion. Las pensions y
servicios sociales gerontol6gicos merecen
comentarios aparte.

Familiar
La familiar rural guatemalteca tiene muchas de las
caracteristicas de la familiar preindustrial: satisfacer
necesidades sexuales, incorporar los vastagos a la
comunidad, funci6n econ6mica cooperative,
transmitir status ocupacionales, proteger contra
extrailos, y cuidar de los ancianos. A su vez, los
ancianos s61o tienen como recurso de protecci6n
social a su propia familiar. Esto es especialmente
cierto en la familiar indigena en la que la autoridad
de padres y abuelos es reconocida y venerada
(Sequic, 1972). Nuestro indigena se forma en el
seno del hogar y de la comunidad, no en la escuela
public, dice el etn6logo Rafael Girard (1977); el
sistema 6tico de los mayas-quich6s se caracteriz6
por autodominio, pacifismo, altruismo, justicia,
amor, al trabajo y a la verdad, respeto a lo ajeno,


cumplimiento de deberes, respeto a la vida humana,
discipline, fidelidad, moderacion, y espiritu de
abnegacion.
La familiar urbana, en el siglo pasado
presentaba similitud con la indigena, dada su
formacion cristiana. Con el industrialismo, la
familiar pierde rasgos tradicionales en las ciudades,
volvi6ndose nuclear, con detrimento de la
protection a la vejez. En este ambiente, los
ancianos son mal tolerados o abandonados por sus
familiares. A los que carecen de fondos propios o
de una pension s6lo les queda la alternative de
mendicidad o de asilo public.

Vivienda
Aunque en Guatemala hay un movimiento
arquitect6nico muy avanzado, la vivienda de las
mayorias es deficiente. Empero, la vivienda rural
represent las 2/3 parties. Estas son rusticas y
unifamiliares; muchas carecen de agua, de servicios
sanitarios, y de electricidad. No tienen pavimento,
estan mal ventiladas, y como combustible se usa la
lefia. Los ancianos viven hacinados con hijos y
nietos, ya que hay cuatro o cinco habitantes por
vivienda, y s61o uno o dos cuartos por vivienda
(dormitorio y cocina).
En las ciudades, especialmente en la capital,
despues de los terremotos se han multiplicado los
barrios marginales donde los ancianos justifican su
existencia cuidando la barraca y los nietos, mientras
los hijos trabajan (Aguilar, 1980).

Salud
Sobre la patologia de la vejez, no hay gran
informaci6n. El Instituto Guatemalteco de
Seguridad Social (1979) en base a un studio sobre
enfermedades, maternidad y accidents, indica que
la morbilidad mas frecuente corresponde a
enfermedades degenerativas. Otras patologias
incluyen:

Enfermedades
Enfermedades y/o signs cardiovasculares.
Arterioesclerosis, insuficiencia cardiac,
insuficiencia coronaria, hipertension arterial,
accident cerebro-vascular, varices en miembros
inferiores, tromboflebitis, hemorroides.
Enfermedades resoiratorias. Efisema,
bronconeumonia y neumonia, bronquitis.
Otras enfermedades frecuentes. Desnutrici6n,
diabetes, alteraciones psiquicas, ilcera gastrica,
cancer, osteoporosis, osteoartritis, tuberculosis
pulmonar, problems oftalmol6gicos y
odontol6gicos, hernias, alcoholism.

Ginecologia obstetrician
Prolapso v6sico-uterino, fibromatosis uterina,
cancer de 6rganos genitales y reproductores, cancer
de la mama.







Accidentes
Las lesiones mencionadas con mas frecuencia son:
fracture de la cadera y miembros inferiores,
luxaciones de cadera y hombro, fractures y
luxaciones de miembros superiores.
La patologia indicada exige servicios de
consult externa y/u hospitalizacion. Como la
mayoria de la poblaci6n de edad avanzada no goza
de seguridad social, recurrird a los servicios del
Ministerio de Salud Pfiblica y a privados para
tratamiento. La situaci6n de la poblacion indigena
es desfavorable; gran parte de ella no busca
atenci6n medica estatal, y usa la terapeutica
indigena traditional. La poblacion campesina
ladina tampoco se ha incorporado a los servicios
medicos estatales. Los servicios geriltricos en el
pais son pocos y deficientes.

Ingresos
De 1,736 families del sector urban en 1969 un
77.1% s6lo recibia el 47.1% del ingreso total y el
22.5% restantes recibia el 52.9%. En el sector
campesino existe un deficit entire las entradas y el
presupuesto minimo de la familiar.

Trabaio familiar
El grupo familiar del altiplano (indigenas en su
mayoria) era mas stable y productive, mostrando
responsabilidad compartida. En la costa norte y la
region sur habia poca cohesion familiar y poco
sentido colectivo y cooperative (ladinos en su
mayoria). En el grupo familiar urban habia
desintegraci6n familiar, bajo ingreso percapita, y
falta de vivienda.

Recreacion
La recreacion debe ser investigada. El anciano
compare la recreation colectiva de la familiar
cuando continue incorporada a esta. En las
instituciones para ancianos hay programs de
recreaci6n, pero los asilados son muy pocos.

Educaci6n
Hay programs de alfabetizacion y educacion para
adults, lo que hace suponer que los viejos no son
excluidos de estos, pero se require investigarlo.

Convivencia IgWl
Hay poca informaci6n en lo concerniente a la
situaci6n rural de los ancianos que "se quedan atras"
debido a las migraciones. Sin apoyo familiar, los
ancianos solo pueden sobrevivir trabajando hasta
que lo permitan sus energies.

Legislacion
La legislaci6n guatemalteca discrimina entire
indigenas y ladinos. En estas leyes, expresibn de la
cultural occidental dominant, el indigena adapta su
conduct a lo normado por otra cultural.


El C6digo de Trabajo ofrece indemnizaci6n en
caso de despido por enfermedad, invalidez, o por
edad avanzada; las pensions deben ser cubiertas
por el Institute Guatemalteco de Seguridad Social.
Las leyes civiles excusan a las personas de 65 aiios
de ejercer tutela y protutela; segun el C6digo Penal
no estan obligados a trabajar los reclusos mayores
de 60. La Ley electoral releva de la obligacion de
votar a mayores de 70. La Ley de Servicio Civil da
derecho a jubilacion a los trabajadores del Estado;
y el Escalaf6n Militar preve edades de retire para
oficiales y el Instituto de Previsi6n Militar da
derecho a jubilacion y pensions por invalidez y
sobrevivencia (Constituci6n, 1985).


Seguridad Social y Pensiones de Vejez

Las pensions merecen consideraci6n aparte. A
Scontinuaci6n se indican las caracteristicas de los
regimenes de previsi6n social establecidos en el pais
que otorgan prestaciones a la vejez.

Institute Guatemalteco de Seguridad Social (IGSS)
El IGSS, creado en 1946, asiste en los siguientes
casos: (a) accidents de trabajo y enfermedades
profesionales; (b) maternidad; (c) enfermedades
generals; (d) invalidez; (e) orfandad; (f) viudez; (g)
vejez; (h) muerte (gastos de enterramiento); (i) los
que los reglamentos determine (IGSS, 1946; 1946;
1953; 1967; 1969).
El IGSS ha ido desarrollando estos programs
gradualmente. En 1948 se comenzo el program
para cubrir accidents dentro y fuera del trabajo;
luego se pusieron en vigor los programs de
protecci6n materno infantil (1953), los de
enfermedades generals (1968) y los de protection
para invdlidos, vejez, y sobrevivencia (1977).
El reglamento sobre la cobertura de estos
riesgos, sobre pensions de vejez establece normas,
entire ellas:
1. Para tener derecho a pension deben
acreditarse 180 meses de contribution. No
obstante, para iniciar el program protegiendo a los
que se aproximaban a los 65, solo se exigieron 12
meses.
2. La edad requerida es 65; el retire no es
obligatorio. Dicha edad es de 60, cuando hay
riesgo a la salud o la vida y cuando el afiliado se
encuentra en desempleo forzoso durante 12 meses
consecutivos.
3. En casos de invalidez, son suficientes 36
meses durante los seis aiaos previous para adquirir
derecho a prestaciones.
4. El financiamiento del seguro se cubre con
el aporte patronal de 3% del salario, 1.5% del
salario de los trabajadores y un 25% per parte del
Estado.
5. Incluye todos los afiliados al R6gimen, pero






de los trabajadores del gobierno central s6lo incluye
a los pagados por planilla. Ello debido a que los
trabajadores con plaza fija, tienen un regimen de
protecci6n que otorga pensions.
6. El monto equivale al 40% de la
remuneracion base, teniendo adiciones de 0.5% por
cada cuatro meses de contribuci6n del asegurado
sobre los primeros 120 meses de contribuci6n.
7. Hay asignaciones familiares adicionales
equivalentes al 10% por el c6nyuge invilido, o por
su compafiera o compafiero invalido.
8. Tambien se otorga un 10% mas por cada
hijo menor o incapaz que exista en el moment de
la pension.
9. Incluyendo la asignaci6n familiar, el monto
de las pensions de vejez o de invalidez no puede
exceder del 80% de la remuneraci6n base.
10. Las pensions son vitalicias y cubren a las
viudas, esposas o mujeres de hecho y a esposos
invdlidos, equivalent al 50% de la pension
correspondiente al causante por invalidez o vejez.

R6gimen de Clases Pasivas del Estado (Gobierno
Central)
Este regimen establecido en 1932 tiene las
siguientes caracteristicas:

Retiro voluntario. Este retire puede
adquirirse mediante: (a) 30 aiios de servicio a
cualquier edad; (b) al cumplir 55 afios, si se
acreditan 10 afios de servicio; y (c) 20 afios de
servicio a cualquier edad (y bastan 10 aiios cuando
se ha llegado a los 50), para personal del Ministerio
de Educaci6n.
Retire obligatorio. El derecho puede
adquirirse por retire obligatorio al cumplir 65, si se
acreditan 10 afios de servicio.
Pensiones d viudez. Las pensions de
viudez incluyen a la viuda o c6nyuge de hecho
como al viudo legalmente incapaz. El monto de
dichas pensions es equivalent al 100% del monto
que corresponde al causante.
Monto de la Pensi6n. La pension inicial
equivale al 33.75% del promedio mensual de los
sueldos de los ultimos cinco alios, con incrementos
conforme al tiempo de servicios prestados de 10 a
35 afios o mas, entire el 33.75% y el 90%, sin poder
exceder de Q.500.00 (Ley de classes, 1970).

Otros Regimenes Estatales de Pensiones
La Universidad Aut6noma de San Carlos, la
municpalidad de la capital, y el Ejercito son
instituciones descentralizadas del Estado con sus
propios regimenes de previsi6n social. De hecho
sus regimenes de protecci6n a la vejez e invalidez
preceden los que el IGSS estableciera en 1977.
Coexisten en el pais various sistemas de pensions.
Algunos trabajadores de tiempo parcial han
cotizado en varias instituciones, con la posibilidad


de recibir mis de una pension. Los sistemas de
previsi6n social son recientes y por ello los viejos
pensionados son minoria.


Servicios Medicos y Sociales


Servicios Medicos
La asistencia medica corre a cargo de los viejos o
de sus familiares, salvo casos en los que se les
protege por invalidez en algunos regimenes de
previsi6n social. Cuando no tienen recursos acuden
a hospitals del Estado que dependent del Ministerio
de Salud Piblica. El IGSS elabor6 un proyecto para
otorgar prestaciones a los pensionados del Regimen
y los pasivos del Estado; se hizo realidad
constitutional en 1985.

Servicios Sociales
En la Division de Bienestar Social del Consejo de
Bienestar Social de Guatemala, una comision
integrada por trabajadores sociales, el director del
Centro Geriatrico Nacional y el doctor Jorge Luis
Arriola, coordinator, hizo en 1958, un studio
sobre la asistencia gerontol6gica en el pais (Consejo,
1959). Ademas de informar sobre los cetnros
estatales y privados existentes en el pais, ofreci6
recomendaciones para mejorar los servicios sociales.
En 1982 el Comite Nacional para la celebration
del Afio Internacional del Envejecimiento realize
otra investigation registrando la capacidad de las
instituciones de internamiento (Lemus Orellano,
1982). Se establecio que habian 14 instituciones
que ofrecian servicios a un total de 757 ancianos
(251 hombres; 506 mujeres). Ocho de 6stos estaban
concentrados en el Departamento de Guatemala, y
los otros seis distribuidos entire cuatro
departamentos.

Recomendaciones sobre Asistencia Gerontologica
El studio de asistencia gerontologica en Guatemala
realizado por el Consejo de Bienestar Social en
1958, recomend6 labores de recreation y terapia
ocupacional, ademis de servicios religiosos.
Ademis, el studio recomend6: (a) centros
regionales en cinco zonas del pais; (b) medidas para
mejorar servicios, ampliando presupuestos,
especializando personal, y creando talleres que
remuneren a los ancianos rehabilitados; (c)
colocaci6n familiar para ancianos con recursos y
para indigentes; (d) subsidiary families supervisadas;
(e) incorporar al medio familiar a las personas
internadas que tengan parientes cercanos; (f)
colaboraci6n con los servicios del Estado y del
IGSS; (g) adoptar los "Derechos de la Ancianidad."
Casi todas estas recomendaciones han sido
ignoradas, pero parecen igualmente vdlidas hoy
como lo fueron en el afio 1958. Por eso hacemos







hincapi6 en ellas. Afiadimos a 6sto la necesidad de
investigation en areas relacionadas con la vejez y la
necesidad de enfatizar la promotion de la salud y la
prevenci6n de enfermedades en la vejez.


Referencia
Aguilar Arrivillaga, E. Estudio de la vivienda rural en Guatemala.
Revista Guatemala Indfiena. 1980, 15(34).
Arias, J.B. Asaectos demograficos de la poblaci6n indfgena en
Guatemala. IV Congreso Indigenista Interamericano,
Guatemala, 1959.
CELADE. Boletin bibliogrifico. America Latina: Tasa global de
fecundidad vor Daises. Trabajo presentado por ante el
Seminario sobre Poblaci6n en Tercera Edad. Costa Rica, 1978.
Consejo de Bienestar Social de Guatemala. Introducci6n al
studio de la asistencia gerontol6gica en Guatemala.
Guatemala: Editorial del Ministerio de Educaci6n Publica,
1959.
Constituci6n de Guatemala decretada por la Asamblea
Constituyente, 1985.
Girard, R. Origen y desarrollo de las civilizaciones antiguas de
Amrica. M6xico: Editores Mexicanos Unidos, S.A., 1977.
IGSS. Ley Orrnica. Guatemala: Autor, 1946.
IGSS. Reglamento sobre protecci6n relative a accidents en


general. Guatemala: Autor, 1949.
IGSS. Realamento sobre protecci6n materno-infantil. Guatemala:
Autor, 1953.
IGSS. Reglamento sobre protecci6n relative enfermedad-
maternidad. Guatemala: Autor, 1967.
IGSS. ReKlamento sobre protecci6n relative a invalid. vejes.
sobrevivencia. Guatemala: Autor, 1969.
IGSS. Bases vara la aplicaci6n de los programas de enfermedad.
maternidad, X accidents a pensionados nor iubilaci6n. vejie e
invalides. Guatemala: Autor, 1979.
International Population and Urban Research Center, University
of California. Crecimiento de la' oblaci6n X desarrollo
econ6mico social en Guatemala. Berkeley: Autor, 1967.
Congress de la Republica de Guatemala. Ley de clause pasivas
civiles del estado, Decreto 28-70. Guatemala: Autor, 1970.
Lemus Orellano, G. Cuadro informative de instituciones gue
vrovorcionan asistencia a ancianos a nivel national.
Guatemala: Secretaria de Bienestar Social de la Presidencia,
1982.
United Nations. The world agin situation: Strategies and
policies. New York: Autor, 1985.
Sequic, R. La familiar indirena. Trabajos del Primer Congreso
sobre la Familia, la Infancia, y la Juventud y su Participaci6n
en el Desarrollo. Guatemala: Tipografla Nacional, 1972.








COMO SON ATENDIDOS LOS ANCIANOS EN BOLIVIA


Elias Crespo-G6mez
Cochabamba, Bolivia


Abstract

The author opens with a brief description of the
factors which have left the elderly of Bolivia in a
desperate state. One of these factors is the constant
economic depressions which have plagued Bolivia
for years. For example, the average monthly
national security pay for an elderly person is USS15
to $20, with which it is impossible to survive.
Because the elderly often find themselves in
financial straits, they may choose to continue
working well past the regular retirement age.
Many aging Bolivians resist the notion of
moving into a home or institution for the elderly.
They do not like the idea of moving into a strange
atmosphere and prefer being in their own
communities. The role of the Bolivian "Pro-Life"
Foundation of Assistance to the Elderly of the City
of Cochabamba. is to bring services to the elderly
in their communities. Some of the services offered
are occupational therapy, exercise, recreation, and
some alimentation.
The author also describes the two housing
establishments available for the elderly of
Cochabamba. Both are run by nuns who have had
special training in caring for the elderly. Despite
the efforts of all those working for the elderly,
however, the author laments that the problems
facing the poor of his city are far from being
solved. His hope for the present is that his
organization can eventually develop the ability and
power to address these problems.


Impacto de la Situaci6n Econ6mica
sobre la Ancianidad

De acuerdo a algunas estadisticas muy antiguas,
el promedio de vida en Bolivia es de 45 afios. Esta
determinaci6n se ha hecho tomando en cuenta a los
trabajadores mineros, quienes por su ocupaci6n y la
poca atenci6n de los empleadores en medidas de
seguridad y asistencia, ha determinado que esos
organismos se consuman muy rapido llegando por
los 35 aifos mdximo de vida util. Quienes
sobreviven a esa edad estIn en condiciones
deplorables sin poder abastecerse a si mismos,
constituyendo una carga para la familiar y para el
Estado. Como una contradicci6n a este promedio
de vida, la ley de Seguridad Social determine la
edad de 55 afios para la mujer y de 60 para el


hombre, como limited minimo para acogerse al
seguro de vejez o jubilaci6n, como mds
comunmente se conoce.
Antes del period inflacionario que ha vivido
Bolivia, las personas que llegaban a este limited de
edad buscaban afanosamente su jubilaci6n para
poder ocuparse en otras labores, mantener su hogar
y sus propias comodidades, gozando de un double
sueldo a espaldas de disposiciones legales. Durante
el tiempo del period inflacionario, que ha durado
por espacio de cinco afios, ningun empleado queria
jubilarse y procuraban mantenerse en el cargo el
mayor tiempo possible; asi encontramos a muchos
trabajadores de 65 y hasta de 70 afios en el
ejercicio de sus funciones, determinando un
decaimiento de sus actividades y una pobre imagen
del "funcionario piblico" especialmente.
Los gobiernos de Bolivia se han caracterizado
por su constant depresi6n econ6mica, raz6n por la
que siempre han dejado en el olvido sus principles
obligaciones: atencion educativa, atencion sanitaria,
atencion a nifios desamparados y sobre todo,
atenci6n al anciano. Todos estos rubros han sido
atendidos a medias o en condiciones tan precarias
que no cubren las expectativas de las sociedades
modernas; de ahi que nuestros pueblos se debate
en situaciones visiblemente contradictorias,
deprimente para las mayorias y ostensiblemente
holgadas para grupos reducidos. Para tener una
idea de las desigualdades indicamos que el sueldo
mensual de un representante national esta por los
Bs. 3,000 y el salario bdsico national es de Bs. 50.
El seguro de vejez, siempre menor que un
salario vigente, oscila entire los Bs. 30 y 40
mensuales, que correspondent a US$15 y $20
respectivamente, con lo cual es dificil sobrevivir
atendiendo solo alimentaci6n y, en la mayor part
de los casos deben pagar un alquiler mensual de
vivienda. La gente de escasos recursos busca
afanosamente ocuparse en actividades productivas
que les permitan subvenir sus necesidades. Muchas
de estas personas, especialmente mujeres, se
dedican al comercio pero en muy pequefia escala.
Sin embargo, entire la gente de escasos recursos
existed una resistencia de albergarse en un hogar o
asilo de ancianos, ya que lo consideran lo uiltimo
que les pueda ocurrir, pese a que saben que alli
pueden tener mejor vivienda y mejor alimentaci6n.
No les gusta la idea de star en un ambiente
desconocido, regidos por normas, por lo que
prefieren permanecer en sus vecindades, aun en la






miseria. Es pues, necesario, desarrollar programs
para servirles en el seno de sus comunidades.


Programs para Ancianos

En Cochabamba hay dos instituciones de
ancianos que reciben apoyo financiero del Estado:
el Hogar de Ancianos San Jos6, y el Asilo de
Ancianos El Buen Pastor. Ambos son atendidos por
religiosas con studios especializados en asistencia al
anciano que laboran con verdadera vocacion y
entrega en pro de los residents. Ambas
instituciones funcionan con un minimo de ingresos.
El estado da una contribucion promedio de Bs. 0.45
diario por persona, equivalent a US$0.22, lo cual
reaulta insuficiente aun para la alimentacion de los
interns. Afortunadamente, se cuenta con la
colaboracion de Cdritas y con donaciones del
comercio y otras instituciones, de quienes las
religiosas solicitan ayuda peri6dicamente. Pero, en
general, la situacion economic es precaria.
Entre las dos instituciones hay 204 plazas. El
Hogar alberga 120 personas, 90 mujeres y 30
varones. En el Asilo hay 84 interns: 47 mujeres y
37 varones. Un gran porcentaje de ancianos son
invalidos y algunos padecen enfermedades mentifes
menores.
En ambas instituciones hay demasiadas
solicitudes de plazas para mujeres, y muchas son
rechazadas por falta de espacio. En cambio, para
varones hay plazas vacantes. Las mujeres se
adaptan mejor que los hombres a la vida
comunitaria y a las normas vigentes. En los
hombres se percibe much intranquilidad, y muchos
optan por dejar la instituci6n una vez se sienten
saludables, aun cuando en su mayoria regresan al
sentirse de nuevo enfermos o delicados de salud.
Ninguna de las instituciones cuenta con talleres
o lugares de trabajo, lo cual es fundamental, ya que
los mismos interns podrian colaborar con algunas
labores de mantenimiento del edificio, o de los
servicios que disponen. Algunos interns ayudan
en el aseo y arreglo de sus propios ambientes, sin
ser cosa obligatoria. Pero si hubiera un component
de terapia ocupacional y actividades recreativas la
adaptaci6n a los hogares seria mayor.


La Labor de Pro-Vida

La Fundaci6n Boliviana Pro-Vida de Asistencia
al Anciano de la ciudad de Cochabamba, de la cual
soy miembro, trata de Ilevar un aliento de vida util
a personas de la tercera edad. La filosofia de Pro-
Vida es reunir a personas de edad avanzada, en lo
possible del mismo grupo o cultural, para que
conversen sobre temas de interns comun.
Asimismo, intentamos llevarles a estas personas


asistencia de terapia ocupacional, ejercicios fisicos
adecuados, recreaei6n, asistencia sanitaria, y alguna
alimentaci6n.
En el afio que tenemos trabajando, ya hemos
formado dos clubes de ancianos en barrios
marginales. Uno de ellos cuenta con 20 miembros,
15 mujeres y 5 hombres. El otro dispone de 10
miembros, 7 mujeres y 3 hombres. (Ya se perfila
que las mujeres son mas cumplidas en su asistencia
a las reuniones semanales que los varones). Nuestro
equipo de voluntarias esta trabajando con todo
entusiasmo, asistiendo a las reuniones, llevdndoles
algo de terapia ocupacional, recreacion, y atencion
m6dica que es prestada por dos galenos socios de
Pro-Vida. Tenemos el convencimiento de que en
todos los barrios pobres de la ciudad podremos
former clubes de ancianos para llevarles alegria y
bienestar en la media de nuestras posibibilidades,
las que al moment se general con las cuotas
mensuales de los socios.
Hemos hecho tambien visits a las instituciones
existeites, el Hogar y el Asilo antes mencionados.
Alli hemos llevado a los interns algo de terapia
ocupacional-iW&i, costuras, otras manualidades, y
un po'eo F~.'f ereti6cn, con-' resultados muy
positives. Lasreligiosas nos han reportado que
muchas personas estdn atentas a sus nuevas
ocupaciones y hay mas tranquilidad en el hogar.
Tambien nos ha tocado colaborar con el Asilo,
colocando rejas de seguridad hacia una calle por
donde se habian entrado ladrones; hemos colaborado
en el arreglo y pintura de una parte de la fachada.
En fin, la misi6n de Pro-Vida es desarrollar
programs dentro de las comunidades, al tiempo
que ofrecemos algun apoyo a las instituciones ya
existentes y a los ancianos que alli se albergan.


Conclusion

Estamos convencidos que pese a la pobre
asistencia m6dica en general, la longevidad viene
aumentando y el numero de ancianos es cada vez
mayor. Con la vejez esta ocurriendo algo similar
que con la educacion. La explosion demografica de
la nifiez y la juventud ha sido un fen6meno no
atendido por el gobierno. Los locales escolares que
atendian a un colegio o escuela, hoy albergan a tres
colegios o escuelas dismuyendo las horas de classes:
un colegio en la mafiana, otro en la tarde y otro en
la noche. En cuanto a instituciones de ancianos,
estos dos hogares han existido desde hacen mas de
50 aiios. No hay aumento de hogares de ancianos
donde se preste atenci6n urgente y necesaria a
personas de la tercera edad. Hay ancianos en los
barrios pobres que llevan una existencia
infrahumana, alimentAndose de desperdicios que
buscan en las basuras y durmiendo en lugares
publicos.






Las rentas de vejez son miserables, equivalentes
a SUSIO 6 a SUS20 en su mayor parte, por lo que
los viejos no pueden darse el lujo de descansar y
siguen buscando alguna ocupaci6n rentable que les
permit vivir. Muy poca gente dispone de una
renta median que le permit dedicar su tiempo
libre a alguna instituci6n de servicio.


Confiamos que nuestra instituci6n sea mas
grande y mas conocida en nuestro medio y
alcancemos a contar con la colaboracion de personas
generosas y de gran sensibilidad social que nos
ayuden a salir adelante en esta labor que nos hemos
impuesto: asistir al anciano.








ANCIANO Y SOCIEDAD EN LA ARGENTINA


Maria Julieta Oddone
Buenos Aires, Argentina


Abstract

The study summarizes an investigation which
addressed three separate issues regarding aging in
Argentina: (a) sociodemographic and economic
characteristics of the population over 60; (b)
exchange networks of the elderly in different
regional contexts; and (c) analysis of the image of
the elderly in textbooks and in the Argentine theater.
The population of those 60 and over is
increasing, which poses increased demands for
goods and services. At present, the majority of the
elderly live in private homes. However, increasing
need for institutional/medical services has caused
migration to urban areas.
Case studies were carried out in urban and
rural areas to investigate networks of exchange and
mutual aid between the elderly, their families,
neighbors, and friends. Though family networks
remain important in both settings, neighbors and
formal institutional care substitute in the urban
settings when families do not live close enough for
daily interaction. Extended family networks are
active in the rural areas.
The image of the elderly as reflected in
textbooks and the Argentine theater has changed
over the course of the century. The past image of
the elderly as respected family members
transmitting basic cultural values is being replaced
by an image of the. aged as a burden and a problem
for families and society.


Aspectos Socioecon6micos y Demograficos
del Envejecimiento

La realidad socioeconomica argentina se
caracteriza por un estancamiento de su aparato
productive desde hace una d6cada. Esto tiene
repercusiones en los indicadores utilizados para
medir el bienestar de los pueblos (e.g., PBI,
desocupaci6n), y en el caso argentino significa
retroceder a los correspondientes al 1970 para
encontrar indices similares. Debemos sumarle la
presi6n de la deuda externa que no se origin en
inversiones productivas y cuyo cumplimiento
autoalimenta al receso economic y social.
Argentina tiene una poblaci6n altamente
envejecida, alcanzando en 1980 al 11.8% de
personas mayores de 60 sobre el total de la
poblaci6n. Este porcentual implica 3,298,287


ancianos (Instituto de Estadisticas y Censos, 1980) y
se prev6, para el afio 2000 un 15%, o sea, 5,476,000
personas.
Los datos sobre el envejecimiento poblacional
indican que habra un incremento de la demand de
bienes y servicios; mayor saturaci6n del sistema de
seguridad social y una sobrecarga para los demas
sectors; produciendo una segura modificacidn de
los actuales sistemas previsionales, laborales,
sanitarios, y educacionales.
Los especialistas aconsejan estimular a los
trabajadores para que permanezcan en su empleo el
mayor tiempo possible. Los acontecimientos propios
de la recesi6n mundial y las elevadas tasas de
desempleo han facilitado la anticipaci6n de las
edades jubilatorias con el consiguiente peligro para
el sistema. No escapa a este fen6meno la
Argentina.
Segun datos del censo de 1980, la poblaci6n
econ6micamente active (PEA) disminuy6. Esto se
explica ya que la poblaci6n se inserta en el mercado
laboral a edades mas tardias y se retira mas
temprano. La poblaci6n de 65 y mis redujo su
participaci6n laboral del 21% al 10% entire 1960 y
1980 (INDEC, 1980).
Asimismo, aumenta la proporci6n de jubilados
y pensionados. Esta categoria creci6 del 12% al
20% de los no activos en los iltimos 20 afios
(INDEC, 1980). Esta situacion se explica por la
retraccion econ6mica y la desocupaci6n creciente ya
que los ancianos son liberados del mercado laboral,
participando cada vez menos en este y dejando los
puestos laborales a personas mas j6venes. El
aumento de la masa de jubilados y pensionados en
activo-pasivo es de 19 a 1. Ello implica un alto
costo para el sistema provisional y una disminuci6n
de las remuneraciones del sector.
La disminuci6n de la PEA, la reducci6n de
aportantes al sistema de previsi6n social, el lento
crecimiento vegetative, y el incremento de
jubilados y pensionados, produce una caida de los
ingresos de estos ultimos disminuyendo la calidad
de vida.
Esta situaci6n es generalizable a toda la masa
de jubilados y pensionados; pero delimitaremos
aquel sector de la poblaci6n que no puede cubrir
sus necesidades basicas. El Instituto de Estadisticas
y Censos (INDEC) elabor6 indicadores para definir
el concept "necesidades basicas insatisfechas" (NBI)
en base a datos del censo de 1980. El 20% de la
poblaci6n de 65 y mds cae en la categoria de NBI.






Del total de argentinos en tercera edad, mas de
la mitad (52.2%) son analfabetos o semianalfabetos
porque dejaron inconclusos sus studios primaries
(39.8) o porque nunca asistieron a la escuela (12.5).
Un tercio (32.2) presentan studios primaries
completes, un 11.6% logr6 un nivel de studios
medio o secundario, y el 2.9% fue a la universidad
o a otro nivel superior. Alrededor de 1.1%
participa en algun program educativo (Hernandez,
1982).
Nos centraremos en aspects rurales-urbanos y
especificamente sobre aquellos datos del Censo 1980
de las dreas geograficas donde se efectuaron las
entrevistas. Los cambios en la estructura por
grupos de edades presentan diferentes
caracteristicas segun su origen rural o urban, ya
que la proporci6n de mayores de 60 es mas elevada
en las dreas urbanas que en las rurales. En cuanto
al sexo, hay un desequilibrio a favor de las
mujeres--dada su mayor longevidad--y mayor
concentraci6n en areas urbanas.
Si bien la migraci6n de mayores no es
significativa, se registran situaciones no
despeciables de analizar. Estas se original en
acontecimientos importantes que ocurren en sus
vidas: jubilacion, muerte de conyuge,
imposibilidad de vivir independientemente. La
necesidad de servicios favorece el traslado de los
ancianos del campo hacia las zonas urbanas.
Las personas mayores de 60 en Buenos Aires,
representan el 20.4%, la mayor concentraci6n de
ancianos del pais. En el Gran Buenos Aires, hay
10.8% vs. 11.8% en el resto del pais. En las zonas
donde se realize el trabajo de campo, las tasas
varian segun su acercamiento a Buenos Aires,
correspondiendo las cifras mas altas a las
localidades mas cercanas y viceversa. (Avellaneda,
15.2%; Lomas de Zamora, 11.4; y Alte Brown,
9.5%).
En la Provincia de La Pampa, el porcentaje es
equiparable a la media del pais, 11.7% La zona es
rural con emigraci6n de j6venes; lo que se confirm
al analizar los datos de Chapaleufu donde se incluye
la localidad de Intendente Alvear, por lo que la
proporcion de mayores de 60 aumenta al 14.2%. Es
una poblaci6n envejecida por la migraci6n.
Hay mayor longevidad de mujeres en todas las
zonas analizadas, sobretodo en las urbanas. Los
niveles educacionales son bajos respect al resto de
la poblaci6n, menores en las dreas rurales, y deben
estar relacionados con la educaci6n asistematica que
recibieron los ancianos en el seno de la familiar
extensa o en el trabajo precoz, formas de "escuelas
t6cnicas" en esos tiempos.
El grueso de la poblaci6n de ancianos vive en
hogares particulares; los'que viven en hogares
colectivos incluyendo asilos, hospitals, y carceles,
son una minoria. La media del pais es de 2.14%,
con Buenos Aires alcanzando un 4%, lo que indica


que en las areas urbanas hay mayor tendencia a
internal a los mayores. Sin embargo, debemos
tener en cuenta que en la ciudad hay mas servicios
de salud y se atienden personas mayores de otros
lugares. Ademas, Buenos Aires concentra la mayor
proporci6n de ancianos del pais.



Ancianidad, Contextos Regionales, y Redes
de Intercambio

Asoectos Metodol6gicos
Para explorer mas a fondo el problema de la
ancianidad, las variaciones regionales, y las redes de
intercambio, Ilevamos a cabo una investigaci6n de
campo. La sociologia de la vejez ha brindado
valiosas generalizaciones que permitieron
desmitificar y avanzar sobre el tema (Hernandez,
1980; Muchinik, 1983; Oddone, 1979). Sin
embargo, la necesidad de un conocimiento mas
profundo de los ancianos y su modo de vida, nos
Ilevo a usar metodos antropol6gicos para
introducirnos en su realidad cotidiana (cf. Bagalau
& Taylor, 1975). Determinamos que el m6todo mas
adecuado era el studio de casos..
En la investigaci6n realizada efectuamos
entrevistas y logramos histories de vida de 48
ancianos (24 hombres y 24 mujeres) ubicados en
tres comunidades (Buenos Aires, conurbano
bonaerense, e Intendente Alvear de la regi6n
pampeana) y de cuatro classes sociales (baja, media
baja, media media, media alta). Para seleccionar
las comunidades se tomo en cuenta los dos ejes
socioecon6micos que caracterizan la region: cord6n
industrial y area rural.
Como representative del medio urban optamos
por Buenos Aires. La Capital Federal tiene todas
las caracteristicas de grann ciudad" donde las
relaciones sociales y multiplicidad de contacts
secundarios dan lugar a formas de aislamiento
social, en especial para los ancianos, quienes poseen
mas tiempo libre y padecen el abandon sistematico
de roles sociales.
La segunda comunidad, el conurbano
bonaerense se destaca por "zonas mezcladas,"
industriales, residenciales, marginales, barrios
obreros, y grandes centros comerciales. Predominan
las casas bajas y el "barrio" como modo de vida
(sobre este t6pico vease Lef6vre, 1973). Es aqui
donde las relaciones cara a cara dan lugar a diversas
formas de solidaridad social.
Como ejemplo rural, trabajamos en Intendente
Alvear, en La Pampa, zona marginal (semiarida) y
drea agricola ganadera mis favorecida de la
provincia. Esta comunidad present un marcado
envejecimiento de la poblaci6n (14%) motivado por
la emigraci6n de !a poblaci6n econ6micamente
active, important factor seialado por la Asamblea







Mundial del Envejecimiento (ONU, 1982).

Marco Teorico
La relaci6n como intercambio commercial. El
marco conceptual de nuestra investigaci6n es la
teoria del intercambio. Esta teoria, segun Dowd
(1980) a partir de Homans (1967), visualiza la
interacci6n social como un intercambio de
recompensas entire dos actors sociales (individuos o
grupos). Similar a transacciones economicas de
dinero por bienes y servicios, en el intercambio
social el "dinero manda". La parte que en la
relaci6n de intercambio posea el mayor grado de
poder social es la que control la tasa de
intercambio y la distribuci6n de recompensas o
provechos. Este esquema aplicado a la vejez,
predice grades de interacci6n y compromise
dependiendo del relative poder de los ancianos con
las fuentes de recompensa, y donde el miembro mas
poderoso dicta los terminos de la relaci6n.
Critico en esta teoria es la reduccion de cada
interacci6n a un "acto commercial Queda asi fuera
la dimension afectiva y simb6lica de las relaciones
sociales.
La relaci6n como intercambio afectivo.
Nosotros buscamos herramientas conceptuales mas
comprensivas al problema de los ancianos,
centrando la atenci6n en el desarrollo de su vida
cotidiana. Aqui las unidades familiares mantienen
redes de reciprocidad y ayuda mutua; de
intercambios con parientes, vecinos, y amigos, que
coadyuvan en las tareas ligadas de sus miembros
(Lomnitz). Definiremos tales redes como: "aquellas
que se establecen entire parientes, vecinos, y amigos
a fin de intercambiar bienes y servicios." El amor
y la obligaci6n moral forman parte de estos
intercambios.
Estos sentimientos son puestos a prueba por las
condiciones materials de existencia (ingresos,
vivienda, salud) y general tensions. Las political
publicas deben tener en cuenta ambas fases de esta
problematica: la existencia de estas redes y las
tensions. La jubilaci6n y los servicios sociales han
favorecido la independencia de los ancianos con
respect a sus families en cuanto a su
autoafirmacion y/o mantenerse en su propio hogar.
Pero las necesidades socio afectivas e incluso
materials expresadas en bienes y servicios son
satisfechos a trav6s de este sistema de redes; de alli
que la familiar nuclear pura no exista entanto se dan
formas de familiar extensa modificada, ampliada, y
casos claramente individualizados de familiar
sustituta con el aporte de amigos y vecinos.
Tales redes de reciprocidad cumplen funciones
de seguridad social y protecci6n. Dan a los
ancianos estabilidad y seguridad, en moments en
que las continues perdidas y la declinaci6n fisica
hacen que la possible ayuda o aun el powder recurrir
a otro, se constituya en recurso organizador de vida


y en "estrategia de supervivencia."
Las relaciones de parentesco surgeon con mayor
frecuencia y durabilidad temporal. Pero en casos
de "ancianos solos" tambien son de vital importancia
las redes de reciprocidad vecinales que suplen con
frecuencia y eficacia a las parentales y a las sociales
comunales.
A largo plazo, los intercambios generacionales,
la ayuda prestada por los padres en el process de
crecimiento y formaci6n de los hijos, es devuelta
por 6stos como protecci6n en la vejez. Son
intercambios normativos de obligaciones morales:
"porque son mis padres...", "ellos me dieron la
vida...", "ellos me criaron..." formas mis corrientes
de explicar tal intercambio.
Vale el intercambio como vinculo en si mismo.
La relaci6n se constitute en un proposito por la
necesidad cotidiana o material o por valores y
normas sociales.
Esta naturaleza del intercambio no Ileva a una
situation de "compliance" como unica alternative de
espacio social de los ancianos, sino que tales
intercambios son el "capital" de los viejos, a trav6s
de redes de reciprocidad, constituyendose estas
redes, que exceden a las familiares, en la base del
sistema de seguridad. Esta organizaci6n es valida
para todos los sectors sociales aunque cambie el
contenido de los intercambios.

Hallazeos de la Investigaci6n
Como product de nuestra investigaci6n podemos
clasificar las formas de organizaci6n de la familiar
de los ancianos en nuestra muestra de la siguiente
forma:

I. Buenos Aires y su conurbano Altaa urbanizaci6n)
A. Hoear nuclear redes caracteristicas de familiar
extensa modificada. Families con
acercamiento geografico cercano. Interaccion
fluida y continue, aun en edificios torre y
departamentos.
B. Redes comunitarias. forms d& families
substitutes:
1. Espontanea (ej. habitantes de un edificio).
2. Institutional.
a. Espontanea (ej. institution religiosa que
deriva en un sistema de organizaci6n para
la vejez).
b. Institucional (ej. clubes para la tercera
edad).
II. Comunidad, families campesinas (areas rurales)
A. Familiar extensa. extensa modificada v
troncal (como formas comunes).
B. Families en reemolazo.
1. Con hijos migrants pero interacci6n fluida
a trav6s de viajes, envies de dinero (Caso I.
Alvear).
2. Con crianza de nietos, hijos migrants.
(Caso Santiago del Estero).






C. in redes: Soluci6n institutional. (Caso
peones de la region pampeana y golondrinas
que por el trabajo solitario, no forman nunca
una familiar stable y Ilegan a la ancianidad
sin redes).

Pasaremos ahora a la tercera parte de nuestro
trabajo, adonde exploramos los cambios
experimentados por la image de la vejez a traves
de medios de socializaci6n como lo son la literature
y el teatro.

La Vejez a Trav6s de la Literatura y el Teatro
(1880-1980)

El Anciano e la Literatura

Los medios de socializaci6n de mensajes que
responded a los valores imperantes en un moment
hist6rico-social determinado, consolidan la image
y rol asignado de y para los actors sociales, grupos
de ellos, en este caso, de los ancianos.
El analisis de contenido de los mensajes de este
siglo, permitira profundizar sobre el problema de la
ancianidad en relacion a la imagen que de ella tiene
y transmite la sociedad, su autoimagen, y su rol.

Los Libros d Lectura de Principios de Si l a 1940
En esta 6poca la vejez es uno de los temas
centrales. Encontramos los matices mas ricos y
variados para el analisis de la vejez, y reflexiones
profundas sobre el tema. Los ancianos ocupan
diversos roles y situaciones; dictan las normas,
sustentadas por tradiciones y experiencias. Se
ensefia al nifio a ver en el anciano su future y el
forjador del present.
El anciano es fuente de respeto. Aun en casos
de marginalidad social, "pobres viejos
abandonados," donde la caridad suplia el beneficio
jubilatorio. Para referirse al hombre de la tercera
edad, se usa la palabra anciano. La palabra viejo,
s6lo es utilizada cuando la precede un adjetivo, no
en forma peyorativa, sino al contrario.
El tipo de familiar predominante es la amplia;
conviven tres generaciones, se envejece en familiar,
y es normal que los hijos se hagan cargo de sus
ancianos. Es el modelo mas incrustado en la 6poca.
La image de vejez en la que se educaron los
ancianos actuales, no es la de una vejez active. Por
el contrario, tiende a representarsele como a un
"pobre viejo": d6bil, enfermizo, pasivo, y cansado.
Pero debe ser y es respetado, y son seguidos sus
consejos. La vitalidad del anciano esta en su
experiencia; el ser fisico desaparece en cuanto tal.
Aparece el anciano como transmisor de valores
fundamentals, los que siempre existieron y
existiran. Cumple con el rol de abuelo, pero es mas
que eso: dicta y transmite valores, realize una
funci6n social. Tiene cabida en la sociedad.


D6cadas del 1940 del 1950
En este period comienzan a tener vigencia otros
sectors de la sociedad que se visualizan en las
imagenes de abuelos obreros y jubilados.
Desaparecen de los libros de lectura la imagen de
viejo mendigo, comun en el anterior.
El tipo de familiar predominante continue
siendo la familiar amplia--rural o urbana--aunque
en algunas lectures aparece la familiar nuclear,
vigente en la actualidad. La familiar amplia se hace
cargo de sus ancianos, pero ya empieza a aparecer
el anciano institucionalizado y el hogar de ancianos.
Una image frecuente es la del abuelo que
cumple con las funciones propias del afecto pero
que transmite los valores morales imperantes. Se
mantiene la imagen del viejo como sustentador de
la cultural.
Al mismo tiempo aparece un anciano active
que debe y necesita ocupar su tiempo libre--no
puede vivir sin trabajar; aparece una marcada
valorizaci6n del trabajo. Aparece tambi6n la
image del anciano minusvalido que necesita ayuda
y debe ser ayudado y protegido. Las imagenes de
esta epoca se correlacionan con los articulos sobre el
derecho a la asistencia, al trabajo y al respeto de los
Derechos de la Ancianidad vigentes en este period.

Eooca Actual
La epoca actual comienza alrededor de 1960 y se
caracteriza por cambios en el sistema de valores.
Coincide con una valorizaci6n de la juventud en sus
aspects externos (belleza fisica, modas, etc.). Se
transmite a los nifios una cosmovisi6n espacial.
Argentina es un trocito de planet, una realidad que
dice que el hombre fue a la luna y los nifois se
proyectan al afio 3000.
El tema de la vejez no se incluye en la mayoria
de los textos y en los que se incluye, las lectures no
suman mas que una o tal vez dos por libro. Los
"abuelos" cumplen un rol secundario pero son
respetados y queridos por los nifios, a quienes
miman.
La familiar es nuclear y ya no decide en ella:
los problems son tratados por los padres. El rol
que se les asigna es el de familiess de abuelos" que
visitan o son visitados por nietos.
Reflexiones sobre la vejez desaparecen;
tambien las ensefianzas sobre respeto y proteccidn a
los ancianos. Con cambios tecnol6gicos acelerados,
que se proyecta en un future espacial, los valores
que transmiten son "pasados de moda" y son
reemplazados en esta funcion por models mas
"j6venes y actualizados": la tia o el tio. Los
ancianos se quedan sin roles sociales. Son definidos
s6lo por el rol familiar de abuelos.

El Anciano en el Teatro

Desde fines del siglo pasado hasta los afios '30,







Argentina recibe el impact de la inmigracibn
masiva, cuya marca--problemas de integraci6n y su
repercusi6n para la sociedad--aparece en las obras
teatrales. Varias vertientes expresan las distintas
formas de integraci6n y_el costo social de este
process.
Desde principios de siglo, la mayoria de los
inmigrantes o los nacidos en el pais que
coexistieron con este process, tienen afios
suficientes como para ser ancianos y asi se los v6
representados en el teatro. Surgen una cantidad de
roles y situaciones que permiten recrear la imagen y
el papel que cumplieron en aquella epoca.
En la sociedad rural, el viejo criollo encarna
tradiciones y formas culturales autoctonas invadidas
por una "modernizaci6n agraria" que se impone a
traves del inmigrante europeo con trad-ici6n
campesina. El viejo inmigrante aparece
apropiandose--a partir de valores muy
economicistas--de la tierra. Ambos son los
representantes de dos cultures que se fusionaran,
simb6licamente--en el teatro--a partir del
casamiento de sus hijos, creando una nueva
identidad.
Estos viejos no son abandonados, son queridos
y viven en la familiar extensa. Son ancianos lucidos
y activos, que se reconcilian con el future.
Trascienden a la familiar y la propiedad.
Esto muestra el ascenso de los inmigrantes a la
clase media; se manifiesta en forma similar cuando
su ambito de expresi6n es lo urban. Los que
hicieron su fortune en el "trabajo duro"--rural o
urbano--con propiedad de tierra, o con comercio,
con ahorro extreme y logrando fundar una nueva
familiar con cierto poder econ6mico mayor que los
nativos, dan a sus hijos mayor educacion ("mi hijo
el doctor"). Logran un ascenso de clase a traves de
estos elements en una sintesis cultural de hijo de
inmigrante y criollo.
Estos viejos inmigrantes, tienen decision y
peso. Son consejeros y educadores, excediendo a
sus propios hijos y nietos. Transmiten valores
cumpliendo con la funci6n social de consultores.
Ante un problema, el viejo tiene el consejo exacto.


Esto es valido en una sociedad donde la experiencia
tiene valor y es aprovechada por los que vienen
atras.
Pero en el mismo period, el grotesco, se
muestra la otra cara de la moneda: El fracaso de
una generaci6n de inmigrantes, que se margin en
el conventillo. El grotesco esta representado por un
viejo, que queriendo hacer la America, se destruye
en un trabajo duro que no le permit salir de la
pobreza mis terrible. No puede dar a su familiar
fortune. Se destruye ya sea por si, o por sus
valores: lo que importa es llegar y no Ilega. Vive
culposamente en el seno de una familiar amplia y es
lucido y consciente de su propia destruccion. Es
superado por sus hijos que se van integrando a la
sociedad.
En la decada posterior disminuyen la cantidad
de apariciones de viejos como personajes centrales.
Los vemos aun como integrantes de la familiar
amplia y con el orgullo que produce el ascenso
social de los hijos, o de los mas jovenes (Vagni).
Son queridos y respetados y aparecen como el paso
necesario de una nueva generaci6n que accede a
mayores posibilidades dado el context sociocultural
y politico.


Refeandci
Bagalau, R., & Taylor, S. Introduction to qualitative research.
New York: John Wiley & Sons, 1975.
HernAndes, I. Sociedad industrial y tercera edad: El caso
Campana. Rev. Techint, 1980.
Institute de Estadisticas y Censo (INDEC), Censo de 1980.
Buenos Aires: Autor, 1980.
Lefevre, H. De la sociedad rural a la urbana. Barcelona: Editorial
Peninsula, 1973.
Muchinik, E. Hacia una nueva imaaen de la veies. Editorial
Belgrano, 1983.
Organisaci6n de Naciones Unidas. Asamblea Mundial sobre el
Envejecimiento. La poblaci6n senescente X el desarrollo rural.
Viena, 1982.
Oddone, M.J. et al. Actitudes y motivaciones asociadas a la
tercera edad. INSSJ y P., 1979.








LA VEJEZ EN LA CIUDAD DE BUENOS AIRES


Roberto Barca y Eva Muchinik
Buenos Aires, Argentina


Abstract

The first part of this work offers a
demographic profile of the aging population in the
Argentine capital of Buenos Aires. The authors
present data and descriptions of this group with
regards to gender, marital status, nationality,
education level, occupation, and health.
This is followed by a discussion of the current
situation presented within a framework of four
themes that the authors describe as common global
concerns for the elderly: housing, health, social
integration, and economics. In the final section the
authors summarize several initiatives on the part of
both the public and private sectors regarding
retirement benefits, health, and social welfare
programs.


Introducci6n

En este trabajo intentamos describir a los
ancianos en Buenos Aires en la d6cada del 80.
Utilizamos como datos fuentes y censos oficiales,
que nos permiten esbozar un perfil demogrdfico y
social de este important sector poblacional. Como
una gran ciudad, ecositemartificial, con dimensions
enormes y espacio privado pequefio, Buenos Aires
es centro de atraccion, consume, y diversiones. Se
trata de la capital de un pais en vias de desarrollo,
donde las condiciones ambientales (poluci6n,
limpieza, sanidad), culturales (bajo analfabetismo,
acceso gratuito a funciones) y de escasa tension
social (carencia de problems etnicos, seguridad)
permitirian una vida acceptable, pero donde aun
queda much por hacer en cuanto a problems de
vivienda, salud, integraci6n social, y recursos
econ6micos por parte de los sectors oficiales y
privados.


Datos Demogrificos sobre la Poblacl6n Anciana

Patrones Residenciales
Buenos Aires alberga 3 millones de habitantes, uno
de cada cinco mayor de 60 aflos. El 18% de la
poblacion anciana del pais vive en la Capital.
Federal. Desde hace 40 ailos Buenos Aires
mantiene una poblacion total stable, pero sus
miembros cada vez estin mis envejecidos. 594,000
personas mayores de 60 afios, equivalentes al 20.4%


de la poblaci6n total forman la poblaci6n; de ellos
159,000 tienen 75 y mis afios, mas de la cuarta
parte de la poblacion afiosa y nos plantean el
desafio gerontol6gico.
Mientras que en Buenos Aires, existen 83
varones por cada 100 mujeres los indices de
masculinidad a los 60 y 75 ailos descienden a 57 y
47 respectivamente, donde se sigue la tendencia
mundial de sobrevivencia femenina. En la
poblaci6n de 60 y mis aios; el 78.8% de los varones
y el 38% de las mujeres estan casados o unidos de
hecho. El comportamiento es diferente para ambos
sexos. En el caso del hombre, un 9% es soltero. El
porcentaje de mujeres que carece de pareja stable
es del 62%, de las cuales un 15% es soltera y el
resto viudas y separadas. Las casadas tienen alta
probabilidad de enviudar en los proximos afios. El
porcentaje de viudas aumenta de 41 a un 58% entire
los 60 y 70 afios.
El alto porcentaje de extranjeros entire la
poblaci6n ailosa represent un sector residual de
importantes corrientes migratorias de origen
europeo y de paises limitrofes que se establecieron
en el cord6n industrial rioplatense. El numero de
extranjeros de 65 y mas afios super al de los
natives hasta el censo de 1960 en la capital. Diez
aieos despues todavia los hombres de 65-69 aiios y
las mujeres de 80 y mas nacidas en el extranjero
superaban a los natives en numero y aun hoy hay
mas nacidos en el extranjero que portefios (oriundos
de Buenos Aires) en la poblaci6n de 75 y mis afios.
Buenos Aires tambien alberga ancianos provenientes
de migraciones internal coincidentes con la crisis
del afio 30 y la industrializaci6n del pais, de la cual
Buenos Aires fue el eje. El impact de esta
inmigraci6n masiva signific6 la introducci6n de
nuevas pautas culturales para la sociedad.
Esta es una de las razones por las cuales no se
pueden establecer models homog6neos de
envejecimiento, tanto en lo que respect a todo el
pais, como a Buenos Aires. No pueden hacerse
generalizaciones en cuanto a los models familiares
vigentes, ni de un modelo unico de integraci6n a la
sociedad urbana.

Educaci6n
El nivel educational en Buenos Aires es el mis alto
del pais. El 94.1% entire 60 y 64 arios y 97% de los
mayores de 65 asisti6 a la escuela primaria. S61o el
46% y el 48.5% respectivamente finalizaron,
convirtiendolos en un numero important de






"analfabetos potenciales" que superaria el 4.5% de
analfabetos para estos grupos de edad, que
puntualiza el Censo Nacional.
Los ultimos censos muestran un descenso del
analfabetismo. La poblacion anciana sigue esta
tendencia: 22.9% (1960), 18.3% (1970), y 13.6%
(1980). Finalizaron studios universitarios 8,500
personas que ahora tienen 65 y mas ailos. Tal vez
esten jubilados o cercano a ello aunque datos de
investigation mostrarian que la mayoria continue en
actividad hasta edad avanzada.

Trabaio y Jubilacion
Casi un 15% de la poblacion de 60 y mas sigue en
actividad, cifras que se duplican en los varones.
Esto supone al anciano como productor del ingreso
familiar. Las edades para la jubilaci6n son de 55 y
60 afios para las mujeres y 60-65 para los hombres.
En sectors de gran desarrollo tecnoldgico y en
fuerzas armadas las jubilaciones son mas tempranas.
Reciben beneficios previsonales el 50% de los
mayores de 60, el 63% de 65, y el 68% para los de
75 y mas. El numero de jubilados y pensionados es
parejo debido a los derechos sucesorales de esposa e
hijas solteras mas que a su participacion en el
mercado laboral.
Los jubilados que continian trabajando no lo
denuncian debido a que solo se permit el trabajo
en jubilados aut6nomos. Muestras de personas de
65-69 afios, informan que el 80% de este grupo
continue en actividad. Esto corresponde a sectors
con mayor nivel ocupacional y con mejores
condiciones de trabajo e incluye actividades
independientes. A pesar de su deseo de continuar
active, cualquiera sea el sector que pertenezca hay
escasas oportunidades y la discriminacidn en los
empleos aparece en edades mas tempranas que las
de la jubilaci6n. Casi un 14% de los hombres y el
42% de las mujeres de 75 y mas carecen de
beneficios jubilatorios. Esto significa 7,000
hombres y 54,000 mujeres en Buenos Aires. La
tendencia es disminucion de ancianos que trabajan
y aumento en la proporci6n de jubilados y
pensionados. La proporci6n entire los que aportan
al sistema provisional y los que lo perciben es de
1.8 : 1.
La carencia de oportunidades de trabajo no es
solo de la poblaci6n afiosa; el desempleo es de 8%,
pero existe una desocupaci6n no registrada y visible
que compite. Existe tambien "desocupaci6n
disfrazada."

Diferencias er Seeo
A partir del censo de 1970, se observa una
diferencia de participaci6n laboral de las mujeres,
muchas solteras (54%), viudas y divorciadas (10%);
el restante 36% tiene pareja. La presencia del
c6nyuge influye en la participation de la mujer en
el mercado laboral. A la edad de 50-59 afios casi el


50% de las mujeres sin pareja permanecen en 61 o
se reinsertan en el. Permanecen en el mercado
laboral la mayoria de las mujeres profesionales.
El grupo mas representative es el del servicio
dom6stico, el 30% de las mujeres que permanecen
en actividad a los 65 afios y mas del total del pais.
Buenos Aires sigue las tendencies nacionales, pero
al existir mayor nivel educational, hay mayor
participacion laboral y mayor permanencia en la
actividad. Mas del 50% de los hombres que
continuan trabajando despues de los 65 afios, son
obreros y empleados y el 44% patron, socio, o por
cuenta propia.

Situaci6n Economica
El INDEC elabor6 un conjunto de indicadores que
miden la satisfacci6n de las necesidades basicas de
la poblacion. Los mayores de 65 afios quedaron
incluidos como grupo de alto riesgo social. El
22.3% de la poblacion del pais cae dentro de la
categoria NBI (hogares con necesidades basicas
insatisfechas), 20.4% para los mayores de 65 afios.
En Buenos Aires, el 8.5% de la poblaci6n de 65 y
mas se clasifica como NBI. Dentro de este grupo
debemos resaltar a aquellos que viven solos en la
ciudad (7%). Esta situacion pareceria ser un
indicador de autosuficiencia, pero el 13% de los
mismos se consideran NBI. El crecimiento
poblacional que experiment el pais en este siglo
fue resultado del aporte migratorio mas que del
crecimiento vegetative. La tasa de natalidad
disminuye de 38/100,000 nacidos vivos en 1910, a
24 en 1947, y alcanza actualmente a 25. Durante
ese period descienden las tasas de mortalidad; de
19/100,000 muertes en 1910, a 11 a mediados de
siglo, y 8.6 durante los iltimos afios. Argentina
inicia su transici6n epidemiologica precozmente
respect a otros paises latinoamericanos.

Natalidad. Mortalidad. v Salud
Buenos Aires tiene una tasa de natalidad por debajo
de la tasa del pais: (16.2), indice de mortalidad por
encima (12.9) debido a su estructura poblacional,
pero 9 de cada 10 residents fallecen de 50 y mas
afios. Las tablas de vida muestran una
sobremortalidad masculine desde edades muy
tempranas, y una duplicacion de la esperanza de
vida al nacer para ambos sexos. El crecimiento de
los valores de esperanza de vida a edades
seleccionadas no fue constant: A media que se
incremental la edad disminuye la pendiente.
La estructura de la mortalidad refleja una
poblacion urbana de alta expectativa de vida y
aceptables niveles de consume de bienes y servicios.
El 80% de las muertes en la poblaci6n portefla de
65 6 mas se debe a enfermedades cr6nicas. Entre
el grupo de 75 6 mas, la neumonia, la influenza, y
los tumores malignos tambi6n son causes
importantes de muerte.






Enfermedades infecciosas que aun son causes
importantes de egresos hospitalarios y de muerte en
la poblacidn afiosa del pais, tienen muy poco peso
en los ancianos residents en Buenos Aires. La
Enfermedad de Chagas, end6mica de nuestro pais,
relacionada con vivienda precaria, entorno human
insaluble y educaci6n deficiente, afecta un 13% de
la poblaci6n general. La forma aguda no se
adquiere en la capital, pero aparecen casos de
cardiopatia chagisica en ancianos provenientes de
dreas rurales.
La nutrici6n tiene una desarmonia entire
disponibilidades de recursos y distribuci6n de los
mismos. El valor cal6rico y el consume de
proteinas es similar al de paises desarrollados, pero
algunos indicadores muestran frecuencias
inquietantes de desnutrici6n en niflos y ancianos.
Las enfermedades cr6nicas adquieren
significado al plantear dilemas complejos de
atenci6n. La desinformaci6n existente lleva a
analizar la Encuesta Nacional de Salud, realizada en
1969/71 en el ambito metropolitan, con
limitaciones de la desactualizaci6n, pero indicative
de comportamiento colectivo respect a la atenci6n
m6dica y a su demand. Las anormalidades fisicas
son mayores en la poblaci6n anciana, especialmente
en las mujeres. El 41% de los encuestados
manifestaba padecer de alguna condici6n cr6nica,
especialmente las ancianas y existed un aumento de
sintomas referidos al aparato circulatorio, la
diabetes, y la patologia articular. Respecto a
invalidez, el 3% de la poblaci6n dice padecer alguin
tipo de incapacidad, aumenta a 8.7% en la
poblaci6n de 65 y mas, predominando los varones
(10.4) respect a las mujeres (7.4).


Los Grandes Problemas Gerontol6gicos

Podemos definir las necesidades de la poblaci6n
anciana en cuatro temas: vivienda, salud,
integraci6n social, y economic.

Vivienda
Existen problems de vivienda para todos los
grupos de edad en Buenos Aires. En las ultimas
d6cadas hubo cambios en las pautas residenciales,
disminuyendo el tamaflo de los hogares
multipersonales.
La convivencia del anciano en el nucleo
familiar es traditional. El 98% de los mayors de
60 afios viven en hogares particulares, y el 50%
continue siendo jefe de familiar. En 1980 el 58% de
los hogares era del tipo nuclear, lo que no favorece
el intercambio intergeneracional.

Viviendas orivadas. Existe ambivalencia frente
a las ventajas del vivir solo. El hombre siente
mayor soledad por "no tener quien se ocupe de


ellos." En las mujeres mayores cuando aceptaron la
condici6n de "nido vacio" aparece el descubrimiento
de la propia individualidad.
Para las mujeres viudas hay alternatives
tradicionales. A veces de transici6n como vivir con
un familiar en hogares colaterales o compuestos.
Existe una clara conciencia de no vivir con los
hijos casados, cuya intimidad desean respetar.
Aunque se viva solo existen redes importantes de
intercambio. Las mujeres que viven solas
adoptaron tempranamente una actitud independiente
y trabajaron fuera del hogar gran parte de su vida.
Debe sumarse una situaci6n economic que se lo
permit. El acceso a la vivienda propia, si no se ha
logrado en etapas de mayor productividad, Ileva a
que las personas de menores recursos deban elegir:
vivir en departamentos alquilados, hotels,
pensions, o inquilinatos. En muchos casos'la
vivienda es pagada o cedida por los hijos o por un
pariente cercano. En los sectors populares hay
redes de parentezco mas fuertes: cuiados,
hermanos, primos, o compadres pueden constituir
una familiar extendida.

Residencias geriatricas. La residencia
geriatrica posee mala imagen y es temida por los
ancianos, aceptada con dificultad y s6lo en casos
especiales por part de los hijos (por ejemplo en
casos de incapacidad). Empero, desde 1973, las
residencias geriatricas toman auge: En 1971
existian 95 establecimientos en la capital, con 1900
plazas; para 1987 habian 16,000 camas y 430
locales.
Hasta 1970 la residencia geridtrica era la
alternative institutional para los ancianos solos, sin
familiar o aquellos cuyo grado de dependencia eran
incompatible con su medio familiar. Al crearse la
Obra Social para Jubilados y financial 6sta
prestaciones, permiti6 el acceso a este tipo de
servicio a families que no podrian costearlos. Es
possible que el que una instituci6n official optara por
esto, estimulo a muchas families a aceptar la idea
de las residencias o bien que Buenos Aires
descubri6 al anciano como consumidor de este tipo
de servicios y se creo una oferta que estimul6 la
demand.

Salud
En Buenos Aires el aumento en la esperanza de
vida y la sobrevivencia de una cantidad creciente
de ancianos ha provocado una situaci6n sanitaria
particular. (a) disminuci6n de muertes prematuras;
(b) menor riesgo de enfermar y de morir por
patologia infecciosa; (c) mayor riesgo de
multipatologia; (d) aumento en enfermedades de
larga evoluci6n; (e) aumento en la iatrogenia
medicamentosa, por medicalizaci6n no justificable,
o por canalizar hacia el sector salud problems de
adaptacibn que no son tratables







farmacol6gicamente; (f) la patologia existente
genera mayor riesgo de afectacion de la capacidad
funcional del individuo; y (g) mayor demand de
atenci6n medical y mayores gastos de
institucionalizaci6n, rehabilitaci6n, y medicamentos.
Lo que define a este grupo etireo no es una
patologia propia, sino la situaci6n en que se
produce la enfermendad, conjugandose la fisiologia
del envejecimiento, con la patologia actual y
pasada, la biografia del sujeto, y los recursos
individuals y sociales actuales e hist6ricos. Esta
situation define el problema gerontol6gico. El
diagn6stico de enfermedad es insuficiente para
solucionarlo. Deben incluirse los funcionales y de
recursos individuals y/o sociales. El equipo
gerontol6gico interdisciplinario es quien puede
medir el daiio, oriental al individuo y a la familiar y
lo canaliza como corresponda.
El 95% de los ancianos son atendidos por
medicos no especializados; se debe incluir la
geriatria y la gerontologia en la formacion de
recursos humans. Debemos orientarnos hacia
studios epidemiol6gicos de enfermedades cronicas
y a detectar los factors que conducen a la
incapacidad. La poblaci6n afiosa no es homogenea
por lo que seria important encarar una
gerontologia diferencial para la planificaci6n de
servicios. Hay que analizar por ejemplo el
problema de los viejos viejos, (poblaci6n de 75 y
mis) los mas vulnerable a la cronicidad, a la
incapacidad, al aislamiento domiciliario, y a la
institucionalizaci6n.
La necesidad sentida y no expresada nos obliga
a la busqueda y soluci6n del problema. La
sectorizaci6n geografica mejora la accesibilidad al
sistema. Necesitamos tecnologia simple,
aprovechando los recursos humans y solidarios con
que contamos para llegar a gran cantidad de
personas. La atenci6n primaria, la prevenci6n
secundaria y terciaria, y la creaci6n de redes de
autoayuda son imprescindibles para imaginarnos el
lema del afio 2000, "salud para todos."

Integraci6n Social
En Buenos Aires y otras ciudades han surgido
clubes, grupos de parroquias, y otros centros
recreativos para la "tercera edad," que ofrecen
programs diversos y cubren una amplia gama de
intereses; estos atraen a sectors medios,
preferentemente mujeres. Tambien existen
proyectos intergeneracionales en barrios populares
que atraen otros publicos. Estin ademas los grupos
espontIneos de ancianos en las plazas de la ciudad,
que se agrupan para charlar o jugar (bochas,
ajedrez, cartas), convirtiendose en important
espacio de interacci6n; se trata de sujetos que
demandan sociabilidad y la buscah. En los ultimos
tres afios, la Municipalidad mejoro los lugares
publicos y aport6 infraestructura para ocupaci6n de


tiempo libre: La permanencia de estos grupos
dependera de la media en que respondan a las
necesidades de los ancianos.
En una sociedad de consume, los ancianos son
pobres consumidores y los medios de comunicacion
estan poco orientados hacia ellos. Hay muy pocos
ambitos sociales donde el viejo pueda insertarse
"productivamente", en tareas significativas para la
sociedad y para si mismos, bien sean remuneradas o
voluntarias. En nuestro pais "clase pasiva" connota
que no se espera mas nada del viejo.
La vejez implica cambios sociales, temporales y
espaciales. Los grandes cambios en la ciudad,
disminuyen la capacidad del anciano para adaptarse
a las discontinuidades que le produce el medio. Por
otro lado, no se han creado sistemas de apoyo
socioespacial. Hay dificultad en transport,
aislando al viejo y reduciendo sus contacts al uso
del telefono--en los casos que exista. Mas alla de
las plazas o de los clubes no existen otros espacios
de interaccion en Buenos Aires.

Economia
La economic debe encuadrarse en la situation
general de la economic del pais (escasos recursos
para repartir, inflaci6n persistent, condiciones
externas desfavorables: deuda externa, altos costs
de intereses a pagar, caida de los precious de las
materials primas). La reducci6n del gasto public
fue para reducir la inflacion. En los ultimos cuatro
afios se consigui6 una disminucion de US$4,000,000.
el 30% del PBI.
En la ancianidad debemos agregar la crisis del
sistema jubilatorio, que no permit pagar una
"jubilaci6n digna." La seguridad social aportaba el
4% del PBI en 1950, 1% en 1970, y 1.5% en 1986.
Esta situaci6n responded a un aumento en el numero
de jubilados, merma entire aportantes y
beneficiaries (de 4:1 cae a 1.8:1 en la actualidad),
envejecimiento poblacional, y la disminuci6n de
aportantes especialmente aut6nomos. Los
movimientos que agrupan los jubilados reclaman
una ley incumplida, otorgada en otras condiciones
econ6micas y sociales que otorgan al jubilado el
82% del salario del trabajador active que ocupa su
lugar.
El sistema provisional debe ser reformado.
Recientemente se incorpor6 un sistema privado que
cubre a la vejez con mayores recursos, pero
carecemos de datos sobre la magnitude de aportantes.
En practice la ancianidad esta amparada por el
regimen jubilatorio provisional y por el regimen de
pensions no contributivas. El otorgamiento de
jubilaciones (ordinarias y por edad avanzada) se
condiciona a la edad, el sexo, a los afos de servicio
y aportes, con variables de trabajadores cuya
actividad laboral ha sido en relaci6n de dependencia
o por cuenta propia. Esta cobertura national se
complete con los sistemas previsionales para






empleados provinciales y municipales similares al
regimen national o al de las fuerzas armadas. Un
37% de. la poblaci6n de 60 y mas carece de
beneficio provisional.


Soluciones y Paliativos a los
Problems Gerontol6gicos

Iniciativas del Sector Pblico
Argentina posee antecedentes internacionales y
nacionales en el tema de la ancianidad. Fue el
primer pais que planted el problema ante la
Sociedad de las Naciones (1948). Sin embargo, el
problema ha estado sometido a la political.
Se han desarrollado, tanto en la esfera official,
como privada numerosos e interesantes programs
que tienen al anciano como sujeto-objeto de la
acci6n. La Subdirecci6n Nacional de Ancianidad,
las direcciones provinciales y municipales, y el
Institute de Jubilados y Pensionados representan la
estructura gubernamental. Estos programs
contienen tres lines political: empleo/jubilacion,
salud, y proteccidn social. No se han integrado, sin
embargo, a una political de vejez que respond a las
teorias aportadas por la gerontologia y signadas a
nivel gubernamental en Viena, Kiev, y Bogota.
Ademas, existe poca coordinacion en material de
ancianidad entire el sector publico y el sector
privado.
A la Subdirecci6n Nacional de Ancianidad, le
corresponde la coordinaci6n de programs y
acciones. Es la encargada de capacitaci6n y
asistencia tecnica a las provincias. Tambi6n le
compete los studios presentados por el Poder
Ejecutivo o Legislativo para la concertacion de
political; y la administration de un program de
atencion integral del anciano, que incluye hogares
de ancianos, subsidies, clubes, y acciones
promocionales y preventivas.
La Asistencia Social da asistencia a pobres con
otras limitaciones (edad, incapacidad, enfermedad).
A este grupo les satisfacen las necesidades vitales
minimas a traves del hospital public y los hogares
de ancianos. Surge la pregunta de los derechos de
la Seguridad Social. 4A qui6n le corresponde esta
cobertura? 413,000 personas, el 80% de la
poblaci6n anciana de Buenos Aires estd cubierta por
el sistema de Obra Social del Instituto de Jubilados
y Pensionados. Quedan excluidos los jubilados
municpales y de las Fuerzas Armadas y los ancianos
que carecen de jubilaci6n o pension.
El Institute cuenta con un sistema m6dico, de
pago por capitacion, con various niveles de atenci6n:


consult, apoyo diagn6stico, internaci6n, y
residencias de estancia prolongada con apoyo fisico
o psiquiatrico. Tiene guardia medical 24 horas,
odontologia, pr6tesis, y medicamentos. Asimismo,
existe un program psiquiatrico con consultorios
externos de control farmacol6gico, psicoterapia
individual y grupal, orientaci6n familiar, hospital
de dia breve, internacion de agudos, y estadia
prolongada.
Ademas del Programa de Asistencia Medica
Integral (PAMI), el Instituto cuenta con el
Program de Asistencia Social (PASI)'que incluye
prevenci6n, subsidies, y residencias para ancianos.
Es destacable a partir de la vuelta a la democracia,
la participaci6n de los ancianos en un nivel
consultivo, a traves de representantes elegidos, tanto
en el Instituto de Jubilados como en los Hogares
Municipales.

Iniciativas del Sector Privado
El sector no gubernamental esta representado por
organizaciones sin fines de lucro. La Iglesia
Catolica se ocupa de la asistencia social con
establecimientos, comedores, y programs en
algunas parroquias. La comunidad judia ha
desarrollado programs avanzados en ocupacion de
tiempo libre (socioculturales y recreativos), comida
a domicilio, centros de atencion diurna, bolsas de
trabajo, viviendas protegidas, etc.
Las comunidades de residents extranjeros,
italiana, francesa, espafiola, britanica, suiza, griega,
o subgrupos importantes de ellos como los gallegos
y los vascos, han creado establecimientos destinados
para su comunidad, pero que fueron
transformandose en hospitals privados sin fines de
lucro que actuan como efectores de planes de
atenci6n de prepago de Obras Sociales. No hay
programs diferenciados para la ancianidad a
excepci6n de hogares geriatricos.
El capital privado tambi6n invierte. Las
residencias geriatricas permiten una renta atractiva.
Un alto porcentaje de las plazas de Buenos Aires
son privadas y aunque no hay cifras actualizadas, el
incremento en el numero de plazas se debe a la
iniciativa privada.
Asimismo funcionan dos hospitals diurnos
geriatricos privados, una escuela de psicologia
social, various grupos de reflexion, talleres de
expresi6n corporal, terapia ocupacional, teatro, e
iniciaci6n literaria destinados a la poblaci6n anciana
especificamente. Si se coordinasen los esfuerzos,
Buenos Aires esta provista de recursos para una
adecuada atenci6n del anciano, aun para aquellos no
cubiertos por pensions u otros esquemas.










Part IV: Implementing Quality Residential
and Community Care



13 Autoasistencia en el Anciano
by Luis Guillermo Suarez (Venezuela)

14 Qualidade dos Cuidados Residenciais
by Flavio da Silva Fernandes (Brazil)

15 Estructuras de Apoyo y Atencibn para Ancianos
y Enfermos Terminales en Estados Unidos de
America
by Eduardo Alvarez (USA)

16 Pro-Vida, a Non-Governmental Organization for
the Care of the Elderly in Colombia and Latin
America: A Video Presentation
by Eduardo Garcia-Jacome (Colombia)

17 Reaching Elderly Abandoned Citizens
Housebound (REACH): A Dominica Program
by Diane Abraham (Dominica)











AUTOASISTENCIA EN EL ANCIANO


Luis Guillermo Suarez
Maracaibo, Venezuela


Abstract

Self-help among the elderly is reviewed as a
concept that stimulates participation in both
preventive and rehabilitative efforts. While self-
help is often associated with health care, a more
global conception is proposed here. This wholistic
perspective of self-help takes into account the
influence of environmental aspects such as
ecosystems, urbanization, traffic accidents, and
socioeconomic variables, on the psychological and
social well-being of the aging. Environmental
variables such as housing (quality, cost, availability,
comfort) and services (access and quality of
sanitary, educational, and recreational facilities) are
helpful in interpreting the relation between aging
persons and their environment.
Under the model of self-help here proposed,
the elderly would assume control over their lives,
their health, their everyday care, and over their
participation in social and community activities.
Self-help builds a positive self-concept, which in
turn impacts positively on health and social
participation.
A program of self-help is important in
developing countries for a variety of reasons: (a) in
human terms, because of the benefits it may bring
to the elderly; (b) demographically, because the
proportion of elderly is expected to increase
dramatically over the next decades; (c) to avoid
increases in health-care and other expenses in
countries which cannot afford these; and (d) to
avoid dependency on government-sponsored services
because these are often late in coming.


Introducci6n


Bajo el termino autoasistencia se identifica el
conjunto de acciones o iniciativas que, partiendo
del propio anciano, constituyen una estrategia que
evite o disminuya la presencia de situaciones
desencadenadas por el envejecimiento. Esta actitud
que en muchas parties se conoce como
"autocuidado," estimula la participaci6n del anciano
en una accion preventive o rehabilitadora de las
afecciones psicofisicas y socio-economicas propias
de la edad avanzada.
Los datos sobre esta material generalmente se
refieren a la salud, desde el punto de vista
.biomedico. Una percepci6n mis global, que


incluya los riesgos del entorno y del ambiente (p.
ej., ecosistema, urbanismo, accidents) no es tan
disponible. Hay tambi6n que tener en cuenta la
problemdtica socio-econ6mica 'donde se original
situaciones que afectan la salud psicol6gica y social
de la persona que envejece.
La articulacion de un program bajo estos
criterios, es obligante--sobre todo en los paises en
desarrollo--por las razones siguientes:
1. Por su contenido humanizante, en beneficio
director de las propias personas de edad
avanzada.
2. Por la determinante demografica, que nos
muestra un mayor numero de ancianos en
los paises en desarrollo en relaci6n a los
paises desarrollados y la parad6jica situation
de tener aquellos menos recursos para
tender a sus ancianos.
3. Para evitar un incremento de los gastos de
salud.
En base a 6sto, hablamos de una estrategia
basada en la auto-atenci6n integral del anciano,
quien se convertiria en protagonista de los logros
que se alcancen en su propio beneficio. Se evitaria
la acci6n descuidada de gobiernos y sociedades que,
por insensibilidad, ignorancia, o descuido retrasan
las medidas que deben aplicarse para que las
personas de edad no solamente tengan un mejor
nivel de salud y participaci6n, sino que su vida
social y comunitaria tenga una resonancia que les
permit integrarse a estas y no seguir marginadas de
las mismas. Asi pues, especial acento se dard a la
situaci6n social y econ6mica de los ancianos, a
mejorar su adaptaci6n a la condici6n de retirado, y
a armonizar con el medio ambiente, sin descuidarse
su salud fisica.


El Autoconcepto y la Autoestima

Segun Kalish (1982), el autoconcepto es la
image que el individuo tiene de si mismo. Esta
imagen refleja las experiencias y circunstancias
actuales, y esti vinculada al modo como los demas
reaccionan ante la persona. Muchas personas se ven
positivamente, adn cuando llegan a la edad en que
son mirados despectivamente por los demas. Dos
components participan prevalentemente en el
autoconcepto: (a) la autoestima o autopercepci6n; y
(b) la imagen corporal. Aunque no se ha
confirmado empiricamente, dada la actitud negative






de la sociedad hacia las personas de edad, la
p6rdida de valorizaci6n social que afecta a las
mismas, y la disminuci6n de sus capacidades fisicas
y/o intelectuales, se piensa que la autoestima de las
personas disminuye a media que aumenta su edad.
La autoestima positive se vincula a various
factors. Las personas de edad que no perciben
diferencias en la calidad de vida de antes y la que
actualmente viven, tendrdn una autoestima mas
positive. En ello juegan un important papel la
condici6n socio-econ6mica, la ausencia de traumas
psicol6gicos, la permanencia en el empleo, una
jubilaci6n exitosa, una actividad nueva con sentido
de realizaci6n, la ausencia de soledad, etc. La
autoestima es una percepci6n muy singular, que
varia de una persona a otra, en respuesta a las
circunstancias.
En cuanto a la imagen corporal y el aspect
que presentan las personas de edad, algunos creen
que ella produce una actitud de rechazo ante
terceros. Un studio sobre belleza y envejecimiento
realizado en Francia por Hugonot, indic6 una
relacion entire la apariencia descuidada en los
ancianos e imagenes negatives sobre ellos. El
concept de imagen corporal no se vincula
unicamente a un fisico atractivo. Se asocia tambi6n
con las percepciones del individuo sobre su fuerza
fisica, mobilidad, salud, sexualidad, y otras
caracteristicas. Se dice que todo lo que mejora la
imagen corporal, mejora tambi6n la autoestima.
Referirnos al autoconcepto y la autoestima en
este trabajo (que trata de explicar la autoasistencia
como una estrategia de atenci6n) se debe a que no
habra una participacion genuina, si no existe en las
personas mayores una motivacion que les estimule a
ser protagonistas de las decisions en favor de su
salud. Y para que las personas de edad se integren
a los programs de autoasistencia es menester que
tengan un autoconcepto positive.


La Autoasistencia en Salud

Coppard (1984; 1985) se refiere a "la
autoatenci6n de la salud y los ancianos," y percibe
la autoasistencia en t6rminos de actualizacion,
ejemplos, y experiencias. Un parrafo citado de
Halfdan Mhales capta este concept con precision:

"Si la question de la salud no comienza a
nivel del individuo, el hogar, del lugar de
trabajo, de la escuela, nunca alcanzaremos la
meta de salud para todos ....Todo aumento
significativo del bienestar fisico, mental o
social dependera en gran media de la
determinacion del individuo y de la
comunidad de ocuparse de si mismos."

Este pensamiento se vincula a los sentimientos


de autoconcepto y autoestima antes sefialados. Sin
esta premisa, la autoasistencia se convertiria en una
costosa utopia disefiada por arriba sin respuesta por
la base.
La autoatenci6n consiste en todas las medidas y
decisions que adopta un individuo para prevenir,
diagnosticar y tratar su propia enfermedad. El
concept de autoatenci6n no es nuevo; popularizar
la autoasistencia y estructurla como program, si lo
es, y la respuesta actual en paises de America
Latina esta en claro deficit. Conviene, pues,
estimular el desarrollo de esta estrategia para
alcanzar mejores niveles en la atenci6n del anciano,
con ahorro de recursos y gasto social.
Plantear la autoatenci6n de salud, en terminos
de una definicibn que la identifique plenamente
debe incluir ideas tales como, (a) que las personas
cuiden de si mismas; (b) que las families se asistan
unas a otras; (c) que los vecinos, amigos y
comunidades, proporcionen respaldo y servicios a
quienes lo necesiten; (d) que las sociedades elaboren
political de mejoramiento de la salud; y (e) que los
profesionales de la salud ayuden y alienten a los
individuos, familiares, y public en general a
cooperar con ellos para fomentar la salud.
La autoatenci6n de salud es important en la
prevenci6n de enfermedades y en el mantenimiento
de la salud. Esto require ciertas habilidades.
Algunas ya son posesi6n comun de las personas
mayors; otras hay que estimularlas. Sin que su
menci6n agote la lista, se sefialan cinco habilidades
individuals:

1. Habilidad para detectar signos bdsicos,
tales como temperature, pulso, emisi6n
exagerada de orina, y p6rdida de peso.
2. Habilidad para lidiar con situaciones
sencillas, v.gr., resfrio comun, diarrhea,
primeros auxilios.
3. Habilidad para tender enfermedades
cr6nicas, p.ej., dietas adecuadas a una
diabetes.
4. Habilidad para prevenir enfermedades y
promover la salud: ejercicio, dieta,
eliminaci6n de habitos a ciertos products;
higiene dental y general; estilos de vida
saludables, etc.
5. Habilidades relacionadas con informaci6n
sobre la salud; c6mo obtener tratamiento
medico; adquirir informaci6n y educaci6n
sanitaria (Coppard, 1985).

Las habilidades sefialadas pueden adquirirse
facilmente y ejercitarlas no conlleva riesgo, aun en
ausencia de apoyo professional. Las personas de
edad avanzada de cualquier sociedad practical la
autoatenci6n con efectividad en ciertas
circunstancias y ensanchan su repertorio mediante
experiencias propias, observaci6n en terceros, y






autoeducaci6n a trav6s de los medios.
En resume, pues, Lvale la pena la
autoatenci6n? El criteria fatalista sobre la
morbilidad y la discapacidad en los ancianos no
tiene fundamento. El envejecimiento. es universal e
inescapable pero no tiene un patr6n para todos los
individuos y las incapacidades de la ancianidad no
son generalizadas. Algunas tienen un fondo social,
psicol6gico, y de conduct sobre los cuales se puede
intervenir para disminuir sus efectos. Estas
observaciones nos conllevan a afirmar: La
autoatenci6n vale la penal

Caoacidad de Resouesta del Anciano para el
Autocuidado
El concept de autocuidado se basa en una
concepcion del hombre como un ser de vocacion,
capaz de hacerse cargo de su vida, de asumir
responsabilidades y de decidir sus opciones (Romo,
1986). La mayoria de los ancianos estin en
condiciones de cuidar su propia salud en alguna
media. Sin embargo, la autoatenci6n en las
personas de edad es resistida y mal promovida por
los profesionales y el colectivo, prejuiciados por el
estereotipo que tienen del envejecimiento.
La imagen de los ancianos como personas
incapaces, enfermas, propensas a perder facultades,
aislados socialmente, rigidos en sus actitudes y
sexualmente incapacitados, es equivocada. No s6lo
debe combatirse, sino sustituirse por una actitud
positive, que tome en cuenta las capacidades que
persisten. Es, pues, necesaria una educaci6n sobre
el autocuidado, no s6lo para los ancianos sino para
los profesionales y otros prestadores de salud.
Promover el autocuidado impondrd, en algunos
casos, observer una actitud 6tica para no descuidar
la atenci6n formal. El autocuidado no es sustitutivo
de los servicios medicos formales; es su alternative
complementaria.


Autoasistencia en "Patologias Sociales"

Al constituirse la Organizaci6n Mundial de la
Salud en 1946, se redefine el concept de salud.
Previamente conceptualizado como la ausencia de
enfermedad, se adopta un concept mis integral y
se redefine como una situaci6n de bienestar no s6lo
fisico sino tambien psiquico y social.
Al quedar admitido un component social en la
salud, fue precise identificar los factors sociales
que incident en la salud. Trasladando el 16xico
m6dico al campo social se habla de "patologia
social," como se habla de patologia medica, y de
"salud social" para contraponerla a la salud, bajo la
acepci6n biom6dica que antes se tenia del termino.
No es juego semantico; es una realidad que nos
permit referirnos a la salud con un criteria
integral.


Entre los elements sociales de implicaci6n
para las personas de edad, se cuentan la actitud
negative de la sociedad; los mecanismos de
jubilaci6n; el status post-jubilatorio; la falta de rol;
la marginalidad y desinserci6n social. La suma de
estos factors, o su acci6n por separado, inicia un
process de deterioro que afecta la salud en su
concepci6n global.
Esos factors en crisis, merecen identificarse
para asi poder intervenir sobre ellos. Entre los mds
importantes se cuentan:
1. La actitud negative de la sociedad hacia los
ancianos. Dentro del criteria consumista de la
sociedad occidental, los ancianos son victims del
desarrollismo. Los criterios de productividad y
consume excluyen a las personas de edad avanzada
de las llamadas sociedades industrializadas y las que
aspiran a serlo. A quidn reclamarle, si como afirma
Tournier (1973), la sociedad como ente colectiva es
an6mima, irresponsible y renuente a modificar lo
que ella misma ha creado.
2. Los modelso" de jubilaci6n inadecuados.
Ningun model actual es satisfactorio, porque no
concilian el monto de las jubilaciones con las
necesidades sociales de los retirados, por ser
impuesta en mementos en que la persona tiene a6n
altos niveles de rendimiento, por basarse
inicamente en la edad, y por no preveer otras areas
de interns para los jubilados.
3. La ignorancia sobre la situaci6n post-
jubilatoria. En muchos casos se desconocen las
consecuencias post-jubiliatorias. Falta preparaci6n
para el retire (vdase Pitzele, 1979). Huet (n.d.)
observa que "la cultural sobre el envejecimiento,"
Ileva a un estado de afectaci6n psico-orginica que
permit hablar de jubilopatias y de trauma de
jubilaci6n.
4. La falta de un rol acceptable. La sociedad
no asigna un rol acceptable a las personas de edad.
Quiere reducirlas a la inactividad, exagerando la
teoria de Cumming y Henry (citado en Kalish,
1983) sobre la desactivaci6n; atribuyendo a todos
los ancianos la percepci6n de Lafargue (citado en
Tournier, 1973) sobre "el derecho a no hacer nada"
o el exagerado pesimismo vertido por Lacroix en su
libro sobre el fracaso, que contiene la interrogante
Lpara que?.
Los factors antes seflalados acarrean
marginalidad y desinserci6n social. Ademgs, los
ancianos se sienten beneficiaries del sistema y no
participants en su desarrollo. Una manera de
defenders ante esta situaci6n es organizarse y
prepararse para combatir los efectos que las
condiciones sociales estan provocando en los
ancianos. La autoasistencia no comporta solamente
la acci6n individual; es necesario asociarse para
crear un frente organizado que confiera calidad a la
denuncia y fuerza a la protest.
Ante la apatia official y la intencionalidad






privada, se debe insurgir con toda asociacion licita
que Ileve a los socios el recurso de la capacitaci6n.
Logrado esto, el colectivo gerittrico estart en
capacidad de presionar para obtener sus beneficios.
Seguir esperando pasivamente es una p6rdida
de tiempo que contribute a la agravaci6n de los
factors actuantes. Se impone una lucha frontal
contra el sistema que margin a los ancianos. Esto
se identifica como una forma de autoasistencia,
porque ya tiene hecho el diagn6stico de una
situaci6n y trata de evitar sus efectos negatives.

Autoasistencia y Salud Mental:
Depresi6n y Envejecimiento

Las personas de edad viven con frecuencia en
un medio social diferente al de los j6venes. Un
28% de personas mayores de 65 afios viven solas y
un 9% sufre de aislamiento social. Mishara y
Riedel (1986) enfatizan la relacidn entire los
contacts sociales y el sentimiento de satisfacci6n
respect a la vida. Esto obliga a aceptar que las
personas de edad que padecen privaci6n social,
vean afectada su salud mental. A tal situaci6n se
afiaden las p6rdidas que sufren los ancianos: la
muerte de series queridos, el alejamiento de los
familiares, problems de salud, ingresos econ6micos
disminuidos, dificultades de transport, etc. Esto a
la vez disminuye los contacts sociales, baja la
autoestima y el valor social del individuo, y
favorece la aparici6n de afecciones psiquicas en las
personas de edad.
El aislamiento conduce a la depresi6n y a un
mal funcionamiento social. Aunque estas
percepciones son subjetivas, pueden mejorarse
mediante intervenciones apropiadas producidas en
el moment oportuno. Ante el riesgo de la
depresi6n, las personas de edad pueden autoasistirse
bloqueando las situaciones precedentes. Para ello
deben pensar en positive y no defender del "si
especular", es decir, de conducirnos de acuerdo a
las reacciones o interacciones que tienen los demas
sobre nosotros, segun lo plantea Sullivan en las
teorias sociales de la depresi6n, citando el concept
de Mead.

Autoasistencla Vinculada al Medio Ambiente

La conferencia de Tbilisi, efectuada en 1977
(Tbilisi, 1986), sent6 la present definici6n:

"Se ha convenido que el concept de
medio ambiente debe abarcar el medio
social y cultural y no solo el medio fisico,
por lo que los analysis que se efect~en deben
tomar en consideraci6n las interrelaciones
entire el medio natural, sus components
biol6gicos y sociales y tambi6n los factors
culturales...."


El medio ambiente urban esta caracterizado
por la nocion de ciudad o espacio urbano
(referencia a lo structural) y al fenomeno urban
(referencia a lo dinAmico) que cumple la comunidad
humana que lo habitat. En ambos, se general
factors que afectan la salud.
Un problema se genera en las ciudades por la
migracion a gran escala de personas provenientes
del medio rural. Si la migraci6n es de todo el
grupo familiar, los ancianos compartiran la zona de
borde de la escena urbana; son los Ilamados
cinturones de miseria con viviendas insalubres,
hacinamiento, inseguridad. En ellas, las personas
de edad estan expuestas a todos los riesgos que
genera el exceso de urbanismo.
Aun los ancianos cuya existencia ha discurrido
en la ciudad sufren el impact ambiental. Hay dos
indicadores ambientales que permiten estimar la
interacci6n del hombre con su entorno: (a) el
alojamiento; y (b) los servicios. Alojamiento se
refiere a espacio interior, espacio exterior, confort,
costo, y disponibilidad. Servicios se refiere al
acceso y calidad de servicios sanitarios, educativos
y recreativos; al transport; a la seguridad y
proteccion personal; y a las oportunidades de
empleo.

Alo iamiento
Aunque no detallaremos la forma en que el
colectivo geriatrico carece de los indicadores
ambientales en cuanto a vivienda, basta decir que el
modelo habitacional multifamiliar esta concebido y
desarrollado en funci6n de la familiar
nuclear--pareja e hijos. Pensar en la internacion
como solucion es una utopia: las personas de edad
expresan creciente rechazo hacia las instituciones
residenciales. Entonces, Lc6mo pueden autoasistirse
los ancianos ante el problema de vivienda? No
podemos sugerir una soluci6n con una just
magnitude de escala. Seria possible, por una via
indirecta, de tipo cultural, legislative, y amplio
apoyo a la familiar, que 6sta se decide a mantener a
sus mayores en su seno. Ademas, el estado, a
traves de disposiciones del sistema de seguridad
social, debe hacer "atractiva" la permanencia del
anciano en su hogar, quitgndole toda presuncion de
carga.

Servicios
En el area de servicios, tomemos como ejemplo la
vialidad urbana y suburban con relaci6n a los
ancianos. Las autopistas y otras vias rapidas, han
convertido la ciudad en fragments o poligonos que
limitan el desplazamiento de las personas mayors;
los que se atreven, corren riesgo de un accident.
Un expert venezolano en accidents de transito
(Casas Rinc6n, entrevista personal, 1988) nos
recomendaba que los ancianos --como media de
autoasistencia--deben evitar salir solos; deben






comprender su mayor exposicion a los accidents
por la disminucion sensorial en su vision, audici6n,
y capacidad reactiva.
La ingenieria de vialidad actua de espaldas a la
seguridad de los ancianos en muchos paises
latinoamericanos. Ante el reclamo para cruzar una
via con seguridad, se han construido las llamadas
pasarelas cuyo acceso, a base de multiples escalones,
las convierten en verdaderas trampas para las
personas de edad. Debemos reclamar semaforos
manuales en vias de densidad peatonal y vehicular.
Debemos reclamar tuneles, con rampas seguras, en
las intersecciones de calls como profilaxia de
accidents.

La Ciudad v el Stress
La ciudad grande ha impuesto un ritmo de vida
rapido: los largos desplazamientos del hogar al sitio
de trabajo, el trafico, la tension de los horarios, el
ruido, son algunas de las consecuencias ambientales
que padecen los habitantes de los nucleos urbanos,
que ponen en peligro su salud psiquica. Hacia la
median y tercera edad existe la cuota mas alta de
cansancio psiquico por estas causes y son mas
graves sus consecuencias.
Concluimos estos comentarios sobre el medio
ambiente y sus implicaciones en las personas de
edad, con una mencion sobre la contamination; los
climas duros de invierno; las exposiciones al fuerte
sol en paises ecuatoriales --causa de cataratas,
deshidrataci6n, arrugas y cancer de piel.
Confiemos que el desarrollo de la medicine
ambiental, nos dara una mayor capacidad de
defense, para que las personas de edad puedan
subsistir mejor en el ecosistema en que tienen que
vivir.


Estrategias de Autoasistencia

La actitud para la autoasistencia hay que
ensefiarla a los ancianos y debe ser aprendida
previamente por los profesionales de la salud que
van a impartirla. Tambien es necesario capacitar a
la familiar y la comunidad. En Chile se edita una
series sobre "Educaci6n para el Autocuidado" que
orienta a los profesionales en programs de
autocuidado y ofrece pautas para la incorporaci6n
del grupo familiar y sector comunitario. Estrategias
mas especificas en cuanto a capacitaci6n de
personal professional en autocuidado se encuentran
en el Apendice.


Conclusion

Los beneficios de la autoasistencia son
indiscutibles en cualquier program de salud. Sin
embargo, su desarrollo y su 6xito no son faciles. El


nivel cultural de los ancianos no es homog6neo; sus
creencias, mitos y habitos dificultan penetrar en
ellos con una acci6n educativa pero, no podemos
renunciar al intent. Hay que actuar.
El primer convencido para desarrollar el
autocuidado debe ser el professional de la salud,
cuando actua como educador sanitario. El objetivo
del autocuidado es la prevenci6n --de
enfermedades, de problems sociales, de la agresion
del ambiente-- y la prevenci6n hay que aceptarla
como una creencia, como un culto. La ideologia de
la prevenci6n, segfn Aiach, reposa en la promesa
de una vida sana, ausente de enfermedad grave, el
mantenimiento de un vigor intellectual y fisico; esto
es possible si se elige un m6todo de vida sano.
Al desarrollar el tema de la autoasistencia,
hemos dado mas importancia a su presentacion
como una via de acci6n de possible desarrollo en los
paises latinoamericanos. Hemos evitado un esquema
particular ya que las caracteristicas varian de
acuerdo a los pueblos y las cultures. Si los ancianos
se capacitan para la autoasistencia habremos logrado
un efecto multiplicador que mejorara la calidad de
vida de ellos mismos, evitando una excesiva
dependencia de los cuidados que necesitan y un
ahorro de los gastos sanitarios que ellos implican.




Bibliograa

Coppard, L. C. La Autoatenci6n de Ia salud y los ancianos. En
OPS (Ed.), Hacia l bienestar de los ancianos. Publicaci6n
Cientifica No. 492. Washington, D.C.: OPS, 1985.
Coppard, L.C. Manual sobre autocuidado de salud. Copenhagen:
OMS, 1984.
Cumming & Henry. Desvinculaci6n. Citado por R.A. Kalish, La
veaes: Perspectiva sobre el desarrollo human. Madrid:
Ediciones Piramide, S.A., 1983.
Huet, J.A. President del Centre Internationale de Gerontologie
Social (CIGS). Paris, Francia.
Kalish, R. A. La vejr: Perspectiva sobre el dearrollo human.
Madrid: Ediciones Pir6mide S.A., 1983.
Lafargue & Del Lacroix, J. Citados on P. Tournier, Aprendiendo
a envejecr. Bueno* Aires: Editorial La Aurora, 1973.
Mishara, B.L. & Riedel, R.C. El proceso de envelecimiento.
Madrid: Ediciones Morata S.A., 1986.
Pitsele, M. S. Organismes da conseil en matitre de preparation a
La retraite: l'experience amdricain. Madrid: Centre
International de Gdrontologie Social*, 1979.
Romo, O. Ideas, planteamientos, recomendaciones y dudas sobre
autocuidado. Educaci6n para e Autocuidado. 1(1), 1986.
(Santiago de Chile).
Tbilisi: Conferencia Interguberamental de Educaci6n Ambiental,
Educaci6n, y Medio Ambiente, Cuaderno de la UNED 1986
(Madrid).
Tournier, P. Anrendndio a nveecer. Buenos Aires: Editorial
La Aurora, 1973.








Ap6ndice


Proaramas Internacionales de Canacitaci6n
en Autoasistencia


Proaramas de Canacitaci6n de Personal

Reino Unido. El Consejo Nacional de
Educaci6n Sanitaria prepare publicaciones sobre
autocuidado en personas de edad dirigidas a
trabajadores comunitarios de salud, a familiares y a
profesionales (Coppard, 1985).

Estados Unidos de Am6rica. La Facultad de
Medicine de la Universidad de Dartmouth, New
Hampshire, capacity a profesionales de salud y
servicio social para que actuen como instructors
bisicos y a ancianos voluntaries para que sirvan
como moderadores en areas de autocuidado.

Belgica y Canada. En B1lgica una asociaci6n
provincial coordina y public los esfuerzos que se
hacen sobre autoayuda, tiene un banco de datos y
un mostrador para proveer information y
referencias al piblico en general. Una acci6n
similar se realize en las provincias canadienses
donde tienen un directorio de los grupos de
autoayuda que operan en la region, que hacen
disponible a los individuos y agencies de salud y
servicio social.

Francia. En Francia existen una series de
instituciones dedicadas a la prevenci6n en
gerontologia y, aun cuando la asistencia en salud
recibe amplia cobertura, se hace enfasis en el
component social, psicol6gico y ambiental de la
autoasistencia. Ejemplos representatives son el
Observatorio de la Edad, el Colegio Regional de
Prevenci6n de Lille, el Centro Regional de
Prevenci6n de Lyon, el Instituto para la Prevenci6n
de la Senescencia de Marsella. Todos coinciden en
que el medio socio-econ6mico incide en el process
de envejecimiento y debe tomarse en cuenta.


Suiza. En Suiza proponen la prevencidn como
una normalizaci6n cultural, es decir una norma de
cultural, donde los factors sociol6gicos deben
intervenir buscando un reduccionismo del modelo
medico y su monopolio sobre la promoci6n de la
salud. Limitar los fen6menos salud/enfermedad al
aspect corporal es simplificar una problemitica
mas compleja.

Programas de Canacitacidn a Personas de Edad

Estados Unidos de America. Existen various
programs que pueden sefialarse como ejemplos. La
Asociaci6n Americana de Personas Retiradas
(AARP), con sede en Washington, tiene una
cobertura national y mis de 15 millones de
miembros. Promueve la educaci6n y autoatenci6n
de la salud a traves de folletos con indicaciones
preventivas: estado fisico saludable a traves del
ejercicio, arthritis, salud cardiovascular, p6rdida de
la audici6n, uso de medicamentos. Disemina
informaci6n sobre nutrici6n, sexualidad, stress,
alojamiento, clima; asesoramiento legal, rol del
retirado, afectividad, tiempo libre, inversiones, etc.
El Institute Nacional sobre el Envejecimiento
public "Age Page," monografias de una pagina en
las cuales present temas de salud de interns al
anciano. Su lenguaje sencillo y director las hace
amenas e ilustrativas. Se publican en ingles y
espafiol y se distribuyen en supermercados,
farmacias, centros de ancianos, hospitals, etc.

Hong Kong. En Hong Kong se difunden
temas sanitarios a traves de conferencias en centros
de servicios multiples y en unidades residenciales
de ancianos. Hay tambien un program semanal de
radio y peri6dicos especializados para personas de
edad.








QUALIDADE DE CUIDADO RESIDENTIAL COMUNITARIO


Flavio da Silva Fernandes
Campinas, Brazil


Abstract

The study deals with the quality of residential
community care of the elderly. Housing is an
important issue of study among the aged because it
represents various sub-themes -- economics,
nutrition and diet, health, education, recreation, the
capacity to work, and most importantly the existence
of a way that guarantees the maintenance of the
aged. Various housing options for the elderly are
examined along with particular problems associated
with each type of residence. This study
recommends: (a) the establishment of "centros
abertos," neighborhood centers designed to meet the
needs of the elderly; and (b) the creation of
Municipal Commissions on Aging comprised of
professionals that organize specific programs for
the elderly. The study reviews public and private
organizations that work with the elderly in Brazil.
In addition, university programs that specialize in
studies on those of the "Third Age" are discussed.
In conclusion, four fundamental objectives of
gerontologists in Campinas are given: (a) a better
quality of life for those in institutions; (b)
development and formation of human resources; (c)
studies and research on topics that relate to the
elderly; and (d) the formation of a diversified
program for the care of the elderly.


Introducao

A habitagao e cuidados domiciliares cor as
pessoas idosas convertese em important tema para
estudos e pesquisas, a ponto de ter sido incluido nas
preocupagoes da Conferencia "Envelhecimento,
Demografia e Bem Estar na America Latina."
Jd se ressaltou que "faltam estudos regionais e
de stores da populacao com problems de vivenda,
safde, economic e qualidade de vida." Muitos
destes dados poderiam ser captados se os governor
incluirem nos censos nacionais alguns parametros
especiais, visando o desnvolvimento das observagoes
e das investigagoes gerontol6gicas.
Naturalmente, os dados sobre o envelhecimento
da populacao precisam ser trabalhados por
especialistas dedicados a esse campo, sem o que sua
interpretagao e avaliagao pouco significariam para
se estabelecer diretrizes numa political social em
favor deste public.
0 alojamento sempre representou um ponto de


seguranca para o ser human, mas assume especial
importancia quando as pessoas envelhecem. Tem
um significado psicol6gico e social profundo,
porque possibility ao individuo conservar a sua
identidade e manter viva uma rede de relagoes
sociais, em que a familiar aparece em primeiro
lugar.


A Habitacao e a Qualidade de Vida

A habitacao surge como uma das necessidades
particulares da gente idosa. Representa um
problema humanitario que abrange diversos
subtemas: a questao familiar e economic, o meio
ambient e a alimentaqao, a sadde e a educagao, a
recreacao e a capacidade laboral e, ponto serio, a
existencia de uma renda que garanta sua
manutenqao.
Em muitos paises ja se caracterizou que
homes e mulheres idosos prefeririam viver com a
familiar, agrupamento ao qual se tem
frequentemente recomendado buscar uma forma de
convivencia, dentro da qual a tolerancia e
compreensao assegurem apoio e protecao aos mais
velhos. Quando os idosos residem cor os filhos,
seria convenient atentar para as instalacoes que
Ihes sao destinadas. Sao elas adequadas? Garantem
uma sensagao de liberdade e privacidade?
Compreender as limitacoes que aos poucos se
apossam dos velhos 6 indispensavel, para ajuda-los
a sentir que a velhice 6 um acontecimento normal,
e nao um problema a mais para o grupo familiar.
Urge estimular os idosos para que tenham
iniciativas e exercitem atividades que lhes sejam
agradaveis, que mantenham suas amizadas e, de
forma alguma, se sintam h6spedes em casa dos
filhos numa habitacao que, tantas vezes, ainda 6
de sua propriedade.
Ter o pr6orio alojamento 6 important, porque
os liberal de um desgastante estado de dependencia,
gerador de expectativas nem sempre animadoras. A
presenqa de cidadaos mais velhos vivendo cor
autonomia, aptos e integrados a sua comunidade e a
todas as formas de vida social, projeta uma image
favoravel da velhice. Muitos desejam ter a sua
moradia. Para isso seria sempre important estarem
gozando de boa saide, mental e fisica, al6m de
contarem cor meios financeiros que lhes
possiblitem manter a continuidade da ambicionada
sensacao de dirigirem a pr6pria vida.







Hi casais idosos que sustentam um
relacionamento agradvvel cor os filhos, com a
vizinhanga e com antigas amizades, o que converted
a residencia em animado centro de reunioes. A
chegada dos netos proporciona, muitas vezes,
oportunidades para que a habitacao retome a funcao
de centro de encontros da familiar, gerando indizivel
satisfaao.
Naturalmente, o lar reflete a personalidade dos
seus moradores. O ambient 6 organizado como
eles desejam, atendendo ao seu conf6rto,
necessidades e exigencias. Bem identificados com o
seu pequeno universe, as pessoas sentem-se de certa
forma defendidas.
Psic6logos e psiquiatras dizem que os velhos,
mesmo enfermos, devem ter o direito de decidir
como viver; nem mesmo os filhos, por mais
afetuosos que sejam, nao podem impor solugoes que
os pais nao se disponham a aceitar, salvo em
situag6es mais graves ou extremes.
Tamb6m ha os que desejam viver sozinhos,
como opcao. Outros, diante da perda do c6njuge,
de repente percebem-se sozinhos. As atencoes
sobre estas pessoas e necessaria e important,
principalmente ao se perceber que vao se
distanciando de amigos e parents, caminhando para
um isolamento capaz de gerar solidao e todo um
cortejo de angustias existenciais. Dai para os
disturbios emocionais que levam a perturbacoes
psicosomiticas e problems mentais o caminho 6
curto; condutas consideradas como anormais pela
sociedade sao um primeiro sintoma.
O dialogo em familiar e a boa comunicacao
poderao ajudar bastante quando a morte separa o
casal idoso. Pode surgir, entao, uma reagao
exagerada e ate desesperada contra o
envelhecimento. E nesse quadro de perplexidade e
dor que os filhos, tantas vezes, na melhor das
intencoes, afastam o conjuge sobrevivente de sua
residencia, de perto dos amigos e de suas atividades
rotineiras, certos de que essa 6 a melhor conduta.
Este 6 um moment em que as decisoes devem ser
cautelosas e ponderadas; o quotidiano mostra como
se tem negado ao velho enlutado o direito de
escolher a forma como pretend continuar vivendo
e readaptar-se. Depois de um period de reflexao,
bem cercado de apoio e carinho, ele pode preferir
permanecer no seu pr6prio ambiente, onde tudo Ihe
6 familiar, mesmo diante das recordagoes que
podem rodea-lo todos os dias. Mas, serd sua opcao.
Com as transformagoes que atualmente sofre a
estrutura familiar, os idosos perdem, parcial ou
totalmente, a assistencia e protegao do elenco de
parents mais pr6ximos. Passam, generalmente, a
defender de si mesmos, da comunidade e das
institutuicoes, as quais nao podem, de qualquer
forma, substituir a familiar quanto a afeto, estima, e
protecao.
As limitagoes impostas pelo process do


envelhecimento exigem que as pessoas idosas
tenham condicoes residenciais que Ihes favoregam
uma forma de vida mais humana e mais agradivel.
Cor o avangar da idade os estados patol6gicos
podem aparecer e aumentar, progressivamente,
tornando estes individuos propensos a fatores de
riscos adversos para a sua sadde, cause comun do
isolamento social e dos acidentes.


Cuidados Domiciliares

Os acidentes dentro de casa sao imprevistos
mas previsiveis. Precaucoes devem ser tomadas no
sentido de protege os idosos contra os acidentes
domiciliares. O alto custo da assistencia medical,
does, imobilizagao eventuais, incapacitagoes
tempordrias ou permanentes e at6 a morte sao
algumas das consequencias dos acidentes.
As quedas se apresentam como fato rotineiro e
desagradivel por causa do piso escorregadio de salas
e banheiros, tapetes e pasadeiras sem revestimento
antiderrapante ou mal press, al6m dos obsticulos
que representam m6veis fora do seu lugar habitual
e objetos menores negligenciados pelo coao. Os
produtos quimicos apanhados por engano ou mal-
fechados, os medicamentos utilizados sem as
devidas cautelas e identificagao, da mesma forma
que vazamento do gas de cozinha e a fumaga do
fogao a lenha em ambiente fechado, tudo isto
provoca intoxicagao e envenenamento. Os fios
eldtricos descobertos, a sobrecarga de energia e a
tentative de idosos quererem fazer consertos em
tomadas e na televisao, quando nada entendem do
assunto sao outros fatores de riscos.
A vida em edificios de apartamento involve
mais alguns problems. O uso de elevadores, que
podem provocar manifestaqoes de claustrofobia,
particularmente se algum acidente jd tiver ocorrido
com o idoso. As preocupacoes excessivas de
seguranca tendem a provocar ansiedade e ate
isolamento, capaz de impedir abrir a porta, sair a
rua, receber visits.
Esti ganhando corpo a ideia de que 6 precise
conscientizar os "mass media", para que reserve
maiores espacos e tempo is noticias e informagoes
relacionadas ao envelhecimento, referentes & arte de
saber viver a terceira idade. Os velhos sao uns dos
maiores consumidores. Os informativos de radio,
televisao, jornais e revistas, pela ordem, conforme
pesquisas feitas em virios paises. Pode-se-lhes
oferecen, didriamente, fatos que os alertem,
mantendo-os ajustados, orientados, e despertos. A
informagao pode ter um cunho educativo e
eficiente, sendo positive e otimista; noticias
alarmantes abalam sua auto-confianga.
E necessario acauteld-los, interessando-os pelas
coisas da sua comunidade, onde ir e o que fazer,
locais de services para a 3a idade. Tudo deve ser






feito no sentido de preservar sua cultural e auxilia-
los a aceitar as transformagoes da sociedade que os
circunda--e da qual nao desejam se apartar. Safde,
nutrigao, problems da auto-medicagao, atividades
ocupacionais e traballo._voluntdrio, direitos,
seguranga dom6stica, atualizagao cultural, al6m de
outros. Sao alguns dos tears que podem ser
dirigidos no interesse do idoso.
Muitos apresentam problems de mobilidade, o
que restringe sua autonomia e participacao
comunitaria. Em favor deles os organismos locals,
somando recursos publicos e particulares, esforcos e
intencoes, podem planejar e concretizar o
funcionamento de servings m6dicos e sociais de
apoio. O process envolve a utilizaqao, num
primeiro moment, de professional medico,
assistente social e enfermeiro, al6m de voluntarios
habilitados a acoes junto de seus coetaneos. Estes
services devem ser intensamente divulgados.
A assistencia domiciliar permit ao idosos
permanecer mais tempo em seu lar, media que
podera evitar (e ate eliminar) qualquer tipo de
institucionalizagao. Por outro lado, revela ts
pessoas necessitadas de ajuda o interesse da
comunidade pela sua sorte e seu bem estar.


O Papel dos Centros Abertos

Os centros abertos podem representar ume
important adigao no prevencao de enfermidodes e
incapacidades nos paises em desenolviento, em apo6
nos cuidados que os idosos adotaron consigo
mesmos. A frequencia a esses centros ajudara ha
vida associativa en a conscientizagao das
necessidades mituas. Eles operam em horario
diurno e possibilitam estender is families sugestoes
e orientagao adequadas, para manutengao das
atencoes no lar, cor presence dos parents mais
pr6ximos.
Os Centros Abertos aparecem como uma id6ia
nova, pritica, simples e de baixo custo. Significam
mais que um ambulat6rio geriatrico. Podem ser
instalados em bairros, em pr6dios antigos,
preferencialmente em zonas onde se tenha
caracterizado maior prensenca de cidadaos idosos.
A media evitard que estas pessoas tenham que
buscar atencoes em servigos distantes, nem sempre
capacitados a melhor tratar da velhice. Os CA
podem tamb6m serem organizados para cumprir
visits a domicilio.
Cor a participagao de pessoal dos servigos
p6blicos sociais e de saude, das Universidades (que
precisam se interessar mais pelo problema) e de
agents voluntarios das areas sociais e de saude
podem ampliar os servigos de orientacao e
aconselhamento que devem incluir desde as
dificuldades da vida diaria no lar (alimentacao,
mobilidade para a limpeza dom6stica, exercicios


fisicos), as situagoes que acarretam confusao,
depressao e mudangas de conduta que podem ser
confundidas cor perturbagoes mentais. Assistencia
para enfermidades que nao exigem hospitalizagao
tamb6m podem ser proporcionadas nos CA,
explicando-se como agir em casa, p.ex., cuanto a
problems de bronquite, enfisema ou arthritis e mal
de Parkinson. Esse apoio pode envolver o
tratamento de enfermidades ocupacionais causadas
pelo meo ambiente, afetagoes de visao e pes
doloridos; devemos lembrar que somente um
minimo de cuidado para os olhos e os p6s pode
fazer uma grande diferenga no bem star das
pessoas idosas.
Acriacon de grupos de trabalho especiais para
tender a terceira idade, como Comissoes
Municipais do Idoso, sera possibel, no nivel local ne
organizacao de pianos e programs especificos.
Estes grupos, compostos por professionals
capacitados no campo gerontol6gico (arquiteto,
m6dico, psic6logo, assistente social) e representantes
de associagoes de idosos, devera ter a capacidade de
opinar e participar dos pianos sanitarios e
urbanisticos, trabalhando em projetos de moradia
para pessoas idosas sozinhas ou casais, bem como
para families que tenham velhos sou sua guard.
Uma das taretas dos grupos de trabalho seria evitar
que a exploragao imobilidria afete o meio ambient
e fira os direitos desses cidadaos, arrancando-os de
seu habitat.
A legislagao e o planejamento em materia de
desenvolvimento e reconstrugao urbanos, deverao
dar especial atencao aos problems das pessoas de
idade, contribuindo para a sua integracao social.


A Institucionalizaqao dos Idosos

Em determinadas condigoes, o home ou a
mulher envelhecido precisa ser institucionalizado,
mesmo quando se sabe dos reflexos
psicol6gicamente desfavoriveis que isto pode Ihe
acarretar. Cabe, aqui, uma pergunta: quando um
idoso deve ser colocado numa instituicao?
A resposta comum e simplista apresenta tries
enfoques: (a) quando as condicoes fisicas nao
garantem mais sua autonomia; (b) quando entra
num quadro de dependencia psiquica; e (c) quando
a familiar nao mais consiga te-lo sob seus cuidados.
Tudo tern um sabor de desculpas dos familiares
para se desfazerem de seus velhos, improdutivos e
transformados apenas em consumidores. A alegagao
geral incorpora razoes economics e falta de espago
nas residencias. As sugestoes para a solugao do
problema, exigem a participagao do Estado atrav6s
de uma Politica Social especifica para a velhice: O
treinamento de adults para trabalharem como
acompanhantes desses idosos nas residencias e em
deslocamentos eventuais para passeios ou assistencia






de saude; e a preparacao de um program de
familiess substitutes", tipo pensionato, que
receberiam pessoas idosas e Ihes garantiriam
cuidados como aqueles que caberiam a familiar.
Se a solugao tiver que ser a institucionalizagao,
6 important pensar que o local passara a ser a
residencia do velho. E uma questao urgente
establecer crit6rios minimos para que se mantenham
em funcionamento as instituigoes tipo asilo.
Deverao fazer todo o possivel para garantir que os
idosos colocados sob sua responsabilidade usufruam
de uma qualidade de vida que corresponda as
condigoes que normalmente se pode encontrar nas
suas comunidades, cor pleno respeito a sua
dignidade, suas crencas religiosas, suas necessidades,
seus interesses e sua privacidade. As exigencias
incluem services de saude e cuidados socials, em
regime aberto e agoes integradas cor toda a
comunidade.

Modernizacon dos Institusos

Uma important inovagao esta sendo
implantada em Campinas, cidade de um milhao de
habitantes, no Estado de Sao Paulo. "Lar dos
Velhinnos," abriga duzentos idosos de amoos os
sexos. Ai foram instalados um Centro de Geriatria
e um Departamento de Gerontologia Social. O
trabalho articulado desses dois stores assume a
feigao de um Centro de Gerontologia.
Ao lado da assist6ncia sanitaria permanent,
realizam-se estudos e pesquisas das patologias do
envelhecimento; ao mesmo tempo funcionam cursos
de preparagao para acompanhantes de pessoas idosas
e formagao de voluntarios para atuagao
complementary na area social.
O estabelecimento mant6m duas residencias
m6dicas e ja funciona como campo de estagio para
profissionais e universitarios de serving social,
psicologia, enfermagem, terapia ocupacional,
nutrigao e fisioterapia. Recebe t6cnicos dos asilos
da regiao para encontros em que sao debatidas
experiencias e problems comuns. Anualmente o
Lar dos Velhinhos realize uma Jornada M6dico-
Social da 3a Idade, corn apoio de organizagoes
cientificas, especializadas, e promove seminarios na
linha "A Cidade e os Idosos", num esquema regional
que tern a co-promoqao de entidades oficiais e
particulares que ajudam a manutencao dos asilos.
Essas entidades preocupam-se cor os altos custos
da institucionalizacao e buscam formas que
possibilitem reduzir o volume dessas despesas. Isto
somente sera possivel cor maior envolvimento da
familiar e da comunidade no process geral de
atengoes para esse grupo social.

Programs Desenvolvidos no Brasil

A base dos programs em favor dos idosos tern


sido organizacoes nao governamentais (NGO), que,
no seu esf6rco vmn motivando e convidando
diferentes stores da comunidade (sindicatos,
igrejas, clubes de servings, associagoes profissionais,
universidades, empresarios, etc) a se identificarem
cor as questoes da velhice-- um problema social
emergente. O assunto vai ganhando interesse,
progressivamente, diante dos reflexos que ja se
observa nos sistemas de saude, economic, trabalho e
na cultural nacionais.
Tamb6m no Brasil os idosos formam uma
populacao ponderavel, com mais de dez milhoes de
homes e mulheres, segundo estimativas do Instituto
Brasileiro de Geografia e Estatistica. Este numero
supera a populagao global do Uruguai, do Equador
e do Paraguai, assim como da Suica, Portugal, e
Noruega. Ha um desenvolvimento diferenciado das
regioes brasileiras, impede que hoje uma
generalizacao de condicao de vida de populagao
idosa para todo o pais. Os contrastes dificultam a
adocao de medidas uniforms visando o
desenvolvimento e a implantacao de uma political
capaz de abranger toda a populacao do Brasil, que
hoje alcanga mais de 130 milhoes de habitantes.


Os Primeiros Rumos SESC

As agoes pioneiras introduzidas na comunidade
brasileira, visando implantar programs de
assist6ncia nao-institucional aos idosos, cabem ao
SESC Servico Social do Com6rcio, entidade
national de carter privado, criada e mantida pelo
empresariado comerical. Embora atuando junto a
varies segments da populacao, a entidade tern se
mostrado sensivel aos problems da terceira idade;
sobretudo, no que diz respeito a sua marginalizagao,
perda gradual de pap6is e funcoes, diminuigao do
convivio social, ausencia de aspiragoes culturais,
responsabilidades political e estimulo a
auto-estima--fator basico para que estas pessoas se
mantenham integradas em seu meio social.
O SESC voz um trabalho educativo que amplia
as expectativas de participagao dos mais velhos na
comunidade, cor presence de 20,000 idosos em 30
diferentes nicleos, em vinte cidades do Estado de
Sao Pulo. O modelo, pelos seus resultados, foi
encampado pelo Departamento Nacional do SESC, e
esta sendo desenvolvido em outros 16 Estados dos
22 que formam a Federacao brasileira.
O trabalho social corn idosos 6 uma proposta de
medidas concretas, capazes de levar estas pessoas a
encontrar novos interesses, sempre atualizadas nas
informacoes e propostas que fortalecam o seu bem
estar. o que se sugere 6 que participem da sua
comunidade e, exercendo plenamente a cidadania,
procure influir sobre medidas que afetem suas
vidas. Meio-ambiente, moradia, transit, transport
e cuidados pessoais que Ihes permitam mobilidade







para a auto-realizagao figuram no esquema que os
t6cnicos sugerem a sao postos em discussao. Os
idosos sao considerados agents multiplicadores das
propostas que os levem a um sentido de realizacao
pessoal e conquistas na_qualidade de vida do seu
grupo etario.
Os objetivos do SESC sao atingidos atraves de
dois projetos bdsicos: os Centros de Convivencia de
Idosos e as Escolas Abertas da Terceira Idade. A
realizagao peri6dica de Encontros Regionais e de
Encontros Naiconais de Idosos, colabora papa
identificar anseios e problems desse public,
permitindo encaminhar relat6rios-propostas sempre
atualizadas as autoridades responsaveis e stores
particulares que possam colaborar para o
desenvolvimento material e o bem estar social das
pessoas mais velhas.

Centros de Convivencia. O modelo comecou
em 1963 na cidade de Sao Paulo (hoje cor 12
milhoes de habitantes), onde o crescimento rapido e
desordenado acarreta profundas mudancas na
estrutura familiar e no comportamento social. As
dificuldades de contatos frequentes entire os
parents gera entire os idosos a maior parcela de
solidao e desamparo, dai um trabalho especial que
visa combater o isolamento social, ponto mais grave
da problematica da velhice. O program 6 dirigido
para as pessoas cor mais de cinquenta anos e os
grupos sao monitorados por .equipes
multiprofissionais. As atividades desenvolvidas
propiciam a sociabilizagao, o desnvolvimento da
criatividade e a auto-expressao.

Escolas Abertas da Terceira Idade.
Representam uma proposta de Educagao
Permanente, numa abordagem cujo objetivo maior 6
o de criar condicoes para que o grupo redescubra
interesses capazes de ajuda-lo a se reequilibrar
socialmente, retardando as manifestagoes negatives
da velhice. O program destina-se a idosos,
aposentados e donas de casa, assim como outras
pessoas que, liberadas pela idade das obrigagoes
professionals e familiares, encontrem tempo para se
atualizar e renovar culturalmente. O curriculum
propicia o conhecimento e reflexao sobre os
aspects biopsicossociais; situa o idoso na sociedade
modern e favorece sua reciclagem e novos pianos
de vida; estimula o relacionamento intergeracional e
a retomada do dialogo cor os mais jovens, evitando
uma ruptura total entire as geracoes e, assim,
prevenindo o process de marginalizacao da velhice.
Essa aproximagao pode gerar mudancas
surpreendentes no estilo habitacional da gente idosa.

Fundaqao L.B.A.

A prevengao dos efeitos desfavoraveis do
envelhecimento 6 o ponto prioritario no program


da Legiao Brasileira de Assistencia (LBA)
organismo governmental vinculado ao Ministerio
da Previdencia e Assistencia Social. Seus services
cobrem o pais, e diante das diferengas regionais
estabelece distintas formas de apoio a velhice
carente. A LBA atue nos seguintes areas:

1. Na comunidade, considerando os elevados
custos das atengoes sociais e sanitarias, procura
consolidar a integraqao da rede de apoio, incluindo
as entidades particulares e oficiais e o pdblico
interessado, que sabe exatanente quais as suas
necessidades. Inspirada na agao do SESC, a LBA
realize atividades grupais, s6cio-recreativas,
buscando a mobilidade e animacao dos idosos;
promove cursos e encontros para a valorizagao do
artesanato e sua producao, capaz de gerar renda;
estimula a formagao de associagoes de idosos,
orientados para trabalhos voluntario e soliddrios
cor pessoas incapacitadas e/ou deficientes que
vivam isoladas em seus alojamentos, ou mesmo cor
suas families.
2. Junto as instituicoes de abrigo da velhice,
celebrando convenios para a melhoria dos
alojamentos e instalacoes fisicas, prestagao de
servigos sanitarios adequados; qualidade da
alimentacao, contratacao de pessoal tecnico
multidisciplinar; estimulo a maior identificagao
dessas entidades cor a comunidade onde
funcionam; desnvolvimento de um esquema de
atividades compativeis, laborais, recreativas e
produtivas; adocao do regime de semi-internato,
cor pernoite junto da familiar.
3. Formacao de pessoal voluntario e
treinamento adequado para atuagao em diferentes
nucleos de idosos, ajudando a pratica de agoes
preventivas que os despertem para a consideraqao
por si mesmos, como forma de possibilitar sua
autonomia e mobilidade.
4. Fornecimento de equipamentos que
permitam aos idosos conservarem suas atividades,
mobilidade e presence social, tais como 6culos,
aparelhos auditivos, dentadura, pernas mecanicas e
cadeiras de rodas.
5. Pesquisas atraves de contratos cor
entidades e instituigoes, para caracterizacao da
populacao idosa em varias parties do Brasil,
permitindo ajustar os programs de apoio ao bem
estar e qualidade de vida deste public, segundo
suas reais necessidades e anseios.

Agao da S.B.G.G.

A Sociedade Brasileira de Geriatria e
Geronotlogia--SBGG 6 um organismo cientifico que
opera a nivel national. Sua contribuigao ter sido
valiosa na capacitacao de profissionais para as areas
da geriatria e da gerontologia, inclusive, levando a
questao da velhice para debates no campo politico-






administrative. Em semindrios, jornadas e
congresses, al6m de cursos em que os tecnicos sao
participants ativos, tem-se reconhecido que o mais
grave problema brasileiro 6 a saude e a saude do
velho merece a mesma atengao e recursos que
recebe a crianga.
Concorda a SBGG em que a atengao dedicada
As pessoas idosas deve ir alem do enfoque
puramente patol6gico e deve abarcar a totalidade do
seu bem estar, levando em conta a interdependencia
dos fatores fisicos, mentais, sociais e ambientais. A
entidade ter procurado conseguir a adesao dos
services de saude oficiais para o reconhecimento da
geriatria e da gerontologia, que ja deveriam ter sido
implantadas em organisms que atendem o piblico
mais velho, a partir da pr6pria Previdencia Social,
que cor frequencia critical os gastos que precisa
fazer para tender os aposentados.
As recomendagoes da Assembleia Mundial
sobre o Envelhecimento verifica-se que e
fundamental o melhor aproveitamento dos recursos
hoje existentes. Especialmente, num sentido de
custos, valorizando e melhor utilizando os servigos
sanitarios e sociais em funcionamento, de forma a
se proporcionar cuidados primarios aos idosos o
mais pr6ximo possivel de suas residencias e na sua
comunidade. Nos ciclos de atualizacao, ter sido
recomendado que o meio-ambiente e a moradia
sejam melhjor considerados nos programs de
desenvolvimento urban.
Ja foi se sugerido a orgaos do governor que a
political habitacional possibility financial construgao
e reforms de moradias para pessoas idosas, dentro
de projetos compativeis cor suas condigoes fisicas
procurando-se ouvir membros deste grupo para o
aperfeigoamento de projetos que poderao ser
oferecidos ao public. E important que eles
mesmos indiquem aspects do bem estar, pontos de
risco e maior seguranca.
A questao das instituigoes conhecidas como
"asilos" ter sido frequentemente posta em questao;
vem-se recomendando mais atengao, recursos e ji
foram sugeridas normas e diretrizes para estes
servings, com vistas a humanizagao e modernizagao
de cerca de tres mil estabelecimentos existentes no
pais. Visando a implantagao da gerontologia-
geriatria no plano national, sao mantidos
entendimentos com organismos governamentais
ligados a saide e a previd6ncia social, para que
profisionais da area participem das political
voltadas para a gente idosa.

A Universidade e o Envelhecimento

O public idoso represent um setor para o
qual quase tudo esta para ser feito no Brasil. Ate
recentemente todos os problems da velhice
sobrecarregavam a medicine; nao nd muitos anos
passou-se a considerar que os fatores sociais tem


precipitado o envelhecimento e influido em suas
patologias.
Mais de 7% da populacao brasileira ultrapassou
os 60 anos de idade. E precise, pois, o concurso de
um grande numero de profissionais, cor novo tipo
de formagao para atuar sobre os aspects biol6gico,
social, economic e cultural que afetam esse
pdblico.
A cresciente preocupagao cor a expansao dos
cidadaos idosos e tantos problems que eles
apresentam na vida quotidiana, levou o Autor a
exp6r ao Conselho Federal de Educagao/CFE a
urgencia de se incluir a gerontologia Social e a
Geriatria no curriculum universitirio. A proposta
foi aceita, mas at6 agora o Ministerio da Educaqao
nao oficializou a implantaqao da media. Todavia,
um grande nimero de institutes universitarios, cor
alguma catedra ligada as ci6ncias humans,
iniciaram trabalhos de informagao gerontol6gica,
levando os jovens a pesquisas e conhecimento
pratico da realidade da situaqao da velhice. A
sistematica discussao do assunto aliada ao "boom" da
terceira idade ja revela que hl um mercado de
trabalho que reclama esse tipo de tecnicos.
Na Universidade Federal de Santa Catarina foi
criado um Nicleo de Estudos da Terceira
Idade/NETI, coordenado por profissionais
habilitados. E o primeiro trabalho no genero, no
Brasil, especilizando inicialmente universitarios que
cursam Servigo Social, Psicologia e Enfermagem, a
fozerem pesquisas apoiados por professors
aposentados. 0 NETI abriu cursos que ora somente
podem tender pessoas validas que discutem cor
profissionais estagiarios e universitarios os
problems do envelhecimento e velhice. As
constatagoes do interesse, companheirismo e boa
comunicagao entire os idosos-alunos e excelente,
assim possibilitando 6xito na investigagao social que
realizam professors e tecnicos estagiarios quanto a
ambiente, moradia, interesses, economic, sadde, e
cultural da gente mais velha. Funcionando desde
1982 o NETI vem procurando o intercambio cor
instituigoes internacionais, desejando que suas
experiencias sejam validas para outras
universidadedes brasileiras que pretendam
estabelecer programs na mesma linha.
Na cidade de Sao Paulo existe o fnico curso
formal, especialmente destinado profissionais
graduados em todas as areas, e interessados no
campo do envelhecimento. Fundado em 1979, o
curso de Gerontologia Social do Institute Sedes
Sapientiae formou ate 1987 duzentas pessoas, dentre
elas funcionarios de servings publicos que comegam
a desenvolver programs pr6-idosos. Acorrem a
Sao Paulo elements de diferentes regioes do Brasil,
ajudando a expandir as perspectives de agao
gerontol6gica no piano national. E um cursor
basico, cujo objetivo e a informagao e atualizagao
daqueles que trabalham cor idosos, orientando as







attitudes professionals tambem frente a familiar e a
comunidade. Incorpora nesse contefido
gerontologia, antropologia e demografia; mudancas
fisicas, sociais, psicol6gicas e suas consequencias
sobre o individuo, legislagao, political social,
atendimento e prevencao em nivel da comunidade
onde esse grupo social esteja radicado.


Preparacao para a Aposentadoria

A recomendaqao de que os governor estimulem
medidas para que seja mais facil e gradativa a
transicao da vida ativa para a jubilacao, embora
lentamente, esta ganhando impulso no Brasil.
Inicialmente langados pelo SESC, os cursos de
preparagao para a aposentadoria estao sendo
particularmente procurados por organismos
subsidiados pelo governor.
Entre o empresariado a ideia esta sendo
estimulada, embora os programs sejam contratados
apenas muito perto da aposentadoria, um ou dois
anos antes do individuo alcangar o prazo legal para
deixar o trabalho ativo. Organismos internacionais
que ha anos avaliam os efeitos dessa linha de
trabalho consideram a preparaCao para a
aposentadoria necessaria, mas nao suficiente, porque
a continuidade da vida normal somente ocorrera se
a opiniao public for sensibilizada para as
consequencias do retorno de tantos cidadaos a
vivencia do lar e da comunidade.
Iste implica, tambem, na conscientizacao da
familiar para que a "volta do guerreiro" nao Ihe
proporcione tratamento que dificulte a readaptaCao,
ha empresas que oferecem sugestoes para pessoas
que talvez pretendam continuar trabalhando ou,
entao, manter-se em alguma atividade util e as
agoes de voluntariado sao bastante significativas.
A preparaqao para a aposentadoria deve ser um
estimulo para que o individuo se program para
uma velhice melhor dentro das mudanqas que vai
enfrentar, de ordem economic, social sanitdria e
cultural. Sempre se indica a importancia de que o
aposentado faga parte de grupos sociais, na defesa
de sua condigao humana; inclusive, lutando no
sentido de pleitear a atualizacao periodica dos
valores da aposentadoria, para que eles nao percam
seu valor aquisitivo.
Gragas ao apoio de t6cnicos da Associacao de
Gerontologia he e Estudos Sociais (AGES), foi
organizado um Centro de Orientacao e
Aconselhamento, capacitado a oferecer sugestoes e
informacoes aos idosos e a seus familiares, em
questoes de relacionamento, convivencia, adaptagao
i velhice a a aposentadoria, alimetacao, lazer,
problems de mobilidade, adaptacao da moradia as
limitagoes por defici6ncias fisicas, etc. Este Centro
tambem proporciona assessoria a universitarios que
procuram dados atualizados em torno da situacao


das pessoas idosas, no Brasil e em outros paises, o
que exige documentacao gerontol6gica atualizada,
que somente sera possivel atraves de urn program
dindmico de intercambio de pulbicaoes, noticias e
experiencias.
Uma important luta que enfrentam os
coordenadores destas inovacoes, consiste em obter
recursos para que a traditional linha de
atendimento biol6gico (comer-dormir-esperar
morrer) se convert num trabalho renovado, que
inclua o retorno & comunidade-sociedade, do
reposit6rio de informagoes e experiencias que
possam permitir a cidade ser mais humana corn os
seus velhos. Principalmente, criando condicoes para
que a familiar tenha novas formas de mante-los na
convivencia dos parents mais chegados,
descobrindo caminhos, tambem, para tender os
deficientes cor dificuldades de locomoqao. Sem se
esquecer de que essa mobil.izagao de consciencia
engloba a preocupacao corn os pacientes cronicos e
os doentes terminals.
Revemos veltar as nossas preocupapgoes dos
gerontologos de Campinas, para as possibilidades
dos novos rumos serem capazes de alcancar os
objetivos visados quanto aspects fundamentals: de
melhoria da qualidade de vida nas instituigoes; de
desenvolvimento e formagao de recursos humans;
de estudos, pesquisas e divulga9ao; de estimulo i
programagao diversificada de atendimento e
encaminhamento do idoso, tanto a nivel comunitario
como institutional (este s6 em circunstancias
extremes). Este quadro faz esperar cor grande
expectativa a realizagao, em future pr6ximo, da
pesquisa patrocinada e orientada por HelpAge,
sobre "A Demografia da Desigualdade na America
Latina". Os resultados poderao ditar novos rumos
para as political em favor de velho, esse esquecido.

Bibliogrfia
Canoas Swain, C. A condicao humana do velho. Sao Paulo: Ed.
Cortes, 1983.
Conferencia Latino-Americana y del Caribe de Gerontologia.
Bogota, junho 1986, Paris: Edicao CIGS, 1986.
Di Veroli, D. Reflexoes sobre a planifacao do habitat para a
tercera edad. In Medicina de la Tercera Edad. Ano 5, no. 10,
Buenos Aires, 1986.
Una poblaci6n en visa de envejecimiento: Enfoque en los centros
abiertos. Federaci6n Internacional sobre el Envejecimiento,
1983.
Fernandes, F. S. Participagao da universidade numa political
social para a 3a idade. In Envelhecimento e velhice: Uma nova
realidade. Sao Paulo: Ed. Pref. Paulinia, 1981.
Fernandes, F. S. Educa;ao, formagao a informagao no Brasil.
Trabalho p/ Conferencia Latino-Americana y del Caribe de
Gerontologia, 1986.
Forum de Organisaoes nao-governamentais sobre o
envelhecimento. Viena, 1982.
Glyn, T. Os idosos num mundo em transformagao. Revista OMS.
Genebra, 1979.








Jordao Neto A. A segrenaca do eio La ociedade. Sao Paulo:
Ed. Conselho Estadual do Idoso/Gov. Est., 1986.
Morelli, A. Tercera edad bio-psico-social: Baseado em
documentos da ONU-1982. Montevideo: Libreria Mddica
Editorial, 1982.
Nista, L.D. Hdbergement des personnel ages: pour une autre vie.
In Le malade agL. Paris: CIGS, 1981.
Piano de Agao Internacional sobre o envelhecimento. Assembldia


Mundial sobre o Envelhecimento, Viena, 1982.
Preparation a la retraite. Strasbourg: Council of Europe, 1982.
Rosa, H. Psicologia da idade adulta. Petropolis: Edit. Voses,
1983.
Salgado, M.A. Estruturas medico-sociais para idosos: algumas
considerasoes sobre a realidade brasileira. Trabalho
apresentado na Conferencia Latino-Americana y del Caribe de
Gerontologia, 1986.








ESTRUCTURAS DE APOYO Y ATENCION PARA EL ANCIANO Y
ENFERMO TERMINAL EN LOS ESTADOS UNIDOS DE AMERICA


Eduardo Alvarez
New York City, U.S.A.


Abstract

The paper presents data on the elderly
population in the United States relating to a number
of broad issues: (a) sociodemographic profile: (b)
legislation regarding health care to the elderly; (c)
description of types of care and aid available; (d)
demographic information regarding the users of
institutional care; and (e) expenditures for various
types of care. In addition to this quantitative data,
Dr. Alvarez discusses quality of different kinds of
care, incapacities, and common infirmities of the
elderly.
The United States shows an increase in people
over 65. In 1980 they comprised 11% of the total
population and an increase of 67% is expected
between 1980 and 2000 in 75-84 year olds. About
49.4 billion dollars were spent on health care to the
elderly in 1978, which is 29% of the federal
government's total expenditure on health care.
Nursing-home care has risen since WWII and the
beginnings of Medicare and Medicaid in 1965
greatly augmented government aid to the
incapacitated and terminally ill.
In the last two decades an alternative to nursing
home care has been the use of home care help to the
elderly. These services are more economic than
nursing homes and are often preferred by the
beneficiaries and their families. Hospice services
provide another alternative for the terminally ill. As
concepts of incapacity change, and as the profile of
the elderly population changes, alternative systems
of care and services should be explored and
expanded.


Introducci6n

Estados Unidos, como otras naciones
industrializadas, present un aumento en la
proporci6n de personas de 65 aiios 6 mas. En 1980,
habia 25 millones sobre los 65 afios, un 11% de la
poblaci6n total; la proyecci6n para el afio 2030 es
de 55 millones, 22% de la poblaci6n (U.S.
Department of Health and Human Services). La
proporcion de 75 a 84 afios es mayor cada dia. Del
1980 al 2000 habri un aumento del 67% entire esas
personas, lo que a su vez se traduce en una mayor
necesidad de asistencia m6dica y social, por el
nimero de ancianos incapacitados y enfermos


terminals incluidos en ese grupo de edad.
El costo al pais por cuidados de salud fue 167.9
billones en 1978, de los cuales 49.4 se emplearon en
el cuidado de ancianos. En los hogares de ancianos,
los costs ascendieron a 10.1 billones en 1979.
Los hogares de ancianos se popularizaron en
Estados Unidos despues de la II Guerra Mundial.
Para evitar que los ancianos ocuparan camas en
hospitales--de los que habia escasez, se sigui6 la
political de aumentar el numero de hogares de
ancianos. Mediante legislaci6n Hill-Burton, se
concedieron fondos para construirlos. Mas tarde,
en 1965, con la creacion de los programs de
Medicaid y Medicare, se hicieron disponibles
fondos adicionales para el cuidado de ancianos
incapacitados y enfermos terminals. En 1970, en
las secciones 222 y 1115 del "Social Security Act,"
el Congress destiny una suma de dinero para
evaluar y ejecutar el cuidado no-institucional de
ancianos incapacitados, incluyendo el cuido en sus
hogares.
Hoy por hoy, el cuidado de los ancianos
incapacitados esta repartido por orden de frecuencia
en los siguientes servicios: (a) hogares de ancianos;
(b) cuidados a domicilio; (c) atenci6n diurna; y (d)
cuidados no-institucionales. Los mayores gastos los
incurre el Estado en los hogares de ancianos; el
cuidado a domicilio de ancianos incapacitados y
enfermos terminales ocupa segundo lugar en el
presupuesto federal y estatal. Segun un studio de
la Oficina de Presupuesto del Congreso realizado en
1976, de los 1.9 a 2.7 millones de adults que
recibian cuidado a largo plazo, 1.4 millones residian
en hogares de ancianos o en hospitals de
enfermedades cr6nicas, y entire 0.5 y 1.3 millones
recibian cuidados fuera de instituciones, tales como
servicio a domicilio, atenci6n diurna, etc. Los
beneficiaries de estos servicios eran en su mayoria
mujeres (70.2% vs. 29.8%) de color blanco (73.2%
vs. 26.8%). La edad promedio era de 76 a 82 aiios.
Los studios sugieren que un 20% de entire el grupo
de 65 afios y mds pasa por lo menos algun tiempo
en hogares de ancianos.


Objetivos de la Asistencia a los Ancianos

Los objetivos para los hogares de ancianos y el
cuidado en casa son los siguientes:
I. Mayor funci6n possible; si curar su






enfermedad no es possible, ayudar a la mayor
independencia que su condici6n permit, por
tratamiento de rehabilitaci6n o mantener su funci6n
y retardar su deterioro.
2. Mejorar la calidad de vida. A veces es
dificil establecer qu6 nivel de calidad de vida es
acceptable para el paciente: generalmente se persigue
mantener la calidad de vida existente antes de la
asistencia social.
3. Prolongar la vida en casos que se pudiese
controlar la enfermedad.
4. Prevenir complicaciones adicionales, por
ejemplo, el caso de problems pulmonares en
pacientes que no se levanten.
5. En ancianos incapacitados o enfermos
terminales, continuar la atenci6n social y medica en
sus casas. No s61o es mas econ6mico que su
internamiento en una instituci6n, sino que parece
ser mas human al mantener el ambient familiar y
la cercania a series queridos. Para esto se utiliza
una enfermera o asistente social que permanece con
el anciano el dia entero y muchas veces las 24
horas.


Cuidados a Largo Plazo y Hospitalizaci6n

Las caracteristicas del cuidado a largo plazo de
ancianos incapacitados en los Estados Unidos son
las siguientes: (a) una gran proporci6n obtiene su
cuido de parte de familiares; y (b) parte de los
gastos incurridos tanto por los institucionalizados
como por los atendidos en la casa son pagados por
el gobierno federal y/o estatal.
Con el numero de ancianos que llegan y
sobrepasan los 80 hay mis personas invalidas,
sobretodo por las condiciones que les acompafian:
p6rdida de vision, demencia, arthritis, hemorragia
cerebral seguida por paraplegia o hemiplegia, mal
de Parkinson. El caso de incapacidad mas tipico en
la edad avanzada es la demencia senil, de la cual
hay dos tipos principals: la enfermedad de
Alzheimer, y las producidas por militples infartos.
Estos dos tipos comprenden la cuarta y quinta parte
de las demencias de los ultimos aflos. Un 4% de la
poblaci6n de 65 afnos y mas sufre de demencia
senil, y un 10% present cierto grado de demencia
(Butler & Lewis, 1982). A pesar de ser
relativamente pequefia la proporcion de ancianos
que sufren de demencia, son 6stos los que
frecuentemente necesitan internarse.
Ciertos factors influyen en la necesidad de
cuido a largo plazo en los ancianos: identificar
aquellos subgrupos que presented un riesgo mayor
de esos cuidados; comprender la relaci6n entire la
condici6n del anciano y el tipo de servicio que
necesite; predecir la necesidad future y clase de
servicio disponible; hacer un estimado de los gastos
futures; localizar d6nde se pueden facilitar esos


cuidados.
La edad cronol6gica, asi como las afecciones
cr6nicas que frecuentemente le acompafian sirve de
base para determinar la ayuda gubernamental y se
consider como criterio de elecci6n para servicios a
largo plazo. Igualmente, se consider tambien la
salud, es decir, el grado en que la persona puede
desempefiar funciones de la vida cotidiana tales
como bafiarse, comer, mobilidad, preparaci6n de
alimentos, control de entradas y gastos, condici6n
mental, memorial, etc.
El concept modern de incapacidad se basa en
la patologia active, ejemplo esclerosis o demencia
senil. Otro concept de incapacidad es perdida
anat6mica o disfunci6n fisiol6gica consecuencia de
su patologia. Ademis ciertas incapacidades como
perdida o anormalidad anat6mica, fisiol6gica,
intellectual, o emotional, no siempre asociado con
una patologia active como pardlisis o desorientaci6n.
Otro concept de limitaci6n funcional e
impact que esta limitaci6n represent en la funci6n
de esa persona es la dificultad que tenga la persona
para doblarse; trastornos de la vision; uso de sus
dedos; funcion emotional; reaccion del individuo
ante problems cotidianos tales como ansiedad,
depression, tensi6n; y algunas manifestaciones psico-
fisiol6gicas. El concept final de incapacidad es
cuindo el anciano necesita "la ayuda de otra
persona" para sus actividades.
La enfermedad cr6nica en la edad avanzada no
siempre significa que esa persona esta incapacitada.
Algunos presentan mas de una enfermedad cr6nica
siendo las mis frecuentes las cardiacas,
hipertension, arthritis, y senectud. El t6rmino
incorrect de senectud se usa a menudo para
designer cierto numero de sintomas de delirio o
depresion several, perdida de la memorial,
desorientaci6n de tiempo y lugar, etc.
Aproximadamente 35% de personas de 65 a 74
allos y 44% de los de 75 a 84 presentan limitaci6n
de sus actividades; esta cifra aumenta al 52% en las
personas de 85 6 mis. La limitaci6n de actividad
por condici6n cr6nica aumenta con la edad. Sin
embargo, esto no significa que la necesidad de
atenci6n a largo plazo esta limitada a un solo grupo
de ancianos por su edad; hay muchos que estan
incapacitados a los 65 aflos o menos y requieren
cuidado a largo plazo.
La mobilidad en los ancianos es de much
consideraci6n. Estadisticas del U.S. House Select
Committee on Aging (1982) en la poblaci6n de 65
afios o mas, estiman que un 2.1% estan confinados o
postrados en cama, 2.6% necesita ayuda para
caminar en su casa, 6% precisan asistencia para ir a
su vecindario, y 8.4% requieren ayuda para salir de
su vecindario. De forma que 5% de ancianos no-
institucionalizados requieren ayuda dentro de su
casa y alrededor del 14% necesita ayuda para salir
fuera de la casa. La conclusion de estos studios es







que hay double cantidad de ancianos postrados en
cama o que no pueden valerse fuera de su casa que
residents en instituciones. La mayoria de ancianos
enfermos incapacitados viven fuera de las
instituciones para ancianos incapacitados o enfermos
terminales.
Las estadisticas existentes sobre la frecuencia
de problems mentales del anciano son limitadas.
Muchos de los que no resident en instituciones
presentan ciertos sintomas de enfermedades
mentales en un 15 a 25%; un 10% han sido
diagnosticados de depresi6n y de un 5 a 6% sufren
de demencia senil, que es mis frecuente en los de
edad mas avanzada. Entre aquellos que resident en
instituciones, principalmente en hogares de
ancianos, 16% entran con el diagn6stico de
demencia senil y 56% sufren de afecci6n mental
cr6nica o senectud (U.S. Federal Council on the
Aging, 1981).
Hay mayor numero de ancianos en instituciones
por trastornos mentales que los que reciben atenci6n
fuera de estas. No esta muy claro si los problems
mentales comenzaron antes y esa fuera la razon de
internarlos, o si los problems se presentaron
despues. Evidentemente la salud mental es un
factor muy important en los cuidados a largo plazo
pues afecta la funci6n y capacidad del enfermo
para poder Ilevar una vida independiente.
Los problems socio-econ6micos de los
ancianos estan asociados en proporcibn direct con
mayor numero de enfermedades, con incapacidad, y
con trastornos mentales. Estan tambiin asociados
con mayor pobreza en sus viviendas, con falta de
cuidados m6dicos, y con nutrici6n inadecuada.
Aquellos que tienen mayores entradas pueden
facilitarse sus necesidades, lo que evita o retarda la
necesidad de entrar a instituciones.
El numero de incapacitados ancianos es mayor
en los hombres (44%) que en las mujeres (35%).
Dos factors influyen en esta diferencia: mayor
frecuencia de accidents de trabajo y menor
extension de vida. A los 65 alios hay una
proyeccidn de 14.1 aiios para los hombres y de 18.1
para las mujeres. A edad mas avanzada la
diferencia entire ambos es menor.
En los hogares de ancianos hay mas mujeres
que hombres porque alcanzan mayor edad y
frecuentemente son viudas o no casadas, pero no
porque sean menos saludables (Butler &
Newacheck, 1981). Los no blancos tienen mayor
nimero de incapacitados que los blancos. La
limitaci6n de actividad por raza de los 65 aiios o
mas es la siguiente: blancos 37%, no-blancos 43%;
de los 65 a los 74, blancos 33%, no blancos 43%; de
los 75 a los 84, blancos 43%, no blancos 52%. A
pesar de estas estadisticas el numero de
institucionalizados es dos veces mayor para blancos
que no blancos, aun excluyendo los factors
educaci6n y situacion econ6mica. Los negros tienen


menor oportunidad a entrar en una instituci6n por
la raza (Palmone, 1976). Los hispanos o
latinoamericanos prefieren su atenci6n en la
familiar.
En un studio en personas con enfermedades
cr6nicas avanzadas en Minnesota (Anderson, Patten,
& Greenberg, 1980) se observ6 que aquellos que
vivian solos estaban menos incapacitados que los
que vivian acompaflados. Sin embargo, los viudos
son cinco veces mis internados que personas
casadas que viven juntos.
Personas que nunca han sido casadas,
divorciadas o separadas son hasta 10 veces mis,
internados. Esto no significa que sean mas
incapacitados, contrario al studio de Minnesota.
Esto prueba que hay otros factors sociales que
influyen en su entrada a instituciones, tales como,
no tener sitio donde vivir, poca entrada econ6mica,
y aislamiento social por falta de parientes o amigos.
Por ejemplo, a los 85 afios o mis, hay mis
probabilidades de problems de salud, de
incapacidad, de viudez, de vivir solo, de tener
pocas entradas, y de falta de apoyo familiar.
La tendencia actual de families mas cortas
significa que en las pr6ximas decadas habra un
numero cada vez mayor de ancianos con pocos o
ningun hijo; muchos seran mujeres viudas, o no
casadas, lo cual aumentara el numero de ancianos
en necesidad de asistencia a largo plazo. En cambio
otros investigadores (U.S. Health care for Aging,
1981) creen que habran dos factors que
favoreceran en la disminuci6n del cuido a largo
plazo. Unos consideran que el termino medio de
vida no pasarM de los 85 afios y que mejorara el
control de enfermedades cr6nicas y producira
disminuci6n de incapacitados. Si esta predicci6n
fuese correct disminuiria el numero de personas en
necesidad de "cuidados a largo plazo."


Los Hogares de Ancianos

En los Estados Unidos, una de cinco personas
de 65 o mas vivird por un tiempo en un hogar de
ancianos antes de morir. Como consecuencia, la
cantidad de dinero necesario para hogares de
ancianos represent el mayor gasto entire los
servicios a largo plazo. Hay unos 18,000 hogares de
ancianos en contrast con 7,000 hospitals. En toda
la naci6n hay una cama en hogar de ancianos por
cada 20 personas de 65 6 mis.
El termino "Nursing Home" se aplica a
residencias done 50% o mas de sus residents
reciben cuidado de enfermeria. Aquellos sitios
donde menos de la mitad require cuidados es
considerado como "residencia de ancianos."
Hay tres categories de "nursing homes": por
beneficio, voluntario, y gubernamental; las dos
ultimas no tienen fines lucrativos.






Aproximadamente 75% de estas instituciones (pero
solo 66% de las camas) pertenecen al primer grupo
(propietario, o por negocio). Una sexta parte de los
nursing homes, 3,000 de los 18,000 son voluntarios
con un 21% de todas las camas. Las del gobierno
comprenden del 5 al 10% con 10% de camas.
Muchos de los hogares voluntarios son de grupos
religiosos.
La gran mayoria de los nursing homes son de
propiedad privada y negocio. Sin embargo, los
servicios son pagados por los gobiernos federal y
estatales a traves del Medicare y Medicaid,
especialmente.


Serviclos a Domicilio

En los ultimos 10 6 15 afios se han empleado
los servicios a domicilio como alternative a los
hogares de ancianos. Estos servicios son mas
econ6micos que los de nursing homes; ademds
much de los beneficiaries y sus familiares
prefieren esta clase de servicios. Algunos ancianos
prefieren el cuidado de nursing homes debido a que
no quieren ser una carga a sus familiares y porque
se sienten mas seguros. Otros encuentran que los
servicios a domicilio tienen mejor calidad de vida,
y consideran ventajoso permanecer dentro de su
propio ambiente y con sus familiares.
Hay tres categories de servicio a domicilio:
cuidado de salud, cuidado personal, y cuidado del
hogar. Las dos primeras estin dirigidas al individuo;
la tercera es para ayudar al domicilio, incluyendo la
preparaci6n de los alimentos.


Los Hospicios

En Estados Unidos hay una tendencia a los
Ilamados "hospicios", donde se admiten pacientes
con enfermedades terminales, especialmente cancer,
no son exclusive para ancianos. La admisi6n a
estas instituciones se hace por solicitud del
paciente, de sus familiares, de clinics u hospitals,
medicos, centros profesionales de salud o agencies
de la comundiad. Estos servicios son pagados por
el Medicare, Medicaid, Blue Cross, otro seguro
comerical, o por el paciente y sus familiares.
Ejemplo de esto es el Calgary Hospital del
Bronx, en Nueva York, mantenido por la
Arquidi6cesis de Nueva York. Con 200 camas y
600 empleados, alli se atienden unos 1200 pacientes
anualmente, sin discriminaci6n de clase, religion, o
etnicidad. El paciente es asignado a un medico,
quien establece la atencion para ese paciente,
tomando en cuenta sus necesidades fisicas,
espirituales, y emocionales. Diariamente se hacen
servicios religiosos catolicos, protestantes, y judios;
el paciente puede asistir en persona o verlo por


television a circuit cerrado. Existe tambi6n un
departamento de recreo terapeutico. Las visits son
de 12 p.m. a 8 p.m., e incluyen niios. Los
familiares pueden quedarse toda la noche cuando
las circunstancias lo requieran. Las informaciones
se suministran en ingles y en espafiol.


Los Seguros Medlcos

El financiamiento de los cuidados a largo plazo
se hace por various canales. Los mas importantes
son el Medicare y el Medicaid.

El Medicare
El Medicare es un program de seguro de salud del
Gobierno Federal. Fue creado en 1965 con el titulo
XVIII del Social Security Act. En 1972'se extendio
este seguro para incluir incapacitados y personas
que necesitasen dialisis y transplant del rifi6n. El
titulo official del program fue cambiado al de
Seguro del Salud del Envejeciente e Incapacitado, y
ests dividido en dos programs complementarios: el
Seguro Hospitalario y el Seguro M6dico
Suplementario.
Personas de 65 o mis son elegibles para el
Seguro Hospitalario, segun determinaci6n del
Seguro Social. El Seguro M6dico Suplementario
require un pago de prima, asi que es opcional.
Los servicios suministrados por el Seguro
Hospitalario cubren al individuo desde su entrada al
hospital hasta 60 dias consecutivos: esto es Ilamado
el Periodo de Beneficio, y no hay limited al numero
de periods de beneficio. Ademds este seguro
cubre los gastos de "nursing homes" y cuidados de
salud a domicilio; para la prolongaci6n de estos
servicios hay various canales dentro del mismo
program.
El Seguro Medico Suplementario cubre
servicios medicos, ciertos materials y equipos,
terapias medicas, pruebas de laboratorio, Rayos X,
curas quirirgicas, pr6tesis, servicio ambulatorio,
servicio de salud a domicilio. y servicios clinics
rurales. Excluye el pago de medicamentos fuera
del hospital, enfermeras privadas en el hospital,
espejuelos, servicios dentales, cuidados de podiatria,
eximenes fisicos de rutina, inmunizaciones, y
atenci6n psiquittrica fuera del hospital que pase de
$250.

El Medicaid
El Medicaid es un program Federal y estatal que
cubre tratamientos medicos para pobres e
indigentes. Es la mayor fuente de pago
gubernamental para los servicios a largo plazo en
los E.E.U.U.
En 1965 cuando el titulo XIX form part del
"Social Security Act", reemplaz6 servicios m6dicos
antes conocidos: Ayuda a los Ancianos, a los







Ciegos, a los Incapacitados, y Asistencia M6dica a
los Ancianos.
Los gastos en las personas de 65 6 mas de este
program en 1978 fueron de $49,366,000,000. La
eligibilidad a este program estd relacionada con las
entradas y condici6n de la persona (incapacidad).
Hay dos categories principles en la elecci6n del
client: la economic y la m6dica.


Incluye servicios medicos, hospitalarios (como
paciente interno o externo), nursing homes,
laboratorio, rayos X, planificaci6n familiar,
examenes rutinarios, cuidado a domicilio, servicios
dentales, terapias medicas, medicines, enfermeras
privadas, espejuelos, pr6tesis, y cuidados personales
y a domicilio. El estado puede limitar el tiempo de
cualquiera de estos servicios.








PRO-VIDA, A NON-GOVERNMENTAL ORGANIZATION FOR THE
CARE OF THE ELDERLY IN COLOMBIA AND LATIN AMERICA:
A VIDEO PRESENTATION


Eduardo Garcfa-Jacome
Bogota, Colombia


Abstract

This video documents the work of PRO-VIDA,
an organization for the care of the elderly in
Colombia and Latin America. Founded in 1974, its
primary objective is to increase public awareness of
the condition of the aged. PRO-VIDA represents
the aged before the National Government in the
promotion and enforcement of the rights of the
elderly. The organization has community-based
programs for: health care; training and job
placement: social industries: youth campaigns to
promote intergenerational relationships and to
educate youngsters in the needs of the elderly;
literacy campaigns; and recreation. PRO-VIDA
works in conjunction with the International Center
of Gerontology Training for-Latin America, which
was created to train people to occupy executive,
scientific, and technical positions that manage and
see to the needs of the aged.


Introduction

In Colombia, as in other countries, the
situation of the aged is critical. The changes
brought about by the modernization and
industrialization of our society, added to the heavy
migration towards the large cities, place the elderly
in a marginal position vis-a-vis society as a whole,
forcing them to struggle for their survival. The
problem of old age is serious in a country with no
general social security or social policy systems
aimed at improving and expanding health care and
assistance. Aged individuals live in the situation of
misery that we see daily in our streets.
This problem becomes even more marked when
taking into account the statistics on world
population which will double by the year 2000,
while in that same time span the population over 60
will have increased threefold. Of the 27 million
inhabitants that Colombia has at present, 6% of the
population is over 60. The fact that each
economically active individual is responsible for
three people should not be overlooked.
Aware of the problems that confront the
elderly, the Asociaci6n Nacional de
Establecimientos Privados de Asistencia al Anciano,


PRO-VIDA, a private nonprofit organization
working at national level was founded in 1974.


The Work of PRO-VIDA

PRO-VIDA cares for almost 30,000 elderly.
Its primary objectives are to increase public
awareness on the living conditions of the aged and
to encourage understanding and goodwill for
attaining the complex solutions required by this
population. Likewise, PRO-VIDA, in its capacity as
a private institution representing the aged before
the National Government, provides support, advice,
and coordination for the care and assistance
services provided to the people of the third age.
The global concept that PRO-VIDA has of the aged
considers them as people with personal needs who
are entitled to perform in and make demands on
society, in search of their active participation in
society's productive process.
PRO-VIDA believes in the promotion and
enforcement of the rights of the aged: their right
to respect, to quiet, to spiritual guidance, to
nutrition, to health, to shelter, to dress, to work, to
recreation, and to die in peace. To accomplish
these goals, a survey was conducted which led to
the implementation of specific programs.
Through Social Work, Social Guidance, and
Individual Assistance Programs, the condition of
the elderly is studied. Campaigns are undertaken to
attain the well-being of third and fourth age people
at both family and community levels. If necessary,
individuals are placed in institutions where they
receive the required care and attention, or, if the
requirements established by PRO-VIDA are met,
they are given identification documents that allow
them to benefit from programs such as
nourishment, clothing, shelter, work, and economic
assistance, as well as from health care services.

The Health Component
The Health Care Program consists of different
services: Medical Visits, Pharmacy of the Aged,
and the Spectacles Bank, services which are
provided free of charge to people over 60 lacking
financial resources. Persons trained in medicine,
odontology, and optometry provide the services.







The drugs prescribed are also provided at no cost.
Financial assistance is granted for lab tests and
hospital expenses, and glasses are provided. In
addition, PRO-VIDA has a Medical-Odontological
Unit with the latest facilities that offers its services
both to centers that care for the aged and to
individual households.
Through the Occupational Therapy, the
Readaptation, and the Training/Job Placement
Programs, physical or mental disturbances are
identified and diagnosed. The aim is the recovery
of functions and/or the use of residual capacities,
thus accomplishing the social, financial, and
psychological readaptation of the aged persons and
their independence in performing daily activities.
The research carried out by the professionals in
charge of these programs revealed that 95% of the
aged do not work. Thus, the need to set up
workshops became apparent, so that with the profit
obtained from the sale of the products
manufactured there, the aged population could
obtain financial support. Several hundred elderly
work daily in these workshops.

The Social Component
Another major program implemented by PRO-
VIDA is that of the Social Industries. These
include the CANITAS store, where the products
manufactured in the workshops are sold; the PAN-
VIDA bakery, that accomplishes a double purpose,
since its profits help to finance the provision of
other services, while it produces an excellent bread
that is distributed at the shelters and among the
dispossessed elderly. Some 300,000 pieces of bread
are distributed at no cost each year. The LAVA-
VIDA laundry accomplishes a similar purpose, since
its profits serve to support other programs, while it
launders the clothes and linen of the aged at no
cost. Another major function of the 'Social
Industries is offering job opportunities in their
facilities to the elderly. A Pilot Training Center for
the Aged was created to improve the level of
implementation of these activities.
PRO-VIDA performs educational campaigns at
primary and secondary school levels. The Youth
Campaign awakens in children the love for the
elderly and changes their attitudes. At the same
time youngsters are provided with the opportunity
to collaborate by voluntary contributions. For this
purpose, PRO-VIDA has created "Paco", a cartoon
character in whom the children see the friend who
brings them into the programs of assistance for the
elderly. Paco has his own club and rewards the
cooperation received from his friends with banners
and certificates. Children maintain a constant
correspondence with Paco to keep informed of the
different recreational and cultural activities carried
out for the benefit of the aged. Approximately
100,000 children from 711 schools participate in


this program.
Aware of society's neglect of the elderly,
PRO-VIDA carries out a literacy campaign with
high school students, for six months of the year.
The campaign aims at teaching the elderly to read
and write, while providing care, company, and
recreational activities. High school students have
the opportunity to be in close contact with the
problems of old age, and to become aware of the
need for a change in the inter-generational
relationships through the practical work they
perform. They receive an induction course to
become familiar with the actual situation of the
elderly in Colombia. Close to 6,000 high school
students who have participated in this program are
now at the university.

The Recreational Component
PRO-VIDA's Recreation and Travel Plan has been
designed and conducted according to the social and
recreational needs of the aged. It also has the
cooperation of the high-school students who devise
some of the games that are used and participate in
the parties given on birthdays and holidays. The
high school students constitute a lively group in the
travel program and in the outings to amusement
parks, shopping centers, and theaters. This is an
attractive program for the aged.
In addition, PRO-VIDA has the collaboration
of performers to entertain the elderly, such as the
Ambassadors of Happiness and the Friendship
Group who with dances, games, music, contests and
entertainment acts accomplish the objective of
entertaining and educating in a single activity.
Over 5,000 elderly people benefit from these
programs each year. Without the permanent
collaboration of the Social Secretariat, none of these
activities could be carried out. This organization is
formed by a group of ladies who are excellent
public relations experts and constant, supportive
companions to the elderly.


Training, Networks, and Resources

It is difficult to find people with adequate
training in the field of gerontology-- both in
Colombia and Latin America-- capable of
occupying executive, scientific, and technical
positions to adequately manage and see to the
multiple and complex needs of the aged. The lack
of trained persons led to the creation of the
International Center of Gerontology Training for
Latin America (CIGAL).
This center trains gerontologists and makes it
possible, through a joint effort, to create and have
in the near future a true awareness of the Latin
American society to stage a social revolution for the
benefit of our aged population. There must be a




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