The dramatic growth in the number of elderly people is one of the most remarkable features of industrial societies in this century. People are living longer and enjoying an increased expectation of life. In Britain since 1900 the percentage of the population over retirement age has gone up from around 6% to over 17%. This is mainly due to medical advances which have virtually eliminated infectious diseases as a cause of death. The general provision of secure food and water supplies and better sanitation, together with improved environmental conditions at home and at work, have also contributed a great deal.
Despite the improvements, increased age, in general, coincides with an increased incidence of both mental and physical illness. This is made worse by a weakening of social contacts and a reduction of income. Thus increasing age is also characterized by a dramatic increase in the use of health and social services. The older the person, the more likely he or she is to be admitted to hospital and the longer the stay.
The increasing demands on the hospital service have not been met by an increase in the total number of hospital beds. Medical and surgical treatments previously thought to require a three- or four-week stay in hospital are treated within a week or ten days. Also more work is now undertaken in the outpatient department on a day-care basis without overnight stay. Many medical cases previously requiring hospital care are now dealt with by the family doctor with the patient at home.
The whole concept of care has changed dramatically in recent years, and this has affected the caring approach in hospitals, residential homes and in the community. In the past, caring involved an active carer looking after a passive patient. Although it seemed quite natural to look after the sick and disabled in this way, the process produced too much dependence of the patient or client on the carer. The modern approach in health and social services is a process of enabling. Carers enable patients (or clients) to do as much as they can for themselves. This approach reduces dependence and keeps down the total level of care required.
The idea is that illness is best treated at home, if possible. The new legislation on community care, which took effect on the 1st April 1993, is based on this principle. Pain is a burden on oneself, and being removed from home and family to the strange environment of a hospital ward adds to the stress. This is especially so for the very young and the very old.
However, not all homes are the most satisfactory places in which to be ill. Many lack the basic amenities of hot and cold water, indoor lavatory, and satisfactory heating. Also there may be no relative or friend to do the caring,-to prepare food, ensure and maintain good standards of hygiene, and to offer companionship. Often the problems can be overcome to a certain extent by the use of voluntary help from religious groups and the agencies of the Health Service and local authority (e.g. community nurses, home helps, and ‘meals on wheels’).
At present only about 6% of all elderly people are in institutional care of some sort (hospitals, residential homes, and private nursing homes). Even this small percentage imposes very heavy burdens on these institutions; present resources are simply not enough to meet even a small increase in numbers. There are waiting lists for most institutions caring for the elderly.
A further 12% of the elderly are enabled to manage in their own homes, with the help of the care agencies already mentioned. The new community care programme strongly encourages such help in the home. Only a reduction in the proportion of very old people in the total population and a healthier elderly population would result in some easing of the problem.
Care on a self help / family / neighbourhood basis backed up by the provisions of the health and social services appears to deliver good results. When husbands, wives, brothers, sisters, friends and neighbours, are involved together in the process of caring for the elderly, a very good sense of community develops. Children in particular have a special responsibility towards their parents. God says in the Qur’an:
Your lord has decreed that you worship none but Him, and that you be kind to parents, whether one or both of them attain old age in your life, say not to them a word of contempt, nor repel them, but address them in terms of honour. And, out of kindness, lower to them the wing of humility and say: ‘My lord! bestow on them Your mercy even as they cherished me in childhood.’ (al-Isra,17.23-4)
26% of elderly people have no children at all and so are especially vulnerable in times of crisis. In other cases the children may exist but are so far away as to be unable to help. Regular help to the elderly is best given by relatives, neighbours, and friends-shopping, housework, house maintenance, gardening and social visits. However, statutory and voluntary services are still required to take over-or at least plug the gaps-if the task proves to be too great for the community. It is, of course, best for society if people learn to care for one another in their own homes.