Mohammad Mosaddek Hussain :
In the whole world the longevity of people are increasing rapidly due to developed medical technology, urbanization, nourished foodstuff, modern lifestyle, new social order, developed educational and nutritional system, developed health facilities, government support, attention of international organizations towards health service development, easy access to health at all level, genders, urban and rural people’s participation in societal activities and incessant health and gerontological research have been playing a pivotal role in increasing the longevity of the human beings.
Needless to say that longevity is one of the top achievements in the 21st century which started since the last century and its impact for this century will be more colossal as a whole. On the other hand, the unprecedented demographic shift to an increasingly older society will have a dramatic impact on individual choices over the life course, the structure of the family, and multiple social institutions. To combat the pressure of the social life, social work can make effective professional contributions to older persons and the late-life family in different communities. It should be also noted that this discipline is not adequately arranged to practice in the aging society for their overall well-beings. This challenge to social work can be resolved through educational innovations and practice on the ethical principles of social work.
The United Nations General Assembly recognized “humanity’s demographic coming of age” by declaring 1999 the International Year of Older Persons. The increased aging of the world population is the most dramatic demographic shift in history. From 1999 to 2050, the world population aged 65 and over is expected to triple. In the United States, the percentage of older persons has already tripled since 1900. In 2030, more than 20% of Americans will be 65 or older. At the same time the older population of Bangladesh will be also increased.
It is largely due to increased longevity, one of the great accomplishments of the 20th century. A child born in 1999 can expect to live 76.2 years; a child born in 1900 had a life expectancy of only 47 years. Rowe and Kahn described the achievement in two major phases. The first phase is the reduction in infant mortality and death rates in childhood predominantly through public health measures. The second phase is the more recent decrease in death rates among middle-aged and older people through advances in self-care and medical science.
On the other hand, increase in the population of older people creates a large challenge to social work activities. The profession must intensify its focus on late life and intergenerational interdependencies, as well as the impact of the demographic revolution on the structure of the family. Besides, the trend of longevity has created an unprecedented opportunity for interaction at all stages of the life course in a complex web of kin relationships.
Only 21% of the US population had a living grandparent in 1990, and by 2000, 76% over this same period, the chance of a person over 60 having a parent alive will increase from 18% to 44%. At the same time, divorce rate has also increased. Fifty percent of all marriages now end in divorce as compared to 10% at the end of the 19th century, further adding to the complexity of the contemporary family. Families now may contain four and five generations, with fewer members in each generation than in the past. This is described as the verticalization in the family system. This contrasts with the former, more intense horizontal linkage of multiple members of a single generation. Individuals now will spend more years than ever occupying inter-generational roles in the society and community as a whole. However, one fifth of older Americans have no children and develop somewhat distinct social networks as opined by Gironda, Lubben, & Atchinson, 1999. Social work has the opportunity to lead in both research and practice with the new intergenerational family in this century.
In this view, the dynamics of intergenerational exchange may be measured in terms of the dependency ratio – the proportion of working adults to the number of persons over 65 and under 18. Though the dependency ratio has increased over time, the largest dependent group will continue to be those under 16 years of age. However, the increase in dependent persons at both ends of the age spectrum makes care-giving more challenging for both families and institutions in the years to come. So, the issues of care-giving will be a major concern in the upcoming aging socities in Asia and Europe as well as other parts of the world.
Measuring dependency in old age, it is necessary to make a distinction between aging and illness. In 1989, 70% of older persons living in the community reported their health as excellent. Yet, with increasing age comes an increase in chronic illness that affects functioning in daily life. The aging process reduces reserve capacity and reduces the physical ability to respond to stress at both the organ and the system level. The chronic conditions that most frequently limit daily functioning are arthritis (49%), hypertension (37%), hearing impairment (32%), and heart disease (30%) (National Center for Health Statistics, 1990) in diabetes in some of the countries. Since chronic illness and its management relate intimately to self-care, family, community and social support, community resources, and social work interventions are crucial to successful long-term care process of the older people. Geriatric care across multiple disciplines recognizes the complex interaction between age and disease and the need for comprehensive assessment that includes assessment of psychological and social elements related to functioning and quality of life. Social work must be prepared to play a vital and effective role in both assessment and treatment planning for older people challenged by chronic health conditions.
It is also noted that the “oldest old” people, 85 years and older, are the fastest growing segment of the aging population in many countries. This population is 33 times larger than it was in 1900. Not only are interests and life style different for those over 85 compared to those 65-85, but the health and functioning pattern are also markedly different. Those over the age of 85 are more likely to have multiple medical problems as Evans et al., 1989; Suzman, Willis, & Manton, 1992, expressed in their study and be more functionally limited. Almost 25% of the oldest old, in comparison to 5% of 65 year olds, live in institutional settings (Bould, Sanbourn, & Reif, 1989). People 85 and older are four to five times more likely to require assistance than those 65 to 74 years of age. About 46% of those over 85 are disabled, compared to 13% of those 65 to 74, and 25% of those 75 to 84 (McBride, 1989). In this complex events social work must bring a sophisticated developmental approach to the 35 or more years that comprise late life. The interventions and service infrastructure for various segments of the older population must be built on an understanding of the complex differences that subsets of the aged have in their need and demand for services in the later life course.
(Mohammad Mosaddek Hossain is a professional social worker by education)
