The elderly population is considered a vulnerable group as they become dependent on others for their routine activities and care. The majority of the elderly population has been neglected in many of the developed and developing countries. However, providing them with a shelter home does not always facilitate quality of life. They need holistic care to live a healthier and peaceful life with dignity. A Case study design was utilized to determine the need assessment of the elderly people living in senior citizen homes. The study was conducted in a senior citizen home situated in one of the metropolitan cities of Pakistan. Elderly people aged 60 years and above living in this home were included in the study. A total of 380 people, 200 males and 180 females were registered with this home. In order to collect the data, a naturalistic observation method was used in the study. As per the findings of the study, the majority of the participants were unaware of the health practices particularly, diet, exercise, regular health checkup etc. The management and staff were not trained in elderly care in the home. Policy makers need to realize the significance of awareness sessions for elderly people. The and management of senior citizen homes should be trained for taking care the elderly people. Higher authorities must be kept in loop for conducting appropriate training sessions and regular health screening of the elderly people.
In the past, care of elderly people remained the responsibility of family members living in an extended or joint family system. However, in the modern era, it has become the responsibility of the state or the charity based institutions to provide them shelter and other basic necessities (Sabzwari & Azhar, 2011).
With the progress of time, care of the elderly has gained ample attention of policy makers and nongovernmental organizations for providing the older population with appropriate care and for fulfilling their basic needs. Therefore, the state provides them with the basic necessities; while, differences in care and facilities exist in the different regions even in the same developed and developing state.
Unfortunately, the care of the elderly people has been remained compromised due to several constraints at different levels in most of the health care delivery systems. Due to the advancement in age and a compromised immune system, elderly people become prone to many communicable and non-communicable diseases. It is worth noticing that the government has not paid enough attention to develop educational programs for professionals to train them as practitioners and specialists for taking care of older people.
Another major challenge faced by senior citizens in Pakistan is abuse in many forms from their family members. Older people in Pakistan undergo abuse from their family members due to numerous factors. They have been deprived of even the basic necessities due to dependency on the younger generation. As people get old, they are no longer able to take care of themselves and have to rely on their family members to fulfill their needs (Sabzwari & Azhar, 2011).
There is an emerging need of elderly care to be provided to senior citizens by policy makers and higher authorities. On the other hand, compromising the elderly care increases the health burden on the state as well as suffering for the people. This paper focuses on identifying the need assessment of elderly people in senior citizen homes and setting recommendations to overcome the challenge of taking care of the elderly population in Pakistan.
The aging population is growing swiftly at the global level. In 2015, 900 million people were aged 65 and above which is over 12 % of world's total population. This number is expected to rise to about two billion in 2050, which is 22% of world's total population (WHO, 2015).
According to the United States Department of Health and Human Services (WHO, 2010), the older population aged 65 years or older numbered 39.6 million in 2009. They represented 12.9% of the U.S. population, about one in every eight Americans. Unfortunately, Pakistan is a country, overwhelmed with meager resources and is challenged to meet the needs of the elderly population. According to Pakistan census 2017, the elderly population has increased from 3.4% to 4.6%, compared to census 1998 estimates. With the current phase of increasing life expectancy, the elderly population will double by 2030. Pakistan is among the top 15 countries where the number of older people aged 65 and above is estimated as 10 million (UNFPA, 2012).
Some of the previous studies have already focused on the physical and psychological issues of the elderly (Baig et al., 2000; Dildar et al., 2012; Itrat et al., 2007; Zafar et al., 2006). A number of physical illnesses including osteopenia, osteoporosis, diabetes mellitus, and hypertension have been reported in similar studies conducted in the context of Pakistan. One of the main leading factors responsible for numerous health problems among elderly people is a sedentary life style and isolation from the family. Another study reported that immigration from Pakistan has also contributed towards elderly isolation from their young family members.
Unfortunately, among the very few senior citizen homes in the metropolitan cities of Pakistan, almost all are managed by charity based and religious organizations. Therefore, the facilities, availability of optimum living standards, and resources remain an issue to be explored and improved. In addition, another major challenge of older people in Pakistan has arisen in the form of abuse. As per the findings of a study conducted in Pakistan, 60% of the elderly people faced one or other form of abuse from their family members (Alam et al., 2016; Cassum, 2014).
This study was conducted to answer the following questions:
The study was done in a senior citizen home in a metropolitan city of Pakistan by utilizing a case study method. A total of 380 people, 200 males and 180 females were registered with this home. With regards to the infrastructure, the setup was divided into two halls which were utilized for attending informative sessions and daily physical exercises, respectively. The management team comprised of a chairman; the senior citizen center comes under the portfolio of social welfare board and is also funded by the same authority.
Naturalistic observation method and information collected through a checklist was utilized to answer the study questions. The following sampling criterion was followed to include participants in the study: those that lived in the senior citizen home for not less than six months and those aged 50 years and above.
The observation findings and checklist were analyzed to group into three basic components: the person accompanying the elderly, characteristics of the working staff, and concerns of the elderly people.
In the first week of study period, the primary investigator was introduced to the clients and workers (staff), and oriented to the place with its daily routine. Daily interaction with senior citizens enabled the investigator to build rapport with them which is imperative for a trusting professional relationship. Moreover, it also assisted the researcher to understand their issues and concerns that the seniors were facing at the end phase of their lives.
While talking with the participants individually, it was identified that most of the senior population were living alone with their spouses or relatives. Many of their children had migrated to foreign countries either temporarily for the purpose of higher education or had settled there permanently. Moreover, some of those who had migrated were unable to communicate frequently with their parents due to country laws or they were not capable of bearing the financial expenses of doing so. The seniors missed their children and felt very lonely; still they were reacting optimistically and stated about the security issues present in the country.
As per the findings of the study, the working staff never attended any kind of formal training to provide care to the elderly people. Dealing with aged clients needs specialized knowledge and experience in this pertinent domain. Literature also suggested that specific education/ training of the staff is very important in order to empower them in delivering efficient and quality care (Murphy et al., 2006; Nolan et al., 2008).
While interacting collectively in a group, the researcher observed that almost all seniors were requesting and are eager to receive some basic information regarding their health concerns such as cholesterol prevention, diet for diabetes, exercises for knee pain and tips for eye sight issues etc.
Pertaining to the study results, it was noted that the working staff were not well trained and did not have any kind of formal training to take care of the elderly population. This finding was in alignment with the previous studies conducted by Murphy et al., (2006) and Nolan et al., (2008).
Furthermore, the older people who lived in senior citizen homes were found to be lonely and missing their loved ones. Similar experiences of elderly people were reported in the previous study conducted by Itrat et al., (2007). Moreover, the current study explored the concerns of the elderly people who were keen to know about their health status and found to be enthusiastic in self-care. This finding was not reported in the earlier studies in the literature. After exploring the concerns and physical needs of the elderly people, the investigators had detailed discussion with the supervisor. The research team had reached to the conclusion that the management was struggling to arrange some sort of training session for the staff members. Sessions on the basic needs of the elderly and communications were conducted, and formal first aid training workshop was planned in the upcoming months. The research supervisor further shared that loneliness of these older adults lightens when they mingle and socialize with each other. This is directly linked to the learning concept of selective optimization theory, that coming daily to the senior citizen center and making friends worked as an adaptive strategy to overcome the issue of loneliness. Yet the issue of acknowledging deficit (for physical problems) was seen as a major concern in the elderly people living in senior citizen homes.
Two main reasons were identified. First, the senior citizen center was run by a management and staff members who were offering their services voluntarily. The workforce was not well trained nor had enough knowledge regarding the health issues encountered by the older population. Another, significant drawback was lack of planning or a formal program plan for every month. On further inquiry, it was identified that health sessions were offered randomly if any speaker arranged to do so. If no speaker was scheduled to speak, then the allocated time was utilized in watching movies, playing indoor games and doing other activities.
Health awareness/education is a very significant issue identified in the clinical setting. It is a very alarming state which needs to be addressed. The basic purpose of health awareness is to promote good health among the increasing elderly population. World Health Organization, (1998) defines health promotion as “the process of enabling people to increase control over and to improve their health” (p.48). Therefore, the aim is to educate the elderly people to make them function independently (partially or completely). This is significant because of the rapid increase in the elderly population worldwide who are more vulnerable to physiological problems as well as psychological illnesses. Moreover, the increasing trend of seniors children to migrate to other countries is very common. Thus, older adults with illnesses are considered a burden upon their families and on the country's economy as well (Chesser et al., 2016). In order to minimize this problem, it is vital to effectively use avenues (such as community senior citizen centers) where these older adults can socialize, and simultaneously get awareness of their common health problems (Rana et al., 2009). Few measures were taken to stabilize the issue. First, physical needs, i.e., physical exercise, diet modification as per disease process etc. were assessed through individual and collective conversations with the seniors. In addition to this, center members collaborated, and plans were made accordingly. Secondly, certain days were allocated when health sessions were held on identified topics, and in the end queries were entertained. Individual risk factors were also identified with the help of members working there and counseling was done on a regular basis.
Some informative movies and videos were also shown to the seniors.
Material resources were provided by the management of the senior citizen center which included a place for conducting the session, multimedia for pictorial presentation/videos and finances for refreshment. The center has well developed infrastructure (well organized sitting area, furniture and LED), and these resources were utilized while giving group health awareness sessions. With regards to human resource, the researcher and supervisor planned and implemented health education awareness sessions for the participants.
After discussion with the research supervisor and other management members, it was decided that monthly planning for health education sessions and programs would be maintained. The biggest challenge was the lack of human resource; specifically how a health care professional can give the time for conducting health awareness sessions and follow-up with these older individuals.
Certain initiatives were taken to overcome the challenges and to ensure sustainability:
With the help of the supervisor, stakeholders were contacted and meetings were arranged. The aim of these meetings were to emphasize the importance of health awareness among older adults. Moreover, trends of non communicable diseases, mental illnesses, and a safe and healthy journey towards the end of life were highlighted. In addition to this, it was also reinforced that the real purpose of these senior citizen homes is to empower elderly people and make them independent.
With the technological advancement and increased life expectancy, provision for quality care to senior citizens has become a challenge for many of the developed and developing states. States and charity based institutions strive to encounter the challenges of meeting their needs.