How We Treat the Elderly

It is said that the greatness of a nation is measured by how it treats its people. In many nations, the elderly ire not given their due respect. But a survey of country reports from The Hastings Center-Maastricht Institute for Bioethics project on care for the elderly makes it clear that not only is the number of elderly growing rapidly, but the way countries care for them is an issue that none will any longer be able to take lightly.[*] The British report refers to a "demographic explosion," the German report describes "fundamental shifts" that will require new infrastructures for the elderly's care, and the American report foresees the future of care for the elderly as a "dangerous and delicate situation." How have these problems come upon us? A review of the country reports reveals several interrelated factors as primarily responsible for increasing problems in care for the elderly: demographics, developments in medical technology, the structure of health care systems, economics, and the elderly's largely negative social status. Despite differences in the way countries configure those factors, there is much overlap in the way they affect the outlook for care of the elderly in each country. The demographics of the situation are unambiguous and virtually universal: the number of the elderly and particularly of the oldest old (over eighty-five) as a percentage of every reporting country's population is growing tremendously, and this trend will increase well into the next century. Germany, for instance, projects the greatest growth, with the percentage of citizens over sixty increasing from 20.4 percent in 1990 to 35.2 percent by 2030. By then, a full 6 percent of its population will also be over eighty. By 2040 most if not all reporting countries will have at least 30 percent of their population over the age of sixty. Life expectancy also continues to grow as more children survive their youth and as medical technology finds new ways to prevent death--extending both living and dying. As a result of this alone, health care resources everywhere will be increasingly strained, and countries will be forced to struggle with new ways to accommodate these developments. At this time, many health care systems around the world are undergoing reform to various degrees. Most European countries have some kind of compulsory, universal coverage and are now moving to accommodate private sector institutions as well as other free market mechanisms. The United States, in contrast, is recognizing the shortcomings of the free market for controlling health care costs, with 15 percent of its gross domestic product--a full one trillion dollars--now going toward health care. In both contexts, however, the imperative of reform is generating at least some attention to how nations are treating their elderly. How is care for the elderly faring in this time of flux? In every country, the elderly are proportionately the heaviest users of outpatient and inpatient services. The Netherlands, for example, reports that 87.3 percent of people of age sixty-five and older see a general practitioner over a twelve-month period, with an average of 6.7 contacts per year. Figures are similar or slightly lower for other countries. In the hospitals, the elderly may occupy just under half of all beds (40% in Great Britain), and they account for about one-third of all hospital days (30.7% of days in the Czech Republic; 42% in the United States). The report card on long-term care is mixed. Countries emerging from Communist systems such as the Czech Republic and Hungary have established structures of care for all ages. Unfortunately, the economies of these countries have been traumatized through their transition to a more mixed market system; thus, quality of care for the elderly is poor and the distribution of resources uneven. The Hungarian report speaks of the elderly's "social isolation, loss of self-esteem, loneliness, depression, fatalism, and lack of dignity and prestige," with all this punctuated by high suicide rates in the older age groups. …