Islamset - Ideals and realities in the Eastern Mediterranean

Dr Darnton-Hill's paper gives us an excellent overview of the global transition often referred to as the "greying" of nations. As recently as the first decade of this century, long life was a privilege enjoyed by relatively few people. Today, as the twenty-first century approaches, it is a reality for millions, even in the developing world. Medical technology, "miracle" drugs, and improved health care generally, have to a very large extent been responsible for making this happen. However, this success has brought with it formidable challenges.

There is not yet much public awareness in the developing countries of this demographic transition and its implications. In most cases, the possibility of living to be a centenarian produces a feeling of euphoria, without much thought about the health and socioeconomic implications. In most countries of WHO's Eastern Mediterranean Region, the elderly only make up 3-5% of the population, and the transition, though it is already happening, receives little attention from national planners and health administrators. Therefore the first step for WHO in responding to this trend has been to make people aware of it at the highest level in the health sector.

Support for the elderly is needed mainly to meet their economic, social and health needs. Perhaps the most daunting question is how to provide the economic support that a large proportion of the elderly population will need just in order to survive. This is particularly the case for elderly women, most of whom will be widows, who greatly outnumber the men, and who also have special social and health needs.

The family and its limits

There is no simple answer to the question of where the increasing number of elderly people will live and who will take care of them. It is frequently said that the cultural norm in most countries of this Region is to take care of elderly parents and other relatives at home, and that sending them to old people's homes and similar institutions is out of the question. However, surveys conducted by the Regional Office have shown that because of migration from rural to urban areas and to other countries, elderly relatives are often left alone in the rural home, even if everyone agrees they should not be.

There is also a distinct trend towards the erosion of the extended family system and its replacement by the nuclear family. Furthermore, the stringent economic conditions currently faced by lower-income and some middle-income families restricts the amount of support they can give their elderly relatives. Economic independence appears to be a vital requirement for happiness in old age, but to achieve it, a dialogue between the State, non-governmental organizations and the families concerned is urgently needed.

The cultural norm of family solidarity prevailing in this part of the world is in great need of support from the State, society, communities and individual carers. It is encouraging to see that several governments in the Region are providing economic support for the elderly through such means as pension schemes, subsidized food and drugs, subsidized transport and accommodation, and financial assistance for families maintaining elderly relatives. In several countries hearing aids, glasses, crutches and other items which reduce disability are provided through the welfare system.

Other sources of support

A significant amount of support is also provided by religious bodies. In Cyprus the churches provide a large part of the care received by the elderly, as do the mosques in Iran. Some nongovernmental organizations are also involved in establishing homes for elderly people who have no one to take care of them, and in organizing programmes for providing them with food and medical care.

Health support is also indispensable. It is often forgotten that aging involves biological changes which reduce the physical and mental competence of even the fittest and healthiest people. However healthily we age, there will be changes in the digestive and nervous systems, muscles, bones, lungs, and blood vessels. An old woman or man can certainly be healthy but it is a relative term.

Though ultimately unpreventable, most of these biological changes can be delayed by taking various steps, most of which involve living in certain ways. To ensure the best.

However healthily we age, there will be changes in the digestive and nervous systems, muscles, bones, lungs, and blood vessels.

possible health in old age, a healthy lifestyle should be adopted in one's 40s or 50s, or preferably even earlier. Awareness of the biological processes of aging will make it easier for people to take the steps necessary to delay them. This awareness can be promoted through the primary health care system, and the Regional Office is focusing its efforts on training primary health care workers for this task, and for care of the elderly in general.