The Elderly between the Needs for Care and Active Ageing

1. Introduction

The article starts from the dichotomy that currently characterises the scientific and political debate on ageing. Two opposing, or rather mirrored theses mark the discussion on the “elderly question”.

On the one hand it is evident that the progressive ageing of the population brings with it growing costs for the welfare system, given the increase in social security and health expenditure. Indeed in our country the social demand for care on the part of the elderly is on the increase (according to the latest ISTAT data -2007- there are around 2 million non self-sufficient elderly people, and more than 4,800,000 affected by chronic illnesses and pluripathologies). On the other hand it is claimed that, generally speaking, the elderly can be a resource for the whole of society, not only because they live longer, but also because often, even beyond the age of 80, they enjoy good health. On this subject many epidemiological studies have shown that improvements in health without precedent are taking place among the population in general, and the elderly in particular. This is thanks to economic and social progress and to the discovery of new cures and new medical technologies which today can act more effectively on multi chronic conditions, thus slowing down, or at any rate putting off the onset of real and true disability. This confirms what Riley (1979) stated, i.e. that ageing cannot be considered an inexorably degenerative process. Rather, it is the result of the systematic interaction of biological, psychological and social processes. Since these biological, psychological and social processes are in continuous change in time, ageing is a process in continuous transformation (author’s italics) which never shows itself the same. From this perspective, since every new cohort is born at a particular moment, and faces a unique series of roles and environmental events they have their own personality. Hence individuals belonging to different cohorts tend to age in different ways. Thus the elderly of the third millennium are experiencing ageing in good health.

On this point it is worth underlining that the most recent data disprove the hypothesis suggested by some scholars (Kramer 1980) that there is a directly proportional relationship between the lengthening of life expectancy and the increase in the level of non self sufficiency. In our country, from 1994 to 2005 the incidence of disability among the elderly went down, despite the fact that in the same decade the population had aged significantly (cf. Figure 1). The health conditions of the Spanish elderly are also improving. According to a recent estimate (cf. Libro Blanco de dependencia) of the approximately twenty years of life left to 65 year old women about 12 of them would be free of disability while of the 16 years left to men 11 would be free of disability. It is interesting to note that in other countries too, such as France and the United States a progressive decline, not only in serious disabilities but also in minor ones has been recorded (Jacobzone 1999, Manton and others 1993 and 1997; Costa 2000; Cutler). So much is this the case that Combois and Robine (1996) conclude that it is legitimate to expect, as Manton had theorised (1982, 1993 and 1997) that in the future the lengthening of life expectancy, and hence delay in the age of death, would be accompanied, not by an increase in mental illnesses, chronic illnesses and disability (Kramer 1980), but rather by a greater expectation of a life free of disability. In this regard the European Commission has reaffirmed the lengthening of the average life expectancy is increasingly accompanied by the continuous increase in the hope of a healthy life (COM 2005, 94) and that if future increases in life expectancy were attained in basic good health and free from invalidity, the forecast increase in public expenditure on the health of and care for the non self sufficient elderly would be reduced by half (COM 2006, 574). Moreover it is empirically observable that psycho-physical decay and loss of functional self sufficiency are occurring at increasingly older age, and as a consequence there are many elderly who remain active and are replanning their lives from the professional and family point of view (Repubblica 16 May 2007)1.

In view of all the above this article intends to specularly analyse the two aspects of ageing, seeking to maintain together, in a manner of speaking, the two sides of the same coin, discussing on the one hand the factors that determine the social demand for care, and on the other, the many factors that influence the continuation of working activity beyond the age of 65 (a fact generally referred to when active age is discussed in literature and political debate).

In the first paragraph of this article we present the data relating to the ageing of Italians from 1995 to 2005, showing not only the speed and intensity of the phenomenon, but also its territorial differences. In the second paragraph, starting from the theoretical perspective of health determinants (Geddes da Filicaia M. e Maciocco G. 2007), which considers health the product of individual and environmental variables, we hypothesise that the different degrees of socio-economic development which characterises the North and South of the country (Pugliese 2006) and the territorial imbalance of the system offering socio-welfare services (Caltabiano 2004), constitute environmental variables which can cause inequalities in health in the various macro-areas of the country and hence have a bearing on a different territorial articulation of the social demand for care. In the third paragraph, given that some indicators such as the difference in the disability rates, the geographic distribution of poverty, the territorial differences in income, the socio-economic imbalance between the North and South of the country and the shortage of welfare and health care on offer in the South of Italy determine a condition of social disadvantage for the elderly of the South, we consider the possible effects of social unease on active ageing. We put forward two hypotheses:

a) Social hardship negatively influences the quality of life, understood in the broad sense, as in Donati (1979) “ability to plan, self mastery, existential vitality and life opportunities”, and ends by inhibiting the capacity for self promotion on the part of the elderly, thus compromising the very possibility of living ageing in an active way.

b) contrarily social hardship and economic deprivation are factors that force the eldelderly to continue working so as to meet their personal and family needs (one thinks of the curse of youth unemployment in Southern Italy).

Finally in the fourth paragraph, starting from a field study carried out in a small town in Southern Italy (Vallo della Lucania) we document the experience of some women in their seventies and eighties who are experiencing their own paths of active ageing.

Figure 1: People of 65 years and over with disabilities – Comparing the years 1994, 1999-2000, 2005 (standardised rates for ages with data from the 2001 census)
Source Istat 2007

Tiziana Tesauro edited the draft of the article.
Luca Pianelli did the data processing.
1 In May 2007 the daily newspaper La Repubblica produced various articles on the subject.

Pages: 1 2 3 4 5

Tags: ,