GROWING OLD IN JAMAICA:
Population Ageing and Senior Citizens’
             Wellbeing




       Paul Andrew Bourne
GROWING OLD IN JAMAICA:
        Population Ageing and Senior Citizens’
                     Wellbeing




                ...
© Paul Andrew Bourne 2009




Growing Old in Jamaica: Population Ageing and Senior Citizens’ Wellbeing




While the copyr...
i




       This book

           Is

   Dedicated
          To


 All Elderly Jamaicans

         And

The Prospective E...
ii


     Acknowledgement

This book was born out of (1) my Master of Science thesis in Demography, which

examined ‘Deter...
iii

        In extending gratitude to Ms. Norma Davis, Assistant Librarian at the Sir

Arthur Lewis Institute, UWI, Mona,...
iv

                           TABLE OF CONTENTS


                                                                Page
De...
v

Chapter Eight                                         136
      Modelling Wellbeing

Chapter Nine                      ...
vi

Appendices                                                         144

Appendix I. Table 2.1.1: Average Growth Rate o...
vii




                                LIST OF TABLES


                                                                 ...
viii

Table 9.1.1: Univariate Analyses of Variables used in Wellbeing Model   147

Table 9.1.2: Percentage of Sex of Respo...
ix



Table 10.1.3: Difference in Wellbeing of Jamaican Elderly based on Area of
Residence (assume that only Area of Resid...
x

                               LIST OF FIGURES

Figure 1.1.1: Explanatory Model for Wellbeing of Elderly Jamaicans     ...
xi




                                     PROLOGUE


       Reports from the PIOJ, STATIN, and the United Nations have s...
xii

more of those conditions identified earlier in operationalizing wellbeing, and this

is so in Jamaica as well. After ...
xiii

beyond). It is developed using socio-economic, environmental and psychological

conditions as self-reported by Jamai...
xiv

       produced legitimately within the framework (Waller 2006, 25).



       Waller’s construct highlights the impo...
xv

scholars such as Erber (2005), Brannon, and Feist (2004) had put forward the idea

that this is timely in the measurem...
xvi

hand, have sought to provide a platform upon which more studies should be

positioned in understanding the health sta...
xvii

order are as follows: Average occupancy per room (β = -0.229), Physical

environment (β = -0.190), Education (β = 0....
xviii

other hand, concludes with the summary, conclusion and recommendation of text

- determinants of the wellbeing of t...
1

                                 Chapter One

                                 Introduction

       Ageing is not a rec...
2

policy makers, who are pivotal in the preparation process to postpone ailments

and disability and in the challenge of ...
3

Table 1.1.2: Selected Age Groups of Jamaican Population: 1950, 1975, 2007,
2025 and 2050 (in %)

Age groups      1950  ...
4

quality of those years lived by someone. Life expectancy (or population ageing)

speaks to number of years, but this fo...
5

political challenge today, tomorrow and in the future for developing countries and

nations like Jamaica. However, this...
6

namely (1) methods, (2) methodology, (3) theoretical perspective, and (4)

epistemology.

       The four schema of the...
7

each year a different module is included with the aim of evaluating a particular

programme. The PLC is a self-administ...
8

the number of conditions that are related to the cohort in investigation, I believe

that it was fitting to use this pe...
9

       The positivists’ philosophy is carried out by hypothesis testing through

conducting experiments (i.e. observati...
10

objective reality (i.e. through precise measurement – that is using the scientific

method).

       From the post-pos...
11

analytical division of social realities. From this standpoint, the objective of the

researcher is to provide internal...
12

over short time intervals that do not affect the age parameter.         As such in

attempting to add further tenets t...
13

EXPLA
 Home Tenure
   Property
  ownership


Sex




Environment




Marital Status




Area of residence



Cost of H...
14

                                    Chapter Two

                                    Ageing Transition




       The ...
15


ageing and when ageing commences.

        Chronological ageing

        However the author, using the available data...
16

that 8% of people in developing nations are 60 years or over (United Nations

2005c), which is approximately 2% less t...
17

primarily responsible for much of the output from that Institution, and for the

training of staff. This may explain w...
18

Eldemire 1999; Ministry of Labour, Social Security and Sports 1997; Eldemire

1997; PAHO and WHO 1997; Eldemire 1995a;...
19

the German retirement system. This explains the use of 65 years of age by many

scholars, practitioners and non-profes...
20

ageing organisms. Here ageing implies growth, development and maturity (Ross

and Mirowsky 2008). This approach emphas...
21

ageing of humans than that argued by Gompertz’s law, as the ‘failing law’ speaks

to the deterioration of human organi...
22

use of the biological approach, ergo, for all intents and purposes, given the nature

of policy implications in effect...
23

Table 2.1.3: Characteristics of the Three Categories of Elderly, and the Ageing
Transition
Characteristic


          ...
24

three groups because they represent the ‘stages of ageing’. The three ‘stages of

ageing’ are widely accepted in geron...
25

childless old people, and other psychosocial conditions will not affect the health

and wellbeing of the aged? This is...
26

as functionally young, whereas by using chronological ageing he/she would have

already shifted from young to old age....
27

persons 65-74 years, 5% had some level of disability with respect to the Activities of

Daily Living (ADL). The preval...
28

                                  Chapter Three

                  Population Ageing: Historical and Global

       In...
29

added a substantial number of years to people’s life expectancies. This is evident

in the life expectancy for the wor...
30

illnesses have arisen and are still lingering in spite of all the advances in science,

medicine and technology. Non-c...
31

ages 60 and over (PIOJ, 2007).    Accompanying this period of the ‘age of

degenerative and man-made illnesses’ are li...
32

Table 3.1.1: Life Expectancy at Birth for Selected Regions by Both Sexes: 1950-
2050 (in years)

                     ...
33

          Generally when one speaks about population ageing, people begin to think

of reduced fertility and mortality...
34



          Globally, apart from the feminization of life expectancy, what else is there

on population ageing? During...
35

          Before the establishment of the American Gerontology Association in the

1930s and their many scientific stu...
36

and their health status have not taken front stage on the radar of demographers

unlike many other demographic issues....
37


              Trinidad &
               Tobago


               St. Lucia
                                           ...
38




                       Stroke




                Hear t disease
                                                  ...
39

(females) among persons 65+years old (Wilks, 2007). These observations provide

further evidence of the eminence of no...
40

patients.   Among those who have studied health are demographers. Is there a

difference between the approach of the o...
41

                                Chapter Four

  Population Ageing: Caribbean Demographic Trends, with Emphasis on

   ...
42

       Several Caribbean countries, such as the aforementioned ones, could be

said to be approaching the third stage ...
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Growing Old in Jamaica
Upcoming SlideShare
Loading in...5
×

Growing Old in Jamaica

25,517

Published on

Ageing is not a recent phenomenon. It goes back centuries, from time immemorial. The total human population, within any geographical area, is made up of children, youth, people of working age and the elderly. This latter grouping is a phenomenon not only in developed nations but also in many developing societies. For many Caribbean countries, this is also their reality. The factors that explain the “greying” of the world’s population are fertility decline, reduced mortality at ‘older ages’ and the external migration of the young, as well as the return of retirees. Those conditions, coupled with increases in life expectancies due to public health improvement and better water qualities, have significant consequences for population size and structure. Where the elderly population outgrows the younger, the population structure at younger ages is constricted and at older ages it expands (Rowland 2003, 98). This is an aspect of demographic transition which will change significantly in the 21st century.

This book for its research design used secondary data taken from a reputable statistical agency to examine socio-political, ecological and psychological factors and how they influence the wellbeing of elderly Jamaicans. The institution began collecting data to aid planning in the late 1980s when the institution collaborated with another, and adopted, with some modifications, the World Bank's Living Standards Measurement Study (LSMS) household surveys. The PLC has its focus of policy implications of government programmes, and so each year a different module is included with the aim of evaluating a particular programme. The PLC is a self-administered instrument (questionnaire) where respondents are asked to recall details of information on particular activities. The questionnaire covers demographic variables, health, immunization of children 0 to 59 months, education, daily expenses, non-food consumption expenditure, housing conditions, inventory of durable goods and social assistance. Interviewers are trained to collect the data, which is prepared by the household members. The survey is usually conducted between April and July annually.

Published in: Education, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
25,517
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
115
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Growing Old in Jamaica

  1. 1. GROWING OLD IN JAMAICA: Population Ageing and Senior Citizens’ Wellbeing Paul Andrew Bourne
  2. 2. GROWING OLD IN JAMAICA: Population Ageing and Senior Citizens’ Wellbeing By Paul Andrew Bourne Health Research Scientist, the University of the West Indies, Mona Campus Department of Community Health and Psychiatry Faculty of Medical Sciences The University of the West Indies, Mona Campus, Kingston, Jamaica.
  3. 3. © Paul Andrew Bourne 2009 Growing Old in Jamaica: Population Ageing and Senior Citizens’ Wellbeing While the copyright of this text is vested in Paul Andrew Bourne, the Department of Community Health and Psychiatry is the publisher and no parts of the chapters may be reproduced wholly or in part without the express permission in writing of both author and publisher. All rights reserved. Published April, 2009 Department of Community Health and Psychiatry Faculty of Medical Sciences The University of the West Indies, Mona Campus, Kingston, Jamaica. National Library of Jamaica Cataloguing in Publication data A catalogue record for this book is available from the National Library of Jamaica ISBN 978 976 41 0232 8 (pbk) Covers were designed by Paul Andrew Bourne and Evadney Delores Bourne
  4. 4. i This book Is Dedicated To All Elderly Jamaicans And The Prospective Elderly
  5. 5. ii Acknowledgement This book was born out of (1) my Master of Science thesis in Demography, which examined ‘Determinants of Wellbeing of the Jamaican Elderly’; (2) an interest in the health status of older people within the context of the current economic downturn in the global economy; and (3) a desire to apply econometric analysis to the study of the health status of the elderly. I have started on many occasions to fulfil this task, but I was overwhelmed by the daunting challenge of investigating matters of the elderly – and though I am not one to complain of the difficulty presented by a task or to be fearful of a voluminous workload, I found it problematic to rework material that has already been in existence for some time. Upon pursuing the Doctor of Philosophy (PhD.) in Public Health, where my dissertation speaks to the: Quality of Life over the Life Course, I was once again challenged to embark on the project. Ergo, I felt that I would have betrayed the academy if this project was not made available to the world. The project is now finalized and there are several people who started the journey with me from the Master of Science degree to the final completed manuscript. I wish to take this opportunity to thank a number of persons who have made this task a reality. Firstly, my past Supervisor for the Master of Science Degree, Ms. Sharon Priestley, and co-Supervisors Mr. Julian Devonish, Professors C. Uche, Patricia Anderson and Professor Anthony Harriott, from the University of the West Indies, Mona for their advice, support and reading of the Master of Science manuscript.
  6. 6. iii In extending gratitude to Ms. Norma Davis, Assistant Librarian at the Sir Arthur Lewis Institute, UWI, Mona, Jamaica, who dedicated quality time to correcting and proofreading my reference, I wish to postulate that although words are powerful, yet they are not enough to express my heart-felt appreciation for a task so well done without requesting any form of remuneration. I wish to also express appreciation to other persons who were instrumental in adding some other form of assistance; namely: Mr. Maxwell “Bunny” Williams, Ms. Thorna Smith, Mrs. Janet Higgins, and Mrs. Audrey Chambers (recently deceased). I miss you Mrs. Chambers – you have left me disliking the socio-physiological reality of death; but our meeting has transformed a normal life into a meaningful one. In terms of proofreading, critique, moral support, insightfulness, and commitment, I hereby extend sincere appreciation to Drs. Samuel ‘Sam’ McDaniel and I. Solan of the Department of Mathematics, the University of the West Indies, Mona, Kingston; and Orville Beckford, lecturer in the Department of Sociology, Psychology and Social Work, at the University of the West Indies, Mona.
  7. 7. iv TABLE OF CONTENTS Page Dedication i Acknowledgements ii List of Tables vii List of Figures x Chapter One 1 Introduction Survey Chapter Two 14 Ageing Transition Chapter Three 28 Population Ageing: Historical and Global Chapter Four 42 Population Ageing: Caribbean Demographic Trends With Emphasis on Jamaica Chapter Five 60 An Overview of the Conceptual Perspective on Wellbeing of the Elderly: Part One Chapter Six 67 An Overview of the Conceptual Perspective on Wellbeing of the Elderly: Part Two Chapter Seven 88 An Overview of the Conceptual Perspective on Wellbeing of the Elderly: Part Three
  8. 8. v Chapter Eight 136 Modelling Wellbeing Chapter Nine 146 Findings: Sociodemographic Characteristics of Sampled Population Chapter Ten 166 Findings: Multivariate Analysis Chapter Eleven 179 Epilogue Glossary 214 Analytic Model of Wellbeing 217 Reference 222
  9. 9. vi Appendices 144 Appendix I. Table 2.1.1: Average Growth Rate of Selected Age Group and Total Population of Jamaica, using Census data: 1844-2050 (in %) Appendix II. Table 2.1.2a: Percentage of Estimated or Projected Populations by Selected Age Groups of different Caribbean Nations: 1950, 1975, 2007 and 2050 Appendix III. Table 3.1.5: Growth Rate (in %) for Selected Regions, and Countries based on certain Time Periods: 1950 to 2050 Appendix IV. Table 4.1.2: Life Expectancy at Birth of Jamaicans by Sex: 1880- 2004 Appendix V: Table 4.1.2: Life Expectancy at Birth of Jamaicans by Sex: 1880- 2004
  10. 10. vii LIST OF TABLES Page Table 1.1.1: Selected Age Groups of Jamaican Population, using Census data: 1881-2001 (in %) 2 Table 1.1.2: Selected Age Groups of Jamaican Population: 1950, 1975, 2007, 2025 and 2050 (in %) 3 Table 1.1.3: World Percentage of Population at Older Ages, 1950—2050 3 Table 2.1.3: Characteristic of the Three Categories of Elderly, and the Ageing Transition 23 Table 3.1.1: Life Expectancy at Birth for Selected Regions by Both Sexes: 1950-2050 (in years) 31 Table3.1.2: World Life Expectancy by Specific Aged Cohorts and by Gender, 1950—2050 32 Table 3.1.4: World Growth Rate (in %) by Aged Cohorts, 1950—2050 33 Table 4.1.1: Net External Migration of the Population by Selected Age Groups, Jamaica: 1988-2006 45 Table 4.1.2: Estimated or Projected Populations by Selected Age Groups of different Caribbean Nations: 1950, 1975, 2007 and 2050 (in %) 48 Table 4.1.3: Rate of Growth for Selected Regions, and Countries based on certain Time Periods: 1950 to 2050 (in %) 49 Table 4.1.4: Cuba: Selected Statistics of the Aged Population, 1899-2025 50 Table 4.1.5: Cuba: Life Expectancy by Gender. 1950-1986 50 Table 4.1.6: Rate of Growth of Selected Age Groups and of Total Population of Jamaica, using Census data: 1844-2050 (in %) 51 Table 4.1.7: Life Expectancy at Birth of Jamaicans by Sex: 1880-2004 (in yrs) 55
  11. 11. viii Table 9.1.1: Univariate Analyses of Variables used in Wellbeing Model 147 Table 9.1.2: Percentage of Sex of Respondents by Elderly Cohort 148 Table 9.1.3: Percentage of Marital Status of Respondents by Elderly Cohort 150 Table 9.1.4: Percentage of Educational Level by Elderly Cohort 152 Table 9.1.5.i: Percentage of Area of Residence by Elderly Cohort 153 Table 9.1.5.ii: Percentage of Area of Residence by Elderly Cohort 154 Table 9.1.6: Percentage of Elderly Receiving National Insurance Scheme (NIS) 155 Table 9.1.7.i: Percentage of Elderly Receiving Government or Private Pension by Elderly Cohort 155 Table 9.1.7.ii: Percentage of Sampled Population who Receive NIS by PENSION (Government or Private) 156 Table 9.1.7.iii: Percentage of Sampled Population who Receive NIS by Area of Residence 157 Table 9.1.7.iv: Percentage of Sampled Population who Receive Pension by Area of Residence 157 Table 9.1.7.v: Percentage of Sampled Population who Receive NIS by Sex 158 Table 9.1.7.vi: Percentage of Sampled Population who Receive Pension by Sex 158 Table 9.1.8: Physical Health Status by Elderly Cohort 159 Table 9.1.9.i: Descriptive Statistics for Health Care Expenditure of the Elderly Cohort 161 Table 9.1.9.ii: Descriptive Statistics for Health Care Expenditure based on Area of Residence 162 Table 9.1.9.iii: Descriptive Statistics for Health Care Expenditure based on Sex 163 Table 10.1.1: A Multivariate Model of Wellbeing of the Jamaican Elderly, N=629 167
  12. 12. ix Table 10.1.3: Difference in Wellbeing of Jamaican Elderly based on Area of Residence (assume that only Area of Residence changes in equation 3) 173 Table 10.1.4: Wellbeing of Different Elderly based on Years Lived 174 Table 10.1.5: Decomposing General Wellbeing Model: Physical Functioning Model, N= 629 175 Table 10.1.6: Decomposing General Wellbeing Model: Economic Model, N=629 177
  13. 13. x LIST OF FIGURES Figure 1.1.1: Explanatory Model for Wellbeing of Elderly Jamaicans 31 Figure 3.1.1: Selected Regions and their Percentage of Pop. 65+ years 35 Figure 3.1.2: Ranked Order of Five Leading Causes of Mortality in the Population 65 yrs and older, 1990 37 Figure 3.1.3: Leading Causes of Self-Reported Morbidity in the Population of Seniors, by gender in Barbados and Jamaica 38 Figure 4.1.1: Percentage Change in the Size of Elderly Age-subgroups, 1991-2001 54 Figure 4.1.2: Population Pyramid of Jamaica by Age and Gender, 2000 56 Figure 4.1.3: Population Pyramid of Jamaica by Age and Gender, 2025 56 Figure 4.1.4: Population Pyramid of Jamaica by Age and Gender, 2050 57 Figure 4.1.5: Percentage Change in Age Sub-groups as a Proportion of Total Population between 1991 and 2001 58 Figure 7.1.1: Respiratory System of a Human 128 Figure 9.1.1: Area of Residence by Sex of Respondents 149 Figure 9.1.2: Percentage of Health Conditions Reported by Sex 160 Figure 9.1.3: Per-capita Population Quintile, by Age Group of respondents 164 Figure 9.1.4: Per-capita Population Quintile, by Age Group Controlled for Sex 165 Figure 11.1.1: Percentage of Elderly (ages 60+ years) in Jamaica, 1850-2050 205
  14. 14. xi PROLOGUE Reports from the PIOJ, STATIN, and the United Nations have shown that life expectancy at birth for both genders (male and female) in Jamaica has more than doubled over the last 100 years. This has increased by up to 20 years from the 1950s to 2004. However, the new focus is not on life expectancy, but on healthy life expectancy and disability free life expectancy. It is undoubtedly clear from statistics that we have managed to add years to life, hence we need to examine the quality of life for those years and in particular that of the elderly. Looking at the life expectancy data for Jamaica (2002-2004), it is 74.1 years for both genders (Demographic Statistics 2006) but according to the WHO (2003) healthy life expectancy of Jamaicans is 65.1 years. This reality reiterates the point that despite the gains in life expectancy, the elderly are living longer but with disability, which is undoubtedly reducing their wellbeing (or quality of life). Thus, by examining factors that influence their wellbeing, we will be unearthing issues that have an impact on their quality of life. Over the years, in operationalizing wellbeing or health, scholars have used (1) physical functioning (Hambleton et al. 2005; Smith and Kington 1997; Grossman, 1972), (2) self reported happiness (Kashdan 2004; Stutzer and Frey. 2003; Diener 2000; Lyubonirsky 2001) or (3) income (Sen 1998). Based on my review of the works, there is no single study that has used a combination of two or
  15. 15. xii more of those conditions identified earlier in operationalizing wellbeing, and this is so in Jamaica as well. After much investigation, it appears that this is the first of its kind in Jamaica in a number of different ways. Firstly, the study has expanded on the operational definition of wellbeing from either functional limitations or income to a composite index that includes health conditions, income, consumption and ownership of material resources (excluding ownership of house or dwelling). Secondly, the research has used the biopsychosocial model in evaluating factors that are likely to influence wellbeing. Finally, the model developed by this work will be able to examine the quality of life of elderly Jamaicans. Historically, in Jamaica, wellbeing has been predominantly conceptualized, diagnosed and treated primarily from a biomedical perspective. To this end, socioeconomic, environmental and psychological issues have not been emphasized. This is evident from the data collected and published by the Jamaica Survey of Living Conditions (JSLC) reports that guide policy formulation in the country. The collected data on health status focus on self- reported illness or injury, severity of illness, utilization of health services and cost of health care. In order to develop a definition that is more reflective of people’s quality of life, we must assess ‘non-biomedical’ factors as a part of the construct of subjective well-being which is multifaceted. Since humans are unique and complex social agents, health and well-being cannot be built around a one-dimensional construct. In this paper a model is framed that will estimate the wellbeing of the elderly (persons 60 years and
  16. 16. xiii beyond). It is developed using socio-economic, environmental and psychological conditions as self-reported by Jamaicans, from a nationally representative data. Theoretical Model - framework There are a number of reasons for this project, and among the purposes for the writing of this book is the development of a model that can be used to examine and evaluate the wellbeing of aged Jamaica. The theoretical model that was used to drive this book is a mathematical function that was earlier developed by Grossman, which I modify to include other variables that were identified from the literature. Hence, the theoretical model that is used herein subsumes all the research findings that indicate the wellbeing (quality of life) of aged people in Jamaica. Theoretical framework guides all research. It is this framework which guides the research materials used, the methodologies, the methods of data collection, the analysis of data, along with the research objectives and the survey questions. Hence, the theoretical framework plays a fundamental role in the research process. With this being the case, Waller’s monograph summarized this perfectly, that: [It] is a self-conscious set of (a) fundamental principles or axioms (ethical, political, philosophical) and (b) a set of rules for combining and applying them (e.g. induction, deduction, contradictions, and extrapolation). … and so determines the kinds of knowledge about the objects that can be
  17. 17. xiv produced legitimately within the framework (Waller 2006, 25). Waller’s construct highlights the importance of assumptions, procedures and principles in the execution of social research. Social research is hinged on particular sets of worlds, and the apparatus which is present for the interpretation of that cosmology. Based on Waller’s proposition, for this project the researcher will employ Ecological, and Selective Optimization with Compensation Model of Ageing, the biopsychosocial model, in an attempt to understand the state of the aged in Jamaica The utilization of this model rests squarely in the thrust for the 21st Century in that we now recognize the complexity of different sociocultural, psychological and economic conditions, playing on the health status and by extension the wellbeing of people. Quality of life is not adequately addressed in the old biomedical model - because they (medical doctors, biologists to name a few scientists) believe that socioeconomic, psychological and environmental factors contribute to the health status of people (see for example Barrett et al. 1998). It is argued that the environment and phenomena such as El Niňo have aided the increase of illnesses such as malaria, dengue fever, asthma and other respiratory diseases, and cholera. (See Barrett et al. 1998, 258-259). The biopyschosocial model is captured in a mathematical model devised by a group of scholars. It is a function that researchers call wellbeing, which is an additive approach of various explanatory variables (wellbeing = f (socioeconomic conditions, psychological variables, biomedical conditions)). While many
  18. 18. xv scholars such as Erber (2005), Brannon, and Feist (2004) had put forward the idea that this is timely in the measurement of quality of life, neither of them proposed a mathematical model to the worded construct. Wii =ƒ (Pmc , ED, Et, Ai, En, G, MS, AR, P, N, O, H, T, V) [1] Individual wellbeing, Wi, is a function of cost of medical care Pmc, educational level of the individual, ED, elderly cohort Ai, where i is 65 years and over), the environment En, gender of the respondents G, marital status MS, area of residents AR, positive affective conditions P, negative affective conditions N, occupancy per room O, home tenure H, property ownership, T, and crime and victimization, V. The model is primarily shaped by regression analysis. Embedded with this model was the correlation between sociodemographic, institutional, environmental and economic conditions on the wellbeing of each individual with different time intervals. Engel’s biopsychosocial model was not really a model. Instead it was a construct which sought to encapsulate body, mind and social conditions in the treating of health. He argued for the expansion of the biomedical model but during the process did not formulate a theory or a model. Thus, Dr. Engel’s work on the biopyschosocial model did not define a set of variables; neither did he use any advancing statistical technique to illustrate what he referred to as a model. Two economists, Smith and Kington, on the other
  19. 19. xvi hand, have sought to provide a platform upon which more studies should be positioned in understanding the health status of a population, when they used theorizing developed by Grossman, which was the actual model building of the construct outlined by Engel, biopyschosocial construct. It is an econometric model, which uses the principles of a production function. This is a broader construct of health that incorporates biological, psychological and sociological conditions in assessing health status. Finding of the Model We found that there is a moderately strongly positive relationship (r= 64.5%, ρ value< 0.05) between the determinants used in this paper and general wellbeing, with a coefficient of variation (r2) of 40.1%. This denotes that the model explains 40.1% of the variation in wellbeing. In this research five additional factors were introduced. These include crime, area of residence, psychological conditions, environmental factors and age of respondents. In addition, we decomposed general wellbeing into both functional ability and material resources, in order to comprehend how the predisposed variables impact on each component of wellbeing. From the selected variables of this study, we have found that there are 10 factors of general wellbeing. General wellbeing of the Jamaican elderly is affected by (i) psychological conditions - positive and negative affective conditions; (ii) area of residence; (ii) crime; (iv) marital status; (v) physical milieu; (vi) property ownership; (vii) educational level; (viii) cost of health care, (ix) average occupancy per room and (x) age of the respondents. The five most important impacting factors of wellbeing of the Jamaican elderly in descending
  20. 20. xvii order are as follows: Average occupancy per room (β = -0.229), Physical environment (β = -0.190), Education (β = 0.173), Area of residence (β = 0.164); and Cost of health care (β = 0.148). Thus, the significance of this paper is that we now have a quantitative model that can be used to evaluate the wellbeing of elderly Jamaicans. LAYOUT OF THE BOOK In this study, the researcher (Paul Andrew Bourne) will provide a conceptual framework along with a theoretical framework for understanding the individual factors that influence wellbeing, as well as the construction of the theories on the topic. This text, ergo, is subdivided into five chapters. Chapters 1 and 2 summarize the context of the study, providing contextual and theoretical underpinning of the discourse on wellbeing, and a number of the explanatory variables. The first chapter (Chapter 1) provides studies and materials on the general discourse from an international, regional and national perspective, while the next chapter (Chapter 2) gives the framework upon which analyses will be done, and how these will aid the study. The third chapter presents the conceptualization, operationalization, and data transformation of the key variables along with the particular method of data analysis. This begins with a brief overview of the choice of paradigm, and the survey design, followed by the method of analysis and explanatory model. Chapter four provides the findings and the analyses of the data against the background of the method. The focus of this section is the provision of information in hypothesis testing. Chapter 5, on the
  21. 21. xviii other hand, concludes with the summary, conclusion and recommendation of text - determinants of the wellbeing of the Jamaican elderly. Paul Andrew Bourne, Dip Edu, BSc, MSc, PhD Political Sociologist, Biostatistician and Public Health Specialist
  22. 22. 1 Chapter One Introduction Ageing is not a recent phenomenon. It goes back centuries, from time immemorial. The total human population, within any geographical area, is made up of children, youth, people of working age and the elderly. This latter grouping is a phenomenon not only in developed nations but also in many developing societies. For many Caribbean countries, this is also their reality. The factors that explain the “greying” of the world’s population are fertility decline, reduced mortality at ‘older ages’ and the external migration of the young, as well as the return of retirees. Those conditions, coupled with increases in life expectancies due to public health improvement and better water qualities, have significant consequences for population size and structure. Where the elderly population outgrows the younger, the population structure at younger ages is constricted and at older ages it expands (Rowland 2003, 98). This is an aspect of demographic transition which will change significantly in the 21st century. Demographic ageing at the micro and macro levels implies a demand for certain services such as geriatric care. In addition to preventative care, there will be a need for particular equipment and products (i.e. wheelchairs, walkers). Then there are future preparations for pension and labour force changes, along with the social and economic costs that are associated with ageing, as well as the policy base research to better plan for the reality of these age groups. The World Health Organization (WHO), in explaining the ‘problems’ that are likely to occur because of population ageing, argues that the 21st century will not be easy for
  23. 23. 2 policy makers, who are pivotal in the preparation process to postpone ailments and disability and in the challenge of providing a particular standard of health for the populace within the context of an ageing population (WHO 1998, 5). What constitutes population ageing? Some demographers have put forward the benchmark of 8-10% as an indicator of population ageing (Gavrilov and Heuveline 2003). Within the construct of Gavrilov and Heuveline’s perspective, the Jamaican population began experiencing this significant population ageing as of 1975 (using 60+ years for ageing) or of 2001 (if ageing is 65+ years) (See Tables 1.1.1 and 1.12), and the world since the 1950s (Table 1.1.3). The numbers comprising the ageing population will double come 2050 irrespective of the chronological definition of ageing (see Table 1.1.2 and Table 1.1.3), but what about the quality of life of the elderly? This book is concerned not about population ageing in the world, the Caribbean or for that matter Jamaica, but we will examine the wellbeing of aged Jamaicans within the reality of population ageing. Table 1.1.1: Selected Age Groups of Jamaican Population, using Census data: 1881-2001 (in %) Age groups 1881 1891 1911 1921 1943 1960 1970 1991 2001 0 – 14 yrs. 38.8 38.7 39.8 39.4 36.6 41.1 45.9 35.2 32.2 15 – 64 yrs. 56.5 57.5 56.7 56.9 59.2 54.5 48.5 57.5 57.6 65+ yrs. 4.7 3.8 3.5 3.7 4.2 4.4 5.6 7.3 10.2 Source: Computed by Author from Statistical Yearbook of Jamaica: 1973-1989 & Demographic Statistics: 1973-2006.
  24. 24. 3 Table 1.1.2: Selected Age Groups of Jamaican Population: 1950, 1975, 2007, 2025 and 2050 (in %) Age groups 1950 1975 2007 2025 2050 0 – 14 yrs. 36.0 45.2 28.6* 24.4 18.5 15 – 59 yrs. 58.2 46.3 60.7* 60.6 57.9 60+ yrs. 5.8 8.5 10.7* 15.0 23.6 65+ yrs. 3.9 5.8 8.0* 10.3 17.7 80+ yrs. 0.2 0.8 2.0** 2.3 5.6 Source: United Nations, 2007, pp308-309 * Using figures taken from Demographic Statistics 2006 for the same year ** Estimate for 2005 from United Nations, 2007 Table 1.1.3: World Percentage of Population at Older Ages, 1950—2050 Details Age 1950 1975 2000 2025 2050 Total 60+ 8.2 8.6 10.0 15.0 21.1 65+ 5.2 5.7 6.9 10.4 15.6 80+ 0.5 0.8 1.1 1.9 4.1 Female 60+ 9.0 9.7 11.1 16.3 22.7 65+ 5.9 6.6 7.9 11.6 17.3 80+ 0.7 1.0 1.5 2.5 5.0 Male 60+ 7.3 7.5 8.9 13.6 19.4 65+ 4.5 4.8 5.9 9.2 14.0 80+ 0.4 0.6 0.8 1.4 3.1 Source: Population Division, DESA, United Nations, in United Nations. 2004. World Population Ageing 1950-2050. New York: United Nations, pp. 46 Caribbean demographers, like other demographers, have been using life expectancy for years as the measure for wellbeing. Over the years, we have accepted the perspective of those scholars who used life expectancy as an indicator of health status and by extension quality of life, but this approach accepted that a quantitative assessment of years allows us to understand the
  25. 25. 4 quality of those years lived by someone. Life expectancy (or population ageing) speaks to number of years, but this focus fails to address the other tenets of this subject. We will present an example that illustrates the disparity between long life and quality of years lived. Ali, Christian and Chung, who are medical doctors, cite the case of a 74 year-old man who had epilepsy, and presented their findings in the West Indian Medical Journal. They write that: Elderly patients are frequently afflicted with paroxysmal impairments of consciousness usually because they often have chronic medical disorders such as diabetes mellitus and hypertension and can also be on many medications. The differential diagnosis of transient impairment of sensorium in the elderly is wide and includes metabolic encephalopathies e.g. medication side effects, syncope, including cardiogenic syncope, transient ischaemic attacks and strokes, the syndrome of transient global amnesia, psychogenic fugue states and epileptic seizures. Many elderly patients may have more than one cause for this symptom. (Ali, Christian and Chung 2007, 376) The case presented by the medical doctors emphasizes the point we have been arguing, that long life does not imply quality of life years. Although the case study cited here does not constitute a general perspective on all the elderly, other quantitative studies have concurred with Ali, Christian and Chung’s general findings. Scientists agree that biological ageing means degeneration of the human body (also see: Hooyman and Kiyak 2005; The Merck Manual of Aging 2004; Eldemire-Shearer 2003; Kalache 2003; Ling and Bathon 1998), and such a reality means that longer life will not mean quality years. Thus population ageing, like life expectancy, does mean more than increased number of people for the human population. Population ageing is going to be a socioeconomic, psychological and
  26. 26. 5 political challenge today, tomorrow and in the future for developing countries and nations like Jamaica. However, this paper is concerned with the wellbeing of the aged from the perspective of the biopsychosocial model and its determinants, and the state of the elderly in Jamaica. The biospsychosocial model posits that biological, sociological, and psychological conditions play a significant role in determining the wellbeing of an individual. How was this study conducted? And what is the prescribed model that is being put forward here that will drive the study? Research Design The research design for this study is an explanatory one. This study utilizes cross-sectional data from a reputable data collections agency in order to identify and explain the determinants of wellbeing among the Jamaican elderly. The use of multivariate analysis to generate a model for the phenomenon clearly indicates a mathematical demographic approach. Many scholars, (for example Crotty 2005; Neuman 2006; Boxill, Chambers and Wint 1997; Babbie 2000; Heiman 1995; Shaughnessy and Zechmeister 1990; Bryman and Cramer 2005) have written on social research methods, but the researcher has found Michael Crotty’s monograph aptly fitting for this paper, as it summarized the research process in a diagrammatic and systematic manner while providing elaborate details of each component. In the text titled ‘The foundations of social research: Meaning and perspective in the research process’, Crotty (2005) aggregated the research process in four schema (i.e. four questions which must be answered in examining social phenomena),
  27. 27. 6 namely (1) methods, (2) methodology, (3) theoretical perspective, and (4) epistemology. The four schema of the research process according to Crotty (2005, 2-4) are encapsulated into a flow chart (See Figure 4.1). Michael Crotty, a lecturer in education and research study at the Flinders University of South Australia, believed that the purpose of research guides the choice of methodology and method. In this way, the chosen methodology and method clearly depict the set of assumptions the researcher has about reality (Crotty 2005, 2) (i.e. what [he/she] brings to the work). The schema of the research process is not simply a unidirectional model (Crotty 2005, 2-4). Crotty (2005) pointed out that this process may begin with epistemology, theoretical perspective, methodology and method, but noted that it may flow from method, methodology, theoretical perspective and lastly epistemology. Embedded in this schema is not the preciseness of the direction but that those areas are a must within a research process. Survey Design This book for its research design used secondary data taken from a reputable statistical agency to examine socio-political, ecological and psychological factors and how they influence the wellbeing of elderly Jamaicans. The institution began collecting data to aid planning in the late 1980s when the institution collaborated with another, and adopted, with some modifications, the World Bank's Living Standards Measurement Study (LSMS) household surveys. The PLC has its focus of policy implications of government programmes, and so
  28. 28. 7 each year a different module is included with the aim of evaluating a particular programme. The PLC is a self-administered instrument (questionnaire) where respondents are asked to recall details of information on particular activities. The questionnaire covers demographic variables, health, immunization of children 0 to 59 months, education, daily expenses, non-food consumption expenditure, housing conditions, inventory of durable goods and social assistance. Interviewers are trained to collect the data, which is prepared by the household members. The survey is usually conducted between April and July annually. The current study extracted data on public-private health care utilization, mean cost for visits to public-private health care facilities in the last 4 weeks of the survey period, and health insurance coverage from the PLC. Information was extracted on the annual inflation rate from 1988 to 2007. Scatter diagrams (graphical plots) were on variations of public-private health care utilization by inflation, mean cost of care for visits, as well as other graphic presentations used to assess whether any statistical association exists between the dependent variable and the independent variable; and some of the graphs were only interpreted. In the current study, sub-samples of 3,009 elderly Jamaicans (60 years and older) were extracted from the PLC’s survey that had 25,018 respondents. The rationale for the use of PLC 2002 was based on two critical issues: 1) it was the largest dataset ever collected by the two Institutions, and 2) it was the first time in the annals of the PLC that crime and victimization, demographic characteristics, household consumption, education, health, social welfare and related programmes, and housing were collected together. Hence, within the context of a large dataset and
  29. 29. 8 the number of conditions that are related to the cohort in investigation, I believe that it was fitting to use this period as against other occasions with less than 3,000 respondents and not having data on crime and victimization, which is a major problem faced by countless Jamaicans. General Hypothesis: The mathematical model which drives this paper. Wiki =ƒ (Pmc , ED, Ai , En, G, MS, AR, P, N, O, H, T, V) Wi is the wellbeing of the Jamaican elderly, i, is a function of the cost of medical (health) care, (Pmc), the educational level of the elderly individual, (Ai , where i is an elderly individual ), the environment (En), gender of the respondents (G), marital status (MS), area of residents (AR), positive affective conditions (P), negative affective conditions (N), average occupancy per room (O), home tenure (H), property ownership (T), and crime and victimization (V). The sample survey research methodology requires objectification in the investigation of phenomena. The primary purpose in using this methodology is objectivism, as some scientists argue that things exist out there independently of our consciousness and experiences. As such, the positivists’ paradigm is the most suitable and preferred theoretical framework to execute the specified methodology. Positivism is fundamentally based on (1) science (i.e. free from value judgment – science is guided by observation and not opinion or beliefs), and (2) measurement - that if a phenomenon cannot be measured, it should not be studied – which explains why positivists embody theories in hypotheses that are testable.
  30. 30. 9 The positivists’ philosophy is carried out by hypothesis testing through conducting experiments (i.e. observation) and the manipulation of variables. This is referred to as the scientific method – that is, logical reasoning, with an emphasis on experience (i.e. observation) and measurement. A renowned methodologist, Neuman (2003), penned the following perspective that aptly summarized positivism, when he said that: Positivism sees social sciences as an organized method for combining deductive logic with precise empirical observation … in order to discover and confirm a set of probabilistic causal laws that can be used to predict general patterns in human activity (Neuman 2000, 66). Embedded in positivist research are the techniques used in obtrusive and controlled measurement. This guides the data-gathering process (also see Waller 2006) – by way of survey, experiments, case-control studies, statistical records, structured observation, content analysis, and other quantitative techniques. The very nature of this research on wellbeing, was not the collection of data through observation, but that a primary institution gathered pertinent data from Jamaicans based on the people’s belief (i.e. self-reported), which makes for value judgements (see for example, Trochim 2006). Hence, in its truism form, the researcher did not use positivism. Instead, a hybrid methodology was used. Based on the fact that the researcher used a survey (Jamaica Survey of Living Conditions) which collected data from people within Jamaica, and that the data given are individuals’ perspective on how they conceptualize what they see, the researcher used mixed positivism, which captures what the post-positivist (see Trochim 2006) called constructivism while applying causation and objectification. Constructivism speaks to the position of each person, and from an
  31. 31. 10 objective reality (i.e. through precise measurement – that is using the scientific method). From the post-positivism stance, the researcher in an attempt to reach “the goal of getting it right about reality” (Trochim 2006) put forward the idea that this can only be attained through triangulation, and so did not use this in its entirety. Nevertheless, based on the type of data gathered by the Statistical Institute of Jamaica (i.e. self-reported information from each respondent on how he/she conceptualizes his/her surrounding); the researcher will use this self-reported data to guide the analysis of a wellbeing function. The function will apply regression analysis to construct a model for wellbeing for the Jamaican elderly, using hypothesis testing, precise measurement of concepts and some econometric modelling techniques (see Explanatory Model, p.124; also see Methodology and Method (Chapter 3) – i.e. hypotheses). The use of multivariate analysis to generate a model for the phenomenon clearly dictates that a mathematical–demographic approach had to be taken; hence, positivism was the preferred and appropriate choice of methodology. Furthermore, the study will test a number of hypotheses by first carefully analyzing the data through cross tabulation – to establish relationship, and then, secondly, by removing all confounding variables. After this, the researcher will use model building in order to finalize a causal model. Hence, the positivist paradigm is the appropriate choice. The positivists’ paradigm assumes objectivity, impersonality, causal laws, and rationality. This construct encapsulates scientific method, precise measurement, and deductive and
  32. 32. 11 analytical division of social realities. From this standpoint, the objective of the researcher is to provide internal validity for the study, which will rely totally on scientific methods, precise measurement, value free sociology and impersonality. The study will design its approach in a similar way to that of natural science by using logical empiricism. This will be done by precise measurement through statistics (chi-square and modelling – logistic regression). By using hypotheses testing, value free sociology, logical empiricism, cause-and-effect relationships, precise measurement through the use of statistics and survey and deductive logic with precise observation, this study could not have used the interpretivist paradigm, as the latter seeks to understand how people within their social setting construct meaning in their natural setting, which is subjective rather than the position taken in this research – an objective stance. Conversely, this study does not intend to transform peoples’ social reality by way of empowerment, but is primarily concerned with unearthing a truth that is out there, and as such, that was the reason for the non-selection of the Critical Social Scientist paradigm. Limitation to the Study Model This model W=ƒ (Pmc, ED, Ai, En, G, M, AR, P, N, O, Ht, T, V, S, HS) + ei is a linear function W= 1.922+ 0.197Pmc + 1.091AR 2 + 1.698 AR 3 – 0.633 En + 0.341 M1 + 0.560 M2 + 0.240 ED 2 + 1.700 ED3 + 0.210S – 0.691O + 0.606 T + 0.105P -0052N- 0.022 Ai + ei Therefore we are unable to distinguish between the wellbeing of two individuals who have the same typology, and the wellbeing of an individual that may change
  33. 33. 12 over short time intervals that do not affect the age parameter. As such in attempting to add further tenets to this model in order to be able to fashion a close approximation of reality, the following modifications are being recommended. Each individual’s wellbeing will be different even if that person’s valuation for quality of life is the same as someone else who shares similar characteristics. Hence, a variable P representing the individual should be introduced to this model in a parameter α (p). Secondly, the wellbeing of the elderly is different throughout the course of the year, and so time is an important factor. Thus, we are proposing the inclusion of a time-dependent parameter in the model. Therefore, the general proposition for further studies is that the linear function should incorporate α (p, t) a parameter depending on the individual and time.
  34. 34. 13 EXPLA Home Tenure Property ownership Sex Environment Marital Status Area of residence Cost of Health Wellbeing care Level of Education Average occupancy per household Psychological: Positive Affective, and Negative Affective Elderly Figure 1.1.1: Bourne’s Linear Conceptual Model of Wellbeing for Elderly Jamaicans
  35. 35. 14 Chapter Two Ageing Transition The issue of ageing and its conceptualization date back to earlier centuries. The scientific study of this phenomenon in addition to that of older adulthood is a more recent debate – nineteenth century – and it began as early as in 1835. This fascination that people have for ageing, older adulthood and the ageing process is a longstanding debate, and it emerged because of man’s eagerness to reduce the ageing process. History has recounted that a Spanish explorer – during 1460 to 1521- in his quest to reclaim youth by rescinding the ageing process, discovered Florida as a result. This explains the pilgrimage and people’s fascination with bath fountains, health spas, dietary requirements, gyms, physical exercise and their willingness to extend themselves in healthy lifestyle practices. Although we have spent millions of dollars on DALY (i.e. Disability Adjusted Life Years) lifestyle issues, we still cannot stop the ageing process. On a point of emphasis, the developing world’s populations are even ageing at a faster rate than in the developed world (Bourne and Eldemire-Shearer 2008b; Bourne 2007; United Nations 2004, 2005; Eldemire-Shearer 2003; Kalache 2003). Thus, what is ageing? And, what is the ageing process? There are many indicators of ageing (i.e. median age, the proportion of the population older than 60 years, mean age of the population, and the dependency ratio), but how do we know when it begins? In this chapter, the author will examine different conceptualizations of ageing, in order to evaluate the process of
  36. 36. 15 ageing and when ageing commences. Chronological ageing However the author, using the available data for Jamaica from the Statistical Institute of Jamaica, was able to compute the average growth rate for children (i.e. ages less than 15 years), work age population (ages 15 through 64 years) and the elderly (ages 65+) from as far back as 1844. The author has concluded that while he was unable to definitely say that population ageing began in the mid 1960s, the average growth rates show that the ageing of the nation’s population occurred between 1960 and 1970. Between 1950 and 1960, the average growth rate was 1.74%, and it rose to 3.36% between 1960 and 1970, with no other period before 1950 and post 1970 showing an average growth rate close to 3.4%. (See Appendix I - Tables 2.1.1). The average growth rate for 1991 to 2001 stood at 1.43%. Professor Denise Eldemire-Shearer, a Jamaican public health and ageing expert, on the other hand, did not substantiate her claim as to why she argued that population ageing in Jamaica began in the ‘mid 1960s’. The author, using a percentage of the elderly population (i.e. ages 60+ years) cannot substantiate Eldemire-Shearer’s claim, but what can be said with authority is that it occurred between 1960 and 1970 (also see Appendix II – Table 2.2.2a and Table 2.2.2b), and for the world (see Table 1.1.3), Barbados and Suriname (Table 2.2.2a) it started in the 1950s. With regard to global population, 10.4% of individuals are 60 years or older (United Nations 2005c). Jamaica’s elderly population in 2005 rose marginally by 0.3% to 10.7% in 2006 (PIOJ 2007). The United Nations data show
  37. 37. 16 that 8% of people in developing nations are 60 years or over (United Nations 2005c), which is approximately 2% less than the number of aged people in Jamaica. According to the Demographic Statistics (2006), 10.9% of Jamaicans females are 60 years and older compared to 10.3% of males. Despite the indecisiveness in reaching consensus on a definition of ageing from the United Nations’ perspective on the elderly, ‘old age’ begins at 60 years while other scholars conceptualize ageing to commence at age 65 years or older (See for example Lauderdale 2001; Elo 2001; Manton and Land 2000; Preston et al. 1996; Smith and Kington 1997a; Rosenberg, M.W., and E.G. Moore. 1997; Smith and Waitzman 1994; Rudkin 1993). The WHO says that we can either use the chronological age of 60 or 65 years or over to indicate the beginning of ageing (WHO 2002, 125). So why is there no standardized definition for the elderly or where ageing begins? Thane (2000) noted that ‘old age’ for all people was defined as 60 years in medieval times. She justified this by putting forward an argument for the established age. In medieval England, men and women ceased at 60 years to be liable for compulsory service under labour laws or to participate in military duties. In Ancient Rome, on the other hand, ‘old age’ began from early 40 to 70 years, with 60 years being ‘some sort of annus climactorius’. Some Demographers see seniors - the elderly or the aged (old people) - as beginning at the chronological age of 65 years and older, and not an individual who is 60 years of age. Up to 1992, the Statistical Institute of Jamaica defined old-age as those people 65 years and older (Demographic Statistics 1992). At that time the Professor of Demography at the University of the West Indies at Mona was
  38. 38. 17 primarily responsible for much of the output from that Institution, and for the training of staff. This may explain why the Statistical Institute of Jamaica used 65 years in its conceptualization of old-age. Furthermore, Western societies use 65 years and older to represent the elderly (seniors) as this is the period when people become fully eligible for Social Security benefits. One Caribbean scholar emphasized that there is no absoluteness in the operational definition of the “elderly” (Eldemire 1995, 1). She commented that from the World Assembly of Ageing (which was held in Vienna in 1982), the term “elderly” uses the chronological age of 60 years and older ‘as the beginning of the ageing process’. Jamaica having signed the Vienna Declaration of Ageing, which defines ageing to begin at 60 years, Eldemire questioned academics and other scholars over their rationale in using 65 years. Many demographers use 65 years and older to represent the commencement of the ageing process, but that is due primarily to the nature of the study. Demographers use 65 years and beyond when they examine the elderly and this is used more in the context of retirement matters. However, these scholars frequently use 60 years and older in situations when health is being examined, which is in keeping with the medical perspective that the chronological age of 60 years is the beginning of the ageing process. Within the study of demography, elderly begins at the chronological age of 65 years – using the unit of analysis of time, based on the number of years and months that have elapsed since birth (See for example Erber 2005; Iwashyna et al. 1998; Preston, Elo, Rosenwaike, and Hill 1996; Smith and Waitzman 1994). However, based on the monographs from other scholars (such as - Marcoux 2001;
  39. 39. 18 Eldemire 1999; Ministry of Labour, Social Security and Sports 1997; Eldemire 1997; PAHO and WHO 1997; Eldemire 1995a; Eldemire 1994; Barrett 1987), the issue of the aged begins at 60 years. Hence, the operational definition of the ‘elderly’ continues unabated in non-standardization. Those who use 60 years adopt this value because of the World Assembly on Ageing (in Vienna, Austria: July-August 1982), which puts forward the idea that ageing begins chronologically at 60 years. In a discussion with Professor Eldemire (on 7th April, 2008), she opined that among the reasons for the non-standardization of the term ‘elderly’ was the disparity in the actual commencement of the ageing process. Eldemire pointed out that, although the World Health Organization (WHO) recommended that we use 60 years to indicate the beginning of ‘old age’, some people start ageing at the chronological age of 60 years, and there are others who begin this stage at a later age – 65 years. Eldemire’s position is in keeping with the arguments put forward by the WHO on the rationale for the non-standardization of the operational definition of when “older age” begins. The Canadian statistical agency used age 65 years as the dividing line between “young” and “old” (Moore et al. 1997, 2; also see Smith and Waitzman 1994; Preston, Elo, Rosenwaike and Hill 1996). The issue of using the chronological age of 65 years to measure older adulthood, according to one academic, comes from the minimum age at which the Social Security System begins disbursing payment for pensions to people living in the United States (Erber 2005, 12). It is argued that in 1935, the U.S. government modelled this on
  40. 40. 19 the German retirement system. This explains the use of 65 years of age by many scholars, practitioners and non-professionals ever since. This approach sub- divides ageing into three categories. These are (i) young-old (ages 65 through 74 years), (ii) old-old (ages 75-84 years) and oldest-old (ages 85 years and beyond). However, is there a difference between biological and chronological ageing? The WHO (2002) offered us a rationale for ‘old age’ in one of its publications entitled ‘World Report on Violence and Health’, that it is based on ‘physical decline’ (or functional limitation) of people in regard to them “no longer [being able to] carry out their family or work roles. Embedded in the rationale for the operational definition offered by the WHO is the recognition that ‘old age’ is both a chronological as well as a biological phenomenon. Hence, what is the discussion on biological ageing? Biological ageing As cells age, they function less well. Eventually, they must die, as a normal part of the body’s functioning (The Merck Manual of Health and Aging, 2004, 5) As the years pass, most people experience changes in the way their body functions. Some changes are obvious. For example, before age 50, most people begin to have trouble seeing objects that are up close. Other changes are hardly noticeable. For example, few people are aware that the kidneys may become less able to filter waste products out of the blood, because the kidneys usually continue to filter the blood well enough to avoid problems. Most people learn that their kidneys have aged only if a disorder develops (The Merck Manual of Health and Aging 2004, 5) Organisms age naturally, which explains biological ageing, including kidney issues, vision, hearing, reduced mobility and even natural death owing to
  41. 41. 20 ageing organisms. Here ageing implies growth, development and maturity (Ross and Mirowsky 2008). This approach emphasizes the longevity of the cells, in relation to the number of years the organism can live. Thus, in this construction, the human body (an organism) is valued based on physical appearance and/or the state of the cells. Embedded in this apparatus is the genetic composition of the survivor. This occurs when the body’s longevity is explained by genetic components (See for example Yashin and Iachine 1997, 32). Gompertz’s law in Gavriolov and Gavrilova (2001) shows that there is a fundamental quantitative theory of ageing and mortality in certain species (the examples here are as follows – humans, human lice, rats, mice, fruit flies, and flour beetles (also see, Gavriolov and Gavrilova 1991). Gompertz’s law went further to establish that human mortality increases twofold with every 8 years of an adult life, which means that ageing increases in geometric progression. This phenomenon means that human mortality increases with the age of the human adult, but that this becomes less progressive in advanced ageing. Thus, biological ageing is a process where the human cells degenerate with years (i.e. the cells die with increasing age), which is explored in evolutionary biology (see Medawar 1946; Carnes and Olshansky 1993; Carnes et al. 1999; Charlesworth 1994). But studies have shown that using evolutionary theory for “late-life mortality plateaus” fails, because of the arguably unrealistic set of assumptions that the theory uses to establish itself (Mueller and Rose 1996; Charlesworth and Partridge 1997; Pletcher and Curtsinger 1998; Wachter 1999). Reliability theory, on the other hand, is a better fitted explanation for the
  42. 42. 21 ageing of humans than that argued by Gompertz’s law, as the ‘failing law’ speaks to the deterioration of human organisms with age (Gavrilov and Gavrilova 2001) as well as the non-ageing term. The latter, based on Gavrilov and Gavrilova (2001), can occur because of accidents and acute infection, which are called “extrinsic causes of death.” While Gompertz’s law speaks to mortality in ageing organisms due to age-related degenerative illnesses such as heart diseases and cancers, a part of the reliability function is Gompertz’s function, as well as the non-ageing component. When the biological approach is used to measure ageing, this may be problematic, as two different individuals with the same organs and physical appearance may not be able to perform at the same rates, which speaks to the difficulty in using this construct in measuring ageing. Nevertheless, this construct is able to compare and contrast organisms in relation to the number of years that a cell may be likely to exist. Erber (2005) argues that this is undoubtedly subjective, as we are unable with any definiteness to predict the life span of a living cell (Erber 2005, 9). Interestingly, the biological approach highlights that the ageing process comes with changes in physical functioning. The oldest-old categorization is said to be the least physically functioning compared to the other classifications in chronological ageing. The young-old, on the other hand, are more likely to be the most functioning, as the organism is just beginning the transition into the aged arena (see for example Erber 2005; Brannon and Fiest 2004). It is important to avoid such pitfalls in constructions as may arise with the
  43. 43. 22 use of the biological approach, ergo, for all intents and purposes, given the nature of policy implications in effective planning, the researcher is putting forward the perspective that seniority in age commences at age 65 years – using the chronological ageing approach. In the ageing transition, both chronological and biological ageing have a similar tenet. It should be noted that as an individual shifts from young-old to oldest-old, the body deteriorates and what was of low severity in the earlier part of the ageing process becomes of critical mass in the latter stage. Hence, at the introductory stage of the ageing transition, the individual may feel the same as when he/she was in the working-age population, but the reality is that the body is in a declining mode. Because humans are continuously operating with negatives and positives, as he/she becomes older – using the ageing transition (i.e. 65 years and older) – the losses (or negatives) outweigh the positives. This simply means that the functionality limitation of the body falls, and so opens the person to a higher probability of becoming susceptible to morbidity and mortality. Secondly, the environment, which may not have been problematic in the past, now becomes a health hazard. One University of Chicago scholars summarizes this quite well in Table 2.1.3: This study seeks to evaluate the wellbeing of the aged and not those who are eligible for Social Security Benefits. Hence, for this study ‘old age’ or the elderly (seniors) will begin from the chronological age of 60 years and older.
  44. 44. 23 Table 2.1.3: Characteristics of the Three Categories of Elderly, and the Ageing Transition Characteristic The Ageing Transition Young-old Aged 1 Oldest-Old Health problems Low Moderate High Physical disability Low Moderate High Demand for medical care Low Moderate High Demand for public service Low Moderate High Demands on children Low Moderate High Dependency on others Low Moderate High Social isolation Low Moderate High Source: This is taken from Essays in Human Ecology 4. Bogue 1999, 3. Eldemire’s classifications differ somewhat from the perspective put forward by Donald Bogue (1993). Old age (i.e. elderly) according to Bogue begins at 65 years, whereas Eldemire believes that this should be 60 years and older, which is in keeping with the conceptual definition of elderly based on the United Nations’ charter. This discourse of the operational definition of ageing and the values for the categories of age cohorts also differ marginally between the two scholars. Like Bogue, Denise Eldemire has three age groups into which she classifies the elderly. These are (1) young-old (ages 60 to 74 years); old-old (ages 75 to 84 years) and (3) oldest-old (i.e. 85 + years). Both researchers used the 1 Donald Bogue (1999) used aged (age 75 – 84 years) to refer to what this paper calls old-old; 65 to 74 years to denote young-old and from 85 years and older to indicate oldest-old.
  45. 45. 24 three groups because they represent the ‘stages of ageing’. The three ‘stages of ageing’ are widely accepted in gerontology as indicators of the biological transition which the elderly pass through, accompanied by progressive physiological deterioration of the human body. Elderly patients are frequently afflicted with paroxysmal impairments of consciousness usually because they often have chronic medical disorders such as diabetes mellitus and hypertension and can also be on many medications (Ali, Christian and Chung, 2007, 376) Despite the claims made by a few medical doctors (Ali, Christian and Chung), another medical practitioner wrote that “The majority of Jamaican older persons are physically and mentally well and living in family units” (Eldemire 1995a, i). Professor Eldemire has extensively researched issues relating to the Jamaican elderly for some time now, and as such she formulated a perspective of this group that encompasses more than biology in examining elderly people’s quality of life. Therefore this speaks to the need for us to understand the difference between biomedical and biopsychosocial models of wellbeing. The implied issue within Eldemire’s monograph is the inadequacy of measuring quality of life using only physiological status. Clearly, with elderly Jamaicans physically and mentally well, it is safe to argue that their wellbeing is high, given the old model of measuring quality of life (i.e. biomedical – using physical illness or lack thereof). However, this measure is simplistic. Can we say in Jamaica that the high crime rate, the death of loved ones, widowhood, unemployment, retirement (separation from employment), insufficient financial resources and cost of living, loneliness, lifestyle changes, dependence on family members or friends,
  46. 46. 25 childless old people, and other psychosocial conditions will not affect the health and wellbeing of the aged? This is answered in later Chapters. Before we begin the discussion on wellbeing, or wellbeing of the aged, we need to address the issue of population ageing. Functional Ageing Functional ageing is having to deal with one’s ability and capability to carry out a physiological functioning – competence in executing a physical task. One of the differences with this phenomenon is that each individual’s competence is not determined at the same chronological ageing – and equally the biological process of each individual is not necessarily the same, as people’s genes predominantly explain what is likely to affect them and at what age. Hence, an individual may not be to perform a particular task at a certain chronological age, but his/her colleague at the same age may be able to execute the same function. Within the same breath, the functional limitation of the same individual can change based on a particular event, time, situation or mass. For instance, a 90 year old man may be able to drive himself to the supermarket and purchase his groceries - but he is not able to open his zipper to urinate. Using physical functioning for definition ageing (or ageing transition), an individual who is 60 years old who is able to perform all physiological activities without assistance as well as being able to run a mile, do miniature things like threading a needle, combing his/her hair, clipping his/her finger and toe nails, lifting his luggage or carrying a container of a particular weight, could be defined
  47. 47. 26 as functionally young, whereas by using chronological ageing he/she would have already shifted from young to old age. In a monologue with my PhD. Supervisor – Professor Denise Eldermire- Shearer – she noted that although the World Assembly on Ageing uses the chronological age of 60 years to mark the commencement of the ageing process – which earmarks the transition from young to middle age to old age – this is not necessarily the experience of each individual. Embedded in Eldemire-Shearer’s perspective is the acceptance that the ageing transition is not a static chronological valuation that we have formulated as the benchmark for ageing, as this is not necessarily the same across ethnicity, genetic composition and traits, or gender of individuals. In summary, ageing is accompanied by normal declines in function as body cells undergo senescence. Age-associated disease is also increasingly evident. Non- communicable diseases and pathological impairment manifest as morbidity, disability, and loss of function among older persons. These factors combine to diminish the capacity to continue to carry out Activities of Daily Living (e.g. eating, bathing, dressing, toileting, transferring (walking) and continence) and Instrumental Activities of Daily Living (e.g. using the telephone, shopping, managing medication and handling finances). As the capacity to fulfil these functions declines, so does the ability to maintain independence and to ‘age in place’. As early as 1987, Jette and Bottomley provided substantial evidence of the magnitude of the increase of disability with age; disability defined as needing help in accomplishing or inability to perform one or more of the Activities of Daily Living or Instrumental Activities of Daily Living. Among
  48. 48. 27 persons 65-74 years, 5% had some level of disability with respect to the Activities of Daily Living (ADL). The prevalence was slightly more than twice that proportion in the 75- to 84-year-old group (11.4%), and among those 85+ years, 35 % had disability with regard to the ADL. The pattern was similar with regard to the Instrumental Activities of Daily Living (IADL) where 40% of elders of 85 years of age or more required help compared with 5.7% of those 65 to 74 years old (Jette and Bottomley 1987). As functional loss or decline increases, the need for support services (intra-familial and extra-familial) to age in place also tends to increase.
  49. 49. 28 Chapter Three Population Ageing: Historical and Global In the late 1800s (1884) an Englishman named Francis Galton, who was both a mathematician and medical doctor, set out collecting data on ‘physical and mental functioning’ of some 9,000 people between the ages of 5 and 80 years (Erber 2005, 4), because of his interest in life expectancy and the state of older people. This was not the first time that such an examination had been done as in 1835 Adolphe Quetelet published a text in which he discussed the physical and behavioural features of people at different ages. Like his predecessor, Galton wanted to understand the human life span, but this time from an empirical perspective. The epistemology at the time was based on authority, tradition, speculation and mere non-scientific observation. Thus in keeping with his interest and training as a mathematician, Galton wanted some empirical basis on which to formulate a position on the matter. Thus, he sponsored an exhibition that would allow for the gathering of pertinent data that would aid empiricism. The data were later analyzed by several scientists. The process culminated with a published text in 1922 by G.S. Hall titled ‘Senescence: The Second Half of Life’. The findings not only concurred with the existing literature in physiology, medicine, anatomy and philosophy but provided empiricism to the knowledge that existed at that time. This begs the question – what explains that fascination of man in seeking to understand ageing, and in particular, his/her intrigue with the aged and their wellbeing? Globally, changes in Public Health – namely sanitation and nutrition, have
  50. 50. 29 added a substantial number of years to people’s life expectancies. This is evident in the life expectancy for the world as it increased from 46.5 years in 1950-1955 to 66.0 years in 2000-2005 (i.e. a 29.5% increase in approximately 50 years) and come the next 50 years it will increase by 13.1%, suggesting that the changes in public health measures and standard of living have improved life expectancy more in the early 5-decades than the next half a century. In addition, it is equally attributed to the introduction of antibiotics in the treatment of patient care. This goes further to explain the reason for the demographic transition toward an aged population. Prior to its development and implementation, pestilence and pandemic would have limited life expectancy to below 50 years, in many instances. During the pre-20th centuries, death statistics were used to measure health status and mortality along with quality of life, which explains why physicians would be preoccupied with illnesses and diseases as a measure of how to effectively address the wellbeing of people. This is captured in a study done by Mckeown (1965) which found a correlation between mortality and diseases from data for 1851 to 1900. He found that reduced mortality for the period was primarily due to infectious diseases such as tuberculosis, typhus, typhoid, cholera and smallpox (Mckeown, 1965, p. 57). The 20th century has brought with it massive changes in typologies of diseases, where deaths have shifted from infectious diseases such as tuberculosis, pneumonia, yellow fever, Black Death (i.e. Bubonic Plague), smallpox and ‘diphtheria’ to diseases such as cancer, heart illnesses, and diabetes. Although diseases have shifted from infectious to degenerate, chronic non-communicable
  51. 51. 30 illnesses have arisen and are still lingering in spite of all the advances in science, medicine and technology. Non-communicable diseases such as heart disease, hypertension, and diabetes mellitus are among the leading causes of mortality in the Caribbean region (McKenzie and Bell 2004). Although a shifting away from communicable and infectious diseases has occurred in the region, there is a remarkable increase in some communicable and infectious ones such as HIV, sexually transmitted infections (STIs), and in one particular country in the region, Jamaica, since 2004 there have been reports of an outbreak of malaria and cholera in particular geographical areas. In spite of morbidities and mortality causing pathogens (Mckeown 1965), non-communicable diseases are responsible for more deaths in the region than communicable diseases. This situation also exists among the Jamaican population where Morrison (2000) in an article entitled ‘Diabetes and Hypertension: Twin Trouble’ establishes that diabetes mellitus and hypertension have now become two problems for Jamaicans and in the wider Caribbean. This situation was supported by Callender (2000) and Steingo (2000), at the 6th International Diabetes and Hypertension Conference, which was held in Jamaica in March 2000, each identifying a positive association between diabetic and hypertensive patients - 50% of individuals with diabetes who had a history of hypertension evident in old age had their origin in childhood and early adulthood. Eldemire (1995a) argues that hypertension and arthritis are two diseases that plague the Jamaican elderly, but that they would have begun in early adulthood. In 2006, 34.8% of new cases of diabetes and 39.6% of hypertension were associated with senior citizens, i.e.
  52. 52. 31 ages 60 and over (PIOJ, 2007). Accompanying this period of the ‘age of degenerative and man-made illnesses’ are life expectancies that now exceed 50 years. (Table 3.1.1)
  53. 53. 32 Table 3.1.1: Life Expectancy at Birth for Selected Regions by Both Sexes: 1950- 2050 (in years) Period Regions: 1950-1955 1975-1980 2005-2010 2025-2030 2045--2050 World 46.6 59.9 66.5 71.1 75.1 More developed 66.1 72.3 76.2 79.5 82.1 regions Less developed 41.1 56.9 64.6 69.6 74.0 regions Least developed 36.1 45.9 52.5 59.9 66.5 regions Africa 38.4 48.7 49.9 58.0 65.4 Asia 41.4 58.6 68.8 73.5 77.2 Europe 65.6 71.5 74.3 77.8 80.6 Latin America and Caribbean 51.4 63.0 72.9 76.8 79.5 Caribbean 52.2 64.5 68.7 73.2 76.9 Central 49.1 63.5 74.8 78.3 80.3 America South 52.0 62.6 72.7 76.6 79.4 America Northern America 68.8 73.3 78.2 80.5 82.7 Oceania 60.4 67.4 75.1 78.6 81.2 Source: World Population Ageing, 2007
  54. 54. 33 Generally when one speaks about population ageing, people begin to think of reduced fertility and mortality and an increase in the population older than 60 or 65 years, and this is rightly so, but having given information on life expectancy, the author will examine the feminization associated with population ageing. While life expectancy for the globe has moved from 46.5 years from birth during 1950-1955 to 66.0 years in 2000-2005, women continue to outlive men. During 1950-1955, global life expectancy for women was 47.9 years, which was 2.7 years more than that of men in the same period, and during 2000-2005, the difference increased by 4.2 years (which is a 55.6% increase). While the gap will narrow come 2025 to 2030 and for 2045 to 2050, life expectancy will still have a feminization to it as women will be still outliving men in the future (Figure 3.1.2). Table3.1.2: World Life Expectancy by Specific Aged Cohorts and by Gender, 1950— 2050 Details Age 1950- 1975- 2000- 2025- 2045- 1955 1980 2005 2030 2050 Life Expectancy: Total Birth 46.5 59.8 66.0 72.4 76.0 60 .. .. 18.8 21.0 22.2 65 .. .. 15.3 17.2 18.2 80 .. .. 7.2 8.2 8.8 Female Birth 47.9 61.5 68.1 74.7 78.5 60 .. .. 20.4 22.8 24.1 65 .. .. 16.7 18.7 19.9 80 .. .. 7.9 9.0 9.7 Male Birth 45.2 58.0 63.9 70.1 73.7 60 .. .. 17.0 19.1 20.2 65 .. .. 13.8 15.5 16.4 80 .. .. 6.3 7.1 7.6 Source: Population Division, DESA, United Nations, in United Nations. 2004. World Population Ageing 1950-2050. New York: United Nations, pp. 47
  55. 55. 34 Globally, apart from the feminization of life expectancy, what else is there on population ageing? During 1950 to 1955, the rate of growth of the world’s population was 1.8 percent and it was the same for the elderly population, and it was 3.1 percent (72% more than the general growth rate for the world’s population) for elderly 80 years and beyond (Table 3.1.4). The rate of growth of different regions of the world can be analyzed in Table 3.1.5. On further examination of the total growth rates (Table 3.1.4) and that of the aged population, the population 80+ was increasing faster than the other elderly age cohorts (Table 3.1.4). Come 2045-2050, the rate of growth for the globe’s population will be 0.5% while it would be 6 times more for elderly 80+ years. Table 3.1.4: World Growth Rate (in %) by Aged Cohorts, 1950—2050 Details Age 1950- 1975- 2000- 2025- 2045- 1955 1980 2005 2030 2050 Total 1.8 1.7 1.2 0.8 0.5 60+ 1.8 1.8 1.9 2.8 1.6 65+ 2.1 2.6 2.3 3.1 1.6 80+ 3.1 2.7 3.8 3.9 3.0 Source: Population Division, DESA, United Nations, in United Nations. 2004. World Population Ageing 1950-2050. New York: United Nations, pp. 49 While people are living to age 70 years and beyond in many developed and in some developing states (see Table 3.1.1), the question is - are they living a healthier life – how is their wellbeing within the increases in life expectancy? Alternatively, is it that we are just stuck on life expectancies and diseases as primary predictors of wellbeing – or health status?
  56. 56. 35 Before the establishment of the American Gerontology Association in the 1930s and their many scientific studies on the ageing process (Erber 2005), many studies were done based on the biomedical model, that is, physical functioning or illness and/or disease-causing organism (Brannon and Feist 2004, 9). Many official publications use either (i) reported illnesses and/or ailments, or (ii) prevalence of seeking medical care for sicknesses, to speak of health status. Some scholars have still not moved to the biopsychosocial predictors of health status. The biopsychosocial model incorporates the mind (i.e. psychological conditions), along with biology and social conditions (i.e. culture, belief systems, demographic characteristics). The dominance of the biomedical approach is so strong and present within the twenty-first century, that many doctors are still treating illnesses and sicknesses without an understanding of the psychosocial and economic conditions of their patients. To illustrate this more vividly, a public health nutritionist, Dr. Kornelia Buzina, says that “when used appropriately, drugs may be the single most important intervention in the care of an older patient … and may even endanger the health of an older patient …” (Caribbean Food and Nutrition Institute, 1999:180) Global Issues on Ageing Even though the ageing process is lifelong, and although it may be constructed within each society differently, many decades have elapsed since Galton’s study on the health status of people. Despite changes in human development and the shift in world population toward demographic ageing – people living beyond 65 years (see ILO 2000; Wise 1997), the issues of the aged
  57. 57. 36 and their health status have not taken front stage on the radar of demographers unlike many other demographic issues. This is equally true for many Caribbean nations. (See Figure 3.1.1 below). U.S.A Sw eden Major Area, region and country Germany Italy Europe Japan India China Latin America and the Caribbean Africa World 0 10 20 30 40 Percentage of the Elderly (65+ years) 1950 2000 2050 Figure 3.1.1: Selected regions and their percent of pop. 65+ years Source: United Nations 2005: World Population Prospects: The 2004 revision (page 20) Again, as we mentioned earlier, global changes in Public Health have added substantially more years to life expectancies, which is captured in the proportion of elderly population come 2050 (Figure 3.1.1). Remarkably, the majority of the world’s population come 2050 will be experiencing population ageing because they would have had more people 65 years and older. Thus, there is a demographic transition toward an aged population. In addition, this is attributed to the introduction of vaccination, in particular to the discovery of penicillin. The issue of non-communicable diseases is not only a phenomenon specific to Jamaica, but is equally a Caribbean challenge for policy makers. (See Figure 3.1.2 below)
  58. 58. 37 Trinidad & Tobago St. Lucia Acute respiratory infections Montserrat Hypertension Jamaica Diabetes Country Neoplasms Guyana Cardiovascular Dominica disease Cerebrovascular disease Barbados Bahamas 0 1 2 3 4 5 Ranked Order of 5 leading causes of mortality Figure 3.1.2: Ranked order of five leading causes of mortality in the population 65 yrs and older, 1990 Source: Adopted from Caribbean Food and Nutrition Institute1999, 222
  59. 59. 38 Stroke Hear t disease Jamaica Female Diseases Jamaica Male Arthritis Barbados Female Diabetes Barbados Female Barbados Male Hyp ertension 0 20 40 60 Percentage Source: Figure taken from Caribbean Food and Nutrition Institute1999, 225. Figure 3.1.3: Leading causes of self-reported morbidity in the population of seniors, by gender in Barbados and Jamaica. The data in Figure 3.1.3 shows that hypertension and arthritis are morbidities that significantly plague both men and women in both Caribbean countries. These chronic non-communicable diseases continue to interface within the functional lives of the elderly, which mean that they are indeed living longer but are faced with lowered wellbeing. In a study, generalizable to the Jamaican population, Sargeant et al. (2004) reported that among persons aged 45-74 years, the overall prevalence of diabetes was 22.4%, and much existing diabetes was undetected. Furthermore, among persons aged 45-74 years, the overall prevalence of diabetes was 22.4%. Another study, based on the Jamaica Lifestyle Survey 2001, documents the gender-specific prevalence of 66% (males) and 71 %
  60. 60. 39 (females) among persons 65+years old (Wilks, 2007). These observations provide further evidence of the eminence of non-communicable disease among older persons in Jamaica. Ageing, though not a disease itself, may be accompanied by increased frequency of disease. Secondly, if they are poor with proper and adequate health care coverage – which could be private or public - the implications of the cost of care along with daily living could add further stresses to the status of life experienced by the elderly. Hence, living longer, although it is directly related to reduced mortality, does not speak to the lifestyle changes and their positive influences on the wellbeing of seniors. A study conducted by Costa, using secondary data drawn from the records of the Union Army (UA) pension programme that covered some 85% of all UA, shows that there is an association between chronic conditions and functional limitation – which include difficulty walking and bending, blindness in at least one eye and deafness (Costa 2002). Among the significant findings is the predictability between congestive heart failure in men and functional limitation (i.e. walking and bending). Although Costa’s study was on men, this equally applies to women as biological ageing reduces physical functioning, and so any chronic ailment will only add further to the difficulties of movement of the aged, be it man or woman. Some scholars have still not moved to the post-biomedical predictors of health status. The dominance of this approach is so strong and present within the twenty-first century, that many doctors are still treating illnesses and sicknesses without an understanding of the psychosocial and economic conditions of their
  61. 61. 40 patients. Among those who have studied health are demographers. Is there a difference between the approach of the other scholars (or scientists) and demographers? Demographers have spent years studying mortality, and this has been used as an indicator of life expectancy, such as the Coale and Demeny Model life tables, and by extension health status. Life expectancy, on the other hand, has always been viewed as the avenue through which demographers evaluate the health status of people; as lived years is an indicator of living beyond certain health conditions. Thus, health and wellbeing are tied to mortality patterns, which is rightfully so, but this approach puts little emphasis on conditions that are likely to decrease morbidity and thereby reduce mortality. With this being the case, demographers have consumed more time assessing mortality, life expectancy and morbidity because of their close approximation of wellbeing (or health status), and this is similarly the case for Caribbean demographers.
  62. 62. 41 Chapter Four Population Ageing: Caribbean Demographic Trends, with Emphasis on Jamaica The Caribbean has been identified as the most rapidly ageing region of the world. During the 1960 -1995 period, there was a 76.8% increase in the elderly population (UN.org). The mean growth rate in the elderly population was 5.3%, which was recorded for the period 1995-2000. The elderly as a percentage of total population has been projected to reach about 15% by 2020, an almost four-fold increase over the 1950 figure of 4.3% (PAHO, 1997). Demographic development in the Caribbean has taken a path similar to the rest of the world (Population Reference Bureau 2007; STATIN 2006; United Nations 2005c). Over the years, the movement has been such that mortality and fertility have been declining, and the population 60 years and older has been increasing proportionately more than the percentage increase in children (aged less than 15 years) and/or the working age (15 through 59 years) population. Jamaica as well as the rest of the Caribbean and Latin America is said to be at the second stage of the demographic transition model (STATIN 2007). Cajanus (1999) argues that what has changed since the 1960s in the Caribbean is the pace of population ageing. He commented that “…demographic changes … began in earnest in the 1960s” (p. 217) to describe what is known as demographic ageing (or population ageing), which is a feature in many developed nations and some developing societies. This is now a characteristic of some states in the Caribbean like Jamaica, Cuba, Barbados, and Trinidad and Tobago.
  63. 63. 42 Several Caribbean countries, such as the aforementioned ones, could be said to be approaching the third stage of the transition. The demographic transition refers to the changes in population growth that are attributable to transition from high to lower levels of fertility and mortality. So for countries to be at the third stage of the transition, they would be experiencing population ageing due to persistently low fertility, and even lower mortality. Like the rest of the world, these changes also brought improvements in living conditions, advancement in medicine, improvements in health care and discovery and use of family planning measures. Statistics revealed that the total fertility from 1970 to 1975 for the world was 4.49 and from 2000 to 2005, it fell to 2.65; whereas in Latin America and the Caribbean between 1970 and 1975, it was 5.05 and this was further reduced to 2.55 from 2000 to 2005 (United Nations 2005c, xxi). As early as 2005, some countries in the Caribbean had reached replacement level fertility. Total fertility per woman reached in the Bahamas is 2.2, Barbados 1.5, Jamaica 1.93 (Demographic Statistics, 2006) and Trinidad and Tobago, 1.6 (United Nations 2006, 87-89). Barbados, Jamaica and the twin islands of Trinidad and Tobago are currently experiencing below replacement level fertility (Total Fertility Rate – TFR of 2.1 – United Nations 2000, 4). Since 2005, this has become a demographic reality for many developed nations. The examples here are some countries in Eastern Europe (TFR, 1.3) Southern Europe (TFR, 1.4) Northern Europe (TFR, 1.7) and the United States, 2.0 (United Nations 2007; 2005c, xxi). In addition, mortality in the Caribbean has been falling, coupled with increased

×