as the world shrinks

6 Geriatric Nursing Volume 20, Number 1

Although John Glenn, 77, waslaunched into space to test theeffects of space travel on geri-atric people, most of us remainearthbound and at times ab-

solutely provincial in our concerns. How manyAmericans were affected by the latest disaster?Were Americans on the plane that crashed inSiberia? Even less conscious are we that“America” is limited in our minds to residents of theUnited States even though this country is only a portionof the Americas. Although at times we make someprogress in “world affairs,” we remain focused on ourown needs and our own elders. In this issue we want toexpand readers’ awareness of the situations of the grow-ing number of elders in the shrinking world.

The United Nations has chosen 1999 as theInternational Year of Older Persons to emphasize theincreasing percentage of elders worldwide. The UN’stheme, “Toward a Society for all Ages,” rings of a broad-ening vision.1 A satisfying old age is dependent on theyoung just as the young are dependent on the lifelongcontributions of their elders. When this interdependencygoes unrecognized, all individuals are impoverished. Anemphasis on the total lifespan is a step toward a realis-tic and holistic approach to aging. The most importantaspect of this focus is that it no longer relegates the oldto a problem group subject to pernicious stereotyping.

GLOBAL AGING In a 1997 summit meeting, heads of state from the

economically powerful nations known as the DenverEight—Canada, France, Germany, Italy, Japan, theUnited Kingdom, the United States, and Russia—identi-fied population aging as an important agenda item.2

Statistics compiled by the U.S. Bureau of the Census3

supply these specific data: the United States ranks 20thin the world in percentage of population ages 60 andolder (16.9%). The highest ranking countries areSweden (22.8%), Norway (20.9%), Belgium and Italy(20.8%), and the United Kingdom (20.7%). Sweden alsohas the largest percentage (40%) of elders who livealone. In the United States and the United Kingdom,30% of people older than 60 live alone, whereas inJapan and China the number is much lower (9% and3%, respectively) but rapidly increasing.3 In Barbados

27% of elders live alone and in Guadeloupe32%. Both developing and developed countriesneed policies and programs designed to supportfrail elders who reside alone.

One thing that becomes abundantly clearwhen traveling outside technologically advancedcountries is the small percentage of very old peo-ple. Arduous survival strategies and unavailablehealth care conspire against attaining extreme

old age. The many countries subject to capricious militaryjuntas and numerous warring factions have neither re-sources nor consistent policies to ensure old age insur-ance, pensions, or other government support of the veryold. Yet even with favorable government policies andsupports, maintaining a quality lifestyle into advanced oldage remains an issue of concern.

Widowhood, poverty, and frailty are the destiny ofmost old women in both developed and developing coun-tries, and, unfortunately, in many countries women’s edu-cation, rights to inheritance, protection from violence,redress for abuse, ownership of land, and access to eco-nomic resources remain severely limited. The WorldHealth Organization points out that great societies arethose in which the basic rights and freedoms of all peopleare protected and fulfillment is possible.4

Worldwide the care and support of the frail elderlyhas become costly in resource consumption and obliga-tions of the younger generations. In Singapore andSouth Korea, adult children are required by law to fi-nancially support their elders. China rapidly is movingin a similar direction; some elders even have sued theirchildren for neglect, and others are demanding con-tracts regarding expected caregiving duties.5

In our attempt to learn how various countries man-age the long-term care of the aged, we found some ex-cellent examples in the literature. One old age home inNamibia accommodates 30 residents with their childrenand grandchildren. The elderly resident contributes athird of his or her monthly pension (nearly universallyprovided to the old in Namibia) for shelter, water, elec-tricity, and plain food.6 Sweden, Canada, and France relyon sophisticated home-help services for much of theirlong-term elder care.7 In Turkey the huzurevi (older peo-ple’s home) has few medications or technological de-vices but focuses instead on nutrition, exercise,socialization, and religious observance. Alternative facil-

E D I T O R I A L

As the World ShrinksPriscilla Ebersole, PhD, RN, FAAN

Geriatric Nursing Volume 20, Number 1 7

ities for elders who need more extensive care are rarelyavailable.8

In Finland most needy older people live in institu-tions. A survey undertaken by the government found that97% of these residents believed their placement was ap-propriate. However, Finnish policy makers, out of eco-nomic and humanistic concerns, are considering ways toavoid institutionalization.9

A model institution in Montreal provides a homeand community atmosphere: staff members wear casualdress and interact on a peer basis with residents. The fa-cility has a “Main Street” with a row of small shops: bar,bakery, greenhouse, clothing shop, and a day care centerfor small children. In addition, the administration has de-veloped a “Charter of Rights and Freedoms of theElderly,” including 31 principles explicating categories ofdignity, privacy, continuity, information, self-expression,respect, responsibility, and participation.10 (This docu-ment is available from Residence Yvon-Brunet, 6250Avenue Newman, Montreal, Quebec, Canada H4E 4K4.)

As the world population of elders increases,lifestyle changes and population controls will limit theavailability of family caregivers. In the shrinking world,nurses are developing international linkages. TheNicaraguan Nurses Association is developing self-regu-lating actions with the assistance of the Canadian NursesAssociation, and one Nicaraguan school of nursing hasdeveloped a sister relationship with DuquesneUniversity School of Nursing in Pittsburgh, Pa. Thesemodels suggest opportunities for nurses worldwide toform links that will influence nursing curricula and up-grade care for all peoples as we all age.11

NOTE: The title of my November/December 1998 ed-itorial was taken from the book Everyday Ethics byRosalie Kane and Arthur Caplan, published by Springerin 1990.

REFERENCES

1. Administration on Aging/International Aging. Strategies for a society for allages. Washington (DC): Old Age Administration U.S. Department ofHealth and Human Services; 1998.

2.American Association of Retired Persons.The opportunities and challenges ofaging populations: observations of the Denver Eight. Global Aging Report1997;2(6):4.

3. U.S. Department of Commerce, Bureau of the Census. Global aging: compar-ative indicators and future trends. Washington (DC): The Census; 1991.

4. Salmon M. Nursing equity and social justice. Reflections 1998;24(2):11.5. American Association of Retired Persons. Charging children for the care of

aging parents: two Asian nations turn to family for cash. Global AgingReport 1996;1(4):4.

6. American Association of Retired Persons. Aging on the youngest continent:reports from Namibia, Ghana, South Africa, and Cameroon. Global AgingReport 1998;3(1):4.

7. American Association of Retired Persons. Does the care suit the client?Reports on home help and a home-like environment. Global Aging Report1997;2(6):5.

8. American Association of Retired Persons. A huzurevi to call home: a Turkishtown shelters its citizens. 1997;2(6):7.

9.American Association of Retired Persons.The time to stop institutionalizationis before it starts. Global Aging Report 1997;2(3):3.

10. American Association of Retired Persons. Main street brings out the crowds:how a Canadian institution stays focused on people. Global Aging ReportGlobal Aging Report 1998;3(3):7.

11. Zamora L. Despite overwhelming poverty, nurses are looking into the futurewith courage, envisioning a new dawn. Reflections 1998;24(2):13.

Geriatr Nurs 1999;20:6-7

Copyright © 1999 by Mosby, Inc.

0197-4572/99/$5.00 + 0 34/1/96072

February 21-24, 1999Pan-American Congress ’99, “Aging in the Americas: Frontiers ofCare, Policy, and Research,” San Antonio, Texas. Contact: MelodyeSeals, phone (850) 906-9344, e-mail mseals@cortex-comm.com

February 26-27, 1999National Pressure Ulcer Advisory Panel’s 6th National ConsensusConference, “The Pressure Ulcer Challenge: Balancing Cost andQuality,” Radisson Twin Towers Hotel, Orlando, Fla. Contact:NPUAP, Sharon Baranoski, phone (815) 740-1078, e-mail s_bara-noski@hotmail.com

March 4, 1999Sigma Theta Tau 1-day Conference, “Demystifying Managed Care,”(preceeding regional assembly), Jacksonville, Fla. Contact: SigmaTheta Tau International Program Department, phone (888) 634-7575, e-mail barbara@stti.iupui.edu

April 9-11, 1999“Research-Based Nursing Makes a Difference,” Eastern NursingResearch Society, New York. Contact: Bill Ward, phone (850) 484-9987, E-mail jwward@puetzamc.com

April 15-18, 1999American Soceity of Pain Management Nurses 9th AnnualConference, Washington, DC. Contact: Bill Ward, phone (888) 342-7766, E-mail jwward@puetzamc.com

April 22-25, 1999Home Healthcare Nurses Association 4th Annual Convention,Washington, DC. Contact: Bill Ward, phone (800) 558-4462, E-mailjwward@puetzamc.com

April 26-29, 1999Asia-Pacific Regional Conference for the International Year ofOlder Persons, Hong Kong. Contact: Eliza Leung, Hong KongCouncil of Social Service, phone 852/2864 2929, E-mailcouncil@hkcss.org.hk

May 17-18, 1999The 8th Annual National Conference for Clinical Nurse Specialists,“CNS: Phoenix Rising,” Portland, Maine. Contact: Irene Bise, Centerfor Continuing Education in the Health Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, Ohio, phone (603) 650-1523

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