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THE LIFE STYLE OFTHE ELDERLY AND ITS
IMPACT ON THEIR QUALITY OFLIFE AT BARANGAY DAL-LIPAOEN NAGUILIAN,LA UNION
An Undergraduate ThesisPresented to
the Faculty of the College of NursingUNION CHRISTIAN COLLEGE
In Partial Fulfillment of theRequirements for the Subject
Research I
By:
Avelino C. Marzo Jr.Nika Joyce NardoJoana Marie Casaclang
Ruzzell NimesMary Ann Generao
March 2011
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ACKNOWLEDGEMENTS
The researchers convey their deepest gratitude to the following thathave significantly contributed to this piece of work.
To Almighty God , for giving those unending blessing and wisdom,through Him, for without Him, none will be possible;
To their Introduction to Research Instructor, Mrs. Cadam-us , forsharing her precious time and knowledge and for her unending supportand encouraging words. It is through her that this meaningful projectwas conceptualized.
To their families, friends, and classmates, for their inspiringwords and encouragements during those times of sleepless nights of finishing this research proposal.
To all of you,
THANK YOU VERY MUCH!
The Researchers
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DEDICATION
With love and sincerity, this humble piece of work is heartily
dedicated to the people whose contribution is significant in making this
study a reality.
To our mentors , for the great effort they have exerted in molding
us to become well rounded and competent students of this institution.
To our families, friends and fellow students, for their
cooperation for the completion of this work and for their moral support
which inspired us in making things possible and in pursuing our
ambition.
Above all, to Almighty God who continually showers His infinite
wisdom, blessings, and skills to the researchers.
Avelino
Nika Joyce
Joana Marie
Ruzzell
Mary Ann
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TABLE OF CONTENTS
PageTITLE PAGE ....i
ACKNOWLEDGEMENT ......ii
TABLE OF CONTENTS .....iii
CHAPTER
1 THE PROBLEM
Background of the Study...1
Statement of the study ..................5
Theoretical framework. ..6
Research paradigm.............11
Hypothesis.12
Significance of the study.... 13
Scope and Delimitation....13
Definition of terms..13
2 REVIEW LITERATURE
The Dynamics of Population Ageing.15
Social and Cultural Changes..18
Legal Framework and Policy Responses 21
Program Intended to Offer Health Insurance to the Poor.24
Age distribution..27
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3 RESEARCH METHODOLOGY
Research Design..30
Population and
Sampling.30
Data Gathering Procedure31
Research Instrument..31
Data Analysis Plan..32
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CHAPTER 1
INTRODUCTION
BACKROUND OF THE STUDY
Lifestyle comes from two words life and style.
What is life? Life is a state that distinguishes organisms from non-
living objects, such as non-life, and dead organisms. Living organisms
are capable of growth and reproduction, some can communicate and
many can adapt to their environment through changes originating
internally. A physical characteristic of life is that it feeds on negative
entropy. In more detail, according to physicists such as John Bernal,
Erwin Schrdinger, Eugene Wigner, and John Avery, life is a member of
the class of phenomena which are open or continuous systems able to
decrease their internal entropy at the expense of substances or free
energy taken in from the environment and subsequently rejected in a
degraded form.
On the other hand, style has different meanings. First, style is the
way in which something is said, done, expressed, or performed: a style of
speech and writing. It is also defined as the combination of distinctive
features of literary or artistic expression, execution, or performance
characterizing a particular person, group, school, or era. Sort or type: a
style of furniture. A quality of imagination and individuality expressed in
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one's actions and tastes: does things with style. A comfortable and
elegant mode of existence: living in style. A mode of living: the style of the
very rich. It is a fashion of the moment, especially of dress; vogue. A
particular fashion: the style of the 1920s. It is a customary manner of
presenting printed material, including usage, punctuation, spelling,
typography, and arrangement.
The focus of this study is the elderly. Elderly or Old age consists of
ages nearing or surpassing the average life span of human beings, and
thus the end of the human life cycle. Euphemisms and terms for old
people include seniors chiefly an American usage or elderly. As
occurs with almost any definable group of humanity, some people will
hold a prejudice against others in this case, against old people. This is
one form of ageism. Old people have limited regenerative abilities and are
more prone to disease, syndromes, and sickness. The boundary between
middle age and old age cannot be defined exactly because it does not
have the same meaning in all societies than other adults. People in the
65-and-over age group are often called senior citizens. But the fact is
elderly should see to it that they should take care themselves by doing
the right health practices especially in their lifestyle. In sociology, a
lifestyle is the way a person lives. A lifestyle is a characteristic bundle of
behaviors that makes sense to both others and oneself in a given time
and place, including social relations, consumption, entertainment, and
dress. The behaviors and practices within lifestyles are a mixture of
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habits, conventional ways of doing things, and reasoned actions. A
lifestyle typically also reflects an individual's attitudes, values or
worldview . Therefore, a lifestyle is a means of forging a sense of self and
to create cultural symbols that resonate with personal identity.
Surrounding social and technical systems can constrain the lifestyle
choices available to the individual and the symbols she/he is able to
project to others and the self.
Many elderly and even young ones are very convenient in buying
over the counter drugs without knowing its right dose and effect. Health
regimen is a treatment plan. The plan includes which treatments and
procedures will be done, medications and their dose, the schedule of
treatments, and how long the treatment will take. Examples of health
regimen are exercise, diet, supplements and nutrition. Medication also
referred to as medicine, can be loosely defined as any substance intended
for use in the diagnosis, cure, mitigation, treatment, or prevention of
disease. Other synonyms include pharmacotherapy,
pharmacotherapeutics, and drug treatment.
One way also to monitor the health status of the elderly is in their
nutrition. The foods they eat and also the foods that they should avoid.
Nutrition is the provision, to cells and organisms, of the materials
necessary (in the form of food) to support life. Many common health
problems can be prevented or alleviated with good nutrition. The diet of
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an organism refers to what it eats. A diet is a pattern of food
consumption which is followed by a population or an individual. The
diets of populations are affected by local factors including geography,
climate, food availability, culture, and religion, whereas the diets of
individuals within populations are further influenced by factors such as
socio-economic status, personal preference, and health considerations.
To maintain life, all diets must supply the essential amounts of energy,
protein, essential fatty acids, vitamins, and minerals, but these needs
can be met by a wide variety of diets, each of which will be sufficient for
growth, survival, and reproduction but may also have obvious or subtle
effects on the long-term state of health. The idea of a healthful diet is to
provide all of the calories and nutrients needed by the body for optimal
performance, at the same time ensuring that neither nutritional
deficiencies nor excesses occur.
Promotion and preservation of health, also called hygienic.
Physical exercise is any bodily activity that enhances or maintains
physical fitness and overall health. It is performed for many different
reasons. These include: strengthening muscles and the cardiovascular
system, honing athletic skills, and weight loss or maintenance. Frequent
and regular physical exercise boosts the immune system, and helps
prevent diseases of affluence such as heart disease, cardiovascular
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disease, Type 2 diabetes and obesity. It also improves mental health and
Sanitation is the hygienic means of preventing human contact from the
hazards of wastes to promote health. Hazards can be physical,
microbiological, biological or chemical agents of disease. Wastes that can
cause health problems are human and animal feces, solid wastes,
domestic wastewater (sewage, sullage, greywater), industrial wastes, and
agricultural wastes. Hygienic means of prevention can be by using
engineering solutions (e.g. sewerage and wastewater treatment), simple
technologies (e.g. latrines, septic tanks), or even by personal hygiene
practices (e.g. simple hand washing with soap). Hygiene refers to
practices associated with ensuring good health and cleanliness. Such
practices vary widely and what is considered acceptable in one culture
may be unacceptable in another. In medical contexts, the term "hygiene"
refers to the maintenance of health and healthy living. The term appears
in phrases such as personal hygiene, domestic hygiene, dental hygiene,
and occupational hygiene and is frequently used in connection with
public health. Hygiene is also a science that deals with the helps prevent
depression. It is safe for most adults older than 65 years to exercise.
Many of these conditions are improved with exercise.
Leisure or free time is a period of time spent out of work and
essential domestic activity. It is also the period of recreational and
discretionary time before or after compulsory activities such as eating
and sleeping, going to work or running a business, attending school and
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doing homework, household chores, and day-to-day stress. The
distinction between leisure and compulsory activities is loosely applied,
i.e. people sometimes do work-oriented tasks for pleasure as well as for
long-term utility.
Nowadays many elderly are not that conscious about their health
especially when one elder is in financial crisis. Their priority is not on
their health but on their foods. Because of the new trends and new
developments nowadays elderly is the last one who can adapt to these
changes. Thats why this study was made to know if these changes or
new lifestyle affects the old practices and lifestyle of the elderly and if
these new changes have an impact to their quality of life. On the other
hand the family members of elderly are also subjected to this study. They
are playing a big role in taking good care and watching the elderly in
their homes. Sometimes the family members are the one reminding the
elderly what to do and what not to do because in this stage of their life
they forget almost all the things including the simple things and even
they forget to take care their own selves.
STATEMENT OF THE PROBLEM
The researchers would like to assess the lifestyle of the elderly and
its impact to their quality of life at Barangay Dal-lipaoen Naguilian, La
Union which intends to answer the following problems:
1. What is the lifestyle of the elderly as perceived by the respondents
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along with the following areas?
a. Health regimen and Medication
b. Diet and Nutrition
c. Hygiene and Sanitation
d. Exercise or Leisure
2. What are the significant differences in the responses of the
respondents as to the lifestyle of the elderly?
3. What is the perception of the respondents as to the extent of influence
of the lifestyle of the elderly to their health status along with the
following areas?
a. Health regimen and Medication
b. Diet and Nutrition
c. Hygiene and Sanitation
d. Exercise or Leisure
4. What are the significant differences in the perception of the
respondents as to the extent of influence of the lifestyle of the elderly to
their health status?
THEORITICAL FRAMEWORK
Health Belief Model (Rosenstock, Becker, Kirscht, et al.)
This model was originally introduced by a group of psychologists in
the 1950's to help explain why people would or would not use available
preventive services, such as chest x-rays for tuberculosis screening and
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immunizations for influenza. These researchers assumed that people
feared diseases and that the health actions of people were motivated by
the degree of fear (perceived threat) and the expected fear reduction of
actions, as long as that possible reduction outweighed practical and
psychological barriers to taking action (net benefits).
The HBM can be outlined using four constructs which represent
the perceived threat and net benefits: 1) perceived susceptibility, a
person's opinion of the chances of getting a certain condition; 2)
perceived severity, a person's opinion of how serious this condition is; 3)
perceived benefits, a person's opinion of the effectiveness of some advised
action to reduce the risk or seriousness of the impact; and 4) perceived
barriers, a person's opinion of the concrete and psychological costs of
this advised action. Another concept is known as cues to action. These
are events (internal or external) which can activate a person's "readiness
to act" and stimulate an observable behavior. Some examples of external
strategies to activate "readiness" can be delivered in print with
educational materials, through any electronic mass media or in one-to-
one counseling. Another concept that has been added to HBM since 1988
in order to better meet the challenges of changing unhealthy habitual
behaviors (such as being sedentary, smoking or overeating) is self-
efficacy. Self-efficacy, a concept originally developed by Albert Bandura in
social cognitive theory (social learning theory), is simply a person's
confidence in her/his ability to successfully perform an action.
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The HBM has been used to help in developing messages that are
likely to persuade an individual to make a healthy decision. Using the
HBM, messages that are suitable to health education for such topics as
hypertension, eating disorders, contraceptive use, or breast self-
examination have been developed.
However, there are two main weaknesses which have been noted
about the HBM. First, health beliefs compete with an individual's other
beliefs and attitudes which can also influence behavior. Secondly, in
decades of research in the social psychology of behavioral change, it has
not been shown that belief formation always precedes behavioral change.
In fact, the formation of a belief may actually follow a behavior change.
Theory of Reasoned Action (Fishbein and Ajzen)
The Theory of Reasoned Action was designed to explain not just
health behavior but all volitional behaviors. This theory is based on the
assumption that most behaviors of social relevance are under volitional
(willful) control. In addition, a person's intention to perform (or not
perform) the behavior is the immediate determinant of that behavior. The
goal is to not only predict human behavior but also to understand it.
According to this theory, a person's intention to perform a
specific behavior is a function of two factors: 1) attitude (positive or
negative) toward the behavior and 2) the influence of the social
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environment (general subjective norms) on the behavior. The attitude
toward the behavior is determined by the person's belief that a given
outcome will occur if he/ she performs the behavior and by an evaluation
of the outcome. The social or subjective norm is determined by a person's
normative belief about what important or "significant" others think he/
she should do and by the individual's motivation to comply with those
other people's wishes or desires.
Attitudes are a function of beliefs in this theory. If a person
believes that performing a given behavior will lead to on the whole
positive outcomes, then he/ she will hold a favorable attitude toward
performing that behavior. On the other hand, a person who believes that
performing the behavior will lead to mostly negative outcomes will hold
an unfavorable attitude. These beliefs that form the foundation of a
person's attitude toward the behavior are referred to as behavioral
beliefs.
Subjective norms are also a function of beliefs. However, these
are beliefs of a different kind. These are the person's beliefs that certain
individuals or groups think he/she should or should not perform the
behavior. If the person believes that most of these significant others
think he/she should perform the behavior, the social pressure to perform
it will increase the more he/ she is motivated to comply with these
others. If he/ she believe that most of this reference group is opposed to
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performing the behavior, her/his perception of the social pressure not to
perform the behavior will increase along with her/his motivation to
comply with these referents. The beliefs which underlie a person's
subjective norms are termed normative beliefs.
Social Networks/Social Support Theories (Eng, Israel, et al.)
Most health educators today recognize the critical importance of
the social environment and advocate changes in the social ecology which
is supportive of individual change leading to better health and a higher
quality of life. However, within the community, long-term behavior
change depends on the level of participation and ownership felt by those
being served. In order to see how Social Networks and Social Support
Theories might impact on health needs, it is first necessary to define
what is meant by certain concepts.
Social networks can be kin (extended family) or non-kin (church
or work groups, friends or neighbors who regularly socialize clubs and
sporting teams). Social networks have certain types of characteristics: 1)
Structural, such as size (number of people) and density (extent to which
members really know one another); 2) Interactional, which include
reciprocity (mutual sharing), durability (length of time in relationship),
intensity (frequency of interactions between members), and dispersion
(ease with which members can contact each other); and 3) Functional,
such as providing social support, connections to social contacts and
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resources, and maintenance of social identity.
Social support refers to the varying types of aid that are given to
members of a social network. Research indicates that there are fourkinds of supportive behaviors or acts: 1) Emotional support - listening,
showing trust and concern; 2) Instrumental support - offering real aid in
the form of labor, money, time; 3) Informational support - providing
advice, suggestions, directives, referrals; and 4) Appraisal support -
affirming each other and giving feedback. This social support is given
and received through the individual's social network. However, it is
important to remember that "some or all network ties may or may not be
supportive."
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HYPOTHESIS
The elderly are prone to illnesses because of the deterioration of
health especially physically and mentally. And one factor that affects theelderly is the lifestyle. Their attitude toward their health regimen and
medication, diet and nutrition, hygiene and sanitation, leisure and
exercise and other practices of the elderly affect their quality of life:
Physically, Socially, Emotionally and Mentally.
SIGNIFICANCE OF THE STUDY
The researchers keep on seeking for answers so that they can help
in their simple ways in their society. People are not getting any younger.
And as they struggle towards their end, our elders sometimes neglect
their own necessities. In a way they do things which they dont usually
do before.
This research is made so that the elders would know that even
though they are already old, they still have to take good care of
themselves. Not just to look neat in the crowd but also to prolong their
life.
As long as we live in this world we are obliged to have a quality way
of living. Our life is a gift from above, so we mustnt do things that could
harm ourselves. Live life and love till our end comes.
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SCOPE AND DELIMITATION
This research is wide and the research is not a computer to give
you all the knowledge about suicide. The researcher did not include:
1.
The Impact of treated hearing loss on quality of life.
2.
Impact on quality of life of fecal incontinence on older adults.
3.
Depressed elderly have worst quality of life.
DEFINITION OF TERMS
1.
Life- A state that distinguishes organisms from non-living
objects, such as non-life, and dead organisms
2.
Lifestyle- the habits, attitudes, tastes, moral standards,
economic level, etc., that together constitutes the mode of living
of an individual or group.
3.
Elderly- pertaining to person in later life
4.
Humanity- the quality or condition of being a human
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INDEPENDENT DEPENDENT VARIABLES VARIABLES
Lifestyle of the elders: Quality of Life
a.
Health regimen and
Medication
b.
diet and Nutrition
c. hygiene and Sanitation
d.
leisure and Exercise
Figure 1: Research Paradigm
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CHAPTER II
REVIEW OF LITERATURE
THE DYNAMICS OF POPULATION AGEING
From 3.19 million in1990, the senior citizens in the Philippines
increased to 4.59 million in 2000. The decadal average annual
(exponential) growth rate of 3.64 percent of the population 60 years and
over went up from the 2.26 percent growth rate recorded during the
previous decade. Hence, the older population is growing faster than the
total population of the Philippines. If the countrys total population is
already rapidly growing, then the myth that population ageing in the
Philippines is low and slow is not true and therefore doubling time is
shorter for the older population than for the total population. The
medium series of the population projection indicates that senior citizens
with be 10 percent of the Philippine population by 2030, with the female
population attaining such proportion five years earlier than the male
population. The projected sex ratio of the population 60 years or higher
would continue to be lower than 100, with female dominance increasing
by age.
However, population ageing is also happening in various
geopolitical areas of the country. Figure 7 reveals that the National
Capital Region (NCR) and the Ilocos Region will have 10 percent of their
population in the 60 years and over category by 2020. Regional data also
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revealed that the female population would reach such proportion earlier
than the males. The female senior citizen population of Ilocos Region
would reach ten percent by 2015 in contrast to 2025 for its male
population.
The population ageing process varies not only by sex and region
but also by province. Moreover, the year when a province starts to have
at least 10 percent belonging to the 60 and over age group may not be
immediately be mirrored at the regional level. Five provinces already
counted in the 2000 census at least 10 percent of their population in this
age category (see Appendix B). These provinces are Ilocos Sur and Ilocos
Norte of Region I Ilocos Region, Batanes of REGION II - Cagayan Valley,
Siquijor of REGION VII - Central Visayas, and Southern Leyte of REGION
VIII - Eastern Visayas. Moreover, the regions where they belong to would
attain the 10 percent regional population mark by 2020, 2025, 2025,
and 2035, respectively. This suggests that while local government units
(LGUs) in smaller geopolitical units such as provinces, cities, and
municipalities would have to be more receptive of the demographic
changes occurring in their localities inasmuch as the national and
regional population ageing could occur much later. This explains why the
national and regional governments could initially be impervious to
demographic shifts and their attendant consequences. Hence provinces,
cities and municipalities should be more in tune with and responsive to
changes in their own demographic processes and outcomes.
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Another aspect of the population ageing process is the changing
balance between age groups. Over the last half of the twentieth century,
the proportion of children (0-14 years old) in the world dropped from 34
per cent in 1950 to 30 percent in 2000. But the proportions of aged
persons increased so that by 2050 the UN (2001) projected that the share
of persons aged 60 or over in the population will match that of persons
younger than 15 (about 21 per cent each). The Philippines has likewise
experienced such a shift in age structure. From 45.7 percent in 1970, the
proportion of the population less than 15 was down to 37 percent in
2000, an 8.6 percentage point decline over a 30-year period. However,
the 2000-based official population projection of the Philippines (medium
series) reveals a larger percentage increment in the 60 years and over
(7.9 percent) than in the economically productive ages (5.7 percent) by
end of the projection period (2040). The larger percentage increase of
senior citizens would come from the 70-79 years and the 80 years and
over age groups. These expected shifts in the age composition of the
Philippines would signal a change in the pattern of resource distribution
in aid of averting intergenerational conflicts (Walker 1990 and Jackson
1998 as cited in UN 2001) since demographic ageing could lead to calls
for greater attention to the needs of the growing number of older persons.
The ageing index, which is calculated as the ratio of those 60 years
or older to those less than 15 years old, provides a commonly used
measure for assessing this process. The ageing index of the Philippines
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increased from 10 senior citizens per hundred children less than 15
years old in 1970 to 16 per hundred in 2000. The medium series of the
Philippine population projection indicates a nearly fourfold increase of
the ageing index by the end of the projection period. This means that by
2040, there will be almost two persons aged 60 or over for every three
children under 15 years in the Philippines. Hence, there may be a need
to reassess the long-term care options for the growing population of older
persons, and the optimal resource distribution in view of the shift in the
young-old balance of the countrys population.
Since support at older ages is a common motive for sustained high
fertility in developing countries, often used to measure the potential
elderly support requirements in a society is the old-age dependency ratio.
The working age population is assumed to provide either direct or
indirect support to the youth and the elderly through the family, religious
or communal institutions, or even the State. Hence, the dependency ratio
is a rough estimate of the burden of dependency and is useful indicator
of trends in the level of potential support needs.
The total dependency ratio in the Philippines would decline as
children below age 15 decreases and senior citizens increases. There will
also be a profound shift in the composition of the total dependency ratio:
the share of the old-age component would rise from 9 percent to 29
percent from 2000 to 2040 (see Figure 10), which is almost triple within
the next 40 years.
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An alternative way of expressing the numerical relationship
between those more likely to be economically productive and those more
likely to be dependents is the potential support ratio (PSR). PSR is the
inverse of the old-age dependency ratio, that is, the number of people in
the working ages of 15-64 years per person 65 or older. Figure 10 shows
that in the Philippines the PSR of 15 in 2000 would drop to seven by
2040. This means there were 15 persons in working-ages who provided
support to one senior citizen in 2000.
In 2040, there would be seven persons in working ages that will
support one older person. This is a 55 percent reduction in the potential
support ratio over the next 40 years. There is larger regional variability in
PSR in 2000 than the expected scenario in 2040. Despite the regional
variation in the initial and final PSR, the general pattern is a reduction of
PSR in all regions between 2000 and 2004 (Table 1). The top three
regions with the largest percentage reduction in PSR over the next 40
years are NCR, ARMM, CALABARZON, and Davao.
PSR also varies by province as shown in Appendix C. Again,
provincial population ageing alert signals are not reflected immediately in
regional population scenarios. Hence, LGUs that monitor closely their
respective demographic indicators would be better able to design local
policy responses and initiatives to address population ageing.
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SOCIAL AND CULTURAL CHANGES
In a developing country like the Philippines, the quality of life of
older persons depends largely on the family support system. The family
and the home are pivotal points of exchange of support and care among
older and younger generations. Is there a change in the role of older
persons within the family? Earlier studies have shown that there is little
evidence of change in the social position of the elderly as they age in
terms of standard of living, familial interaction and support, or health
services (Casterline et al. 1991). Based on focus group discussion data,
however, Williams and Domingo (1992) have found that being better off
in terms of health, frequency of social contacts and financial
independence enables older persons to have more influence in family
decisions. Recent research updates on these would be helpful in
documenting shifts in elderly role in Filipino family dynamics, especially
in family decision-making.
The Filipino family as the building block of the nation appears
resilient despite transformative forces in its own core. Children continue
to symbolize love and joy that keep families together but marriage (i.e.,
the social institution that brings families into being) seems to be in a
flux. Data suggest that traditional norms of early and universal marriage
are eroding. Males and females in the Philippines are delaying their entry
into marriage. The singulate mean age at marriage (SMAM) or the
number of years spent at single hood has increased from 25 years for
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males and 22 for females in 1960 (Gultiano and Xenos 1992) to 26 years
for males and 24 years for females in 2000 (Williams , Kabamalan and
Ogena 2001). On the other hand, the males are catching up with the
females in not marrying as the gender gap in the proportion who never
married at age 4549 years declined over the same time period. The
proportion for males has nearly doubled (i.e., from 3.2 percent in 1960 to
5.6 percent in 2000), while for females the proportion slightly declined
from 7.1 percent in 1960 to 6.1 percent in 2000. Cohabiting unions
among young Filipinos also increased between 1994 and 2002 with
frequent media portrayals of cohabiting couples challenging the more
conservative positions against the practice (Kabamalan 2004). If these
changes in nuptiality in the Philippines continue in the next decades and
be large enough, Costello and Casterline (2002) suspect a downward
pressure on Philippine fertility as what happened in many parts of the
world. In turn, this could further speed up the population ageing process
as mortality level has flattened at a quite low level due to improvements
in health care and hygiene.
Marital instability and spousal separation also strike at the
foundations of the Filipino family. There is no divorce law in the
Philippines so marriage when formalized binds a man and woman for life.
Many married couples, especially those with children, remain together
despite marital troubles for the sake of the family. As expected therefore
is the rather low level of marital dissolution in the country although a
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slight increase was noted during the 1990s (Costello and Casterline
2002). Despite lack of a divorce option, a married couple who wish to
break away legally from a marital partner may choose annulment of
marriage, which of course has corresponding social, temporal, and
financial costs. Nevertheless, this option has become quite popular
recently not just for the upper but also for middle classes. Again, media
appears to play a large part in having this included as an option in the
lifestyle change of married couples in the country along with changes in
peoples attitudes and behavior regarding marriage and family formation.
Perhaps more of a challenge to marital stability is the temporary
spousal separation due to overseas work of a marital partner. As of
December 2004, there were 8.08 million Filipinos overseas, with nearly
half (44.52 percent) on temporary work contract abroad. The average
annual deployment of OFWs during the period 2000-2005 was 897
thousand (POEA 2006). OFW remittances increased from US$6.03 billion
in 2001 to US$10.69 in 2005 (BSP 2006). Documented economic gains
from these remittances abroad have benefited many families and the
country as a whole but providing mechanisms to channel remittances to
productive investments is a continuing challenge.
LEGAL FRAMEWORK AND POLICY RESPONSES
In recognition of the family as the basic unit of society, the
Constitution of the Republic of the Philippines recognizes the families
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duty to take care of elderly members but the State may also do so
through just programs of social security (RP 1987). The needs of older
persons, among others, are included in the priority list when designing
and implementing integrated and comprehensive programs that would
make essential goods, health, and other social services available to all
the people at affordable cost.
The Philippine Constitution and three enacted laws since 1992
recognize the positive role of older persons in society. The objectives of
the first piece of legislation for older persons in the Philippines, i.e.,
Republic Act (RA) No. 7432, are to motivate and encourage the senior
citizens to contribute to nation building and to encourage their families
and communities they live with to reaffirm the valued Filipino tradition of
caring for their senior citizens. This law granted the following privileges
to senior citizens (RA
7432, Section IV):
a) The grant of twenty percent (20 percent) discount from all
establishments relative to utilization of transportation services, hotels
and similar lodging establishment, restaurants and recreation centers
and purchase of medicines anywhere in the country: Provided, That
private establishments may claim the cost as tax credit;
b) A minimum of twenty percent (20 percent) discount on admission fees
charged by theaters, cinema houses and concert halls, circuses,
carnivals and other similar places of culture, leisure, and amusements;
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c) Exemption from the payment of individual income taxes: Provided,
That their annual taxable income does not exceed the poverty level as
determined by the National Economic and Development Authority
(NEDA) for that year;
d) Exemption from training fees for socioeconomic programs undertaken
by the OSCA as part of its work;
e) Free medical and dental services in government establishment
anywhere in the country, subject to guidelines to be issued by the
Department of Health, the Government Service Insurance System and
the Social Security System;
f) To the extent practicable and feasible, the continuance of the same
benefits and privileges given by the Government Service Insurance
System (GSIS), Social Security System (SSS) and PAG-IBIG, as the case
may be, as are enjoyed by those in actual service.
In 1995, passed was RA 7876 or the "Senior Citizens Center Act of
the Philippines" which established senior citizens centers in every city
and municipality of country. The centers serve as venues for the delivery
of integrated and comprehensive services to older persons. The
organizations of older persons manage these centers with the support of
the local and national governments.
Based on the Vienna Plan of Action on Ageing and the Macao Plan
of Action on Ageing for Asia and the Pacific, the Philippines adopted the
Philippine Plan of Action for Older Persons in 1999. The plan of action
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addresses eight major areas of concern: namely, older persons and the
family; social position of older persons; health and nutrition; housing,
transportation and environment; income security, maintenance, and
employment; social services and the community; continuing
education/learning; and, older persons and the market.
The most recent law passed (RA 9257) known as the "Expanded
Senior Citizens Act of 2003" grants additional benefits and privileges to
senior citizens without qualifying whether not they earn less than
P60,000, which was a prerequisite under the old law. The full
implementation of these laws, however, would benefit millions of senior
citizens but complains abound regarding rampant violation of seniors
discounts by operating establishments especially in rural areas.
Moreover, many of the older persons are neither aware of the existence of
the laws nor of the mechanisms to enable them to availing of such
benefits. But even if they are aware and knowledgeable of these
mechanisms, limitations in older peoples mobility could prevent them
from acquiring required documentation to prove that they are qualified
for the discounts and much more in availing themselves of the senior
citizen discounts due them. Again, the OFW phenomenon contributes in
preventing the trickle down effect of benefits to senior citizens especially
in the rural areas. With the absence of children and no surrogates who
could assist the older persons, the benefits from existing laws remain to
be fulfilled.
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Nevertheless, Philippine legislators continue to work on policy
reforms that would further improve the conditions of senior citizens in
the country. Pending bills in the House of Representatives and the
Senate include the following, among others: local governance
representation of senior citizens; increase the discount privileges enjoyed
by senior citizens to all establishments; lowering of retirement age of
teachers; protection from institutional, community and domestic violence
and sexual assault; and expansion of the discount benefit from just
prescribed medicines to cover all types of medicines Except for the
proposed lowering of retirement age of teachers, the other pending bills
may put less strain on government coffers. While 55 years may be
considered as appropriate for optional early retirement, the increasing
life expectancy of males and females and the growing number of older
people in the country suggest that the proportion of national resources to
be allocated to retirement benefits is expected to increase over time.
Hence, rather than reduce the age of retirement, prospects of increasing
it may be more economically rational, as what advanced European
countries with large elderly population are currently considering.
Another issue is whether retirement age should be legislated in view of
significant age-structural shifts anticipated in the next decades.
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A Program Intended to Offer Health Insurance to the Poor
A program sponsored by the International Labor Office and the
World Bank that is under way in the Philippines has offered hope for a
solution to an enduring problem of developing countries: providing
health insurance to poor people. The solution involves adding a
reinsurance backstop to small, regional insurance plans to guarantee
their solvency through periods of extreme need.
Private insurers rarely offer insurance to poor people, since their
health is usually worse than that of wealthier people and they cannot
afford to pay high premiums. So in developing countries, governments or
donors typically offer limited aid in the form of free care. That, however,
does not take advantage of the benefits of risk-pooling, and assumes that
the poor have no ability to share the cost of care. As a result, medical
care maybe severely underprovided.
Small regional insurance plans already address this problem in the
Philippines and elsewhere in the developing world. But these small plans
are extremely susceptible to insolvency when faced with an epidemic or
other health catastrophe that might befall an entire community. The
I.L.O. and the World Bank set out to demonstrate the positive impact of
the small plans and to demonstrate the practical potential for
reinsurance.
At a meeting in Montreal last week, the program's organizers
reported results from a survey of members and nonmembers of small
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insurance plans with various backers in five regions of the Philippines.
Hospital visits were 40 percent higher, on average, among members than
among comparable nonmembers in the last two years. Compliance with
drug regimens for the chronically ill was higher in all five regions
reported, reaching 100 percent among the survey's respondents in one
region, La Union. In four of the five regions, mortality rates for micro
insurance members were substantially lower in the last five years than
mortality rates compiled from regional statistics.
"Where governments and the private sector have failed to reach
low-income and low-health-status people the poor we have found
alternative solutions that make a big difference," said David M. Dror, a
health insurance specialist at the I.L.O. who is a co-director of the
program.
The results also suggested that reinsurance could work, at a
surprisingly small cost. Under reinsurance, the small insurance plans
would pay premiums to a central fund each year. If one of the small
plans is unable to cover its own losses in a given year, the central fund
would pay out an award the equivalent of a regular insurance claim
to bail out the plan. Within six years, according to a range of estimates
by the I.L.O., reinsurance could expand to encompass regional plans
covering 600,000 to one million people in the Philippines.
Starting the program would require an initial injection of capital in
case catastrophic losses occurred in the first few years, before the plans'
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reinsurance premiums had accumulated. Despite the increased medical
care among the plans' members, according to Dr. Dror's calculations, the
amount needed to keep the system solvent would be only about $9
million.
The Filipino program is the most extensive yet tried, said Elisabeth
Rhyne, senior vice president of Action International, a nonprofit
antipoverty group based in Boston that makes small loans to poor
entrepreneurs in Africa and the Americas. Previous micro insurance
efforts, she said, usually covered only "a very limited package of
services," not including in-patient hospital care. More ambitious
programs had a difficult time calibrating coverage to need, ensuring the
availability of medical care and achieving diverse pools of healthy and
sick people, Dr. Rhyne said, and thus could not even attempt
reinsurance.
Yet the money to start the reinsurance program has not been
forthcoming, either from the government, independent donors or private
insurance companies. The program's organizers have paid for training
and administration in the Philippines so far, but neither has a mandate
to provide the start-up funds.
"It's too small for the big money that usually finds takers for
infrastructure," Dr. Dror said. "On the other hand, there are still a lot of
people in the development community and the donor community that live
under the assumption that the poor are uninsurable."
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Dr. Dror and his colleagues came up with the figure of $9 million
in start-up funds by measuring health risks and the cost of care for the
populations already insured in the five regions about 40,000 people
and adding a conservative margin of error. Just less than 5 percent of
the population suffers from chronic disease, but more than half of
hospitalizations cost $50 or less. About half of the $9 million would pay
for administration, Dr. Dror said.
"If you don't come with some initial capital, no insurance can ever
work," Dr. Dror said. "You have to be capitalized at your maximum
exposure."
Covering widely dispersed micro insurance units under the same
reinsurance umbrella would be crucial to containing that exposure, said
Howard C. Kunreuther, a professor of decision sciences and public policy
at the University of Pennsylvania. When all the insured are concentrated
in one area, he said: "Whatever the risk is, there are always possibilities
of high correlation. That's what you try to avoid in insurance, if you can
are there any sicknesses that could really hurt everyone?"
Once reinsurance systems are up and running, though, micro
insurance units in villages all over the world could protect each other
from epidemics, with a slim chance that all would befall the same
catastrophe at the same time.
"You can pool the north of the Philippines with the south of the
Philippines, which is about as different as Cambodia is from Africa," Dr.
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Dror said. "Every village that joins this social reinsurance is assessed
according to their variance of risk, and thus you can pool any kinds of
risks."
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Chapter III
RESEARCH METHODOLOGY
RESEARCH DESIGN
This chapter presents the methods and procedures to be adopted
by the researchers. It includes the research design, the population and
locale of the study and sampling techniques, the method of data
collection, the instrument and the statistical technique employed for data
analysis.
In this study, the researchers used the descriptive method to
determine objectives that it seeks to attain. According to Bienvenido and
Medel, descriptive research involves the description, recording, analysis
and interpretation of the nature of composition and processes of
phenomenon.
Furthermore, descriptive survey method according to Best is
concerned with conditions that exist; practices that prevail; beliefs,
points of view or attitudes held; effects that are being felt; or trends that
are developing. However, it is not confined to fact gathering alone. It
involves an element of interpretation of meaning or significance of what
is described.
POPULATION AND SAMPLING
The respondents involved in the study were the elderly people of
Barangay Dal-lipaoen Naguilian, La Union. The age bracket is 60 years
old and above at present. The total population of the elders in this
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barangay is 100.
All of these elderly people were included as respondents. According
to Gay, as cited by Adanza, in descriptive research, ten percent of the
population is an acceptable sample but twenty percent of the total
population is required for a small population.
However, the researchers favored the idea that the bigger the
sample, the more valid are the findings and conclusions; Hence, we used
the total number of the population.
DATA GATHERING PROCEDURE
Following the approval and validation of the data gathering tool,
the researcher formally asked for the approval of the Barangay Captain
of Dal-lipaoen Naguilian, La Union in the administration of the
questionnaire to the elders in that Barangay. The questionnaires were
distributed by the researchers which were guided by the health workers
on where they could find the abodes of these elders. During the
distribution, the researchers explained the purpose of the research and
that their responses would be treated with confidentiality and respect.
The questionnaire was composed of many questions which made it
hard for the respondents to answer it in just one seating. The
questionnaires were distributed to the population and were retrieved
after 2 days by some members of the group.
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RESEARCH INSTRUMENT
The main data gathering toll used in collecting information was a
one set questionnaire constructed by the researchers. This questionnaire
contains question related to the awareness of the elder of their health
practices and how does it affect their quality of life. This questionnaire
was very lengthy and is composed of the questions formulated by the
researchers about their Health Regimen and Medication, Diet and
Nutrition, Hygiene and Sanitation, and Leisure and Exercise.
According to Sevilla, et al, validity refers to the appropriateness,
meaningfulness and usefulness of inferences a researcher on the data
collected. She added that a common way of determining the content
validity of an instrument is by having one or more individuals look at the
content and format of the instrument and judge whether or not they are
appropriate. Thus, validity of an instrument is established by the
judgment of three competent persons in the given field.
The first questionnaire was presented to the panel for review,
modification and validation. The panels gave 4.2 and 4 for the
questionnaire and for the final score is 4.1 which mean that the
formulated questionnaires are valid and the researchers were permitted
to float the questionnaire to the population.
DATA ANALYSIS PLAN
The data gathered has been tallied, tabulated, analyzed and
interpreted. The statistical tool used is the weighted mean. The mean
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describes the level of awareness or the perception of the elders of their
lifestyle and the following scale and descriptive equivalent was used for
its assessment and analysis.
On the other hand, the mean describes the perception of the elders
on the effects of their practices to their quality of life; physical, social,
mental, emotional. The following scale and descriptive equivalent was
used for the assessment and analysis.