Saturday 9 February 2019

How Different Countries Care for Seniors: A Look at Caregivers and the Elderly Around the World

Today, guest blogger Roxanne Baker gives us a world tour of eldercare attitudes and practices. I loved learning about how families in different cultures take care of older loved ones and I wonder what differing cultural practices can teach us about looking after our own. Please chime in with comments if your family's culture influences your caregiving. 

There's just no escaping the cultural milieu and cultural forces that mold and shape us, especially when it comes to attitudes toward and treatment of the elderly. With declining birth rates and an aging population in most countries around the world now, those attitudes matter immensely. How a society thinks about aging and the elderly determines in large part the kind of care the elderly get, and it becomes increasingly more important as populations age. We also have to factor in the decreasing numbers of younger people to serve as caregivers for the elderly. So let's look at the situation and take a quick tour.

Elderly Support Ratio and Attitudes in the West

According to the Population Reference Bureau, we now have a rapidly aging world, and many countries are facing challenges in caring for elderly citizens. "[T]he elderly support ratio – the number of working-age people ages 15 to 64 divided by the number of people 65 or older – is declining in many countries, most notably in developed countries. According to PRB estimates, by 2050 Japan will have the lowest ratio of one working-age adult per elderly person, while Niger, a developing country, will still have a ratio of 19. No country will have an elderly support ratio above 20 by 2050."

These are indeed some sobering statistics. They also illustrate the burgeoning need for trained caregivers for the elderly, who serve on the front lines of caregiving.

Further exacerbating this problem in the developed West is the undeniable fact that ours is a youth-oriented, youth-driven culture. If we have enough money, we resort to cosmetic medical measures to keep us young looking as we age. Many families, rather than caring for aging parents and grandparents in the home, shuffle them off to nursing homes. It's not heartlessness – it's just a way for us to avoid facing the inevitable fact that we will someday be old too.

But it's not this way in all cultures and societies around the world and not even within some subcultures here, for example, among Native Americans.

Family Caregivers and the Elderly Around the World

Being old isn't just a matter of biology: it's also a social and cultural construct. So, while aging is a universal human experience, it is not viewed the same everywhere. Here are just a few examples of attitudes toward the elderly around the world, as well as how that translates into care from family caregivers.

In China, respect and care for the elderly are actually ensconced in law, and, in fact, elderly parents can sue their children for both financial and emotional support. In addition, companies and businesses are required by law to give workers time off to tend to aged parents. The idea is to protect the economy and not overburden resources owing the dense population and growing numbers of elderly people. But it's not all about money. Under these laws, many parents have sued because their adult children don't visit them regularly.

"China is projected to have 636 million people over age 50 by 2050, or nearly 49 percent of the population – up from 25 percent in 2010 . . . And somebody needs to care for them, goes the government thinking" (HuffPost). It may be law now, but Chinese culture has always upheld respect for the elderly as a Confucian attitude. It's just standard in China to honor and care for older people.

Japanese culture has always valued and still values the elderly. It has been ingrained in families and children for generations upon generations, which makes Japan one of the best and kindest places on earth for seniors. In fact, many Japanese families live with several generations under the same roof – one of the reasons why the elderly in Japan live longer than those elsewhere. Besides exercise and proper diet, strong community and family bonds are the chief ingredients in longevity.

All of that is a good thing because Japan has more people over 65 than any other age group. Efforts are made to ensure that all the elderly get some attention, with a national holiday for that purpose. The third Monday of every September is Respect for the Aged Day, a holiday that includes paid time off from work. It aims to honor and show respect to the elderly with gifts given to grandparents and a shared festive meal. "Neighborhood volunteers distribute free bento boxed lunches to elderly people. In some small villages, younger people and school children dance and provide entertainment" (HuffPost).

Then there's Scotland. Although it is part of the developed West, older people are still cherished and valued as an asset. There is now a concerted effort underway to ensure older people are heard and that they are supported in family settings for full and positive lives. For the West, this is a paradigm shift – a movement away from hospitals and nursing homes to family caregivers, preventive care, and quality of life.

This shift also means a different use of money and resources. Adjustments are made and homes adapted so that older relatives can live in the homes and age in a family environment. In general, families work hard to care for elderly loved ones, honoring them and respecting them as valued members of society.

Respect for elders is a valued and deeply entrenched sentiment in Vietnam. In Vietnamese culture, elders are viewed as treasured sources of knowledge and wisdom and the transmitters of tradition. Typically, elderly grandparents live with their families so that they receive support and care. And in return, the grandparents retain their usefulness by contributing to the household, doing such things as preparing meals and caring for grandchildren.

In Vietnam, elders are held to be the head of the family. Their opinions and advice are sought and valued, and they are the de facto decision makers in many households. Basically, being old is not a liability, but rather an asset.

Old age is also seen as an asset and advantage in Greece, where it is equated with wisdom and, sometimes, holiness. "'Old man' isn't a slur in Greece; in fact, it is quite the opposite. As Arianna Huffington discussed in her book On Becoming Fearless: 'I visited the monastery of Tharri on the island of Rhodes with my children. There, as in all of Greece, abbots are addressed by everyone as "Geronda," which means "old man." Abbesses are called "Gerondissa." Not exactly terms of endearment in my adopted home. The idea of honoring old age, indeed identifying it with wisdom and closeness to God, is in startling contrast to the way we treat aging in America'" (HuffPost).

Implications . . .

Attitudes toward and care of the elderly around world, then, often present quite a contrast to what they are here. "Other countries appreciate and admire this transition of life and respect and welcome their elders into society as an integral part of existence. As a society in the Western world, if we want to change the attitudes around caring for our elderly, we must first develop a new perspective on aging and caring for our seniors. With the strides in healthcare and medicine that the United States has made, our citizens are living longer . . . [We must ensure] that the needs of our oldest members are being met with respect and admiration" (MIR).

The upshot of all this is that there is a growing need – a desperate need, really – for more and more trained, long term caregivers with valuable skills and knowledge comprising, for example, patient positioning, pulse and respiration monitoring, and range of motion maintenance. But we also need to strive for a shift in thinking and move toward caregiving in domestic family settings provided by skilled family caregivers.

About the Author:
Roxanne Baker has been a writer and producer for 15 years working at national TV stations, magazines, and newspapers. She is the co-founder and editor of, a website specializing in certified nurse assistant education and training.


Claudia Zalla said...

Hi Roxanne,

Why did you not review Russia and Germany?

The Caregivers' Living Room said...

Hi Claudia, Thank you for your question! This was a guest post and I think Roxanne simply didn't have the space to include Russia and Germany in blog post (which is typically quite short). I would love to know your thoughts about how these cultures care for their older relatives! My husband and I lived in Moscow from 1978-80 - my husband is a retired diplomat and this was our first posting. We both speak Russian and I found that culture fascinating. I didn't specifically look at caring in those days, but I do know that 'Babas' or 'Babyshkas' (Grannies) used to play a big role in society. I'm not sure if that's the case. They basically ruled the roost at home in those days.