By: Musdah Mulia

Are you ready to become an elderly person? Elderly is a stage in a person’s life, like it or not, that phase comes naturally in every human life. Because elderly is something that is certain to come, everyone should welcome that stage with peace and happiness.

However, in reality, many people feel anxious about facing the elderly. Several reasons have emerged, including anxiety about losing relatives and friends; anxiety about worsening health conditions, anxiety about economic problems because they are no longer productive, and anxiety about security protection.

In order not to be anxious about becoming elderly, thorough preparation is needed. The preparation in question includes physical, mental, and financial preparation. In terms of physical, the preparation should start from an early age because a person’s physical health is not formed in a short time, but rather the result of years of effort. Likewise, mental preparation should have been built from a very young age. Since a young age, a person should be accustomed to training their mind and getting used to positive and meaningful things.

In terms of finance, dr. E. Oswari, DPH explained that every elderly person needs to have savings to meet their daily needs, a decent place to live, and enjoyable activities. To face old age, financial factors are one of the factors that must be considered considering that in the elderly, physical abilities are very limited, in addition, there are also few institutions that want to employ elderly groups because they are considered unproductive.

Population Aging, Lack of Appreciation

One form of successful development in the economic and health sectors is the increasing life expectancy of the population or also called population aging . Currently, the growth of the elderly group reaches 2.5% per year while the average world population growth only reaches 1.7% per year. This means that human life expectancy is getting higher.

Demographic data shows that the number of elderly people continues to increase in line with efforts to improve the quality of human life in the health sector. Unfortunately, the increase in the quantity of elderly people is not accompanied by an increase in the quality of services, let alone the quality of social services for them. This unpleasant condition is caused, among others, by the government’s lack of support for them, for example, seen from the government’s policy of reducing pension funds for civil servant widows, and secondly, due to the public’s perspective which tends to be ageism or not friendly to the elderly group.

The change in the way people view the world is influenced by a number of factors, including the change in the pattern of society from an agrarian society to an industrial society. In an agrarian society where the family is an economic unit, elderly family members are cared for by their relatives and they can still contribute to the family economy by doing light tasks according to their abilities.

However, in an urban industrial society, the family is no longer an economic unit, the father as the head of the family is usually the breadwinner and his workplace is separate from the home. His income is often only enough for daily food needs, not to mention having to face the risk of layoffs from work. To be precise, in an industrial society, families are often unable to take care of their elderly family members because of the limitations they have, such as economic limitations, time limitations, and limitations of health facilities and infrastructure. In addition, the industrial world is usually unwilling to employ the elderly because they are considered unproductive.

Who is the Elderly?

There is no agreement on who can be categorized as elderly. However, in general, especially in Indonesia, the elderly category is given based on age. Health providers, for example, classify patients aged 60 years and over as geriatric patients as elderly. This age limit is used in Law No. 13 of 1998 concerning Elderly Welfare which defines the elderly age group as those who have reached the age of 60 years or more.

UN statistical data shows that the number of world population aged over 60 years is around 605 million people. This means that currently 1 in 10 people in the world are over 60 years old. By 2025, that number is predicted to double to 1.2 billion people.

For Indonesia alone, the Central Bureau of Statistics (BPS) in 2020 recorded the number of elderly people reaching 32 million people, around 12% of the total population. BPS (1998) further estimated that life expectancy would increase, namely 62.84 years for men and 66.68 years for women. This means that women’s life expectancy is four years longer than men’s. This data shows that women occupy the largest portion in the elderly age group.

Why is being elderly something to worry about? Because the elderly group tends to be a neglected group in society. The condition of the elderly in Indonesia is very worrying considering the social reality shows that 55.7% of the elderly are still heads of households, even 68% of them are still actively working in various sectors, such as agriculture, trade, industry and services. The saddest thing is that 80% of the 22 million elderly in Indonesia do not have pension fund benefits and health insurance so they cannot access health facilities.

Becoming elderly is not only a series of biological changes, but is much more complex than that. Elderly can mean a process of loss, starting from losing a social role due to retirement, loss of income, and loss of friends or family for various reasons such as moving, or they have gone before the Creator. Elderly can also mean anxiety, such as anxiety about personal safety and security, anxiety due to uncertainty of income, and anxiety due to having to depend on others.

State Protection for the Elderly

Unlike developed countries, such as Australia, Canada, and the United States, public policies for the elderly in Indonesia are not encouraging. The Indonesian government has indeed issued Law No. 13 of 1998 concerning the Welfare of the Elderly. The policy has provided legal instruments to guarantee the existence of the elderly. The problem is, the implementation of the law is still very weak in society.

There are at least three articles that guarantee protection for the elderly in the law. First, article 12 explains the forms of services provided for the elderly, such as religious and mental spiritual services, health services, services to obtain convenience in using public facilities, infrastructure, and facilities, as well as providing convenience in legal services and assistance, and also social protection. Second, article 17 emphasizes that services to obtain convenience in using public facilities are implemented in the following ways: providing convenience in administrative services, cost relief, convenience in traveling, and special recreation and sports facilities. Services to obtain convenience in using public facilities and infrastructure are intended so that the elderly can access public facilities such as hospitals, transportation, banks, post offices, and shopping centers. Accessibility in these places is the availability of public facilities and infrastructure that can facilitate the mobility of the elderly, such as wheelchair paths, paths for those with canes, special doors, stairs, and elevators or special crossing places.

There are two main things outlined in the law as a form of protection for the elderly, namely providing easy accessibility and providing social security in the form of pension funds and health insurance. In developed countries, the elderly usually receive a pension from the state whose amount is adjusted to their cost of living so that the elderly can live decently.

To anticipate the anxiety of the elderly, it is necessary to encourage retirement savings to help everyone face old age later. Ideally, all residents in their productive years set aside part of their income as mandatory savings or social security savings or social insurance. This financial preparation is very necessary so that in old age, they are no longer a burden to others or their families.

In this context, those who have the status of civil servants are lucky. Because, retirement age almost does not cause major problems because of the pension funds they receive even though the amount is no longer as large as their salary during their productive period. At least the guarantee of pension funds can provide a pleasant psychological effect. Something that cannot be enjoyed by all people in their old age.

Growing Old Doesn’t Mean Suffering Pain

Getting older is often synonymous with increasing health problems experienced by a person. In other words, old age is synonymous with “illness”. The general assumption in society that the elderly are synonymous with a pile of sickly organs must be eliminated immediately. Serious efforts are needed to empower the elderly from a young age so that in their old age they do not have to suffer from illness.

Gerontologists, such as RL. Kane (1994) concluded that health problems that commonly afflict the elderly are physical or non-physical instability, inability to move agilely (immobility), inability to hold back the urge to urinate and defecate (incontinence), impairment of vision and hearing, memory impairment (intellectual impairment), infection, insomnia, irritable colon, depression malnutrition, constipation, diseases due to drug overdose, impotence, and disorders of the immune system  (immune deficiency).

Several types of diseases have been detected as the diseases that cause the most deaths in the elderly, both in developed and developing countries, such as pneumonia (lung inflammation), neoplasm (cancer), cerebrovascular (brain blood vessel disease), and ischemic heart disease (lack of oxygen).

In addition, it is still exacerbated by a number of other infectious diseases. Theoretically, various diseases suffered in old age are the result of lifestyle habits in youth that are often far from healthy which may be caused by a person’s lifestyle or economic condition. Worse still, diseases suffered by the elderly tend to develop into chronic, while health services provided by the government to the elderly are at the lowest priority.

Especially for the elderly in Indonesia, the most common health problems experienced are related to degenerative diseases, such as diabetes mellitus and cholesterol disorders. In addition, a number of other chronic diseases, such as rheumatism, hypertension, heart disease, bronchitis, tuberculosis, osteorophosis, and cancer are very risky to make the elderly helpless.

Unlike those who are young, there are special difficulties for elderly care. In general, elderly diseases are endogenous, that is, they originate from within the body and are hidden. In addition, they are generally cumulative and chronic, even progressive, so that many cause disabilities that are suffered for years before death.

In medical treatment for the elderly, a doctor usually has to prioritize which diseases should be cured first. It is almost certain that it is difficult to cure all diseases in the elderly’s body considering that their organs have experienced decreased function. Therefore, according to Prof. Supartondo, a professor of geriatrics at the Faculty of Medicine, University of Indonesia, an integrated and comprehensive approach is needed in treating elderly patients because they experience multidimensional problems. This means that the elderly do not only experience physical pain, but also suffer from psychological and psychosocial problems.

Elderly Women

Not all elderly people have access to health services, including the cheapest ones, usually due to economic constraints. As a result, they suffer more because their health conditions decline as they age. Although some elderly people have pensions, some of them are still burdened with the responsibility of raising children, and even grandchildren, so that health care issues are often not a priority.

This condition is even worse for elderly women. Patriarchal culture and social structures generally require women to continue working in the domestic sphere. I often feel bad seeing an old grandmother still having to cook and prepare food for her family. Still having to work hard to meet daily living needs. Maybe if they just “help out” working at home it will bring them happiness, but if it becomes a kind of obligation, it is truly inhumane. The elderly, especially elderly women, should be freed from all domestic obligations. That is why we need to campaign for the principle of justice and gender equality. This principle demands fair and equal treatment for elderly women and men.

In addition, unlike elderly men, elderly women generally do not have the same access as men to get jobs that earn money to meet the family’s economic needs. Even if they work, they are only absorbed in domestic work with a smaller income than that earned by men. The low income of elderly women, especially those who have become widows, is a serious obstacle to their efforts to meet their health care needs.

The Importance of Cultivating Mental Health

Mental development or spiritual aspects of a person are very dependent on their physical development, and vice versa. Human development can be broadly divided into several stages as follows. The prenatal period which is then followed by infancy and childhood. After that, entering the pre-puberty and puberty periods. Then passing through adulthood and ending in old age.

Each stage in a person’s life characterizes different needs in various aspects. According to JP. Guilford, human needs can be divided into several forms as follows. First, individual needs consisting of homeostatic needs, namely the needs demanded by the body in the process of adjusting to the environment, temperature regulation, sleep, and sex. Second, social needs that include praise and insults; power, association, imitation and sympathy, and attention.

Mental development and spiritual aspects within a person are things that must be built continuously. One of the most effective methods offered by education experts is through religion. Therefore, it is very important to increase understanding of religious values which in turn makes the practice of religion more intensive. The reality in society shows that the tendency of the elderly group towards religious life increases as their age increases.

In closing, it is interesting to state W. Starbuck’s view that explains that the characteristics and nature of religion in mentally healthy people are optimistic and happy, they believe that the nature of God as the Most Gracious and Most Merciful overcomes His other characteristics, such as the giver of punishment. In addition, they are always optimistic and open mind, therefore they are more forgiving and do not hold grudges. Other characteristics are having a moderate religious view inclusive and not rigid, always having a positive view, and believing in religious teachings through a reasonable process, not instantly and suddenly. Religion should make people feel peaceful and happy! Elderly people with spiritual provisions can weave a more peaceful and happy life.

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