Care of Older Adult NCM 114: Educational Publishing House

CARE OF OLDER ADULT NCM 114
MODULE 1
THE AGING POPULATION: AN OVERVIEW
INTRODUCTION
The United Nations (UN) estimates that in a year 2000, persons 60 years of age and older throughout
the world was 590 million. By the year 2025 the number of aging populations is projected.
In the Philippines, the number of older people is increasing rapidly, faster than growth in the total
population. In 2000, there were 4.6 million senior citizens (60 years or older), representing about 6% of the
total population. In one decade, this grew to 6.5 million older people or about 6.9% of the total population.
The National Statistics Office (NSO) projects that by 2030, older people will make up around 11.5% of the
total population.
Therefore, to provide comprehensive and holistic care among increasing number of older people in the
country, gerontological nurses must know the facts about the older population.
LEARNING OBJECTIVES
After reading this Chapter, you should be able to:
1. Describe the ageing population in the Philippines in terms of
a) Situation of older people
b) Key facts on the statistics on the Philippines' population of older people.
2. Discuss the Philippine Government Policies related to other Older People.
3. Describe the characteristics of older population in terms of:
• Life expectancy
• Marital status and living arrangements
• Income and employment
• Health status
4. Explain projected changes in the future generations for older people and the implications for
health care.
 TERMINOLOGIES
GERONTOLY. The study of old age the process of aging, and the particular problems of old people.
GERIATRICS. Is a branch of medicine that deals with the problems and diseases of old age and the
medical care and treatment for aging people.
GERONTONIC NURSING. Nursing care pertaining to an older person, a compromise between geriatric
nursing (nursing care primarily for older persons who are ill) and gerontological nursing (a more holistic
view of the nursing care of older persons).
GERONTOLOGICAL NURSING. Is the specialty of nursing pertaining to older adults.
GERONTOLOGICAL NURSING FIRST EDITION- 2021 COPYRIGHT 2021 BY JOSIE QUIAMBAO-UDAN PUBLISHED BY: APD
EDUCATIONAL PUBLISHING HOUSE
 KEY FACTS
The following are the key statistics on the Philippine population of older people.
2012 2050
Older people (total) 5,905,000 23,633,000
Older people as % of total population 6.1% 15.3%
Life expectancy (males) 66
Life expectancy (females) 73
 GOVERNMENT POLICIES RELATED TO OLDER PEOPLE

The Philippine Government has enacted laws that cater to the needs and provides privileges and
benefits to the older person.
▪ National Policy on Older People

Republic Act No. 344 or the Accessibility Law of 1982 provides for the minimum
requirements and standards to make buildings, facilities, and utilities for public use accessible
to persons with disability, including older persons who are confined to wheelchairs and those
who have difficulty in walking or climbing stairs, among others.
Republic Act No. 7876 known as the "Senior Citizens Center Act of the Philippines."
There is hereby established a senior citizens center, hereinafter referred to as the Center, in
every city and municipality of the Philippines, under direct supervision of the Department
of Social Welfare and Development, hereinafter referred to as the Department, in
collaboration with the local government unit concerned.
(a) Identify the needs, trainings, and opportunities of senior citizens in the cities and
municipalities.
(b) Initiate, develop, and implement productive activities and work schemes for senior
citizens in order to provide income or otherwise supplement their earnings in the local
community.
(c) Promote and maintain linkages with provincial government units and other
instrumentalities of government and the city and municipal councils for the elderly and the
Federation of Senior Citizens Association of the Philippines and other non-government
organizations for the delivery of health care services, facilities, professional advice services,
volunteer training and community self-help projects; and
(d) To exercise such other functions which are necessary to carry out the purpose for
which the centers are established.
Republic Act No. 8425 provides for the institutionalization and enhancement of the social
reform agenda by creating the National Anti-Poverty Commission (NAPC). Through its
multi-dimensional and cross sectoral approach, NAPC provides a mechanism for older
persons to participate in policy formulation and decision making on matters concerning
poverty alleviation.
Republic Act No. 10155, known as "The General Appropriation Act of 2012," under
Section 28 mandates that all the government agencies and instrumentalities should allocate
one percent of their total agency budget to programs and projects for older persons and
persons with disabilities.
Republic Act No. 9994, known as "Expanded Seniors Citizen Act of 2010", an act
granting additional benefits and privileges to senior citizens.
 PRESIDENTIAL PROCLAMATIONS AND EXECUTIVE ORDERS

Presidential Proclamation No. 470, Series of 1994, declaring the first week of
October of every year as " Elderly Filipino Week."
Presidential Proclamation No. 1048, Series of 1999, declaring a "Nationwide Observance in

the Philippines of the International Year of Older Persons".
Executive Order No. 105, Series of 2003, approved and directed the implementation of the
program providing for group homes and foster homes for neglected, abandoned, abused,
detached, and poor older persons and persons with disabilities.
 THE PHILIPPINE PLAN OF ACTION FOR SENIOR CITIZENS (2011-2016)

The Plan envisions to elevate their role from passive beneficiaries to self-reliant, highly motivated,
and participating citizens. It is noteworthy that the Department of Social Welfare and Development
(DSWD), together with the committed representatives of the different agencies and of the senior
citizens sector have convened to come up with this plan of action designed to ensure that issues,
concerns and needs of senior citizens in our country are adequately addressed.
HEALTH AND CARE

The Department of Social Welfare Development (DSWD) has issued Administrative
Order No. 4, Series of 2010, "Guidelines on the Home Care Support Services for Senior
Citizens", establishing community based on health care services for older persons.
The RA 9994 provides health care services for poor people persons such as free medical services on
private hospitals and clinics, free vaccines, discounted medicines, and mandatory PhilHealth
coverage.
OLDER PEOPLE'S ASSOCIATION (OPAs)

The Philippine Constitution supports the formation of community-based organizations. The DSWD
have facilitated the formation of older people association in every city and municipality.
SOCIAL PENSION
Under the RA 9994, the Philippine Government provides a social pension of Php 500 per month to
poor older persons aged 77 and over who are not yet receiving any government or private pension.
SENIOR CITIZENS
The senior citizens shall be entitled to the following:
(a) the grant of twenty percent (20%) discount and exemption from the value added tax (VAT),
if applicable, on the sale of the following goods and services from all establishments, for the
exclusive use and enjoyment or availment of the senior citizen
(1) on the purchase of medicines, including the purchase of influenza and pneumococcal
vaccines, and such other essential medical supplies, accessories and equipment to be
determined by the Department of Health (DOH).
The DOH shall establish guidelines and mechanism of compulsory rebates in the sharing of burden
of discounts among retailers, manufacturers, and distributors, taking into consideration their
respective margins.
(2) on the professional fees of attending physician/s in all private hospitals, medical facilities,
outpatient clinics and home health care services.
(3) on the professional fees of licensed professional health providing home health care services as
endorsed by private hospitals or employed through home health care employment agencies.
(4) on medical and dental services, diagnostic and laboratory fees in all private hospitals, medical
facilities, outpatient clinics, and home health care services, in accordance with the rules and
regulations to be issued by the DOH, in coordination with the Philippine Health Insurance
Corporation (PhilHealth).
(5) in actual fare for land transportation travel in public utility buses (PUBs), public utility
jeepneys (PUJs), taxis, Asian utility vehicles (AUVs), shuttle services and public railways,
including Light Rail Transit (LRT), Mass Rail Transit (MRT), and Philippine National
Railways (PNR).
(6) in actual transportation fare for domestic air transport services and sea shipping vessels and
the like based on the actual fare and advanced booking.
(7) on the utilization of services in hotels and similar lodging establishments, restaurants and
recreation centers.
(8) on admission fees charged by theaters, cinema houses and concert halls, circuses, leisure, and
amusement; and
(9) on funeral and burial services for the death of senior citizens.
(b) exemption from the payment of individual income taxes of senior citizens who are
considered to be minimum wage earners in accordance with Republic Act No. 9504.
(c) the grant of a minimum of five percent (5%) discount relative to the monthly utilization of
water and electricity supplied by the public utilities:
Provided, That the individual meters for the foregoing utilities are registered in the name of the
senior citizen residing therein: Provided, further, That the monthly consumption does not
exceed one hundred kilowatt hours (100 kWh) of electricity and thirty cubic meters (30m3) of
water:
Provided, furthermore, That the privilege is granted per household regardless of the number
of senior citizens residing therein.
(d) exemption from training fees for socioeconomic programs.
(e) free medical and dental services, diagnostic and laboratory fees such as, but not limited to,
x-rays, computerized tomography scans and blood tests, in all government facilities, subject
to the guidelines to be issued by the DOH in coordination with the PhilHealth.
(f) the DOH shall administer free vaccination against the influenza virus and pneumococcal
disease for indigent senior citizen patients.
(g) educational assistance to senior citizens to pursue pot secondary, tertiary, post tertiary,
vocational and technical education, as well as short-term courses for retooling in both
public and private schools through provision of scholarships, grants, financial aids,
subsides and other incentives to qualified senior citizens, including support for books,
learning materials, and uniform allowances, to the extent feasible:
Provided, that senior citizens shall meet minimum admission requirements.

(h) to the extent practicable and feasible, the continuance of the same benefits and
privileges given by the Government Service Insurance System (GSIS), the Social Security
System (SSS) and the PAG-IBIG, as the case may be, as are enjoyed by those in actual
service.
(i) retirement benefits of retirees from both the government and the private sector shall be
regularly reviewed to ensure their continuing responsiveness and sustainability, and to
the extent practicable and feasible, shall be upgraded to be at par with the current scale
enjoyed by those in actual service.
(j) to the extent possible, the government may grant special discounts in special programs
for senior citizens on purchase of basic commodities, subject to the guidelines to be
issued for the purpose by the Department of Trade and Industry (DTI) and the
Department of Agriculture (DA).
(k) provision of express lanes for senior citizens in all commercial and government
establishments: in the absence thereof, priority shall be given to them; and
(l) death benefit assistance of a minimum of Two thousand pesos (Php2, 000.00) shall be
given to the nearest surviving relative of a deceased senior citizen which amount shall be
subject to adjustments due to inflation in accordance with the guidelines to be issued by
the DSWD.
"In the availment of the privileges mentioned above, the senior citizen, or his/her duly authorized
representative, may submit as proof of his/her entitled thereto any of the following:
(1) an identification card issued by the Office of the Senior Citizen Affairs (OSCA) of the place
where the senior citizen resides: Provided, That the identification card issued by the particular
OSCA shall be honoured nationwide.
(2) the passport of the senior citizen concerned; and
(3) other documents that establish that the senior citizen is a citizen of the Republic and is at least
sixty (60) years of age as further provided in the implementing rules and regulations.
In the purchase of goods and services which are on promotional discount, the senior citizen can
avail of the promotional discount or the discount provided herein, whichever is higher.
The establishment may claim the discounts granted under subsections (a) and (c) of this section as
tax deduction based on the cost of the goods sold or services rendered: Provided, That the cost of the
discount shall be allowed as deduction from gross income for the same taxable year that the discount
is granted: Provided, further, That the total amount of the claimed tax deduction net of VAT, if
applicable, shall be included in their gross sales receipts for tax purposes and shall be subject to
proper documentation and to the provisions of the National Internal Revenue Code (NICR), as
amended.
 CHARACTERISTICS OF THE OLDER ADULT POPULATION
The country consists of approximately 103 million inhabitants, with less than 5% of the population
65 years and older (Central Intelligence Agency, 2016). Currently, the age structure of the
Philippines resembles many other developing countries because there is a greater proportion of
younger Filipinos in comparison to older Filipinos (Figure 1).
Despite the larger number of young Filipinos, the 60 years and older population of the Philippines
is expected to increase by 4.2%, whereas the 80 years and older population is expected to increase
by 0.4% from 2010 to 2030 (Help Age Global Network, 2017b).
The Philippines’s population increased by over 35% over the last two decades with the older adult
population (60 years and older) expected to overtake those aged 0–14 years old by 2065 (Help Age
Global Network, 2017a).
Currently, life expectancy of Filipinos is 57.4 years for males and 63.2 years for females. Females
are projected to expect an increase of 4.0 years in life expectancy and males an increase of 4.7 years
in life expectancy by 2030 (Help Age Global Network, 2017b). The improvement in life expectancy
can be attributed to advances in public health in the Philippines, which have eradicated many of the
diseases that once caused earlier mortality in Filipinos.
 Research on Aging
Aging in the Philippines remains a subject that is severely under-theorized in research. Although
older Filipinos do appear in the country’s national reports, current empirical studies incorporating
older adults appears to be lacking in the Philippines The majority of research centered on older
Filipinos appears to focus on perceptions of aging, quality of life of older Filipinos, and older adults
in the workforce.
 Perceptions Regard
Many Filipinos view the aging process from direct interactions with their family members and older
Filipinos in their surrounding community. Living in multigenerational households and communities
shape perceptions of aging as a responsibility, due to the establishment of family roles, adult
engagement in the workforce, and family social ties.
For example, older adults who receive more social support from their relatives often feel encouraged
and have better perceptions about their own aging process. Filipino elders’ perceptions of aging are
derived from the unique life experiences and social units that encompass their lives. These
experiences, either negative or positive, form their views on aging and outlook on life. Although
older Filipinos do acknowledge the physical and functional declines that might occur with increasing
age, they view aging in a more positive light due to the respect and dignity that are attained with
maturation.
 Quality of Life
In terms of research on quality of life of older Filipinos, many elders generally report positive health,
community participation, and financial security. However, Filipinos who reported higher
socioeconomic status and more educational attainment also tended to report better quality of life.
Increased age was directly correlated with better subjective well-being in Filipinos.
Older Filipinos can attain greater stability in later life, and they may develop methods to cope with
distressing events through previous challenges they experienced and overcame.
 Social Welfare and Health

A major area of policy focus for older Filipinos is on social welfare. The Philippines has a high
poverty rate that is attributed to low worker education, a lack of skilled work, living in a rural area,
and the high dependency burden that the working-age population must shoulder.
Due to the large percentage of young adults and children in the Philippines, there is a high
dependency ratio, which means that older Filipinos often are not able to save for retirement because
they may have young dependents. Older Filipinos may have to sacrifice their financial assets to care
for younger family members. Another major issue is that almost a quarter of Filipinos living in
poverty are older adults who do not have the financial means necessary to sustain an adequate quality
of life.
 Policy and Caregiving

A lack of institutional care in the Philippines means that older Filipinos are often cared for by family
members at home. This informal care network is vital because there are inadequate social security
and institutional care available for older Filipinos. Although caregiving is expected of Filipino
families, those who are of lower socioeconomic status may be financially strained in providing
adequate care to an ailing loved one.
There are current policies to protect the welfare of formal caregivers ( “Caregivers
Welfare Act,” 2016); however, policies should also address the demands of Filipino informal
caregivers by offering paid family leave or even payment to family caregivers who are in need. Also,
although Filipino family caregivers are less likely to utilize services, culturally tailored support
services could be useful in alleviating any caregiver strain.
 Emerging Issues
Like many countries, the Philippines will experience a growth in the population of Filipinos 65 years
and older. Currently, the nation is not prepared to meet the needs of the influx of aging Filipinos. The
Philippine government must recognize that national policies for older Filipinos, like the Senior
Welfare Act, must be modified to address the unique demands of its aging citizens. Social welfare
and wellness programs should be expanded to offer coverage to more aging Filipinos. Disparities in
access to services must be addressed to improve the well-being of older adults throughout the
different provinces.
FUNCTIONAL AGE
Is a term used by the Gerontologists to describe physical, psychological, and social function; this is
relevant in that how older adults feel, and function may be more indicative of their needs than their
chronological age.
PERCEIVED AGE
Is another term that is used to describe how people estimate a person's age based on appearance.
 The common living arrangements among elderly men and women:

evidence from the 2000 Census
The living arrangements in this study are described in terms of the type of the household the
elderly belongs to and the position he or she holds in the household. That is, whether he or
she is the head of the household, the spouse, parent, or other relative of the household head,
or a non-relative. The category other relative of the household head includes brothers, sisters,
parents-in-law, children-in-law, uncles, aunts, and cousins.
 Co-residence of parents and children
There is some belief that in the Philippines and even in other countries of South East Asia co-
residence of elderly persons with any of their children might be declining because of
substantial social and economic changes that occurred in these countries over the past
decades. Some basic indicators of living arrangements of the elderly in selected countries for
selected years.
 Greatest obstacle to a secured old age
One of the issues is the security in old age. security in old age. Poverty is perceived security
in old age. as an obstacle to a secured old age. As such, the current pension system in the
Philippines requires careful consideration and evaluation. The government offers welfare
services such as homes for the aged and Senior Citizens Centres to better address the plight of
the Filipino elderly. However, the effectiveness of such welfare services can only be
confirmed by the level of satisfaction of their intended beneficiaries.
Fortunately, government officials and policy planners have recognized the rising need to
address the predicament of the elderly sector. The 1986
Constitution, Article II, Section 9, provides that “The state shall promote a just and dynamic
social order that will ensure the prosperity and independence of the nation and free the people
from poverty through policies that provide adequate social services, promote full
employment, a rising standard of living, and an improved quality of life for all”. Article 13,
Section 11 also provides that “The state shall adopt an integrated and comprehensive
approach to health development which shall endeavour to make essential goods, health and
social services available to all people at affordable cost. There shall be priority for the needs
of the unprivileged, be priority for the needs of the unprivileged, sick, elderly, elderly
disabled, women, and children. The State shall endeavour to provide free medical care to
paupers”. Article XV, Section 4 also stipulates that “The family has the duty to care for its
elderly members although the State may also do so through just programs of although the
State may also do so through just programs of social security”. Further, Article XVI, Section
7, states that “The State shall provide immediate and adequate care, benefits and other shall
provide immediate and adequate care, benefits and other forms of assistance to war veterans
and veterans of the military Ms of assistance to war veterans and veterans of the military
campaigns, campaigns, their surviving spouses and orphans”. Lastly, for the benefit of those
who are retiring, Article XVI of Section 8 states that “The State shall from time to time,
review and upgrade the pensions and other benefits due to retirees other benefits due to
retirees of both the government and private sector.”
 Medical Dental Care

A senior citizen is entitled to free medical and dental services in government establishments
anywhere in the country subject to guidelines to be issued by the DOH GSIS, and SSS.
The DOH shall direct the government establishments in the entire country to provide free
medical/dental services where capability and facility for such services are available. The term
“free” shall mean free of charge CONCERNS OF THE ELDERLY IN THE PHILIPPINES
Clarita R. Carlos 15 on
medical/dental services where capability and facility for such services are available. The term
“medical services” shall refer to services pertaining to the medical care/attendance and
treatment given to senior citizens.
It shall include health examinations, medical/ surgical procedures within the competence and
capability of DOH establishments/hospitals/units and routine/special laboratory examinations
and ancillary procedures as required.
The term “dental services” shall refer to services pertaining to dental care/attendance and
remedy given to senior citizens. It shall include oral examination, curative services like
permanent and temporary fillings, extractions, and gum treatment. Professional services shall
refer to services rendered or extended by medical, dental, and nursing professionals, which
shall also include services rendered by surgeons, EENT practitioners, gynaecologists,
urologists, neurologists, psychiatrists’ psychologists, and other allied specialists. Counselling
services shall refer to advices given by health professionals, e.g. psychologists, psychiatrists,
nutritionists, nurses, and other allied health professionals in support to specific treatment of
illnesses.
The following are the health services that may be availed for free in any government
establishments, subject to availability of facilities and manpower/technical expertise of the
receiving government establishment: a. Medical and dental services
b. Out-patient consultations
c. Available diagnostic and therapeutic procedures
d. Use of operating rooms, special units, and central supply items
e. Accommodations in the charity ward
f. Professional and counselling services
In addition, the elderly is trained to become "Community gerontologists" CG. The training includes a
number of practical methods such as massaging, reflexology, herbal medicine, basic assessment and
vital statistics check-up.

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CARE OF OLDER ADULT NCM 114

 GOVERNMENT POLICIES RELATED TO OLDER PEOPLE

▪ National Policy on Older People

 PRESIDENTIAL PROCLAMATIONS AND EXECUTIVE ORDERS

Presidential Proclamation No. 1048, Series of 1999, declaring a "Nationwide Observance in

 THE PHILIPPINE PLAN OF ACTION FOR SENIOR CITIZENS (2011-2016)

HEALTH AND CARE

OLDER PEOPLE'S ASSOCIATION (OPAs)

Provided, that senior citizens shall meet minimum admission requirements.

 CHARACTERISTICS OF THE OLDER ADULT POPULATION

 Social Welfare and Health

 Policy and Caregiving

 The common living arrangements among elderly men and women:

 Medical Dental Care

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