This blog is one in a series of blogs on the Future of Ageing, published in the lead up to the ILC-UK Future of Ageing conference on the 24th November. To register to attend this conference, click here.
A few weeks ago, a video of an 89-year old man being physically and verbally abused at a private Old Age Home in Trinidad and Tobago (T&T) elicited national outrage on social media. The incident raised serious concerns about the challenges Trinbagonians face regarding the health and care of older persons. Much like the UK, T&T has a free, public healthcare system, but has depended heavily on an emergent private care sector to meet the long-term needs of a chronically ill, older population. However, unlike the UK, T&T has experienced population aging only in recent years and effective policy, research and legislation has not yet met growing needs. For instance, the offending employee at the Old Age Home in question was arrested, yet the home remains operational as there is no formal means to facilitate state intervention in the private care sector. This lack of formal support is a major challenge to ensuring proper healthcare of older persons, especially in private homes where owners capitalize on the lack of regulation by cutting corners on proper food, facilities and caregivers for their residents.
In a small society which believes that the young should care for the old, why are people turning to unregulated care homes in the first place? A lack of proper care resources is a major challenge for older persons. As Dr James Bratt, the sole geriatric psychiatrist in the country put it, “transportation to facilities, (hospital) waiting times, a need for care-givers (support) and stress, among other things” can prove very difficult for families to cope with.
This is especially true for dementia patients. Regarding the disease predicted to become particularly prevalent in developing countries by 2050, Dr Bratt notes; “(T&T) doctors have no idea what the appropriate treatment is for Alzheimer’s versus Vascular versus Lewy Body Dementia. Doctors and especially GP’S are overmedicating and over-sedating patients. Nurses have little training in geriatrics. Caregivers are atrocious and have no training.” The care resources for dementia treatment appear particularly bleak.
Dr Bratt’s observations highlight yet another challenge: a lack of awareness among healthcare professionals and the general public regarding elder health and care. As one doctor at a public hospital insisted, “there is a dire need for education, education, education!” While some Ministry of Health programs are aimed at raising awareness about ‘lifestyle diseases’ like heart disease and diabetes, issues like mental health and disability in later life are rarely tackled. Yet, raising awareness about complex, sensitive healthcare issues in ageing is crucial to empowering older persons to live a healthy lifestyle.
Like many developing countries, the challenges of healthcare for older persons in T&T are plentiful. However, there are some opportunities. Senior Activity Centres and branches of the Trinidad and Tobago Association of Retired Persons (TTARP) have laid promising foundations for an active and engaged older population. If a culture of active retired persons continues, T&T may serve well as an international retirement community destination.
As one of the fastest aging Caribbean countries (the over 60 population is predicted to reach 30% in 2050 from its current 13% rate, according to the World Health Organisation) T&T also presents an opportunity for research into a trajectory quite different from that experienced by older, developed societies like the UK. Such insight may aid other developing societies experiencing similar issues.
It would be helpful to engage with ageing professionals in other rapidly aging countries about the pressing questions policy makers face regarding healthcare of older persons like; How will we meet these challenges? Which challenges should we prioritise? Will we do so fast enough? It remains to be seen.
Ageing Consultant and Writer