REVIEW ARTICLE
Significance of population aging and its impact on Cuban society
Trascendencia del envejecimiento poblacional y su impacto en la sociedad cubana
Eric Fuentes Rodríguez 1*, http://orcid.org/0000-0002-3167-7810
Camila Vilorio Pérez 1, http://orcid.org/0009-0008-1284-9139
Elsa Rodríguez Herrera 1, http://orcid.org/0000-0001-6794-8048
1 Faculty of Medical Sciences of Sagua la Grande. Villa Clara, Cuba.
* Corresponding author: ericfuentess020722@gmail.com
Received: 23/03/2024
Accepted: 05/05/2024
How to cite this article: Fuentes Rodríguez E, Vilorio Pérez C, Rodríguez Herrera E. Significance of population aging and its impact on Cuban society. Med. Es. [Internet]. 2024 [cited access date]; 4(2). Available in: https://revmedest.sld.cu/index.php/medest/article/view/193
ABSTRACT
Introduction: the aging process is a necessary topic to address and discuss for the broad social sectors related to comprehensive care for older adults. It constitutes a challenge for modern societies, and the need for policy and social strategy changes that enable healthy aging.
Objective: to explain the significance of aging and its impact on Cuban society.
Methods: a bibliographic review was carried out using a total of 24 bibliographies from Scielo, PubMed, and the Google Scholar search engine. The selection criterion was the most recent literature in accordance with the novelty of the topic.
Development: currently, aging continues to be a taboo topic in society. Saying that someone is old is almost impolite, and people try to be kind by saying expressions such as "you look great" to avoid acknowledging the reality of aging. However, it has a significant impact on society.
Conclusions: population aging globally represents a challenge that imposes great challenges on states by generating significant transformations in all spheres of social, economic, and cultural life. It is essential to value aging with a broad vision of society as a whole for quality comprehensive care that people demand as they age, and to achieve satisfactory and inclusive longevity for all.
Keywords: Demography; Aging; Population
RESUMEN
Introducción: el proceso del envejecimiento es un tema necesario a tratar y discutir por los amplios sectores sociales relacionados con la atención integral a los adultos mayores. Asimismo, constituye un reto y desafío para las sociedades modernas, y la necesidad de cambio de políticas y estrategias sociales que posibiliten un envejecimiento saludable.
Objetivo: explicar la trascendencia del envejecimiento y su impacto en la sociedad cubana.
Métodos: se realizó una revisión bibliográfica utilizando un total de 24 bibliografías de las bases de datos de Scielo, PubMed, y el motor de búsqueda de Google Académico. Se consideró como criterio de selección aquella literatura publicada más recientemente en concordancia con lo novedoso del tema.
Desarrollo: en la actualidad, el envejecimiento continúa siendo socialmente un tema tabú. Decirle a una persona que es viejo es casi de mala educación, sin embargo, este fenómeno presenta un gran impacto en la sociedad.
Conclusiones: el envejecimiento poblacional a nivel global representa un desafío que impone grandes retos a los estados al generar grandes transformaciones en todas las esferas de la vida social, económica y cultural. Es esencial valorar el envejecimiento con una amplia visión de la sociedad en su conjunto para una atención integral de calidad que demandan las personas al envejecer con el fin de lograr una longevidad satisfactoria e inclusiva para todos.
Palabras clave: Demografía; Envejecimiento; Población
INTRODUCTION
Aging is defined as the series of morphological, psychological, functional and biochemical modifications that the passage of time causes on living beings. It is characterized by the progressive loss of the organism's ability to adapt and reserve in the face of changes. It is a dynamic process that begins at birth and develops throughout our lives. (1)
In this way, interest in old age has always been among human beings with demonstrable evidence throughout history. The ancient Egyptians and the author of the 12 chapters of Ecclesiastes were familiar with disabilities attributable to the elderly. Great thinkers such as Hippocrates, Aristotle, Francis Bacon and William Harvey left their considerations on the last stages of human life. It was only at the beginning of the 20th century that gerontology and one of its branches, geriatrics, were established for the study of aging. (2)
The phenomenon of population aging worldwide occurs gradually and is influenced by fertility, mortality and migration, variables that in combined action over time determine the growth and age structure of the population, in short importance for the economic and social planning of any country. (3)
Since fertility is below the replacement level, less than one daughter per woman for thirty years, the population aged 0-14 has been reducing compared to the total, and at the same time, as mortality levels have also decreased The proportion of people aged 60 and over has been increasing in recent years, which, from a quantitative point of view, has had an important significance in the aging process. (3)
This is a global phenomenon from which Cuba does not escape. The birth rate decreased between 1950 and 2 000 from 37,6 to 22,7 births per thousand inhabitants; while mortality went from 19,6 deaths per thousand inhabitants to 9,2, in the same period. This transformation adopted the name demographic transition, which has caused a progressive increase in the size of the world population and, simultaneously, it’s aging. (3)
In Latin America and the Caribbean, according to studies carried out, demographic changes will intensely affect most countries in the coming decades, but in very different ways. During the 20th century, there was an increase in the life expectancy of the Latin American and Caribbean population, as a result of improvements, among others, in nutrition, health and sanitation and technological changes. Almost 900 million people aged 70 and over are alive today and there will be 1,4 billion in 2030. (4)
According to estimates from the United Nations Population Division; Barbados and Cuba will be the oldest countries in Latin America and the Caribbean in the immediate perspective. (5)
In Cuba, according to estimates, by 2025 it will be the oldest country in the Latin American region and by 2050 it will become one of the oldest in the world with more than 11 million inhabitants and 19 % aged 60 and over; It is estimated that by that date, this population will exceed 34 %, which will increase the risk of disability and social cost that derives from this circumstance. (6)
At the end of 2021, of the 11 201 549 inhabitants in Cuba, 20,8 % are 60 years old or older, the oldest provinces are Villa Clara with 23,67 % of its total population, Havana with 21,6 %, Sancti Spíritus with 21,44 % and Pinar del Río with 21,17 %, and closes this year with a life expectancy at birth of 79 years for both sexes. (7)
In the next 50 years, Cuba will be the oldest Third World country, and is today the third in Latin America, which is related to the increase in life expectancy, the decrease in fertility below the replacement level, the negative migratory balance and the decrease in infant mortality, all of which has not only affected the size and growth rate of the population, but also its structure by age groups. (8)
In the midst of all this context, the province of Villa Clara does not escape this aging process and is today the oldest in the country, with a population of 779 125, of which 185 637 are over 60 years of age, with a considerable number of elderly over 85 years old (17 5469. The Cifuentes municipality is the oldest followed by Placetas and Camajuaní. (7)
When the study of the statistical data of the municipality of Sagua la Grande was carried out, it was observed that it has a population over 60 years of age of 13 724, with a predominance of the male sex, which differs from the behavior of this process worldwide where it predominates the female sex, which represents 55,45 % of the entire population. The oldest health area is that belonging to Idalberto Revuelta with 7 913 older adults, which represents 57,65% of the entire population. (9)
When assessing the process of demographic aging, it is observed how it has transformed the social landscape in most nations. This has required numerous investigations, with diverse approaches that analyze, from the multiple dimensions of society, this phenomenon as new and complex, which will modify the agenda of public policies aimed at the older adult population; where the family has a predominant role in providing care to the elderly.
Cuban society has today, as happens globally, few children and many elderly people. This is a simple way to identify the aging process of the population: a new and complex phenomenon.
All of the above motivated us to carry out the research with the objective of explaining the significance of aging and its impact on Cuban society.
METHODS
A bibliographic review was carried out in relation to the topic. The information was searched in the SciELO database, PubMed, and the Google Scholar search engine. The descriptors demographics were used; aging; population and its translations into the English language. A total of 24 articles were selected based on their relevance, timeliness and adjustment to the topic. Ethical aspects were taken into account. The bases of the cited statements were respected. No ethical conflicts declared.
DEVELOPMENT
If when analyzing the aging process it is compared to climbing a great mountain, as one climbs the forces decrease, but the gaze is freer, broader and more serene; this is really what happens over the years: people lose fundamental functions, but the vision of the world in all its spheres and interpretation is different.
Aging has always been of interest for study by the fundamental branches of society such as philosophy, art and medicine. This is why the oldest members have always received a degree of attention, whether in a positive or negative sense, in all societies: for the Chinese it was a great honor, the Egyptians hated it and created potions to avoid it, for the Greeks who loved it, beauty was an offense to the spirit and a source of ridicule in his comedies, among other examples. (2)
Among the new challenges facing aging are: promoting the empowerment of older adults with active participation in public policies; promote active aging, visualize the intergenerational blurring because the elderly are contributing care work to their family and society; greater funding in gerontological research with diverse approaches but with similar objectives, supporting families with older adults who lack a pension and guaranteeing the rights to a full life free of violence. (10)
The authors of this work consider that the aging of the population is, without question, a great achievement of society, and at the same time a great challenge for the community worldwide, since social development requires other perspectives. Furthermore, community efforts in all areas must be aimed at providing quality care to older adults, where the health sector, together with intersectoral participation, plays an important role.
In both traditional and modern societies, the elderly maintain a certain status when living conditions are good, but this status is degraded in times of high tension and adverse circumstances. The living conditions of the elderly are a reflection of the vicissitudes of daily life. (11)
As individuals and populations age, societies are also affected by the characteristics and rhythms of aging. This is how the course of life in these societies is divided in a varied way and influenced by changes, for example, the increase in life expectancy. This new vision of the life cycle, a product of longevity, leads to rethinking a series of sociocultural activities and practices throughout life, such as in education. Not only in terms of including social gerontology subjects in the social sciences curricula, (12) but it is also one of the actions of the national program of care for the elderly to ensure that Diplomas in community, hospital and institutional gerontology are taught in all provinces of the country. (13)
In this aspect, it is worth highlighting the role that the University played for the elderly, which was an opportunity for improvement for people in this age group, and gave them the possibility of courses with topics related to the physiological changes of the human body at the same time aging, the family and its importance in society, the practice of physical exercise, general culture, among others.
Nowadays, old age continues to be a socially taboo subject. Telling someone they are old is almost rude. Similarly happens with retirement; to raise the issue with an older worker is to further establish her condition. Both old age and retirement (a topic culturally associated with the former) are unwanted realities, about which we do not speak fluently. (13)
Given the current conception of old age, marked with negative connotations, the alternative is to lay the foundations for a new construction of it: first of all, to see old age as another stage of the vital process, it is necessary to see it as another stage of the learning that begins at birth, and being aware that the elderly have many possibilities. This idea about old age must permeate each individual and society. (13)
In the assessment of the authors of this article, the view and interpretation of aging as a social phenomenon must be in accordance with the current situation, which, as has already been explained, is a global phenomenon. This process is nothing more than a stage of life that occurs physiologically, therefore, we are not talking about a morbid entity, but on the contrary, the positive way it is faced, the healthier it will be. Furthermore, the individual perspective plays a fundamental role, each person is responsible for the construction of their old age, taking into account their history and their perspective on life.
On many occasions, older people feel invisible to the family and society and that is when important alterations appear in the psychological order to be considered by those involved in their care.
Cantos Mengs (14) states in their study that loneliness in older people is a risk factor, which responds to an emotional state condition that occurs when a person feels distanced, misunderstood or rejected by others, and/or lacks adequate social resources to carry out the activities you want, particularly activities that provide a sense of social integration, as well as opportunities for emotional intimacy with other people.
Gajardo Jauregui (15) suggests that discrimination in older adults is another very important aspect of analysis when talking about aging, together with the loneliness explained above. The elderly feel that on several occasions they are discriminated against both socially and in the family itself, since old age produces a return to dependency: autonomy, loss of roles, and their economy decrease. Sometimes, they are limited in their daily activities and the comorbidity of different diseases and disabilities are added.
The authors of this work share the criterion that these aforementioned aspects must be taken into account by society and the sectors involved in the promotion of a healthy life to carry out campaigns with positive visions of aging, where the mass media come into play an important role and along with them other sectors such as education, sports, health, with the aim of providing older adults with leisure and recreation activities.
Examples of these activities are establishing groups of older adults in the community, for example, grandparents' circles, offering personal advice by the health team, as well as educating and training the population regarding the aging process. In addition, organize cultural and recreational activities in the community to rescue their traditions, games and dances in accordance with the needs of older adults, and use their experience in educational activities in primary and secondary schools, as well as in groups and cultural houses. .
When the biological sphere is analyzed, without a doubt this stage of life is a risk factor for the appearance of chronic diseases such as heart disease, cerebrovascular diseases, disabilities in all spheres, those related to the osteomyoarticular system, cancer in any of its locations, among others that lead not only to the underestimation of the elderly by the family or their environment, but also due to the psychological damage that is present in the elderly themselves. In addition, the economic damage they bring with them, since they require expenses in the purchase of medications, supplies, and in many cases, days of hospitalization. (7)
They also constitute a vulnerable group for communicable diseases, such as the 21 175 consultations made for diarrheal diseases and the 645 910 for respiratory diseases, undoubtedly the most frequent cause of requesting medical assistance in our environment. (7)
Likewise, in the COVID 19 pandemic, it constituted the most affected age group due to biological aging, comorbidity and immunosenescence, which makes older people more vulnerable and evolve less favorably; with a daily average of around 18 % of cases diagnosed during the second outbreak of the disease. (16)
Due to the above, it is a challenge for the health system together with the government to draw up measures that allow better care for the elderly, which is contemplated in the Care Program for the Elderly. The secondary prevention actions carried out in Primary Health Care constitute palpable examples, to cite examples: (1) Mammography, Examination of the oral cavity, Examination of visual acuity, Examination of hearing acuity, Rectal examination, Cholesterol Serum, Blood glucose, Thyroid function tests, Occult blood in feces, Electrocardiogram, Bone densitometry, PSA (Prostate-specific antigen), Periodic health examination.
In the economic order, aging also has its impact on both society and the family. Social assistance protects people who require special attention, providing monetary benefits, in service and in kind. Although pensions for retirees have increased in recent years, it does not mean that increasing them should not be considered even more since the increase in the cost of certain resources affects the “domestic economy” and the possibilities of access for older adults to various products.
The aging of its members has an impact on the family economy, the attention and care that must be given to the elderly, means that their resources must be redistributed to satisfy all the needs of the family nucleus.
Socio-psychological changes affect the entire social and cognitive area of the person: their close environment, their family, their community and society in general. There are changes in the individual role as an individual and as a member of a family, and there are changes in the social role (at work and within a community). (17)
As people live longer, which is an achievement, certain conditions appear that make aging a great challenge, since there is a double burden of disease and a greater burden of disability.
Retirement is undoubtedly one of the main causes that alter the emotional state of the elderly, this aspect closely linked to the conditions that derive from the economic sphere. The main consequences of retirement are: going from a state of work activity to a state of inactivity, loss of purchasing power in many cases, loss of social contacts and increase in free time. The repercussions that it can have on health would be the following: states of anxiety, states of depression, emotional lability, sleep disorders, difficulty relating, among others. (18)
Aging is essentially a triumph, in which people who live in better living conditions can reach advanced ages, but at the same time it implies a challenge for various spheres of society such as: services, material production, social security, among others; Therefore, this process has become a challenge for contemporary societies, from which Cuba is no stranger. (19, 20)
In Cuba, having such a high rate of people in the third age of life, the Cuban state's priority is to protect them, which is demonstrated in article 88 of the Cuban Constitution: “The State, society and the Families, as far as each one is concerned, have the obligation to protect, assist and facilitate the conditions to satisfy the needs and raise the quality of life of older adults. Likewise, respect their self-determination, guarantee the full exercise of their rights and promote their integration and social participation.” One of the fundamental premises for establishing a social policy is that the situation that gives rise to it is a problem of public interest and is part of the Government's agenda. (21)
All of the aforementioned aspects related to the aging process, regardless of the sphere affected, have their impact on a social level. It is the political will of our state that the older adult population passes this last stage of the life cycle satisfactorily and taking into account that the keys to good aging are keeping the body and brain active and expanding social relationships. Thus, with the support of the state, community-level activities have been created that allow generational exchange in a permanent, active and dynamic way and provide a “change of scenery” to those who live alone, and provide a network of social support to all individuals of gerontological age. (22)
Among these actions are: grandparents' homes, nursing homes, grandparents' circles, community workshops, rehabilitation rooms, a canteen plan for older adults with economic difficulties and help from social workers for lonely elderly people, protected housing, among others. (22)
In the opinion of the authors of this work, the well-being of older adults in contemporary society will depend on the living conditions that are created in the environment, where psychological, socioeconomic, biological and functional needs must be satisfied to avoid appearance of pathological processes. Accepting aging not as a problem, but as an achievement, is essential. You must learn to live with people who are over 60 years old, the so-called senior citizens, who in many cases are parents, grandparents, teachers and even leaders, who transmit their experiences daily and instill their example. This is, without a doubt, a privilege.
When faced with a given situation in older adults, one cannot think that the solution lies in a medical consultation. This goes further, starting with changes in the conception, in health policies and undoubtedly in the implementation of health promotion and prevention activities. Being able to detect the problems of the elderly in time to promote their correct rehabilitation is recommended. Ensuring that people live longer must go hand in hand with ensuring that they also live better.
CONCLUSIONS
Population aging at a global level represents a challenge that imposes great challenges on states by generating major transformations in all spheres of social, economic and cultural life. It is essential to value aging with a broad vision of society as a whole, for the comprehensive quality care demanded by people over 60 years of age, and to achieve satisfactory and inclusive longevity for all.
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STATEMENT OF AUTHORSHIP
EFR: conceptualization, editing, writing the initial draft and research.
CVP: conceptualization, methodology and editing.
ERH: conceptualization, methodology and editing.
CONFLICT OF INTERESTS
The authors declare no conflict of interest.
FINANCING
The authors did not receive funding for the development of this article.