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Azerbaijan: from a perspective of Gerontology
Studying aging process is a complex course as age itself is a multidisciplinary field. The study of aging process is referred as gerontology. Gerontology integrates information from various disciplines including sociology, biology, and psychology. It involves the study of people’s mental, physical and social changes as they age. The investigation of these changes in the society is important because the information collected is used to guide the elderly health policies and the healthcare programs in Azerbaijan (Ibrahimov et al. 2010).
Ageing and its associated problems concerning the elderly has been the domain of developed countries. However, recent past indicates that developing countries are experiencing the burden of aging population. This is attributable to the fact that previous Government policies on elderly care were a least priority as the elderly population represented a small percentage of Azerbaijan’s population. This paper discusses situation, behaviour and experiences of elderly people in Azerbaijan from gerontology perspective (Rzaev et al. 2015).
Background: Socio-demographic characteristics
Azerbaijan demography is undergoing transition which is attributable to the low growth rate and steady decline in its fertility rates in the past several decades. Research estimated that the population of Azerbaijan is 9 826397 people, which indicates a 1.39% increase compared to the previous population of 9 691 874. There were 205 568 new live births and 67 649 deaths. The population density is estimated to be 113.5 people/square kilometre. The age structure is as shown below;
This pyramid structure is a stationary type which is described by declining birth rate and low death rate. This type of pyramid structure is common in developed countries. The dependency ratio in Azerbaijan is 42.1%. This indicates that the dependant part of the population is more than the working population. The aged dependency ratio is reported at 9.2% in Azerbaijan (Caravanos et al. 2014).
Similar to many East and South East Asia, the ageing population is a demographic reality that results into a decline in fertility and improved life-expectancy. According to World population report, Azerbaijan has experienced increase in the population rate of people above 60 years from 3.7% in 1960s to 9.7% in 2011. The figure is projected to increase by 2% by 2020 and by to 25% by 2050. This indicates that a substantial burden on resources will be experienced (Rabbi & Karmaker, 2015).
Aging in Azerbaijan
Aging in Azerbaijan and across Asia is occurring more rapidly in comparison to the other developing countries. This is supported by Asia/Pacific Regional Conferences Ageing 2012 report which indicates that the proportion of the elderly population is growing at a very faster pace as compared to the rest parts of the world. This increased percentage of the older people in Azerbaijan implies that the percentage of the working adults is reduced and increased dependency ratio. The following are the consequences of the demographic changes.
To start with, there is rapid increase of old-older women. This is a major crisis because like in other countries, women are the primary caregivers in the family. Additionally, the old-older women are the most vulnerable group in the society who need acute care. Most of these women in Azerbaijan are widowed and live alone. Most of them have fewer assets as compared to men and are likely to be poor. This heightens their vulnerability and need for care. (International Action Plan on ageing problems, 2010).
Older Azerbaijan’s are spread throughout the country. However, the number of older people living in rural area is higher than in urban region. This is attributed to massive immigration of the young people to urban areas to seek greener pastures. The family is the most important support system for the elderly in Azerbaijan. Most of the elderly people in this country live with their family members. Only a small percentage of elderly live alone (Habibov, 2010). Azerbaijan is undergoing a social change. The society is shifting from larger extended family towards a nuclear family groups.
This change is associated with globalization and western culture influence. However, only few elderly persons reside in aged care homes. The nursing homes are managed by the government. The low number of residents is due to cultural influences. The Azerbaijan culture demands that it is the young child responsibility to take care of their parents. Culturally, it is shameful for the family to admit their elderly parents to these care facilities (Babaie et al. 2015).
Body changes observed are due to changes occur in individual cells and within the entire body organ systems. These changes are manifested through changes in function and appearance. The aging cells function capacity is usually reduced. The normal functioning of the body, the old cells must die as part of normal functioning of the body system. The genes are programmed in a way that causes old cells death to create room for new cells (Namazova & Taghi-Zada, 2015).
The first indicators of aging are the musculoskeletal system. This is followed by reduced eyesight and hearing capacity. Most internal organs function disorders do decline with age, but extensive reduction of the body organ functionality is associated with disorders and infections. Therefore, decline in function ability implies that the elderly are less able to manage strenuous activities such as physical activity, infections or temperature changes. This also implies that the elderly people are more likely to experience medication side effects. The most commonly affected internal organs include heart, kidney and brain (Bui et al. 2015).
Mental health disorders
The expansion of the elderly people in the population is unavoidably accompanied by increased number of age-related health disorders such as Alzheimer disease (D), Mild cognitive impairments (MCI) and Vascular Dementia (VD). There lacks adequate reports of Alzheimer disease in Azerbaijan but from the population dynamic and the world health reports, AD is a health issue that needs to be addressed among the elderly in Azerbaijan.
According to World Alzheimer reports, Alzheimer Disease International (ADI) estimates that there are over 36 million incidences worldwide about dementia. The numbers is doubling every two decades and it is projected that there will be 66 million dementia incidences by 2030. Most of these incidences are reported in the low and the low income countries (World Population Ageing, 2014).
The common mental disorders in Azerbaijan are depression, anxiety and dementia. From the statistics collected, depressive disorders in Azerbaijan have increased rapidly. However, the precise aetiology of depression and anxiety is unknown, but the environment, genetic factors and psychological factors contribute to these disorders. Research conducted in Arabic countries, obesity, physical activity, psychological distresses are the major risks for mental disorders in Azerbaijan.
The cultural expectations of this country have women have significantly lower physical activeness than men. In terms of dietary intake, 55% of the Azerbaijan is obtained from carbohydrates (grains). The increased carbohydrate intake and reduced physical activity among the elderly is a key risk factor for mental disorders in Azerbaijan (Caravanos et al. 2014).
The important characteristics of dementia and AD in Azerbaijan are determined by the public knowledge aspect, culture as well as socioeconomic aspects. There lacks adequate public knowledge on dementia. Therefore, the elderly person’s behavior that presents with the early disease symptoms are considered as natural results of aging. This implies that most of the elderly and their care hivers will only seek medication in the moderate stage of the disease.
One of the core indicators of social development in any community is the rate of literacy. Illiteracy is an important aspect in gerontology because it is a risk factor that facilitates the development of AD due to low knowledge on disease prevention; or control of the modifiable risks factor for age related disorders such as diabetes, coronary artery, stroke, osteoporosis, hypertension, hypercholesterolemia and depression.
Although illiteracy levels have reduced in the last decades, the reduction rate is considerably low in Azerbaijan. The higher illiteracy is a risk factor for the increased rates of dementia and Alzheimer disease among the elderly in Azerbaijan (World Population Ageing, 2014).
There is sufficient evidence that culture and peoples life experiences shape the mental stability of a person. The society culture, behaviours and experiences shape the person’s ability to react to cognitive impairments such as dementia. This is because cultural values impact the elderly person’s responses to illness and ways they interact with the healthcare professionals.
For instance, in Azerbaijan cultural values of individualism as well as collectivism regarding the elderly care can negatively impact the treatment regimen and care. Azerbaijan collectivistic culture values the elderly and it demands that they should be treated with respect by the rest members of the family (Habibov, 2010).
The changes in the patient’s behaviour due do dementia might threaten their family respect to the elderly. One of the issues that affect the dementia patients in this country is the forgetfulness nature of the disease. This is the root of their problems. Most of these elderly patients feel bad whenever they realise that they have forgotten things which makes it troublesome for them to live with their family members. Some complain that the disease is a teasing disorder as sometimes one cannot recognise relatives and can no longer identify their friend’s face which really breaks them down (Habibov, 2010).
The challenges of difficulties in the management of forgetfulness nature of the elderly and distractibility caused by the disease makes the elderly feel stressed. The elderly person’s life is described by use of many reminders and a lot of comments for their mistakes or failures. This makes the patients feel deeply unfulfilled in their own views as well as their lives.
Most feel that their intellect is disrespected due to their altered mental stability especially each time they are disrespected or treated in a harsh manner. In Azerbaijan, the elderly greatly depends on other family members in conducting most of the daily tasks and daily living activities. Majority feel that they are bothersome and the burden to the family members (Caravanos et al. 2014).
Financial difficulties are another issue that affects the elderly. Most of the elderly have feelings of hopelessness and deprivation. Most feel miserable when they are financially dependent on others. The elderly diagnosed with dementia in this community long to re-establish their own lives in order to be respected and to be valued by the rest of the society. They need recognition, appreciation and acceptance.
In Azerbaijan, the elderly people from low income households suffer disproportionately from the mental disorders. People’s health is determined by their socio-economic situations. The social determinants of health includes the conditions the live, work, age and the health systems. These are shaped by the economic and socio-political status. The differences in these circumstances are produced by the society systems (Habibov, 2010).
Despite the fact that there is significant improvement in care and management of chronic illness which are the modifiable risk factors for mental health among the elderly, the primary focus of the healthcare system in Azerbaijan has been on maternal health and pediatric health. The caregiver burden is high due to strong bonds between the elderly person and the family members.
This makes most of the people become opposed to the idea of institutional homes. The limited number of qualified mental healthcare providers in these healthcare facilities is also a contributing factor to negative attitude towards these healthcare facilities. This indicates that the number of elderly people benefiting from the few mental health services available (World Population Ageing, 2014).
Gender also plays a major role in aspects of gerontology as aged women are likely to present with multiple health and mental disorders as compared to men. Education status and individuals physical health dictates the mental health status in Azerbaijan. For instance, depressive mood disorders in Azerbaijan are common in elderly men diagnosed with chronically ill disease.
In women, depressive mood disorders in this community are associated with their sense of belonging level of isolation, faith, and family cohesion. Additionally, life events such as bereavement, poor physical health and loss of status are other factors associated with depressive disorders in this community (Rabbi & Karmaker, 2015).
Elderly abuse has recently gained increased attention in the past Decade. This is common societal problems that have serious consequence on health as well as the wellbeing of the elderly people. Elder abuse remains one of the most hidden types of interfamily conflict in Azerbaijan. There are only few studies that have been conducted on elderly mistreatment in Azerbaijan, thus, little is known about the prevalence rates or risk factors.
Although the issue of child and female abuse in Azerbaijan is well recognised, the issue of elder mistreatment is overlooked. This is probably because most people believe that elder mistreatment cannot occur due to the culture that supports strong family support. The lack of valid statistics, limited information, and consistent denial of the family members perpetuate vulnerability of the elderly. This could be a contributing factor for psychosomatic disorders among the elderly (Rzaev et al. 2015).
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Mental healthcare systems
According to old Soviet model, mental healthcare in Azerbaijan leans towards the institutional approach. However, the Azerbaijan psychiatric institution does not meet the basic standards. Although all kinds of the mental health services are at the level of special care, the primary care for the elderly mental health is not well developed. The principles mental healthcare providers for the elderly are psychiatric dispensaries, psychiatric hospitals and in private practice.
There are about 22 psychiatrists per 100,000 people. Each administrative districts of the country have outpatient clinic that have a consulting room for psychiatrist. There are eight cities at inter-regional psycho-neurological dispensaries (PNDs). In Baku city, there are about two PNDs; one offers paediatric mental services and the other offers adult mental services (Caravanos et al. 2014).
There are nine psychiatric hospitals that provide in-patient services. In addition, there are psychosomatic services in two General hospitals and psycho-neurological services that are provided in military healthcare facilities. The main challenge of elderly mental healthcare in Azerbaijan is finance. The healthcare provider’s salary is low, which makes them demand for fee for their services even in public sectors.
This indicates that there are illegal demands for payment in health care services including medication and food fee in inpatient services. Most of the elderly people are not able to afford mental healthcare treatment. Another challenge is that there is over-centralization of mental care services. The community care as well as rehabilitative care is carried out by non-governmental organizations (Habibov, 2010).
In order to ensure better life for the old population, it will require the harmonic interactions between policy making, health systems, medical education and the public sector. The government should establish policy that will ensure that elderly people cost of care is effective and manageable. The government should establish programs that will focus on prevention of the old age associated healthcare condition.
There are reports that support that the government should apply “spend to save” strategies. This implies that the cost of care in treating dementia in its early stages is more effective than when the disease has progressed. The benefits include reduced institutionalization and improved on quality of life for patients with dementia.
The healthcare policies should enhance the insurance systems in order to ensure patients get adequate support. The quality and quantity of the social services available in the community should be compatible to the medical standards, the community needs as well as the community culture (International Action Plan on ageing problems, 2010).
The health systems should establish strategies that will promote early diagnosis of the disease. This includes increasing community awareness to facilitate early diagnosis of people mental disorders among the elderly. This will help them get the necessary information and non-pharmacological treatments which will improve the elders cognitive impairments, manage the behavioural symptoms and reduce their quality of life. There is need to increase knowledge and awareness on the age-related disorders and the normal aging process. There is need for the community to understand that the elderly person’s physical and mental health may decline but these are also indicator of mental disorders. They should seek medical attention (World Population Ageing, 2014).
The elder community centres can also increase the society awareness in order to maintain their independence, leading to purposeful and productive lives. The support and enhanced family care must be emphasised through the help of support groups. There is need to collaborate to reduce stigma and to improve care. The area of concern in this community includes discrimination, elderly abuse, improve the standards of living such as housing, improve independence, autonomy and promote independence, increased participations as well as social protection including social security and pension (World Population Ageing, 2014).
New strategies to improve health in Azerbaijan
Recently, more resource centres for the elderly people have been established to protect the physical and psychological health of the elderly. The centres do so through constitutional rights for the elderly and legal consultations. There is need to have consultations and a range of public hearings and participation of every person in the community including the elderly representatives and those with disabilities. This will provides an opportunity for every person to express their feelings. The recommendations should be put into the considerations during the policy making processes (World Population Ageing, 2014).
The increased awareness and the promulgation of the multidisciplinary disciplines is expected to foster respect for the elderly and improve social defence for the families as well as the relevant authorities. There are undergoing plans such as the draft of “state program to strengthen the social protection of the elderly 2016-2020 years” which is focusing the issue of elderly empowerment by eliminating incompetence and useless relation between the elderly and the communities. Understanding the legal status for the elderly people will help the relevant authorities to protect the vulnerable group taking into the account of the essential contribution to the family, community and the societies (World Population Ageing, 2014).
There is much that will be learned by giving the regional municipalities’ space and involvement of the specialist. This will provide the necessary environment for the elderly people to engage them in activities such as sewing, hand works and weaving. Establishing such centres for the elderly people in Azerbaijan will be beneficial in improving the elderly quality of life (International Action Plan on ageing problems, 2010).
Currently, the Azerbaijan economic has grown due to the foreign investments and ongoing reforms. The population poverty level has decreased considerably from 49% in 2003 to 16% in 2016. . This has generally improved the life expectancy, improved the level of education and advanced healthcare systems. The fact that more people are getting best education and health care have made the people to live longer and stay healthy for longer period. The humanitarian needs still prevail as the socio economic indicators have continued to drop. Poverty is the greatest issue facing the elderly people.
Millions of elderly people in the Azerbaijan continue to face unequal treatment and infringement of their fundamental rights. Most of the older people living in the rural areas are still having poor living condition and lack adequate education making them have little information on their rights and law. Most of the elderly people are excluded from the social life. Therefore, the question of human rights of the elderly is increasing becoming more and more sensitive to this society.
The important aspect to improve the health of the elderly people in Azerbaijan is promoting their physical and psychological attributes such that they can remain independent and productive to the communities and their families. It is important to ensure that the elderly people remain in good health. In order to do so, the health workers and social workers should be adequately trained so that they can effectively prevent or manage the mental disorders that are associated with age. There have been some improvements, but the government need to establish sustainable care policies that are long-term, and develop services that are favourable to the elderly.
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