AGEING IN TURKEY

AGEING IN TURKEY

Sevilay Senol Celik and Yusuf Celik, Hacettepe University, Turkey

Turkey's population pyramid shows the elderly population is increasing both in number and in ratio in Turkey. For this reason the purpose of this study is determined to show the current situation of the elderly in Turkey and to discuss the problems faced by the elderly. The data used in the study come from the 1998 Turkey Demographic and Health Survey (TDHS). By accepting to be elderly those people who are aged 65 and more, sample of this study consists of 1,106 older people. In order to show the current situation of the elderly in Turkey, socio-economic variables classified under individual-level, household-level and community level factors were selected from 1998 TDHS. Frequency distributions were applied for these variables. According to the results it can be concluded that the situation of the elderly in Turkey must be improved and necessary measures have to be taken to lessen the severity of the elderly problem in the future.

Over the coming decades the populations of OECD countries will experience aging, particularly as the post-war "baby boom" generation moves through the age structure, but also because people are living longer and fertility rates have fallen. While the same general pattern holds across most OECD countries, there are considerable differences in the speed with which such changes are likely to occur. The aging of populations will put pressures on government’s tax and spending systems in nearly all OECD countries, requiring major changes to existing social systems if substantial increases in public debt are to be avoided. Because of economic results of aging, aging populations will have major effects on the growth of productive potential and living standards in all OECD and non-OECD countries (1).

Although the ration of the elderly non-active to the working age population is already rising, an accelerating pace is expected in the second decade of the new millennium, posing serious challenges for many public sector pension schemes. Recognizing that the financial needs of public pensions could become intolerably high if benefit rates remain unchanged, several governments have been considering reforming their pension systems (2).

Estimations done by United Nations (UN) show that total population of the world will reach to 6,1 billion by the year of 2000. Turkey is among the most crowded 20 countries and its population consists of 1% of the world population. According to the 1998 data, population of Turkey is about 63 million. Parallel to other OECD countries, Turkey population pyramid shows that elderly population is increasing both in number and in ratio (3).

If the ratio of population aged over 65 is higher than 7% in a country, that country is considered being older populated. It can be seen that this value varies between 12% and 18% in developed countries. In Turkey this figure is estimated as 5% (4).

UN estimates that elderly population will keep increasing in 2000s. According to these estimations in 2000s, it is expected that the rate of people aged at between 65 and 70 is 13,2% and 75 and more is 5,1% in Europe. In Turkey, it is expected that the rate of older people will be 5,3% in the year of 2000, will be 5,5% in 2005, and will be 5,6% in 2010 (5).

The Elderly Services in Turkey

In elderly periods, some changes in human body and retirement after long working life cause some limitations in daily activities and changes in life style. When you add some health problems to natural changes in human organism, the problems of the elderly become more complex (4,6,7).

As of June 1, 1999 there are 50 elderly houses in 36 provinces providing their services to 5435 older people. Only those elder who are over 60, those who do not need continuos medical care and treatment, those who do not have serious and infectious disease, those who are health mentally, and those who are not alcohol and drug addicted are accepted to these houses. According to the result of an investigation about the older persons applying to these houses, the older persons who do not have any income are accepted for free while those who have enough income to meet the fee of these houses are accepted provided that they pay the fee (4,7).

Run by other ministries, municipalities, non-profit organizations, private sector, and ethnic groups, there are also 77 elderly houses providing services to 5823 older people (7).

Elderly information centers provide their services to those older people feeling lonely and desiring to make their diminishing relations strong. The beneficiaries of these centers are those who are living in their own houses or are living with their families or are not desired to be left alone at home. These centers give an opportunity to the older people to be together with other older people and to participate some social and daily activities (4,7).

The project of caring for older people at home includes the services aiming at meeting the needs which the elderly do not meet themselves or the needs that are not met by their families. For this purpose, those people whose are willing to participate this project are taken to training. After this training, they are accepted by the families whose older relatives are in need of care (7).

Government pays a salary quarterly to the older people who are over 65. But the amount of salary given is not enough to meet the older people’s need. In addition, free public transportation opportunity is provided to those older who are over 65. The majority of the elderly in Turkey do not have access to health and geriatrics services. Even if they are required to get these services, the number of facilities giving medical care services in bed is few and geriatrics services are scarcely available (5).

Though these services try to offset some problems of the elderly in Turkey, there are numerous problems still needing to be solved. With this study, it was purposed to show how a big problem Turkey is going to be more likely to encounter in the future by using nationally representative 1998 Turkey Demographic and Health Survey (TDHS).

Material and Method

The data used in the study come from the 1998 Turkey Demographic and Health Survey (TDHS), (8). Data were collected from 8,059 households on a wide variety of socioeconomic and demographic indicators at the individual-, household-, and community-level. The sample used for this study were those people who were at the age of 65 years and more. As a result of these inclusion restrictions, our sample consists of 1,106 older people.

In order to show the current situation of the elderly in Turkey, socioeconomic variables classified under individual-level, household-level and community level factors were selected from 1998 TDHS. Frequency distributions of these variables were summarized in the tables.

Findings

Table 1 contains descriptive statistics for community-level factors. The community-level factors included in the model consist of two indicators of the location of the older person's household: urban/rural status and geographic region. As presented in Table 1, 53.1 percent of total respondents reside in urban areas while 46.9 percent reside in rural areas. With respect to region, 29.3 percent live in the West, 17.0 percent live in the South, 23.6 percent live in Central Anatolia, 14.2 percent live in the North, and 15.9 percent live in the East region of Turkey. As the results show the majority of the elderly in the sample of this study live in urban areas and the West part of the country.

The descriptive statistics for household-level factors were summarized in Table 2. Almost 90 percent of the respondents reported that their household did not own a car. The type of floor was categorized into three groups: earth, wood and modern. 64.1 percent of the respondents reported living in a house with a modern floor, which was classified as being constructed of cement, vinyl, asphalt, ceramic, or carpet. The responses on the type of toilet used by the household were grouped into two categories: (1) flush toilet, and (2) pit and others. The majority of women resided in households that had a flush toilet (54.2 percent). The majority of respondents (72.3 percent) had telephone in their households and the house of 82.7 percent respondent was heated by stove. As seen from the table 2, although the main source of drinking water for the majority can be defined as good it is worth mentioning that still there are some households using rivers, water stations, or spring fountains. 56.1 percent of the households used piped into residence/garden.

The descriptive statistics for respondents-grouped age were summarized in Table 3. According to table 3, majority of the respondents (76.4 percent) have 65-74 grouped age, 23.6 percent of the respondents have 75 age and over. With respect to educational level and marital status, 51.4 percent of the respondents and did not have schooling, 0.4 percent did not get married. As presented in Table 3, 3.9 percent of total respondents did not have children, 45.8 percent live same house with their children and 66.6 percent has prime responsibility for welfare by himself/herself. It was pointed out that 25.2 percent of the respondents do not have any income and majority of respondents (93.4 percent) has no old age pension (Table 3). As seen from the table 3, 87.4 percent of the respondents had their own houses.

Discussion

According to the results 87.4 percent of the elderly in the sample of this study had their own houses while the remaining (12.5 percent) said that either they were living at rental houses or they did not pay anything for housing (Table3). There are many studies showing that there is a close relationship between the house and the elderly in terms of both physically and emotionally. For many elderly the house they live so important that when they have to change the house it is the case to die. (5).

Since the type of house, heating, source of drinking water and the type of toilet are very important factors affecting the elderly in their daily lives. The findings of this study showed that of the elderly respondents 82.7 percent were using stove for heating, 45.8 percent were living at the houses with pit or other type of toilets, 1 percent were using river, stream and take trucks as a source of drinking water, and 35.9 percent were living at the houses with earth or wood floor (Table 2). When the above figures are taken into account it can be said that the security of the majority of elderly are under threat because of decreasing abilities of seeing, hearing and muscle-skeleton. In the US, more than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. Hospital stays are longer in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason. Compared with the elderly, who do not fall, those who experience fall have greater functional decline in activities of daily living and in physical and social activity (9). The study of Sathiyasekara on 4,333 houses in slum areas examined the incidence of injury for 12 months, and found that 57 per 1000 injuries was home accidents (10).

Improving the quality of housing (healthy floor and toilet type, source of water, and heating) will decrease the incidence of falls, injuries, and burns and as a result of these improvements the elderly will have a quality live. Among the elderly to decrease unintentional injuries rate The Community and Home Injury Prevention Program for Seniors (CHIPPS) was set up and applied to a group of elderly. Reported falls were reduced by 60 percent after intervention. Scalds were reduced from 9 to 0 and burns from 7 to 0 during the six months period before and after the intervention (11).

By this study it was found that 25.2 percent of the elderly did not have a regular income (Table 3). When compared with the findings of the study done by Özcan et all. (12), it can be said that there is an improvement in terms of regular income of the elderly. It was shown that 54.1 percent of the elderly had a regular income in the study of Ozcan et all. (year). However it might be wrong conclusion saying that this is an improvement. Before saying this it is necessary to see the level of income since even if the majority said that they had regular income the amount they received might not be enough to have a quality live. The results of the study of Ross et al. showed that the elderly had the lowest level of income compared with the other groups (13). The results of having less income are the elderly depending on the others and the low quality of live for the elderly.

Looking at Table 3 it can be seen that 45.8 percent were living with their children and 66.6 percent had their own welfare responsibility. These findings are consistent with the other studies done on the elderly. For example the study of (12) showed that the big majority of the elderly (91.3 percent) were living with their sons and the elderly had raised traditional values by saying "...of course my son will take care of me because I also grow up him", emotional dependencies by saying "I can’t stand being away from my children", physical and economical dependencies by saying "what if I am in need of…." The results of the study of Bowles et all. revealed that frail elderly were significantly less likely to report feeling very close to family. Family contact, feeling that church was important and receiving church support was similar for the frail and nonfrail. Frail elderly were more likely to use community services (14).

The results of this study also showed that 72.3 percent of the elderly had phone in their homes and 10.3 percent owned a car (Table 2). These results also can not be ignored when one considers the social security of the elderly.

Conclusion and Recommendations

First of all actually Turkey has a big problem to improve the quality live of the elderly. The figures show that the majority of the elderly were living at undesirable conditions and the government or related institutions have to make better these conditions. Even if the result of this study does not support it, it is a fact that the rate of the elderly depending on their relatives and children is much higher than that of this study showed. That means that having irregular income or being lonely is very big problem especially in rural areas. The situation comes more serious when the Turkish culture is considered. Because the elderly may not say their real needs easily to somebody else, even if they are really in need of regular income, better food, more access to health care services, the study might underestimate the real situation of the elderly in Turkey. The another fact that this study raised is that the elderly are under threat of so many negative conditions such as using toilet away from home especially in rural areas, living at unsafe houses. All of these factors are among the reasons of accidents. For this reason either the centers must be increased in number or the programs should be prepared to make the elderly more knowledgeable how to lessen home accidents. Another fact that should be mentioned here that Turkey like other aged countries will anyway have to face with some financial burdens and problems to offset the aging problem. For this reason Turkey that is a country not under big pressures of aging problem has to take necessary steps in advance to make easier the aging problem in near future and to be ready handle aging. For example especially in aged Europe countries pension systems and their effects on economy have been discussed. Turkey should share the experiences of these countries and has to conduct more detailed studies concentrating on aging and its problems in the future.

By taking into account the results of this study some recommendations can be made to policy makers and researchers:

• • To make policies encouraging and supporting the projects of caring for the elderly at home

  • To have the older take some responsibilities on themselves

  • To increase the efficiency and improve the quality of facilities providing elderly services

  • To increase the facilities providing elderly services in number

  • To train the health personnel on geriatrics services

  • To give opportunity to the elderly to benefit from health care services easily

  • To give income opportunity to the elderly

  • To benefit from the elderly in the areas that they are interested in, and to have the elderly participate to manpower.

References

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  2. Hviding, K., Merette, M. (1998). Macroeconomics Effects of Pension Reforms in the Context of Ageing Populations: Overlapping Generations Model Simulations for Seven OECD Countries. Economics Department Working Papers, No. 201, OECD, 4.

  3. Çilingiroğlu, N. (1995). Demografi ve Sağlık. Bertan, M., Güler, C. (Eds), Halk Sağlığı Temel Bilgiler, Güneş Kitabevi, Ankara, 29-44.

  4. Akdemir, N. (1997). Hemşirelik Bakımı. Kutsal, G. (Eds), Geriatri. Hekimler Yayın Birliği, Ankara, 116-145.

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Table 2. The Distribution of Respondents by Household-Level Factors