Before the arrival of COVID-19, which led to our mandatory, preventive social isolation as a means to mitigate its outbreak, it was common to see elderly couples out on the streets of Buenos Aires, going about their daily lives at a leisurely pace. And whenever I saw them, I would wonder: Who is taking care of whom? The answer is particularly important today since we all know that older adults are the social group that is most at risk.
Consequences of Increased Life Expectancy and an Aging Population
Increased life expectancy and the aging of the world’s population are two converging processes. The former derives from the control of infectious-contagious diseases and medicine’s technological advancement, while the latter results from the global increase in the population that is over the age of 60 and the reduction of younger age groups.
In Argentina, the National Population Census conducted in 2010 indicated that the percentage of adults over the age of 65 was 10.2% and, specifically in the Autonomous City of Buenos Aires, the percentage increased to 17%, so its population is considered the highest aging population in the country.
In parallel with this transformation, there has been an increase in the prevalence rates of diseases caused by human behavior (such as obesity, traumatic brain injuries, and those caused by smoking and leading sedentary lifestyles) and by neurodegenerative processes (such as Alzheimer’s Disease and Parkinson’s Disease). In this regard, Alzheimer’s Disease International reported that, in 2018, every three seconds someone in the world developed dementia and only half of them were diagnosed.
Therefore, we can estimate that a large number of older adults have a high probability of suffering from disabling conditions and that other older adults—in addition to addressing their own aging—will have to become primary family caregivers.
Family Caregivers and Their Burden
A family caregiver is defined as a relative, friend, or neighbor who belongs to the social support network of a person with a chronic condition and who dedicates the most time to his or her care. Family caregivers do not receive financial compensation for the tasks they perform, and they are perceived by other family members as primarily responsible for the patient. Therefore, when the demand levels involved in taking care of a family member with dementia exceed the caregiver’s internal and external resources, he or she experiences negative emotions and perceptions, subjectively characterized by a feeling of burden, grief, strain, or distress regarding his or her caregiving role.
These circumstances have led to studies that analyze the impact of caregiving tasks on the well-being of family caregivers. Findings show that taking care of an older adult with a disability is a stressful process that heightens the likelihood of having physical and mental problems and increases death rates. Therefore, scientific literature describes caregivers as “second victims” of the condition or “hidden patients.”
Most caregivers are women and, regarding kinship with the patient, they are predominantly their wives and daughters. So far, studies point to the greater vulnerability of women caregivers, and even more so if they are older adults. In this regard, in a preliminary study of elderly wives as caregivers, we found that 93% of them had high burden levels and 60% had geriatric depression.
However, in recent years we have seen an increase in the percentage of men who are starting to take on the role of family caregiver. We should clarify that, although results are preliminary, some authors point out that the impact on their well-being is lower, which would be associated with the fact that, in general, men have help carrying out housework. In contrast, women tend to take on and combine both housework and caregiving tasks. This increase in the proportion of male caregivers is observed in most countries that have different degrees of support and social and health resources available. The Men… Let’s Share in Caregiving! article (in Spanish) addresses the unequal distribution of tasks between men and women and describes the resources available in each Latin American country.
Social Determinants of Health in Argentine Family Caregivers
The WHO describes “Social Determinants of Health” as conditions in which people are born, grow, work, live, and age, including health systems.
When comparing the findings of two studies carried out in the Autonomous City of Buenos Aires and its areas of influence (in the 2004-2008 and 2012-2018 periods), we observed certain changes in the sociodemographic profile of the caregivers we interviewed:
- The average age of family caregivers rose from 58 to 70.
- Regarding gender, women outnumbered men (71% and 75%, respectively) in both periods.
- Regarding education levels, in the first period, 35% of caregivers had had a high-school education, and in the second period, 39% of caregivers had had a college education.
- Work activity decreased from 54% (in the first period) to 37% (in the second period).
- The relationship of the “patient-caregiver” dyad showed marked changes: spouse caregivers rose from 44% to 62%, while son or daughter caregivers fell from 42% to 26% between the two periods that were compared.
- While male caregivers were a minority, an increase in the number of husband caregivers was observed between the two periods (from 65% to 92%).
Gender differences have traditionally been analyzed as the consequence of genetic and/or endocrine factors. However, in recent decades, sociocultural variables have become more prevalent, like those that condition the manner in which men and women express and cope with their psychological distress.
Lastly, we think it is necessary to underscore the substantial epidemiological, social, and economic impacts that chronic diseases generate throughout the world. It is therefore imperative that the health system address them by attending to the specific requirements of patients and their family caregivers, especially considering the age and gender of these new caregivers.
What is long-term care like in your country? Access our “Age with Care” publication to learn about the long-term care systems that exist in the region.