In noting the 70th anniversary of the Universal Declaration of Human Rights, did you know that there is no universal declaration of the rights of older adults, like there is for children and indigenous peoples? What does exist in the United Nations is a space for formal discussion about which rights are the most relevant for this population.
The issue of older adults initially seemed to concern only some developed countries. In 1991, when the United Nations Principles for the Elderly were adopted, only 7 percent of the population in Latin America and the Caribbean was 60 years of age or older. By 2010, when the United Nations’ permanent Working Group on Aging was established, that figure had increased to 10 percent, and that number will increase again soon for the region. In the coming decades it is expected that the growth of the older adult population will accelerate, so that by 2050, one out of every four inhabitants of the region will be older adults. As a point of comparison, while in only 35 years the structure of the population of the region will change, it took almost double that amount of time (65 years) for the same demographic change to occur in Europe.
Autonomy vs. Dependency
The United Nations has recognized that specific efforts are needed to improve the living conditions of older adults, including access to health and long-term care services. This last point is particularly relevant, since older adults are more likely than other population groups to require support to perform basic tasks that most of us consider ordinary and personal. This includes, for example, making decisions about personal finances or medical treatment or doing extremely private activities such as using the bathroom and showering. According to IDB estimates, 11 percent of older adults (60+) in Latin America and the Caribbean have difficulty performing at least some of these activities. This proportion increases considerably in the older age groups and affects women more than men.
The most recent technical discussion of the Working Group on Aging addressed, among others topics, the role of autonomy in long-term support services. It understood autonomy as the ability to choose and make decisions in accordance with one’s conscience, values, will, and preferences.
At first, it might seem difficult to reconcile the concept of autonomy with the idea of needing the help of someone else to carry out activities of daily life. However, keeping this principle in mind is essential to maintaining high-quality long-term social and health services aimed at the elderly in a situation of dependency.
But this is not a simple task because it involves complex dilemmas such as:
- What is more important, respecting the will of the elderly or their safety? For example, what do you do when a person insists on living alone, but has already suffered some falls, though luckily has not (yet) fractured a hip? What do you do if the person forgets to take his or her medications and does not follow the proper diet to control the diabetes he or she suffers from?
- What should the people who care for the elderly prioritize? The abilities of the elderly to carry out activities or the time and costs of care? For example, what do you do when the option of partially assisting an older adult to get dressed takes much more time than doing it for them?
Frequently, the people who make these decisions are family members and service providers, depriving older adults of control to decide what is best for themselves.
Do Not Silence Their Voices
Few countries identify autonomy as a right of the elderly. This is a fundamental first step to generate spaces and protocols so that the provision of services considers the will and preferences of the elderly. A promising effort to incorporate the voice of users of services in the measurement of the quality of long-term support services is the quality of life module of the standardized instrument interRAI.
There have been some advances in Latin America and the Caribbean. More and more countries are incorporating long-term support services into their legal frameworks on aging and disability, and some are considering implementing comprehensive support systems. For example, in Costa Rica the law gives users the right to maintain close relationships with family and friends, to be informed about their health condition, and to oppose receiving excess medication. In Uruguay, the National Integrated Care System considers the respect to their personality, human dignity, and privacy as a right of the users.
These efforts are critical, but the road ahead is long.
What does the legal framework in your country say about the autonomy and independence of older adults? How do you think we could move towards aging with autonomy? Share your answer in the comments section or via @BIDgente on Twitter.