The silent majority: the elderly population in Italy and in Europe at the time of Covid-19
The number of elderly people in Europe is growing steadily. The transition to old life is above all a family transition; independently of the cohabitation, all the members who are in relationship with the elderly find themselves filling new roles and assuming new responsibilities.
I chose this title The silent majority recalling the title of a text The deviant majority by Franco Basaglia and Franca Ongaro Basaglia, published for the first time in 1971. The authors analyze the typology of deviance and its insertion within the social and economic period, when in Italy the psychiatric culture was closed in an “ideology of diversity” which sanctioned the inferiority of the other. The big problem that Basaglia highlights is the custodial and punitive social organization.
Someone might wonder what this reference has to do with the elderly population today in Italy and in Europe. As a citizen and professional psychologist, I had to point out that the Western world became aware of the large number of the elderly only on the occasion of the number of deaths that the virus has mainly caused in patients aged between 70 and over.
And in what contexts did the virus spread? In RSA (Healthcare Residences) structures with exclusively elderly users, whose organization has nothing to envy to the depersonalizing and custodial Total Institutions of the 70s. We will all have observed how the information that the media provided on a daily basis, such as “war bulletins” on the dead, were devaluing and superficial when they focused on the percentages concerning the elderly. As prof. Alessandro Vespignani from Boston, interviewed by Lucia Annunziata, “… after all, as if they represented a burden”. Will this tragic experience serve to rethink and redesign the social and socio-health organization destined for this impressive number of citizens and their families?
From today the Italian population can be considered younger: they are officially “elderly” aged 75 and over. The turning point came from the National Congress of the Italian Society of Gerontology and Geriatrics (SIGG) which was held in Rome in November 2019:
Geriatricians launch the adoption of a dynamic definition of the concept of “seniority” that fits
Picture 1 – Istat data on the elderly population
Picture 2 – Istat data on the elderly population
The number of elderly people in Europe is growing steadily, according to Eurostat data. The Aging Europe 2019 report returns an already known picture, for some years, regarding the age, health and living conditions of the over 65s.
It is the entire European population that shows an upward age curve: the elderly are more numerous, their life expectancy is longer and at the same time fewer children are born. Eurostat writes that the average age of the population, in the 28 EU countries, on 1 January 2018 is 43.1 years. Translated: half of European citizens are over 43 years old. In Italy, this ratio is slightly higher, i.e. half of the population is already 46.3 years old.
In addition, the population of older people aged 65 and over in Europe is estimated to rise from 101 million in early 2018 to 149 million by 2050.
Although the studies of relational sociology highlight the weakening and crisis of the family, it is appropriate to deal with the phenomenon of aging in relation to this irreplaceable cell of society, expression of a natural need for encounter and exchange between generations.
If we refer to the life cycle of the family, the entry into the elderly phase today represents a new challenge in life, assuming that we are able to live the transition in a positive way. In fact, the transition to elderly life is above all a family transition, regardless of cohabitation, which does not only concern the elderly subject, but rather all the members who are in relation to him and who find themselves in that moment to fill new roles and assume new responsibilities. .
In this sense, the concordance between various factors is of fundamental importance for the well-being of the elderly:
Chronological age is no longer the primary element of the personal experience of aging; there is a gap between the society of images that focuses on chronological age and bodily modifications, and the personal perception of each.
The systemic approach, unfortunately, has not dealt with this phase of the family life cycle, despite the particular lens with which it looks at relational dynamics could offer a great contribution in dealing with the complexity and heterogeneity of families with older generations. The transition to old age must be analyzed from a relational perspective, identifying risks and resources precisely in the family context considered as a place of meeting and exchange between generations.
The phenomenon of grandparents as a resource in the family scene is present in all European countries, especially grandmothers, as a support figure in the care of children and I support parents engaged in the difficult task of reconciling family and work; a role that becomes particularly crucial for all single or separated parents.
Caring for grandchildren also plays a role in the balance between giving and receiving between generations and introduces a greater likelihood that, as adults, grandchildren will be willing to reciprocate by offering assistance to their grandparents.
The contemporary Italian family has inherited home care for its elderly from previous generations: from the 1980s onwards the recourse to the institutionalization of the self-sufficient and even partially self-sufficient elderly has decreased significantly. This has happened thanks to the fact that families have organized themselves autonomously in home care, despite a thousand difficulties, through a role of care giving generally carried out by women with the help of carers.
The first report on innovation and change in the Long Term Care (LCT) sector (edited by CERGAS SDA BOCCONI, 2018), photographed the existence of a silent army of 8 million family caregivers who self-organize to to meet the assistance needs of loved ones, even if they are no longer autonomous, who are joined by almost a million regular and non-regular carers.
Today it is the middle generation, the sandwich generation, which has undergone a progressive aging, leading to witnessing the phenomenon whereby “young seniors” find themselves lending support and help to “older seniors”. Continuing in this direction there is a strong risk that the excessive burden of home care can lead to the burnout of the family caregiver with consequent urgent recourse to hospitalization in nursing homes, experienced as defeat and with feelings of guilt that complicate the delicate transition from domicile at the Institution.
It should also be considered that the insertion in the RSA – Total Institution – on the one hand deprives the new guest of its specific singularity and on the other hand tends to make the family system feel “deprived” of taking care of one’s relative. This experience is described by family members as extremely painful and accompanied by a feeling of disorientation.
I had the opportunity to take care, as a trainer of operators of different professions, of the methods of welcoming the new guest and his family in numerous nursing homes. More critical issues were described by all the operators when the use of the residential structure is assimilated with the arrival to an emergency room rather than to a preparation and care of reception. In any case, the absence, or the low percentage of presence on the territory, of intermediate Care and Assistance services has always been noted, which can therefore delay, where actually necessary in the case of multiple pathologies and complexification of care, the transition from home to residential structure.
In the second report on the future of the LCT sector and the prospects of services (edited by CERGAS SDA BOCCONI, 2019), public, private and regional policy managers stressed the fundamental role of counseling for families, necessary to guide them on new services, such as:
The report ends with open questions on the directions that innovation will take:
Thus ends the report published in September 2019; now, in May 2020, we could add: “as the spread of Covid-19 in nursing homes for the elderly revealed”.