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Introduction
Population ageing is an obvious outcome of the process
of demographic transition. While the developed countries
of the world have already experienced the consequences
of ageing, the developing countries are facing them
now. The present paper reflects on some of the dimensions
of the elderly people's vulnerability in Tehran, Iran.
While the recent emphasis on studies pertaining to the
elderly in the developing world is mainly attributed
to demographic transition, the deteriorating conditions
of the elderly are results of the fast-eroding traditional
family system in the wake of rapid modernization, migration
and urbanization (Irudaya, Sankara, & Mishra, 2005).
This has in turn caused the elderly in almost every
society to face challenges and various forms of insecurity.
In Iran too, conditions, such as isolation, loneliness,
physical weakness, uncertain future, etc., contribute
to the sufferings of the elderly people as a whole.
Abuse of the elderly or elder abuse was publicly acknowledged
in the 1980s. It takes many forms, from passive neglect
to active torment, and includes verbal, emotional, financial
and physical harm. As the proportion of elderly people
rises, so does the incidence of abuse.
Most older people get support and comfort from their
families, but some people face exploitation and abuse.
No single term refers to abuse and neglect "any
action or inaction by any person, which causes harm
to the older or vulnerable person" (Council against
Abuse of Older Persons, 2002).
Abuse against elder persons includes physical abuse,
neglect (active or psychological passive), institutional
abuse, and domestic violence. However, most abuse against
elder persons comes from family members. Some theorists
say that abuse against elder persons fits into a larger
societal pattern of ageism and devaluation of elder
people (Harbison, 1999).
As in other parts of the world, there has been an enormous
growth in the elderly population in Iran also. Until
the early 18th century, global population size was relatively
static and the lives of the vast majority of people
were "nasty and short". Since then, the size
and structure of the global population have undergone
extraordinary change. More than three decades have been
added to life expectancy, with a further gain of one
or two more decades commonly projected for this century
(Bloom, & Canning, 2008).
If we look at the global ageing scenario, we would find
that the population of the world, which was 5.7 billion
in 1995, is expected to reach 10.8 billion by 2050-a
two-fold increase. In this fast growing population,
the percentage of the elderly will also increase rapidly,
i.e. from 9.5 in 1995 to 20.7 in 2050. Further, amongst
the elderly, the number of the oldest ones-those aged
80 and above will increase more rapidly. That is, from
320 million in 1995 to 1,050 million in 2050 (UN World
Population Projections, 1998).
So far as Iran is concerned, today, nearly 4,500,000
elderly people live in Iran. According to Iran's national
census in 2006, about 7.27 percent of the total population
of the country, and 6 percent of Tehran's population
were over 65 years of age. With regard to the current
demographic structure, it is anticipated to have an
unprecedented increasing trend of population ageing
in the years to come, i.e. from 7.27 percent in 2006
to more than 16 percent in 2050 - a phenomenon that
has never happened before. Besides, since Tehran City
has a good record of in-migration flow, the ratio of
ageing population will be higher than the other urban
areas in the coming years. It may also be pertinent
to mention here that those born in the early 1940s;
at the outset of Iran's modernization process, are at
present increasingly reaching ages 65 and over, and
are usually much concerned about their economic security,
safety, marginal participation, and economic independence.
This has also become a priority area for social welfare
planning in Iran.
Table 1 below presents comparative trends of the elderly
growth in Iran and Tehran City between 1956 and 2011:
Table 1: Comparative Trends in Elderly Growth in
Iran and Tehran City between 1956 and 2011
Source: Results of the Population and Housing Censuses
of Iran, 1956-2011.
As the Iranian society in general
and Tehran City in particular are transforming, the
characteristics of modern mega-cities are also appearing
in them. Similarly, as the families are also transforming
from traditional to modern, the living space is becoming
very small and tight. In this process, the elderly face
insecurity and other vulnerabilities. Besides, factors
such as social, psychological, economic and cultural
changes also influence the different dimensions of the
lives of the elderly, including their social security,
welfare, safety, social cares/services, and ageism.
In this backdrop, the issues pertaining to ageing, elderly
protection, residence quality, food conditions and their
social networks are of prime importance. As a whole,
the study intends to reflect an objective picture of
the elderly people in Tehran.
In this sociological appraisal, apart from studying
the physical, material and emotional well-being of the
ageing population, their socio-cultural similarities
and differences will also be appraised. The scenario,
therefore, considers the elderly's quality of life from
a variety of perspectives, such as demographic foundations,
social and family relations, economics, health, disability
etc. While the elderly with better economic conditions
have more social security in their old age, the impoverished
elderly largely face social insecurity. Therefore, paying
attention to the economic and social security of the
elderly, particularly the women, with regard to their
health and treatment services, is of prime importance
in both urban and rural areas (UNFPA, 1999).
The present study aims at identifying the quality and
quantity of different age-groups, including those moving
towards the old age, which would help the social planners
to be familiar with this hidden phenomenon that has
not much been touched by any governing body so far.
It is expected to improve the quality of life of these
people from the perspectives made in this study. For
the purpose of this research, the 'elderly' age-groups
of 60/65 years of age are included. Such people usually
have common characteristics (Turner, 2000). The study
would not only prove useful to students of gerontology,
social sciences and welfare studies, but also help social
workers, urban planners and others in understanding
the quality of life of these people in a better way,
their deficiencies, weaknesses and other dimensions
of their vulnerabilities. It could also be a beginning
for further studies in this field at national level.
In the present paper, consequences of change in family
as a unit, and in the living style of the elderly, their
expectations, and relevant sociological theories will
be analyzed. Besides, social policies necessary for
the elderly will be discussed at length. Though policy
makers and social researchers themselves, too, are prone
to sufferings arising from old age, in this regard,
they do not often project their own future and loneliness
(Shamloo, 1985).
Method
of Research
The focus of the research is to present a combination
of theoretic frameworks and empirical realties. For
the empirical part of the study, 500 elderly people
were randomly selected from different parts and neighborhoods
of Tehran City. They were approached through direct
interviews with the help of pre-designed questionnaires.
Eventually, the filled-in questionnaires were edited,
electronically extracted and presented in the form of
tables. The researcher also reviewed the background
literature on ageing population from different societies
of the world. In the theoretical part, the researcher
tried to refer to, and make use of sociological and
gerontological theories within reach.
The main hypothesis in this research is "increasing
security of the elderly positively enhances their quality
of life".
Findings
Among the respondents, i.e., 500 elderly people, who
were referred to, and surveyed in various parts of Tehran
City on a random basis, 89 (17.8%) were in the age-group
60-62, and 99 (19.8%) were in the age group 63-65. Gradually,
and with increase in age, the ratio and number of ageing
people finds a declining trend: in such a way, only
six (0.5%) of people within the samples were found in
the age-group 90 and above. The age structure further
shows that the sex ratio for the elderly (i.e., 60 years
and above) is 106 . This high sex ratio for the elderly
is due to high fertility and high maternal mortality
for the women in the past.
The survey also found that the elderly people with spouse
were 60 percent, whereas the percentage of elderly widows
was 29, male elderly 8.4 percent, and finally those
never married were 2.6 percent of the total elderly
studied in various neighborhoods of Tehran. Similarly,
55.8 percent of the respondents enunciated that they
never received any financial assistance from their sons,
whereas 19.2 percent received a little bit. Likewise,
18 percent declared that they were reliant on their
sons' assistance, and finally 7 percent stated that
they received a considerable amount of financial assistance
from their sons every month. In Iranian culture, parents
normally expect to be financially assisted by their
sons in their old age. The above figures indicate that
most of the elderly are facing financial constraints
despite having male offspring. So far as the emotional
attachment of the sons is concerned, almost 20 percent
of the respondents said that they were highly attended
by their sons, whereas 44.6 percent said that they were
much benefited by the emotional support of their sons,
and 35.2 percent declared that they were not absolutely
attended by their sons. The figure indicates that sons
did not care for their elder parents at all. However,
government support and help by social workers can to
some extent reciprocate this lack. That is to say, due
to such failure, social workers provide the elderly
with the necessary assistance.
Results of the survey further show that financial support
by daughters towards old parents is very insignificant.
While a little less than two-thirds, i.e., 63.4 percent,
of the respondents declared that they did not receive
any financial help from their daughters, 20.4 percent
asserted that they got a little bit, and only 16.2 percent
were satisfied with such help from their daughters.
Such a scenario strengthens the idea of son preference
in the Iranian society, and this heritage passes to
the future generations too. However, daughters emotionally
attend to their old parents very much, as less than
three-fourths, i.e., 73 percent of respondents gave
an affirmative answer in this regard, whereas only 27
percent replied in negative.
Generally speaking, such dissatisfactory help and attention
from offspring to parents, particularly in the old age,
and towards people who are highly traditional in their
lifestyles and attitudes, creates problems more due
to the emerging generation gap. Although literacy can
help the elderly to get themselves engaged in reading
books and newspapers, something like 27 percent of the
respondents were not literate at all. This percentage
was 16.7 for the male elderly and 37.8 for the female
elderly. However, in the present study, about 20 percent
of the male respondents had higher qualifications, while
this ratio stood at only 1.6 percent for the female
elderly.
The elderly people usually have plenty of leisure time,
and that is also reflected in the present study. While
about 48.2 percent of the respondents preferred to watch
television during their free time, 29 percent read books
and newspapers, and the remaining 23 percent used other
means of entertainment. Similarly, while the rate of
reading newspapers by male samples as leisure is 22
percent, 55 percent of female samples assert that they
watch television as their leisure.
The results of the research show that little less than
two- thirds of the elderly, i.e., 64.6 percent, had
mostly interrelations with their children, whereas 14.5
percent had it with their friends, 9.4 percent with
relatives, and finally 11.5 percent with neighbors and
others. While one of the psycho-spiritual needs of the
elderly people is known to be travel and tour, more
than 20 percent of them had not traveled at all during
the period of study. It is worth noting that the elderly
people in the Western countries usually travel very
frequently.
Within the samples of the present study, the elderly
were usually found satisfied with their access to medical
services. To a question about their health and safety,
only 39.3 percent of them declared that they were safe
and healthy. Health demography is very much associated
with safety and security. On the other hand, 25 percent
informed that they had arthritis problems, 10 percent
of them had diabetes, and 27.4 percent had other ailments.
In the course of inquiries, it was also found that 91
percent of the respondents were not interested at all
in staying in nursing homes.
Discussion
The basic concept of social security is not new to Iran.
Traditionally, a sort of traditional support system
(e.g., joint family system) existed before, to provide
security to elder destitutes and other vulnerable groups
in society. In such circumstances, family was the protector
of the elderly, and thereby, the elderly did not have
to resort to the secondary institutions, such as nursing
homes, for their protection. However, such a system
is gradually disappearing, and a state-based social
security system has come into being, but it is not adequate
for a large chunk of elderly population. Findings indicate
that the offspring still feel responsible to help their
elder parents as much as they can. For example, 18 percent
of the respondents receive monthly financial help from
their sons, and 7 percent assert to be fully assisted
by their sons per month.
Iran, which is comprised of 31 provinces and 1148 towns
and cities (SCI, Tabnak News, 2015), does not have the
conditions of a balanced development; in that, some
provinces are more developed, than others. Under such
conditions, some of the elderly people living in affluent
provinces are in improved and better conditions, whereas
others in deprived provinces need to be more attended
and cared for. In the latter provinces, they are in
a state of more insecurity and vulnerability. For example,
Tehran Province, especially Tehran City, is reckoned
as a more secure site for the elderly people. In Tehran,
the elder people have more facilities with regard to
public and private nursing homes, easier access to medical
facilities etc. They have more and easier access to
parks, hospitals and other sites which can provide them
with the required services. Therefore, under such circumstances,
men and women in other parts of the country tend to
migrate to this province, particularly Tehran City,
to be more benefited of care and security in their old
age. Similarly, as larger cities attract more social
and material capital in Iran, they are more developed,
and hence are provided with more facilities. Such perspectives
attract more elderly people; often accompanied by their
children.
Because of young population structure in Iran, almost
60.5 percent of the entire population of the country
stand at age groups 0-29 (Iran Population Census, 2011).
This young population is prioritized in different sectors
of planning and housing investments. Thus, smaller investments
on housing and health sectors are done in favor of the
elderly. For instance, while a great number of the elderly
people in various parts of the country are in immediate
need of protection centers, they cannot easily have
access to such facilities. They have to either live
alone, or be a burden on their offspring. Nevertheless,
it is hoped that more priorities would be accorded to
the elderly community in the sixth five-year plan scheduled
to start in 2017.
Based on inferences and ad hoc interviews with a number
of elderly people, they do face many problems as far
as their protection and care are concerned. However,
the elderly with poor socio- economic backgrounds face
multiple problems and constraints. What is therefore
required as an immediate step towards an improvement
in the elderly's quality of life, is the establishment
of centers for the elderly in all regions, which could
meet their various needs, such as habitation, care and
food. In the meantime, the negative attitudes of the
people towards nursing homes must be changed in an acceptable
manner, so that they could access improved social and
economic lives.
I must add that transformation of the economic structure
of Tehran City in the past few decades-from agricultural
to industrial and service sectors; in the wake of urbanization,
has, to a great extent, changed the attitudes of families
towards the elderly members, and the quality of protection
that they provide. They have now largely recognized
nursing homes as a social fact and as a positive alternative
to keep and protect the elderly. Younger family members
being involved in modern civil life, they have implicitly
come to recognize nursing homes as positive places to
accommodate, and attend the elderly. Increase in life
expectancy rate in 2015 up to 72 years for males and
76 years for females in Iran (World Population Data
Sheet, 2015), represents a good outlook of ageing in
the country, which requires appropriate planning in
both rural and urban areas. Based on table 1 in the
present paper, life expectancy has highly contributed
to increase in percentage of the elderly people between
1956 and 2006. Yet, increase in longevity is unjustly
distributed among various social strata in Iran. However,
such a transition contributes to rising needs of housing,
pension, medical care, etc., within the growing elderly
citizens. Generally speaking, this scenario has contributed
to the Iranian elderly people gradually facing the loss
of inter-generational solidarity and integrity. Somehow
or other, results of the study confirm the emergence
of the scenario.
Based on the research conducted in different parts of
Iran including Tehran City, there are considerable differences
in the quality of life within elderly males and females.
Males are found to be in a comparatively better position.
The differences stem mainly from more wealth that they
hold, possibility of remarriage after losing spouse
for males, more social respect for the male elderly
etc. Such opportunities more await male ageing people
rather than the females.
Theoretical
Concepts
In the past, not only in Iran, but in many other societies
also, the elderly people were considered as sources
of knowledge, rationality and experience. Currently,
with the passage of time, and as a consequence of the
social, economic and cultural changes taking place in
all societies, they have gradually lost their importance
and charismatic values. While in the 19th century, and
even in the early 20th century, grandchildren rarely
had the chance of seeing their grandparents, now and
particularly at the outset of the 21st century, with
the rise in average age, three or more generations have
got the opportunity to simultaneously live together.
Physical changes that spring up in people in the course
of time, are not necessarily displayed among all people
of the same age-groups in a similar manner, but their
physical and mental effectiveness, and their reactions
towards such factors, are different within different
age-groups of elderly people. In fact, the elderly suffer
one (in some cases, three at the same time) treatable
sickness(es) (Keddie, 1998).
From the demographic point of view too, the number of
the ageing people in Iran is increasing, and the scenario
needs the provision of more medical care, sufficient
nutritious foods, and other necessities of life. Under
such conditions, special social policies should be made
and applied for these elderly people, and any failures
in this regard would lead to problems for them, and
consequently they would reflect as a burden. In other
words, though entering old age has been identified as
ages 60-65, i.e., the age in which people usually retire,
yet, we cannot apply a definite age border in which
the people should be named 'aged' (Akbarzadeh, 1997).
In another definition, old age has been called repeated
dependency, i.e., a period followed by the period of
dependency and socialization, followed by the second
period, i.e., independence and maturity, and eventually
the 'Third Age' or the beginning of the elderly period
(Laslett, 1998).
Census data indicate the sex ratio of 108 for those
elderly people aged 80 and over (Population Census of
Iran, 2011). Therefore, with regard to increasing female
elderly, more arrangements should be made to protect
them in their old age. Elderly women being poorer than
men due to their limited sources of income in their
old age, need to be more protected and attended.
In a global comparison, in the developed world, while
17 percent of the people are aged 65 and above, the
ratio stands at only 6 percent in the developing world
(World Population Data Sheet, 2015). In this regard,
Iran's ratio of ageing population stands at 7.3 percent,
and that of Tehran City stands at 6 percent (Iran Population
Census:2006). On the other hand, while because of ageing,
there happens a sharp fall in people's safety, and people's
social costs, their medical and health costs increase
(IFA, 2015). In this regard, creation of supportive
establishments at neighborhood levels would be very
effective and enabling.
Social
Isolation of the Elderly People
One of the main dimensions of social insecurity and
vulnerability of the elderly people stems from their
social isolation. In fact, isolation is one of the general
issues of old age, and that is the result of the elderly's
non-functionality or lack of role in the society. However,
it is extremely difficult to measure or define social
isolation (Shanas, 1968). It may be objective (e.g.,
social contacts can be counted), or it can be subjective
(e.g., people can be asked about their feelings). Most
studies on social isolation have been concerned primarily
with the four types of isolation as outlined below:
• By comparison with their contemporaries in the
developed world: peer-contrasted isolation.
• By comparison with younger people: generation-contrasted
isolation.
• By comparison with the social relationships and
activities enjoyed by (other younger or middle-aged
people): age-related isolation.
• By comparison with the preceding generation of
old people: preceding cohort isolation.
Measurement of isolation usually consists of information
about social activities as a way of estimating the number
of social contacts (Townsend, 1968).
Quite a lot (one-fifth) of those interviewed in the
present study were found isolated, or extremely isolated,
and the majority of them included women (widowed). This
high percentage of isolation within the elderly people
is more due to the breakdown of joint family system,
weakening of family network, and more migrations by
the younger family members in Iran in current times
as a whole. Isolation does not necessarily increase
with age, but there is little variation in the likelihood
of being visited by family, friends and relatives. The
appearance of this phenomenon is highly due to the complexity
of life in highly populated Tehran City with a poor
and congested transportation network. Though the two
concepts of isolation and loneliness are almost synonymous
and are used interchangeably, yet, there is a conceptual
distinction between the two. Isolation relates to circumstances
(which can usually be measured, however crudely), whereas
loneliness relates to feelings (often about these circumstances).
Widows are also likely to experience loneliness as do
others who have been bereaved (Bury & Holme, 1991).
The problems of isolation and loneliness not only arise
within the elderly people who are dispersed in a city,
but they may also happen to the elder people residing
in nursing homes. Studying the older people in residential
care, Townsend (1986), has commented that "the
lack of even a single friend, a higher rate of severe
or frequent loneliness, the discouragement of spontaneous
social activity, the inability of visiting relatives
and friends to adopt useful roles, the lack of satisfying,
and sociable occupation, all represent isolation and
loneliness by the elderly even in care centers."
Social isolation is more problematic for women, since
they usually live longer than their male counterparts.
Culturally speaking, women usually have less outside-home
relationships and contacts in Tehran City as compared
with men, and that contributes to more likelihood of
isolation among them. Similarly, as mentioned earlier,
women in Tehran City have longer life expectancy than
men in this city. Such a phenomenon makes them highly
vulnerable in various grounds and spheres. Under such
conditions, women are more prone to psychological sufferings
like dementia. While sociologists highly recommend that
the elderly people should have their own independent
lives, yet providing them with adequate financial resources
remains unsolved in many instances. Clinicians have
identified a broad array of risk factors typically associated
with elder abuse and neglect (Podnieks, 2004).
Factors such as caregiver's mental health, substance
abuse, dependence on the care recipient etc., have been
described as important indicators leading to social
isolation of the elderly people. Similarly, widowhood,
the deaths of friends or children moving away can lead
to social isolation (Hall & Havens, 2002). Such
circumstances widely relate to Tehran City too.
To get rid of the problem of isolation among the elder
people, social networks can prove to be very important.
These networks may include both the fellow co-residents
as well as from beyond the household, including friends,
neighbors, etc. So far as the elderly in Tehran City
are concerned, there are still further steps to be taken
in their favor. For example friendship centers are to
be established in neighborhoods to help them with isolation.
The Elderly's
Housing
Adequate and suitable housing is also reckoned as an
example of the elderly security, and the provision of
which would bring safety and security to the weak and
disabled elderly people. However, there is a growing
recognition of the link between poor health and housing.
Features such as the absence of stairs/ramps may force
even a very frail person to continue living independently.
Many old people, however, live in less than desirable
housing and some of them have particular problems. There
is evidence too, that some people remain in residential
care only because alternative accommodation is lacking
(Wagner, 1988).
In the course of interviews with the senior respondents
in Tehran City, the researcher came to know that almost
60 percent of the interviewees preferred/wanted neighbors
without children. The study found that such housing
sites give elder people more feelings of well-being
- giving them more control over their social contacts.
Though the problem of elderly's adequate and suitable
housing has to some extent been tackled in the Western
societies, it still does exist in the developing nations,
including Iran. If we look at the basic family structure
in Tehran City, many parents are found to live with
their children, as joint families. Therefore, the elderly's
housing quality tends to depend on the economic capacity
and shelter patterns of the household. It is worth noting
that the trend in population ageing (growth) in Iran
is even faster than its socio-economic growth rate.
Thus, if necessary arrangements are not made for the
elderly in a futuristic manner, the gap/difference will
contribute to further challenges for the elderly. In
view of this, dealing with this problem in urban areas
has been a priority for the large City of Tehran.
So far as preferences in apartment living is concerned,
no single type of housing fits all older people in Tehran.
But, older people do prefer some types of apartments
and neighborhoods over others; depending on their middle-age
lives and backgrounds.
Types
of Insecurity
Although there has been a rise in the all-age mortality
from accidents, the number of deaths from accidents
in those aged 65 and above is fairly constant. In the
course of study, the researcher came to know that the
elderly people are frequently at risk of different conditions.
• Older people, like people of other age-groups,
suffer domestic accidents, fires, burns, poisoning,
road/workplace accidents and falls.
• Older people are at particular risk from injury
or death from domestic fires.
• Falls account for almost one-third of deaths
from all accidents. Older people are at particular risk
with 65 percent of fatal falls occurring among those
aged above 75.
Risks Factors and Recommended
Strategies
The risks factors that the researcher acknowledged are
associated with accidents and injuries among old people
are very broad, and include the following:
• Environmental factors
• Inappropriate use of medicine
• Poor health status
• Disability
• Being overweight
• Lack of exercise
• Nutritional deficiency
• Poor housing
• Lack of training for careers
However, as the number and proportion of the elderly
people in Iran is growing; especially those living alone,
they may be more vulnerable to accidents. Therefore,
greater attention should be paid to their safety and
security both inside and outside home. Thus, a number
of strategies aimed at these people should be implemented:
• Extended awareness programs for elder people,
their careers and health professionals, associated with
accidents.
• Promotion of healthy ageing practices, such as
reduced smoking, increased exercise etc.
• Educational programs to improve knowledge and
safety skills.
Conclusion
In this research, a multidimensional perspective of
the elderly people's lives in the capital City of Tehran,
as part of the macro society of Iran, is presented.
The research reflects that the 'new elderly' (those
born in the early 1950s) have even more concerns as
compared with the 'older elderly', or a generation before
them. Tehran City, being a migrant-receiving city, while
the ratio of its in- migrants is higher than other cities,
the expectations of the elderly people in this city
are by far different from those in other cities. Under
the conditions of modern life, elderly's general welfare,
care/protection and financial constraints are quite
remarkable in different neighborhoods with special reference
to the current socio-economic conditions.
Tehran City is considered as a part of the country wherein
the elderly are more prosperous. They have easier access
to medical care, nursing homes etc. Based on research
done in various age-groups, marked variations have been
found with regard to the quality of life of male and
female elderly people; stemming from more wealth within
the reach of males, possibility of remarriage by the
male elderly and so on. While the improved socio-economic
conditions have made it possible for three generations
to live together, yet, modern life has also forced them
to live away from their families. Regardless of class,
race, creed and color among the elderly, what is common
among them, is disability and dementia.
While this research has considered and analyzed some
of the challenges, profiles and problems of the elderly
people, yet, the scenario of ageing needs more research
studies on a regular basis in the future too.
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