From ‘cure to care’ among the elderly

General theme
Old-age research in developing countries is gradually gaining in importance in the Social Sciences. However, anthropological studies on elder care, care support schemes and burden of elder care are only in its initial stage. This proposed research builds on review of current literature and on findings of a previous study of the applicant on old-age vulnerability in Southeast Asia, where care needs related to chronic illnesses were identified by the elderly persons as principal spheres of concern. As a matter of fact, in non-Western societies the degree of old-age vulnerability is influenced to a great extent by providing – or just failing – care support.

Theoretical Framework
This Medical Anthropology research study is based upon the conceptual framework of ‘health transition’ – that includes rapid demographic and epidemiological transformation, fast urbanisation and migration as well as broad change of lifestyle in most developing countries – and correlates it with the assumption of a growing ‘triangle of uncertainty’ for elderly people nowadays in developing countries (i.e. uncertain family, kinship and community support, minimal state provision, and increased risk of suffering concurrently from an infectious and a chronic disease). Harsh living conditions for elderly in Sub-Saharan Africa, shaped, for instance, by economic poverty, poor access to professional health services and last but not least the HIV/AIDS pandemic, put already a heavy burden and strain on the elderly whose most important asset is still a healthy body and mind. Along with the global processes of ‘health transition’ and the ‘triangle of uncertainty’, appropriate and adequate care for frail elderly becomes a major challenge for every society in Sub-Saharan Africa. The above-stated transformations postulate a distinct shift ‘from cure to care’. Care in this sense is understood as both practice and attitude and encompasses more than mere medical activities. Households ‘produce’ not only health, but also care which belongs to the biggest part into the realm of lay people and of women as principal caregivers. The ‘vulnerability’ concept refines these approaches by regarding elderly individuals as being social actors who share particular risks and exposures, but who can mobilise coping resources and potentials to prevent, mitigate or overcome bad outcomes.

Objectives
The five specific research objectives are:

1. to identify relationship of main carer(s) to chronically ill elderly and main activities of care and support provided by care-givers,
2. to look into resources and capacities of elderly people which strengthen their resilience regarding care and support,
3. to explore the significance of rural-urban relations for chronically ill elderly persons and their caregivers,
4. to find out the role and burden of caregiver(s) providing elder care and support, and
5. to study the burden of disease (etic view) and burden of illness of chronically ill elderly people (emic view) and assess nature and priority of health improvements.

Methodological Approach
Qualitative and, on a smaller scale, quantitative research methods are applied to achieve these objectives. The study approach comprises different societal levels, namely community, household and individuals, and diverse stakeholders. The research period will last three years (January 2008-December 2010). In order to study urban-rural dynamics in relation to care schemes and old-age vulnerabilities as well as mobility of elderly people and their caregivers, we have designed a research approach that includes a rural and an urban area. Main research area and also ‘point of departure’ is the Rufiji District (in Pwani or Coast Region), and metropolitan Dar es Salaam will be the selected urban environment. In Tanzania, we have an interdisciplinary research team including two PhD students (of Social Anthropology); the main applicant acts as principal project coordinator.

Das Scheinbild: Alte Leute in der Werbung für Mobilfunkanbieter, Dar es Salaam
(Photo: Piet van Eeuwijk)

Relevance
This project makes a major contribution to old-age research in developing countries, particularly to care schemes. The effects of ‘health transition’ and concomitant HIV/AIDS and poverty on elder care schemes in non-Western societies are not yet widely studied and understood, thus this research fills this gap of knowledge. Moreover, this study strengthens the international dimension of North-South research and exchange. And finally, it will provide empirically grounded recommendations for Tanzanian researchers, politicians and policy-makers.

Keywords: Care, Elderly, Old-Age Vulnerability, Health Transition, Medical Anthropology, Tanzania