Written by Stephanie Yu-Ching Chen.
Taiwan has an ageing population. The total proportion of elderly people exceeded 14% in March 2018. Among Taiwan’s 25 counties and cities, the proportions of elderly people are the highest in Chiayi, Yunlin, and Penghu counties. The proportion of elderly people is the highest in Chiayi county, reported as 18.4% in 2017 alone. In Chiayi County, 20% of the total employed population works in agriculture, forestry, fishery, or animal husbandry.
Chiayi in particualr is representative of Taiwanese villages with aging populations. There are three main problems characterize such villages: (1) inadequate employment, insufficient resources, and serious population drain; (2) chronic diseases are more prevalent in the elderly population than in the overall national population, but medical resources in aging communities are insufficient, and elderly people often do not seek the medical treatment they require; (3) the education level of elderly population in rural villages is low, and health literacy is generally poor.
In particular, in Chiayi county, low employment opportunities are contributing to a serious outflow of young people. The county’s social increase rate is −3.3%
Chronic diseases are prevalent among people aged over 65 years. In 2013, 81.8% of this age group in Taiwan reported experiencing more than one chronic disease. Compared with the average for the national population, numerous chronic diseases occur more often among elderly people, including high blood pressure, osteoporosis, high blood lipids, asthma, gastric or duodenal ulcers, liver and gallbladder diseases, arthritis, mental illness, and uterine and ovarian diseases. Among elderly people in Chiayi, 91% reported requiring family assistance when going outdoors. Thus, care for elderly people is a major burden on the people and government of Chiayi County.
The education level among elderly people in rural areas in Taiwan is generally low. In Chiayi county, 12.86% of people aged over 65 years are illiterate, and 79.3% have received education until primary school or below; by contrast, the education level of elderly population nationally (illiteracy rate, 7.7%; primary school or below, 59.1%) is higher. Older people with low literacy may delay seeking medical treatment due to lack of information and understanding; they may underestimate the severity of a disease. For example, among elderly people with a low educational level in rural areas, approximately 24% did not seek medical attention for degenerative knee arthritis. Inconvenience of transportation or lack of accompaniment may also cause elderly people to delay seeking medical treatment.
The Taiwanese government has established community health care centres to improve the health of elderly populations in rural and remote areas. These health centres promote integrated care for chronic diseases and provide mobile medical service, composite screening, and drug education for community members.
However, additional measures are required to resolve the challenges of insufficient human and material resources, super aging, and low education level. Education of elderly population in rural areas should be strengthened through the promotion of aging friendly environments, development of textbooks to improve literacy, and provision of community volunteers to assist the elderly in learning self-care for chronic diseases.
1.Promoting aging-friendly communities
To solve the problem of region-specific lack of children, aging population, talent drain, and unbalanced development, Japan’s Abe administration launched a “Local Creation” policy in 2014 to inspire young people to return to their home regions and engage in innovation, entrepreneurship, and creation. Similarly, the National Development Committee of Taiwan proposed the “Design for Flip: Local Creation” project in 2016. This project combines resources from numerous sectors, including culture, industry, agriculture, and tourism. Township and county governments may apply the project measures to attract young people to return to their home communities and contribute to the care of elderly population. However, this policy still faces severe challenges, and limited success has been reported from its implementation. The primary task of elderly care in the rural areas of Taiwan is to empower community members, integrate social resources, and strengthen aging-in-place networks.
2. Developing educational materials to teach life skills to older people with low literacy
Education level, economic status, and physical health are critical factors that contribute to whether elderly people participate in learning activities. People with low literacy often experience psychological phenomena such as low self-confidence, low self-esteem, and feelings of worthlessness and helplessness when living with medical conditions or attempting to use medical resources. Therefore, educational activities that assist these senior citizens with low literacy in attaining basic literacy skills are critical to enabling them to gain opportunities and confidence.
3. Empowering volunteers to help older people with chronic disease self-care
Medical resources in Taiwan are insufficient to address the needs in Taiwan’s rural areas. Even if all the nurses currently in the island’s health care system were assigned to care for the elderly people of Taiwan, the numbers would not be able to cover the entire elderly population.
In 2009, SenEmpower project courses to train volunteers to work with senior citizens were established by the European Commission at six locations in Europe. SenEmpower offers training to the members of senior citizens’ self-help groups and promotes voluntary initiatives to empower seniors with weak family and social networks to assume active roles in society. Compared with health professionals, volunteers experience more opportunities to connect with elderly people in their community and understand elderly people’s family backgrounds and problems with disease adaptation.
Furthermore, low education levels and economic disadvantages are common among elderly people in Taiwan’s rural areas. These populations are vulnerable and require accessible, long-term care. Therefore, the involvement of volunteers in rural communities to help older people with chronic diseases learn about self-care is worth further promotion and evaluation.
Stephanie Yu-Ching Chen is Associated Professor at the faculty of Department of Adult and Continuing Education at National Chung-Cheng University, Taiwan. Before joining the University, she has worked in the Department of Health, Executive Yuan from 1991 to 2008. Image credit: CC by Pixabay.