Eldercare across cultures – what makes us different and what can we learn?

Routine headlines like ‘Families’ Horror at Privately Run UK Care Homes’ (Guardian), or ‘The WORST Care Homes in England: Interactive Map’ (Daily Mail), appeal to a quiet shame many of us feel about the state of eldercare in the UK. It’s hard to escape the sense that many other countries, other cultures, treat their elders better than us. But is that totally true? And if so, why?

I’ve been fortunate to live and spend extended periods of time in several other countries around the world. During my time in South East Asia, I observed and was inspired by the profound respect and reverence shown towards elders, which stood in such contrast to how elder people are regarded and treated in the UK. Equally, in Latin cultures (Italy, Spain, central and south America), I noticed strong family ties, the taking care of elders within the family, and more intergenerational mixing at social events.

It always made we wonder why we have such a different attitude and approach towards elders and why growing old has such a miserable undertone in the UK.

Why are we different?

Drawing comparisons across cultures is notoriously tricky as each nation has its own peculiar set of arrangements, influenced by a complex interplay of historical, geographical, religious, economic, and social factors. But I’ve done a little digging as to why some cultures respect and include their elders more than others.

Bearing in mind this is a loose sketch, a general starting point is whether countries are rooted in individualistic or collectivist cultures.

Latin and Asian societies, like those I observed, have collectivist cultures and values, which prioritise the needs of the (extended) family and community over personal desires, and great value is placed on family interdependence. The social framework encourages a positive view of both the ageing process and elders.

In contrast, the UK is deeply rooted in individualistic culture, where self-reliance and individualism are esteemed. Dependence is viewed unfavourably and leads to a loss of social status, contributing to a negative view of ageing and a loss of self-worth as health declines and dependence increases.

Economics has also played an important role in our differences. The UK was the first country to industrialise, witnessing a mass movement of workers from the fields into the cities and new factories. Naturally, as people moved away from their families to seek work, family bonds weakened over time. Our long-established welfare state, while providing a safety net, has also lessened the sense of personal responsibility for looking after our elders.

Cultural and regional differences have started shrinking.

In many cultures where elders have been traditionally respected and treated well, globalisation and changing economics are altering the status quo.

Within living memory, most Chinese generations lived together under one roof. Today, just 38% of over 60s live with their children. The two great homes of filial piety (duty to respect and care for parents), India and China, are today dogged by shocking stories of families abandoning or abusing their elders.

The Chinese government is so concerned about this shifting social change that it passed an ‘Elderly Rights Law’ requiring children to visit their parents “often,” or face fines and even jail.

Changing demographics also weigh heavily. Like us, many of these countries face daunting demographic projections with rapidly ageing populations and steep declines in fertility rates. According to the World Bank, China has the fastest-growing ageing population: by 2050, 40% are predicted to be over 60.

All eyes on Japan and Singapore

As alarm about the ‘ageing population time-bomb’ has spread around the world, all eyes are turning to Japan and Singapore.

For decades, Japan has led the world both in population age (nearly a third of the Japanese are already over 65), and efforts to address it.

In Japan, like much of Asia, elderly care is deeply rooted in the culture of respect and familial duty. The concept of oyakoko (filial piety) emphasises honouring one’s parents and taking care of them in their old age.  

Living with parents and grandparents in Japan has been a traditional practice for many years. However, while multi-generational households are still relatively common in rural parts of Japan, this type of living arrangement is declining for many reasons, including a growing emphasis on individualism amongst younger generations.

To address this issue, and maintain the benefits that multigenerational living can bring, shared intergenerational sites have been created across Japan. The yoro shistesu (meaning ‘facility for children and elderly’) come in various forms from day care to long-term residential, such as Kotoen – a nursing home in Tokyo that has a shared facility with childcare. 

Equally, an important feature of Japanese culture is the fear of being a burden to your family or society, meiwaku. This is a big motivation for older Japanese to retain their independence… and keep working. Japanese elders have a high uptake of hobbies, social activities and light exercise, which support higher cognitive performance, better health and general well-being. Remarkably, it is often groups of senior citizens who proactively initiate community ‘healthy ageing’ programmes and activities themselves.

Singapore, also a collectivist culture, offers another useful blueprint for action. Their population is ageing at an unprecedented rate (by 2030, it is estimated that one in four Singaporeans will be over 65) placing immense strain on families and health services. However, the nation recognised the need for coordinated planning and policymaking early, and have adopted a holistic, ‘whole of society’ approach. It’s 2023 ‘Action plan’ emphasises preventative health, with community-based ‘Active Aging Centres,’ older adult learning, employment opportunities, intergenerational interactions and digital connectivity.

What does this teach us how we can improve?

Firstly, maybe we don’t need to be quite so down on ourselves.  Looking around the world, even the (historically) best countries to grow old in are struggling to cope with many of the same forces, and rapid change, that we contend with.

There is a lot we can learn from the practical initiatives and policies that countries like Japan and Singapore have put in place, and it’s encouraging to see some of these starting to appear in the UK. Combining eldercare and childcare, the UK’s first intergenerational nursery, Apples and Honey, opened on the grounds of Nightingale House care home in London. Organisations like Share and Care, that promote intergenerational living outside the traditional family set-up, have also sprung up in recent years.

Practical initiatives like these have an important role to play. But for me, a major lesson to be drawn, and one of the key reasons why I think countries like Japan and Singapore are tackling the issue so well, is the deep underlying respect for elders in the social consciousness.  

Perhaps the most useful measure we can take to make a success of the huge demographic changes ahead is to cultivate a culture that values elder people for their wisdom and experience. The question is, how do we do this?

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Are you caring or have you ever been a carer for your parent or elder relative?

Are you caring or have you ever been a carer for your parent or elder relative?

Eldering would like to better understand general attitudes and experiences around preparing and caring for ageing parents in the UK, so we can raise awareness of the challenges people face.

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