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THE LIFE STYLE OF THE ELDERLY AND IT’S

IMPACT ON THEIR QUALITY OF LIFE AT BARANGAY DAL-LIPAOEN NAGUILIAN,

LA UNION

An Undergraduate ThesisPresented to

the Faculty of the College of NursingUNION CHRISTIAN COLLEGE

In Partial Fulfillment of theRequirements for the Subject

Research I

By:

Avelino C. Marzo Jr.Nika Joyce Nardo

Joana Marie Casaclang Ruzzell Nimes

Mary Ann Generao

March 2011

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ACKNOWLEDGEMENTS

The researchers convey their deepest gratitude to the following that have significantly contributed to this piece of work.

To Almighty God, for giving those unending blessing and wisdom, through Him, for without Him, none will be possible;

To their Introduction to Research Instructor, Mrs. Cadam-us, for sharing her precious time and knowledge and for her unending support and encouraging words. It is through her that this meaningful project was conceptualized.

To their families, friends, and classmates, for their inspiring words and encouragements during those times of sleepless nights of finishing this research proposal.

To all of you,

THANK YOU VERY MUCH!

The Researchers

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DEDICATION

With love and sincerity, this humble piece of work is heartily

dedicated to the people whose contribution is significant in making this

study a reality.

To our mentors, for the great effort they have exerted in

molding us to become well rounded and competent students of this

institution.

To our families, friends and fellow students, for their

cooperation for the completion of this work and for their moral support

which inspired us in making things possible and in pursuing our

ambition.

Above all, to Almighty God who continually showers His infinite

wisdom, blessings, and skills to the researchers.

Avelino

Nika Joyce

Joana Marie

Ruzzell

Mary Ann

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TABLE OF CONTENTS

Page

TITLE PAGE………………………………………………………………………..…..i

ACKNOWLEDGEMENT………………………………………...…….…………..…

ii

TABLE OF CONTENTS…………………………………………………..…..

…….iii

CHAPTER

1 THE PROBLEM

Background of the Study……………………………….

…………..1

Statement of the study

………………………………..................5

Theoretical framework…………………………………. ………..…

6

Research

paradigm……………………………………….............11

Hypothesis……………………………………………………….……

12

Significance of the study……………………………………..…..

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13

Scope and Delimitation……………………………………….

…...13

Definition of terms……………………………………………….

….13

2 REVIEW LITERATURE

The Dynamics of Population Ageing……………………….……

15

Social and Cultural Changes………………………………….….18

Legal Framework and Policy Responses……………… ………

21

Program Intended to Offer Health Insurance to the

Poor….24

Age

distribution……………………………………………………..27

3 RESEARCH METHODOLOGY

Research

Design………………………………………………………..30

Population and

Sampling………………………………………………………………….3

0

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Data Gathering Procedure……………………………………………

31

Research

Instrument…………………………………………………..31

Data Analysis Plan……………………………………………………..32

CHAPTER 1

INTRODUCTION

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BACKROUND OF THE STUDY

Lifestyle comes from two words life and style.

What is life? Life is a state that distinguishes organisms from

non-living objects, such as non-life, and dead organisms. Living

organisms are capable of growth and reproduction, some can

communicate and many can adapt to their environment through

changes originating internally. A physical characteristic of life is that it

feeds on negative entropy. In more detail, according to physicists such

as John Bernal, Erwin Schrödinger, Eugene Wigner, and John Avery, life

is a member of the class of phenomena which are open or continuous

systems able to decrease their internal entropy at the expense of

substances or free energy taken in from the environment and

subsequently rejected in a degraded form.

On the other hand, style has different meanings. First, style is the

way in which something is said, done, expressed, or performed: a style

of speech and writing. It is also defined as the combination of

distinctive features of literary or artistic expression, execution, or

performance characterizing a particular person, group, school, or era.

Sort or type: a style of furniture. A quality of imagination and

individuality expressed in one's actions and tastes: does things with

style. A comfortable and elegant mode of existence: living in style. A

mode of living: the style of the very rich. It is a fashion of the moment,

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especially of dress; vogue. A particular fashion: the style of the 1920s.

It is a customary manner of presenting printed material, including

usage, punctuation, spelling, typography, and arrangement.

The focus of this study is the elderly. Elderly or Old age consists

of ages nearing or surpassing the average life span of human beings,

and thus the end of the human life cycle. Euphemisms and terms for

old people include seniors — chiefly an American usage — or elderly.

As occurs with almost any definable group of humanity, some people

will hold a prejudice against others — in this case, against old people.

This is one form of ageism. Old people have limited regenerative

abilities and are more prone to disease, syndromes, and sickness. The

boundary between middle age and old age cannot be defined exactly

because it does not have the same meaning in all societies than other

adults. People in the 65-and-over age group are often called senior

citizens. But the fact is elderly should see to it that they should take

care themselves by doing the right health practices especially in their

lifestyle. In sociology, a lifestyle is the way a person lives. A lifestyle is

a characteristic bundle of behaviors that makes sense to both others

and oneself in a given time and place, including social relations,

consumption, entertainment, and dress. The behaviors and practices

within lifestyles are a mixture of habits, conventional ways of doing

things, and reasoned actions. A lifestyle typically also reflects an

individual's attitudes, values or worldview . Therefore, a lifestyle is a

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means of forging a sense of self and to create cultural symbols that

resonate with personal identity. Surrounding social and technical

systems can constrain the lifestyle choices available to the individual

and the symbols she/he is able to project to others and the self.

Many elderly and even young ones are very convenient in buying

over the counter drugs without knowing its right dose and effect.

Health regimen is a treatment plan. The plan includes which

treatments and procedures will be done, medications and their dose,

the schedule of treatments, and how long the treatment will take.

Examples of health regimen are exercise, diet, supplements and

nutrition. Medication also referred to as medicine, can be loosely

defined as any substance intended for use in the diagnosis, cure,

mitigation, treatment, or prevention of disease. Other synonyms

include pharmacotherapy, pharmacotherapeutics, and drug treatment.

One way also to monitor the health status of the elderly is in

their nutrition. The foods they eat and also the foods that they should

avoid. Nutrition is the provision, to cells and organisms, of the

materials necessary (in the form of food) to support life. Many common

health problems can be prevented or alleviated with good nutrition.

The diet of an organism refers to what it eats. A diet is a pattern of

food consumption which is followed by a population or an individual.

The diets of populations are affected by local factors including

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geography, climate, food availability, culture, and religion, whereas the

diets of individuals within populations are further influenced by factors

such as socio-economic status, personal preference, and health

considerations. To maintain life, all diets must supply the essential

amounts of energy, protein, essential fatty acids, vitamins, and

minerals, but these needs can be met by a wide variety of diets, each

of which will be sufficient for growth, survival, and reproduction but

may also have obvious or subtle effects on the long-term state of

health. The idea of a healthful diet is to provide all of the calories and

nutrients needed by the body for optimal performance, at the same

time ensuring that neither nutritional deficiencies nor excesses occur.

Promotion and preservation of health, also called hygienic.

Physical exercise is any bodily activity that enhances or

maintains physical fitness and overall health. It is performed for many

different reasons. These include: strengthening muscles and the

cardiovascular system, honing athletic skills, and weight loss or

maintenance. Frequent and regular physical exercise boosts the

immune system, and helps prevent diseases of affluence such as heart

disease, cardiovascular disease, Type 2 diabetes and obesity. It also

improves mental health and Sanitation is the hygienic means of

preventing human contact from the hazards of wastes to promote

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health. Hazards can be physical, microbiological, biological or chemical

agents of disease. Wastes that can cause health problems are human

and animal feces, solid wastes, domestic wastewater (sewage, sullage,

greywater), industrial wastes, and agricultural wastes. Hygienic means

of prevention can be by using engineering solutions (e.g. sewerage and

wastewater treatment), simple technologies (e.g. latrines, septic

tanks), or even by personal hygiene practices (e.g. simple hand

washing with soap). Hygiene refers to practices associated with

ensuring good health and cleanliness. Such practices vary widely and

what is considered acceptable in one culture may be unacceptable in

another. In medical contexts, the term "hygiene" refers to the

maintenance of health and healthy living. The term appears in phrases

such as personal hygiene, domestic hygiene, dental hygiene, and

occupational hygiene and is frequently used in connection with public

health. Hygiene is also a science that deals with the helps prevent

depression. It is safe for most adults older than 65 years to exercise.

Many of these conditions are improved with exercise.

Leisure or free time is a period of time spent out of work and

essential domestic activity. It is also the period of recreational and

discretionary time before or after compulsory activities such as eating

and sleeping, going to work or running a business, attending school

and doing homework, household chores, and day-to-day stress. The

distinction between leisure and compulsory activities is loosely applied,

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i.e. people sometimes do work-oriented tasks for pleasure as well as

for long-term utility.

Nowadays many elderly are not that conscious about their health

especially when one elder is in financial crisis. Their priority is not on

their health but on their foods. Because of the new trends and new

developments nowadays elderly is the last one who can adapt to these

changes. That’s why this study was made to know if these changes or

new lifestyle affects the old practices and lifestyle of the elderly and if

these new changes have an impact to their quality of life. On the other

hand the family members of elderly are also subjected to this study.

They are playing a big role in taking good care and watching the

elderly in their homes. Sometimes the family members are the one

reminding the elderly what to do and what not to do because in this

stage of their life they forget almost all the things including the simple

things and even they forget to take care their own selves.

STATEMENT OF THE PROBLEM

The researchers would like to assess the lifestyle of the elderly

and its impact to their quality of life at Barangay Dal-lipaoen Naguilian,

La Union which intends to answer the following problems:

1. What is the lifestyle of the elderly as perceived by the respondents

along with the following areas?

a. Health regimen and Medication

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b. Diet and Nutrition

c. Hygiene and Sanitation

d. Exercise or Leisure

2. What are the significant differences in the responses of the

respondents as to the lifestyle of the elderly?

3. What is the perception of the respondents as to the extent of

influence of the lifestyle of the elderly to their health status along with

the following areas?

a. Health regimen and Medication

b. Diet and Nutrition

c. Hygiene and Sanitation

d. Exercise or Leisure

4. What are the significant differences in the perception of the

respondents as to the extent of influence of the lifestyle of the elderly

to their health status?

THEORITICAL FRAMEWORK

Health Belief Model (Rosenstock, Becker, Kirscht, et al.)

This model was originally introduced by a group of psychologists

in the 1950's to help explain why people would or would not use

available preventive services, such as chest x-rays for tuberculosis

screening and immunizations for influenza. These researchers assumed

that people feared diseases and that the health actions of people were

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motivated by the degree of fear (perceived threat) and the expected

fear reduction of actions, as long as that possible reduction outweighed

practical and psychological barriers to taking action (net benefits).

The HBM can be outlined using four constructs which represent

the perceived threat and net benefits: 1) perceived susceptibility, a

person's opinion of the chances of getting a certain condition; 2)

perceived severity, a person's opinion of how serious this condition is;

3) perceived benefits, a person's opinion of the effectiveness of some

advised action to reduce the risk or seriousness of the impact; and 4)

perceived barriers, a person's opinion of the concrete and

psychological costs of this advised action. Another concept is known as

cues to action. These are events (internal or external) which can

activate a person's "readiness to act" and stimulate an observable

behavior. Some examples of external strategies to activate "readiness"

can be delivered in print with educational materials, through any

electronic mass media or in one-to-one counseling. Another concept

that has been added to HBM since 1988 in order to better meet the

challenges of changing unhealthy habitual behaviors (such as being

sedentary, smoking or overeating) is self-efficacy. Self-efficacy, a

concept originally developed by Albert Bandura in social cognitive

theory (social learning theory), is simply a person's confidence in

her/his ability to successfully perform an action.

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The HBM has been used to help in developing messages that

are likely to persuade an individual to make a healthy decision. Using

the HBM, messages that are suitable to health education for such

topics as hypertension, eating disorders, contraceptive use, or breast

self-examination have been developed.

However, there are two main weaknesses which have been

noted about the HBM. First, health beliefs compete with an individual's

other beliefs and attitudes which can also influence behavior. Secondly,

in decades of research in the social psychology of behavioral change, it

has not been shown that belief formation always precedes behavioral

change. In fact, the formation of a belief may actually follow a behavior

change.

Theory of Reasoned Action (Fishbein and Ajzen)

The Theory of Reasoned Action was designed to explain not just

health behavior but all volitional behaviors. This theory is based on the

assumption that most behaviors of social relevance are under volitional

(willful) control. In addition, a person's intention to perform (or not

perform) the behavior is the immediate determinant of that behavior.

The goal is to not only predict human behavior but also to understand

it.

According to this theory, a person's intention to perform a

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specific behavior is a function of two factors: 1) attitude (positive or

negative) toward the behavior and 2) the influence of the social

environment (general subjective norms) on the behavior. The attitude

toward the behavior is determined by the person's belief that a given

outcome will occur if he/ she performs the behavior and by an

evaluation of the outcome. The social or subjective norm is determined

by a person's normative belief about what important or "significant"

others think he/ she should do and by the individual's motivation to

comply with those other people's wishes or desires.

Attitudes are a function of beliefs in this theory. If a person

believes that performing a given behavior will lead to on the whole

positive outcomes, then he/ she will hold a favorable attitude toward

performing that behavior. On the other hand, a person who believes

that performing the behavior will lead to mostly negative outcomes will

hold an unfavorable attitude. These beliefs that form the foundation of

a person's attitude toward the behavior are referred to as behavioral

beliefs.

Subjective norms are also a function of beliefs. However, these

are beliefs of a different kind. These are the person's beliefs that

certain individuals or groups think he/she should or should not perform

the behavior. If the person believes that most of these significant

others think he/she should perform the behavior, the social pressure to

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perform it will increase the more he/ she is motivated to comply with

these others. If he/ she believe that most of this reference group is

opposed to performing the behavior, her/his perception of the social

pressure not to perform the behavior will increase along with her/his

motivation to comply with these referents. The beliefs which underlie a

person's subjective norms are termed normative beliefs.

Social Networks/Social Support Theories (Eng, Israel, et al.)

Most health educators today recognize the critical importance of

the social environment and advocate changes in the social ecology

which is supportive of individual change leading to better health and a

higher quality of life. However, within the community, long-term

behavior change depends on the level of participation and ownership

felt by those being served. In order to see how Social Networks and

Social Support Theories might impact on health needs, it is first

necessary to define what is meant by certain concepts.

Social networks can be kin (extended family) or non-kin (church

or work groups, friends or neighbors who regularly socialize clubs and

sporting teams). Social networks have certain types of characteristics:

1) Structural, such as size (number of people) and density (extent to

which members really know one another); 2) Interactional, which

include reciprocity (mutual sharing), durability (length of time in

relationship), intensity (frequency of interactions between members),

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and dispersion (ease with which members can contact each other); and

3) Functional, such as providing social support, connections to social

contacts and resources, and maintenance of social identity.

Social support refers to the varying types of aid that are given to

members of a social network. Research indicates that there are four

kinds of supportive behaviors or acts: 1) Emotional support - listening,

showing trust and concern; 2) Instrumental support - offering real aid

in the form of labor, money, time; 3) Informational support - providing

advice, suggestions, directives, referrals; and 4) Appraisal support -

affirming each other and giving feedback. This social support is given

and received through the individual's social network. However, it is

important to remember that "some or all network ties may or may not

be supportive."

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HYPOTHESIS

The elderly are prone to illnesses because of the deterioration of

health especially physically and mentally. And one factor that affects

the elderly is the lifestyle. Their attitude toward their health regimen

and medication, diet and nutrition, hygiene and sanitation, leisure and

exercise and other practices of the elderly affect their quality of life:

Physically, Socially, Emotionally and Mentally.

SIGNIFICANCE OF THE STUDY

The researchers keep on seeking for answers so that they can

help in their simple ways in their society. People are not getting any

younger. And as they struggle towards their end, our elders sometimes

neglect their own necessities. In a way they do things which they don’t

usually do before.

This research is made so that the elders would know that even

though they are already old, they still have to take good care of

themselves. Not just to look neat in the crowd but also to prolong their

life.

As long as we live in this world we are obliged to have a quality

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way of living. Our life is a gift from above, so we mustn’t do things that

could harm ourselves. Live life and love till our end comes.

SCOPE AND DELIMITATION

This research is wide and the research is not a computer to give

you all the knowledge about suicide. The researcher did not include:

1. The Impact of treated hearing loss on quality of life.

2. Impact on quality of life of fecal incontinence on older adults.

3. Depressed elderly have worst quality of life.

DEFINITION OF TERMS

1. Life- A state that distinguishes organisms from non-living

objects, such as non-life, and dead organisms

2. Lifestyle- the habits, attitudes, tastes, moral standards,

economic level, etc., that together constitutes the mode of

living of an individual or group.

3. Elderly- pertaining to person in later life

4. Humanity- the quality or condition of being a human

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INDEPENDENT DEPENDENT VARIABLES VARIABLES

Lifestyle of the elders: Quality of Life

a. Health regimen and

Medication

b. diet and Nutrition

c. hygiene and Sanitation

d. leisure and Exercise

Figure 1: Research Paradigm

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CHAPTER II

REVIEW OF LITERATURE

THE DYNAMICS OF POPULATION AGEING

From 3.19 million in1990, the senior citizens in the Philippines

increased to 4.59 million in 2000. The decadal average annual

(exponential) growth rate of 3.64 percent of the population 60 years

and over went up from the 2.26 percent growth rate recorded during

the previous decade. Hence, the older population is growing faster

than the total population of the Philippines. If the country’s total

population is already rapidly growing, then the myth that population

ageing in the Philippines is “low and slow” is not true and therefore

doubling time is shorter for the older population than for the total

population. The medium series of the population projection indicates

that senior citizens with be 10 percent of the Philippine population by

2030, with the female population attaining such proportion five years

earlier than the male population. The projected sex ratio of the

population 60 years or higher would continue to be lower than 100,

with female dominance increasing by age.

However, population ageing is also happening in various

geopolitical areas of the country. Figure 7 reveals that the National

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Capital Region (NCR) and the Ilocos Region will have 10 percent of their

population in the 60 years and over category by 2020. Regional data

also revealed that the female population would reach such proportion

earlier than the males. The female senior citizen population of Ilocos

Region would reach ten percent by 2015 in contrast to 2025 for its

male population.

The population ageing process varies not only by sex and region

but also by province. Moreover, the year when a province starts to

have at least 10 percent belonging to the 60 and over age group may

not be immediately be mirrored at the regional level. Five provinces

already counted in the 2000 census at least 10 percent of their

population in this age category (see Appendix B). These provinces are

Ilocos Sur and Ilocos Norte of Region I – Ilocos Region, Batanes of

REGION II - Cagayan Valley, Siquijor of REGION VII - Central Visayas,

and Southern Leyte of REGION VIII - Eastern Visayas. Moreover, the

regions where they belong to would attain the 10 percent regional

population mark by 2020, 2025, 2025, and 2035, respectively. This

suggests that while local government units (LGUs) in smaller

geopolitical units such as provinces, cities, and municipalities would

have to be more receptive of the demographic changes occurring in

their localities inasmuch as the national and regional population ageing

could occur much later. This explains why the national and regional

governments could initially be impervious to demographic shifts and

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their attendant consequences. Hence provinces, cities and

municipalities should be more in tune with and responsive to changes

in their own demographic processes and outcomes.

Another aspect of the population ageing process is the changing

balance between age groups. Over the last half of the twentieth

century, the proportion of children (0-14 years old) in the world

dropped from 34 per cent in 1950 to 30 percent in 2000. But the

proportions of aged persons increased so that by 2050 the UN (2001)

projected that the share of persons aged 60 or over in the population

will match that of persons younger than 15 (about 21 per cent each).

The Philippines has likewise experienced such a shift in age structure.

From 45.7 percent in 1970, the proportion of the population less than

15 was down to 37 percent in 2000, an 8.6 percentage point decline

over a 30-year period. However, the 2000-based official population

projection of the Philippines (medium series) reveals a larger

percentage increment in the 60 years and over (7.9 percent) than in

the economically productive ages (5.7 percent) by end of the

projection period (2040). The larger percentage increase of senior

citizens would come from the 70-79 years and the 80 years and over

age groups. These expected shifts in the age composition of the

Philippines would signal a change in the pattern of resource

distribution in aid of averting intergenerational conflicts (Walker 1990

and Jackson 1998 as cited in UN 2001) since demographic ageing could

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lead to calls for greater attention to the needs of the growing number

of older persons.

The ageing index, which is calculated as the ratio of those 60

years or older to those less than 15 years old, provides a commonly

used measure for assessing this process. The ageing index of the

Philippines increased from 10 senior citizens per hundred children less

than 15 years old in 1970 to 16 per hundred in 2000. The medium

series of the Philippine population projection indicates a nearly fourfold

increase of the ageing index by the end of the projection period. This

means that by 2040, there will be almost two persons aged 60 or over

for every three children under 15 years in the Philippines. Hence, there

may be a need to reassess the long-term care options for the growing

population of older persons, and the optimal resource distribution in

view of the shift in the young-old balance of the country’s population.

Since support at older ages is a common motive for sustained

high fertility in developing countries, often used to measure the

potential elderly support requirements in a society is the old-age

dependency ratio. The working age population is assumed to provide

either direct or indirect support to the youth and the elderly through

the family, religious or communal institutions, or even the State.

Hence, the dependency ratio is a rough estimate of the burden of

dependency and is useful indicator of trends in the level of potential

support needs.

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The total dependency ratio in the Philippines would decline as

children below age 15 decreases and senior citizens increases. There

will also be a profound shift in the composition of the total dependency

ratio: the share of the old-age component would rise from 9 percent to

29 percent from 2000 to 2040 (see Figure 10), which is almost triple

within the next 40 years.

An alternative way of expressing the numerical relationship

between those more likely to be economically productive and those

more likely to be dependents is the potential support ratio (PSR). PSR is

the inverse of the old-age dependency ratio, that is, the number of

people in the working ages of 15-64 years per person 65 or older.

Figure 10 shows that in the Philippines the PSR of 15 in 2000 would

drop to seven by 2040. This means there were 15 persons in working-

ages who provided support to one senior citizen in 2000.

In 2040, there would be seven persons in working ages that will

support one older person. This is a 55 percent reduction in the

potential support ratio over the next 40 years. There is larger regional

variability in PSR in 2000 than the expected scenario in 2040. Despite

the regional variation in the initial and final PSR, the general pattern is

a reduction of PSR in all regions between 2000 and 2004 (Table 1). The

top three regions with the largest percentage reduction in PSR over the

next 40 years are NCR, ARMM, CALABARZON, and Davao.

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PSR also varies by province as shown in Appendix C. Again,

provincial population ageing alert signals are not reflected immediately

in regional population scenarios. Hence, LGUs that monitor closely

their respective demographic indicators would be better able to design

local policy responses and initiatives to address population ageing.

SOCIAL AND CULTURAL CHANGES

In a developing country like the Philippines, the quality of life of

older persons depends largely on the family support system. The

family and the home are pivotal points of exchange of support and

care among older and younger generations. Is there a change in the

role of older persons within the family? Earlier studies have shown that

there is little evidence of change in the social position of the elderly as

they age in terms of standard of living, familial interaction and support,

or health services (Casterline et al. 1991). Based on focus group

discussion data, however, Williams and Domingo (1992) have found

that being better off in terms of health, frequency of social contacts

and financial independence enables older persons to have more

influence in family decisions. Recent research updates on these would

be helpful in documenting shifts in elderly role in Filipino family

dynamics, especially in family decision-making.

The Filipino family as the building block of the nation appears

resilient despite transformative forces in its own core. Children

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continue to symbolize love and joy that keep families together but

marriage (i.e., the social institution that brings families into being)

seems to be in a flux. Data suggest that traditional norms of early and

universal marriage are eroding. Males and females in the Philippines

are delaying their entry into marriage. The singulate mean age at

marriage (SMAM) or the number of years spent at single hood has

increased from 25 years for males and 22 for females in 1960 (Gultiano

and Xenos 1992) to 26 years for males and 24 years for females in

2000 (Williams , Kabamalan and Ogena 2001). On the other hand, the

males are catching up with the females in not marrying as the gender

gap in the proportion who never married at age 4549 years declined

over the same time period. The proportion for males has nearly

doubled (i.e., from 3.2 percent in 1960 to 5.6 percent in 2000), while

for females the proportion slightly declined from 7.1 percent in 1960 to

6.1 percent in 2000. Cohabiting unions among young Filipinos also

increased between 1994 and 2002 with frequent media portrayals of

cohabiting couples challenging the more conservative positions against

the practice (Kabamalan 2004). If these changes in nuptiality in the

Philippines continue in the next decades and be large enough, Costello

and Casterline (2002) suspect a downward pressure on Philippine

fertility as what happened in many parts of the world. In turn, this

could further speed up the population ageing process as mortality level

has flattened at a quite low level due to improvements in health care

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and hygiene.

Marital instability and spousal separation also strike at the

foundations of the Filipino family. There is no divorce law in the

Philippines so marriage when formalized binds a man and woman for

life. Many married couples, especially those with children, remain

together despite marital troubles for the sake of the family. As

expected therefore is the rather low level of marital dissolution in the

country although a slight increase was noted during the 1990s

(Costello and Casterline 2002). Despite lack of a divorce option, a

married couple who wish to break away legally from a marital partner

may choose annulment of marriage, which of course has corresponding

social, temporal, and financial costs. Nevertheless, this option has

become quite popular recently not just for the upper but also for

middle classes. Again, media appears to play a large part in having this

included as an option in the lifestyle change of married couples in the

country along with changes in people’s attitudes and behavior

regarding marriage and family formation.

Perhaps more of a challenge to marital stability is the temporary

spousal separation due to overseas work of a marital partner. As of

December 2004, there were 8.08 million Filipinos overseas, with nearly

half (44.52 percent) on temporary work contract abroad. The average

annual deployment of OFWs during the period 2000-2005 was 897

thousand (POEA 2006). OFW remittances increased from US$6.03

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billion in 2001 to US$10.69 in 2005 (BSP 2006). Documented economic

gains from these remittances abroad have benefited many families and

the country as a whole but providing mechanisms to channel

remittances to productive investments is a continuing challenge.

LEGAL FRAMEWORK AND POLICY RESPONSES

In recognition of the family as the basic unit of society, the

Constitution of the Republic of the Philippines recognizes the families

“duty to take care of elderly members but the State may also do so

through just programs of social security” (RP 1987). The needs of older

persons, among others, are included in the priority list when designing

and implementing integrated and comprehensive programs that would

make essential goods, health, and other social services available to all

the people at affordable cost.

The Philippine Constitution and three enacted laws since 1992

recognize the positive role of older persons in society. The objectives of

the first piece of legislation for older persons in the Philippines, i.e.,

Republic Act (RA) No. 7432, are to motivate and encourage the senior

citizens to contribute to nation building and to encourage their families

and communities they live with to reaffirm the valued Filipino tradition

of caring for their senior citizens. This law granted the following

privileges to senior citizens (RA

7432, Section IV):

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a) The grant of twenty percent (20 percent) discount from all

establishments relative to utilization of transportation services, hotels

and similar lodging establishment, restaurants and recreation centers

and purchase of medicines anywhere in the country: Provided, That

private establishments may claim the cost as tax credit;

b) A minimum of twenty percent (20 percent) discount on admission

fees charged by theaters, cinema houses and concert halls, circuses,

carnivals and other similar places of culture, leisure, and amusements;

c) Exemption from the payment of individual income taxes: Provided,

That their annual taxable income does not exceed the poverty level as

determined by the National Economic and Development Authority

(NEDA) for that year;

d) Exemption from training fees for socioeconomic programs

undertaken by the OSCA as part of its work;

e) Free medical and dental services in government establishment

anywhere in the country, subject to guidelines to be issued by the

Department of Health, the Government Service Insurance System and

the Social Security System;

f) To the extent practicable and feasible, the continuance of the same

benefits and privileges given by the Government Service Insurance

System (GSIS), Social Security System (SSS) and PAG-IBIG, as the case

may be, as are enjoyed by those in actual service.

In 1995, passed was RA 7876 or the "Senior Citizens Center Act

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of the Philippines" which established senior citizens centers in every

city and municipality of country. The centers serve as venues for the

delivery of integrated and comprehensive services to older persons.

The organizations of older persons manage these centers with the

support of the local and national governments.

Based on the Vienna Plan of Action on Ageing and the Macao

Plan of Action on Ageing for Asia and the Pacific, the Philippines

adopted the Philippine Plan of Action for Older Persons in 1999. The

plan of action addresses eight major areas of concern: namely, older

persons and the family; social position of older persons; health and

nutrition; housing, transportation and environment; income security,

maintenance, and employment; social services and the community;

continuing education/learning; and, older persons and the market.

The most recent law passed (RA 9257) known as the "Expanded

Senior Citizens Act of 2003" grants additional benefits and privileges to

senior citizens without qualifying whether not they earn less than

P60,000, which was a prerequisite under the old law. The full

implementation of these laws, however, would benefit millions of

senior citizens but complains abound regarding rampant violation of

seniors’ discounts by operating establishments especially in rural

areas. Moreover, many of the older persons are neither aware of the

existence of the laws nor of the mechanisms to enable them to availing

of such benefits. But even if they are aware and knowledgeable of

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these mechanisms, limitations in older people’s mobility could prevent

them from acquiring required documentation to prove that they are

qualified for the discounts and much more in availing themselves of

the senior citizen discounts due them. Again, the OFW phenomenon

contributes in preventing the trickle down effect of benefits to senior

citizens especially in the rural areas. With the absence of children and

no surrogates who could assist the older persons, the benefits from

existing laws remain to be fulfilled.

Nevertheless, Philippine legislators continue to work on policy

reforms that would further improve the conditions of senior citizens in

the country. Pending bills in the House of Representatives and the

Senate include the following, among others: local governance

representation of senior citizens; increase the discount privileges

enjoyed by senior citizens to all establishments; lowering of retirement

age of teachers; protection from institutional, community and domestic

violence and sexual assault; and expansion of the discount benefit

from just prescribed medicines to cover all types of medicines Except

for the proposed lowering of retirement age of teachers, the other

pending bills may put less strain on government coffers. While 55

years may be considered as appropriate for optional early retirement,

the increasing life expectancy of males and females and the growing

number of older people in the country suggest that the proportion of

national resources to be allocated to retirement benefits is expected to

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increase over time. Hence, rather than reduce the age of retirement,

prospects of increasing it may be more economically rational, as what

advanced European countries with large elderly population are

currently considering. Another issue is whether retirement age should

be legislated in view of significant age-structural shifts anticipated in

the next decades.

A Program Intended to Offer Health Insurance to the Poor

A program sponsored by the International Labor Office and the

World Bank that is under way in the Philippines has offered hope for a

solution to an enduring problem of developing countries: providing

health insurance to poor people. The solution involves adding a

reinsurance backstop to small, regional insurance plans to guarantee

their solvency through periods of extreme need.

Private insurers rarely offer insurance to poor people, since their

health is usually worse than that of wealthier people and they cannot

afford to pay high premiums. So in developing countries, governments

or donors typically offer limited aid in the form of free care. That,

however, does not take advantage of the benefits of risk-pooling, and

assumes that the poor have no ability to share the cost of care. As a

result, medical care maybe severely underprovided.

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Small regional insurance plans already address this problem in

the Philippines and elsewhere in the developing world. But these small

plans are extremely susceptible to insolvency when faced with an

epidemic or other health catastrophe that might befall an entire

community. The I.L.O. and the World Bank set out to demonstrate the

positive impact of the small plans and to demonstrate the practical

potential for reinsurance.

At a meeting in Montreal last week, the program's organizers

reported results from a survey of members and nonmembers of small

insurance plans with various backers in five regions of the Philippines.

Hospital visits were 40 percent higher, on average, among members

than among comparable nonmembers in the last two years.

Compliance with drug regimens for the chronically ill was higher in all

five regions reported, reaching 100 percent among the survey's

respondents in one region, La Union. In four of the five regions,

mortality rates for micro insurance members were substantially lower

in the last five years than mortality rates compiled from regional

statistics.

"Where governments and the private sector have failed to reach

low-income and low-health-status people — the poor — we have found

alternative solutions that make a big difference," said David M. Dror, a

health insurance specialist at the I.L.O. who is a co-director of the

program.

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The results also suggested that reinsurance could work, at a

surprisingly small cost. Under reinsurance, the small insurance plans

would pay premiums to a central fund each year. If one of the small

plans is unable to cover its own losses in a given year, the central fund

would pay out an award — the equivalent of a regular insurance claim

— to bail out the plan. Within six years, according to a range of

estimates by the I.L.O., reinsurance could expand to encompass

regional plans covering 600,000 to one million people in the

Philippines.

Starting the program would require an initial injection of capital

in case catastrophic losses occurred in the first few years, before the

plans' reinsurance premiums had accumulated. Despite the increased

medical care among the plans' members, according to Dr. Dror's

calculations, the amount needed to keep the system solvent would be

only about $9 million.

The Filipino program is the most extensive yet tried, said

Elisabeth Rhyne, senior vice president of Action International, a

nonprofit antipoverty group based in Boston that makes small loans to

poor entrepreneurs in Africa and the Americas. Previous micro

insurance efforts, she said, usually covered only "a very limited

package of services," not including in-patient hospital care. More

ambitious programs had a difficult time calibrating coverage to need,

ensuring the availability of medical care and achieving diverse pools of

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healthy and sick people, Dr. Rhyne said, and thus could not even

attempt reinsurance.

Yet the money to start the reinsurance program has not been

forthcoming, either from the government, independent donors or

private insurance companies. The program's organizers have paid for

training and administration in the Philippines so far, but neither has a

mandate to provide the start-up funds.

"It's too small for the big money that usually finds takers for

infrastructure," Dr. Dror said. "On the other hand, there are still a lot of

people in the development community and the donor community that

live under the assumption that the poor are uninsurable."

Dr. Dror and his colleagues came up with the figure of $9 million

in start-up funds by measuring health risks and the cost of care for the

populations already insured in the five regions — about 40,000 people

— and adding a conservative margin of error. Just less than 5 percent

of the population suffers from chronic disease, but more than half of

hospitalizations cost $50 or less. About half of the $9 million would pay

for administration, Dr. Dror said.

"If you don't come with some initial capital, no insurance can

ever work," Dr. Dror said. "You have to be capitalized at your maximum

exposure."

Covering widely dispersed micro insurance units under the same

reinsurance umbrella would be crucial to containing that exposure, said

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Howard C. Kunreuther, a professor of decision sciences and public

policy at the University of Pennsylvania. When all the insured are

concentrated in one area, he said: "Whatever the risk is, there are

always possibilities of high correlation. That's what you try to avoid in

insurance, if you can — are there any sicknesses that could really hurt

everyone?"

Once reinsurance systems are up and running, though, micro

insurance units in villages all over the world could protect each other

from epidemics, with a slim chance that all would befall the same

catastrophe at the same time.

"You can pool the north of the Philippines with the south of the

Philippines, which is about as different as Cambodia is from Africa," Dr.

Dror said. "Every village that joins this social reinsurance is assessed

according to their variance of risk, and thus you can pool any kinds of

risks."

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Chapter III

RESEARCH METHODOLOGY

RESEARCH DESIGN

This chapter presents the methods and procedures to be adopted

by the researchers. It includes the research design, the population and

locale of the study and sampling techniques, the method of data

collection, the instrument and the statistical technique employed for

data analysis.

In this study, the researchers used the descriptive method to

determine objectives that it seeks to attain. According to Bienvenido

and Medel, descriptive research involves the description, recording,

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analysis and interpretation of the nature of composition and processes

of phenomenon.

Furthermore, descriptive survey method according to Best is

concerned with conditions that exist; practices that prevail; beliefs,

points of view or attitudes held; effects that are being felt; or trends

that are developing. However, it is not confined to fact gathering alone.

It involves an element of interpretation of meaning or significance of

what is described.

POPULATION AND SAMPLING

The respondents involved in the study were the elderly people of

Barangay Dal-lipaoen Naguilian, La Union. The age bracket is 60 years

old and above at present. The total population of the elders in this

barangay is 100.

All of these elderly people were included as respondents.

According to Gay, as cited by Adanza, in descriptive research, ten

percent of the population is an acceptable sample but twenty percent

of the total population is required for a small population.

However, the researchers favored the idea that the bigger the

sample, the more valid are the findings and conclusions; Hence, we

used the total number of the population.

DATA GATHERING PROCEDURE

Following the approval and validation of the data gathering tool,

the researcher formally asked for the approval of the Barangay Captain

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of Dal-lipaoen Naguilian, La Union in the administration of the

questionnaire to the elders in that Barangay. The questionnaires were

distributed by the researchers which were guided by the health

workers on where they could find the abodes of these elders. During

the distribution, the researchers explained the purpose of the research

and that their responses would be treated with confidentiality and

respect.

The questionnaire was composed of many questions which made

it hard for the respondents to answer it in just one seating. The

questionnaires were distributed to the population and were retrieved

after 2 days by some members of the group.

RESEARCH INSTRUMENT

The main data gathering toll used in collecting information was a

one set questionnaire constructed by the researchers. This

questionnaire contains question related to the awareness of the elder

of their health practices and how does it affect their quality of life. This

questionnaire was very lengthy and is composed of the questions

formulated by the researchers about their Health Regimen and

Medication, Diet and Nutrition, Hygiene and Sanitation, and Leisure

and Exercise.

According to Sevilla, et al, validity refers to the appropriateness,

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meaningfulness and usefulness of inferences a researcher on the data

collected. She added that a common way of determining the content

validity of an instrument is by having one or more individuals look at

the content and format of the instrument and judge whether or not

they are appropriate. Thus, validity of an instrument is established by

the judgment of three competent persons in the given field.

The first questionnaire was presented to the panel for review,

modification and validation. The panels gave 4.2 and 4 for the

questionnaire and for the final score is 4.1 which mean that the

formulated questionnaires are valid and the researchers were

permitted to float the questionnaire to the population.

DATA ANALYSIS PLAN

The data gathered has been tallied, tabulated, analyzed and

interpreted. The statistical tool used is the weighted mean. The mean

describes the level of awareness or the perception of the elders of their

lifestyle and the following scale and descriptive equivalent was used

for its assessment and analysis.

On the other hand, the mean describes the perception of the

elders on the effects of their practices to their quality of life; physical,

social, mental, emotional. The following scale and descriptive

equivalent was used for the assessment and analysis.

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