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Influential psychiatrist stresses need for caregiving for elderly
  • By Constance Williams
  • Published 2017.03.16 15:36
  • Updated 2017.03.22 14:07
  • comments 0

Korea is known for its high-tech advances, the rise of K-pop and luxurious skin care products, but what everyone doesn’t know is Korea’s forgotten generation.

The nation has the worst senior poverty rate among developed countries, and the options for older adults are slim.

According to Statistics Korea, Seoul citizens aged 60 or over had the highest suicide rates, with 50.3 seniors per population of 100,000 taking their last year. The suicide rate for those aged 45 to 64 was the second highest at 31.9, followed by those aged 25 to 44 at 27.9 and those aged 15 to 24 at 10.4.

Poverty among the elderly has been blamed for the growing rate of senior citizen suicide here. According to Korea Labor Institute, 48.6 percent of the elderly were living in poverty in 2014, with 50 percent or less of median household income.

The dismal living environment for people in senescence is why Korea needs experts like Dr. Arthur Kleinman. An internationally renowned physician (psychiatrist) and cultural anthropologist, he has contributed to the anthropological and medical understanding of culture-bound mental disorders, particularly in Chinese and East Asian culture. Since 1968, Kleinman has conducted research in Chinese society in Taiwan, and since 1978 in China, on depression, somatization, epilepsy, schizophrenia, suicide and other forms of mental troubles.

Kleinman will speak at Yonsei, Ewha Woman’s and Seoul National University to talk about global initiatives for elderly care for inspiration in medical students. The Korea Biomedical Review met him in advance to hear about his message.

Arthur Kleinman talks about elderly care in Korea, during an interview with The Korea Biomedical Review Tuesday.

Question: Please tell our readers about yourself.

Answer: I’m a professor of anthropology, medical anthropology, and psychiatry at Harvard Medical School, a physician (psychiatrist) and cultural anthropologist as well as a China scholar. I trained in psychiatry, and my lifelong interest has been in caregiving.

I have lived in Taiwan in the 1960s and in China up to the present for seven years. I traveled widely to Japan and Southeast Asia. I headed Harvard’s Asia Center during this time from 2008-2016. I have a variety of experiences, including caregiving such as the given to my late wife who died in 2011.

Q: Korea is rapidly chasing Japan, which has the highest ratio of elderly population in the world. Is there anything that Korea should follow, or do something different from, its neighbor?

A: It’s relevant to me because I have a series of study in aging and elderly care in five cities in China plus Kyoto, Seoul, Hanoi and Bangkok. We are looking at models that are useful in showing what’s successful in caring for the frail, demented elderly. All the Asian countries are facing the same set of problems.

By 2040, 40 percent of Japanese will be over 60 years of age. Chinese and Koreans will not be far behind. All of Southeast Asia will be right behind that. Except for India, Asia is aging at a rapid rate. The problems and how to deal with it is a very substantial issue, for example, of family/professional caregiving.

Q: Can you elaborate?

A: If you look at the world, Japan has one of the truly outstanding care systems for the elderly. For example, if you have a weak person living on their own or living with their family who has needs, they get a home-health aid coming several hours every day, and the health system provides it.

But it would be impossible to keep this up in the future of course; there will be too many seniors and the system won’t be able to afford it. In China today, you have seven workers for every retiree. By 2040, they will have 1.7 workers; you won’t be able to maintain the system under the circumstances. In Japan, there are 100,000 people who are over 100 years of age.

By 85 years of age as a general rule around the world, most people have some degree of cognitive deficiency: they’re slower which is normal aging. If you think of the needs, they’re great. What’s happening in families is increasingly women who played the central role in the family have now entered the workforce. Men, and now women, are not available.

Q: What should we do then?

A: Now all kinds of programs are being developed: day-care programs, community centers for the elderly, and so on. But the elderly are too frail to transport themselves to the facilities. In many of East Asian societies, because of the Confucian backgrounds, it is a stigma about the elderly entering these institutions, but it can be the best situation.

My research is looking for one of the best models in the local setting who can afford it. Care-giving right now is in a crisis all over the world. Family caregiving for children, the sick and the elderly is under too much pressure so how can a society provide them? Everyone one of our societies would fall apart immediately if women were unable to provide care. So the issue has to be figuring out compensation.

Q: Elderly suicide is high in Korea because their happiness and pensions are small. Is there any advice you would like to give about this?

A: There are often Confucian suicides. A senior who is faced with a serious illness and might drive his or her family into bankruptcy to receive treatment can commit suicide as a way to save the family. This is one of the reasons Korea has one of the highest suicide rates in the world.

China was similar in the past, but it was able to reduce its overall suicide rate by reducing the suicides of young women. It had a significant effect but not on elderly suicides. Suicide, in a way, is bringing mental illness out of its shell; it’s about depression and in society as sophisticated as Korea, depression should be something to talk about and to treat, but it is often stigmatized.

For older people, they are not willing to discuss. Hence they don’t get diagnosed and treated. The end results can often be suicide. Early diagnosis and treating it is a good way of preventing suicide among the elderly. Social supports and reducing loneliness can significantly prove the way the old experiences the last stages of their lives.

Q: You are speaking in four conferences at three different universities here. What is the key message you would like to share with college students?

A: I believe that for medical students, they are coming into the world more challenging than the world I came into when I graduated medical school in 1967. They can participate, reform and conspire to deal with social and health inequality, a better understanding of family care and how important families are and their elderly members.


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