Elderly Care

1
Elderly Care Elderly Structures in Turkey

• Prof. Dr. Zerrin Söylemez
• National Coordinator of LdV Project ComPro
• University of Gaziantep, Turkey
• 21-24 November 2006
• Wuppertal, Germany

2

• SOCIAL SECURITY SYSTEM
• Turkey's social security system is structured
  under three major social insurance funds.
• The Civil Servants Pension Fund (ES) for civilian
  and military public employees,
• The Social Insurance Institution (SSK) for wage
  earners employed on contractual basis,
• The Social Security Organisation of the
  Self-Employed (Bag-Kur) for self employed
  including craftsmen, artists and artisans, small
  business owners working on their own account, and
  people working independently in the agricultural
  sector.

3

• Groups outside the defined benefit mechanism in
  Turkey are served by a variety of schemes.
• The Green Card program was initiated in 1992 for
  providing free in-patient health services for the
  poor.
• By Old Age and Disability Assistance Schemes, the
  needy people over the age of 65 and the disabled
  receive payments from government without having
  to pay any premium. The Fund to Encourage Social
  Aid and Solidarity provides support in kind and
  in cash to needy people.

4

• OLD IN TURKEY
• Turkey, if compared with the other countries,
  from the point of view of the age, it is among
  the countries that have a population of rather
  young people. However, the elderly population
  will come into agenda for Turkey in near future.
  According to the calculations, because of the
  various reasons, it is foreseen that the
  proportion of the elderly population in our
  general population will increase two or three
  times more in thirty years. Because of this the
  health of the elderly is getting gradually more
  important in our country.

5

• Turkey is a society who looks after their elderly
  with their traditions and customs. The big
  majority of the elderly live with their children,
  the ones who live apart are in close contact.
  Because of this culture of harmony of family life
  bears big importance in the elders' problem
  solving.
• In the hospitals other than general health
  services, the geriatric services are not enough
  to pay attention particularly to the elderly who
  need help and special care for their needs from
  the point of view of health .

6

• The number of people who are over 65 is about 7
  of the whole population of Turkey.
• The ratio of old people to total population is 6
  in urban areas, whereas it is 9 in rural areas.
• The ratio of older population, which was 4.3 in
  the 1990 General Census, was 6.9 in 2003
  (Population and Health Study of Turkey).

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• The increase in the percent of old population is
  believed to be a result of the decrease in the
  birth rate and the increasing life expectancy.
• Besides, the past roles of old age have changed,
  it has lost much of its prestige and the
  home-care of the old has become an ever-worsening
  problem that we face.

8

• The improvements in medicine, the evolution of
  large families into nuclear ones, migration from
  rural areas to urban areas, the increase in the
  number of working women, the change in
  traditional culture and values and the
  differences between the young and the old
  generation are some of the factors that have
  brought about such a problem.
• All these factors have, thus, increased the need
  for more care at nursing homes for the old whose
  number is ever increasing and who suffer from
  social and economic deprivation.
•  

9

• Although the old are traditionally inclined to
  live with their family and children, a change
  towards the nuclear family has caused the number
  of those living at a nursing home to increase.
   In Turkish society, the sons are widely
  considered as the tool for ensuring the
  continuation of family name and as a security for
  the parents old ages. Therefore, the parents
  usually expect to live together with their sons
  and to be supported by them.
• The ratio of old people who live at a nursing
  home in Turkey is said to be 3.6.

10

• One of the important issues that affect the old
  is the role of the old in the society.
• Family environment is the healthiest atmosphere
  where social, emotional and physical needs of the
  old are fulfilled.
• However, their needs are no longer answered in
  this fast and complicated life of modern times.

11

• The services that the old receive in Turkey have
  continuously been bettered.
• These services are mostly carried out by the
  Association of Social Services and Child
  Protection (SHCEK) and, to a lesser extend, by
  local administrations, foundations, associations,
  some public organizations and private individuals
  with the aim of helping many old people at the
  same time.

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• Irrelevant and inadequate physical conditions of
  establishments that take care of the old and the
  insufficient quality and quantity of staff that
  work in such establishments are two foremost
  sources of problems encountered in services
  provided for the old in Turkey.

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• Another problem is the lack of social and
  cultural programs that may socialize those who
  live in these establishments and help them join
  the social life in a productive manner.
• Moreover, there are no special programs
  concerning geriatrics at departments of nursing
  and medicine. Geriatrics is covered only as a
  topic in syllabuses of departments of public
  health and psychiatry 1.

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• 5.4 per cent of the elderly people living alone,
  2.4 per cent of those living in nursing homes and
  0.4 per cent living with families could be
  regarded as malnourished. The elderly people
  living in nursing homes have more risk for
  malnutrition compared to those leaving with their
  families2.

15

• People who are 65 years or older constitute 6 of
  the Turkish population, 90 of whom have chronic
  health problems. In Turkey, there is a high
  possibility that elderly people's requirements
  are not met by today's health care system in the
  way they would wish. They prefer not to be
  hospitalized when they have health problems 3.

16

• The prevalence of depression was investigated in
  2 groups of elderly people in Turkey living in a
  public old people's home and in their own home.
  Depression was assessed according to the Hamilton
  Rating Scale for Depression, not clinical
  diagnosis. The prevalence of depression was 35
  (33 for men, 37 for women) for the total
  population, 41 (40 for men, 42 for women) for
  those living in an institution and 29 (24 for
  men, 33 for women) for those living at home 4.
  

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• INSTITUTIONAL CARE
• In order to provide institutional care for the
  elderly in Turkey, there are 231 nursing home and
  rehabilitation centres.
• Central Government 70 (SHCEK)
• 7 (others)
• NGOs 34
• Municipalities 19
• Private Sector 94
• Minorities 7

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• NURSING HOME IN GAZIANTEP
• Established in 1986 for 220 residents. There are
  86 residents now (32 women and 54 men). Only half
  of the residents were borned in Gaziantep. One
  medicine doctor, three specialist in social
  services, one specialist on nutrition and one
  nurse are the staff of nursing home in additon to
  administrative staff.

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• EDUCATIONAL STATUS OF RESIDENTS
• Illiterate 60
• Literate 27
• Primary school graduates 10
• Middle school graduates 2

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• ECONOMICAL STATUS OF RESIDENTS
• 64 residents are economically disadvanteged.
• Number of Residents
• Nursing 18
• Nursing 28 (free of charge)
• Rehabilitation 13
• Rehabilitation 27 (free of charge)
• Total 86

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• AGE DISTRIBUTION OF RESIDENTS
• Age Number of residents,
• 55-60 1
• 60-64 10
• 65-69 13
• 70-74 28
• 75-79 24
• 80-84 18
• 85-89 4
• 90-100 1
• ?100 1

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• REFERENCES
• 1. The Ministry of Health of Turkish Republic
  The Report of the Old Age Group the Evaluation
  of the Current Circumstances (1992) Healthy Aging
  Symposium, Ankara, pp. 385-388
• 2. Nevin Sanlier and Nurcan Yabanci (2006) Mini
  nutritional assessment in the elderly living
  alone, with family and nursing home in Turkey
  Nutrition Food Science, 36(1), 50 58
• 3. Hanzade Dogan and Mebrure Deger (2004)
  Nursing Care of Elderly People at Home and
  Ethical Implications An Experience from
  Istanbul, Nursing Ethics, 11(6), 553-567
• 4. M.Bekaroglu, N.Uluutku, S.Tanriöver  and I.
  Kirpinar (1991) Depression in an elderly
  population in Turkey Acta psychiatr. Scand.,
  84(2), 174-178