Senior Citizens and Their Health

Senior Citizens

What is the most important problem that senior citizens face today - Deteriorating health, malnutrition, lack of shelter, fear, depression, senility, isolation, boredom, non-productivity, and financial incapacity are the most common problems that senior citizens all over the world face today. These problems can be grouped into two categories that relate to the physical andmental health and the financial capacity of the senior citizen.

Physical and mental health

Stability of physical and mental health is a key concern that senior citizens have to contend with as they go through their twilight years.

The human body is a system that wears out with long and repetitive use; and quite easily, with neglect and abuse. Aging is a life-cycle stage where the human capacity to think, act, relate, and learn starts to falter and deteriorate. Aging breeds illnesses such as loss of memory, immobility, organ failure, and poor vision. These are critical dysfunctions that could sideline a senior citizen to a lonely and miserable life.

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While a clean and discreet lifestyle in his or her prime could reduce the susceptibility of a senior citizen to dreaded post-retirement illnesses, the onset of any dysfunction is one unpredictable happening even if the person might have had robust financial health. The frailty of the human body grows with the aging process regardless of who the person is, a sure-to-come event magnifying the primacy of physical and mental health stability as a fundamental problem of senior citizens.

Financial capacity

Possessing sustainable financial capacity before, during, and after the inception of a senior status is both a basic problem and an elusive dream for most people.

This financial dilemma is common among senior citizens who are usually relegated to an abject position of economic inactivity. Lack or absence of financial capacity creates a stressful life and invites the entry of problems other than physical and mental health issues. For instance, domestic problems in an extended family system can aggravate the problem of a financially-destitute senior citizen. Should any of the children be wallowing in a similar state of poverty, the senior citizen becomes physically and mentally loaded up with intense and continuing pressure out of being totally helpless to come to the financial rescue a grieving son or daughter. While it may not be the panacea to aging-related problems, the value of money cannot be overstated in the post-retirement period. A financially-handicapped senior citizen, afflicted with some degenerative or serious illness, is practically on the road to an early death. A financially secure senior citizen with the same illness, however, may have a longer life to live because money can give quick and convenient access to life-giving remedies. Even with state-of-mind dysfunctions like severe depression, boredom, nervous breakdown, and self-pity, financial capacity can buy options to rejuvenate and

refresh a financially-capable senior citizen, through travels, elderly recreation, social renewal, and continuing education. A poor senior citizen in the same state of mental degradation cannot afford to do the same; and more so, be back into the mainstream of society. As can be discerned from the preceding discussions, the severity and importance of both health and financial problems is a function of the milestones the senior citizen had set up preparatory to facing the challenge of post-retirement. These milestones are: 1) Quality: what lifestyle had been lived in the past 2) Quantity: what endowments and financial fortune had been built 3) Relationships: what community of people the senior citizen had moved about and is attached with.

What is then the most important problem that senior citizens face today? Is it health (physical and mental) or financial capacity? From a practical and realistic standpoint, I consider the inseparable tandem of health and financial capacity as the most important problem that senior citizens have to prepare and plan for. I use the phrase "prepare and plan for" because health and financial capacity becomes a problem only if the senior citizen had, in the past, been unmindful or neglectful of its future importance. A healthful life is like a running well-oiled machine, with its vital parts continuously maintained so that it can perform normally, or at peak productivity, beyond its anticipated useful life. The onset of sudden serious health problems can be substantially mitigated, if not totally avoided. This holds true if the senior citizen, at the time of his or her prime, had led a clean, discreet, active, family-based, helpful, and interconnected life, a discipline that builds premium on fitness, integrity, peace, humility, fulfillment, and friendship.

Financial hardships can be avoided if the senior citizen, during his or her period of economic activity and utility, had deliberately exercised foresight, focus, continuous learning, perseverance, and simplicity, a discipline that consistently upholds the importance of modest needs, savings, productivity, competence, and delivering superior value to people and organizations. The idea here is to build a sustainable wealth of lifetime resources to address the financial requirements of the person across the twilight zone. On my mother's side, my grandma died at the age of 95 years old while my grandpa passed away at 92. With no known serious illness at the time of their death, we were all of the opinion that they died by reason of old age. How did they manage to both live a long life? With regard to their having a healthful life, both my grandma and my grandpa were vegetarians. They religiously observed full eight-hour night sleep and two-hour afternoon nap everyday. They were both active. With my grandma coming from a political family, she was all over the community interacting with people during her free time. My grandpa, who was a full-blooded Christian, was quite busy each day evangelizing on the bible with different kinds of people. As we had initially lived at my grandparents' home, I could clearly recall that there was no day that they did not have visitors, at least two to three batches of people with different stories and problems to tell and request advice for. In short, they were always interconnected with people. It was a home full of excitement, sharing, and guidance, an abode that I think was the spring of long life for my grandparents. As to how my grandparents sustained a fairly comfortable life, even if both of them were economically inactive, was to me a story of disciplined survival worth emulating and modeling upon. The household just lived on the small pension of my grandpa plus some assistance from an uncle who was gainfully employed. But my grandma, who closely tracked and managed the finances, had the regimen and capacity to prioritize and stretch the budget in a manner that, on a monthly basis, the basic needs were sufficiently addressed and some residual money were tightly saved.

Though my grandma was a stickler of kindness and generosity to people, I never witnessed any moment that they were in the run for some emergency money. Neither had they borrowed anything from any relatives or friends. To my estimation, they had a retirement fund chest that remained intact until the hour of their death. And how did this happen? I think it was a providential blessing. Incremental assistance money, though in reasonably small amounts, regularly flowed in from people who had been helped by my grandparents, not financially, but on the resolution of their domestic and career problems. Whenever I go on a recollection mode about my childhood and adolescent days, I am elated for being a grandson to my grandparents. Such recollection always reinforces in me the non-erasable thought that the abstract endowments of wisdom, compassion, kindness, humility, and transparency not only build a reputation of respectability and a life of longevity; but also, over time, they give finite financial returns that can bridge people to a fulfilling post-retirement life as a senior citizen.

With all the exciting, fun-filled, and encouraging lessons from my grandparents, I have no apprehension facing the life of a senior citizen. It is all how you live and love your life in the service of your family, of the people around you, and of humanity in general. * Implementation of senior citizen-

A couple of weeks ago, news clips featured some of our elders rejoicing outside the Malacañang Palace. No, they were not reenacting the “Cry of Pugadlawin”. Neither did they win the lotto jackpot. They were celebrating the signing of President Gloria Macapagal-Arroyo of Republic Act (RA) No. 9994, otherwise known as the “Expanded Senior Citizens Act of 2010”. Of course, we are all aware that senior citizens, or those resident citizens of the Philippines at least 60 years old, are entitled to a 20 percent discount on their purchases of basic essential goods and services such as medicines, transportation, medical and dental fees, services in hotels and restaurants, etc. As introduced in RA 9994, purchases covered by the discount are considered exempt from value-added tax (VAT).

Previously, senior citizens claim that they are effectively getting only an 8 percent discount because of the 12 percent VAT imposed on their purchases. With the passage of the new law, they can now enjoy the full impact of the 20 percent discount. The establishments selling those goods and services, on the other hand, may claim the discounts as deduction from their gross income. However, finance people claim that the additional VAT exemption could translate to at least P1.6B annual revenue loss for the government. This loss, however, can be better recouped through efficient tax collection. The need to support the most vulnerable members of our society in this challenging stage of their lives far more outweighs the projected revenue loss of the government. While our beloved “young once” felt triumphantly jubilant with the passage of this new law, doubts loom whether this feeling is equally shared by the selling establishments. For one, this development necessitates an adjustment in the computerized accounting system (CAS) particularly to those using cash registers or point of sale (POS) machines like fast food chains. As we know, the 20 percent discount is applied only on the total bill, divided by the number of customers, for those who come in groups.

These POS machines may be designed or programmed only to take up discounts, but may have to be calibrated to exclude the sales allocated for the exclusive use and enjoyment of the senior citizen from the tax base subject to VAT. With regard to those using manual invoices/official receipts, compliance for BIR purposes entails additional time to separately indicate the gross sales/receipts pertaining to senior citizen as VAT-exempt transaction. Furthermore, these establishments must keep a separate book to monitor their VAT-exempt sales. What could be controversial in this new law is the effect of the input VAT incurred by the seller on the goods or services sold to senior citizens. As a rule, input VAT directly attributable or allocated to VAT-exempt gross sales/receipts forms part of the cost of the goods or services. This is deductible from the gross income to determine the taxable income. Thus, instead of enjoying the full benefit of the input VAT as creditable against its output VAT, the seller stands to realize only 30 percent (income tax rate) of the input VAT it incurred in bringing the goods or services in its salable condition.

This, in effect, creates undue burden on the part of the sellers since they will have to shoulder the 70 percent of the input VAT that they may not be able to fully utilize or credit against their output tax liability. The scenario would have been different if the law declared the transaction as VAT zero-rated instead of VAT-exempt sale. Input VAT for zero-rated sales may be refunded or applied against the gross sales/receipts subject to output VAT. This would make the benefit more VAT neutral to the sellers as it would allow them to still credit the full input VAT against their output VAT liability. At any rate, with the Expanded Senior Citizens Act of 2010 in place, the next challenge is for the different government agencies to come up with their respective implementing rules and regulations (IRR) to give life to the law. For the BIR, the IRR shall sufficiently cover the compliance requirements to prevent any issues that may be raised by the taxpayers in the course of its implementation. In crafting the IRR, it must always be kept in mind that the objective of the law is to maximize the potential benefit to our elders and to provide them the much needed means to weather the uncertainties of old age without adversely affecting the selling establishments.

* Religion of senior citizen - Statistics Canada reports that seniors are one of the fastest growing population groups in Canada (Statistics Canada: 2005). In 1995, seniors made up 12% of the population. It is estimated that by 2041, about 23% of the population will be over 65. Statistics also show that seniors tend to be very involved in religious activity and are most likely to attend religious functions on a regular basis. Given the increase in our senior population, and the importance of religious involvement for seniors, it is timely that further consideration be given to the spiritual care needs of this growing population. In the course of the past forty years, an impressive body of research concerning the relationship between religion and health has been published. Many recent studies focus even more specifically on aging, religion, and health. Kimble (1995) emphasizes the need to consider the health of seniors from a multi-dimensional perspective of aging that encompasses the whole person. This wholeness, he adds, takes into account the spiritual, physical, mental, emotional, and social dimensions of human life. The purpose of this paper is to identify some of the ways that religion might affect the health of seniors both positively and negatively in relation to these dimensions of health.

Consideration will be given to three key areas of research: social support, religion and coping, and the importance of meaning and purpose in the lives of seniors. For the purposes of conducting research, investigators often employ definitions that distinguish between religion and spirituality (Koenig, McCullough, & Larson,2001). In order to remain consistent with the research, the term religion will be used to refer to an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to a sacred reality and to foster an understanding of one’s connection and responsibility to a community (Koenig, McCullough & Larson, 2001,18). Researchers have sought to measure religiosity based onvariables such as church-attendance and involvement in institutionally organized ctivities.Spirituality has been defined as “the quest for understanding life’s ultimate questions and the meaning and purpose of living, which often leads to the development of rituals and a shared religious community, but not necessarily” (Koenig, George, & Titus, 2004,555). Spiritual health may involve a belief in a supreme being, the feeling of unity with the environment, a sense of meaning and purpose in life, along with the ability to experience love, joy, pain, sorrow, peace, contentment, and wonder (Donatelle, Davis, Munroe & Munroe, 2001,4). Spiritual health can be assessed through conversations with the individual, or through the use of standardized spiritual assessment tools, such as the “Spiritual Well-being Scale” (Ellison,1983) or the “Spiritual Health

Inventory” (in Topper 2003,72). Spiritual assessment can be an important means of gaining an understanding of a person’s spiritual needs. Spiritual support can involve the sharing of religious experiences and feelings, helping others adapt religious teachings and principles to daily life(Krause 2004), seeking pastoral care, participating in organizational and non-organizational religious activities, and expressing faith in a caring God (Koenig,1994). Some of the dimensions of religion and spirituality identified by researchers include religious meaning, values, beliefs, forgiveness, public and private religious practices, religious coping, religious support, religious history, religious commitment, organizational and non-organizational religiousness, and social relationships with religious community members and clergy. While a number of people have influenced my reflections on the importance of religion and spirituality in relation to the health and well-being of seniors, Florence’s story serves as one case example that will be used in this paper to highlight the importance of religious coping, meaning and purpose, and social support. (The name Florence is a pseudonym used to protect the individual’s anonymity.) When Florence was 62 years of age she suffered a cerebral aneurysm.

The aneurysm was successfully treated by surgery, but both the aneurysm and the emergency treatment caused permanent damage. Florence spent the next six months in a comma. The prognosis was not good, and the doctors offered the family little hope for her recovery. Florence defied the odds. Two years later, shortly after her return from a holiday to Mexico, Florence informed a gathering of friends that it was her faith in a loving God that sustained her through the many challenges she faced during her long, difficult, and limited recovery. While her retirement years are perhaps not as she imagined they would be, it is her deep sense of faith in a loving God and a feeling of gratitude for life that inspire her to live each day as fully as possible, in spite of her many limitations. Her faith, along with the support and encouragement she receives from her spouse, family, and friends, are as integral to her continued health as is the medical attention she received.