- Insaf Altun, MScN.
Doctorate student, Istanbul University, Florence Nightingale Nursing School, Istanbul, Turkey.
- Nermin Ersoy, PhD.
Kocaeli University, Medical Faculty, Department of Medical Ethics and Medical History, 41900 Kocaeli, Turkey.
Eubios Journal of Asian and International Bioethics 8 (1998), 143-145.
Old Age in Turkish Traditions
When we look at the social values concerning the elderly people
and old age in the Turkish society from the historical point of
view, we see that in ancient Turkish societies the elders kept
their existence after death. People believed that their spirit
was living in the home. During the ages of Shamanism, the Shamans
usually were the elders. In tribal communities, experienced elders
were very beneficial, and thus esteemed and this fact became a
custom. In the Oguz legends, the ones who treated the weak and
elder people were referred as the bad ones, and as an indication
of respect they used to kneel in front of the elders and kiss
their hands. After the accepting the principles of Islam, Turks
began living in accordance with it. There are verses in the Koran
concerning respect and care to the elderly, disabled, poor people
and parents. Respect and loyalty to the elders is a major social
norm in Turkish traditions. In the Bektashi phrases and anecdotes,
disobedience to father is symbolized as disobedience to God (1).
Old Age in Contemporary Turkey
According to the 1996 census in Turkey, 6% of the 66 million population were 65 years old or older and 43% is 25 years old or younger. Rapid industrialization and urbanization in Turkey is one of the major reasons of the fact that approximately 60% of population are living in the cities. Therefore, with respect to family order, we see that nuclear families are highly common in cosmopolitan areas while the rate of traditional families increases as the size of communities decreases. The general decrease in the number of traditional families makes us consider the reasons for the increase in the rate of nuclear and dispersed families. In spite of a rapid transformation from the traditional families to the nuclear families, mutual assistance and support among the relatives still persists, so that the structure and function of the families remains. Traditional family type is still considered as an ideal by many, and the functions in the nuclear families operate as in the larger one. Such traditional values come into being within the frame of group loyalty, measured by the respect accorded to the elders.
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. Although sisters and brothers have equal rights with respect to inheritance, the properties of a family are considered to belong to the sons and thus naturally the responsibility of supporting the parents belongs to the sons whose economic strength is sufficient for this purpose. When this is realized, status and social approval of the elders is ensured. The perspective on the old ages in the groups where such values are dominant is usually positive. For example, in research which was conducted in an Anatolian village, some advantages of old age that were obtained were as follows: "people listen to me when I talk", "I work less", "I have time to worship", "Old age is good if you are not ill", "If old age was not good, God would not give it". As disadvantages of old age: weakness, economic and social losses, were mentioned (1).
However, in research conducted in the proximity of Elazy which is in the eastern part of Turkey and one of the districts where family customs are still dominant, it was found that the more than half of the elders are illiterate, nearly half are widows and female. 87% of the elders defined old age negatively and 78% stated it is are not pleasant to be old. There is a significant relationship between the pleasantries of old ge and economic level of families, and living together with the spouse and children (3).
In research conducted in the proximity of Erzurum which is close to the same region, it was found that 68% of old people live together with their spouses, 25% also stay with their sons and 91% does not even consider to go a rest home. It was observed that in contrast to the research in Elazy, 82% of old people said their lives are pleasant. 64% considered themselves as old after their ages of 40-50 and 42% did their housework by their own and made hand crafts in their spare time. They stated that they are sad for the loss of their physical powers and being dependent on someone (4).
Research conducted in Istanbul, the largest metropolitan of Turkey established that the 73% of elderly people have problems with their sense organs (5) while research in Izmir determined that 90% of elderly people have systematic health problems. Among these problems are high blood pressure, mouth or teeth defects, visual and audio defects (6).
Another research in Istanbul, established that the life satisfaction
of elderly people increases parallel to their self-care power
oes. The life satisfaction levels were found higher with those
living with their spouses, those satisfied with their homes, those
having regular health control, and Jews (7). In research surveying
the perspectives on death of elderly people in Istanbul (1994),
44% of them indicated that they are not afraid of dying and death,
with females having more anxiety about death with 47% on average
(5). This result suggests the elderly accept the concept of death
as they get older and older.
Conditions of Elderly People in the Rest Homes
In our country, generally the elder people who do not have sufficient economic resources and anyone to support them legally are allowed to live in the old people's homes free of charge and those having sufficient economic resources but socially deprived are accepted in charge (5,8). Most residents are widows or widowers alone and more are male (5).
Research conducted in a rest home in Eskiehir, in Central Anatolia where mostly disabled and paralyzed people are accommodated, established that more than half the residents are males, 4% have no one to take care of them and 24% stay there due to internal family incompatibility. 82% are not satisfied with their lives, 70% feel themselves to be alone and in order to overcome it 20% watch television (8).
A research conducted in Gaziantep which is an important residential area in South Anatolia, established that 7.5% of the elderly people, the majority of whom are male, reside in the old people's homes voluntarily and 85% due to the lack of someone to take care of them. 68% of the elderly people residing in a rest home stated that they are pleased to reside in an old people's home and 93% of the elderly people living in the same area stated that they do not want to live in the rest homes. The elderly people living in the rest home turned out to be more suspicious, distrustful, doubtful and having an average level of life satisfaction. No meaningful relationship was observed between life satisfaction and whether living at home or in a rest home or poorhouse (9).
Research conducted in a large province in the western part of
Turkey (Izmir), established that 54% of the elderly people live
in the rest home due to loneliness and of these 75% voluntarily,
61% of them are males and 75% do not have anything to do and spend
their time by watching television (6).
Perspectives on Old Age of the Social Groups
The perspectives on the elderly people and the respect accorded them are affected by religious and traditional attitudes. As a traditional value, elderly are supposed to live with their sons. Another factor for accommodating the elderly in the sons' family, is the lack of economic independence of the young women in Turkey. To live together with the family elders decreases the economical burden of the families. Another factor for living together is the physical and economic inability of the elderly, as 48% of the people of 65 years old and older are not included in any social security coverage (5).
It was reported that 43% of women live with their mothers-in-law and 42% live both with their mothers and fathers-in-law by a research conducted on the young generation of women in a province of Black Sea region (Trabzon) where family ties are quite strong. Also it was established that 97% of women living with their older members of a family do not work and are not economically independent. It was reported that not the husbands but the elder ones make the decision on living together (72%). The women living together with the elders presented the disadvantages of living together with the elders agreeing with reasons like "I can not do whatever I want at my home (21%)", "The elder interferes in everything (15%)", "It requires permanent obedience and responsibility (11%)". On the positive side they indicated that they utilize their moral support (15%) and the elders help them in housework (11%). When the women were asked with whom they want to live when they get older, 40% said that they want to live with their sons and 60% said they do not want to. Almost all the women stated that it is not appropriate for the elders to live in the old people's homes and as a reason for this (97%), they said they (their spouses) have children and our customs do not permit them to stay at a rest home (10).
Research conducted on university students, 73% of whom are living in the city and have a nuclear family, found that mothers of 77% of them do not work and there is an elder member of family living in 81% of their houses. 75% of those elders are women. 46% of these women are mothers of the son. 56% of the interviewees said that living with an elder makes the life conditions of their families harder. Most of the interviewees with an elder living in their houses believe that the elders should live in the rest homes and do not accept such a collective life. In this research, it was reported that the interviewees whose mothers are working are more sympathetic towards the elders. The difference between the perspectives on the old ages of the young people whose mothers who are working and whose mothers are not working has a meaningful relation with "the efforts of the young people whose mothers are working or retired, for understanding the elders" (11).
When the perspectives of the employees working in the institutions that are providing service to the elders (experts in social service, nurse, psychologist, physician, officer and servant) on the old ages are examined, it was found that the perspectives of 88% are positive, 35% want to live together with children when they get older, 19% want to live in the old people's homes and 36% want to take care of their grand children (12).
Finally, with respect to perspectives of the nurses on the old ages, 69% of the nurses consider giving care to the elders as a problem. They reported that they have problems in the physical care services, mostly, communication and social aspects. The physical problems included that the patient is untidy and having excreting problems. The communication problems included tthat the patient rejects treatment, is noisy and distrustful. In the social aspects, they have problems because the relatives of the elderly criticize the treatment applied and the family of the elder leaves them when the elder becomes sick. Moreover, it is observed that when the elder gets sick they do not want to live in the houses of his/her kids not to bother them. The nurses reported that both their information levels and the conditions of their institutions are not sufficient to provide services to the elders (13).
Consequently, the elders constitute 6% of our population, and 90% of the people of 65 years-old or older have usually chronic health problems. Nevertheless, adequate training for the problems of old age are not provided in the medical and nursing schools. Lack of information concerning old ages of the health employees makes them consider elder-caring services as a problem. There is an insufficient number of institutions where the elders can live without causing internal family problems in Turkey, the share allocated from the national income for this purpose is very small (14). These are the reasons for the negative considerations about old age, on the part of the elders and the relatives of them. Scarce economic resources, urbanization, concern for nuclear families, changing family values, all these factors are reasons why the elders and adult population become anxious for their old age.
1. Emiolu V. Health Aging With Its Social-Cultural Aspects, pp.31-36
in The Booklet of Healthy Aging Symposium, Ankara, 1992
(in Turkish); (Hereafter refered to as BHA)
2. The Annual Statistical of Turkey: The Institute of Government Statistics of Turkish Republic. Ankara, 1996.
3. Mete S, Gkdoan F. The Way The Elders In The Proximity Of Elazy Perceive The Old Ages, pp.370-387 in BHA.
4. Erci B, G¸len , Bingl M. The Factors Making Adaptation to Old Age Difficult, pp.68-75 in BHA.
5. Yazýcý R. Research On The Death Anxiety Of The Old Individuals And The Effect Of It On Their Lives (Masters thesis on nursing). Istanbul University, The Institute of Health Sciences. 1994, Istanbul.
6. Fadýlolu «, et al. Research on the Daily Life Activities and Health Conditions of the Elderly Living in the Rest Home, pp.139-147 in BHA.
7. «imen S. Research on the Self-Care and Life Satisfaction of the Old Individuals (Masters thesis on nursing). Istanbul University, The Institute of Health Sciences. 1996, Istanbul.
8. Kogerolu N, Aksoy F, ÷zkaya G. Evaluation of the Problems and of the Ways to Cope with them of the Elderly Living in Rest Homes and Their Own Houses, pp.338-349 in BHA.
9. Ekici H, nal S. Life Satisfaction and Psychological Symptom Scanning on the Elderly Living In Their Own Houses and Living in the Rest Home of Akyol Health Center, pp.121-129 in BHA.
10. ÷zcan A, Nural N, Karata B. Place of The Elders in The Large Families and The Way They Are Perceived, pp.184-188 in BHA.
11. Pektekin «, et al. Investigation on the Knowledge and Opinions of the Young Generation about the Process of Aging and Old People, pp.76-81 in BHA.
12. Terakye G, ÷z F, st¸n B. The Perspectives of the Staff Employed about Aging and Old Age at Rest Homes and Poor House, pp.296-304 in BHA.
13. Durmuþ B. The Study on the Nursery Problems Faced in the Process of Caring for Old Patients, pp.232-237 in BHA.
14. The Ministry of Health of Turkish Republic: The Report of the Old Age Group: the Evaluation of the Current Circumstances, pp. 385-388 in BHA.