A History of Caring for Our Elders
For as long as there have been people there has been senior care. We’ll look at the history of this care, from the earliest evidence that elders received care to a new law in China requiring the children visit their elderly parents.
Evidence for Prehistoric Senior Care
Humans are inherently caring. This year archaeologists unearthed bones of an early human who lived approximately 500,000 thousand years ago. Analysis showed the bones belonged to an aged and disabled man who would have trouble walking or carrying the slightest load. To live as long as he did despite his disability, he must have had support from others in his group. This suggests that that senior care is at least half a million years old and that caring and empathy are core human traits.
In Ancient Greece and Rome, elderly people who required care had to rely on their children or extended family. For example, in Ancient Greece, Athenian law required that children care for their aging parents, and the punishment was loss of citizenship (the second most severe punishment for Athenians, besides execution). This arrangement did not change much for about 2,000 years. From antiquity all the way through the nineteenth century, senior care was ultimately the responsibility of the elder’s family.
Medieval Islamic World
Some of the only real progress made in the understanding of aging and senior care between antiquity and the enlightenment occurred in the Islamic world, where incredible advances in science were being made while Europe was mired in the dark ages. In 1025 CE, the Arabic writing Canon of Medicine, one of earliest known texts to describe care for the elderly and one of the most influential medical texts ever, was completed by Ibn Sīnā.
The Dark Ages
During the Dark Ages in Europe, old age was frequently seen as a positive evil, and old people were often denigrated and feared (as demonstrated by the frequent witch trials). Art during the period, which invariably conveyed religious themes, portrayed the elderly as grotesque – an effort to discourage materialism and attachment to the body.
The Age of Enlightenment
But during the Age of Enlightenment, as reflected in art of the time, society seems to have to have grown to appreciate the elder and the benefits of aging. In the Renaissance and the Age of Enlightenment, the best paintings of older people evoke the experience, wisdom and even beauty of the subject who is being painted. Following the French Revolution, in town and villages across France, festivals were developed to honor local elders.
The 19th Century: Uncharitable Charity
The 1800′s saw major changes both for humanity and seniors specifically. In Europe and North America, governments came to realize they had some sort of obligation to insure that indigent seniors at least had somewhere to live. “Workhouses” and “poorhouses” were built for seniors with no means and no family to take them in. While they were intended to be charitable, these so called workhouses or poorhouses were rather awful places to live. The seniors who resided in them were referred to as “inmates”. They were segregated by sex, forced to wear uniforms, and, if feasible, required to participate in work to upkeep the property. These poorhouses also often housed orphans, disabled people, mentally ill people, and alcoholics. In History of Long Term Care, Karen Stephenson writes that conditions “ranged from barely tolerable to horrific.” In 1901, an astounding 10% of elderly English men lived in workhouses.
Institutions for the Aged
Gradually, care became more specialized although not necessarily much better. A law was passed that forbade housing orphans in poorhouses. Asylums opened for the mentally ill while residences especially for indigent seniors developed. For example, in 1823 Philadelphia’s Indigent Widows’ and Single Women’s Society, one of the first homes for the elderly, opened in the U.S. While elderly people were no longer forced into the poorhouse, these homes were oppressively institutional and still had much to be desired. America was rapidly industrializing and it was thought the efficiency of the factory could be applied to caring for seniors.
Towards a Modern Approach
The kernels of the modern care system developed in the mid-1800′s. As an alternatives to state-run institutions for the elderly, fraternal organizations, tradesmen, and religious groups began to open nonprofit homes for seniors. Stephenson writes that these organizations, often called “benevolent societies”, were “affiliated with nearly every ethnic, religious, trade, profession, and social group imaginable.” Examples of these groups include the German Benevolent Society, the Odd Fellows, Masons, and Knights of Columbus. Young member of these groups would pay into a pool that would operate much like a pension plan today. The homes that they operated were often quite nice, and some still operate today. Stephenson wrote, “In sharp contrast to the poorhouses, the voluntary and charitable facilities seemed luxurious. Many were newly-constructed buildings, built specifically to house the elderly, and others were stately old mansions whose owners had died.
The 20th Century and Beyond
In the 20th century, aging became, for the first time, an area of study in its own right. The terms “gerontology” (study of aging) and “geriatrics” (medical care for aging people) were both coined in the first decade of the century. Interestingly, Alzheimer’s disease was first identified and described in the first same decade.
Furthermore, governments across the world Western world began instituting programs that provided income to older people who were no longer able to work. The first pension for retired workers was instituted in Germany in the 1880′s but other nations were slow to follow. It was the Great Depression that provided impetus for the United States to finally create its own “old age pension”, and in 1935 Social Security was passed under the leadership of Franklin Delano Roosevelt. Now nearly every developed nation provides a pension for retired workers. And just 30 years later in 1965, Medicare and Medicaid were formed, helping to ensure that seniors had access to medical care no matter what their means.
Today, the elderly population is increasing rapidly. Every day, 8,000 Americans from the Baby Boom join the 40 million Americans who are already 65+. This boom in the aging population, along with the need for alternatives to the classic institutional nursing homes, prompted many types of senior care to flourish across the U.S. and the rest of the developed world. To provide intermediate care for those who don’t need a nursing home but cannot live independently, assisted living communities have sprouted up all over the U.S. Other are types of senior care and senior housing have appeared and flourished too, including in-home care, memory care, continuing care retirement communities (CCRCs), and respite care.
Age related health issues are being made a priority too. For example, Obama administration has made Alzheimer’s disease research a priority and set an optimistic goal of finding a cure for Alzheimer’s by 2025, dedicating significant funding to the mission.
Milestones of Elderly Care
- 500,000 years BCE : First evidence of senior care (bones of elderly, disabled early human discovered in 2013)
- 3100 BCE – 332 BCE: Egyptian Pharaohs buried with walking sticks (canes).
- 1900 BCE – 1600 BCE: Elderly men from the Bronze age buried with copper axes, suggesting veneration.
- 700 BCE: Ancient Etruscans created dentures out of human and animal teeth.
- 44 BCE: Roman philosopher Cicero writes his treatise On Old Age.
- 104 : Roman Egyptian census records show many multi-generational households.
- 600 : Latin poet Maximianus writes On Old Age and Love.
- 1025 : The Arabic text Canon of Medicine, one of first texts to describe caring for elderly, is completed by Ibn Sīnā.
- 1200 : Icelandic law exempts those over 70 from fasts.
- 1632 : Historical Austrian census records show 8.7% of women were widows and 4% of men were widowers.
- 1790s : Following the French Revolution, villages and towns across France hold festivals to honor elders.
- 1823 : One of the first homes for the aged opens in the U.S. (Philadelphia’s Indigent Widows’ and Single Women’s Society).
- 1853 : One of the earliest guides to aging is published (On the Decline of Life a book on “the best means of attaining a healthful old age” by Barnard Van Oven)
- 1880′s : Germany is first nation to institute Old Age Pension
- 1893 : Visiting Nurse Society formed to provide charitable in-home care to indigent seniors.
- 1898 : Oldest known living person, Misao Okawa is born.
- 1901 : 10% of elderly English men and 6% of elderly English women confined to workhouses (or “poorhouses”).
- 1906 : Alzheimer’s disease is first described by German psychiatrist Alois Alzheimer’s.
- 1909 : The term “geriatrics” is coined by Austrian doctor, Ignatz Nascher.
- 1933 : First lightweight, collapsible wheelchair invented.
- 1935 : Social Security passes as part of FDR’s New Deal.
- 1946: Great Britain enacts free health care for elderly citizens through National Health Service.
- 1965: Medicare and Medicaid instituted, prompting the rise of nursing homes.
- 1974: First hospice in U.S. opens.
- 1981: First recognized assisted living facility opens in U.S.
- 1993: Nicknamed “Dementiaville”, De Hogeweyk, a revolutionary new dementia care “village” opens in Holland.
- 2010: Baby Boom becoming “Silver Tsunami”: 40 million Americans are 65+.
- 2012: 5.4 million Americans are living with Alzheimer’s disease.
- 2013: New law in China says adult-children must visit their elderly parents.
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