In this article we present highlights of the interview with MICARE Director Claudia Miranda published by CIPER Académico, on the characteristics of old age and the need to generate care policies focused on those who perform this task.

Adapted by Gabriela Campillo. Original article by Marcela Ramos, CIPER Académico.

“Throughout the world, caregiving is associated with women. In Chile, caregivers of elderly persons, on average, are about 60 years old and we call them ‘the sandwich generation’ because they are women who are still caring for their own families and also have to take care of their parents,” explains Claudia Miranda, director of the Millennium Institute for Caregiving Research (MICARE) and an academic at Andrés Bello University.

Claudia began to observe caregiving dynamics from her own experience. First, it was her grandmother: an active, autonomous, and very present woman who was diagnosed with Parkinson’s in her 70s. What the family did not know was that dementia could develop in association with Parkinson’s disease.

Her grandmother’s children then decided that someone had to take care of her on a permanent basis. She had had five children: 2 women and 3 men. The men took care of their mother in other roles, but it was the women who were the candidates to take care of her on a daily basis:

‘The candidate is always a woman: a daughter, a daughter-in-law, that’s the way it is, culturally’.

Claudia Miranda, MICARE director.

Twenty years later, the issue of caregiving touched her even closer to home, with her second child. “My son was born with achondroplasia, commonly called “dwarfism”, but following an operation in which there was a complication, when he was almost two years old, he was left with permanent neurological sequelae. My son is now 6 years old and has general developmental delay and multiple disabilities,” she says.

Her own story taught Claudia two things: that caregiving is a task fundamentally performed by women, and that we generally go into it with few tools:

“What a mom caring for a child with an intellectual disability, or even a physical disability experience, is different from the reality of a mom caring for a child who is within the norm. Fortunately, I have someone who helps me with my son and who is essential for his development. This allows me to work, but even with that support, the frequent trips to the doctor, keeping an eye on exams, and thinking about what will happen to him once his father and I are gone, takes its toll”, Claudia Miranda says.

In addition to the enormous physical and financial demands, Claudia adds the mental health costs suffered by caregivers. For this reason, she says that when it comes to promoting public policies on the subject, both the people being cared for and those who undertake this task must be addressed.

–As if there were two patients:

-We know that caregivers are women with low education and lower-income, and this profile is sometimes perpetuated across generations. Also, caring for a dependent person makes you more and more isolated. When you feel that you have stopped doing what you used to do, that you cannot work or have a self-care routine, this generates mental health problems with symptoms of anxiety and depression.

-How does this manifest?

-Depressive symptomatology has to do with mood, energy, having a somewhat pessimistic view of the future. Anxiety, on the other hand, is linked to worrying. You have trouble sleeping, or recurring negative thoughts that are sometimes based on evidence but are often all in your head. Then your palms sweat and your stomach kind of clenches. Another concept that is often mentioned is overload: the feeling that you have to do a lot of things associated with caregiving, and you don’t know to what extent you’ll be able to do them and do them well. We call this constant stress “overload”, and it is something that women caregivers experience.

‘We know that carers are women with low education and lower income, and this profile is sometimes perpetuated across generations’.

Claudia Miranda, MICARE director.

OLD AGE IN CHILE

According to Claudia Miranda, the challenges associated with caregiving in Chile are growing, as the birth rate has decreased and life expectancy has increased, which has accelerated the aging process. In concrete figures, this means that, by 2050, “one-third of the population will be elderly”.

– How do elderly people live in Chile? The documentary film The Mole Agent (in Spanish, Agente Topo), which has been nominated for an Oscar, depicts a sad, lonely, misunderstood old age. Is it like that?

-Old age is a very heterogeneous stage of the life cycle, more so than any other. Picture this: you have two newborn children, and they probably have 90% of things in common. But when you have people who have lived 60 years or more, their life experiences and what they have learned are clearly very diverse. So, rather than talking about old age, we talk about “old ages”. Now, within this heterogeneity, in terms of their functionality, you could classify elderly people as dependent or autonomous. And here we are going to put an end to a stereotype because around 80% of people over 60 in Chile are autonomous. Institutionalized elderly people, i.e. those living in institutions, are the minority.

-What data are available? Is vulnerability higher in any group, by age, by gender, by social class?

-We know that both perceived support and social participation make people more or less vulnerable. We also know that, according to the latest National Survey of Quality of Life in Old Age, between 63% and 74% of elderly people say they feel satisfied with their life. So, in the end, these indicators make you think that regardless of economic income, most seniors are satisfied with their lives and perceive that they have people or networks to turn to.

-In other words, we must cultivate our “social beings” component.

-Exactly. And this is very interesting at a time like the present. Because the current economic system tells us that we have to compete, that everyone tends to their own garden. But all that collapses when you think about the social determinants of physical and mental health, because we are social beings, and we have to develop that all the time. It’s not something we’re going to do only in our old age.

-I understand that this is one of the explanations for women living longer. At the end of life, that more sociable side may end up saving you…

-Yes, that also has to do with the roles that have been assigned. Old age has a whole prior history. In the case of men, their history, in general, has been that of providers, with work as their maximum source of social participation. But you lose that as you get older, and if your social networks were limited to that, you lose them too. On the other hand, women, for different reasons, develop in different areas, especially since we have entered the labour market, and this potentially allows us to develop more significant support networks and be more protected against loneliness. Yet, this can be truncated when you are a caregiver, which is why it is essential to raise awareness and intervene in this area.

Read the full interview written by Marcela Ramos in CIPER Académico.