Perception of Old Age and Institutions for the Elderly among the Inhabitants of Beirut, Lebanon: a Cross-Sectional Study

doi:10.21203/rs.3.rs-2231245/v1

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Perception of Old Age and Institutions for the Elderly among the Inhabitants of Beirut, Lebanon: a Cross-Sectional Study

https://doi.org/10.21203/rs.3.rs-2231245/v1

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Background

Aging is a social factor that every human considers. Consequently, myths and stereotypes have been associated with old age, sometimes depicting a negative image. The human perception of old age is formed by knowledge, opinions, and cultural realities. Some people perceive old age as a sign of wisdom, while others consider old age as a loss of or decline in independence. This study aims to explore the perceptions, opinions, and attitudes of a representative sample of the inhabitants of Beirut, Lebanon toward old age and institutions for the elderly.

Methods

We conducted a cross-sectional survey of the inhabitants of Beirut using an anonymous, self-administered questionnaire in the Arabic Language, filled out voluntarily by the respondents. The information obtained through the survey included socio-demographic characteristics, perception of old age and residential institutions for the elderly, and factors influencing the fear of old age.

Results

A total of 400 individuals completed the questionnaire, 50.3% of whom were male. Only 7% of the respondents were 65 years and older. The mean age considered by respondents as old age was 64.23 years. For 28.8% of the respondents, old age mainly meant illness and health problems. Most of the respondents (89%) expressed worry when thinking about old age. The respondents expressed several concerns about old age; the most prominent were health concerns (38.4%) and loss of autonomy (23.7%). Furthermore, our sample’s perception of homes for the elderly was positive: good (39.8%) and very good (11.8%). However, only 3.5% of the respondents had an elderly relative in such institutions. Finally, 33.5% of the respondents agreed to pay for the services in such institutions, and 28.3% suggested an increase in compulsory levies to improve the care of people in such institutions.

Conclusions

Most of the respondents had a negative perception of old age, which was marked by pessimism about their health and autonomy. Similarly, institutions for the elderly represent an undesirable option as the respondents outlined several factors that explain their reluctance. The findings indicate an urgent need for action to improve people’s perceptions and attitudes toward old age.

elderly

old age

perception

autonomy

institutions

Old age is a normal stage of human life because people are born, grow, age, and die. Aging is the impact of time on the human body (1). Although old age is a natural phenomenon, it has a socio-cultural dimension (2); therefore, it is a chronological, physical-biological, psycho-affective, or social reality.

According to the World Health Organization, people who are 65 years old or older are considered old (3). However, the old age range varies among different localities and may start at 55 or 75 years. According to Baslevent, the average onset of old age is 62.9 years in Europe (4), while the “French Institute of Public Opinion” reported in 2011 that individuals are considered old at 69 years (5).

The image this human reality reflects is influenced by several conscious and unconscious considerations. Aging can be associated with declining physical abilities, diminishing financial resources, and sometimes loss of psychological autonomy (6). Thus, the younger generations mostly perceive older people as a social and economic burden rather than an asset to society. Inaccurate and stereotypical perceptions of aging often lead to discrimination and social exclusion. However, this negative perception of the elder age is changing as aging is becoming a pleasant stage of life (7). This change in mentality is due to medical advances and improvements in the quality of life of older people.

Several studies on the perception of aging have been performed among various populations, and the perception varies from one country to another. A survey of 1,000 people in Quebec showed that Quebecers perceived old age with a great deal of serenity and optimism (8). Despite this positive attitude, 75% of people still have concerns about illness and loss of autonomy. Moreover, 34% of Quebecers feared looking old while 24% were concerned about being sexually incapacitated due to old age.

In 2007, a survey in France found that old age has a positive image in society (9), indicating experience (45%), wisdom (40%), and wealth (30%) in society. On the other hand, 23% of the French associate old age with a burden; old age has been reported as a sign of functional decline (18%) or a handicapped state (16%). People’s perception toward institutions for the elderly, also known as rest homes or retirement homes, has deteriorated, with 49% of Quebecers having a bad opinion regarding homes for the elderly in 2006 compared to 38% in 2005. The poor image of these homes is based on the following fears: high fees (96%), limited room availability (86%), and absence of insurance coverage (69%).

In 2012, a survey in Europe showed that the perception of old age varies according to countries and social strata (sex, age groups, and professions) (10). The onset of old age in the Netherlands (70 years old) and Slovakia (58 years old) are more than 10 years apart (10). In Portugal and Sweden, people are considered young until the age of 37, while this age limit is 50 in Cyprus and Greece (10).

In Lebanon, demographic data show a significant increase in the number of older people, from 4.9% in 1970 to 9.6% in 2007. Consequently, the Lebanese population is experiencing a significant acceleration in the number of older people (11,12). Of the number of older people in 2007, 1.4% lived in institutions, while the vast majority resided with their siblings (13). Therefore, this study aims to explore the perceptions, opinions, and attitudes of a representative sample of the residents in Beirut toward old age and institutions for the elderly.

Study design

This is a cross-sectional survey conducted in Beirut, Lebanon through face-to-face interviews in the homes of the respondents. The recruited sample is representative of all the social strata of this population.

Sampling method

The number of people who were surveyed was 400, and they were recruited from the general population and from a housing census conducted from 1999 to 2007 in the municipality of Beirut using the stratified, two-stage sampling method.

Target population

The respondents included male and female Lebanese aged 18 years and above and from different religions and socio-economic classes who live in Beirut. They all agreed to fill out the questionnaire in their native Arabic language.

Sample size

The sample size was calculated using statistical formulas from Statistical Package for Social Science (SPSS) [version 22] to ensure the representativeness of the population of Beirut, with a confidence level of 95% and a margin of error (α) of 5%.

Survey tool

This is an anonymous, self-administered questionnaire in Arabic, filled out voluntarily by the respondents, and consists of three components. The first component asks individual questions about the socio-demographic characteristics of household members (age, sex, marital status, level of education, professional activity, and socioeconomic level). The second component assesses the perception of respondents toward old age in terms of their perception of old age, the image they have of old age, the factors that make them afraid of old age as well as the difficulties they experience when providing care to older people. Finally, the third component assesses the surveyed population’s evaluation of institutions for the elderly and their participation in improving the care system of the elderly.

The survey process

Data collection started on March 24, 2017, and ended on April 4, 2017. Each district was surveyed by one male or female interviewer. The duration of the survey at each district was one to two days, including the filling of the questionnaires and the commuting from one district to another. The respondents completed the questionnaires in the presence of the interviewers, who clarified any query when needed. The scientific purpose of the survey was explained to the respondents, which helped to limit exaggerated responses. In the case of long-term absence, relocation, or refusal to participate, the interviewer could replace the household. The recorded replacement rate was 15.1%. To replace a household, the interviewer considered the closest household on their right and subsequently, if necessary, the closest on their left.

Data entry

The data were entered into an SPSS 22 spreadsheet. During the entry, the data was audited along with code verification and validation of the variables.

Statistical analysis

The data were analyzed using SPSS 22 according to classic statistical tests. Descriptive analysis was performed for most of the data. The following data was collected: socio-demographic characteristics of the population, their perception of aging, and the image they have of old age as well as the fears they have about old age. The institutions for the elderly were also evaluated. The chi-squared test was used to calculate the level of significance in comparison with the significance threshold set a priori at 5%.

Sociodemographic Characteristics of the Respondents

The respondents in this study were 400, 50.3% of whom were male. The age group that was the most represented was 18–34 years (38.5%). More than half of our respondents were married (58.8%) (Table 1).

Table 1. Sociodemographic Characteristics

Sex
	Frequency	Percentage (%)
Man	201	50.3
Woman	199	49.8
Total	400	100.0
Age Group
NR*	5	1.3
18–34	154	38.5
35–49	112	28.0
50–64	101	25.3
65+	28	7.0
Total	400	100.0
Family Situation
Married	235	58.8
Single	150	37.5
Divorced	10	2.5
Widow/Widower	5	1.3
Total	400	100.0
Living Condition
Alone	24	6.0
Couple	231	57.8
Family	145	36.3
Total	400	100.0
Professional Situation
*NR	72	18.0
Still Working	297	74.3
Retired	13	3.3
Unemployed	18	4.5
Total	400	100.0
Level of Education
Primary Studies	118	29.5
High School	138	34.5
University Degree (Bachelor or Masters)	144	36.0
Total	400	100.0
Monthly Income (LBP)**
< 500×10³	4	1.0
500–999×10³	59	14.8
1000–1999×10³	170	42.5
2000–2999×10³	110	27.5
≥ 3000×10³	57	14.3
Total	400	100.0

*NR = No Response **LBP= Lebanese Pound

Perception of Old Age

The mean age considered by the respondents as the onset of old age was 64.23 ± 8.44 years. Most respondents (42.5%) considered the onset of old age to be from 61 to 70 years. The image of old age among respondents in Beirut was negative. The following are their perceptions of old age: illness and health problems (28.8%), retirement (14.5%), loneliness (12.9%), dependence and loss of autonomy (8.2%), and functional decline (7.5%). Our population seemed to be aging with some concerns, as 31.0% were very worried, 14.3% were somewhat worried, and 43.8% were a little worried (Table 2).

Table 2. Perception of old age among respondents

Onset of Old Age
	Frequency	Percentage (%)
NR*	36	9.0
40–50	38	9.5
51–60	106	26.5
61–70	170	42.5
71++	50	12.5
Total	400	100.0
Image of Old Age
Free Time – Leisure Time	50	7.2
Retirement	101	14.5
Serenity	73	10.5
Experience – Wisdom	72	10.4
Loneliness	90	12.9
Illness – Health Problems	200	28.8
Dependence – Loss of Autonomy	57	8.2
Functional Decline	52	7.5
Total	695	100.0
Concerns about Old Age
Not at all Worried	44	11.0
A Little Worried	175	43.8
Quite Concerned	57	14.3
Very Concerned	124	31.0
Total	400	100.0
Reasons for Concern
Health	227	38.4
Poverty	68	11.5
Retirement	24	4.1
Loss of Autonomy	140	23.7
Isolation – Loneliness	86	14.6
Loss of Loved Ones	34	5.8
Stopping Sexual Activity	7	1.2
Other	5	0.9
Total	591	100.0

*NR = No Response

Caring for the Elderly

This study shows that 42.7% of respondents have had the opportunity of previously taking care for an elderly person. The perceived difficulties reported by 29.2% of the respondents were mainly related to personal and family living conditions. This may limit the possibility of achieving favorable conditions in taking care of older people. The nutritional (23.4%), psycho-emotional (21.1%), and medical (14.6%) aspects of aging also constituted other aspects of these perceived difficulties. Only 11.1% of these difficulties were due to financial problems (Table 3).

Because of these difficulties, nearly half of our respondents tend to host the elderly at their own houses (45.6%). Furthermore, 28.7% preferred that the elderly be cared for at their homes. Of the people interviewed, 22.2% already provide elderly assistance at home. Only 3.5% entrusted the elderly to specialized centers. What is more, 94.3% of the respondents affirm that elderly needs are not well addressed by Lebanese officials.

Table 3. Care for the elderly

Care for an Elderly Person
	Frequency	Percentage (%)
Yes, Currently	127	31.7
Yes, in the Past	44	11.0
No	229	57.3
Total	400	100.0
The Elderly Person was Able to Manage all his Needs
Yes	71	41.5
No	100	58.5
Total	171	100.0
Difficulties Perceived by the Respondents in Managing these Elderly People
Psychological and Emotional Aspects	36	21.1
Medical Aspects	25	14.6
Nutritional Aspects	40	23.4
Personal and Family Aspects	50	29.2
Financial Aspects	19	11.1
Administrative Aspects	1	0.6
Total	171	100.0
Measures Taken to Deal with this Situation
Home Care for the Elderly	78	45.,6
Home Care for the Elderly with a Nurse or Caregiver	38	22.2
Accommodation in my Home or with Family	49	28.7
Accommodation in a Specialized Center	6	3.5
Total	171	100.0
In your Opinion, are the Elderly Listened to enough today?
Yes	17	4.3
No	377	94.3
Do Not Know	6	1.5
Total	400	100.0

Perception toward Facilities for the Elderly

Our study found that more than half of the respondents (51.6%) had a fairly positive opinion of nursing homes. According to 48.0% of respondents, the fees were not too high, 53.5% responded that the facilities were enough, and 32.5% indicated that the staff is professional. On the other hand, 43.8% of the respondents were uncertain of satisfactory care for the elderly in these facilities, particularly in the case of functional dependency.

The study participants were concerned about conditions at institutions that care for the elderly. They indicated that the staff is not attentive to the elderly (37.0% indicated that the situation was bad and 18.0% indicated that it was very bad) and those institutions do not ensure good quality of life for the elderly (bad, 37.8%; very bad, 19.8%).

Besides, our survey revealed that nursing homes seemed to be a default solution. Regarding the alternatives to institutional care, the respondents indicated that they chose the most affordable solution: 33.5% preferred to pay for an institution to care for the elderly, 28.3% preferred higher compulsory levies, and 14.0% preferred to pay for home care assistance. On the other hand, 9.8% chose to do nothing. Finally, 8.0% found it more appropriate to take care for the elderly in their own home.

Perception of Old Age According to the Sociodemographic Characteristics of the Population

Concerning the onset of old age, our study reveals that it increases along with the age of responders. The ones aged 65 and more considered themselves to be “old” at an average age of 69.7 years, while this age was 64.7 years for those in the 50–64 years age group, 64.1 years for those in the 35–49 years age group, and 63.0 years for those in the 18–34 age group.

These assessments also varied according to the level of education and monthly income. The higher the level of education (i.e., university), the more significantly the increase in the onset of old age, with a p-value of 0.001 (Table 4). Similarly, higher monthly income correlated significantly with a higher onset of old age perception, with a p-value of 0.0001 with an average of 52.5 years for monthly income less than 500×10³ LBP (1 USD = 1515 LBP at the time of the study) compared to 66.32 years for incomes more than 3000×10³ LBP (Table 4). Conversely, other demographic factors did not significantly correlate with the perception of the onset of old age (Table 4).

Table 4. The onset of old age by demographic factors

Sex	Average (Year)	N	SD*	p-Value
Man	63.75	180	8.11	0.281
Woman	64.71	184	8.76	0.281
Age Range	Average (Year)	N	SD	p-Value
NR**	70.80	5	5.76
18–34	63.00	143	8.39
35–49	64.12	104	8.14	0.004
50–64	64.69	91	8.35
65+	69.67	21	8.93
Family Situation	Average (Year)	N	SD	p-Value
Married	64.09	208	8.70	0.140
Single	64.56	142	7.98
Divorced	59.33	9	9.10
Widow/Widower	69.80	5	7.26
Living Condition	Average (Year)	N	SD	p-Value
Alone	66.43	23	9.37
Couple	63.97	205	8.80	0.414
Family	64.26	136	7.72
Profession	Average (Year)	N	SD	p-Value
NR	65.36	64	8.33	0.629
Still in operation	64.06	278	8.51
Retired	63.89	9	5.46
Unemployed	62.62	13	9.69
Level of Education	Average (Year)	N	SD	p-Value
Primary Studies	63.56	106	9.56
High School	62.66	130	8.17	0.001
University Curriculum	66.39	128	7.25
Monthly Income (LBP)*	Average (Year)	N	SD	p-Value
< 500×10³	52.50	4	8.66
500–999×10³	63.69	52	8.45
1000–1999×10³	62.70	155	8.58	0.000
2000–2999×10³	66.25	103	8.37
≥ 3000×10³	66.32	50	6.36

*SD = Standard Deviation **NR = No Response ***LBP = Lebanese Pound

The Onset of Old Age

In our study, the respondents considered 64.23 years as the onset of old age. This result is different from surveys conducted by other authors (4,5). This difference could be influenced by the age of retirement, which is set a priori in Lebanon at 64 years.

Our survey showed that some socio-demographic factors affect the perception of old age. For example, the perceived onset of old age was higher in the older age groups compared with the other age groups. When approaching old age (the threshold age), there is a general tendency for an individual to push the age limit further so that the individual is not included among the “old”. In 2012, the Quebec Association of Health and Social Services Establishments carried out a survey leading to the same result. In their study, the respondents aged 65 consider themselves “old” at 80, while those aged 18–34 believe they will be “old” when they reach 60 (8)

Concerns about Old Age

Our survey confirmed the concerns and uneasiness felt by the elderly population. These factors were confirmed when we compared our results with that of others, such as the survey of 403 Guadeloupeans performed by the Departmental Union of Family Associations of Guadeloupe (14). From their sample, 10% were very worried about old age compared with that observed in this study (31% of the respondents).

Fear of stopping sexual activity represented only 1.2% of all the fears of old age, which may be an underestimation as recently, the Beirut population avoids talking about sex.

Image of Institutions for the Elderly

Although the image the respondents had of the institutions for the elderly was positive, only 3.5% of the respondents found a solution to their difficulties in caring for the elderly in these institutions. It is important to note that the study respondents were convinced that these institutions do not offer the elderly a good quality of life and that the nursing staff, although professional, do not pay sufficient attention to the elderly. There is a need to improve these two perceptions to make these institutions a first resort for the Beirut population.

Regarding the steps to be taken to improve the care for the elderly, our study participants were not ready to contribute directly to this care by themselves. The majority have entrusted this role to the governmental and private sectors, hence the importance of improving their involvement in elderly care.

Our survey clearly shows that the respondents in this study have a negative perception of old age, and they age with a level of pessimism. Their fear was mainly regarding the incidence of health problems as well as loss of independence and autonomy. Improvements in the health care system could help to reduce these fears.

Nursing homes appear to be a default solution to the care for the elderly. Nevertheless, despite the acceptance of these institutions as rescues for the elderly, study participants were repetitively criticizing the quality of care in this setting. Regarding alternatives to institutional care, the participants were in favor of increasing the compulsory contributions or providing direct financial support to these institutions. Therefore, it is imperative to take the necessary actions to improve this situation.

LBP: Lebanese Pound

SPSS: Statistical Package for Social Science

USD: United States Dollar

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The study protocol was approved by the ethics committee at Saint Joseph University of Beirut, Lebanon and was under its supervision. All methods were conducted in accordance with the World Medical Association Declaration of Helsinki. An informed consent was obtained from all participants to the study. The questionnaire was anonymous, and the information collected was confidential.

CONSENT FOR PUBLICATION

Not applicable

AVAILABILITY OF DATA AND MATERIALS

The datasets used and/or analyzed during the current study are available from the corresponding author on request.

COMPETING INTERESTS

The authors declare that they have no competing interests.

FUNDING

The authors received no financial support for the research, authorship, and/or publication of this article.

AUTHORS CONTRIBUTION

AMW and HAR contributed to the conception, design, and acquisition of data.

AMW, HAR, and LEO attributed with analysis and interpretation of data.

AMW and HCH were involved in drafting the manuscript.

HCH and LEO revised the manuscript.

All authors read and approved the final manuscript.

ACKNOWLEDGMENTS

The authors would like to express their deep gratitude to the participants and their family members.

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No competing interests reported.

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published 17 Jan, 2023

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You are reading this latest preprint version

Perception of Old Age and Institutions for the Elderly among the Inhabitants of Beirut, Lebanon: a Cross-Sectional Study

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Journal Publication

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Abstract

Background

Methods

Results

Conclusions

Background

Methods

Results

Sociodemographic Characteristics of the Respondents

Perception of Old Age

Caring for the Elderly

Perception toward Facilities for the Elderly

Perception of Old Age According to the Sociodemographic Characteristics of the Population

Discussion

The Onset of Old Age

Concerns about Old Age

Image of Institutions for the Elderly

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

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