Executive Summary
The United Arab Emirates (UAE) is a country with rapid economic growth, universal access to healthcare, and high life expectancy rates. Older people depend on social security/pension to cover daily expenses and need assistance due to health concerns and physical limitations. The options for supported living are family homes, retirement villages/facilities, and rehabilitation centers. Traditions and culture of the community determine the preference of the elderly to stay with their families instead of relocating to senior care facilities, which places a considerable burden on informal carers. Abu Dhabi government provides health insurance for the citizens, but there is a lack of technologically advanced rehabilitation centers or retirement communities providing quality medical care and psychosocial support. Government aged-care strategies and resources ensure abuse protection and convenient transportation, communication, and social services for senior Emiratis. The carers can rely on mobile clinics, home care services, volunteer organizations, and authorities to address the medical concerns of the elderly and introduce opportunities for socialization and active living. The recommendations for improving geriatric care are resolving the issue of abuse via standardized assessments of family caregivers, preventing financial abuse through literacy and legislation changes, and promoting affordable retirement and rehabilitation facilities.
Supported Living Options
Supported living options are available in my community in Abudhabi.Dubai.Sharjah, UAE, includes family, retirement villages and homes, and rehabilitative centers. Access to healthcare, high living standards, adequate income, and widespread health awareness in the UAE resulted in improved life expectancy rates (1). However, older people often experience health issues, so they have to depend on other people for care and rely on income from a pension or social security subsidies for financial support (1). The elderly might be viewed as a vulnerable population due to the risk of psychological stress, abuse, and neglect, so it is important to consider the advantages and disadvantages of each supported living option.
Family assistance is the primarily supported living option in my community. According to the Emirati tradition, older people remain in their family homes supported by relatives for the rest of their lives. The primary advantage of informal family caregivers is the relatives’ emotional support, which might prevent depression (2). Informal carers can also help an older adult cope with an injury within the comfort of a family home. Additional benefits are the decrease in government expenses on elderly care services and the minimization of legislative efforts to develop public policies targeting elderly populations (1). For instance, informal carers can be trained to perform minor procedures and change dressings or medical devices without the involvement of geriatric specialists or costly equipment (2). The main disadvantage of family-assisted living for the elderly is the significant burden on caregivers, especially when dealing with a disability, chronic condition, or terminal illness (3). Moreover, the number of older people is expected to rise from 4% to 20% during the next 40 years, which might increase the financial, physical, and emotional pressure on families and lead to abuse (2). Another problem is that busy high-income families hire unlicensed and uneducated nurses and maids from different countries/cultures (Ethiopia, India) to care for the elderly. Due to stress, cultural incompetence, and the lack of training, migrant workers in a position of trust might physically abuse seniors in the absence of family members (10). Finally, family assisted living cannot always substitute formal care and nursing involvement (4). In cases of severe health conditions, such as cancer or diabetes, the older individual requires medical assistance and professional care.
Retirement villages/homes are residential facilities that encourage older people’s independence and autonomy and provide them with communication and support from a peer environment. In my community located in Abudhabi.Dubai.In Sharjah, the majority of retirement living options for the elderly are represented by expensive retirement homes and villages or a small number of public government-funded establishments. Villages and homes for senior citizens and retired expatriates aged 65+ offer recreation, socializing, and medical services. Retirement homes also undergo considerable technologic changes, including the introduction of IoT (Internet of things) technology. In 2014, about 100 initiatives were introduced to transform Dubai and surrounding cities through the use of smart homes and projects designed specifically for IoT retirement housing (5). The benefits of the retirement living options are technologically advanced healthcare services available at the premises of senior homes/villages and high quality of care and living conditions. The drawback of the senior communities is that private centers are expensive and there is a limited number of government-funded facilities, so more public centers are needed to provide care for insured citizens. Another concern is that the idea of living outside of the home without the family may be culturally unacceptable for senior Emiratis who prefer home care to retirement facilities.
Rehabilitation centers are short-term medical care establishments that help older adults recover from an injury or disease. There is a limited number of elderly care facilities and rehabilitative centers in the UAE (1). Abu Dhabi Rehabilitation Center is the largest rehabilitative facility in my community that provides care and social services to senior citizens and their families (6). The interventions include physical and speech therapy, exercise activities, and counseling. Nightingale Health Services in Dubai is a specialized rehabilitation center promoting physiotherapy use to improve safety and achieve the reduction of fall risk. The advantage of rehabilitation centers is the focus on restoring and maintaining senior health accompanied by psychosocial support and activities. Medical services successfully work towards fall recovery and chronic condition management (diabetes, dementia). Counseling services and social workers’ assistance help improve seniors’ emotional/psychological state after the loss of a family member and facilitate adaptation to community living. The disadvantage is the small number of rehabilitation facilities in the UAE, so some seniors might have to travel to the nearest facility and spend time in queues. Thus, inpatient nursing homes might be more appropriate for older citizens seeking local rehabilitation services to remain close to family.
Field Report Findings
The UAE government’s aged care strategy aims to establish an integrated care system allowing senior citizens to have universal access to social protection and healthcare services. The National Policy for Senior Emiratis was approved in 2018 and included the development projects of specialized housing and community centers for older adults (7). Aged care plans also included the protection of seniors from abuse and violence to guarantee safety. Federal legislation secures the rights of seniors for medical care, socialization, independence, confidentiality, and freedom of choice regarding government agencies and services. For example, Federal Law No. 9 on the Rights of Senior Emiratis was issued in 2019 and described the aforementioned rights as well as the punishments (jail, fine) for abuse or neglect (7). Additionally, Sharjah joined WHO’s Global Network of Age-Friendly Cities and implemented 52% of their 2017-20 plan (8). According to the strategy, government agencies adjusted public spaces and buildings, transportation, IT education, and community/volunteer services to seniors’ needs. The government strategies affect the nursing professionals as they provide guidance on the age-competent practice and the rights of elderly patients that should be respected.
Due to the long-standing tradition of family-assisted living and caring for elderly relatives, senior citizens in my community prefer to remain with the family instead of relocating to retirement villages/homes. It should be noted that retirement and the loss of a spouse or family member may pose the risk of depression and poor quality of life in seniors (9). The local culture and traditions limit the choice of aged care, as seniors choose to stay at the family home instead of moving to retirement homes or rehabilitation facilities. The traditional/cultural considerations are important for the nursing practice since they reflect the need for home-based nursing services respecting older adults’ preference to receive care at home. Family involvement in the decision-making should also be addressed because seniors rely heavily on their families as a primary support system.
There is a variety of resources that the government offers to support healthy aging. Senior citizens can receive monthly social assistance, pension, and end of service benefits to cover daily expenses and support financial independence and autonomy. Age-friendly transportation, discounts, and free parking encourage older adults to remain active and spend time outdoors, while private medical transportation services for bedridden seniors alleviate the burden of family caregivers (7). However, free national ambulance services are not always available for the elderly because they are also used for major accidents and emergencies. Nursing advocates for the elderly should inform the patients and families about available resources helping to maintain health, prevent injury, and improve the quality of life via physical activity and socialization.
The government supports the carers of the elderly through mobile clinics and home care services. Mobile clinics are moveable vehicles or healthcare units, where elderly patients can consult doctors or nurses and use their services to have the medicine delivered to their homes. Mobile clinics, especially in remote communities, help family caregivers with medical assistance for the seniors, as they offer natural treatment options, rehabilitation, and preventive measures in addition to optical, dental, and dermatological procedures (6). Home care programs are free services that ensure family carers’ involvement in psychological and physical care for older adults. Red Crescent Authority is a volunteer-based initiative that organizes events and public activities to raise awareness of elderly issues and provide education and training for caregivers. Dubai Health Authority performs health evaluations of seniors, and home safety assessments and offers advice on nutrition for carers. The nurses can volunteer or participate in the events organized by aged-care projects and authorities to enhance their knowledge of current problems and contribute their experience and skills to improve the quality of senior care. The nursing practice might be improved via networking and collaboration with other healthcare professionals working at mobile clinics and home care services.
Evidence-Based Recommendations
There are several relevant recommendations based on the available supported living options, the findings described in the field report, and current evidence. Firstly, the problem of abuse at home should be addressed via psychological assessment of family carers and observation of private home conditions. Ali (1) suggests that elderly abuse is common in low-income families due to the lack of education, unsatisfactory living conditions, and poverty. Mistreatment risk might be reduced by introducing regular standardized evaluation via mental health and mood questionnaires for caregivers and dependency surveys for seniors (10). Victimized individuals should be referred to elderly care facilities or nursing services if abuse is detected. Secondly, the policy for governmental support of family carers needs to be developed to prevent financial exploitation and secure the autonomy of older adults with different levels of dependency. Financial abuse is widespread in the UAE and more frequent compared to physical neglect (1). Educating family caregivers and seniors on financial literacy may decrease care-related expenses and reduce the risk of financial abuse or fraud (11). Evidence-based policies and programs offering economic assistance for family caregivers and extra bonuses for carers of seniors with dementia and chronic conditions might eliminate financial abuse.
Finally, retirement homes/villages and rehabilitation centers should be constructed, promoted, and subsidized to alleviate the physical and emotional burden of working family members caring for elderly relatives and sustain the growing number of senior citizens. Due to the rapid economic development, the structure of Emirati families changes along with traditional norms and values, so the shift requires family-assisted living arrangements to be transformed (12). The government should invest in the development of retirement and rehabilitation centers practicing geriatric medicine to decrease the prices and make the option affordable for most elderly Emiratis without sacrificing the quality of care. Alternatively, accessible home-care agencies or home-based nursing services might be needed to provide quality care and counseling for individuals who do not want to relocate or travel to rehabilitation centers.
References
Ali AZ. Aging in the UAE and services available for the elderly: Structured interviews with experts in the field. Dubai School of Government Policy Brief. 2013;34:1–12.
Hashemi BA, Underwood M. Elderly Emiratis a key part of family life. The National News [Internet]. 2013. Web.
Ge L, Mordiffi SZ. Factors associated with higher caregiver burden among family caregivers of elderly cancer patients: A systematic review. Cancer Nurs. 2017;40(6):471–478. Web.
Ris I, Schnepp W, Imhof, RM. An integrative review on family caregivers’ involvement in care of home-dwelling elderly. Health and Soc Care Community. 2018 May;27(3):95–111. Web.
Jung C, Awad J, Chohan A. The planning of smart elderly housing in Dubai with IoT technologies. Open House International [Internet]. 2021. Web.
UAE. Senior people’s health and rehabilitation [Internet]. 2019. Web.
UAE. Senior Emiratis [Internet]. 2021. Web.
Sharjah Govt Media Bureau. Sharjah age-friendly initiative: 52% implementation of 2017-20 strategic plan [Internet].
Webster N, Clarke K. UAE’s growing elderly population at risk from isolation and depression [Internet].
Orfila F, Coma-Sole M, Cabanas M, Cegri-Lombardo F, Moleras-Serra A, Pujol-Ribera E. Family caregiver mistreatment of the elderly: Prevalence of risk and associated factors. BMC Public Health. 2018;18(167). Web.
Judge K, Fazio S. Development of an innovative financial literacy and preparedness program for family caregivers. Innovation in Aging. 2020;4(1): 357. Web.
Khan HT, Hussein S, Deane J. Nexus between demographic change and Elderly Care Need in the Gulf Cooperation Council (GCC) Countries: Some Policy Implications. Ageing Int. 2017;42(4):466-487. Web.
