The Graying of the World: Who Will Care for the Frail Elderly?

Olson LK, ed. New York 13904-1580, The Hawthorne Press Inc, 1994, paperback, 328 pp, S24.95.

This book attempts to describe the social and medical conditions of the frail elderly in 11 countries, including the United States. The editor included an introductory chapter as a review of the current conditions of the frail elderly worldwide, and an overview of the text.

The editor saw a need for a summary work with intercountry comparisons, as the proliferation of older people is not unique to American society. These demographic changes are occurring throughout the world. especially in industrialized countries. By investigating the climate of care worldwide, the editor hoped to find strategies and, perhaps, a model program for elder care. Chapters 3 through 12 are written by scholars representing Sweden, Finland, Israel, Britain, Canada, France, Germany, Japan, The People's Republic of China, and Yugoslavia. Contributors from each country attempted to answer similar questions regarding care, perceived need, payment sources, and kin responsibility of the frail elderly. This type of format leads to easy comparisons among systems. Because the chapters start similarly, much of the statistical information is analogous and redundant from chapter to chapter.

The fundamental point where nations differ is the question of where the primary responsibility for care lies. Though all of the countries represented in this volume appear to be seriously concerned with the rising costs of supportive services for the elderly, they diverge on the question of who should bear the cost. They also vary on the issue of who, if anyone, should profit from this service provision.

Each author attempts to describe long-term care services as a means of comparison. Discussions center on the type of care; the method of delivery; and the focus of that care, whether on the caregiver, the care recipient, or both. Specific outlined programs are also examined, focusing on medical versus social factors. The editor concluded that, where the entire family is of primary concern, respite services and day care are more common. Successful long-term care models created a continuum of interrelated health and social services, as well as a supportive environment. In addition, rehabilitation or the ability to cope with disabling physical or mental conditions depended on the social conditions and the support systems. Most authors feel that an effort of cooperation and coordination between health care and social services should be considered for future development of old-age policies.

The increasing burdens on women as the primary family caregiver is also a common theme. Countries that had depended on women for this role are grappling with alternative programs and networks that would ease this burden.

The editor perceives the United States as providing inadequate care for the frail elderly. Regardless of the political economy, however, each country is struggling with varying political, social, economic, and psychological issues associated with caring for the growing frail elderly populations. All the authors address issues relating to policy, approaches to long-term care, institutionalization, the burden of the caregiver, and service imbalances. Investigators and clinicians interested in

a broad perspective of health care of the frail elderly would find this book a helpful reference. The cultural differences and expectations outlined are helpful reminders to any health care professional working with patients of dissimilar cultural backgrounds. Persons interested in health care and public policy decisions would find worthwhile discussions and a synthesis of worldwide problems related to the demographic aging of the population.

Ms LaFollette is a geriatric clinical specialist employed as a rehabilitation consultant to Beverly Enterprises. She is currently pursuing an advanced degree with an emphasis on health care financing of long-term care.