Healthcare for Elderly People in Islamic Countries

The Quran states that the elderly should be respected and valued by their relatives.ⁱ Such approach seems to be true to life not only in the framework of family relations but also when speaking about health care delivery. Many older persons are not able to manage everyday activities without support. Commonly, they receive assistance from their relatives, but when the issue turns out to be more critical, caregivers are approached.

The way they interact with each other tends to affect the condition of the patient and his/her health outcomes. However, the provision of daily care alongside with the necessary clinical procedures is far from being enough for the wellbeing of the elderly. Nursing homes residents, for instance, stress that the sense of autonomy and dignity are crucial for the older individuals emotional as well as physical state.ⁱⁱ Reportedly, many residents of nursing homes have to fight for their right to make decisions and remain autonomous.ⁱⁱⁱ

It is necessary to add that elderly people face similar challenges even if they are at home with their family, as younger generations tend to make decisions for them, thinking that the older adults are unable to do so. In this chapter, the focus is on the positive influence of dignity and respect for autonomy on the health of the elderly in Islamic countries.

The Support of how Respecting Human Dignity and Personal Autonomy Can Help to Improve Elderly Health Care in Islamic Countries

Lessons from the West

While the need and usefulness of geriatrics as a medical specialty is just discussed today in the Middle East, scientists from the UK underlined its value many years ago. Even being an infant specialty, it received much attention and its knowledge increased greatly. Remedial therapists and social workers cooperated with nurses to make professional contributions to geriatrics, which presupposes caring about the older. The concept of ‘care’ means a set of activities that include maintaining and repairing (if necessary) the world so that a person could live as comfortable as possible. The world stands for bodies, minds, environment and everything that affects a person in any way.^iv

As usual, nurses manage domiciliary health care and provide it in the hospital. They monitor patients 24 hours per day. They start cooperating with a wider range of professionals but have the main role in care delivery, because remedial therapists and social workers are not prepared to look after the patients who are not independent. Thus, without the partnership, it would be impossible to provide needed services.^v

Geriatrics allows the patients who were previously thought to be almost untreatable and assigned for long-term care to restore their independence and live a normal life. Many representatives of the elderly population suffer from dementia. At the end of the 20^th century, this issue was considered to be the one of the major community care problems. That is why the specialists devoted a large part of their time to work with people who are in charge of care delivery to teach and train them how to deal with such symptoms.

British practitioners used a wide range of facilities to take care of patients with dementia. First of all, they divide all elderly patients into the two main categories:

• Those who have relatives that care of and look after them;
• Those who have no support or whose relative will soon be not able to manage such activities due to the personal disabilities.^vi

The care that these groups receive cannot be offered in the same way and requires adaptation. If the patient has a family, the specialists are to be focused on making the lives of relatives less overloaded. Thus, it is vital to cope with patient’s insomnia, aggression, restlessness, etc. In this way, the professionals prevent the crises and allow the family to keep to a positive approach. They can remove the older person for some time when one is an added burden. Mainly, the symptoms should be alleviated and regular provision of relief maintained. Such things can be done in various forms.

It can be a day care with a flexible schedule so that a professional will take care of the older person when one’s family is at work. ‘Baby-sitting’ presupposes the opportunity to refer to the voluntary organization or to hire an individual who will take care of the elderly when one’s relatives are away.^vii

Intermittent relief admission looks after the person in different ways, including relief on holidays and on the regular basis.^viii Such practice is beneficial as during the advanced stage of symptoms the patient receives high-quality professional treatment and the relations with the family members do not spoil. Moreover, it is a great way to reduce overloading of the long-stay residential and hospital services. This approach is likely to be advantageous for the UAE, as it allows the families to take care of their relatives as long as possible, which is critical for them. For this approach to be successfully implemented, the primary care workers should take the cases as early as possible.^ix

If the patient has no family, the priority changes to the needs of the elderly. The professionals can provide services at home and come to the client. Still, it can be managed only if one is not in the critical condition, as people with dementia require constant assistance. Thus, they are mainly encouraged to enter residential facilities where various professionals look after them day and night. They try to make patients feel as if they are at home. The personnel and other older people tend to substitute family and relatives.^x

For clients of nursing homes, the staff and other patients become their close ones as they share their concerns, fears, hopes, happy moments. Their family members only occasionally visit the elderly in the nursing homes, which breaks the family bonds making them weaker. In this way, British scientists underline that emotional aspect is considered even more valuable than the medical one.^xi Of course, it is vital to control all symptoms, but it cannot be managed if the patient feels nervous or frustrated, which proves that one should be treated ethically.

The representatives of the health care system in Islamic countries should consider the way their Western colleagues accepted geriatrics and started to take care of their older patients.^xii Of course, it will be difficult to reform health care and make medical professionals share new views, but the first steps that are already done will be streamlined. It is important to change the public opinion and make people understand that addressing specialized healthcare facilities is not equal to an attempt to get rid of problems associated with caring for the elderly.

People should see institutionalization as an opportunity rather than a hazardous scenario. This means another level of care when the home care is unavailable. British opinion that professionals can help the families provide better care and treatment is rationale.^xiii Its usefulness cannot be denied when the services are provided with respect for people’s autonomy and desire to make them feel of dignified and independent as long as possible.

The Ethics of Caring for Elderly and Human Responsibilities

Chronic conditions that elderly people have make them refer for external help, which can be provided by family members and professionals in different locations. They suffer from changes in their bodies that are often followed by pain, lose their identity and feel lonely and powerless. Such emotional condition affects the physical one adversely and worsens the symptoms. Care and the relationship between the professional and the patient are the main things that can improve this situation.^xiv That is why it is critical to stick to the ethics of daily care.

While the family has a moral responsibility to take care of the older relatives, specialists who work in the home or help the family at home manage the duties due to their professional responsibility. It is vital for them to refer to the professional code, which deals with ethics, guidelines, and responsibility. According to it, one of the main points is that the specialist should not do any harm to the patient.^xv

This harm may be not only physical. When a care provider limits one’s autonomy and neglects dignity just to simplify the working process or because of some other reasons, it cannot be said that he/she does one’s best to help the elderly. Such limitations are also harmful to the patient, and their existence presupposes that the professional responsibilities are not maintained decently. Today it mainly happens because of the lack of knowledge and particular prejudices.^xvi

People tend to believe that the elderly are not able to manage the things that the younger people can easily conduct. As a result, their will to provide more help turns into the creation of boundaries that prevent the older from living their own lives. Both groups of people including those who receive care from their relatives and from the professional report that they cannot do some things they are able to do just because others want to help them.^xvii It makes older people less adapted to living on their own. To be sure how to act, specialists should refer to the ethics of caring and use it as a guideline when looking after the patients.

An ethic of justice focuses on such aspects as equality and fairness, as well as their consistent application. An ethic of care focuses on attentiveness, trust, responsiveness to need, narrative nuance and cultivating caring relations. Whereas an ethic of justice seeks a fair solution between competing individual interests and rights, an ethic of care sees the interest of cares and cared for as importantly intertwined rather than as simply competing.^xviii

Unfortunately, the ethics of care does not presuppose autonomy, as the older population requires it. Only the combination of various concepts provides an opportunity to create a decent guideline that the professionals can follow when managing their duties and interacting with the patients. In this way, it is extremely important to ensure that all mentioned aspects of ethics are emphasized by care providers; otherwise, the elderly are likely to feel neglected and frustrated which may cause serious complications in their mental state and worsen their conditions.^xix People who cannot manage their everyday activities by themselves and require constant help realize that they are dependent, but need to be engaged in the interaction that allows them to feel their autonomy and identity even though they are limited.

Needless to say, that the person who has some illness require support. Still, it is vital to limit the interference for one not to become totally dependent and lose oneself. The professionals should consider both ethics of justice (private sphere) and of good (public sphere). All in all, Chadwick and her colleagues emphasize that it is vital to make sure that “the public life, and particularly care, is served will with an ethics that is purely based on justice”.^xx

In this way, human rights should be considered. Such view is also supported by Roberto Andorno who states, “all human beings are born free and equal in dignity and rights”.^xxi The authors of both works claim that the elderly like all other people should have the right to equal access and safeguarding of privacy.

They should be able to receive, use and provide information, which is an important part of today’s world. Only if they are considered in the framework of the health-care system, the ethics of caring can be managed decently. Such concepts presuppose interaction between care providers and patients. Still, it is vital to refer to the most appropriate ethics of care that puts emphasis on responsibility, engagement, empathy and similar values as they are not a part of “the contract perspective” but are central to the provision of high-quality care to those who need it.^xxii In this way, the ethics of caring is a complex concept that can be observed only when all its components are considered.

Wilmoth and Ferraro stress that diversity is the most important characteristic feature of the elderly.^xxiii They have different income and health status, they are used to live in various environments and conduct distinct activities.^xxiv

Of course, in nursing homes, the majority of older people’s everyday activities are managed in a group where everyone is equal and conducts the same thing, which seems to make them alike. Some may think that all patients have equal needs, which are completely satisfied in nursing homes. However, the staff of the nursing home would not be able to focus on all patients at the same time if they were occupied in various activities all day long.^xxv The existence of the schedule tends to simplify their tasks and ensure safety for the elderly. The personnel understand that it is critical to help people feel better. Thus, they manage their duties (including but not confined to delivering medication, bathing, changing clothes, implementing various clinical procedures, and so on) so that the patients feel independent and dignified.^xxvi

Thus, it is critical to remember that the family and professionals are responsible for providing the elderly with decent care. They should consider the situation in different perspectives and do their best to make the older people feel valued and powerful. It is not enough to consider just one aspect of ethics in this perspective. It is important to remember that older adults have equal rights with younger generations and should receive both normal treatment and help on the everyday basis.

Unfortunately, many people today tend to believe that elder persons need more care and support than other individuals, as they are vulnerable and weak. Such views deteriorate elderly people’s autonomy and dignity and lead to the development of depression in this population. Older people start feeling a burden, which impairs their emotional balance and may lead to the development of various psychological conditions (depression, anxiety and so on).

An Elderly Focused Approach: Maintaining the Dignity and Autonomy of Older People

Freedom and autonomy are critical when speaking about caring of the older population. Even if the patient’s condition requires constant interventions, it does not mean that he/she is to become totally dependent.^xxvii An elderly-focused approach has become the most widespread paradigm in western countries. Western healthcare professionals have adopted a holistic view concerning health, which is also shared in Islamic countries.^xxviii

Doctors focus on the physical, mental and emotional wellbeing of their patients, which is especially important when the elderly are involved.^xxix The needs, interests, values, expectations are considered when treating elderly. Clearly, autonomy and dignity are of paramount importance. The holistic approach is utilized in various institutions providing care to older adults where healthcare professionals try to ensure the autonomy of their clients. This paradigm involves addressing all aspects of elderly people’s needs.

These aspects include provision of all the necessary clinical procedures (tests, injections, messages and so on), care procedures (bathing, changing clothes and so on), wellness procedures (physical exercise, art and so on) as well as emotional support (small talks, group discussions, activities and so on). This comprehensive care ensures patients’ wellbeing in such terrains as health conditions, emotional and psychological state. It is necessary to add that the majority of western nursing homes are very successful in the implementation of the paradigm. The elderly and their caregivers report their satisfaction with the services provided at such facilities.^xxx

At the same time, older adults still prefer staying in their homes rather than moving to a nursing house. The deteriorating quality of services elderly patients receive (which is also a result of the shortage of the personnel) accounts for that trend.^xxxi The turnover rate in the sphere is between 50% and 100% per year,^xxxii which has adverse effects on the quality of services provided. Researchers also note that screening and physical examination are not properly held, which poses certain threats to the quality of services provided and wellbeing of patients.^xxxiii However, western nursing homes are improving as the government pays a lot of attention to this sector.^xxxiv

Various programs and wise allocation of funds is leading to the development of high-quality nursing homes. Another reason for older people’s reluctance to go to nursing homes is that they feel more empowered in their own houses. They need their close ones’ care, which is also a part of the feeling of autonomy and dignity. It is clear that such problems exist in all countries, and people still prefer home-based care in Western countries. Nonetheless, it is also evident that people do not have a negative view concerning the facilities.^xxxv Many people understand that these are proper solutions for those who have significant health problems. It is a prevailing view that a nursing home is a place where the elderly can receive high-quality care.

As it was mentioned earlier, the elderly who require long-term care may receive it being at home as well as in a care home or nursing home. British professionals state that elderly people who have serious health problems (for example, dementia) need a more sophisticated level of care, but their family members are rarely able to provide it.^xxxvi However, researchers also underline that a nursing home is a place, where people become extremely depended and may lose their autonomy.^xxxvii The oppressive environment may lead to physical and mental issues as well as worsen chronic conditions.^xxxviii ‬

This right to care and to receive care is among the basic ones in the framework of this investigation. For the older people to avoid mental deprivation and do not suffer, the professionals who work in the facility pay much attention to patients’ autonomy and preserving their dignity.^xxxix Trying to find out why people have the basic right to remain dignified and respected, scientists came to the decision that dignity is the key instrument that contributes to a person’s physical, mental and emotional wellbeing.^xl Researchers claim that the maintenance of older people’s autonomy is one of the priorities in elderly care.^xli

Today, mainly the law and religion make people treat each other with respect, as they both state that people have inherited dignity, which means that others are obliged to recognize it.^xliixliii. Issues related to the contemporary culture of care mirror the need of dignity of identity. The modern care reflects people’s need to remain dignified and respected.^xliv It has been acknowledged that the loss of autonomy leads to the loss of the dignity, as individuals who are not able to cope with the easiest tasks and are in need of continuous assistance tend to believe that they do not deserve the things others can easily gain.^xlv Still, the Quran encourages always to regard and respect the older people.^xlvi

Moreover, the Islamic law holds a clear position on the matter. According to Islamic law, an individual who provides care to or supports an elderly relative in any way (financially, psychologically, emotionally) does not do it for this person. This is done to discharge every individual’s “sacred obligation”.^xlvii

The law also involves quite clear guidance to children who care for their parents. It is stressed that children should respect and reveal their love to their parents. They should talk with their close ones and make sure their needs are met. According to the Sharie’a theory, care rights are equal for children and parents. In other words, parents have certain responsibilities to their children. At the same time, children also have particular responsibilities to their parents when they become old or disabled.^xlviii This ruling is seen as a divine command of God. Therefore, it is deeply rooted in the Islamic culture. At the same time, to apply this pattern to healthcare issues, it is necessary to use the approach implemented in the Western countries. In the West, ethical concerns and values were translated into particular care procedures and codes, which can also be utilized in the Islamic world.

The law is an illustration as well as a result of the Islamic culture concerning the relationships between the elderly and younger generations. Thus, children understand that they are responsible for the well-being of their elderly relatives. The elderly also expect care, respect and support. These beliefs create strong ties within families, which make the society stronger. Nonetheless, these perspectives also create obstacles to the provision of the high-quality services to the elderly. Older adults in the Islamic world are still reluctant to leave their houses as they believe they will not get the care they would have at home. People also believe it is their children’s responsibility to care for them as it is written in the law.

However, it is possible to use similar strategies that have proved to be effective in the western world. For example, governments of Western countries allocate significant funds to improve elderly care. The issue also receives considerable media coverage, and stakeholders (officials, elderly people, younger generations, healthcare professionals and so on) are encouraged to participate in the debate. People should understand that they will be unable to receive and provide the services that are commonly given in nursing homes. Children do not have the necessary skills to react in cases of emergency, but the elderly can receive the necessary clinical treatment in nursing homes.^xlix When such facilities start operating in all the Arab countries, the public opinion can change.

The experience of Western countries shows that wide media coverage leads to the shifts within the terrain of policy-making and healthcare provision.^l The debate brings policy-makers, practitioners, the elderly, family members, the community together, which have resulted in the development of a positive view concerning nursing homes in Europe.^li It is important to provide media support to the spread of nursing homes. The focus should be made on the concept of care and the responsibility as Arabic people should understand that caring for the elderly can be delivered through nursing homes. Children do not hand over the responsibility to care for their parents but bring another level of care, which involves professional care. At that, children visit their parents and spend a lot of time together. The elderly can feel they are still the core of the family even living in nursing homes. Such messages should be delivered through media, which can bring some shifts in the public opinion.

The Home as a Site of Care

The care received by elderly people today in the Islamic countries cannot be considered to be an excellent one for now.^lii Constant improvement is needed in different spheres, including geriatric services. Even though scientists do not pay enough attention to them, nursing homes were created to improve the quality of life for elderly people. Still, cultural peculiarities of the Islamic world and the belief in the fact that children should take care of their parents prevents the general population from sending the older people to the special facilities. Of course, moral attitudes play a vital role in the lives of all people, but health care professionals encourage everybody to consider one’s condition and decide what can improve it.^liii

Thus, nursing homes become more popular due to the advantages they provide. The nursing home is an institution where elderly people live and have a particular daily routine.^livThese home-like facilities are preferred by the representatives of the elderly population and by their relatives. They allow patients to be occupied in the activities they prefer, communicate with other people and receive care, which can include treatment.^lv

Nonetheless, many elderly people choose to remain in their homes with their children. Some older adults prefer living with their partners or even alone, which is their right to choose the way to spend their lives. The ability to make choices is one of the aspects of autonomy and dignity. In many countries, however, elderly people tend to be institutionalized in earlier stages even if they are able to function without healthcare professionals’ aid.^lvi

At the same time, obtaining home care can be a beneficial option for many elderly people who do not have severe health conditions. In the UK, people tend to receive this kind of care, and it has proved to be effective, as the elderly who obtain the necessary care remain empowered and autonomous.^lvii. Their emotional state improves, which positively affects their overall health conditions.^lviii One of the desired premises for emotional wellbeing and comfortable living at home is the presence of the partner.^lix

During interviews held in Northern Sweden, elderly couples noted that they felt empowered and autonomous as long as they could live together with their partners who supported them and provided the necessary care. When the elderly individual did not have a partner or a close one, they were likely to make a decision to live in a nursing home, especially when they would develop a serious disorder. ^lx

Clearly, home care differs from the nursing home care in many aspects. First, it provides a significant amount of autonomy to the elderly who can spend their time with their friends or close ones. The elderly do not have to change their routines, which is often the case with nursing homes where a particular schedule is established. The residents obtain the necessary clinical procedures and comprehensive care while those living at home can have regular clinical procedures. They can go to the hospital or receive some procedures at home, which is usually the case.

Nevertheless, the two types of care share a lot in common. One of the most evident similarities is that the elderly still receive the necessary care. Healthcare professionals visit the elderly at home regularly or in the case of emergency. The two types of care are also associated with a certain investment into resources. Nursing homes are well-equipped with all the necessary facilities (including medical equipment, furniture and so on).

At the same time, home care requires certain preparation as some technologies may enhance older adults’ autonomy and sense of dignity.^lxi The patient’s home should have the convenient means of communication. The elderly should have a telephone, a cell phone and (or) tablet and laptop to be able to contact (or respond to) a healthcare professional. The ability to call for help can be regarded as one of the tools to increase autonomy and make sure the patient will be cared for in case of emergency. The elderly person’s house should be equipped properly to make it more comfortable. It can be beneficial to have an elevator if the house is multistoried. Such technologies will help the elderly feel less vulnerable and helpless.^lxii

It is necessary to add that this approach can be the most appropriate alternative for Islamic countries where home care is seen as the only option. Importantly, people should understand that elderly people want to be in control of their life, which means they should have an opportunity to address healthcare professional rather than go to see a doctor when their close ones think it is needed. It is crucial to make sure that the older adults make choices and have the technological premises to acquire the necessary healthcare aid.

Ethics in Clinical Practice: What Works and What Doesn’t

A New Look at Ethics in the Home, Institutions, and Community

Prior to the second part of the 20^th century, geriatrics did not attract a lot of attention and practitioners as well as theorists tended to focus on treating particular diseases rather than diseases within particular age groups.^lxiii One of the reasons for the increase in works on the issues concerning aging is the rise of the number of the elderly. The issues have become prevailing at the end of the 20^th century and the beginning of the 21^st century as the number of people over 60 is rapidly growing. It has been estimated that individuals over 60 will constitute around20% of the population of the world by 2050.^lxiv

Fortunately, such attitude changed soon and specialists started to investigate this sphere. In 1996 already, the social work administrator and philosopher decided to cooperate and to create a new program that would enhance care for elderly people. Researchers note that there is a need to create a program for those providing home care to elderly patients.^lxv One of such programs was created in the USA by the professionals from different spheres related to caring for the elderly, including ethics, community services, and health. Phyllis Mitzen, a social work administrator (the Council for Jewish Elderly), and Mark Waymack, a philosopher working at Loyola University were key figures in the process of the project’s development and implementation.^lxvi

Mainly, the program was designed to help the staff cope with the arising issues. Such practical needs were also entailed by the willingness to determine why ethics is connected to care, and in what way this connection affects the patient’s condition. Thus, the main change that later influenced the whole vision of ethics was implemented due to the practitioners’ aims to assist the clients to end their lives with a sense of dignity and self-identity.^lxvii Of course, it does not mean that practitioners should be totally responsible for such things; still, they are expected to do their best. Fifteen years later, ethics and aging started to be normally considered as connected concepts, and models for care in long-term-care settings were designed.

The necessity to improve geriatrics that was emphasized by the British scientists and practitioners^lxviii was also supported by the US specialists who made a significant contribution to ethics of caring about the elderly people. The project “Home- and Community-Based Services for Elders: An ethics Resource for Providers” attempted to assess opinions of the stakeholders with the focus on care providers rather than patients and their families.^lxix

It was found that some elderly people have problems with professionals while the workers claimed that they never observed them. They seemed to be knowledgeable and stated that they are kind people who love their job. Such opposition is likely to prove the idea presented earlier that people tend to assist the older persons even when they want to conduct some action themselves.^lxx In this way, the findings needed for the program also emphasized that dignity and autonomy of the elderly are affected if the caregivers fail to consider them, which leads to more critical problems. As a result, the training program for the workers to improve their performance was designed.

It was mainly based on the ethics of everyday life. The scientists pointed out that the care should be managed according to the consumer-centered approach so that the patients feel that they are valued. They emphasized that the professionals that closely interact with the elderly should take into consideration how they greet them every day, do they have a trusting relationship and how to build it, and how to care for a particular patient, etc.^lxxi

Unfortunately, many people think that such things are a part of a simple routine that does not require any special approach. As a result, they treat the patients in the way that does not appeal to them by mistake and fail to realize what spoils their attitudes. On the basis of this information, Holstein states that healthcare professionals and practitioners at nursing homes as well as elderly people’s close ones should be aware of particular needs of older adults. This can be achieved through extensive training and discussions that can result in the significant improvement of the quality of older people’s life.^lxxii In other words, there is a close connection between the promotion of people’s dignity and autonomy, application of everyday ethics and patients’ health that was not previously discussed. Before such conclusion was made, the scientists and professionals investigated some of these elements separately, and their extreme influence was not taken into consideration by the practitioners who cared about the elderly.^lxxiii

A new look at ethics gave the caregivers a chance to support the older and show that they respect their privacy even though some were not able to cope with simple activities and required assistance in bathing, etc. According to the latest advances in geriatric medicine, caregivers should make sure that the patient feels autonomous and dignified. Although some procedures may be associated with complete dependence and the absence of autonomy, it is a caregiver’s job to make the patient feel that the procedure is routine and has nothing to do with restricting the patient’s autonomy.

For instance, the caregiver should explain that helping with such activities as bathing is nothing but a procedure related to hygiene. At that, the caregiver should make sure that the patient does everything they can on their own and the caregiver steps in when the assistance is really required.^lxxiv

Due to the changes in this sphere of health care, the relationship between the caregivers and clients started to be emphasized in the majority of facilities. The plans targeted at its improvement were designed on the basis of information received from the agencies, relatives and older people. In this way, another point of view became the basis for the new approach of caring. It widened the scope of ethics adding new aspects.

The professionals were suggested to develop several significant skills “attentiveness, clear and gentle communication, and appropriate responsiveness”.^lxxv The changes were implemented in various facilities, and professionals providing home care and daily services emphasized that the mentioned earlier features should not be neglected in community-based long-term care. As the information was gained from the stories told by the individuals who were close to the topic, the plans designed on its basis were likely to be useful in practice.

Except for the new everyday ethics, the ways of solving ethical dilemmas was discussed by the scientists. They tried to provide the best guideline for decision-making managed by both individuals and society. The influence of such things as ageism on this process was underlined along with other issues, such as paternalism. Roy states the way the aging concept is perceived has an impact on the provision of care services.^lxxvi

Moreover, they were also considered in the work by Wilmoth and Ferraro, which proves that they are very influential and provide an adverse effect on the individuals.^lxxvii The concepts of autonomy and dignity are too broad and abstract to be clearly understood from the very beginning when they deal with the older people. It is normal that people cannot realize how their views on the same situation differ. Thus, when defining the major issues of caregiving, specialists gain an opportunity to make the first step forward and find out what can be done to improve the situation.

Raising Standards: Educations, and Attitudes through Training

Progress and science never stayed apart for a long time, which can be seen on the example of geriatric medicine. Its objectives changed with the course of time, which was done with the help of research. One of them implemented a new image of ethics of caring for elderly people, and the professionals needed to continue their education to obtain a new set of knowledge. Due to the number of interviews, it was found that the specialists sometimes fail to provide decent care. One of the most significant issues associated with nursing homes is the lack of privacy.^lxxviii Another issue is concerned with the lack of autonomy when it comes to treatment as patients often have no ability to affect the treatment developed.

The written consent is seen as one of the possible solutions to the problem as patients of nursing homes understand the benefits of each procedure and feel safer as well as empowered since they may question some procedures (if their mental health is not impaired).^lxxix The problem of the lack of knowledge or skills is considered to be the main one, and to solve it, the staff receives special training.^lxxx

The majority of elderly people are claimed to have several health problems. This condition makes them search for health care in order to improve the situation. It proves that geriatric medicine and its quality are vital for the elderly. Researchers underline that all health care services for such populations should be not only well organized but also based on ethical concepts.^lxxxi Unfortunately, the quality of medical education in many countries is not good enough, and Lebanon is one of them.

The mentioned specialty is not offered by schools, which makes it impossible to choose it. As a result, that little amount of geriatricians that provide their services in the country receives education and training abroad. Such difficulties have an adverse impact on the sphere of health care and on the patient’s condition. It is rather hard for many people to leave their motherland for several years. Thus, the number of specialists is not enough to deal with the whole population. Other medical professionals, who work with the elderly, often lack needed skills and knowledge, which affects people’s health adversely.

Knowing that such situation is common for many countries, the governments in the US established new infrastructures. Thus, people received professional training to meet the needs of health care staff in foreign countries and contribute to the development of the their communities.^lxxxii

However, Nordenfelt claims that the majority of the professionals who look after the elderly have never had an adequate training for their job even though they received education and worked in developed and rich countries.^lxxxiii The author also mentions the opposite opinion of his colleague who stated that care for elderly individuals is mistakenly regarded as rather basic. It is often believed that older people who do not have severe health condition do not need any specific treatment, and anyone without special skills can care for the elderly.^lxxxiv Still, on the basis of this paper, it can be claimed that the first view is the right one, as it was proved that even routines actions such as greeting that are done in different manners are likely to change the way the older treat themselves and build relations with caregivers.

With the help of training, the members of the staff enhance their knowledge and start considering the same situation from different perspectives. In this way, their attitudes also change.^lxxxv When previously, patients and their caregivers could not find a common language and considered the same situation in different ways, today the professionals gain an opportunity to let them know how their actions affect the lives of the elderly population, their mental state and the way they see themselves. The caregivers tend to become more engaged due to the training they receive.^lxxxvi Such qualities may be less critical if the professional works with the general population, but, when dealing with the elderly, they are extremely vital.

Thus, the improvement of everyday ethics led to the alterations in the standards of education. Still, many professionals claim that caregivers do not receive adequate training in many countries even now. As a result, there is a lack of specialists who are able to provide the elderly with decent care. When interacting with the older persons, caregivers are encouraged to be respectful and involved. They should control the situation but let the patient make one’s own decisions at the same time. It is critical to remain patient and attentive, as the elderly require normal treatment even though they are not able to manage their lives without support. So caregivers should do their best to build trustful relations and find a common language with their patients.

Conclusion

The 21^st century is known for the tendency to improve various spheres of life. Due to the advances in healthcare and technology^lxxxvii, it became the time of global demographic transition. The elder population is claimed to increase every year so that it will number more than one-fifth of the whole population in less than 40 years.^lxxxviii

Realizing that elderly people often require more care and support than the general adult population, scientists and practitioners all over the world started to actively consider in what way the quality of life of older people can be improved in the 21^st century. Such approach arose in the west but soon it spread worldwide and remained advantageous even today. Still, in many countries, such as Islamic ones, the population tends to believe that the families are fully responsible for caring for their grandparents. Their religion and moral views seem to be opposite to those accepted in the west.

This paper provides a detailed analysis of the approaches to geriatrics existing in the Western as well as the Islamic world. Each chapter provides insights to a particular aspect of the problem. Thus, in “The Support of how Respecting Human Dignity and Personal Autonomy Can Help to Improve Elderly Health Care in Islamic Countries”, the patient-based approach and its use in both Western and Islamic countries are examined. It is clear that the majority of countries across the globe have adopted this paradigm, which involved a particular attention to caregivers’ responsibility to enhance autonomy and the sense of dignity in the elderly. This paradigm is evident in both home and nursing home care. It can be concluded that the home care is beneficial for older adults who do not need intensive care while nursing homes can be the only option for people with severe health conditions.

In “Ethics in Clinical Practice: What Works and What Doesn’t”, various ethical issues are discussed. Specific attention is paid to education and training. It is possible to conclude that ethical values are similar in Western as well as Islamic cultures. Younger generations understand that they are obliged to create proper conditions to the elderly who deserve proper and respectful treatment. They also understand that older adults have the right to remain autonomous and have a high sense of dignity.

Unfortunately, these values are often neglected when people face the need to provide care to their elderly close ones. Professionals are trained to provide high-quality services and develop an ethical conduct towards patients. It is also clear that people may also need to obtain some training, especially when it comes to home care. They should actually understand how to ensure the elderly people’s autonomy. It is vital to understand that professional caregivers receive special training and education, which allows them to bring the most benefit to the elderly. Thus, when the family refers to them, it gives the older relative an opportunity to be healthier and live longer.

The analysis implemented helps understand the major opportunities for and barriers to successful shift in the Islamic populations as regards nursing homes and home care and the overall process of aging. It has been acknowledged that the quality of life of the elderly people improves greatly when the caregivers promote their dignity and autonomy.^lxxxix The Islamic countries lack the focus on this sphere of the human life. However, it is vital for the successful development of the society.

The Quran emphasizes the vitality of respectful treatment when dealing with the elderly population.^xc At the same time, religious leaders should not be the only source of knowledge on the matter. The government should take up more responsibilities. It is clear that the government should allocate more funds to develop a network of nursing homes where high-quality services will be provided. Significant funds should also be allocated to educational establishments that will train professionals in the sphere of geriatrics. Finally, media can also play an important role in the process as they can educate people as regards the benefits of nursing homes and home care. The media can start the ongoing debate in the society that will eventually lead to the shift in the Islamic societies, and the elderly will have access to a truly comprehensive care that will address their physical, psychological and emotional needs.

• i Radwa Elsaman, and Arafa Mohamed, “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice”, Marquette Elder’s Advisor 14, no. 1 (2012), 11.
• ii Ashild Slettebo, “Safe, but Lonely: Living in a Nursing Home”, Vard I Norden 28, no. 1 (2008), 22.
• iii Maria Riedl, Franco Mantovan and Christa Them, “Being a Nursing Home Resident: A challenge to One’s Identity”, Nursing Research and Practice (2013). Web.
• iv Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices (New York, New York: Springer Publishing Company, 2001), 61.
• v Molly L. Clarke, “Organizing Nursing Services,” Age Ageing 6, no. 1 (1977), 108.
• vi Jill Manthorpe, Steve Iliffe, Kritika Samsi, Laura Cole, Claire Goodman, Vari Drennan and James Warner, “Dementia, Dignity and Quality of Life: Nursing Practice and Its Dilemmas”, The International Journal of Older People Nursing 5 (2010): 236.
• vii Ibid., 236.
• viii Ibid, 236.
• ix Radwa Elsaman, and Arafa Mohamed, “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice”, 45-46.
• x Molly L. Clarke, “Organizing Nursing Services,” Age Ageing 6, no. 1 (1977), 111.
• xi Jill Manthorpe, Steve Iliffe, Kritika Samsi, Laura Cole, Claire Goodman, Vari Drennan and James Warner, “Dementia, Dignity and Quality of Life: Nursing Practice and Its Dilemmas”, 240.
• xii Radwa Elsaman, and Arafa Mohamed, “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice”, 46.
• xiii Jill Manthorpe, Steve Iliffe, Kritika Samsi, Laura Cole, Claire Goodman, Vari Drennan and James Warner, “Dementia, Dignity and Quality of Life: Nursing Practice and Its Dilemmas”, 242.
• xiv Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 31.
• xv Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬, The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics (Thousand ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Oaks, CA: SAGE, 2011), 4.
• xvi Kenneth Ferraro, Janet Wilmoth. Gerontology: Perspectives and Issues. (NY: Springer Publishing Company, 2013), 9.
• xvii Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 67.
• xviii Ibid., 44.
• xix Ibid., 31.
• xx Meulen, Ruud ter, “Ethics of Care,” in The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, ed. Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬ (Thousand Oaks, CA: SAGE, 2011), 44.‬‬‬‬‬‬‬‬
• xxi Roberto Andorno, “Human Dignity and Human Rights As a Common Ground for a Global Bioethics.” Journal of Medicine and Philosophy 34, no. 3 (2009): 228.
• xxii Meulen, Ruud ter, “Ethics of Care,” 44.
• xxiii Kenneth Ferraro, Janet Wilmoth. Gerontology: Perspectives and Issues, 9.
• xxiv HelpAge International, “Global AgeWatch Index 2013”, 35.
• xxv Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 60.
• xxvi Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬, The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, 6.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬
• xxvii Ibid., 6.
• xxviii Ibid., 6-7.
• xxix Lennart Nordenfelt, Dignity in Care for Older (UK: John Wiley & Sons, 2009), 4.
• xxx Ibid., 8.
• xxxi “Caring for the Elderly,” CQ Researcher 16, no. 36 (2006): 849. Web.
• xxxii Ibid., 849.
• xxxiii Ibid., 849.
• xxxiv Ibid., 846.
• xxxv Ibid., 850.
• xxxvi Molly L. Clarke, “Organizing Nursing Services,” 114.
• xxxvii Meulen, Ruud ter, “Ethics of Care,” 46.
• xxxviii Molly L. Clarke, “Organizing Nursing Services,” 114.
• xxxix Meulen, Ruud ter, “Ethics of Care,” 46.
• xl Roberto Andorno, “Human Dignity and Human Rights as a Common Ground for a Global Bioethics”, 230.
• xli Darvishpour, Kakhaki A., Abed Saeidi, Delavar Ali, Saeid Alzakerni. “Autonomy In the Elderly: APhenomenological Study”, 1.
• xlii Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 60.
• xliii Roberto Andorno, “Human Dignity and Human Rights As a Common Ground for a Global Bioethics”, 230.
• xliv Lennart Nordenfelt, Dignity in Care for Older (UK: John Wiley & Sons, 2009), 24.
• xlv Darvishpour, Kakhaki A., Abed Saeidi, Delavar Ali, Saeid Alzakerni. “Autonomy In the Elderly: A Phenomenological Study.” HAKIM 12, no. 4 (2010): 1.
• xlvi Rawda Elsaman and Mohamed Arafa, “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice”, 11.
• xlvii Mohamed A. ‘Arafa, “What’s New in the Residential Care of the Elderly in the Arab and Islamic world? The Case of Egypt,” in Towards Human Rights in Residential Care for Older Persons: International Perspective, ed. Helen Meenan, Nicola Rees and Israel Doron (New York: Routledge, 2015), 27.
• xlviii Ibid., 26.
• xlix Molly L. Clarke, “Organizing Nursing Services,” 114.
• l Jill Manthorpe, Steve Iliffe, Kritika Samsi, Laura Cole, Claire Goodman, Vari Drennan and James Warner, “Dementia, Dignity and Quality of Life: Nursing Practice and Its Dilemmas”, 237.
• li Ibid., 237.
• lii HelpAge International, “Global AgeWatch Index 2013”, 16.
• liii Radwa Elsaman, and Arafa Mohamed, “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice”,1.
• liv Meulen, Ruud ter, “Ethics of Care,” 46.
• lv Lennart Nordenfelt, Dignity in Care for Older People, 91.
• lvi Norman Daniels, “Equal Opportunity, Justice, and Health Care for the Elderly,” in Ethical Dimensions of Geriatric Care: Value Conflicts for the 21^st Century, ed. S.F. Spicjer, S.R. Ingman, and Ian Lawson‬ (Norwell, MA: Springer Science & Business Media, 2012), 209.
• lvii Ibid., 209.
• lviii Ibid., 209.
• lix Christina Harrefors, Stefan Savenstedt and Karin Axelsson, “Elderly People’s Perceptions of How They Want to Be Cared for: An Interview Study with Healthy Elderly Couples in Northern Sweden”, Scandinavian Journal of Caring Sciences 23 (2009): 356.
• lx Ibid., 356.
• lxi Norman Daniels, “Equal Opportunity, Justice, and Health Care for the Elderly”, 208.
• lxii Christina Harrefors, Stefan Savenstedt and Karin Axelsson, “Elderly People’s Perceptions of How They Want to Be Cared for: An Interview Study with Healthy Elderly Couples in Northern Sweden”, 356.
• lxiii David G. Troyansky, Aging in World History (New York: Routledge, 2015), 122.
• lxiv Ibid., 127.
• lxv Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 31.
• lxvi Ibid., 31.
• lxvii Ibid., 32.
• lxviii Molly L. Clarke, “Organizing Nursing Services,” 111.
• lxix Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 34.
• lxx Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬, The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, 5.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬
• lxxi Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 36.
• lxxii Ibid, 36.
• lxxiii Ibid, 36.
• lxxiv Ibid., 37.
• lxxv Ibid., 37.
• lxxvi Roy O. “Ageing: Better Understanding for Better Care”. Canadian Nurse 92, no. 4 (1996): 42-44.
• lxxvii Kenneth Ferraro, Janet Wilmoth. Gerontology: Perspectives and Issues, 8.
• lxxviii Susan Sherwin and Meghan Winsby, “A Relational Perspective on Autonomy for Older Adults Residing in Nursing Homes”, Health Expectations 14, no. 2 (2010): 187.
• lxxix Ibid., 187.
• lxxx Martha Holstein, Voices of Community Care: Ethics, Aging, and Caring Practices, 36.
• lxxxi Abdulrazak Abyad, “Geriatric in Lebanon the Beginning”, 299.
• lxxxii Leonardo D. de Castro, Peter A. Sy and Teoh Chin Leong, “Poverty and Indigenous Peoples,” in The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, ed. Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬ ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ (Thousand Oaks, CA: SAGE, 2011), 300.
• lxxxiii Lennart Nordenfelt, Dignity in Care for Older, 19.
• lxxxiv Ibid., 140.
• lxxxv Yagoub Al-Kandari, “Religiosity, Social Support, and Health among the Elderly in Kuwait,” Journal of Muslim Mental Health 6, no. 1 (2011): 87.
• lxxxvi Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬, The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, 40.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬
• lxxxvii HelpAge International, “Global AgeWatch Index 2013”, 5.
• lxxxviii Ibid., 5.
• lxxxix Ashild Slettebo, “Safe, but Lonely: Living in a Nursing Home”, 22.
• xc Rawda Elsaman and Mohamed Arafa, “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice”, 11.

Reference List

Abyad, Abdulrazzak. “Health Care for Older Persons: A Country Profile-Lebanon.” The American Geriatrics Society 49, no. 10 (2001): 1366–1370.

Abyad, Abdulrazak. “Geriatric in Lebanon the Beginning.” The International Journal of Aging and human Development 41, no. 4 (1995): 299-309.

Al-Kandari, Yagoub Y. “Religiosity, Social Support, and Health among the Elderly in Kuwait.” Journal of Muslim Mental Health 6, no. 1 (2011): 81-93.

Andorno, Roberto. “Human Dignity and Human Rights As a Common Ground for a Global Bioethics.” Journal of Medicine and Philosophy 34, no. 3 (2009): 223-240.

‘Arafa, Mohamed A. “What’s New in the Residential Care of the Elderly in the Arab and Islamic world? The Case of Egypt.” In Towards Human Rights in Residential Care for Older Persons: International Perspective, edited by Helen Meenan, Nicola Rees and Israel Doron, 26-45. New York: Routledge, 2015.

“Caring for the Elderly.” CQ Researcher 16, no. 36 (2006): 841-864. Web.

Castro, Leonardo D. de, Peter A. Sy and Teoh Chin Leong. “Poverty and Indigenous Peoples.” In The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, edited by Rut Chadwick‬, Henk ten Have‬, and Eric Meslin‬, 289-306. Thousand Oaks, CA: SAGE, 2011.‬‬‬‬‬‬‬‬‬‬‬‬‬‬

Chadwick‬, Rut, Henk ten Have‬, Eric Meslin‬. The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics. Thousand Oaks, CA: SAGE, 2011. ‬‬‬‬‬‬‬‬‬‬‬‬‬‬

Clarke, Molly L. “Organizing Nursing Services.” Age Ageing 6, no. 1 (1977): 108-117.

Daniels, Norman. “Equal Opportunity, Justice, and Health Care for the Elderly.” In Ethical Dimensions of Geriatric Care: Value Conflicts for the 21^st Century, edited by S.F. Spicjer, S.R. Ingman, and Ian Lawson‬, 197-221. Norwell, MA: Springer Science & Business Media, 2012.

Darvishpour, Kakhaki, Abed Saeidi, Delavar Ali, and Saeid Alzakerni. “Autonomy in the Elderly: A Phenomenological Study.” HAKIM 12, no. 4 (2010): 1-10.

Elsaman, Radwa, and Mohamed Arafa. “The Rights of the Elderly in the Arab Middle East: Islamic Theory Versus Arabic Practice.” Marquette Elder’s Advisor 14, no. 1 (2012): 1-47.‬‬‬‬‬‬‬

Ferraro, Kenneth, and Janet Wilmoth. Gerontology: Perspectives and Issues. New York, NY: Springer Publishing Company, 2013.

Harrefors, Christina, Stefan Savenstedt and Karin Axelsson. “Elderly People’s Perceptions of How They Want to Be Cared for: An Interview Study with Healthy Elderly Couples in Northern Sweden”. Scandinavian Journal of Caring Sciences 23 (2009): 353-360.

Holstein, Martha. Voices of Community Care: Ethics, Aging, and Caring Practices. New York, NY: Springer Publishing Company, 2001.

Manthorpe, Jill, Steve Iliffe, Kritika Samsi, Laura Cole, Claire Goodman, Vari Drennan and James Warner, “Dementia, Dignity and Quality of Life: Nursing Practice and Its Dilemmas”. The International Journal of Older People Nursing 5 (2010): 235-244.

Meulen, Ruud ter. “Ethics of Care.” In The SAGE Handbook of Health Care ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Ethics, edited by Rut Chadwick‬, Henk ten Have‬, and Eric Meslin, 39-49.‬ Thousand Oaks, CA: SAGE, 2011.‬‬‬‬‬‬‬‬‬‬‬‬‬‬

Nordenfelt, Lennart. Dignity in Care for Older People. West Sussex, UK: John Wiley & Sons, 2009.

Riedl, Maria, Franco Mantovan and Christa Them. “Being a Nursing Home Resident: A challenge to One’s Identity”. Nursing Research and Practice (2013). Web.

Roy O. “Ageing: Better Understanding for Better Care”. Canadian Nurse 92, no. 4 (1996): 42-44.

Sherwin, Susan, and Meghan Winsby. “A Relational Perspective on Autonomy for Older Adults Residing in Nursing Homes”. Health Expectations 14, no. 2 (2010): 182-190.

Slettebo, Ashild. “Safe, but Lonely: Living in a Nursing Home”. Vard I Norden 28, no. 1 (2008): 22-25.

Troyansky, David G. Aging in World History. New York: Routledge, 2015.