Aging in the Philippines

The Philippines is a diverse country that will experience an increase in its aging population in the near future. The aim of this article is to provide an overview of the main issues surrounding population aging, as well as family caregiving and policies that are of concern to older adults in the Philippines. Policymakers and government leaders must plan for the expected growth in the numbers of older adults, which is likely to increase the demand for services and support for elders and their caregiving families. The Philippines’ unique history and rich culture shapes its citizens’ views on aging and bolsters expectations of informal caregiving for older family members. Research on aging in the Philippines and current policies must be enhanced to adequately address the needs of the country’s aging citizens.

Overview

The Philippines is a culturally and historically diverse archipelago consisting of a cluster of over 7,000 islands in the Southeast Pacific Rim. Various historical events have shaped the society and heritage in the Philippines. The islands were first colonized by the Spanish in the 16th century, and then they were seceded to the United States during the Spanish American war in the late 19th century ( Central Intelligence Agency, 2016). During World War II, the Philippines repeatedly exchanged hands between Japan and the United States until after the wars ended, at which point the Philippines gained its independence on 4 July 1946. During the 1970s and into the 1980s, the Philippines was in a state of martial law under President Ferdinand Marcos. After the People Power Revolution evicted Marcos, the Philippines transitioned into a presidential constitutional republic, which it remains today.

Modern-day Philippine society is an amalgamation of the different countries that once governed its many islands. A mixture of Asian, Spanish, and American influence has shaped society in the Philippines and the different languages in various regions of the country. There are currently more than eight dialects spoken in the country, yet English and Tagalog (Pilipino) are the official languages of the nation. Inhabitants of the Philippines often refer to themselves as Pinoy (general term), Filipino (masculine term), Filipina (feminine term), or Filipinos (plural term). The majority (82.9%) of Filipinos identify Catholicism as their religion ( Central Intelligence Agency, 2016), and religion is an important component that shapes both Filipino family life and customs.

Demography

The country consists of approximately 103 million inhabitants, with less than 5% of the population 65 years and older ( Central Intelligence Agency, 2016). Currently, the age structure of the Philippines resembles many other developing countries because there is a greater proportion of younger Filipinos in comparison to older Filipinos ( Figure 1). Despite the larger number of young Filipinos, the 60 years and older population of the Philippines is expected to increase by 4.2%, whereas the 80 years and older population is expected to increase by 0.4% from 2010 to 2030 ( Help Age Global Network, 2017b). In contrast, the 60 years and older population of the United States will increase 5.4% from 2010 to 2030 ( Help Age, 2015). The Philippines’s population increased by over 35% over the last two decades with the older adult population (60 years and older) expected to overtake those aged 0–14 years old by 2065 ( Help Age Global Network, 2017a). Currently, life expectancy of Filipinos is 57.4 years for males and 63.2 years for females. Females are projected to expect an increase of 4.0 years in life expectancy and males an increase of 4.7 years in life expectancy by 2030 ( Help Age Global Network, 2017b). The improvement in life expectancy can be attributed to advances in public health in the Philippines, which have eradicated many of the diseases that once caused earlier mortality in Filipinos ( Coscoluella & Faustino, 2014).

Population pyramid of the Philippines ( Central Intelligence Agency, 2016)

Compared to developed countries, which have a low fertility rate of about 1.7 children per woman ( United Nations, 2015), there is a high fertility rate of 3.1 children per woman in the Philippines ( Help Age Global Network, 2017a). Although the dependency ratio of the Philippines has been steadily decreasing since the 1960s ( World Bank Group, 2017), the nation still contains a greater proportion of dependents to working-age people when compared to other Asian countries.

Millennium Development Goals

To address disparities in health and well-being, the Philippines was a member of the United Nation’s Millennium Declaration. The declaration established eight Millennium Development Goals, including various topics ranging from mortality and disease to education and poverty. The 189 participating countries submitted regular progress reports to assess and track periodic changes over time in addressing the goals. Since its inclusion in the Millennium Declaration, the Philippines achieved certain subcomponents of the eight key goal indicators established by both the country and the United Nations. Outcomes improved for infant mortality, malaria disease distribution, and education for females. However, issues with poverty and deaths from communicable diseases, such as tuberculosis, remain a concern in the Philippines. The country’s progress in addressing the indicators is displayed in Table 1.

Philippine Millennium Development Goals Progress

Note: Information for this table is from the Philippine Millennium Development report ( Philippine Statistics Authority, 2015).

Philippine Millennium Development Goals Progress

Note: Information for this table is from the Philippine Millennium Development report ( Philippine Statistics Authority, 2015).

Research on Aging

Aging in the Philippines remains a subject that is severely under-theorized in research ( Villegas, 2014). Although older Filipinos do appear in the country’s national reports, current empirical studies incorporating older adults appears to be lacking in the Philippines. The main universities in the Philippines house research institutions that study a variety of topics; however, the University of the Philippines Manila is currently the only major institution where there is an established center specifically for aging research. The majority of research centered on older Filipinos appears to focus on perceptions of aging, quality of life of older Filipinos, and older adults in the workforce.

Perceptions Regarding Aging

Many Filipinos view the aging process from direct interactions with their family members and older Filipinos in their surrounding community. Living in multigenerational households and communities shape perceptions of aging as a responsibility, due to the establishment of family roles, adult engagement in the workforce, and family social ties ( Valdez, Angeles, Pareja-Corpuz, & Hernandez, 2013). The study by Valdez and colleagues (2013) found common themes about perceptions of aging, both positive and negative, from focus group interviews. In fact, Valdez and colleagues (2013) discovered that although older Filipinos acknowledge the physical decline that can occur with aging, there is a general positive outlook that aging is a period of increased productivity and promising experiences. Social resources can be predictive of positive views of aging for older Filipinos ( Valdez et al., 2013). For example, older adults who receive more social support from their relatives often feel encouraged and have better perceptions about their own aging process. Filipino elders’ perceptions of aging are derived from the unique life experiences and social units that encompass their lives ( Valdez et al., 2013). These experiences, either negative or positive, form their views on aging and outlook on life. Although older Filipinos do acknowledge the physical and functional declines that might occur with increasing age, they view aging in a more positive light due to the respect and dignity that are attained with maturation.

Quality of Life

In terms of research on quality of life of older Filipinos, many elders generally report positive health, community participation, and financial security. However, Filipinos who reported higher socioeconomic status and more educational attainment also tended to report better quality of life ( De Leon, 2014; Tariga & Cutamora, 2016). Increased age was directly correlated with better subjective well-being in Filipinos ( Tariga & Cutamora, 2016). Older Filipinos can attain greater stability in later life, and they may develop methods to cope with distressing events through previous challenges they experienced and overcame. Also, higher access to community resources was also directly correlated with better quality of life ( De Leon, 2014). Older Filipinos residing in rural areas lacked the same access to services than older adults living in more urban settings. A separate study by Esteban (2015) discovered that religion, mainly Christianity, may serve as a protective buffer to the suffering that may accompany the aging process. Religion and spirituality in older Filipinos may enhance their outlook on life and assist them in overcoming hardships. Older adults in the Philippines may also reframe ageist stereotypes and instead find positive aspects of aging, such as growing older as a time of increased creativity and a period of personal fulfillment ( Esteban, 2015). Instead of acknowledging stereotypes associated with aging, older Filipinos can view late adulthood as a period of life where new relationships can be created and as an opportunity to become more engaged in their communities.

Overall, older Filipinos report adequate life satisfaction and well-being; however, social and financial inequalities may act as a hindrance. To improve life satisfaction for older Filipinos, services should equally be made available to older adults living in low income or rural areas. Barriers to access community and health support services should be reduced for older adults who may need assistance. Local government units can address barriers to access in their communities by offering wellness programs to enhance older Filipinos’ health ( Tariga & Cutamora, 2016). Additional research is needed to examine disparities in quality of life in the older Filipinos and evaluate services and supports that may improve their well-being.

Workforce and Aging

Research examining employed older Filipinos found that recognition of employee progress impacts older worker’s happiness in the workplace ( de Guzman, Largo, Mandap, & Munoz, 2014). Furthermore, positive mental and physical health had a beneficial impact on job satisfaction. Enhancing job satisfaction in the work environment can potentially retain older workers in their positions and benefit the economy in the Philippines. A study focusing on older Filipino university instructors found similar results with older instructors reporting life satisfaction and high psychological resilience when faced with both work-related and family stressors ( De Jose, 2014). Older workers did experience stressful experiences in the workplace and at home; however, resources, such as prayer and social support, aided them in coping with those perceived stressors. Although the study by De Jose (2014) only sampled older teachers, the findings may translate into work environments in the Philippines where older employees experience similar strain. Additional research can examine the impact of stress and coping in other professions and utilize stress and coping models to serve as theoretical frameworks in future studies.

Secondary Data sets

There are a variety of data sets that can be used to study health and social outcomes throughout the Philippines. These data sets are publicly available and are regularly updated by the Philippines Statistics Authority. A sample of secondary data sets are presented in Table 2. These population-based data sets can be utilized in research to incorporate the different provinces in the Philippines and account for longitudinal changes over time. Including larger samples of older Filipinos from the various islands will ensure heterogeneity and capture a more diverse view of aging from different Filipino cultures throughout the nation.

Secondary Data sets

Note: Information from these databases were found using the National University of Singapore (2017) list of archives and data sets in Asia.

Secondary Data sets

Note: Information from these databases were found using the National University of Singapore (2017) list of archives and data sets in Asia.

Family Caregiving

Filipinos, like many other Asian cultures, value filial piety and caring for older family members later in life. Although Filipinos may share the same obligation to care for family members as other Asian cultures, they differ because both males and females share decision making and financial tasks; Filipinos are predominantly Catholic, and family members are expected to contribute to the family through various means ( Kimura & Browne, 2009). In contrast to the more maternalistic role of caregiving seen in many cultures, multiple Filipino family members are often vested in the caregiving process and serve various roles. For example, older Filipino male caregivers may ask their adult children to assist with the more physically demanding caregiving tasks, while they themselves take on more of the household tasks ( McBride, 2006). Filipinos living overseas may even travel abroad to assist in caregiving for a close friend or family member ( McBride, 2006). Research shows that even after Filipinos migrate to the United States, they still maintain the propensity to provide caregiving despite acculturation and new identity formation in America ( Jones, Zhang, Jaceldo-Siegl, & Meleis, 2002; McBride, 2006). The dedication to family caregiving is evident in Filipino culture, and it is a part of the very fabric of Philippine society. Caregiving in Filipino households is so commonplace that failure to provide care or resources to family members in need is seen as shameful, or “hiya” in Tagalog.

Filipino caregivers utilize mainly family resources in care provision, so they are often less reliant on formal services for assistance ( Jones et al., 2002). In Filipino culture it is perceived as a stigma to accept services from the community, so many families either forgo them or use them in secret ( McBride, 2006). Families would opt to provide care themselves rather than resort to any health or social services for assistance in providing care. Filipino caregivers who do not utilize external services fear that society will deem them unable to adequately care for a family member if they utilize support services ( McBride, 2006). Families believe that the care provided by relatives is sufficient for the needs of the care recipient. The social support that Filipino caregivers have in the community and at home can moderate the negative impact of care recipient problematic behavior on caregiver strain ( Varona, Saito, Takahashi, & Kai, 2007). Therefore, the Filipino caregiver’s social support may act as a protective factor and make them less likely to seek or utilize support services.

Christian Filipinos’ core-belief system in religion, rooted mainly in Catholicism, also reinforces the concept that caregiving is expected of family members ( McBride, 2006). Catholicism instills a “self-sacrificing” ideation of caregiving ( McBride, 2006) where the family caregiver selflessly sets aside his or her personal life to provide quality care to a family member. Many Filipinos also use religion as a means to provide coping for the daily stresses and strain of life ( Nakonz & Shik, 2009). Religion is an integral component of many Filipinos’ cultural identity, and it bolsters societal views of family caregiving.

Filipino caregivers also report positive aspects of caregiving and are able to manage the challenges of caregiving and integrate the new role in their lives ( Jones et al., 2002). Some of the positive benefits reported were personal growth and finding meaning by overcoming obstacles ( Jones et al., 2002). The beneficial aspects that Filipino caregivers discover through caregiving may be attributed to how they center it around a value system ( McBride, 2006) where they derive personal fulfillment from caring for a loved one.

Key Policy Issues

Social Welfare and Health

A major area of policy focus for older Filipinos is in social welfare. The Philippines has a high poverty rate that is attributed to low worker education, a lack of skilled work, living in a rural area, and the high dependency burden that the working-age population must shoulder ( Bayudan-Dacuycuy & Lim, 2013). Due to the large percentage of young adults and children in the Philippines, there is a high dependency ratio, which means that older Filipinos often are not able to save for retirement because they may have young dependents ( Duaqui, 2013; World Bank Group, 2017). Older Filipinos may have to sacrifice their financial assets to care for younger family members. Another major issue is that almost a quarter of Filipinos living in poverty are older adults ( Villegas, 2014) who do not have the financial means necessary to sustain an adequate quality of life. Although 1.3 million older Filipinos in poverty may qualify for a monthly pension under the country’s Social Pension Act (RA 9994), the amount equates to about 12 U.S. dollars for Filipinos aged 77 years or older ( Help Age Global Network, 2017b), which may not be sufficient to cover older Filipinos’ living expenses. An extension of the Social Pension Act does provide certain health services to poor, older Filipinos, such as free medical services in government hospitals, discounted health services, free vaccines, discounted medicines, and PhilHealth insurance coverage ( Help Age Global Network, 2017b). The Pantawid Pamilyang Pilipino Program (PPPP) is another service that acts as a safety net for families who are below the threshold for poverty and aims to stop the cycle of intergenerational poverty ( Bayudan-Dacuycuy & Lim, 2013; Pantawid Pamilyang Pilipino Program, 2017). Poor households may qualify for up to 600 Philippine pesos (about 12 U.S. dollars) a month, providing the monetary grant primarily to pregnant mothers and families with children ( Pantawid Pamilyang Pilipino Program, 2017). Expansion of the PPPP benefits to include the needs of older Filipinos and their families may help alleviate the negative effects of poverty by extending the monetary grant, PhilHealth insurance, and employment facilitation to older adults.

Access to health care services can help improve the quality of life of older Filipinos who may have health conditions, especially because many older Filipinos are burdened by both chronic and infectious diseases ( Help Age Global Network, 2017a). The 2010 Expanded Senior Citizens’ Act does provide health service benefit to older Filipinos, such as discounted pharmaceuticals and vaccinations. However, the availability of these resources depends on the health services providers, who often are reluctant to provide health services to older Filipinos ( Romualdez et al., 2011). The expected increase in number of older Filipinos in the future may also place a strain on the Philippine health care system because the health care work force may not be prepared to properly assess and treat older patients.

The Workforce

Older Filipinos remaining in the workforce may be beneficial to older workers because the country’s social security pension may not be financially sufficient to support them in retirement. Working-age Filipinos must often remain in the workforce longer to financially support younger dependents and other family members ( Cruz, Natividad, Gonzales, & Saito, 2007). By working longer, older Filipinos can support their dependents and possibly invest in savings for retirement. It is important that institutions promote policies that acknowledge the unique needs of older workers and offer benefits, such as paid family leave and flexible working conditions, to retain productive and satisfied workers. The ability to remain in the workforce longer may allow Filipinos to invest further in savings and allow them to be less reliant on external funding, such as the government pension, to supplement their finances.

Another workforce issue in the Philippines is that a majority of Filipinos are underemployed, with low education and a lack of decent jobs creating issues for both younger and older workers ( Rutkowski, 2015). Older Filipino workers are often at a greater disadvantage than younger workers because they are less likely to obtain an adequate education and attain salaried positions in the workforce ( Rutkowski, 2015). Offering training programs to enhance worker education and skills may allow older Filipino workers to qualify for better positions with higher pay levels.

Policy and Caregiving

A lack of institutional care in the Philippines means that older Filipinos are often cared for by family members at home ( Duaqui, 2013). This informal care network is vital because there are inadequate social security and institutional care available for older Filipinos. Although caregiving is expected of Filipino families, those who are of lower socioeconomic status may be financially strained in providing adequate care to an ailing loved one. There are current policies to protect the welfare of formal caregivers ( “Caregivers Welfare Act,” 2016); however, policies should also address the demands of Filipino informal caregivers by offering paid family leave or even payment to family caregivers who are in need. Also, although Filipino family caregivers are less likely to utilize services, culturally tailored support services could be useful in alleviating any caregiver strain.

Emerging Issues

Like many countries, the Philippines will experience a growth in the population of Filipinos 65 years and older. Currently, the nation is not prepared to meet the needs of the influx of aging Filipinos. The Philippine government must recognize that national policies for older Filipinos, like the Senior Welfare Act, must be modified to address the unique demands of its aging citizens. Social welfare and wellness programs should be expanded to offer coverage to more aging Filipinos. Disparities in access to services must be addressed to improve the well-being of older adults throughout the different provinces.

Conclusion

The recent establishment of the Institute of Aging at the University of the Philippines Manila exemplifies how aging in the Philippines is now garnering national attention. This new focus on aging must also revitalize research in gerontology by incorporating larger, more diverse samples of older Filipinos to capture the different cultures found across the nation. Population-based studies can be advantageous in recruiting a heterogeneous sample of older Filipinos, similar to national studies that are conducted in the United States and other countries, to obtain a nationally representative sample of participants. Former aging research in the Philippines has relied on predominantly qualitative methods to capture older Filipinos’ perceptions of aging. Utilizing a quantitative method or mixed-methods approach can offer greater insight into this field of aging research. Researchers can also incorporate theoretical models to act as a guiding framework for their studies. The use of theoretical models can strengthen studies and allow research to be replicated and modified by other researchers.