There are many elderly concerns faced by Indonesia related to the programs that are already running. Among them, first, the increase in the elderly population causes changes in the profile of the elderly and their families. Second, many programs and services for the elderly are not yet coordinated or integrated. Third, the reach of the program is limited. Fourth, there are a number of key gaps in services and programs. To bridge these issues, Community Care Hub (CCH) is established and managed to be an innovative solution.

It was conveyed by the Executive Director of SurveyMETER, Dr. Ni Wayan Suriastini M.Phil, in the Workshop on Curriculum Review of the Dietitian Professional Education Study Program held by the Yogyakarta Health Polytechnic, Health Human Resources Development and Empowerment Agency, Ministry of Health of the Republic of Indonesia, on Wednesday, April 28, 2021, at Gamping, Sleman, DIY. She was appointed as the first speaker to deliver the material "Problems and Health Nutrition Service Programs for the Elderly in the Community." The workshop was held in hybrid as a combination of offline and online and commenced directly by the Director of Poltekes, Ministry of Health, Yogyakarta, Joko Susilo SKM, M.Kes.

The elderly experienced a decline in income during the COVID-19 Pandemic that affected food consumption. It was conveyed by Suriastini referring to the study results on the Elderly and COVID-19 in Indonesia conducted in collaboration with ERIA, Bappenas, and SurveyMETER in 2020.

She further explained that CCH is in line with the 5 elderly policy strategies prepared by Bappenas and already included in the 2020-2024 RPJMN (Presidential Decree No. 18 of 2020 concerning the 2020-2024 RPJMN). Namely, improving social protection, improving health status, increasing public awareness, strengthening institutional implementation agency, and fulfilling the rights of the elderly.

The CCH itself was in the capacity development stage in 5 important modules, namely Introduction to Long-Term Care (LTC), Community-based Integrated Service Training for the Elderly, Case Management Training, Elderly Care Team Training, and Clinical Issues in LTC. (JF)

Time is rolling past the fourth month since the Covid-19 case was first discovered in Indonesia. Based on data collected, the highest percentage of deaths due to Covid-19 in Indonesia was experienced by the age group ≥ 60 years. As we know, the elderly are one of the vulnerable and easily exposed groups of Covid-19.

Then how does the elderly posyandu play a role in the middle of a pandemic? The government is currently trying to break the chain of transmission of the Corona virus. The call for physical distancing, work, study and worship at home continues to be echoed. All activities that create crowds should be avoided including elderly posyandu activities. The role of posyandu elderly through cadres is very important to always monitor the condition of the elderly.

Although the Posyandu for the elderly was temporarily inactive, the role of cadres is still ongoing. The cadre's role is to provide information to the elderly about healthy living behavior and maintaining health during the pandemic. This information is given when the cadre meets with the elderly on the street or in the mosque. The cadres also distributed masks to the elderly, both of which were bought from posyandu’s fund and from the help of other institutions. Another important role is cooperation between stakeholders, such as with the RT. Because the coverage area is small and close together, it will be easier to monitor the condition of the elderly.

Then do the elderly feel the effects of the Covid-19 pandemic? The social impact is felt by the elderly in the absence of an elderly posyandu, which in turn reduces psychological health. Elderly Posyandu activities not only maintain physical health to always be in shape, but it is also a place to meet with peers, the elderly can communicate with each other. During this pandemic they felt lonely because they could not meet each other.

In addition to social impacts, the economic impact is also felt by the elderly. As experienced by Mbah Marto (70) who usually sells rice at Yogyakarta City Gede Market. But during the pandemic he is no longer dared to go to the market. He only sells rice at home which results in reduced income. The same story is also experienced by many other elderly who are in the same fate with Mbah Marto.

Another impact that is no less important is the low level awareness of the elderly to protect themselves during this pandemic. A concrete example is seen when the elderly do the activity outside their home, many do not use masks. And a lot of them still ask why they have to wear a mask, why they have to stay at home.

Elderly families themselves cannot convey information clearly, many elderly do not watch the news on television, posyandu cadres cannot play a large role in this situation. This proves that the information they received about Covid-19 is still lacking while they are vulnerable to contracting it.

What needs to be done to help the elderly affected by Covid-19?

The elderly are the groups that need special attention. In accordance with the mandate of the "Guidelines for the Protection of the Elderly" by the KPPPA, the role of the elderly posyandu cadre at the community level is needed to help overcome the problems faced by the elderly during the Covid-19 pandemic by involving and cooperating across sectors.

Posyandu cadres hope for assistance in the form of groceries and nutritious food. Elderly is still lacking attention, there is no specific assistance targeting them. Other assistance received by the elderly is cloth masks, basic necessities, hand sanitizers. However, this assistance has not yet been received by all the elderly in posyandu. It is hoped that if it distributes assistance the village government can work together with Posyandu cadres in its distribution.

It is also important to consider how the elderly can get precise and clear information about Covid-19. According to posyandu cadres, they should be given information from competent sources, such as officers from the puskesmas. But in a pandemic like this, health workers already have many tasks to deal with patients at the forefront. One wise step that can be taken is to document information about Covid-19 from various trusted sources such as those published by the relevant ministries.

The village government can help coordinate documentation, then convey it through youth clubs, RT, RW, or posyandu cadres. Cadres with extensive networking will convey information to the elderly. Also involve families and the community to actively explain information about Covid-19 to the elderly. In line with the general guidelines for dealing with Covid-19 issued by the Ministry of Home Affairs, ensure that the elderly obtain awareness and personal protection related to Covid-19.

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* The article was first published in Bahasa, in the rubric "INSPIRATION FOR POLICY" SKH Kedaulatan Rakyat, Friday Edition July 10, 2020.

The COVID-19 pandemic has influenced our social system and make the world in a standstill. In Indonesia, as of June 19, 2020, the number of COVID-19 cases reached 43,803. Of these, 14% were elderly (aged 60 and older) and 44% of the mortality rate (2,373 cases). This shows that the highest number of deaths was experienced by the age group ≥ 60 years.

As we get older, our immune system weakens. This makes the elderly more vulnerable to all types of infections. Therefore, it is very important to support and protect the elderly during this pandemic, especially those who live alone. The government must be supported to provide interventions to ensure the elderly get what they need. This support can include nutritious food, basic needs such as food, medicines to support physical health and access to social and mental health support.

In the Special Region of Yogyakarta, as the province with the highest life expectancy in Indonesia, several actions and activities have been taken by various parties in supporting the elderly during the pandemic. We also try to do small activities according to our capacity as a research institution.

Our small activity was a documentation interview about Posyandu service initiatives and breakthroughs by elderly Posyandu cadres during the pandemic in 5 regencies / cities, namely Bantul, Gunungkidul, Kulon Progo, Sleman and Yogyakarta. In the interview we found that among their small activities during the pandemic included distributing masks and knowledge through flyers and posters about how to wear masks and wash hands properly.

In one village in Kulon Progo Regency, an initiative from an elderly posyandu cadre that was quite solutive was to encourage the elderly to continue to carry out additional activities such as gardening. Apart from living in the village and generally their profession is farmers, gardening activities can help economic and social conditions and maintain their immunity. Thus, during these activities they can also interact with each other while still observing the health protocol.

In another village in Bantul Regency, the village youth organization took the initiative to collect funds from local residents that were used to buy food that would be distributed to underprivileged people, including the elderly.

From the small interview activities during the pandemic, there are actually many lessons that we can learn. That the small concern of people in all sectors and ages can have a big impact on the health and happiness of others. We need to realize that the responsibility to maintain a healthy and safe environment rests with all of us. As President Joko Widodo said on Monday 18 May 2020, the most effective way to control the spread of Covid-19 was at the lowest community unit. We will be able to overcome this pandemic, but for that we must make active efforts to stay healthy both mentally and physically for ourselves and for those around us, including the elderly.

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Thus a glimpse of the lessons we learned from our documentation. We also write notes in another version in the Active Aging Consortium Asia Pacific (ACAP) Bulletin June-July 2020 Edition (pp. 10-11), with the hope of learning from society and the global community. The full note can be read and downloaded here.

The coverage on SurveyMETER’s mentoring programs on elderly at Village Guwosari, Pajangan Bantul is published in Active Aging Consortium Asia Pacific, January-February edition. The bulletin publishes two articles entitled “Intergenerational Traditional Music Group Unites Older Person to Young People” by Wayan Suriastini,  and “Young Cadres Care Older Person” by Bondan Sikoki.

As Bali gains a reputation not only as a tourist destination but as a retirement option for Indonesians and foreigners, the island province is considering how to better accommodate its own elderly population.

Nationwide, lower fertility rates and a longer life expectancy mean that Indonesia is heading quickly towards an ageing population. The proportion of the population aged 60 and older has doubled over the past 50 years, and is projected to constitute a quarter of the population by 2050, according to records from Statistics Indonesia(link is external). A healthy and productive elderly population can bring prosperity to the nation. But an unhealthy elderly population can bring social and economic burdens.

Dementia, including dementia resulting from Alzheimer’s disease, is a brain disorder that influences an individual’s emotions, memories and decisions. It is a common ailment among elderly populations, and has been highlighted as a public health priority by WHO, which is working to build awareness of its symptoms and how to prevent it.

Bali has very high rates of dementia(link is external), affecting 32 per cent of the province’s elderly population by age 70. This is compared to only 20 per cent of people of the same age in Yogyakarta(link is external), for example, which has a higher proportion of elderly people relative to its population.

These findings come from a large-scale study of dementia in Bali and Yogyakarta by SurveyMETER in collaboration with Alzheimer Indonesia, the Suryani Institute for Mental Health, and Atma Jaya and Udayana Universities, funded by the Knowledge Sector Initiative.

Deeper analysis reveals that elderly people in Bali generally have a lower level of education than those in Yogyakarta. The majority of Bali’s senior citizens were also found to live in rural areas, where they are statistically more likely to suffer from stress and non-communicable diseases. A low level of social participation further drives their vulnerability. In combination, these factors help to explain the high rate of dementia among Bali’s elderly population.

Guided by the research, a pilot project(link is external) trialling an “elderly- and dementia-friendly community(link is external)” was launched in September 2018 in Ketewel village, in Bali’s Gianyar district, where rates of dementia were found to be the highest. It aimed to raise awareness about the symptoms of dementia, and how to take preventative action to minimise the risks of developing it.

Bali’s government and Regional Representatives Council (DPRD) issued a policy on elderly wellbeing in late 2018, setting a good example for evidence-based policy for this vulnerable section of the population.

The costs of ageing

According to a 2017 WHO report, the social and economic impacts of dementia are borne not only by individuals but also their families and communities, and by extension, the nation. The estimated cost of dementia globally reached US$1 trillion in 2018, and is projected to reach US$2 trillion by 2030, according to last year’s World Alzheimer Report. Expenses can arise from medical costs, salaries for caregivers, or the opportunity cost of other household members who give up paid work to take care of elderly family members with dementia.

The Ministry of Health points to ageing and an increase in the prevalence of non-communicable diseases as the main factors behind cognitive decline. These conditions can curb daily activities, which can eventually accelerate the onset of Alzheimer’s disease and other types of dementia among the elderly.

Stigma and misinformation about dementia remains a global issue, and remains relevant in Indonesia. Of most concern, dementia appears to be broadly considered a normal part of ageing across Indonesia, with very little awareness of preventative actions that can be taken.

The Bali government’s new policy takes a rights-based approach to ensuring well-being among its elderly population. Under the new policy, Bali’s elderly individuals are guaranteed access to geriatric care in public health facilities without charge. Further, the policy affirms the right of the elderly population to protection from exploitation, violence, poor treatment from inside or outside the home, and from natural disasters.

Encouraging an active life into old age, the policy also affirms the right of the elderly to be involved in the community and to obtain a decent job. Financial support for the policy has been pledged under provincial, district, and village statutes and bylaws.

A paradise for all?

Before the pilot project in Ketewel, about 90 per cent of elderly residents had never heard of dementia. So the first step was to raise awareness and understanding among the whole community about what dementia is, how to prevent it, and what the risks and symptoms are.

Further training in treatment of people with dementia was conducted by Alzheimer Indonesia, followed by training for health workers in community health centres (puskesmas) and related local government staff in Gianyar district.

Ketewel village officials supported the project by reviving integrated health services for the elderly (posyandu lansia), introducing nutritious food subsidies, and organising group activities for the older population. These programs aim to improve general well-being among the elderly, as well as minimise the risk of developing dementia.

Ageing is a fact of life, but well-being outcomes for the elderly are better when they are supported by their families, communities and government. Dementia should not be seen as inevitable part of ageing, but a condition that can be prevented and treated.

Stakeholders must sit together and make a concerted effort to increase general knowledge of dementia and its symptoms, and to promote early prevention efforts, including expansion and improvement of health services for the elderly.

The approach being trialled in Ketewel sets an example for how the whole community can be involved in improving well-being among the elderly, something that will become of vital importance in a rapidly ageing Indonesia.

*Riska Dwi Astuti is a researcher at SurveyMETER, a research institute in Yogyakarta.

Source:

https://bit.ly/352vvRl

We arrived at the hamlet head house less than ten minutes from nine in the morning when the program started. It seems that tens of elderly and posyandu cadres have been waiting for our arrival. Some of them even came before seven am. They waited for us (and the village head) for more than 30 minutes in the living room and in the lobby, after the weight checks, blood pressure checks, and eating supplementary food (PMT).

Our enthusiasm was fueled by theirs. They just obeyed when we asked to move by sitting on a mat in the courtyard of the house. They were also loyal to remain still at the place when the morning drizzle had fallen for a moment. We expect the enthusiasm will be a good start for future program implementation.

Sunday morning December 31, was a special event for them and of course also for us. We called the activity on the last morning of 2017 the “Iroyudan Hamlet Elderly Gathering Activity” to mark and welcome the assistance program for the Bougainvillea Elderly Posyandu activities in Guwosari Village which was conducted by SurveyMETER as of January 2018. It is a small program of SurveyMETER in an effort to create an elderly-friendly community. The Iroyudan became the second hamlet that was accompanied after Watugedung.

“Starting January next year, the service for the elderly posyandu will be separated from the toddler one. Every implementation will carry out health checks and elderly gymnastics with varied materials and agendas. We also schedule a home care program for the elderly who are bedridden (got sick and being only lie down at home)”, said Titis Putri Ambarwati, program coordinator, in front of the audience.

“I expect all of the elderly to enthusiastically participate in posyandu activities since by being active in Posyandu may find out about health. Health is very important and we must take care of it constantly. In addition, posyandu is also a melting pot for friendship and chatting with others,” said the Village Head of Guwosari Village, H Suharto, in his remarks. He also thanked SurveyMETER for expanding the range of assistance.

Furthermore, a series of activities ran smoothly, naturally, and enjoyably. All audiences were enthusiastic when invited to play anti-senile gymnastics. Their smiles and laughter broke out between movements. Some of them who are unable to do so participate while sitting.

They also nodded in understanding when a SurveyMETER researcher, Endra Dwi Mulyanto, explained the results of a study on (and the importance of) posyandu for the elderly conducted in Bantul regency. He conveyed the results of the study in easy-to-understand language, including when recommending an increase in the allocation of village funds to support posyandu activities for the elderly. He added that based on the study results, the joint task is to encourage the activity of male elderly are far below the female one. “Health is the capital of life." In addition, being active posyandu for the elderly is part of the spirit of the Healthy Living Community Movement (GERMAS) promoted by the Indonesian Ministry of Health," he said. Having completed the presentation and representing the management of SurveyMETER, he symbolically delivered a set of Portable DVD Players to assist the posyandu cadres in learning various exercises for the elderly.

After a while, they were invited to remember their youth and childhood. The male elderly are welcome to create something originating from palm tree leaves while the female ones from banana leaves. A few minutes later the Master of Ceremony called the first finisher to show his creation. He came forward to approach the MC with a woven keris in hand. An eccentric creation from him was greeted with boisterous laughter from others. The atmosphere was shining and lively. By his agility, he was awarded a door prize.

Then some grannies scrambled to get to the MC, showing off their creations in order to get gifts. Two grannies snatched to compete for their creations showing off their work, followed by the others. We and the cadres certainly provide excess gifts so that all the participants get a share. In addition to woven keris, several other creative products are produced ranging from various types of diamonds, whips, birds, propellers, trays, plates, pads, wrap, and similar foods packaging.

To avoid scrambling over the gifts, the MC changed the terms for getting a gift by allowing them to show their "hidden talent". A grandfather who claims aged 95 years old started by singing the national anthem, Indonesia Raya. The alternating and back-and-forth pronunciation of the verses and the hoarse voice (maybe because of his missing teeth) made the atmosphere full of laughter and admiration. Then a granny asked to sing Indonesia Raya again. She became the conductor with enough appreciation that she was able to echo Indonesia Raya for the second time quite well and completely. Ultimately, a grandfather consolidated the festivities of the event by singing literary art songs full of advice.

On the morning of the last day of 2017, we really had a great time, that was fun, we were certainly proud, happy, entertained, and grew excited looking forward to 2018.