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Elderly health care in the Philippines is promoted by the family and government institutions. Care for the elderly is regarded as a core Filipino value, and is primarily the family's responsibility. Nevertheless, the government provides for laws and legislation which ensure the well-being and protection of the country's older constituents based on the framework of active aging. These are stipulated in the 1987 Constitution under Article XV, Section 4. The Department of Social Welfare and Development (DSWD) is the government agency responsible for the welfare of the Filipino elderly. It works in coordination with other government agencies, as well as non-government organizations.

Health care services for the elderly has improved since the first Philippine Plan of Action for Older Persons in 1999. Geriatric clinics have opened in both private and public hospitals, as well as advocating for community-based initiatives. While majority of older persons live alone, with their spouse, or with their children, residential institutions have also been established. Existing legislation mandates health insurance coverage for all senior citizens, discount privileges on medicine and other medical services, and infrastructures that help increase their mobility.

However, access to health care services remain to be a problem for the elderly. The elderly was identified as the 8th poorest sector in the Philippines, majority of them living with low incomes. Consequently, most of them cannot afford private health care. Although the government provides social supports and legislation, only the richer and better educated are aware of and have access to the privileges granted. Furthermore, there is a noted lack in geriatric wards and specialists in the country. Common illnesses and disabilities among the elderly are poor eyesight, cardiovascular diseases, and pulmonary diseases.

The Filipino Elderly

The Filipino elderly (or "senior citizens") constitute the sector of the population aged 60 years old and above. Between 1990 and 2000, the median age of the elderly remained at 68 years old. In 2000, 94.54% of the elderly in the Philippines are Filipinos, while the remaining 5.46% were either British, Americans, Bahrainis, Chinese, and other or of unknown nationalities.

Population Trends

As of 2010, the elderly comprises 6.8% of the country’s 9.21 million household population, higher compared to 5.97% in 2000.

Since the 1960s, the older population remains to be the fastest growing sector. Across three age sectors (0-15, 16-59, 60+), the elderly has the highest growth rate, topping at 3.2% in 2000. While lower ages exhibited a downward trend between 1970 to 1995 (from 45.7% to 38.3%), upper ages exhibited an upward trend (ages 15-59 at 50% to 56.2%, and ages 60+ at 4.3% to 5.4%). This constant increase in growth rate of the elderly is attributed to the improved longevity of life.

Nevertheless, the growth rate of the aging population in the Philippines is slower compared to other countries. Increase in life expectancy has been associated with the “mortality reduction in chronic diseases"; in the Philippines, however, improved health has mostly benefited the youth sector. The Philippines is currently considered a young nation, but it is expected to reach the status of an aging population by 2025, with the elderly accounting for at least 10% of the total population.

Elderly T'boli woman.

Geography

Based on the 2000 census, the elderly population in each region is closely correlated with the region's population size. Luzon and Visayas contribute the largest number of senior citizens: Region IV with 14.20%, Region III with 10.56%, and Region VI with 10.38%. NCR places 4th with 10.27%. In Mindanao, Region XI has the highest number of senior citizens with 5.68%. ARMM, CAR, and Region XII have the lowest number with 1.68%, 1.90% and 2.64%, respectively.

Region I, however, has the highest ratio of elderly to a region's population at 8.04%. This is followed by all three regions in Visayas: Region VI at 7.63%, Region VIII at 7.49%, and Region VII at 7.18%. On the other hand, the lowest ratios are found in ARMM, Region XII, and NCR at 3.18%, 4.63%, and 4.72%, respectively. In 1995, CAR had the lowest ratio at 3.2% (following ARMM at 2.4%), but has increased to 6.35% in 2000.

Gender

Based on the 2010 census, the aging population is comprised of 55.8% females and 44.2% males. Females outnumbered males in all age groups, with the biggest gap among the 80+ years old. Females were shown to have a longer life expectancy at 73.2 years old, compared to males at 67.3 years old. However, females spend more of their lives living in disability, losing 14.3% of their healthy years while males lose only 12.4% of theirs.

Socioeconomic status

The elderly constitutes one of the 14 basic sectors of society classified by the National Anti-Poverty Commission. In 2006, it had a poverty incidence of 16.2% and was recognized by the National Statistical Coordination Board as the 8th poorest sector.

According to a 2013 study by the University of the Philippines-Population Institute (UPPI), most elderly Filipinos have low economic status with a median monthly income of only Php 3,000 despite multiple financial sources. More than half of their elderly participants expressed difficulty in meeting household expenses. 39% have gainful occupation, 47% of which are males (mostly in the agriculture sector) while 33% are females. In addition, 22% receive pension. Nevertheless, 78% rely on their children working in the country or overseas.

According to the 2000 census report, majority of senior citizens were literate, 81% of which were able to read and write a simple message. A 2004 study conducted under the National Statistics Office (NSO) shows that only 1 out of 10 elderly participants did not complete a grade. While only 10% reached tertiary and higher levels, majority were able to complete their elementary education.

Living Arrangements

As of 1999, the DSWD has accredited 12 government and private institutional homes for the elderly. However, demographic data on institutional households (including jails/detention centers, mental hospitals, leper colonies, and rehabilitation centers) remain unavailable. Likewise, demographic data on the elderly within indigenous peoples (IP) communities are lacking.

Of those living outside institutional households and IP communities, an NSO study conducted in 2004 reports that the most common living arrangement for those aged 60-64 years old is to live with their nuclear families. Males within this age group are typically identified as heads of the household and females as spouses of the household head. Among more advanced age groups, the elderly live within extended families; males as either household head or parent of the head, and females as either parent or relative of the head. Co-residence has been attributed to strong family ties and economic dependence of either child or parent. The number of elderly living within extended families were also found to be higher in urban cities, while those living alone or with their spouses were higher in rural provinces. This was attributed to more expensive housing and household maintenance in urban areas. In cases of separate households, the elderly lived near their children.

Current Health Situation of the Filipino Elderly

In the Philippines, elderly health encompasses physical, mental, and socioemotional well-being. Self-evaluation reports from a 2013 study by UPPI show that most of the elderly people have average health status. Likewise, general assessments from a small-scale study in 2014 show positive health status. Despite developments in the current health situation, however, elderly health continues to be a challenge in the Philippines today.

Disabilities and Common Illnesses

Due to declining bodily functions and immunity brought about by old age, the elderly are prone to disabilities and chronic diseases. The most common impairment among the Filipino elderly is poor eyesight/low vision, usually in the form of cataracts. A higher occurrence rate was found in females than in males. Neurological problems such as Alzheimer's disease and Parkinson's disease are also common among the elderly.

According to the DSWD, there is a high mortality rate from preventable diseases influenced by the elderly's lifestyle. These include diseases of the heart and vascular system, diabetes mellitus, chronic obstructive pulmonary diseases (COPDs), and iron deficiency anemia. In 2000, cardiovascular and respiratory diseases such as pneumonia, tuberculosis, and COPD were identified as the leading causes of mortality among the elderly.

In terms of functional health, the 2013 UPPI study reports that 15% of the elderly has at least one Activities of Daily Living (ADL) difficulty, such as standing/sitting, going outside, and walking. In this regard, females show greater functional disability than males. Considerable portion of an elderly's life is lived in disability; however, the status of functional health has been improving over time. In 2007, only 9.2% of the 70-79 age group was found to have any ADL difficulty, showing a downward trend from 15.4% in 1996.

Geriatric Medicine

There is an inadequate number of geriatricians in the Philippines, with a ratio of 1:186,839 geriatricians to elderly as of 2004. To date, there is an estimated number of 130 specialists in geriatric medicine. There is an even smaller number of nursing, rehab, allied, pharmacy, nutrition, and dental professional and caregivers with specialized training in the care of senior citizens. Likewise, there is a noted lack of geriatric wards in government hospitals. It was only in 2003 that geriatric clinics were opened in the University of the Philippines-Philippine General Hospital (UP-PGH).

Health Insurance and Privileges

Majority of senior citizens are reported to have low incomes and could not afford private health care. In the 2013 UPPI study, the percentage of elderly with unmet needs for health care due to financial reasons is as follows: 24.9% within the 60-69 age group, 22.8% in the 70-79, and 27.9% in the 80+ age group. Only 16.9% of the 60-69 age group have health insurance, while only 14.2% of the 70-79 age group and 9.6% of the 80+ age group have. Although there are existing laws that provide discount privileges to private health care and medicine for the elderly, only the wealthier and better educated are aware of these and have better access to them. In 2014, Republic Act No. 10645 was passed, stipulating mandatory PhilHealth coverage to all senior citizens. Previously, this has only been afforded to indigent elderly in R.A. No. 9994.

Role of the Family: Filial Obligation

Traditionally, the care of the elderly population is largely a filial obligation rather than a responsibility falling on the state. This is stipulated in the 1987 Constitution (Acrticle XV, Section 4) which mandates the family to assume the predominant caregiving role for their elderly members. Strong family ties and children's "utang na loob" (debt of gratitude) influence the intergenerational exchange of support and co-residential arrangement between the elderly parent and at least one of their living children, usually a daughter.

Earlier studies report that it is a common practice of Filipino married children to continue residing in their parent's homes because of economic difficulties. This has been attributed to a lack of family size management brought by inadequate reproductive health information and services.This entails the senior member of the family to continue engaging in gainful economic activity. However, a 2011 study argues that co-residence may also mean the parent's social and financial dependency on their children, especially during their later years.

While this tradition is still practiced at present, the limited range of public geriatric services and the rising cost of living has been putting strain on Filipino families to provide a good quality life for their elderly members. Rising cost of basic commodities, education, health care, and recreation are among the many factors that affect the welfare of older persons since these needs may be held in favor over caring for the elderly.

The role of the family in elderly care and quality of life has also been threatened by domestic violence towards the elderly. In a 2005 study on the elderly in urban poor communities, 40.6% of elderly said that they have experienced abuse from their children and family. Many of the elderly respondents also said that they did not do anything to address the violence.

Role of the Government: National Policies and Initiatives

The 1987 Constitution

Article XV, Section 4 recognizes the family as primarily responsible for the care of their elderly, and delegates the government with a supportive role. Article XIII, Section 2 broadly defines the role of the government on elderly health care as "adopt[ing] an integrative and comprehensive approach to health development which shall endeavor to make essential goods, health, and other social services available" and affordable.

Philippine Plan of Action for Older Persons/Senior Citizens

The Philippine Plans of Action for Older Persons (or Senior Citizens) express the country's vision for its elderly population based on the framework of active aging. It outlines main areas of concern, as well as major action steps in instituting appropriate policies, strategies, mechanisms, and programs/projects. Three plans of action have been developed following international, regional, and national mandates on ageing.

The first covers 1999-2004 in response to the 1997 Presidential Proclamation No. 1048, which declared a nationwide observance of the International Year of Older Persons in 1999, and in line with the Macau Plan of Action on Ageing for Asia and the Pacific. It was approved and adopted through Executive Order No. 266, series of 2000 which organized an inter-agency committee to spearhead its implementation. It focused on eight areas of concern, including health and nutrition under the Department of Health. In keeping with the plan, Executive Order No. 105, series of 2003 was issued, mandating the provision of housing programs that would address the housing requirements of neglected, abandoned, abused, and unattached elderly. Subsequently, R.A. No. 9257 was signed into law as an amendment to R.A. No. 7432. The following are health-related programs developed under the first PPAOP:

• Geriatric Clinics were established in the UP-PGH and in St. Luke's Medical Center. These clinics provide medical services, such as geriatric evaluation, rehabilitative management, and specialty evaluation by the Memory Clinic, Psychiatry, Ophthalmology, Dentistry, etc. to underprivileged and poor persons.
• Health Promotion and Disease Prevention for adults was implemented, providing free flu vaccines, and osteoporosis and eye screenings.
• A memorandum was issued by the Department of Health (DOH) to all drugstores, requiring their strict compliance with the 20% senior citizen discount on medicines.
• Life-long Education Programs were conducted for Ageing Preparation.
• Geriatric Assessments were conducted in hospitals.
• Seminars, lectures, and symposiums on gerontology, family health, positive values, nutrition, etc. were conducted.
• Training programs on care-giving and physical fitness were provided.

Through Resolution No. 4, series of 2005, the NCMB created the Inter-Agency Committee on Philippine Plan of Action for Senior Citizens to formulate the action plan for older persons. Building upon the results of the previous plan, the second PPASC covers 2006-2010 in line with the Madrid International Plan of Action on Ageing and the Shanghai Implementation Strategy. It sought to contribute towards the attainment of the Millennium Development Goals (MDG) and Medium Term Philippine Development Plan. The second PPASC outlines three areas of concern, one of which is advancing health and well-being into old age. Through the second PPASC, R.A. No. 9994 on February was signed into law as a further amendment to R.A. No. 7432. In area of health and nutrition, the following milestones were achieved under the second PPASC:

• In 2013, 55,887 senior citizens were provided with PhilHealth Insurance.
• In 2010, Dr. Eva Macaraeg-Macapagal National Center for Geriatric Health was established in San Miguel, Manila as the country's premier specialty center for providing comprehensive health care for senior citizens.
• In 2009, Miriam College opened a course in gerontology.
• In 2009, UP-PGH and and the Department of Science and Technology (DOST) National Academy of Science and Technology conducted 30 batches of lecture series in the National Capital Region and Regions VII, VIII, and XI.
• Forums on health and well-being for older persons were conducted.
• Flu/pneumococcal vaccines and medicines were distributed, and dental missions were conducted.
• Government and private hospitals are continuously monitored for compliance to standards of facilities.
• Senior citizens participated in healthy lifestyle activities in coordination with DOH and other organizations. Furthermore, they were provided with geriatric care services or therapy sessions, and/or rehabilitation treatments.

The third PPASC follows covers 2012-2016, building on the achievements of the previous plans. It is in line the country's MDG and the 2012 Bangkok Statement on the Asia-Pacific Review of the Implementation of the Madrid International Plan of Action on Ageing. It adopts the same three major concerns from the second PPASC, including the advancing health and well-being into old age.

Laws and Legislation

Section 36, Republic Act No. 10717

Section 36 of R.A. No. 10717 or the General Appropriations Act for Fiscal Year 2016 mandates all government agencies to formulate plans, programs, and projects in line with current national policies for the elderly and persons with disabilities. Following R.A. 344 and 7277 (also known as the Magna Carta of Disabled Persons), it also stipulates that all government establishments provide structures and facilities that would enhance the mobility of senior citizens. Previous GAA have also included provisions addressing the concerns of senior citizens.

Republic Act No. 10645

R.A. No. 10645 was approved on November 5, 2014 as a third amendment to R.A. No. 7432. It stipulates mandatory PhilHealth coverage to all senior citizens, which was formerly only afforded in R.A. 9994 to indigent elderly.

Republic Act No. 9994 or the Expanded Senior Citizens Act of 2010

R.A. No. 9994 was approved on February 15, 2010 as a second amendment to R.A. 7432.  It seeks to provide community-based services and rehabilitation programs for the elderly. Under the DSWD, the National Coordinating and Monitoring Board (NCMB) was created to establish a network between national initiatives and the local Offices of the Senior Citizens Affairs (OSCA). An identification card issued by the OSCA is to be presented in availing the privileges stipulated in this act.

For health-related benefits, medical and dental services, and diagnostic and laboratory fees are free in government facilities and subject to 20% discount and VAT exemption in private facilities (e.g., hospitals, outpatient clinics, and home health care services), including professional fees of attending physicians and licensed professional health providers (in accordance with guidelines set by the DOH and PhilHealth); as well as 20% discount and Valued Added Tax exemption on the purchase of pneumococcal vaccines and essential medical supplies, accessories, and equipment.

This act also identifies indigent senior citizens, referring to “any elderly who is frail, sickly or with disability, and without pension or permanent source of income, compensation or financial assistance from his/her relatives to support his/her basic needs.” Indigent senior citizens receive additional health-related benefits such as free vaccination against influenza virus and pneumococcal disease, and mandatory PhilHealth coverage.

In addition to the benefits provided in R.A. 7432 and 9257, other benefits include: specification of 20% discount and VAT exemption on air travel, sea travel, and public transportation fares (including bus, railways, skyways, jeepneys, and taxis); 5% discount on monthly water and electricity use provided by public utilities; special discounts on the purchase of basic commodities; and provision of express lanes in all commercial and government establishments. Indigent senior citizens will also receive a monthly stipend of 500 pesos, to be reviewed by Congress every two years.

Republic Act No. 9257 or the Expanded Senior Citizens Act of 2003

R.A. No. 9257 was enacted on February 26, 2004 as an amendment to R.A. 7432. In this act, senior citizens are inclusively re-identified as those at least 60 years old, removing the criteria on current income. It expands government assistance to include the employment, education, social services, health, housing, and public transportation privileges of the elderly. It also seeks to further involve the private sector in improving the welfare of senior citizens and in promoting active ageing. An identification card issued by the municipal mayor or barangay captain is to be presented in availing the benefits stipulated in this act.

For health-related benefits, medical and dental services, including all attending doctors, and diagnostic and laboratory fees are to be free in government establishments and subject to 20% discount in private facilities (in accordance with guidelines set by the DOH and PhilHealth). In addition to the benefits provided in R.A. No. 7432, other privileges include: educational assistance (e.g., scholarships and miscellaneous subsidies) in both public and private institutions, specification of 20% discount on air travel, sea travel, and public transportation (e.g., bus, railways, skyways) fares, as well as  20% discount on funeral and burial services.

Republic Act No. 7876 or the Senior Citizens Center Act of the Philippines

R.A. No. 7876 was enacted on July 25, 1994. It seeks to establish recreational, educational, and health services for the elderly as a response to current policies on active ageing. Senior citizen centers are to be established in every city and municipality under the supervision of the DSWD in coordination with other national departments and agencies, local government units, and non-government organizations.

Republic Act No. 7432 or the Senior Citizens Act

R.A. No. 7432 was enacted on July 22, 1991. It recognizes senior citizens as active participants in nation building, and consequently sought to provide them with assistance. In this act, senior citizens are identified as those at least 60 years old with current income no more than 60,000 per year, including those retired from government and private work. To ensure the planning, implementation, and monitoring of programs in line with this act, it installed the Office for Senior Citizens Affairs (OSCA) in the Office of the Mayor.

Health-related privileges include free medical and dental services from government facilities (in accordance with the guidelines set by the DOH, GSIS, and SSS), and 20% discount on medicines from all establishments. Other benefits include income tax exemption, and 20% discount on all transportation and lodging services, restaurants, and recreation centers.

Republic Act No. 344 or the Accessibility Law of 1982

R.A. No. 344 was enacted on February 25, 1983. It seeks to enhance the mobility of persons with disabilities, including the elderly. It required the renovation and construction of public buildings and private buildings for public use, streets, highways, and public utilities (e.g., vehicles, telephones) to include features and architectural structures that are safe and accessible for persons with disabilities. These structures include ramps, railings, elevators, parking spaces, and designated seats.

Organizations

Coalition of Services for the Elderly or COSE, is an organization that has been actively promoting the welfare and rights of the elderly since 1989. While partnering with both urban and rural elderly, the organization mostly deals with the elderly in the former category. The goal is to foster community-based care for the elderly, with the organization seeking to "heighten awareness on the importance of older population." In their activities, the elderly are encouraged to be independent through the creation of a plan specific to their area, which will be based on assessments they have made. Plans may include the training of the elderly in specific skills (e.g. being a community gerontologist) or income-generating activities (soap-making, small retail). As of 1999, there are 17 self-reliant groups present in Metro Manila.

The Philippine College of Geriatric Medicine Inc. or PCGM, is an organization of geriatricians advocating for the proper practice and further improvement of geriatric medicine as a subspecialty in order to guarantee quality care for the elderly in society. The PCGM, in partnership with other institutions, ensures the training of quality geriatricians by accrediting training institutions, providing conventions and conferences, as well as facilitating the certifying examinations in the subspecialty of geriatric medicine. Moreover, it promotes geriatric medicine through research and publications.

The Philippine Society of Geriatrics and Gerontology or PSGG, is a non-stock, non-profit organization of health care professionals and lay-people advocating for high-quality and well-integrated healthcare of the elderly in the country. This well-rounded healthcare for the elderly is achieved by the PSGG along with other organizations through the enhancement and promotion of the study of geriatrics and gerontology via scientific research, publications, and forums, integration of geriatrics and gerontology in the educational curricula, reinforcing the Filipino value of strong family ties, and through building a political will that will urge the government to support efforts in improving the lives of the Filipino elderly.