Program of active aging in a rural Mexican community: a qualitative approach

The Political Declaration of the Second World Assembly on Aging states "... the potential of older persons is a powerful basis for future development. This enables society to rely increasingly on the skills, experience and wisdom of older persons, not only to take the lead in their own betterment but also to participate actively in that of society as a whole" [1].

The paradigm advanced by the World Health Organization defined active aging as "the process of optimizing opportunities for health, participation and security in order to enhance the quality of life as people age" [2].

Specifically, active aging refers to the empowerment of older persons in the biological, psychological and social areas, understanding empowerment as the individual's self-promotion, independence, and self-confidence, as well as his/her right to a dignified way of living according to self-imposed values, and the ability to stand for one's own rights, and to be free [3]. To become empowered, it is considered essential that the individual be kept informed about aging as a process, mainly within the perspective of community gerontology.

Our research group proposes a Gerontological Care Model framed with four key elements to achieve and promote an efficient level of empowerment in elderly populations (Figure 1). First, it is considered that knowledge is power, and providing education on gerontological, social, and health matters will provide the older adults with the tools they need to gain full access to the current health resources provided in Mexico, to fully promote their rights as citizens, and to promote the recognition of their needs and interests to government and nongovernmental agencies. Second, it is considered that inclusion and participation should be at the core of any educational initiative in the field. That is, the elderly population must be included at all stages of decision-making processes to guarantee both direct access to public and private health care, as well as a coherent response from their health and social institutions to their most demanding needs and interests. Third, it is believed that quality assurance and accountability by government officials, politicians, and those responsible for nongovernment organizations are of utmost importance. Therefore, it is necessary to establish horizontal mechanisms that guarantee the accurate evaluation of the performance, management and efficiency of those organizations by their ultimate beneficiaries: the elderly. Fourth, it is essential that local communities develop the capacity for both organization and team work to promote their autonomy and their direct participation in the negotiation of financial support for their community programs [4, 5].

It is considered that self-care, mutual-help and the ability for self-negotiation constitute the fundamental strategic elements to be promoted and supported by the communitarian gerontological programs [6‐9].

Education is one of the key elements in the promotion of a thorough paradigm for active aging. However, in some rural locations of Mexico a commonly held myth is that elderly have quite difficult to acquire new knowledge, which limit the implement of health promotion programs for this people group.

The critical approach to education for older adults has established the following four major principles [10‐12]:

To summarize, the main purpose of this study is to analyze factors that contribute to empowerment of the older adults in a rural Mexican community to promote continuous and systematic active aging based on the theoretical and pedagogical principles previously outlined.

The intervention program was based on an action-research paradigm. The study involved three main stages: (1) diagnostic evaluation; (2) intervention; and (3) follow-up. The evaluation of the intervention phase was made on the basis of questionnaires, recordings, documentary analysis, and field diaries. The main aspects of empowerment evaluated were the following:

One hundred and fifty five subjects were selected to participate in the program (out of 205 applicants) for the workshop, 133 females (86%) and 22 males (14%). In this case, 100 older adults finished the program and 55 dropped out of the workshop, with a retention rate of 65% (Table 2). At the same time, 60 subjects who finished the first workshop were selected to act as gerentological promoters, who participated in the second workshop. Thirty groups of 20 older adults were formed, directed by two promoters for each one, to run the workshop, with the assistance of the four gerontologists. In the second workshop 600 persons participated and 500 finished the program, with a retention rate of 83% (Table 3). The difference of retention rate was statically significant in the second workshop rather than in the first workshop (65% vs. 83%, p < 0.001). At the same time, the principal reported causes for drop-out in the first workshop were: (i) Difficulty in apprenticeship 40%, (ii) domestic work 22%, (iii) grandchild care 18%, iv) diseases 10%, and v) unjustified causes 10%.

In the second workshop the causes for drop-out were: (i) difficulty in apprenticeship 26%, (ii) domestic work 38%, (iii) grandchild care 27%, (iv) diseases 5%, (v) unjustified causes 4%.

As for the academic achievement, all participants complied with the originally established evaluation criteria. That is, they submitted homework papers, handed in the completed quizzes in the workbook, passed course examinations satisfactorily, presented and participated in the analysis of a case study, carried out supervised practice sessions, and provided preliminary information about the new gerontological group they had started, so as to apply and replicate the information received during training (Table 4).

Informal help has been acknowledged as a necessity for healthy and frail older people in community care [15‐18]. During the Second World Assembly on Aging, the need to develop community health care models under an active aging paradigm was pointed out [1]. For this reason, it is a conviction that training older adults as promoters of gerontological health programs is a major undertaking in such a direction.

The development of a feeling of empowerment through the implementation of educational intervention programs focused on active aging, constitutes a key element to guarantee successful community intervention that may eventually have a positive impact on the health and quality of life of the older population [19, 20].

The results here made evident a systematic and gradual process of empowerment in the participants of program, with their assuming an active and leading role within their communities, developing specific abilities to promote actions toward change, and increasing their feelings of self-confidence. It is important to emphasize that the imparting of relevant knowledge played a fundamental role in moving toward such an objective.

However, even when it can be said that most of the key objectives of the intervention program were met, it has to be acknowledged that empowerment was not as generalized as originally expected, because this process is dependent on individual variables, becoming much slower and limited in certain subjects. Specifically, not all of those levels of empowerment outlined by Roelands have been achieved by all participants [4], but in the case of those who have made evident a rapid movement toward that goal it is a certainty certain that it has had an impact on their personal lives and in their interaction within their communities, thus paving the way toward active aging. In this study, women had greater participation than man in actions of self-negotiation and adoption of healthy life styles. This could be due the women of several rural communities of Mexico have a roll linked to care of the family, and therefore they have more interaction with social and health institutions than the man. However, in others studies has been found that the voices of older women are rarely heard in debates about the health of the disadvantaged groups and that their potential to positively contribute to family and community health care is seldom acknowledged [21, 22].

Our results show that the active aging paradigm constitutes a feasible option to face current challenges related to aging in developing countries. Five months to finish the second workshop, five hundred older adults are participating in the program with actions of active aging in neighboring towns and communities. Therefore is an error considerer to older adult population as "objects", when the reality shows that they are "active subjects".

These results demonstrate that when the older persons are given the necessary tools, they can develop successful and creative coping strategies that go well beyond original expectancies. In this sense, it is important to outline that the retention rate was significantly higher (p < 0.001) in the second workshop, when the knowledge was imparted by the gerontological promoters, probably because of the language used, information framed in the context, communication (elderly-elderly), and a relaxed environmental.

Moreover, training older adults as promoters for active aging provides them with an opportunity to construct spaces of social and emotional change, and interact within the particular social contexts in which they are immersed, increasing feeling of belonging and identity.

Finally the empowerment process during this intervention program was not linear, without it was varied according to the participants' life experiences, to their personal histories, and to their level of subordination within the family sphere.

Our results showed that the main factors that contribute to empowerment of older adults in a rural Mexican community for participate in active aging programs are the training and teaching of gerontology topics themselves; besides, their interest, experience and involvement. Therefore the empowerment in older adults to reach active aging is feasible with training programs that considering the participation themselves in the teaching of gerontology topics.