Lacanaria et al.

/ Hierarchy of needs of Filipino elderly

Hierarchy of needs of Filipino elderly

Mary Grace C. Lacanariaa, Angela Cerisse C. Alabanzab,
Arianne Antonette F. Basadreb, Kaselyn R. Cambab, Rachelle C. De Mesab, Oscar M. Halum Jr.b, Kirstie Marice F. Limb, Mae Annegeli B. Munarb, Joebert D. Obillob, Daneizza T. Peraltab, Shaira F. Segundob, Kevin Ray A. Tabandab & Diane Carmina C. Zacariasb Abstract The study focused on the prioritization of needs of selected Filipino elderly and whether there are significant differences in the prioritization of needs according to gender and ethnic background particularly between Ilocanos, Cordillerans, and Pangasinenses. The findings revealed that the identified prioritized needs are not supported by the different human needs theories, with spirituality as the most prioritized need and sexuality as the least prioritized need. There are no significant differences in the prioritization of needs of the elderly according to gender and ethnic background. The findings can help local health care professionals and selected agencies to develop relevant and responsive programs and activities that support the needs of the aging population. Keywords: Filipino elderly, prioritized needs, spirituality

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a b

Dean, College of Nursing, Saint Louis University Student researcher, College of Nursing
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Introduction Aging is increasingly being seen as well as experienced as a cultural phenomenon (Higgs, 1999). It is inevitable and is experienced by anyone, anywhere, and at any time. Thus, aging is a reality. The population is continuing to age and as people survive longer, they are more likely to suffer from age-related illnesses. Some very old people are still mentally and physically active. However, they are likely to suffer in poor health, forgetfulness, lack of energy and initiative, and gradually failing body. Time-related changes alter or modify psychologic functions but do not deprive the elderly to have security, responsiveness, recognition, and new experiences. This shows that even at their peak ages, they are still adaptable to lifes circumstances and they can still recognize available opportunities to their advantages. As individuals grow older, there are peculiar needs that have to be addressed. Needs are considered to be those that are essential for a person to survive. If the specific needs of the elderly are not satisfied, this can have negative effects on the life of the aging population. Living with unmet activities of daily living needs lead to worsening health and increased use of medical resources (Sands et al., 2006). Unmet dependency needs leads to anxiety and/or depression, which in turn, can lead to complaints of physical illness. Social support does not seem to be a reliable enhancer of adjustment to stressful life events. Those who are able to remain socially active will be more likely to achieve a positive self-image, social integration, and satisfaction of life. Social interaction is an important influence on the well-being of people of all ages (Arnold et al., 2007). There are different need theories but none that is culturally specific for the needs of the elderly. Maslows human needs are arranged in hierarchies of predominance. At the base of the pyramid is the physiologic needs followed by safety, love and belongingness, self-esteem and at the topmost level of the pyramid is self-actualization which includes personal journey and growth in illness, connection to others, peace, transcendence, closure and
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generativity. According to this theory, the higher levels cannot be met without first meeting the lower needs. In other words, moving toward healthy aging is an evolving and developing process. As basic level needs are met, the satisfaction of higher level needs is possible with ever deepening richness to life regardless of ones age (Potter et al., 2007). Majersikc (2005) opposed Maslows hierarchy of needs and showed that the hierarchy should be an inverted pyramid. His theory says that self-actualization should be given the lowest priority, and physiologic care, the highest. The rest, namely, safety, love and belongingness, self-esteem, and self-actualization are on the same level in the pyramid. Moreover, from the literature on the elderly, there are additional needs that are added to Maslows hierarchy of needs. These are the elderlys independence, aesthetics, and knowing and understanding (Chang, 2006). Lastly, deep internal sense of insecurity develops as elders discover that the body they have taken for granted most of their lives begin to betray them. Organ systems work less effectively, and automatic actions and reactions require concentration. This then becomes the source of much anxiety that erodes ones security. It has directed that safety is given higher priority than physiologic needs (Ebersole, 2005). The Learned-Needs Theory, proposes that individuals specific needs are acquired over time and are shaped by ones life experiences (McClelland, 2006). A persons motivation and effectiveness in certain job functions are influenced by those three needs: need of achievement, need of affiliation and the need for power. Needs are shaped and designed through time by the cultural background of the individual. The Filipino based-hierarchy of needs presents that familism is identified as the first needs (Andres et al., 1987). It is the economic, social, political, psychological, spiritual, and moral unit among Filipinos. The second need is the reciprocity, which is based on utang-na-loob value, a behavior where every service received, favor or treatment accomplished has something in return. The third need is the social acceptance wherein it is based on the value of pakikisama
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to be accepted by his fellow for what they believe, how to be, and to be treated in accordance with his status. Social morality needs is the fourth identified need, where the Filipino works for an upward socio-economic mobility to achieve higher social class and enjoy better life. The highest and fifth need is heroism or pagkabayani, which is considered as the value of honor, dignity, and pride. The elderly may have difficulty meeting their needs alone. This is a reason for health care workers to get knowledgeable of and be responsive to their needs in general. Yet, it is evident that there are varying presentations of the needs of the elderly which are sometimes left unrecognized and unmet even by family members and health care providers. The lack of professional experience of health therapists with the elderly and personal contacts with aged persons led to varying feelings and attitudes of the therapist regarding a variety of issues in treating the aged patient often resulting in the absence of care, or at best poor quality of care (Mayarr, 2002). The conflicting presentations on the hierarchy of needs as applied among the elderly, the increasing emphasis on the quality of life of the elderly who are considered a high-risk group, and the reports of unsatisfactory care of the elderly prompted the conduct of this study. Thus, this research aims to determine the prioritized needs of the elderly in the Philippine setting as well as the influence of ethnic background and gender to the prioritization of the needs of the elderly. The findings provide information on the different aspects of gerontological needs to improve the quality of health care. These can also be used as guide for relevant agencies to develop relevant and responsive programs and activities to support the needs of the aging population. Methods and procedures The research utilized a quantitative, descriptive survey design. The respondents of the study were 600 elderly aged 60 to 94, male and female, with sound mind regardless of literacy, able to perform
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activities of daily living without assistance and regardless of health problems if any. The Ilocano elderly respondents were from La Union and Nueva Vizcaya, the Cordillerans were from Baguio City and Benguet, and the Pangasinenses from Pangasinan. The respondents were selected through convenience quota sampling. A questionnaire was the main tool in data gathering. These questionnaires were distributed to the respondents personally. In the event that the respondent had difficulty in reading or is illiterate, the questionnaire was converted into a structured interview guide. The tool was translated to their local dialects to be used for those who cannot understand English. A pretest of the tool was done prior to floating of the questionnaire yielding a content validity index of 0.9 indicating that the tool was highly reliable. Ethical considerations were observed such as obtaining consent from the subjects, assuring confidentiality of data, and maintaining the anonymity of subjects. Each respondent was instructed to rank the cluster of needs with one as the highest priority need and 10 as the least priority need. After which the average mean of all rating was obtained as basis in determining the common priority needs of the Filipino elderly. To compare the significant differences in rank according to gender and ethnic background, Kruskal Wallis was used. Interpretations of findings were based at 0.5 level of significance. Results and discussions Prioritization of needs. Table 1 presents the prioritized need of the elderly respondent which shows the highest priority need as relationship with God and spirituality with the mean score of 2.668 and the least priority need as sexuality, sexual desires and attractiveness with the mean score of 9.038.
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Table 1. Prioritized needs of selected filipino elderly Cluster of Needs 1. Relationship with God, spirituality 2. Food, fluids, clothing, shelter and exercise 3. Financial support to meet personal and health needs 4. Need for love, affection, close family ties, affiliation with others, social integration, companionship 5. Rest and sleep, freedom from pain, discomfort and disabling health problems 6. Safety, protection from harm 7. Independence in performing activities of daily living 8. Need to be competent, to gain approval, ability to make decisions for ones self, sense of self- worth 9. Realization of desires, self-fulfillment, achievements 10. Sexuality and sexual desires , attractiveness X 2.668 3.465 4.572 4.747 Rank 1 2 3 4

4.902

5.328 6.435 6.598

6 7 8

6.845 9.038

9 10

Filipinos believe that old age is a period for preparation for meeting spiritual needs. There is almost unanimity in the belief that death is inevitable and should, therefore, be accepted wholeheartedly. It is also perceived as the time to rest and to face the Creator. Filipino elderly are innately religious making spirituality as their priority need. Likewise, they express their faith through active involvement in religious activities. The Philippines is dominated by Roman Catholics, thus, specific nursing interventions catering to the spiritual needs of elderly clients such as praying with them
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and allowing them to practice their religious beliefs can be done as appropriate. According to Pedro (1989), religious activities constitute a significant part of the community and social life among Filipino elderly. Involvement in religion often helps the older adult to resolve issues related to the meaning of life, to adversity or to well-being. Religion takes on a new meaning for the elderly who may find comfort, solace and affirmation in religious activities. Grossman and Lange (2006) also proposed that faith develop as we age based on ones cognitive and moral development. Foods, fluids, clothing, shelter and exercise is ranked 2nd. According to Hogstel (2001) one of the most important needs of older adults is adequate, available and nutritious food based on their age, physical condition and possible health problems. The lack of adequate nutrition, shelter and exercise can cause major health problems, prevent recovery from illnesses and cause a major decline in many chronic health conditions. When chronic illnesses or disabilities occur, independent living may not be possible. Financial support to meet personal and health needs is ranked 3rd. Income has been frequently linked with life satisfaction. Multivariate analysis confirmed that one of the strongest predictor of life satisfaction were self-rated financial situation. Older persons who had higher levels of financial strain have a lower level of satisfaction with life (Chaud and Chi, 1999). Adequate finances to meet needs and provide a comfortable lifestyle are essential especially to provide adequate housing, nutrition, and health care sources. Need for love, affection, close family ties, affiliation with others, social integration and companionship is ranked 4th. Filipinos are known for close-knit family relationships and support, a value that is carried through old age. This is supported by the Filipino theory of Dr. Angelina Ramirez with familism as a priority need of Filipinos (Andres et al, 1987). Likewise, according Gordon (2006), social interaction, specifically friendship, is an important influence on the well being of people of all ages. Activity theory also argues that social interaction is the essence of life for all age groups and
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that those who are able to remain socially active will be more likely to achieve a positive self image, social integration and satisfaction with life (Brooker, 2007). In Maslows hierarchy of needs, he also emphasized the need for belongingness. Maslow sees people as social beings with a need to belong to something outside of them and these needs can be met through membership in churches and civic and social organizations (Zalenski and Raspa, 2006). One factor in successful aging is a strong support system from the family, friends, neighbors and individuals in the persons life. Also according to the age satisfaction theory, age is conceptualized as the crucial factor in the allocation of social roles and the accompanying rights and privileges. This theory views age as a universal criterion for the allocation of social roles, thus the approach does not encapsulate the diversity of older people. Rest and sleep, freedom from pain, discomfort and disabling health problems is ranked 5th. There must be a balance between sleep and rest and activity. Although Zalenski proposed that the relief of physical pain is a first-order need due to the devastating and depriving effects of chronic illness, this is not true to health elderly thus ranked 5th by the respondents. Safety and protection from harm is the 6th in the rank. Safety and security is important for the elderly because a deep internal sense of insecurity develops as elders discover their body and organ systems work less effectively and automatic actions and reactions require concentration (Ebersole, 2005). The elderly is particularly vulnerable to accidental injury thus fear of falling hampers his desire to be active. When safety and security needs are not met, fears can dominate living, ranging from daytime worry to nighttime anxiety and insomnia. Satisfaction of this need include being able to perform functional activities of daily living, to exercise to maintain balance and prevent falling, to make effective change in his/her environment, to follow recommended health screening for his/her age and to seek health information. The importance of safety is relevant since the leading cause of death among older adults is accidents and/or falls. Decreasing vision, hearing loss, poor balance, dizziness, medications
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and environmental factors such as inadequately marked steps and delayed reaction time may predispose the elderly to traumatic injury, thus older people should be helped to function safely in their homes and other places they visit (Hogstel, 2001). Also, illness, functional impairments, and losses of all kinds may make it difficult to create a life where one feels safe, contented, in control and competent (Ebersole, 2005). Independence in performing activities is ranked 7th by the respondents. Activity theory states that in order to militate against the overwhelming negative societal view of aging, an individual must deny the existence of old age by maintaining pre-existing roles or activities or by adoption of new ones. On the other hand, the disengagement theory proposes that there is a pressing need for independence for successful aging to be best achieved (Lliffe, 2005). It is important to be able to look after themselves even if they have to struggle to do so. Although assistance is appreciated, the bitter feeling of increasing dependence affected ones outlook on life. Ranked 8th are the need to be competent, gain approval, ability to make decisions for ones self and sense of self worth with a mean score of 6.598. Disability and resulting unemployment can devastate the persons self-esteem and worth. Special efforts must be exerted to appreciate the elderly for all that her/his life is and has been important. Recognizing the elderlys contributions to a profession, as well as to a friend or family may restore a sense of value and esteem (Zalenski et al., 2006). Realization of desires, self fulfillments and achievement are ranked 9th . Old age is often a time to be instead of do and to pursue self fulfillment and self actualization. At age 60 and above, they can still do many things, to fulfill and achieve what they really want in life. According to Patricia Hess (2005), a major developmental task of old age is to enjoy the achievement of being a completed human being. The elderly person has to learn to relinquish power and some activities. The aged often savor life intensely and are able to relish the joy of daily living. For the elderly
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who wish to leave a legacy to coming generations, this capacity for enjoying life is most valuable one. According to Erikson (1980), the primary activity in late adulthood is reflection, which is focused on the developmental task of integrity. To achieve positive resolution, one must successfully achieve early tasks throughout the previous stages, from a meaningful whole to achieve a feeling of satisfaction and self-worth (Hogstel, 2001). Sexuality, sexual desires, and attractiveness are ranked 10th among all the presented needs. Filipino elderly are also not generally expected to be vocal and demonstrative about their sexual life. The Filipino elderly, like any other aging population, do not give high priority to sexuality due to biological, cognitive, social and even psychological factors. According to Hess (2005), the incidence of sexual dysfunction increases with old age, this is primarily related to the increase rate of health problems. Numerous endocrine, vascular and neurological disorders may interfere in sexual functioning. While Matteson (1988) mentioned that the presence of degenerative disease or pathological condition may affect the sexual function of an elderly such as the presence of a cardiovascular disease, diabetes mellitus, dementia, and arthritis and also that pharmacological factors play role in sexual problems. They pointed out, however, that whereas many drugs can adversely affect the sexual functioning of an individual, others can enhance it. These health factors are more prevalent in older people and hence, it is perhaps not surprising to find an increase in biologically-caused sexual probes in the elders, thus decreasing their sexuality and their sexual desire. Spence also mentioned that it is important to mention the cognitive decline which may occur in elderly persons and which may influence sexual activity. Cognitive deterioration related to dementia disorders may affect sexual behaviors producing problems such as disinhibition or relationship difficulties with subsequent effects upon the couples sexual relationship. Another point emphasized by Spence as a factor which influences sexual functioning in the elderly relates to opportunity. This may be affected by the availability of a sexual partner and also the living circumstances of the individual or couple.
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Based on the priority of needs of the Filipino elderly, the health care providers particularly the nurses may use such information as basis for planning appropriate care to meet the prioritized needs of the elderly, not just their actual health problems. The findings of this study contradict that of Maslows and Majersiks hierarchy of needs, including the needs theory among the Filipinos. The needs as prioritized by the Filipino elderly covers a wide range of spiritual, physiologic, social, emotional, and mental dimensions. Such differences in the prioritization of needs as compared with the existing need theories may be reflective of the peculiarity of the elderly population in the Philippine context. The findings of this study, however, should be assessed in light of the small number of respondents involved vis-a-vis the actual elderly population in the country. Prioritized needs according to ethnic background and age. There is no significant difference in the prioritization of needs according to ethnic background and age. Conclusion The study reveals a culture-specific hierarchy of needs of the Filipino elderly which bears a strong cultural affinity to religious beliefs and values as well as the influence of the physiologic changes occurring among the elderly in the last developmental stage. The prioritization of needs of selected Filipino elderly does not support the existing needs theories. The Filipino elderly, though divided by different ethnic background and gender, have the same hierarchy of needs, giving greater emphasis on spirituality and lesser priority on physiologic, economic, social, and emotional needs. This re-ordered priority of needs among Filipino elderly should be considered by family members, health professionals, and concerned agencies who are involved in the health care, support and services to the elderly. The findings of this study can likewise be further corroborated by other studies with samples that are more representative of the population of Filipino elderly.
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