Gerontological Withdrawal

Or where are all the old people? One thing I noticed in my time in the Abacos, Bahamas was the dearth of older people.  I saw more folks over the age of 65 on boats than on land.  Had I done my homework, I would have added Freeport or Nassau to our travel itinerary, where there are significantly more individuals aged 65+. 

But cay to cay I kept looking with the certainty that a visit to church would have clarified much more than meandering through “town”.  We found several (2-3) older folks at Guana Cay who congregated in the shade of the central tree right near the ferry dock.  Having silently joined them on an occasion, it was great fun seeing tourists arrive as well as watching the supply barge unload various orders into the waiting truck bed of a shop owner.   And the tree was great shadeJ.

On Man O’War Cay we met the local baker, who was an octogenarian living with an equally seasoned family member.  We inquired at the hardware store for the bakery.  The response was, “oh she’s out on her golf cart somewhere.”  We met her at the corner of the street in her cart.  She strongly encouraged us to come to the back house and try her baked goods.  As we traversed the side yard of another house, flashbacks of Bates Motel were in our sub-conscious.  In her kitchen, cats were shooed off the table.   No semblance of a bakery except for the 20-30 “pans” of cinnamon buns on a side counter. How can you say no?  We bought politely, happy to meet an older Abaconian.  In speaking she told us that only her heart was aging, she was going strong. 

One bite of a cinnamon bun that afternoon opened the possibility of some cognitive decline. There was a strong taste of detergent.  We discarded the experiment in gerontology.  It was great that she was engaged, but perhaps she needed some oversight. 

In three months, these were the only examples of aging Bahamians. 

While at the airport I was fortunate to have a conversation with a dental surgeon who had married a Bahamian woman, and had assimilated many cultural nuances.  When I queried about “aging in the Bahamas” he delineated several deterrents.  First was dietary.  He said his wife was fit and lean, but when he visited family he learned that she was the exception, not the rule.  A true Bahama Mama is 300-350 lbs.  It is a cultural norm, even encouraged.  The Bahamian men state, bones are for the dogs, meat is for the men.    Every family dinner was saturated with carbs and fat.  From the Bahamian macaroni and cheese, coupled with conch fritters, coleslaw, macaroni salad, fried chicken, the list went on. 

Secondarily he said the common diseases were often a result of in-breeding.  There is not much emigration from the Bahamas.  A certain form of breast cancer and diabetes have been linked to this lack of genetic variety.

Then he described the triage that takes place in the hospital emergency room. “You don’t understand this triage.  No one makes it past the entrance until they provide a payment plan.  Either a credit card, or check is what opens the triage we are used to.  If a hospital stay is likely, pre-payment is expected.  On the bright side, aka my airport companion, prices are better.  There is no malpractice insurance because there is no litigation.  The maximum settlement a family may get is burial expenses for a negligent death claim.  Put that in the thought process of the American healthcare debate.

So, my companion continued, if there is memory loss or tremors or any of the chronic symptoms classified as “old age”, no one takes mom or dad to the emergency room.   

All of this is anecdotal information which I have looked into since returning.  It is true that the life expectancy of a Bahamian male is 71.5 years and of a female 77.4.  It is mandatory to retire at the age of 65 in the Bahamas, with a high rate of poverty in the 65+ category.  One third of these folks have no pension or retirement funds.  As reported, most Bahamians over 65 live with family.  Family reports that this is a financial burden.  Hypertension is the highest (44%) in the over 65 group with diabetes at 18%.  Only 33.8% of those Bahamians over 65 have medical health insurance.  So, you can see why seeking answers as the body changes are considered carefully.

Medical presence was a shocking statistic I gleaned state-side.  In 2010 there were only 965 doctors per 10,000 Caribbeans, and only 26.6 nurses per 10,000!  Yikes.  If I wanted to see more aged Bahamians I would have to visit New Providence (Nassau or Freeport) where 64% of those over 65 live. 

So it is as we prepare to return to explore more of the Caribbean, I have added research to my pre-trip list.  Already I see that I want to check out Cat Island’s care facilities as well as those on the Crooked Islands.  In Vero Beach, I have found plenty of seasoned citizens to return my sense of balance. 

About Cate

Passionate about dementia care and quality of life throughout the last days of life----sums up Cate McCarty, Dr. Cate, Dementia Coach. With close to forty years of long-term care experience in nursing and recreation, a Master's in Thanatology and a PhD in Aging Studies, Dr. Cate seizes every opportunity to translate research into quality of life for individuals with dementia and all of us who have the honor to "rub elbows" with them.
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