Interview with Dr. Susana Hierrezuelo Cortina, head of the Functional Rehabilitation Department of the Longevity, Aging and Health Research Center (CITED), member of the National Rehabilitation Group of Cuba and member of the Cuban Society of Geriatrics and Gerontology.
I’m among the others, too.
who said looking at us, with air
of such fine sadness “Come on, play”
to step aside. And in the beautiful gloom
of the crowded park benches
What were they talking about, oh say, and who were they?
Superiors, as gods, were sorry.
They looked a lot like slow
looked at us distantly, like a group
of trees that joins an autumn day.
I’m among the others, too.
of those of us who mocked at times,
there like fools, so tired.
We, the little ones, the ones who swim
we had, we looked, without seeing them,
that’s his way of agreeing.
I’ve walked slowly to your banks
to meet with them forever,
and I’m among the others,
the elderly, the melancholy,
and how strange it sounds, doesn’t it?
Fina García Marruz
“Already I am among the others”
“… independence of oneself means
self-demanding personal decision,
not to give up on the excuse
of ‘what they’ve made of me'”
The ethical imagination
Just a month ago, I was invited to participate in a workshop on the eldest adult on the initiative of the non-governmental organization Centro Félix Varela. The person in charge of executing him was Dr. Susana Hierrezuelo, where I met her. Not only did I become your patient, but I made a commitment to promote, as far as possible, the anonymous and heroic work of this woman who does a very important job. In his meager department of CITED he rehabilitates, together with his competent young team, people who are faced with certain problems of functionability. This specialist in Prevention of Disorders on the March, Balance and Falls, who only truly lives when something is transmitted, may not be fully aware. Once Umberto Eco was asked what it means to be happy today? The Italian writer replied, “Having something to do that urges us to carry it out.” I hope Dr. Hierrezuelo can fulfill all her dreams, but at first, she has already turned her small workspace into a realm of the Aurora.
How does aging manifest itself in Cuba?
“I consider, like Dr. Juan Carlos Albizu-Campos, that the term ‘population ageing’ should be replaced by ‘demographic ageing’ or by ‘ageing population structure’; that is, now in Cuba 20.1% of the population is sixty years and older. This will allow us to understand that the difficulty is not in the age structure, but in its interrelationship with the economic and social development that must be articulated.
“In 2025 we will be one of the 2025 most aging countries in Latin America and in 2050 the sheepdog, this is precisely explained by the arrival in 2030 to sixty years of those generations that were baby-boom and will therefore become the retirement boom.
“Ageing should be seen as a contribution of the elderly to society, because they have experiences to share and thus make a difference. This increases social capital, including both individual and collective resources in the various social contexts. Aging is also to prepare cognitively and physically to have a better functional level, to attend pre-retirement programs and to incorporate into different levels of post-care, as appropriate.
“In Cuba there are Nursing Homes, Grandparents’ Houses, Lyceums, Grandparent Circles and geronto-geriatric preparation staff, but it is not yet enough. Life expectancy at birth is 78.43 years and sustained low levels of fertility have conditioned a growing population ageing. Aging here should mean having a good life in health, an increase in universal access to knowledge and the permanent improvement of the conditions and satisfactions of the eldest population.
“Removing barriers to aging and rejecting existing stereotypes about age is imperative in the process of improving care for older adults. In addition, the latter are required to have greater access to housing, transport and healthy environments. Having a good quality of life in this social group is not to exclude it in decision-making.
“The World Health Organization (WHO) argues that aging society can balance needs and benefits. The Global Health and Aging Report notes that healthy aging is the development of a strategy that promotes and maintains functional capacity, enviating well-being in old age.
“The eldest population should not be seen as an expense, but as an investment that facilitates the well-being of society. Aging in conditions of dignity and safety is to wait for you and not to fear you.”
Do you consider that aging is synonymous with funcio-nability?
“While there is no typical older person, older age should not be synonymous with dependence. There are individual factors such as behavior, genetics, diseases, age-related changes, and environmental factors, such as housing, assistive devices, social facilities, and acting transportation.
“Older people are valued biomedically, functionally, socially and psychologically. The real challenge is to maintain autonomy and independence as you age. Therefore, the health of older people should be measured in terms of function and not disease; it is the function that determines life expectancy, the quality to maintain a level of functionability that allows the highest degree of autonomy possible to have a healthy aging.
“To be able to do for as long as possible the things we give value to whether or not they are activities of daily life: basic ones such as eating, dressing, going to the bathroom; instruments such as managing finances, going to the bank, to the pharmacy; and complex or performance, which are measured by the speed of the march, the grip on the force, and that also allow us to dance, drive, play musical instruments, etc.
“In Cuba, Primary Health Care (APS) is the ideal means of care for the detection, prevention and early diagnosis of functional and cognitive impairment, that is, to improve the functionability you have to act on its main risk factor that is inactivity.
“If the older adult has an optimal functional state, aging is satisfactory. Your interrelationship with the environment is important. The better the functionability, the better the activities are carried out and there is greater communication and social exchange, mobility, self-care and better perception of health.”
Is the role of the caregiver in our country currently, in your experience, primarily played by women?
“The issue of caregivers is very important, caring for an older person means helping them, responding to their basic needs and trying to maintain their well-being, but this involves taking responsibility for all aspects of the sick person’s life, hygiene, food, dressing, medicating, providing safety and, above all, the person in charge of this task has to face the physical and emotional overload of continued dedication to care. There are scales for assessing existing loads in caregivers.
“In Cuba, responsibility is not only for women, but for a family member or friend appointed by the family member or older adult, although statistically it has been shown that the highest percentage of caregivers are women.
“There are formal and informal caregivers in different health institutions. Caregiver schools have been designed to include, through socialization, chronic diseases that cause disability. Action strategies are taught here, but the reality is that these educational workshops are insufficient and when they are held, sometimes they are not continued.
“In this training space, people who care for older adults are taught how to take care of their own health and avoid isolation, are advised to ask for help when they need it, express their feelings, how to use health services, and are advised to be alert to signs of overload, physical discomfort, tiredness, lack of appetite, muscle aches , sleep disturbances, abandonment of your physical appearance. From a psychic point of view, symptoms of sadness, feelings of guilt, mood swings, low self-esteem, loneliness, selflessness can manifest in this arduous task. Socially, relationships with family and friends can break up.”
Is there any kind of exercise that benefits the body, mind, and soul in general?
“There are multi-component exercises that include aerobic endurance, muscle strength, balance and coordination, and flexibility exercises.
“If we want to improve cardiovascular endurance, we must walk, pedal; can be three days a week from five to thirty minutes.
“For increased strength should be used from free weights to variable resistance machines, these exercises should be specific to muscle groups and include some that simulate the activities of daily life (such as sitting and getting up from a chair) two or three days a week.
“Exercise in flexibility consists of stretching exercises of ten to fifteen minutes, two or three days per week. Yoga, Pilates, remain important and perform, together with this, tai chi.
“The balance runs in position of feet together, separated, one foot in front of the other, eyes open and closed.
“People with low physical activity and no history of systematic exercise practice, have to start by starting a low training, in order to effectively adhere to the scheduled plan, it should always be prescribed by medical personnel due to possible contraindications.” Ω