Gray land

It's time for a change of course. Over the last few decades, Brazil has been so busy repeating to itself and to the world that it is a country of the future and a nation of youngsters that it didn't notice the gray hairs multiplying on millions of its citizens' heads. So many gray heads that today a better description of Brazil would be a country of "oldsters." According to the World Health Organization's (WHO) latest figures, there is no other nation in the world, among those more populous and developed, with such a large proportion of elderly.

In 1950, Brazil had a population of 50 million, of which 2.1 million (4.2%) were elderly. Nowadays, 12 million Brazilians (7.8%) are 60 years old or older in a population of 155 million. United Nations projections reveal that in the year 2025 Brazil will have 250 million people, of which 31.8 million (12.7%) will be 60 or older. The Brazilian Health Ministry's estimates see all this white hair increasing at an even faster pace. Their figures show 33 million oldsters, or 15% of the population by the year 2020.

By comparison, the United States had 18.5 million elderly in 1950, with a projected increase to 67.3 million by 2025. While the US will experience a 363.8% increase of its older population in 75 years, Brazil's increase will amount to 1,514.3% (see table). Only Mexico (with a 1,346.2% increase) and Nigeria (1,230.8%) come close to the Brazilian explosion of gray hair. China (668.5%), India (429.3%), and Japan (517.2%) will all have a significantly smaller percentage increase. In 20 years Brazil should have the sixth largest elderly population in the world.

The largest concentration of older people is in the Southeast, where 5.14% of the population is 65 or older. In the state of Rio de Janeiro, the champion of old age, the average age is 26. Roraima state has the lowest percentage of old people (2.09%), and the lowest average age (15.9) is in Amapá.

Migration of youngsters in search of job opportunities has contributed to the concentration of older people in the states of Rio Grande do Sul, in the extreme South, and Paraíba in the Northeast, where the percentage of elderly people (6.51%) is the highest in the country.

Among all age groups in Brazil, the elderly, with an annual increase of 4.04%, is growing at the fastest pace. On the other hand, the tier of children 14-years-old and younger has been decreasing 0.69% a year. This new makeup of the Brazilian population is due primarily to a drastic reduction of birth rates and an increase in life expectancy. Symptomatically, in the lower classes the most-used contraceptive is not the pill but sterilization through tubal ligation. Close to 30% of child-bearing-age women in the Northeast have been sterilized, while only 25% use the pill.

At the turn of the century, life expectancy in Brazil was 33.7 years. In 1948 this number had increased to 50 years. Forty years ago, a 60-year-old Brazilian could expect to live an average of only five more years. From 1945 to 1960, Brazilians increased their life expectancy by 16.9 years. Nowadays, a 60-year-old can expect to live 18 more years.

Infecto-contagious diseases, which accounted for 40% of all deaths in the country in 1950, are now responsible for only 10% of the mortality rate. On the other hand, cardiovascular diseases account for 40% of Brazilian deaths nowadays, compared to only 12% in 1950. That's why in 1995 the 11.5 million Brazilians over 60 consumed 20.8% of all the resources destined to public hospitals. In 1950, Americans could expect to live 25 years more than a Brazilian. This difference had fallen to less than 10 years in 1993 and by the year 2025 the gap should be only four years.

ELDERLY AND SICK

The average size of a family in Brazil has fallen from 5.8 children in 1970 to 2.7 in 1991. Similar to what happens in developed countries, the Brazilian demographic pyramid has been changing in such a way that its youthful base shrinks while its elderly top widens. This is an unwelcome reality for a country that is still trying to provide adequate education and health care for its younger population. Brazil is completely unprepared to deal with an elderly population requiring costly medical treatment and pensions.

"The treatment of the elderly requires much more money than that of patients from other age groups," says psychiatrist Renato Veras, 46, director of Universidade Aberta da Terceira Idade (Open University for the Third Age) from Universidade do Estado do Rio de Janeiro (UERJ). "A child with measles gets cured or might die in seven days. But an old person with a cardiovascular disease can have its case drag for 25 years."

Veras, one of the biggest authorities on gerontology in Brazil, has authored the thesis País Jovem de Cabelos Brancos (Young Country of Gray Hair). The academic study, published as a book, has become required reading for those interested in studying the Brazilian elderly. The work has shed light on one of the cruelest sides of growing old in Brazil: the loneliness of the elderly, especially among women.

More than 60% of the oldsters are by themselves. There are 46 widows, seven divorced, and nine never married for every 100 women 60 years or older. Loneliness is much less of a problem on the male side. For every 100 men in the same age group, 78 are married.

País Jovem de Cabelos Brancos also has some good news: 82% of the Brazilian elderly don't have health problems. Those who do, however, use a disproportionate share of the public resources to care for them. Health care for the aged costs three to four times more than for other age groups. "We don't have enough money to properly treat the multiple diseases of the elderly," says Veras. "Our health system is totally wrong. The old person here gets in through a hospital's door and ends up in an asylum." He notes that while the US has been saving money for the elderly since 1930, Brazil is only now waking up to the problem.

Data from the 1991 Census for Rio de Janeiro show that even though people 65 or older represent 5.9% of the population, they have a disproportionate number of diseases, with 28% of the paraplegia cases, 29% of deafness conditions, and 32% of the cases of visual deficiency. And in São Paulo, according to an Escola Paulista de Medicina (Paulista School of Medicine) study, 30% of the patients in public hospitals are elderly, even though they represent only 8% of São Paulo's population. Since their treatment is twice as expensive as that rendered to children, the aged end up consuming 45% of all the money spent by the state Health Department.

Two scandals in the last few months involving dozens of deaths have helped bring the aged's predicament to the forefront of the political agenda. First, 55 patients undergoing hemodialysis at the Clínica de Caruaru in the state of Pernambuco died when contaminated water was used in the hemodialysis machines. Then, the country was shocked to learn that in two months' time, 94 elderly patients at the Clínica Santa Genoveva in Rio had died for lack of hygiene and proper treatment. Despite all the public clamor, in the end the responsible parties in both cases were let go with just a slap on the wrist.

OF GERONTOLOGISTS AND GERIATRITIANS

In an interview with the daily Folha de São Paulo, the president of the Sociedade Brasileira de Geriatria e Gerontologia (Brazilian Society of Geriatrics and Gerontology), São Paulo section, Dr. Ricardo Shoiti Komatsu, denounced the chaotic predicament of the aged: "There is nothing being done about the population growing old. We need to develop an old-age citizenry as it exists in older countries. Right now all we can see is the tip of the iceberg. A great number of old people with some disease might be locked in their houses without treatment." He points out that only diseases that cause pain are treated and reminds us that illnesses like depression, which is very common among the elderly, are simply ignored.

Brazil still has a long way to go to meet the needs of its old population. Only this year has Gerontology became a compulsory course in medical schools, and among the 59,561 specialized doctors and members of the Sociedade Médica Brasileira there are just 228 geriatricians. In all of Brazil there aren't more than 360 geriatricians¾and this is a big improvement when compared to the paltry 100 that treated the elderly just 10 years ago.

Thanks to prosecutor José Estevam da Silva, São Paulo has one of the few programs in the country that inspect rest homes and asylums for the elderly. Since 1994, the Grupo de Assistência e Proteção ao Idoso (GAPI ¾Group of Assistance and Protection to the Elderly) has conducted more than 200 inspections in concert with the Military Police and the Center of Sanitary Vigilance, resulting in the closure of at least 33 locations that were unfit to care for the elderly.

As a result of this work, the Hospital Geriátrico e de Convalescença D. Pedro II, part of the municipal hospital Santa Casa de São Paulo, has become a model for the treatment of the aged. The facility has a doctor on duty 24 hours a day, and every two months each of the nearly 700 patients is case-reviewed by a doctor. The Santa Casa doctors going through residency also have to spend a training period in the geriatric hospital.

On a more somber note, a recent study by the Santa Casa doctors revealed that 50% of the 174 people who were admitted to the hospital in 1994 died one year or less after their admission. Of those, 19% were in the institution less than one month. The study concluded that some of the deaths, mainly those caused by depression and loneliness, might have been avoided if the state had alternative programs that would keep the elderly in their homes or in day care centers.

Talking to the daily newspaper O Estado de São Paulo, Silva told horror stories unveiled by the inspections of elderly facilities. Officials found deteriorated food, men and women sharing the same room, physical abuse, and even solitary confinement. He recalled the situation when the inspections began: "A total of 99% of the houses had no license."

THE PENSION QUESTION

It was back in 1948 that the government decided Brazilians could retire after 35 years of work. But with the dramatic increase in life expectancy and the fact that many workers start their first job as young as 13, a large contingent of the population is retiring before they reach 50. Worried about not having enough money to pay all these retirees, Palácio do Planalto (the presidential office) prepared a laundry list of changes it wanted made.

Among the alterations sought by President Fernando Henrique Cardoso was fixing the age of 65 as the minimum age for retirement, regardless of the time spent at the job. He also wanted to eliminate the clause that allows women to retire five years earlier than men. After months of deliberation, Congress decided not to change these rules. Another problem is the special retirement plans for judges and journalists, among others, who are able to work from 5 to 15 years less than the rest of the population.

Ideally, a social security system should have five workers paying contributions for every retiree collecting benefits. That was the case in Brazil in the 1970s. When this ratio falls to less than 3 to 1 (three workers to one retiree), it is cause for alarm. In Brazil today, there are only 2.3 workers for every retiree receiving a pension, and the average pension is a meager $125.

To complicate matters, only 30 million of the more than 60 million able-to-work Brazilians contribute to Social Security. While Brazil's population doubled in the last 30 years, the number of retirees grew eleven fold, and the future looks even more dismal. Projections estimate 1.1 persons working for each retiree by the year 2030.

In 1995, the Previdência Social (Social Security) collected only $30 billion from workers, not enough to pay three million new retirees added to the existing pool of 15.2 million. To pay everybody, the government department had to borrow $3.5 billion!

In July, President Henrique Cardoso signed the Estatuto do Idoso (Senior Citizens' Statute), an executive order regulating Law 8,842, which created the Política Nacional do Idoso (Senior Citizen's National Policy). One of the measures mandated by the law is to increase the number of geriatricians and gerontologists in the country. At the huge hospital school Hospital das Clínicas in São Paulo, for example, there are only ten positions for geriatrics residency.

The statute also orders the creation of day-care centers, rest homes, and community centers where the elderly might spend their days in recreational activities, as an alternative to the now widespread asylum care. In 1995, 271,000 elderly Brazilians were attended to by the Department of Social Assistance of the federal government. For 1996 the goal is to almost double this figure to 408,000.

Another objective of the new law is to secure a minimum salary of $110 for every Brazilian over 70 who doesn't make more than $30 a month. If everything works as planned, 315,000 elderly should be enjoying this benefit by the end of the year. Although at first glance insignificant, this government pension can make a big difference in small cities with a large concentration of elderly people. In Arara, a town with a population of 10,000 in the state of Paraíba, for example, this monthly salary has become its main source of revenue: $200,000 against the $100,000 it receives from the federal government its share as a municipality.

VIEILLESSE DORÉE

Despite the gloomy picture painted above, there is also a much rosier side to the old-age predicament in Brazil. The present generation of oldsters has a lot to cheer about. A recent study in 10 metropolitan areas conducted by SEADE (Sistema Estadual de Análise de Dados - State System of Data Analysis) showed that 70% of senior citizens at least own a house. Another research project in the Greater São Paulo area revealed that families whose head of household is 60 years old or older have a monthly per-capita income of close to $400. Families headed by men up to 44 years old, in comparison, make an average $350 a month. InterScience, a data consulting company, has concluded that Brazilians over 50 have a collective annual income of $33 billion, $22 billion of which is earned by the lower-earning classes.

A dramatic new outlook on inheritance has also helped to enrich the elderly. Until recently, Brazilian children had an undisputed and sacred right to the wealth their parents had amassed during their lives. To avoid family feuds, some parents would deed their properties while still in their prime and suffer a life of deprivation until their death. More and more of these oldsters, however, are now selling what they have to make their final years a little easier.

Many children refuse to accept this, and legal actions to prevent the parents from selling their property have multiplied. This notion that parents have an obligation to leave an inheritance is ingrained in the Brazilian legislation that forbids men over 60 and women over 50 to engage in community-property marriages. People can only donate half of their wealth, and the other half that belongs to the heir cannot be given away, not even by will.

The sheer number of elderly and all their newly achieved affluence hasn't been overlooked by advertisers and manufacturers. Minelli, a traditional apparel manufacturer, has created a special department to study the tastes of the older folks. Cosmetic maker Natura's leading line of products is Chronus, a series of items made especially for older consumers. Its moisturizing cream alone has become a $16 million-a-year success story.

Antarctica a beer manufacturer; Pepsi; and Bradesco the largest private bank in Brazil, have all used elderly models to advertise their products on TV and in printed media. And DuLoren, a brash lingerie maker, found that their clients between 45 and 65 wanted more elaborate panties and bras, prompting them to create new intimate apparel with more colors and laces. In two years, they had to quadruple their line for the older set.

In São Paulo, gerontologist Maria Verônica Carneiro, 53, director of Centro de Valorização da Terceira Idade (Center for the Valorization of the Third Age) has created a modeling agency specifically for the elderly. In an interview with the variety weekly magazine Manchete, Carneiro pointed out, "When these girls model clothing I don't want people saying, `How cute! How cuddly!', but `What an appetizing old lady.'"

At Rio's Universidade Aberta da Terceira Idade , one of the most-sought courses is "Sexuality." Sexologist and course instructor Arnaldo Risman, 31, is always answering questions about how to use condoms or addressing doubts about the utilization of penile prostheses. Risman performed a study with the students of Universidade Aberta and found out that 73% of men and 38% of women continue an active sex life past their 60th birthday. He also discovered that 74% of men and women practice masturbation with regularity. (See box)

It was in 1989 that state assemblyman Sérgio Cabral Filho created in Rio the Clube da Maior Idade (The Coming of Age Club) for senior citizens. The 20,000-plus-member club promotes parties, trips, and city tours. Older people have also reinvigorated such sectors as domestic and foreign tourism. They've been infiltrating many areas previously reserved for the youngster.

They have their own colleges, such as Rio's Universidade Aberta da Terceira Idade, and they have been invading exercise academies and even computer literacy classes. The Computer Lab of Museu da República in Rio, for example, has a waiting list of 500 oldsters who want to learn the basics of computing and how to surf the Internet. The courses here, as in other schools such as Mister Byte and Associados Herz de Informática, are not free and might cost anywhere from $40 to $150 per unit. For the most part, the elderly students don't have computers at home, but they want to be able to understand what their children and grandchildren have been doing.

The elderly have also been actively participating in travel exchange programs, once the preserve of young students. One such program is Experimento, in São Paulo, which since 1993 has offered people 60 and over the opportunity to live overseas at a family's house for an extended period of time. Close to 200 people have already benefited from the offering. And a recent beauty contest in São Paulo called Miss Terceira Idade (Miss Third Age) has enticed elderly ladies with such prizes as a trip to the US, plastic surgery, or a diamond ring.

Listening to music 93.5%

Man's natural smell 91.7%

Kiss on the mouth 90.8%

Dancing 85.4%

The partner's voice 84.4%

Bathing together 83.5%

Man's perfume 80.8

Romantic movie 78.9%

Hairy chest 76.1%

Romantic chat 75.2%

Skin color 69.8%

Big penis 67.9%

Gray hair 60.2%

Erotic magazine 33.1%

Woman's natural smell 94.8%

Contact with skin 89.5%

Thick lips 89.5%

Bathing together 89.4%

Mouth 84.2%

Woman's perfume 73.7%

Legs 73.7%

Going to the beach 73.7%

Kiss on the mouth 73.7%

Small breasts 68.4%

Tip of the breast 68.4%

Erotic magazines 63.1%

Long hair 57.9%

Panties 36.8%

Big breasts 21.1%

Motel

Bus

Lawn

On a horse

On an island

In a desert

Kitchen sink

Bathrooms

Ships

That the so-called Princesinha do Mar (Little Princess of the Sea) is a magnet for the older population is no secret. On sunny days, the calçadão (large sidewalk) that borders the beach is full of gray- and white-haired people, in groups or by themselves, chatting or walking their dogs. Many came from other neighborhoods or other states and bought property close to the beach, and it's common for them to make new friends on these daily walking excursions.

Rio's daily Jornal do Brasil cites Glória Monteiro Martins, 76, who has lived in Copacabana for 25 years, as saying: "I cried for ten years after my husband died. So much so that I didn't have the time to love somebody else. I am happy here now. Old people can do whatever they please and nobody cares a hoot. Here is the paradise of the third age." Martins used to live in Madureira, a Rio suburb, before buying her apartment in Copacabana.

Some American groups have shown interest in building apartment-hotels in Rio similar to those that exist in Miami, Florida. Rio has already become the Brazilian Miami in attracting the elderly to its sunny and laid-back beachfront lifestyle. But they should take heed of what happened to other pioneer projects like the one started in São Paulo by geriatrician Norton Sayeg. He conceived of an old-age-friendly building with special ramps and elevators for wheelchairs and another amenities for the elderly and thought he had a winner. Sayeg, however, wasn't able to sell so much as one unit. Apparently, the big handicap was presenting the undertaking as a venture for the elderly. Similar projects in Miami, Florida, avoided this pitfall and became very successful.