Aging in the Philippines PDF

The Gerontologist cite as: Gerontologist, 2018, Vol. 58, No. 2, 212–218 doi:10.1093/geront/gnx203...

The Gerontologist cite as: Gerontologist, 2018, Vol. 58, No. 2, 212–218 doi:10.1093/geront/gnx203 Advance Access publication January 8, 2018 International Spotlight Aging in the Philippines Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022 Adrian N. S. Badana, MPH* and Ross Andel, PhD School of Aging Studies, The University of South Florida, Tampa. *Address correspondence to: Adrian N. S. Badana, MPH, School of Aging Studies, The University of South Florida, 4202 E. Fowler Ave., MHC 1300 Tampa, FL 33620. E-mail: [email protected] Received: September 25, 2017; Editorial Decision Date: November 9, 2017 Decision Editor: Rachel Pruchno, PhD Abstract The Philippines is a diverse country that will experience an increase in its aging population in the near future. The aim of this article is to provide an overview of the main issues surrounding population aging, as well as family caregiving and poli- cies that are of concern to older adults in the Philippines. Policymakers and government leaders must plan for the expected growth in the numbers of older adults, which is likely to increase the demand for services and support for elders and their caregiving families. The Philippines’ unique history and rich culture shapes its citizens’ views on aging and bolsters expecta- tions of informal caregiving for older family members. Research on aging in the Philippines and current policies must be enhanced to adequately address the needs of the country’s aging citizens. Keywords: Family caregiving, Health care, Asia, Global aging, Social welfare Overview in various regions of the country. There are currently more The Philippines is a culturally and historically diverse archi- than eight dialects spoken in the country, yet English and pelago consisting of a cluster of over 7,000 islands in the Tagalog (Pilipino) are the official languages of the nation. Southeast Pacific Rim. Various historical events have shaped Inhabitants of the Philippines often refer to themselves as the society and heritage in the Philippines. The islands were Pinoy (general term), Filipino (masculine term), Filipina (fem- first colonized by the Spanish in the 16th century, and then inine term), or Filipinos (plural term). The majority (82.9%) they were seceded to the United States during the Spanish of Filipinos identify Catholicism as their religion (Central American war in the late 19th century (Central Intelligence Intelligence Agency, 2016), and religion is an important com- Agency, 2016). During World War II, the Philippines repeat- ponent that shapes both Filipino family life and customs. edly exchanged hands between Japan and the United States until after the wars ended, at which point the Philippines Demography gained its independence on 4 July 1946. During the 1970s and into the 1980s, the Philippines was in a state of martial law The country consists of approximately 103 million inhabit- under President Ferdinand Marcos. After the People Power ants, with less than 5% of the population 65 years and older Revolution evicted Marcos, the Philippines transitioned into (Central Intelligence Agency, 2016). Currently, the age struc- a presidential constitutional republic, which it remains today. ture of the Philippines resembles many other developing Modern-day Philippine society is an amalgamation of countries because there is a greater proportion of younger the different countries that once governed its many islands. Filipinos in comparison to older Filipinos (Figure 1). Despite A mixture of Asian, Spanish, and American influence has the larger number of young Filipinos, the 60 years and shaped society in the Philippines and the different languages older population of the Philippines is expected to increase © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. 212 For permissions, please e-mail: [email protected]. The Gerontologist, 2018, Vol. 58, No. 2 213 and education for females. However, issues with poverty and deaths from communicable diseases, such as tuberculo- sis, remain a concern in the Philippines. The country’s pro- gress in addressing the indicators is displayed in Table 1. Research on Aging Aging in the Philippines remains a subject that is severely under-theorized in research (Villegas, 2014). Although older Filipinos do appear in the country’s national reports, cur- rent empirical studies incorporating older adults appears to be lacking in the Philippines. The main universities in Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022 the Philippines house research institutions that study a var- Figure 1. Population pyramid of the Philippines (Central Intelligence iety of topics; however, the University of the Philippines Agency, 2016) Manila is currently the only major institution where there is an established center specifically for aging research. The by 4.2%, whereas the 80 years and older population is majority of research centered on older Filipinos appears expected to increase by 0.4% from 2010 to 2030 (Help Age to focus on perceptions of aging, quality of life of older Global Network, 2017b). In contrast, the 60 years and older Filipinos, and older adults in the workforce. population of the United States will increase 5.4% from 2010 to 2030 (Help Age, 2015). The Philippines’s popula- tion increased by over 35% over the last two decades with Perceptions Regarding Aging the older adult population (60 years and older) expected Many Filipinos view the aging process from direct interactions to overtake those aged 0–14 years old by 2065 (Help Age with their family members and older Filipinos in their sur- Global Network, 2017a). Currently, life expectancy of rounding community. Living in multigenerational households Filipinos is 57.4 years for males and 63.2 years for females. and communities shape perceptions of aging as a responsi- Females are projected to expect an increase of 4.0 years in bility, due to the establishment of family roles, adult engage- life expectancy and males an increase of 4.7 years in life ment in the workforce, and family social ties (Valdez, Angeles, expectancy by 2030 (Help Age Global Network, 2017b). Pareja-Corpuz, & Hernandez, 2013). The study by Valdez and The improvement in life expectancy can be attributed to colleagues (2013) found common themes about perceptions of advances in public health in the Philippines, which have aging, both positive and negative, from focus group interviews. eradicated many of the diseases that once caused earlier In fact, Valdez and colleagues (2013) discovered that although mortality in Filipinos (Coscoluella & Faustino, 2014). older Filipinos acknowledge the physical decline that can occur Compared to developed countries, which have a low fertil- with aging, there is a general positive outlook that aging is a ity rate of about 1.7 children per woman (United Nations, period of increased productivity and promising experiences. 2015), there is a high fertility rate of 3.1 children per woman in Social resources can be predictive of positive views of aging for the Philippines (Help Age Global Network, 2017a). Although older Filipinos (Valdez et al., 2013). For example, older adults the dependency ratio of the Philippines has been steadily who receive more social support from their relatives often decreasing since the 1960s (World Bank Group, 2017), the feel encouraged and have better perceptions about their own nation still contains a greater proportion of dependents to aging process. Filipino elders’ perceptions of aging are derived working-age people when compared to other Asian countries. from the unique life experiences and social units that encom- pass their lives (Valdez et al., 2013). These experiences, either negative or positive, form their views on aging and outlook on Millennium Development Goals life. Although older Filipinos do acknowledge the physical and To address disparities in health and well-being, the functional declines that might occur with increasing age, they Philippines was a member of the United Nation’s view aging in a more positive light due to the respect and dig- Millennium Declaration. The declaration established eight nity that are attained with maturation. Millennium Development Goals, including various top- ics ranging from mortality and disease to education and poverty. The 189 participating countries submitted regu- Quality of Life lar progress reports to assess and track periodic changes In terms of research on quality of life of older Filipinos, many over time in addressing the goals. Since its inclusion in the elders generally report positive health, community participa- Millennium Declaration, the Philippines achieved certain tion, and financial security. However, Filipinos who reported subcomponents of the eight key goal indicators established higher socioeconomic status and more educational attain- by both the country and the United Nations. Outcomes ment also tended to report better quality of life (De Leon, improved for infant mortality, malaria disease distribution, 2014; Tariga & Cutamora, 2016). Increased age was directly 214 The Gerontologist, 2018, Vol. 58, No. 2 Table 1. Philippine Millennium Development Goals Progress Goals Progress 1. Eradicate extreme poverty and hunger The poverty gap ratio decreased from 9.3 in 1991 to 5.1 in 2012. The proportion of the population below the national food threshold decreased from 17.6% in 1991 to 10.4% in 2012. 2. Achieve universal primary education The literacy rate and rate for primary school completion did not improve at the rate expected. About 98.1% of Filipinos aged 18–24 were literate in 2013, whereas only 78.5% of Filipinos completed primary school at that same time. 3. Promote gender equality and empower The ratio of girls to boys in elementary, secondary, and tertiary education was equivalent or women higher. However, the proportion of women holding seats in the national parliament (25.9%) was still not equivalent to their male counterparts. Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022 4. Reduce child mortality Infant mortality improved from 57% in 1990 to 23.0% in 2013. The under-five-year-old mortality rate also decreased from 80% in 1990 to 31% in 2013. 5. Improve maternal health The maternal mortality ratio increased from 209 deaths per 100,000 live births to 221 deaths per 100,000 live births in 2011. 6. Combat HIV/AIDS, malaria, The prevalence and death rate from malaria decreased from 118.7 per 1,000 persons in 1990 and other diseases to 7.9 per 1,000 persons in 2013. However, the prevalence and death rate from tuberculosis did not improve at the target rate. 7. Ensure environmental sustainability More families have access to potable water (85.5%) and sanitation (94.1%). 8. Develop a global partnership for Debt (as a percentage of services and export of goods) decreased from 27.2% in 1990 to 8.1% development in 2013. Note: Information for this table is from the Philippine Millennium Development report (Philippine Statistics Authority, 2015). correlated with better subjective well-being in Filipinos in quality of life in the older Filipinos and evaluate services (Tariga & Cutamora, 2016). Older Filipinos can attain and supports that may improve their well-being. greater stability in later life, and they may develop methods to cope with distressing events through previous challenges they experienced and overcame. Also, higher access to community Workforce and Aging resources was also directly correlated with better quality of Research examining employed older Filipinos found that life (De Leon, 2014). Older Filipinos residing in rural areas recognition of employee progress impacts older worker’s lacked the same access to services than older adults living happiness in the workplace (de Guzman, Largo, Mandap, in more urban settings. A separate study by Esteban (2015) & Munoz, 2014). Furthermore, positive mental and phys- discovered that religion, mainly Christianity, may serve as a ical health had a beneficial impact on job satisfaction. protective buffer to the suffering that may accompany the Enhancing job satisfaction in the work environment can po- aging process. Religion and spirituality in older Filipinos may tentially retain older workers in their positions and benefit enhance their outlook on life and assist them in overcoming the economy in the Philippines. A study focusing on older hardships. Older adults in the Philippines may also reframe Filipino university instructors found similar results with ageist stereotypes and instead find positive aspects of aging, older instructors reporting life satisfaction and high psycho- such as growing older as a time of increased creativity and logical resilience when faced with both work-related and a period of personal fulfillment (Esteban, 2015). Instead family stressors (De Jose, 2014). Older workers did experi- of acknowledging stereotypes associated with aging, older ence stressful experiences in the workplace and at home; Filipinos can view late adulthood as a period of life where however, resources, such as prayer and social support, aided new relationships can be created and as an opportunity to them in coping with those perceived stressors. Although become more engaged in their communities. the study by De Jose (2014) only sampled older teachers, Overall, older Filipinos report adequate life satisfac- the findings may translate into work environments in the tion and well-being; however, social and financial inequali- Philippines where older employees experience similar strain. ties may act as a hindrance. To improve life satisfaction Additional research can examine the impact of stress and for older Filipinos, services should equally be made avail- coping in other professions and utilize stress and coping able to older adults living in low income or rural areas. models to serve as theoretical frameworks in future studies. Barriers to access community and health support services should be reduced for older adults who may need assist- ance. Local government units can address barriers to Secondary Data sets access in their communities by offering wellness programs There are a variety of data sets that can be used to study to enhance older Filipinos’ health (Tariga & Cutamora, health and social outcomes throughout the Philippines. 2016). Additional research is needed to examine disparities These data sets are publicly available and are regularly The Gerontologist, 2018, Vol. 58, No. 2 215 updated by the Philippines Statistics Authority. A sample of secret (McBride, 2006). Families would opt to provide care secondary data sets are presented in Table 2. These popu- themselves rather than resort to any health or social services lation-based data sets can be utilized in research to incorp- for assistance in providing care. Filipino caregivers who do orate the different provinces in the Philippines and account not utilize external services fear that society will deem them for longitudinal changes over time. Including larger sam- unable to adequately care for a family member if they util- ples of older Filipinos from the various islands will ensure ize support services (McBride, 2006). Families believe that heterogeneity and capture a more diverse view of aging the care provided by relatives is sufficient for the needs of from different Filipino cultures throughout the nation. the care recipient. The social support that Filipino caregiv- ers have in the community and at home can moderate the negative impact of care recipient problematic behavior on Family Caregiving caregiver strain (Varona, Saito, Takahashi, & Kai, 2007). Filipinos, like many other Asian cultures, value filial piety Therefore, the Filipino caregiver’s social support may act Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022 and caring for older family members later in life. Although as a protective factor and make them less likely to seek or Filipinos may share the same obligation to care for family utilize support services. members as other Asian cultures, they differ because both Christian Filipinos’ core-belief system in religion, rooted males and females share decision making and financial mainly in Catholicism, also reinforces the concept that tasks; Filipinos are predominantly Catholic, and family caregiving is expected of family members (McBride, 2006). members are expected to contribute to the family through Catholicism instills a “self-sacrificing” ideation of care- various means (Kimura & Browne, 2009). In contrast to giving (McBride, 2006) where the family caregiver selflessly the more maternalistic role of caregiving seen in many cul- sets aside his or her personal life to provide quality care to a tures, multiple Filipino family members are often vested in family member. Many Filipinos also use religion as a means the caregiving process and serve various roles. For example, to provide coping for the daily stresses and strain of life older Filipino male caregivers may ask their adult children (Nakonz & Shik, 2009). Religion is an integral component to assist with the more physically demanding caregiving of many Filipinos’ cultural identity, and it bolsters societal tasks, while they themselves take on more of the house- views of family caregiving. hold tasks (McBride, 2006). Filipinos living overseas may Filipino caregivers also report positive aspects of care- even travel abroad to assist in caregiving for a close friend giving and are able to manage the challenges of caregiv- or family member (McBride, 2006). Research shows that ing and integrate the new role in their lives (Jones et al., even after Filipinos migrate to the United States, they still 2002). Some of the positive benefits reported were per- maintain the propensity to provide caregiving despite ac- sonal growth and finding meaning by overcoming obsta- culturation and new identity formation in America (Jones, cles (Jones et al., 2002). The beneficial aspects that Filipino Zhang, Jaceldo-Siegl, & Meleis, 2002; McBride, 2006). caregivers discover through caregiving may be attributed The dedication to family caregiving is evident in Filipino to how they center it around a value system (McBride, culture, and it is a part of the very fabric of Philippine so- 2006) where they derive personal fulfillment from caring ciety. Caregiving in Filipino households is so commonplace for a loved one. that failure to provide care or resources to family members in need is seen as shameful, or “hiya” in Tagalog. Key Policy Issues Filipino caregivers utilize mainly family resources in care provision, so they are often less reliant on formal ser- Social Welfare and Health vices for assistance (Jones et al., 2002). In Filipino culture A major area of policy focus for older Filipinos is in so- it is perceived as a stigma to accept services from the com- cial welfare. The Philippines has a high poverty rate that is munity, so many families either forgo them or use them in attributed to low worker education, a lack of skilled work, Table 2. Secondary Data sets Name Years Description Cebu Longitudinal Health and 1991–2005 Focuses on the impact of early nutrition and health on later life development, Nutrition Survey including work, morbidity, and education. Family Income and Expenditure 1999–2012 Consists of information on family income and household characteristics by Survey (FIES) national, regional, and city levels. Labor Force Survey 1988–2002 Contains employment information and household characteristics. Information can be used to track changes in the employment. National Statistics Office of the Multiple years Provides a variety of data sets ranging from the labor force to poverty and Philippines population statistics. Note: Information from these databases were found using the National University of Singapore (2017) list of archives and data sets in Asia. 216 The Gerontologist, 2018, Vol. 58, No. 2 living in a rural area, and the high dependency burden them in retirement. Working-age Filipinos must often that the working-age population must shoulder (Bayudan- remain in the workforce longer to financially support Dacuycuy & Lim, 2013). Due to the large percentage of younger dependents and other family members (Cruz, young adults and children in the Philippines, there is a high Natividad, Gonzales, & Saito, 2007). By working longer, dependency ratio, which means that older Filipinos often older Filipinos can support their dependents and possibly are not able to save for retirement because they may have invest in savings for retirement. It is important that insti- young dependents (Duaqui, 2013; World Bank Group, tutions promote policies that acknowledge the unique 2017). Older Filipinos may have to sacrifice their financial needs of older workers and offer benefits, such as paid assets to care for younger family members. Another major family leave and flexible working conditions, to retain issue is that almost a quarter of Filipinos living in poverty productive and satisfied workers. The ability to remain are older adults (Villegas, 2014) who do not have the fi- in the workforce longer may allow Filipinos to invest nancial means necessary to sustain an adequate quality of further in savings and allow them to be less reliant on Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022 life. Although 1.3 million older Filipinos in poverty may external funding, such as the government pension, to sup- qualify for a monthly pension under the country’s Social plement their finances. Pension Act (RA 9994), the amount equates to about 12 Another workforce issue in the Philippines is that a U.S. dollars for Filipinos aged 77 years or older (Help Age majority of Filipinos are underemployed, with low edu- Global Network, 2017b), which may not be sufficient to cation and a lack of decent jobs creating issues for both cover older Filipinos’ living expenses. An extension of the younger and older workers (Rutkowski, 2015). Older Social Pension Act does provide certain health services to Filipino workers are often at a greater disadvantage than poor, older Filipinos, such as free medical services in gov- younger workers because they are less likely to obtain an ernment hospitals, discounted health services, free vaccines, adequate education and attain salaried positions in the discounted medicines, and PhilHealth insurance coverage workforce (Rutkowski, 2015). Offering training pro- (Help Age Global Network, 2017b). The Pantawid grams to enhance worker education and skills may allow Pamilyang Pilipino Program (PPPP) is another service that older Filipino workers to qualify for better positions with acts as a safety net for families who are below the threshold higher pay levels. for poverty and aims to stop the cycle of intergenerational poverty (Bayudan-Dacuycuy & Lim, 2013; Pantawid Pamilyang Pilipino Program, 2017). Poor households may Policy and Caregiving qualify for up to 600 Philippine pesos (about 12 U.S. dol- A lack of institutional care in the Philippines means that lars) a month, providing the monetary grant primarily to older Filipinos are often cared for by family members at pregnant mothers and families with children (Pantawid home (Duaqui, 2013). This informal care network is vital Pamilyang Pilipino Program, 2017). Expansion of the PPPP because there are inadequate social security and institu- benefits to include the needs of older Filipinos and their tional care available for older Filipinos. Although care- families may help alleviate the negative effects of poverty giving is expected of Filipino families, those who are of by extending the monetary grant, PhilHealth insurance, lower socioeconomic status may be financially strained in and employment facilitation to older adults. providing adequate care to an ailing loved one. There are Access to health care services can help improve the current policies to protect the welfare of formal caregivers quality of life of older Filipinos who may have health condi- ( “Caregivers Welfare Act,” 2016); however, policies should tions, especially because many older Filipinos are burdened also address the demands of Filipino informal caregivers by by both chronic and infectious diseases (Help Age Global offering paid family leave or even payment to family car- Network, 2017a). The 2010 Expanded Senior Citizens’ Act egivers who are in need. Also, although Filipino family car- does provide health service benefit to older Filipinos, such egivers are less likely to utilize services, culturally tailored as discounted pharmaceuticals and vaccinations. However, support services could be useful in alleviating any caregiver the availability of these resources depends on the health ser- strain. vices providers, who often are reluctant to provide health services to older Filipinos (Romualdez et al., 2011). The expected increase in number of older Filipinos in the future Emerging Issues may also place a strain on the Philippine health care system Like many countries, the Philippines will experience a because the health care work force may not be prepared to growth in the population of Filipinos 65 years and older. properly assess and treat older patients. Currently, the nation is not prepared to meet the needs of the influx of aging Filipinos. The Philippine government must recognize that national policies for older Filipinos, The Workforce like the Senior Welfare Act, must be modified to address Older Filipinos remaining in the workforce may be bene- the unique demands of its aging citizens. Social welfare and ficial to older workers because the country’s social se- wellness programs should be expanded to offer coverage to curity pension may not be financially sufficient to support more aging Filipinos. Disparities in access to services must The Gerontologist, 2018, Vol. 58, No. 2 217 be addressed to improve the well-being of older adults De Jose, E. G. (2014). Psychological attributes, stressors, and throughout the different provinces. coping of older adults teaching in selected state universities in Manila, Philippines. Paper presented at the International Symposium on Education and Psychology, Meiji University, Conclusion Tokyo, Japan. De Leon, A. (2014). The quality of life of the Filipino elderly in The recent establishment of the Institute of Aging at the selected cities and provinces. Retrieved July 2017, from Tsao University of the Philippines Manila exemplifies how aging Foundation: http://tsaofoundation.org in the Philippines is now garnering national attention. This Duaqui, Y. (2013). Growing old gracefully: A Filipino family’s grand- new focus on aging must also revitalize research in ger- mother’s story. Asia-Pacific E-Journal of Health Social Science, ontology by incorporating larger, more diverse samples 2, 1–2. Retrieved July 2017, from https://sites.google.com/site/ of older Filipinos to capture the different cultures found asiapacificejournalofhss/ across the nation. Population-based studies can be advan- Esteban, R. C. (2015). Thinking about aging: Experience, identity Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022 tageous in recruiting a heterogeneous sample of older and meaning among an elderly population in the Philippines. Filipinos, similar to national studies that are conducted in Advances in Aging Research, 4, 133–153. doi:10.4236/ the United States and other countries, to obtain a nation- aar.2015.45015 ally representative sample of participants. Former aging Help Age. (2015). AgeWatch report card: United States. Retrieved research in the Philippines has relied on predominantly July 2017, from http://www.helpage.org qualitative methods to capture older Filipinos’ perceptions Help Age Global Network. (2017a). Ageing and health: Philippines. of aging. Utilizing a quantitative method or mixed-meth- Retrieved July 2017, from Help Age International Works: http:// ods approach can offer greater insight into this field of ageingasia.org/ageing-population-philippines1/ aging research. Researchers can also incorporate theoret- Help Age Global Network. (2017b). Ageing population in the ical models to act as a guiding framework for their stud- Philippines. Retrieved July 2017, from www.helpage.org ies. The use of theoretical models can strengthen studies Jones, P. S., Zhang, X. E., Jaceldo-Siegl, K., & Meleis, A. I. and allow research to be replicated and modified by other (2002). Caregiving between two cultures: An integrative researchers. experience. Journal of Transcultural Nursing, 13, 202–209. doi:10.1177/10459602013003009 Kimura, J., & Browne, C. V. (2009). Eldercare in a Filipino com- Funding munity: Older women’s attitudes toward caregiving and service use. Journal of Women & Aging, 21, 229–243. None reported. doi:10.1080/08952840903054815 McBride, M. R. (2006). Working with Filipino American families. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity and Conflict of Interest the dementias (2nd ed., pp. 189–207). New York: Taylor and None reported. Francis. Nakonz, J., & Shik, A. W. Y. (2009). And all your problems are gone: Religious coping strategies among Philippine migrant workers References in Hong Kong. Mental Health, Religion & Culture, 12, 25–38. Bayudan-Dacuycuy, C., & Lim, J. A. (2013). Chronic and transient doi:10.1080/13674670802105252 poverty and vulnerability to poverty in the Philippines: Evidence National University of Singapore. (2017). List of selected archives and using a simple spells approach. Social Indicators Research, 118, datasets. Retrieved July 2017, from http://www.fas.nus.edu.sg/ 389–413. doi:10.1007/s11205-013-0409-5 Pantawid Pamilyang Pilipino Program. (2017). Pantawid Pamilyang Caregivers Welfare Act, 269, House of Representatives of the Pilipino Program. Retrieved July 2017, from http://pantawid. Republic of the Philippines 1–8 (30 June 2016). dswd.gov.ph/ Central Intelligence Agency. (2016). The world factbook: Philippines. Philippine Statistics Authority. (2015). The Philippines Millenium Retrieved July 2017, from https://www.cia.gov/library/ Development Goals. Retrieved July 2017, from Philippine publications/the-world-factbook/geos/rp.html Statistics Authority: http://nap.psa.gov.ph Coscoluella, C., & Faustino, E. R. (2014). A legacy of public health Romualdez, A. G., dela Rosa, J. F. E., Flavier, J. D. A., Quimbo, (C. I. Tan Ed., 2nd ed.). Manila, Philippines: Department of S. L. A., Hartigan-Go, K. Y., Lagrada, L. P., & David, L. C. Health. (2011). The Philippines health system review. Retrieved July Cruz, G. T., Natividad, J. N., Gonzales, M. L., & Saito, Y. (2007). 2017, from World Health Organization: http://iris.wpro.who. Aging in the Philippines: Findings from the 2007 Philippine study int/handle/10665.1/5536 on aging. Retrieved July 2017, from https://www.uppi.upd.edu. Rutkowski, J. J. (2015). Employment and poverty in the Philippines. ph/node/174 Retrieved August 2017, from The World Bank: http://www. de Guzman, A. B., Largo, E., Mandap, L., & Munoz, V. M. (2014). worldbank.org/ The mediating effect of happiness on job satisfaction of Tariga, J. A., & Cutamora, J. C. (2016). Assessment of the common aging Filipino workers: A structural equation model (SEM). predictors and their correlation in subjective wellbeing among Educational Gerontology, 40, 767–782. doi:10.1080/0360127 elderly in Bohol, Philippines. The Malaysian Journal of Nursing, 7.2014.882108 8, 19–38. Retrieved July 2017, from http://www.mjn.com.my 218 The Gerontologist, 2018, Vol. 58, No. 2 United Nations. (2015). World fertility patterns 2015. Retrieved July of Gerontology and Geriatrics, 45, 27–41. doi:10.1016/j. 2017, from United Nations: http://www.un.org archger.2006.07.007 Valdez, P., Angeles, J. L., Pareja-Corpuz, E., & Hernandez, C. (2013). Villegas, J. K. A. (2014). Graying matters: Aging in contemporary Perceptions towards aging among selected Filipino adults. Philippine society. Philippine Sociological Review, 62, 139– International Journal of Research Studies in Psychology, 2, 89– 157. Retrieved July 2017, from http://www.jstor.org/stable/ 96. doi:10.5861/ijrsp.2013.458 43486391 Varona, R., Saito, T., Takahashi, M., & Kai, I. (2007). Caregiving in World Bank Group. (2017). World Bank data: Philippines. Retrieved the Philippines: A quantitative survey on adult-child caregivers’ August 2017, from http://data.worldbank.org/indicator/ perceptions of burden, stressors, and social support. Archives SP.POP.65UP.TO.ZS?locations=PH Downloaded from https://academic.oup.com/gerontologist/article/58/2/212/4792953 by guest on 04 January 2022