introduction to gerontology

Classification and Characteristics of the Elderly

Concepts and Issues

Andrea M McPherson UWISON Jan 13, 2014

ObjectivesAt the end of the 2 hour session, students will be able

to:

Outline the important reasons for the study of older adults

•Define terminologies related to the ageing population

•Outline the classification of ageing

•Identify the characteristics of ageing

•Describe the socio-cultural issues impacting the older adult

•Describe the political, ethico-legal/frameworks of geriatrics

•Identify common ethical issues

Gerontology versus GeriatricsGerontology – study of the processes of aging;

all aspects

(logy – study of ; gero - Greek term elders)

Geriatrics – specialty which includes:

the study of disease in later life and the

care and treatment of older persons

Association for Gerontology in Higher Education (2004)

Gerontology and GeriatricsDiffering emphasis but same goal:

Understanding aging Helping people maximize their functioning …Achieve highest quality of life

Why Study Gerontology?DEVELOPING COUNTRIES:

- expected rise in proportion of older persons from 8% to 19% by 2050

CARIBBEAN: fastest growing ageing population

JAMAICA Population estimated at 2,705,800 in 2010Demographic transitioning *– intermediate stage where age composition of population is

changingGreater number of older females are living longer than men

Desk Review: The situation of older persons in Jamaica (2011)

Why Study Gerontology?“Revolution in longevity” – people are living

longer Globally:

- proportion of older persons is growing at a

faster rate than the general population Average life expectancy at birth

– increased by 20 yrs. since 1950 to 66 yrs;

- expected extension of 10 years by 2050


Why Study Gerontology?JAMAICA (Cont’d)

Findings of particular concern: Large proportion of elderly live in multigenerational households The oldest old (>80 years); fastest growing group


OLD AGE

Old age is not a status we choose to become; it is a status that we inherit simply by the virtue of

living, not dying. Holstein, 2006, 317[46]

http://www.lco-cdo.org/en/older-adults-lco-funded-papers-charmaine-spencer-sectionII

Terminologies

Age: chronological, biological, social, functional (slide below)AgeingElderlySenescenceAgeism

Definition of Age Number of years since birth

Other :

Chronological Age Biological Age

Social Age Functional Age

Mr. Calendar is 85, but is as healthy and active as his son who is 65 years old. Which definition of age would this best refer to ?

A. SocialB. biological C. functional D. Psychological

2% 3%

80%

15%

Mrs. Calendar retired at age 65. Age in this context is

A. PsychologicalB. FunctionalC. BiologicalD. Social

7% 12%

3%

78%

Psychological Functional Biological Social

Characteristics of the Older AdultPopulation

Young - old 60 – 74 years

Middle –old 75 - 84 years

Old – old 85 – 100 year• Centenarians > 100 years

(Tabloski 2010)

Characteristics of Ageing • Physically & mentally well (described by functional

ability)Chronic disease

Majority live in private householdsSupport – two way process

Gender: different health problems female: 3-4 year advantage

Life expectancy has increased from mid fifties (1950’s)

to mid seventy’s (2005).

Classification of the Older Adult• Independent seniors• Dependent seniors

• Seniors with disability• Seniors near end of life

AgeismPrejudice and stereotyping applied to any

age group (e.g. older people) “a process of systematic stereotyping or

discrimination against people because they are old

younger generation to see the older people as different than themselves; subtly cease to identify with their elders as human beings


Emerging Themes from Ageism

Negative Ageism: prejudice & discrimination against the aged

•Terms used : ‘infirm’; ‘senility’; ‘getting old’ ‘dirty’ ‘being like a child’•Expected to accept ‘facts of aging’•Discrimination: e.g. compulsory retirement over elders at age 65 years

Emerging Themes from ageismPositive Ageism: prejudice and discrimination in favour of the agede.g. Provision – national health insurance

NB Ageism violates basic democratic and ethical principles.

……..(Prejudice and discrimination are seen as undemocratic and wrong)

Socio-cultural influences

The conceptual understanding of old age is strongly influenced by

socio-cultural factors

Socio-cultural

Increased older persons in population

indicates policy successes in:

public healthsocial stability**education

https://www.un.org/ageing/documents/papers/guide.pdf

Social-cultural Influences

Culture

Family

Education

Ascribed roles

Home and living setting

Personal image of the older person

CultureAncient Chinese believed that attaining

old age was a wonderful accomplishment that deserved honour

Egyptians dreaded old age and experimented on potions to aging

Ancient Romans had limited respect for their elders

CulturalMYTHS

Being old means being sickOlder people are set in their ways and

can’t learn new thingsHealth promotion is wasted on old people The elderly do not pull their own weightIts too late now to change my bad habitsOlder people have no interest in sex

Economic issues• Pension & financial concernsOtherWork force related issuesOlder workers & an ageing work forceWorkplace wellness programmesDay care issues for middle aged workers with

older relativesPost retirement health insurancehttp://caribbean.scielo.org/scielo.php?

script=sci_arttext&pid=S0043-31442008000600009

Economic issues Retirement ageCosts of providing care/supportMaintaining the adequacy of pension

fundsExtending pension coverage

ConsiderationsRecognition of aging and definition of limitations

Redefinition of physical and social life space

Substitution of alternative sources of need satisfaction

Reassessment of criteria for evaluation of the self

Reintegration of values and life goals

Factors Contributing to LongevityPositive state of health can contribute to longevity

Exercise is a good ingredient to longevity

Laughter causes a relief of endorphins.

Faith: strong faith, church attendance and prayer life

Empowerment: powerlessness diminishes self care

Stress management

Nursing ImplicationsAssist patients in experiencing health,

fulfillment and a sense of wellbeing.

*Nurse’s philosophy of aging influences the

care she delivers.

Political frameworks for Geriatric Care

1982 – first World Assembly on Ageing (Vienna)

* did not focus on the developing world

Ageing placed on Health Ministers agenda

1986 – Dr Eldermire – Shearer: established contact with WHOs Ageing & Health Unit


1988 – Eldemire- Shearer made contact with an NGO – Help Age International * focus – developing countries

1989 - 60+ survey - basis for the Jamaica

National policy on Ageing1999- UN Year of the older person * ageing introduced into under/ postgrad programmes


1999- the UN Year of the Older person2002- Madrid International Plan of Action* on Ageing and political declaration

adopted at 2nd World Assembly ……….. ** progress – beyond protection to empowerment & inclusion in national development

agenda


THE MADRID INTERNATIONAL PLAN OF ACTION ON AGEING

Addresses opportunities and challenges of ageing in the 21st century;promoting development of society for all ages

• Secretariat: United Nations• 2 core concepts : 1. developmental approach to population ageing 2. intergenerational life approach to policy

https://www.un.org/ageing/documents/workshops/Vienna/issues.pdf


Issues covered by the MIPAA:

Older persons and developmentAdvancing health and well-being into old ageEnabling and supporting environmentsImplementation and Follow- up

Non-Governmental (NGOs)Help Age International consultancy status with UN and WHO Helps older people:

claim their rights challenge discrimination

overcome poverty

(works through Senior Citizens Clubs)http://www.dogoodjamaica.org/organizations/helpage_international_jamaicahttp://www.jamaicaobserver.com/news/-Vision-2030-mentions-old-people--but-not-enough-_13260539

Legislative & policy framework

Government Ministries:

•Ministry of Justice•Ministry of Labour and Social Security

http://www.ohchr.org/Documents/Issues/OlderPersons/Submissions/Jamaica.pdf

Legislative & Policy framework Ministry of Labour and Social Security-effects policies surrounding ageing issues- agency - National Council for Senior Citizens

(NCSC)

Highpoints•NCSC - national infrastructure for older person

- established long before 1st World Assembly 1982

- role of NCSC

Legislative & policy framework

National Policy for senior citizens•Health -**NHF , JADEP •Social activites•Income security•Education

Legislative and policy frameworkVISION 2030: -Jamaica’s first comprehensive development plan-Review: Assessed for the extent to which it addresses leglislative & policy issues related to the elderly


Ethical frameworkICN Code of Ethics Inherent in nursing is respect for human rights

- right to live- right to dignity- right to be treated with respect

2009 – UN Report of the Expert Working Group on “Rights of the Older Person”

Ethical Framework

Increasing Awareness /Ethical Dilemmas:•Greater number of older adults•Medical technology•Fiscal constraints•Expanded role of nurses

Ethics for the Elderly: -relates to how they want to be treated & allowed to make their own decisions

Eliopoulous, 2010

Principlism: Ethical Framework

Autonomy: respect for the elder’s choices

Beneficence: do goodNonmaleficence: do no harmDistributive justiceSanctity of life

Rules of Ethical Care

Veracity

Confidentiality

Fidelity

UtilitarianismGoal oriented and dictates that in all

situations

One must act to provide the most good for

the most people

The end justifies the means.

Ethical and Legal Issues

Ethico-legal Issues

Existing infringements•Ageism•Abuse•Neglect•Violencehttp://www.un.org/esa/socdev/ageing/documents/egm/bonn09/report.pdf

Ethico-legal IssuesRecommendations:•Ageism: policies and public statements•Abuse: enhance awareness; self-reporting•Neglect, abuse , violence – data collection towards preventive strategies•Infrastucture to support mistreatment•Advocacy and empowerment; access to services

•http://www.un.org/esa/socdev/ageing/documents/egm/bonn09/report.pdf

Ethico-legal IssuesCommon Issues confronting elder care providers: Actual conflicts of interestspouses & their wishes versus the elder’s wishes & interestscare provider’s business interests versus the elder’s interests

Potential conflicts of interestConfidentialityDecision making capacity

•http://www.ensignlaw.com/Ethical%20Issues%20and%20Elderly.html

-

Potential Legal Liability Acts Assault

Battery

Defamation of characterLibel & slander

False Imprisonment

Fraud

Invasion of privacy

Larceny

Negligence*MalfeasanceMisfeasanceNonfeasanceCriminal negligence

MalpracticeAll of the following must be present for

malpractice to exist:

Duty

Negligence

Injury

DutyA relationship between the nurse and the

patient in which the nurse has assumed

responsibility for the care of the patient.

Malpractice Negligence is:

Failure to conform to the standard of care (i.e.

malpractice).

Injury:

Physical or mental harm to the patient or

violation of the patient’s rights resulting from

the negligent act.

Other Ethico-Legal IssuesDecision making

Client’s ability

Appropriate surrogate decision maker

Disclosure of information to make informed decisions

Care and treatmentLevel of care

Basis of function

Termination of treatment at end of life

Abuse

Types of AbusePhysical abuse

The willful infliction of physical pain or injury

Financial abuseTheft or mismanagement of money or resources

Social abuseInfliction of debilitating mental anguish and fear

AbuseNeglect

Failure of caregiver to provide necessary services

Services for physical and mental health

Violation of individual rightsUnreasonable confinement Deprivation of servicesExploitation

The illegal use of a person or resources for another’s profit

Elder Abuse Complex:

Family arrangements

Carer issues

Socio-cultural issues

Advanced Medical Directives

Advanced Medical DirectivesClient’s wishes in different situations

Documented preferences

Living willClients wishes re: medical treatment should

s/he become terminally ill

Durable medical power of attorney Someone is designated to make health care

decisions when s/he is unable to do so

Scenario Two months ago, Mr M.T. (80 years old) and his wife

were involved in a severe auto accident. Mrs. A T died.

Mr. M.T. previously told his 3 children that should he

ever become seriously injured or ill and unable to live his

life as he has in the past, he doesn’t wish to be treated

with extraordinary measures to continue his life.

ScenarioTwo of the children agreed that their father

would not want to live with the residual effects

of his injuries should he recover. The third child,

emotionally distant from the father until the last

6 months, desperately desires any relevant

treatment for her father to allow his possible

recovery even if it means he has decreased

quality of life.

Steps in the Process

Questions to consider?

What are the ethical principles and duties

related to appropriate actions by the nurse

and other health care professionals?

What things are optional actions?

What are the obligatory actions?

ReferencesII. Ageism: Concepts and theories


Biological theories of aging: Psychology of aging (2005). http://flash.lakeheadu.ca/~mstones/Biological%20theories%20of%20aging.pdf

Canning, D. (2011). Program on the global demography on ageing. Working paper series - the causes and consequences of the demographic transition

References

Ageism: Concepts and theorieshttp://www.lco-cdo.org/en/older-adults-lco-funded-papers-charmaine-spencer-sectionII

Aging in the 21st century: A Celebration and a challenge http://www.google.com.jm/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDkQFjAC&url=http%3A%2F%2Fwww.helpage.org%2Fdownload%2F50af6e9c8f44b%2F&ei=BXOzUp6MBYPZkQebgYGwCA&usg=AFQjCNEOpxGzPhzfWrtQfQDMkAoeONvSiw&sig2=HF6fZKB4_zXEmuKH99vIvw

ReferencesDesk Review: The situation of older persons in Jamaica (2011)

UNFPA and HelpAge International. Retrieved from http://caribbean.unfpa.org/webdav/site/caribbean/shared/publications/2011/Jamaica Finalized_TheSitOlderPersonsInJamaica_UNFPA_030811-2.doc

•Eldemire-Shearer,D. (2008). Ageing. The response: Yesterday, Today and Tomorrow. Retrieved from

http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-31442008000600009

Eliopoulos, C. (2010). Gerontology Nursing. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

ReferencesJamaica’s older person’s call for protection

http://www.jamaicaobserver.com/news/Jamaica-s-

older-persons-call-for-protection_12667661

Mainstreaming ageing into national policy frameworks: An Introduction. Retrieved from https://www.un.org/ageing/documents/workshops/Vienna/issues.pdf

Palmore, E., (1999). Ageism:Negative and positive.

Springer Publishing Co. 2nd ed. Retrieved from http://

books.google.com.jm/books?

id=Cg4_DTUuV4IC&dq=ageism+negative+and

+positive&source=gbs_navlinks_s

References• Perspectives on aging.(2007).

http://www.sagepub.com/upm-data/15090_Chapter1.pdf

Political declaration and Madrid International Plan of action on ageing.(2002). Second world assembly on aging. United Nations, New York

Stewart, T.(2009). The elderly: sixty years and beyond. 2nd ed. National Library of Jamaica

Thank youHappy Ageing !!