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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
Desk Review: The situation of older persons in Jamaica (2011)
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
Desk Review: The situation of older persons in Jamaica (2011)
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
http://www.lco-cdo.org/en/older-adults-lco-funded-papers-charmaine-spencer-sectionII
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
Political frameworks for Geriatric Care
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
Political frameworks for Geriatric Care
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
Political frameworks for Geriatric Care
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
Political frameworks for Geriatric Care
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
Desk Review: The situation of older persons in Jamaica (2011)
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
http://www.lco-cdo.org/en/older-adults-lco-funded-papers-charmaine-spencer-sectionII
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 !!