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Introduction to Gerontology. Classification and Characteristics of the Elderly Concepts and Issues Andrea M McPherson UWISON Jan 13, 2014. Objectives. At the end of the 2 hour session, students will be able to:

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introduction to gerontology

Introduction to Gerontology

Classification and Characteristics of the Elderly

Concepts and Issues

Andrea M McPherson

UWISON Jan 13, 2014

objectives
Objectives

At 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 geriatrics
Gerontology versus Geriatrics
  • Gerontology – 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 geriatrics
Gerontology and Geriatrics

Differing emphasis but same goal:

  • Understanding aging
  • Helping people maximize their functioning
  • …Achieve highest quality of life
why study gerontology
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 2010
  • Demographic transitioning *– intermediate stage where age composition of population is changing
  • Greater number of older females are living longer than men

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

why study gerontology1
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 gerontology2
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
  • 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
Terminologies
  • Age: chronological, biological, social, functional (slide below)
  • Ageing
  • Elderly
  • Senescence
  • Ageism
definition of age
Definition of Age
  • Number of years since birth

Other :

  • Chronological Age
  • Biological Age
  • Social Age
  • Functional Age
slide11
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 ?
  • Social
  • biological
  • functional
  • Psychological
mrs calendar retired at age 65 age in this context is
Mrs. Calendar retired at age 65. Age in this context is
  • Psychological
  • Functional
  • Biological
  • Social
characteristics of the older adult population
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
Characteristics of Ageing
  • Physically & mentally well (described by functional ability)
  • Chronic disease
  • Majority live in private households
  • Support – 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
Classification of the Older Adult
  • Independent seniors
  • Dependent seniors
  • Seniors with disability
  • Seniors near end of life
ageism
Ageism
  • Prejudice 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
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 ageism1
Emerging Themes from ageism

Positive Ageism: prejudiceand discrimination in favour of the aged

  • e.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
Socio-cultural influences
  • The conceptual understanding of old age is strongly influenced by socio-cultural factors
socio cultural
Socio-cultural

Increased older persons in population

indicates policy successes in:

  • public health
  • social stability**
  • education

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

social cultural influences
Social-cultural Influences
  • Culture
  • Family
  • Education
  • Ascribed roles
  • Home and living setting
  • Personal image of the older person
culture
Culture
  • Ancient 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
cultural
Cultural
  • MYTHS
  • Being old means being sick
  • Older people are set in their ways and can’t learn new things
  • Health promotion is wasted on old people
  • The elderly do not pull their own weight
  • Its too late now to change my bad habits
  • Older people have no interest in sex
economic issues
Economic issues
  • Pension & financial concerns

Other

  • Work force related issues
  • Older workers & an ageing work force
  • Workplace wellness programmes
  • Day care issues for middle aged workers with older relatives
  • Post retirement health insurance
  • http://caribbean.scielo.org/scielo.php? script=sci_arttext&pid=S0043-31442008000600009
economic issues1
Economic issues
  • Retirement age
  • Costs of providing care/support
  • Maintaining the adequacy of pension funds
  • Extending pension coverage
considerations
Considerations
  • Recognition 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 longevity
Factors Contributing to Longevity
  • Positive 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 implications
Nursing Implications
  • Assist 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
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 care1
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 Ageing

  • 1999- UN Year of the older person

* ageing introduced into under/

postgrad programmes

political frameworks for geriatric care2
Political frameworks for Geriatric Care
  • 1999- the UN Year of the Older person
  • 2002- 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 care3
Political frameworks for Geriatric Care

THE MADRID INTERNATIONAL PLAN OF ACTION ON AGEING

Addresses opportunities and challenges of ageing in the 21stcentury;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 care4
Political frameworks for Geriatric Care

Issues covered by the MIPAA:

  • Older persons and development
  • Advancing health and well-being into old age
  • Enabling and supporting environments
  • Implementation and Follow- up
non governmental ngos
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_jamaica
  • http://www.jamaicaobserver.com/news/-Vision-2030-mentions-old-people--but-not-enough-_13260539
legislative policy framework
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 framework1
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 framework2
Legislative & policy framework

National Policy for senior citizens

  • Health -**NHF , JADEP
  • Social activites
  • Income security
  • Education
legislative and policy framework
Legislative and policy framework

VISION 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 framework
Ethical framework
  • ICN 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 framework1
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
Principlism: Ethical Framework
  • Autonomy: respect for the elder’s choices
  • Beneficence: do good
  • Nonmaleficence: do no harm
  • Distributive justice
  • Sanctity of life
rules of ethical care
Rules of Ethical Care
  • Veracity
  • Confidentiality
  • Fidelity
utilitarianism
Utilitarianism
  • Goal oriented and dictates that in all situations
  • One must act to provide the most good for the most people
  • The end justifies the means.
ethico legal issues
Ethico-legal Issues

Existing infringements

  • Ageism
  • Abuse
  • Neglect
  • Violence

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

ethico legal issues1
Ethico-legal Issues

Recommendations:

  • 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 issues2
Ethico-legal Issues

Common Issues confronting elder care providers:

  • Actual conflicts of interest
  • spouses & their wishes versus the elder’s wishes & interests
  • care provider’s business interests versus the elder’s interests
  • Potential conflicts of interest
  • Confidentiality
  • Decision making capacity
  • http://www.ensignlaw.com/Ethical%20Issues%20and%20Elderly.html
potential legal liability acts
Potential Legal Liability Acts
  • Assault
  • Battery
  • Defamation of character
    • Libel & slander
  • False Imprisonment
  • Fraud
  • Invasion of privacy
  • Larceny
  • Negligence*
    • Malfeasance
    • Misfeasance
    • Nonfeasance
    • Criminal negligence
malpractice
Malpractice
  • All of the following must be present for malpractice to exist:
  • Duty
  • Negligence
  • Injury
slide50
Duty
  • A relationship between the nurse and the patient in which the nurse has assumed responsibility for the care of the patient.
malpractice1
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 issues
Other Ethico-Legal Issues
  • Decision making
    • Client’s ability
    • Appropriate surrogate decision maker
    • Disclosure of information to make informed decisions
  • Care and treatment
    • Level of care
    • Basis of function
    • Termination of treatment at end of life
  • Abuse
types of abuse
Types of Abuse
  • Physical abuse
    • The willful infliction of physical pain or injury
  • Financial abuse
    • Theft or mismanagement of money or resources
  • Social abuse
    • Infliction of debilitating mental anguish and fear
abuse
Abuse
  • Neglect
    • Failure of caregiver to provide necessary services
    • Services for physical and mental health
    • Violation of individual rights
    • Unreasonable confinement
    • Deprivation of services
    • Exploitation
      • The illegal use of a person or resources for another’s profit
elder abuse
Elder Abuse

Complex:

  • Family arrangements
  • Carer issues
  • Socio-cultural issues
advanced medical directives1
Advanced Medical Directives
  • Client’s wishes in different situations
    • Documented preferences
  • Living will
    • Clients 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
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.

scenario1
Scenario
  • Two 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.
questions to consider
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?
references
References
  • II. 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
references1
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

references2
References
  • Desk 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.
references3
References
  • Jamaica’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

references4
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 you
Thank you
  • Happy Ageing !!
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