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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


Introduction to gerontology
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 who is 65 years old. Which definition of age would this best refer to ?

  • Psychological

  • Functional

  • Biological

  • Social


Characteristics of the older adult population
Characteristics of the Older Adult who is 65 years old. Which definition of age would this best refer to ?Population

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • Independent seniors

  • Dependent seniors

  • Seniors with disability

  • Seniors near end of life


Ageism
Ageism who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

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 who is 65 years old. Which definition of age would this best refer to ?

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 who is 65 years old. Which definition of age would this best refer to ?

  • The conceptual understanding of old age is strongly influenced by socio-cultural factors


Socio cultural
Socio-cultural who is 65 years old. Which definition of age would this best refer to ?

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 who is 65 years old. Which definition of age would this best refer to ?

  • Culture

  • Family

  • Education

  • Ascribed roles

  • Home and living setting

  • Personal image of the older person


Culture
Culture who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • Retirement age

  • Costs of providing care/support

  • Maintaining the adequacy of pension funds

  • Extending pension coverage


Considerations
Considerations who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ?

  • 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 who is 65 years old. Which definition of age would this best refer to ? 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 who is 65 years old. Which definition of age would this best refer to ? 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 who is 65 years old. Which definition of age would this best refer to ? 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 who is 65 years old. Which definition of age would this best refer to ? 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 who is 65 years old. Which definition of age would this best refer to ? 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) who is 65 years old. Which definition of age would this best refer to ?

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 who is 65 years old. Which definition of age would this best refer to ?

    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 who is 65 years old. Which definition of age would this best refer to ?

    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 who is 65 years old. Which definition of age would this best refer to ?

    National Policy for senior citizens

    • Health -**NHF , JADEP

    • Social activites

    • Income security

    • Education


    Legislative and policy framework
    Legislative and policy framework who is 65 years old. Which definition of age would this best refer to ?

    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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • Veracity

    • Confidentiality

    • Fidelity


    Utilitarianism
    Utilitarianism who is 65 years old. Which definition of age would this best refer to ?

    • 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.


    Ethical and legal issues
    Ethical and Legal Issues who is 65 years old. Which definition of age would this best refer to ?


    Ethico legal issues
    Ethico-legal Issues who is 65 years old. Which definition of age would this best refer to ?

    Existing infringements

    • Ageism

    • Abuse

    • Neglect

    • Violence

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


    Ethico legal issues1
    Ethico-legal Issues who is 65 years old. Which definition of age would this best refer to ?

    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 who is 65 years old. Which definition of age would this best refer to ?

    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 who is 65 years old. Which definition of age would this best refer to ?

    • Assault

    • Battery

    • Defamation of character

      • Libel & slander

    • False Imprisonment

    • Fraud

    • Invasion of privacy

    • Larceny

    • Negligence*

      • Malfeasance

      • Misfeasance

      • Nonfeasance

      • Criminal negligence


    Malpractice
    Malpractice who is 65 years old. Which definition of age would this best refer to ?

    • All of the following must be present for malpractice to exist:

    • Duty

    • Negligence

    • Injury


    Introduction to gerontology
    Duty who is 65 years old. Which definition of age would this best refer to ?

    • A relationship between the nurse and the patient in which the nurse has assumed responsibility for the care of the patient.


    Malpractice1
    Malpractice who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    Complex:

    • Family arrangements

    • Carer issues

    • Socio-cultural issues


    Advanced medical directives
    Advanced Medical Directives who is 65 years old. Which definition of age would this best refer to ?


    Advanced medical directives1
    Advanced Medical Directives who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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.


    Steps in the process
    Steps in the Process who is 65 years old. Which definition of age would this best refer to ?


    Questions to consider
    Questions to consider? who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • 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 who is 65 years old. Which definition of age would this best refer to ?

    • Happy Ageing !!