Basic Concept 2

1. Basic Concept 2 Aging, Health Care, and Society

2. The Challenge of Longevity • There are many questions about modern societies values towards old age • Are the old less valued than the young? • Where will we find the resources to take care of the frail elderly? • Could medical breakthroughs have unforeseen consequences for society, either for good or ill? • There are also many challenges that people face as they grow older, including: • Coping with an aging body • Maintaining a valued place in society while aging • Individuals grow older in the wider context of an entire society that is undergoing a transition to population aging

3. The Challenge of Longevity (cont.) • Questions and challenges faced by the prospect of longevity also include: • Biomedical Advances • Rationing Health Care • Providing Long-Term Health Care • Self-Determined Death • There are also questions about “normal aging” • It’s important to understand “normal aging” because health care workers, etc. who mainly see frail and sick elderly people can develop negative stereotypes about aging

4. Epidemiology of Aging • While aging itself is not a disease, it does come with increasing susceptibility to disease • Three-quarters of people over age 65 die from: • Heart disease, Cancer, and Stroke • Chronic conditions – persist for a long period, regardless of whether they cause death • Ex., Arthritis, Osteoporosis, Parkinson’s Disease, Cancer, Cardiovascular Disease, Dementia and Alzheimer’s Disease

5. Economics of Health Care • Reimbursement systems – Medicare is the chief federal government program that pays for health care for 35 million people over age 65 • Created in 1965 as part of the Social Security Act • Then, over half of people over 65 didn’t have health insurance; Today, almost all people are covered • However, it doesn’t pay for the first day of hospitalization; it doesn’t cover hearing aids, eyeglasses, or dental care; it excludes long-term care coverage • Still only covers about half of the “out-of-pocket” expenses of older people • Because of the “medigap,” most need to have secondary insurance plans that cover what Medicare doesn’t

6. Long-Term Care • Questions arise about: 1) how to pay for long-term health care, and 2) whether it should be the responsibility of families or institutions • Housing for the elderly – many possible options, but may produce greater demand for low-cost housing and coordination of services • Continuing-care retirement community – offer a combination of housing and health care, and typically provide a level of social support for people having difficulty living on their own • Domiciliary-care facilities (and) board-and-care homes – homes that provide mainly custodial or personal care for those who need help with Activities of Daily Living (ADL’s) • Assisted-living facilities – offer residents and their families a homelike environment with personal, but limited, supportive care

7. Long-Term Care (cont.) • Section 202 (and) Section 8 housing programs – rental housing subsidized by the federal government for low-income elderly; offer no social support or health care – simply a place to live at a lower cost • Congregate housing – a residential facility providing nutrition, housekeeping, and supportive services for the marginally independent elderly • Shared housing – an alternative housing arrangement involving either group residence with shared common areas, or a homeowner who rents out unused rooms • Nursing home – refers to any residential facility that gives some degree of nursing care to elderly or disabled people • The nursing home has been called a “total institution,” like prisons, mental hospitals, or boarding schools, that treat people like inmates, rather than individuals

8. The Continuum of Care • Continuum of care – based on the goal of offering a range of options responsive to changing individual needs • whether from less intense to more intense • whether at home or in an institution • The ideal aim of a continuum of care is to keep people out of nursing homes for as long as possible • Nursing homes are the most expensive and service-intensive setting

9. Self-Determined Death • Modern biotechnology enables many people to survive into old age, which forces individuals and care providers to make decisions about end-of-life care • Right-to-die debate – involves choices ranging from forgoing life-sustaining treatment all the way to assisted suicide • Financial concerns become intertwined with right-to-die considerations, which could make it more difficult for elderly patients to assert their rights

10. Late-Life Suicide • Self-determined death includes: • Termination of treatment • Active euthanasia • Assisted suicide • Emile Durkheim – the first great sociological investigator of suicide • Distinguished several types of suicide: • Altruistic suicide – self-sacrifice for the sake of the group or society • Anomic suicide – derived from a condition in which individuals feel hopeless and cut off from any sense of meaning in life

11. Late-Life Suicide (cont.) • Among the elderly in America, 80% of people who threaten suicide actually follow through • No way to estimate how many people choose to end their lives by noncompliance with medical treatment or other forms of self-neglect • Highest rate of suicide in the United States occurs among older White men • Blacks have a suicide rate about 60% of the average for Whites, and the rate does not increase in old age