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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. At the end of the 2 hour session, students will be able to:

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Introduction to Gerontology

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  1. Introduction to Gerontology Classification and Characteristics of the Elderly Concepts and Issues Andrea M McPherson UWISON Jan 13, 2014

  2. 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

  3. 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)

  4. Gerontology and Geriatrics Differing emphasis but same goal: • Understanding aging • Helping people maximize their functioning • …Achieve highest quality of life

  5. 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)

  6. 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)

  7. 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)

  8. 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

  9. Terminologies • Age: chronological, biological, social, functional (slide below) • Ageing • Elderly • Senescence • Ageism

  10. Definition of Age • Number of years since birth Other : • Chronological Age • Biological Age • Social Age • Functional Age

  11. 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

  12. Mrs. Calendar retired at age 65. Age in this context is • Psychological • Functional • Biological • Social

  13. 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)

  14. 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).

  15. Classification of the Older Adult • Independent seniors • Dependent seniors • Seniors with disability • Seniors near end of life

  16. 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

  17. 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

  18. 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)

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

  20. 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

  21. Social-cultural Influences • Culture • Family • Education • Ascribed roles • Home and living setting • Personal image of the older person

  22. 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

  23. 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

  24. 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

  25. Economic issues • Retirement age • Costs of providing care/support • Maintaining the adequacy of pension funds • Extending pension coverage

  26. 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

  27. 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

  28. Nursing Implications • Assist patients in experiencing health, fulfillment and a sense of wellbeing. • *Nurse’s philosophy of aging influences the care she delivers.

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. Legislative & policy framework Government Ministries: • Ministry of Justice • Ministry of Labour and Social Security http://www.ohchr.org/Documents/Issues/OlderPersons/Submissions/Jamaica.pdf

  36. 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

  37. Legislative & policy framework National Policy for senior citizens • Health -**NHF , JADEP • Social activites • Income security • Education

  38. 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)

  39. 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”

  40. 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

  41. Principlism: Ethical Framework • Autonomy: respect for the elder’s choices • Beneficence: do good • Nonmaleficence: do no harm • Distributive justice • Sanctity of life

  42. Rules of Ethical Care • Veracity • Confidentiality • Fidelity

  43. 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.

  44. Ethical and Legal Issues

  45. Ethico-legal Issues Existing infringements • Ageism • Abuse • Neglect • Violence http://www.un.org/esa/socdev/ageing/documents/egm/bonn09/report.pdf

  46. 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

  47. 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

  48. Potential Legal Liability Acts • Assault • Battery • Defamation of character • Libel & slander • False Imprisonment • Fraud • Invasion of privacy • Larceny • Negligence* • Malfeasance • Misfeasance • Nonfeasance • Criminal negligence

  49. Malpractice • All of the following must be present for malpractice to exist: • Duty • Negligence • Injury

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

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