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

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

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

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

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

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

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

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

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

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

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