1. 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 ? A. Social B. biological C. functional D. Psychological

12. Mrs. Calendar retired at age 65. Age in this context is A. Psychological B. Functional C. Biological D. Social

13. Characteristics of the Older Adult Population 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: prejudice and 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 http://caribbean.scielo.org/scielo.php

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 2 nd 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 21 st century;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_ja maica 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/Subm issions/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 1 st 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/re port.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.

51. 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.

52. 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

53. 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

54. 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

55. Elder Abuse Complex: Family arrangements Carer issues Socio-cultural issues

56. Advanced Medical Directives

57. 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

58. 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.

59. 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.

60. Steps in the Process Identify the issueWhose decision is it? Does an ethical dilemma exist?

61. Does an ethical issue exist? Yes Identify ethical principles Relate principles to facts Appeal to an ethical theory No Resolve using usual problem solving methods

62. Appeal to an ethical principle Utilitarian ism Identify alternatives Predict consequences Identify positive and negative consequences Deontology Identify alternatives Rank ethical principle(s) of case Resolution

63. 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?

64. References II. Ageism: Concepts and theories http://www.lco- cdo.org/en/older-adults-lco-funded-papers- charmaine-spencer-sectionIIhttp://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%20the ories%20of%20aging.pdf Canning, D. (2011). Program on the global demography on ageing. Working paper series - the causes and consequences of the demographic transition

65. References Ageism: Concepts and theories http ://www.lco-cdo.org/en/older-adults- lco-funded-papers-charmaine-spencer-sectionII http ://www.lco-cdo.org/en/older-adults- lco-funded-papers-charmaine-spencer-sectionII Aging in the 21 st 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%2F50af6e 9c8f44b%2F&ei=BXOzUp6MBYPZkQebgYGwCA&usg=AFQjCNEOpxGzPhzfWr tQfQDMkAoeONvSiw&sig2=HF6fZKB4_zXEmuKH99vIvw

66. 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.phphttp://caribbean.scielo.org/scielo.php? script=sci_arttext&pid=S0043-31442008000600009 Eliopoulos, C. (2010). Gerontology Nursing. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

67. 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/issue s.pdf Palmore, E., (1999). Ageism:Negative and positive. Springer Publishing Co. 2 nd ed. Retrieved from http:// books.google.com.jm/books? id=Cg4_DTUuV4IC&dq=ageism+negative+and +positive&source=gbs_navlinks_s

68. References Perspectives on aging.(2007). http://www.sagepub.com/upm-data/15090_Chapter1.pdfhttp://www.sagepub.com/upm-data/ 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. 2 nd ed. National Library of Jamaica

69. Thank you Happy Ageing !!