Age

Sociocultural context of health and

healthcare deliveryAge, disability, gender & social

class and stratification

The social significance of age

O As with biological traits, we observe a person’s age when interacting with him/her.

O Significant as it defines what is appropriate and expected from people of different ages.

O For this reason we are not surprised to see a small child crying for sweets in a shop.

O We also treat children different than we would treat adults.

The social significance of ageO Age is defined in terms of the number of

years one has been alive. (chronological age).

O It is different from one’s functional age- refers to observable individual attributes such as physical appearance, mobility, strength and mental capacity.

O We automatically look at how old people are in our day-to-day lives and interaction. We look at things like grey hair, wrinkles etc.

O Society decides thus what is considered as ‘old’.

The social significance of age

O Because life expectancy differs from country to country, a 68 year old can be considered old in a society where people live to an average of about 45 years old.

The changing age structure of society

O ‘Greying of nations’- the elderly who make up a growing proportion of societies.

O Figure 3.2 illustrates that we can expect to be faced with a growing number of elderly people in society as the elderly make up a growing % of the total population.

O It is estimated that by the year 202, almost 10% of the world population will be 65 years and older.

Problems in inter-age interaction and how these manifest in healthcare

O 1) Ageism

O is stereotyping and discriminating against individuals or groups on the basis of their age

O Often the elderly are seen as unattractive, unemployable, mentally incompetent, slow, caught up in the past, demanding, absent-minded etc.

O As with all other forms of diversity, the danger for the healthcare provider lies in the fact that treatment of the elderly patient might be based on stereotypical ideas.

O It manifests in the following ways:O Marginalization.O The use of dismissive and demeaning

language.O Humour and mockery.O Physical, sexual, emotional and

financial abuse.O Economic disadvantage.O Restricted opportunities.O Psychological abuse.

O Financial exploitation typically involves the theft or misuse of the elderly person’s money.

O Medical abuse occurs when a person withholds or improperly administers medication or health aids.

O Neglect. O Abuse ( difference)

2) Ageism in nursing and how to combat it

O Thompson points out that ageism in healthcare involves dehumanisation, depersonalisation (the action of divesting someone or something of human characteristics or individuality), ageist language, elderly abuse and infantilisation.

2) Ageism in nursing and how to combat it

O Nurses should act in an anti-ageist manner:

O - personhood: ascribe value to all people of all ages.

O - citizenship: the relationship between the individual and society is acknowledge. It emphasises the rights and responsibilities of individuals in society.

O - celebration: age is to be celebrated and an achievement.

3) Senior status of the elderly

O Role conflict that nurses experience when it comes to the elderly.

O Cultural backgrounds mostly enables nurses to have respect for the elderly.

O Role conflict on ‘informing’ an older person on what to do.

O In some cases elderly people may refuse to do what is instructed.

Old age and healthO The older population usually has a lower

incidence of acute diseases than the younger population.

O They suffer from more chronic conditions. O The likelihood of having a chronic disease

not only increases in old age, but varies in sex.

O Women tend to have more arthritis and vision problems.

O Men have a higher rate of life-threatening chronic conditions such as heart disease.

Old age and healthO Whatever disease the elderly may be suffering

from, healthcare may not be always accessible. The reasons being: the bad attitude of health staff towards poor people, shortage of supplies, lack of information, lack of funds and poor implementation structures.

O In addition to this, the elderly have to wait until someone is available to accompany them to the health centres.

O The difficulty of getting to a doctor may result in many of the elderly going without proper care.

Old age and healthO A primary care giver can thus be identified as a

person who attends to the elderly person’s immediate needs.

O Usually a person within lose proximity. Often it is a female.

O Primary caregivers suffer from emotional or physical strain due to caring for the elderly

O BurdenO May have a negative effect on the quality of

care. O Old age homes.

Old age and healthO The 2001 population census found that 7.3% of the total

population were 60 years or older.28 This proportion may be perceived as low, or at least considerably lower than the 2000 proportions of some developed nations, such as Italy (24.1%), Greece (23.4%) and Japan (23.2%), but it is higher than the proportions of almost all other African nations in 2000, with the exception of the two island populations of Mauritius (9%) and Reunion (9.9%). South Africa’s 7.3% was noticeably higher than the 5.1% for the African continent as a whole, but displayed similar levels of ageing as those in such nations as Brazil (7.8%), India (7.6%), Mexico (6.9%), Samoa (6.8%) and Vietnam (7.5%). The average proportion for the Southern African region in 2000 was 5.7%, and neighbouring countries’ proportions ranged from 4.5% in Angola and Botswana to 6.5% in Lesotho.

Old age and healthO Despite the demographic impact of HIV/AIDS, the

South African proportion is projected to increase over the next two decades, and that by 2025 more than one person in ten will be 60 years or older.

O The demographic ageing of populations throughout the world is directly related to fundamental changes in the health and disease patterns within that population, as epidemiological change ensues with a change from the predominance of infectious, parasitic and nutritional disease to the growing weight of chronic diseases of lifestyle (CDL)

Old age and healthO The individual ageing process, from a medical

perspective, is often associated with disease and disability. This association has been challenged on the grounds that there are many older persons who do not suffer chronic illness or disability, and many claiming to be in good health despite the presence of chronic illness.

O However, this ‘medical myth’ is supported by morbidity and cause of-death statistics showing that diseases are usually more common among older than younger people, and that the prevalence of disability and chronic disease increases with advanced age.

Old age and healthO As in many other countries, mortality

statistics in South Africa are an important and often-used source of evidence on the health status of the population, while it is difficult to find reliably measured population-based information about disease, disability and health risks. Given the recent emphasis on reproductive, child, adolescent and maternal health in the country, it is likely to be even more difficult to find reliable representative information about disease, disability and health risks in the older population.

Selected risk and lifestyle factors for chronic diseaseO It is widely acknowledged that being

overweight or obese is associated with an increased risk of disease. The adverse metabolic effects include raised blood pressure, altered blood lipid profiles and the development of insulin resistance; these, in turn, are related to a range of chronic diseases.

Selected risk and lifestyle factors for chronic diseaseO In the population 65+ years old, 43%

of men and 60% of women had excess body weight with a BMI ≥25 kg/m2.

O This implies that large proportions of this population are at risk of a range of associated chronic conditions – including IHD, hypertensive disease, stroke, type 2 diabetes, osteoarthritis and several cancers – and the associated limitations in survivors.

DISABILITY

Disability

O"Disability is the disadvantage or restriction of activity caused by a society that takes little or no account of people who have impairments and thus excludes them from mainstream activity."

DisabilityO It is estimated that half a billion people are

disabled, worldwide as a result of physical, sensory or mental impairment.

O SA- 2 255 982.O About 5% of the South African population. O It is argued that disabilities increase yearly

as advances in medical science and demographic changes result in more people surviving life threatening conditions, only to be left with chronic ill health or impairments.

DisabilityO Disability focusses on impairment:

mental, physical, emotional).

Approaches to defining disabilities:

O Medical model of disability:O The medical model is presented as viewing

disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at a "cure," or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue

Approaches to defining disabilities:

O Impairment: the result of a biological or physical abnormality.

O Disability: the resulting restrictions in activity due to impairments.

O Handicap: a disadvantaged faced by people with disabilities that arises due to impairments and disabilities.

Approaches to defining disabilities:

ICIDH Model of disabilities:

Impairment: person with a

physical disability

Disability: cannot walk up

the stairs

Handicap: cannot get a

job application form