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Care of the Older Person – Unit 1 5N2706

Care of the Older Person

5N2706

Unit One - Ageing Process

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Care of the Older Person – Unit 1 5N2706

Following this Unit, the learner will gain understanding of:

➢ Healthy ageing.

➢ Global and national demographic trends.

➢ The normal physiological process of ageing.

➢ The normal psychological process of ageing.

➢ The social impact of ageing on older people.

➢ Attitudes to ageing and older people.

➢ Role of statutory and voluntary agencies in promoting the well- being of older

people.

➢ The retirement process.

➢ Ethnic and cultural influences on the older person.

Care of the Older Person – Unit 1 5N2706

Contents

HEALTHY AGEING & THE AGEING PROCESS ............................................................ 3

HEALTHY AGEING ...................................................................................................................... 4

Life Span Continuum ................................................................................................................. 7

BODY SYSTEMS: THE AGEING PROCESS .................................................................................... 9

THE MUSCOSKELETAL SYSTEM ................................................................................................ 12

THE RESPIRATORY SYSTEM ...................................................................................................... 16

THE CIRCULATORY SYSTEM ..................................................................................................... 17

THE DIGESTIVE SYSTEM ........................................................................................................... 20

THE NERVOUS SYSTEM ............................................................................................................ 24

THE ENDOCRINE SYSTEM ........................................................................................................ 28

THE URINARY SYSTEM ............................................................................................................. 29

THE REPROPUCTIVE SYSTEM ................................................................................................... 31

THE SENSORY SYSTEM ............................................................................................................. 32

PSYCHOLOGICAL AGEING .................................................................................... 37

Learning ................................................................................................................................... 38

Memory ................................................................................................................................... 38

Reaction time .......................................................................................................................... 39

Intelligence .............................................................................................................................. 39

Stresses & Worries .................................................................................................................. 39

SOCIAL INCLUSION & THE ROLE OF STATUTORY & VOLUNTARY AGENCIES ........... 41

ATTITUDES & STEREOTYPING .............................................................................. 46

Stereotypes of the Elderly ....................................................................................................... 47

THE RETIREMENT PROCESS ................................................................................. 49

CULTURE & ETHNICITY ........................................................................................ 54

Care of the Older Person – Unit 1 5N2706

HEALTHY AGEING & THE AGEING PROCESS

Ageing is a constant process and begins when a person is born. It is also an individual

process affecting each person differently with regards to the speed at which a

person ages and the effects of ageing. It is a natural process and does not always

lead to the certainty of disease and disability. Farley et al (2006) suggest that this

decline may not be obvious or uniform and it may not interfere with the individual’s

ability to function socially. What does happen as we age however, is that there is a

decline in bodily systems and the organs of the body to function effectively as overall

functional ability deteriorates.

There are trillions of cells in the human body and they can become damaged

immediately upon injury, or, after some time, the damage accumulates with

deterioration occurring gradually and often going unnoticed. As we age, the body

can become more vulnerable to injury and damage both internally and externally,

illness and disease can lead to death at any age, but as we become older the chances

of dying approximately doubles with every additional eight years that pass

(Wellcome Trust, 2006). Kirkwood (2003) points out that ageing is a result of a

gradual build-up of faults in the cells and tissues of the body that play a part in an

increased risk of chronic disease and death.

Normal ageing in the absence of disease is a remarkably benign process. In other

words, our body can remain healthy as we age. Although our organs may gradually

lose some function, we may not even notice these changes except during periods of

great exertion or stress. We may also experience slower reaction times. However a

number of older persons are independent and active but for some, ageing brings

frailty and chronic illness. Older people are significant users of health services and, in

the coming years, population growth combined with ageing, will mean that a greater

number of Irish persons will need access to health and community care services.

Care of the Older Person – Unit 1 5N2706

People are staying in hospital for shorter periods due to advances in medical

treatment and increased opportunities for community-based care. The majority of

elderly people are in relatively good health (Kovar, 1986a); although they usually

have one or more chronic conditions that require medical attention (DeLozier &

Gagnon, 1991). The most common complaints are cardiovascular disease,

hypertension, arthritis, hearing impairment, cataracts, glaucoma, and lower back

problems.

Elderly people also experience acute illnesses, but less frequently than younger

people. However, when they do get an acute illness such as influenza, it tends to be

more severe and of longer duration than it is among younger people. Elderly people

are hospitalised for illness more frequently than younger individuals.

HEALTHY AGEING

Healthy ageing can be defined as:

“Healthy ageing is the development and maintenance of optimal mental, social,

and physical well-being and function in older adults. This will most likely be

achieved when communities are safe, promote health and well-being and use

health services and community programmes to prevent or minimise disease.”

{West Virginia Rural Healthy Ageing Network}

Adding Years to Life and Life to Years: A Health Promotion Strategy for Older

People (Brenner and Shelley, 1998) marked the formal beginning of the Healthy

Ageing Programme in Ireland. The objectives of the strategy are:

To improve life expectancy at age 65 and beyond.

To improve the health status of people aged 65 and beyond.

To improve the lives and autonomy of older people who are already affected

by illness and impairment.

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The term ‘active ageing’ gained prominence during the 1999 United Nations Year of

Older People and was subsequently used by the WHO, who currently define active

ageing as ‘the process of optimising opportunities for health, participation and

security in order to enhance quality of life as people age’ (WHO, 2002).

Healthy ageing implies a focus on the maintenance of health, often through lifestyle

choices and preventive measures (Davey, 2002); it is concerned with increasing the

quantity and quality of life of older people. While health is an important determinant

of quality of life of older people, it is by no means the only factor that is important.

All factors that potentially contribute to the quality of life of older people (including

health, income, security, social relations, participation, empowerment etc.) must be

considered and addressed. Healthy ageing refers to the capacity of older people to

function across many domains, including the cognitive, medical, social and

emotional.

Healthy Ageing: A Challenge for Europe Project (2007), gave us the following

definition of healthy ageing;

‘As the process of optimising opportunities for physical, social and mental health to

enable older people to take an active part in society without discrimination and to

enjoy an independent life of good quality.’

The aim of the project is to promote healthy ageing in later life stages (people aged

50 plus). The project will focus on different aspects of health and promote healthy

ageing through the development of an integrated and holistic approach to health in

later life.

The ageing process is of course a biological reality which has its own dynamic, largely

beyond human control. However, it is also subject to the constructions by which

each society makes sense of old age. In the developed world, chronological time

plays a paramount role.

Care of the Older Person – Unit 1 5N2706

The age of 60 or 65, roughly equivalent to retirement ages in most developed

countries is said to be the beginning of old age. In many parts of the developing

world, chronological time has little or no importance in the meaning of old age.

Other socially constructed meanings of age are more significant, such as the roles

assigned to older people; in some cases it is the loss of roles accompanying physical

decline which is significant in defining old age. Thus, in contrast to the chronological

milestones which mark life stages in the developed world, old age in many

developing countries is seen to begin at the point when active contribution is no

longer possible {Gorman, 2000}.

According to the WHO more than one billion people will be over 60 years old by

2025 and, as population’s age, the burden of chronic diseases will increase. To help

tackle the public health implications of ageing, the World Health Organization (WHO)

launched Towards Age-Friendly Primary Health Care, new general principles that will

serve as guidelines for community-based primary health care (PHC) centres.

Today, there are 600 million people in the world aged 60 years and over. This figure

is expected to double by 2025 and to reach 2 billion by 2050, the vast majority in the

developing world. Population ageing is characteristically accompanied by an increase

in the burden of chronic non-communicable diseases (NCDs) such as cardiovascular

diseases, diabetes, Alzheimer's disease and other ageing-associated mental health

conditions, cancers, chronic obstructive pulmonary disease and musculoskeletal

problems.

As a consequence, pressure on health systems worldwide will increase. In Ireland

longevity is 72 years for men and 75 for women The Central Statistics Office (CSO)

estimates that there were 461,000 people aged 65 or over in Ireland in April 2005.

This is just over 11% (11.2%) of the total population of a little over 4 million.

According to the DOH&C {2013} the population of Ireland will begin to age rapidly in

the years ahead.

Care of the Older Person – Unit 1 5N2706

While currently just over 500,000 people in Ireland are aged 65 or over, by 2021 the

number of older people living in the State is expected to be in the region of 775,000,

a rise of 55% in just 11 years.

Generally speaking, the population of Ireland continues to be a young population in

relation to other European states. There are a number of reasons for this. One is the

relatively high birth rate (compared with other developed countries) up to the early

1980s. This resulted in a relatively large youth population. Another reason is high

emigration in the 1950s, which meant that the numbers of people reaching 65 in the

1990s and the early part of this decade were smaller than they otherwise would

have been.

Early detection, appropriate intervention, management and follow-up of chronic

conditions take place mainly at the primary health care level. Older people already

account for a sizeable proportion of PHC centre patients and as population’s age and

chronic disease rates climb, that proportion is expected to increase. PHC centres are

ideally positioned to provide the regular and extended contacts and on-going care

that older persons need at community-based level.

Life Span Continuum

The life span is a continuum indicating movement of an individual from birth to

death. According to Roper et al (1996), as a person moves along the lifespan there is

a continuous change and every aspect of living is influenced by the biological,

psychological, socio-cultural, environmental, and the politico-economic

circumstances encountered throughout life. The life span is linked to age. There are

five stages of life:

Infancy

Childhood

Adolescence

Adulthood

Old age.

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As stated previously, ageing starts from the day we are born, as we enter young

adulthood, physical signs of ageing occur.

YOUNG ADULTHOOD (20 TO 40 YEARS) Young adults typically enjoy stable, supporting friendships and good health. The

primary tasks of this stage include completing one’s education, starting a career,

and, possibly finding a partner and marrying. The young adult learns to be successful

on his or her own, and may need to adjust to living with a partner. Many young

adults choose to start families. For many women, the most significant physical

change that will occur during young adulthood is pregnancy. Otherwise, the physical

changes that occur in young adults are generally minor.

MIDDLE ADULTHOOD (40 TO 65 YEARS)

Middle adulthood frequently finds people at the height of their careers and

productivity. It also sees many middle aged adults finding themselves in the role of

caretaker to their children. As their children grow up and become less reliant, many

middle adults find that they have more time to travel or participate in leisure

activities. During middle adulthood, many people become grandparents. Physically,

the middle adult begins to show signs of ageing, such as wrinkles or a few grey hairs.

Women typically experience menopause (cessation of menstruation and fertility) in

their early 50s. Although good health is usually still enjoyed, some chronic illnesses,

such as hypertension and diabetes, become apparent during this stage.

LATER ADULTHOOD (65 TO 75 YEARS)

During this stage, normal physical changes occur as a result of ageing and the

development of chronic illnesses becomes more prevalent. Retirement may place

the older adult on a fixed income, but those who have planned wisely are able to

travel and pursue hobbies that they did not have time for when they were

employed. During this stage, many people must cope with the loss of friends or a

spouse due to death.

Care of the Older Person – Unit 1 5N2706

OLDER ADULTHOOD (75 YEARS AND BEYOND)

During this stage, a primary task is looking back on one’s life and preparing for one’s

own death. Some older adults continue to be relatively healthy and independent,

but many must adjust to failing health and a growing dependency on others. Many

older adults enjoy sharing their life’s experiences and the wisdom they gained along

the way with younger people. Reminiscing (remembering and retelling events and

experiences) helps older adults find meaning and purpose in their lives (Carter and

Goldschmidt, 2010).

BODY SYSTEMS: THE AGEING PROCESS

The systems include:

1. The skin 2. The musculoskeletal system 3. The respiratory system 4. The circulatory system 5. The digestive system 6. The urinary system 7. The nervous system 8. The endocrine system 9. The reproductive system 10. The sensory system

THE SKIN:

The skin is the largest system of the body and the largest organ. It has epithelial,

connective and nerve tissue. It has 3 layers – the epidermis, the dermis, and

subcutaneous/hypodermis layer.

The Epidermis: This is the outer, superficial epithelial layer of the skin that we can

see. It is made up of both living and dead cells. The outermost layer of the epidermis

consists of dead cells. These cells are constantly being shed, a process known as

desquamation. The bottom layer of the epidermis consists of living cells and it is at

this level that new cells are being produced.

Care of the Older Person – Unit 1 5N2706

These cells are then pushed up through the epidermis to the surface in order to

replace the dead cells, before being shed themselves. There is no blood supply in the

epidermis, minimal nerve supply and it receives nutrients from the lymphatic vessels

in the dermis.

The Dermis: This is often referred to as the true skin, the dermis is a deeper

connective tissue layer which is strong flexible and thicker than the epidermis layer.

It consists of a more complex variety of tissues, such as smooth muscle, fibrous

connective tissue, nervous tissue and blood vessels. There are also hair roots,

sebaceous glands, which produce oil within the skin and sweat glands within the

dermis.

Subcutaneous/Hypodermis layer: This third layer of tissue is structurally located

below the dermis layer. It is comprised of loose connective tissue and adipose (fat)

tissues. The hypodermis binds the dermis and epidermis to the underlying organs of

the body.

FUNCTIONS OF THE SKIN

❖ Body’s protective covering

❖ Prevents bacteria and other substances entering the body

❖ Prevents excess water loss

❖ Protects internal organs from injury

❖ It is an important sensory organ = nerve endings

❖ It helps regulate body temperature

❖ Synthesis of vitamin D

❖ Body Shape.

Care of the Older Person – Unit 1 5N2706

AGEING & THE SKIN

During ageing changes to the integumentary [skin] system occurs: changes with the

subcutaneous tissues, the reduction in muscle mass and a thinning of the dermis

make the underlying tissue more fragile. Wrinkling of the skin and a reduction in

elasticity, accompanied with an inability to respond to sensations such as heat, cold

or pressure means that the older person is more vulnerable to the development of

pressure ulcer formation.

It takes longer for some older people to repair tissue damage (for example, a surgical

incision) as there is a decrease in epithelial turnover and repair as well as a reduction

in blood flow through the skin (micro circulation) (Herbert, 2006). This can have

implications for those people who need to have topical medications applied to their

skin; they may not be able to absorb the medicines as effectively as younger people

can because of the reduced microcirculation.

The most obvious visible signs of ageing are wrinkling (most likely caused by changes

in collagen and elastic aspects of the dermis), loss of moisture and the greying and

thickening (coarseness) of hair. The sebaceous glands and sweat production reduce,

causing the skin to lose its ability to retain moisture, this in turn leads to the skin

becoming dry and scaly (Benbow, 2002). The following skin disorders may be more

prevalent in an elderly person (Koch, 2001):

Care of the Older Person – Unit 1 5N2706

❖ Itching of the skin

❖ Liver spots (lentigo)

❖ Eczema

❖ Bleeding into the skin (purpura)

❖ Benign skin tumours (for example, seborrhoea, Kerasotes)

THE MUSCOSKELETAL SYSTEM

The skeletal system serves many important functions; it provides the shape and form

for our bodies in addition to supporting, protecting, allowing bodily movement,

producing blood for the body, and storing minerals. Its 206 bones form a rigid

framework to which the softer tissues and organs of the body are attached. Vital

organs are protected by the skeletal system. The brain is protected by the

surrounding skull, as the heart and lungs are encased by the sternum and rib cage.

The axial skeleton consists of bones that form the axis of the body and support and

protect the organs of the head, neck, and trunk. The skull is the bony framework of

the head. It is comprised of the eight cranial and fourteen facial bones. The sternum

is a flat, dagger shaped bone located in the middle of the chest. The ribs are thin,

flat, curved bones that form a protective cage around the organs in the upper body.

They are comprised of 24 bones arranged in 12 pairs. The vertebral column (also

called the backbone, spine, or spinal column) consists of 33 irregularly shaped bones,

called vertebrae, which are: 7 cervical; 12 thoracic; 5 lumbar vertebrae; 5 sacral

vertebrae fused into a single bone and, 3-5 coccyx bones fused together.

Movement is carried out by the interaction of the muscular and skeletal systems.

Muscles are connected to bones by tendons. Bones are connected to each other by

ligaments. Where bones meet one another is typically called a joint. Muscles which

cause movement of a joint are connected to two different bones and contract to pull

them together. An example would be the contraction of the biceps and a relaxation

of the triceps. This produces a bend at the elbow.

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The contraction of the triceps and relaxation of the biceps produces the effect of

straightening the arm.

Blood cells are produced by the marrow located in some bones. An average of 2.6

million red blood cells is produced each second by the bone marrow to replace those

worn out and destroyed by the liver. Bones serve as a storage area for minerals such

as calcium and phosphorus. When an excess is present in the blood, build-up will

occur within the bones. When the supply of these minerals within the blood is low, it

will be withdrawn from the bones to replenish the supply.

Bone Composition: Bones are composed of tissue that may take one of two forms.

These are compact or dense bone and spongy or cancellous bone. Most bones

contain both types. Compact bone is dense, hard, and forms the protective exterior

portion of all bones. Spongy bone is inside the compact bone and is very porous (full

of tiny holes). Spongy bone occurs in most bones.

See below Gross Anatomy of Bone image:

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AGEING & THE MUSCULAR SKELETAL SYSTEM

According to Eliopoulos (2005), there is a decrease in bone and muscle mass (the

loss of muscle mass also affects other systems of the body, for example, the muscles

of the heart and the intercostal muscles associated with respiration) and muscular

weakness. The rate of bone re-absorption and new bone formation is altered as the

person ages. There is more bone re-absorption than bone formation making the

bones of older people more brittle.

Osteoporosis, osteoarthritis and an increase in fractures are potential consequences

that are associated with the ageing process.

The amount of skeletal muscle fibres decrease with age along with a reduction in

muscle fibre size. There is often a decrease in the individual’s strength and stamina

(Amella, 2004). Joints can become stiff as engagement in exercise decreases, as well

as a consequence of the production of synovial fluid becoming more viscous. The

tendons and ligaments can shrink and become hard and fixed, with joints increasing

in size adding to problems associated with joint mobility (Eliopoulos, 2005).

Limitations may be imposed by the structural and functional effectiveness of

cardiovascular and/or respiratory systems.

There may also be a psychological element that needs to be given consideration, for

example, isolation and loneliness may result in a lack of motivation, and the person

may lack confidence (particularly after a fall) or self-esteem. Physically, the individual

can experience height loss caused by a reduction in bone mass and thinning of the

vertebral discs, there can be an accompanying shortfall in fluid content within the

intervertebral discs causing a narrowing of joint space.

Postural changes can be the result of spinal curvature, leading to modifications in

relation to the person’s centre of gravity (Farley et al, 2006), that can increase the

risk of falls.

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THE RESPIRATORY SYSTEM

The respiratory system consists of the upper tract and a lower tract and the thoracic

cage. Respiration is the process of supplying the cells with oxygen {O2} and removing

carbon dioxide {CO2}. It involves a process of inhalation and exhalation. The upper

respiratory tract consist of the nose = air enters, and then passes into the PHARYNX,

then into the LARYNX. A piece of cartilage called the EPIGLOTTIS acts like a lid over

the larynx to prevent food entering the airway during swallowing. During inhalation,

the epiglottis lifts up to let air pass. Throughout this stage air is humidified and

warmed.

The lower respiratory tract is contained within the thoracic cavity, and involves air

passing into the TRACHEA [windpipe} a tubular pipe made up of cartilage and lined

with mucosa membrane with small hair like projections called cilia which push out

foreign dust particles. The trachea divides into the left bronchus and the right

bronchus.

Each bronchus enters a LUNG and there the bronchi divide into BRONCHIOLES and

continue to subdivide ending in air-sacs called ALVEOLI. The alveoli are a subdivision

of the bronchioles and look like a small cluster of grapes, they are supplied by

capillaries and within the alveoli the exchange of oxygen and carbon dioxide takes

place via the capillaries.

The lungs are cone shaped, with the right lung being shorter, broader and larger

than the left. The right lung has three lobes and the left lung has two lobes, both

lungs are spongy tissues and are separated from the abdominal cavity by a muscle

called the diaphragm. Each lung is covered with a sac called the pleura.

Care of the Older Person – Unit 1 5N2706

AGEING & THE RESPIRATORY SYSTEM

As we age, the lungs become less efficient. Lung tissue loses some of its ability to

expand and bounce back – the diaphragm and intercostal muscles become weaker. A

serious deterioration in the functioning of the respiratory system will have an effect

on the person's ability to breathe. This, in turn, will affect their ability to perform

everyday activities. As we get older we are more prone to respiratory infections as

the lungs become les elastic.

THE CIRCULATORY SYSTEM

The cardiovascular system refers to the heart and blood vessels such as the arteries,

veins and capillaries which carry blood throughout the body. As blood is

continuously pumped out from the heart and around the system in two circuits, it

carries oxygen and vital nutrients to all parts of the body and removes waste

products from tissue.

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The heart and blood are the transport system in the body, an adult has 5/6 litres of

blood in their body. The composition of blood includes; red blood cells, white blood

cells and platelets which are suspended in watery liquid called plasma. Plasma makes

up 55% of blood volume; it is a straw coloured fluid and consists of 90 – 92% of

water. It transports the following substances around the body:

❖ Mineral salts

❖ Nutrients

❖ Waste

❖ Hormones

❖ Enzymes

❖ Gases

❖ Antibodies and antitoxins

Red blood cells have a life span of 120 days, they are made in the bone marrow of

the sternum and ribs and broken down in the spleen and liver. The vitamins

necessary for the formation of red blood cells are:

❖ Vitamin B12

❖ Folic acid

❖ Iron

White blood cells are larger than red blood cells, and there are two main types:

granulocytes – defend against viruses and bacteria and non granular leucocytes –

lymphocytes (formed in lymphatic tissue and monocytes – eat bacteria known as

phagocytosis). Their function is to protect the body from certain diseases. Platelets

are formed in the red bone marrow and play an important function in blood clotting.

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Functions of blood:

Transport of materials

Temperature regulation

Defense against disease

Blood clotting

The Heart: is a hollow muscular organ which lies behind the sternum to the left. It is shaped like a cone. The heart is surrounded by the pericardium which allows friction free movement. The cardiac muscle does not fatigue and the heart has its own blood supply (coronary arteries and veins). Factors affecting heart rate include:

Exercise

Excitement

Raise in temperature

Strenuous work

Fear

Fright

Stimulants

Inactivity

Sleep

Depression.

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AGEING & THE CIRCULATORY SYSTEM

The cardiovascular system can be greatly affected by individual lifestyle choices, for

example, if the person smokes and the degree of exercise they engage in.

Cardiovascular dysfunction results in significant mortality and morbidity in the

elderly (Evenden and Gesty, 2007).

Changes occur to the structure and function of the cardiovascular system; the veins

and arteries (i.e. the aorta) stiffen, becoming less elastic, in some instances dilation

can also occur, which, as the lumen of the vessels become bigger, can cause an

increase in cardiac workload (Lakatta and Sollot, 2002). Pathological changes can

cause a disturbance in the formation of new vessels and this can have a systematic

impact, as well as a specific impact, on the vessels of the brain and in the heart.

As the person ages, the activity associated with electrical impulses may be reduced

resulting in cardiac problems such as a reduction in the heart’s ability to pump blood

effectively (Eliopoulos, 2005). Blood flow can be restricted as fibrosis and

atherosclerosis occurs, leading to chest pain and angina for example. Overall, with

ageing the following occurs:

❖ Diminished cardiac output

❖ Diastolic murmurs

❖ A reduction in the ability to respond to changes in the blood pressure

❖ Poor perfusion to vital organs such as the brain.

THE DIGESTIVE SYSTEM

Also called the gastrointestinal system and is involved with the physical and chemical

breakdown of food. Thus, nutrients can be absorbed by the body cells via the blood

stream in order to provide the body with energy and fuel for growth and repair. The

digestive system is structured as follows, except for the mouth and pharynx:

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❖ Outer fibrous layer

❖ Muscle layer of circular and longitudinal fibers

❖ Submucosa {a connective tissue with blood vessels and nerves}

❖ Mucosa {inner layer which secretes digestive juices}

FUNCTIONS

Ingestion

Digestion

Absorption

Elimination

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ORGANS & STRUCTURES

ORAL CAVITY: digestion begins in the mouth, using chewing motions the teeth cut,

chop and grind food into small particles to aid swallowing. The tongue aids in

chewing and swallowing and the taste buds on the tongue allow the various tastes to

be sensed. The 3 pairs of salivary glands in the mouth secrete saliva which moistens

food particles to ease swallowing. During swallowing, the tongue pushes food into

the pharynx.

THE PHARYNX: {throat} is a muscular tube which lies behind the mouth and here

swallowing continues as the pharynx contracts. This is involuntary. The food is then

pushed along into the oesophagus.

THE OESOPHAGUS: muscular tube about 25 cm. It is long and narrow extends from

the pharynx to the stomach just below the diaphragm. The walls of the oesophagus

are lubricated by mucus which assists the passage of the bolus of food. Involuntary

contractions called peristalsis move the bolus of food down the oesophagus into the

stomach.

THE STOMACH: is J-shaped and situated in the upper left part of the abdominal

cavity. Within the stomach, chemical and physical digestion occurs and the strong

muscles within the stomach churn food, thus breaking it up into tiny particles.

Gastric juices are secreted and the food is mixed with them to form a substance

called chyme. Through peristalsis, the chyme is pushed into the small intestine.

SMALL INTESTINE: {small bowel} is continuous with the stomach at the pyloric

sphincter. It is approx. 15 to 20 feet long and is divided into sections.

The Duodenum: is c-shaped around the head of the pancreas. In the

duodenum, digestive juices are added to the bile, these include bile from the

gallbladder and pancreatic juices.

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The Jejunum is the middle part and the ileum is the end part. Villi line the

small intestine and absorb the digested food into the capillaries. The function

of the small intestine is to complete chemical breakdown and to undertake

absorption of nutrients.

THE LARGE INTESTINE: {large bowel / colon} = = is about 5 feet long and begins at

the caecum and ends at the rectum. The large intestine forms an arch round the

coiled up small intestine. The large intestine is divided into:

The caecum

The ascending colon

The transverse colon

The descending colon

The sigmoid

The rectum/anal canal.

When the undigested chyme passes from the small intestine into the large bowel,

water is absorbed from the chyme. The remaining waste, called faeces, is stored in

the sigmoid and then passes into the rectum by peristalsis.

THE ANAL CANAL: leads to the exterior at the anus and is controlled by internal and

external sphincter muscles. Here faeces is expelled from the body.

AGEING & THE DIGESTIVE SYSTEM

There is a decrease in taste, smell, saliva secretion, gastric acidity, gastric

movements, appetite and absorption. Along with this there is an increase in

problems associated with dentures, chewing and constipation. Constipation, more

common in older adults due to slowed circulation, reduces the sense of thirst, and

results in a lessened activity level. Emotions play a significant role in appetite and

digestion.

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Tooth enamel thins and periodontal disease rate increases. Also the effectiveness of

the gag reflex lessens, resulting in increased risk of choking.

THE NERVOUS SYSTEM

The central nervous system (CNS) acts as the command centre of the body. It

interprets incoming sensory information, and then sends out instructions on how the

body should react. The CNS consists of two major parts: the brain and the spinal

cord.

The peripheral nervous system (PNS) is the part of the nervous system outside of the

CNS. PNS contains only nerves and connects the brain and spinal cord to the rest of

the body. The PNS can be divided into two systems: the somatic nervous system and

the autonomic nervous system.

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The autonomic nervous system control activities in the body that are involuntary or

automatic.

These include the actions of the heart, glands, and digestive organs and associated

parts of the autonomic nervous system can be divided further into two subdivisions:

the parasympathetic and sympathetic nervous systems.

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The brain is composed of three parts: the cerebrum (seat of consciousness), the

cerebellum, and the brain stem (these latter two are "part of the unconscious

brain"). The cerebrum or cortex is the largest part of the human brain. The cerebrum

coordinates sensory data and motor functions and governs intelligence and

reasoning, learning and memory.

The Cerebellum: The cerebellum, or "little brain", is similar to the cerebrum in that it

has two hemispheres and has a highly folded surface or cortex. This structure is

associated with regulation and coordination of movement, posture, and balance.

The Brain Stem: is made of the midbrain, pons, and medulla and is involved with the

regulation of heartbeat, breathing, blood pressure and reflex centres for vomiting,

coughing, sneezing, swallowing. The hypothalamus regulates homeostasis. It has

regulatory areas for thirst, hunger, body temperature, water balance, and blood

pressure, and links the nervous system to the endocrine system.

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AGEING AND THE NERVOUS SYSTEM

There are a number of health-related issues that are associated with the ageing

process and the nervous system, for example:

Dementia (including Alzheimer’s disease)

Delirium

Depression

Epilepsy

Insomnia

Parkinson’s disease.

As the person ages, the weight of the brain declines along with a reduction in the

size and density of neurons. This decline can have an impact on cognitive

functioning, memory and learning, and changes associated with the nervous system

can impinge on effective communication with others.

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Different parts of the brain are concerned with different functions; the nervous

system controls everything from breathing to memory and intelligence and, as such,

when the effects of ageing impacts on the functions of the brain, this will have an

effect on other bodily systems. Nerve cells are the basic unit of the nervous system.

Nerve cells are easily damaged by toxins and lack of oxygen and are unable to

replace themselves. Therefore, nerve damage is permanent and is responsible for

many cases of mortality and morbidity.

THE ENDOCRINE SYSTEM

This system is a collection of hormone producing glands and cells which are located

in different parts of the body. Hormones are complex chemical substances that are

secreted into the blood stream and regulate bodily functions such as metabolism,

growth, and sexual reproduction.

The endocrine system of human beings consists of the following glands:

❖ Hypothalamus and pituitary gland

❖ The pineal gland

❖ The thyroid gland

❖ The parathyroid glands

❖ The adrenal glands

❖ Islets of Langerhans (pancreas)

❖ Ovaries (female)

❖ Testes (male).

AGEING AND THE ENDOCRINE SYSTEM

With age, the level of hormones in the body decreases i.e. there is a decrease in the

amount of oestrogen and progesterone. The decrease in oestrogen results in a loss

of calcium, causing bones to become more brittle. Insulin becomes less effective.

There is an increase in the numbers of older people being diagnosed with type 2

diabetes.

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THE URINARY SYSTEM

The urinary system, sometimes called the urinary tract or the renal system, consists

of:

❖ 2 kidneys

❖ 2 paired ureters

❖ Urinary bladder

❖ Urethra

The role and purpose of the organs that comprise the urinary system are to ensure

that the waste products that are derived after the food that is eaten or the fluid

drunk, are removed by the body via the blood stream, mainly by the liver and

kidneys.

Two Kidneys: Each kidney is about 10-12.5cm long and as blood passes through

them they filter out waste products that will be excreted from the body as urine.

Two Ureters: Each kidney has a ureter, which carries urine away from the kidney

into the bladder.

The Bladder: The bladder is a hollow muscular organ, which stores urine until it is

expelled.

The Urethra: The female urethra is short (4cm) which causes frequent urinary tract

infections. It lies just in front of the vagina. The male urethra is about 20cm long.

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AGEING AND THE URINARY SYSTEM

With age there is a decrease in kidney filtration due to the reduction in the number

of nephrons within the kidney. A nephron is a tiny tube that continuously filters the

blood to form urine.

With age, the system becomes less efficient in the removal of waste from the blood,

resulting in decreased muscle tone, risk of incontinence, enlargement of the

prostate gland, increased risk of urinary tract infection.

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THE REPROPUCTIVE SYSTEM

The male reproductive system contains:

❖ Ureter

❖ Bladder

❖ Vas deferens

❖ Prostate gland

❖ Erectile muscle

❖ Epididymis

❖ Testes

❖ Scrotum

❖ Foreskin

❖ Urethra

❖ Penis

❖ Erectile muscle

❖ Seminal vesicle.

Female reproductive system contains:

❖ Fallopian tubes

❖ Uterus (womb)

❖ Cervix

❖ Ovaries

❖ Cervical canal

❖ Vagina.

Problems associated with the reproductive system and ageing include thinning and

drying of the vaginal wall. Men can experience a decrease in sperm and difficulty

with erections. The prostate gland may enlarge, putting pressure on the urinary

system. Despite what many people think, sexual needs continue into old age and

older couples have a healthy sex life.

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THE SENSORY SYSTEM

Humans have 5 senses = touch, taste, smell, sight and hearing. Our sensory system

allows us to interact with the environment, as the senses are based on receptor cells

called sense organs. Receptors respond to stimuli and send nerve impulses along

sensory neurons, where the brain interprets and thus, we perceive the impulse as

one of our senses.

The skin is the organ which contains the receptors for touch and temperature; it is

able to receive sensations of pressure, heat, cold and pain. Receptors on the skin are

found at different concentrations at different areas on the body. Receptors for taste

are located on the tongue at the taste buds – papillae {which are the small

projections on the tongue}. The taste buds are located at the top and the sides of the

tongue.

There are 4 different taste receptors: sweet, sour, salt, and bitter. The sense of taste

is a combination of taste, smell, texture and temperature. The sensory organ for

smell is the nose; the olfactory epithelium within the nose is the organ of smell,

perceiving odours when the cells are stimulated. Smells are transmitted to the

olfactory bulb and continue on to the brain.

The eye is the sensory organ of sight and transmits visual images to the brain for

interpretation; the eye socket lies within the bony orbit of the skull. 6 cranial nerves

serve the eye and they co-ordinate the actions of 6 muscles which control eye

movement.

The optic nerve carries the impulses to the visual centre of the brain. The eye is

protected by the eyelids and the conjunctivae and lubricated by the lacrimal

apparatus when tears are produced by lacrimal glands.

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Structure of the Eye:

Sclera: outer white layer of the eyeball, it helps maintain shape and protects

delicate internal parts as it is covered with conjunctiva and bathed by

lacrimal tears. Cornea: is the transparent, powerful lens of the eye and

contains no blood vessels. The cornea bends the light towards the retina.

The Iris: coloured ring of muscle fibers located behind the cornea and in

front of the lens. It contracts and expands opening and closing the pupil in

response to the brightness of surrounding light.

The ear is the organ for hearing and balance. In hearing, the ear detects vibrations,

frequency and amplitude, these become nerve impulses which are carried to the

brain. For hearing to occur, sound waves travel by air conduction {waves travel in the

air through the external and middle ear to the inner ear} and by bone conduction

{sound waves travel through bone to the inner ear}. For balance, the ear detects the

direction of motion, acceleration and head position related to gravity. There are 3

sections to the ears: the outer, the middle and the inner ear:

THE OUTER EAR : The Pinna = collects sound waves and channels them into

the external auditory canal. Auditory canal = is a tube that carries sound

vibrations to the eardrum. Wax and hairs prevent foreign material entering

the ear. The tympanic membrane {eardrum} = is a small tight membrane

that separates the outer ear from the middle ear.

THE MIDDLE EAR: located in a small air-filled cavity in the temporal bone

called the tympanic cavity. Ear ossicles = hammer, anvil, stirrup are three

tiny bones in the middle ear which transmit and amplify the vibrations of

the eardrum to the inner ear. Eustachian tube = runs from the middle ear to

the pharynx, when it opens the air pressure on both sides it allows the

eardrum to vibrate freely so accurate sound sensations are generated, it

also keeps air pressure equal on both sides.

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THE INNER EAR: Consists of a bony labyrinth. Oval window = is a flexible

partition allowing transfer of vibrations from the middle ear to the inner

ear. Round window = flexible partition which deepens the pressure change

in the inner ear. Cochlea = is spiral shaped and is responsible for the

conversion of sound waves into nerve impulses. Auditory nerve = is the

nerve that carries impulses from the cochlea to the brain's hearing centre.

Semi-circular canals = detect direction of motion and acceleration and are

responsible for balance.

AGEING AND THE SENSORY SYSTEM

Sight, among all other senses, is the most highly valued and loss of vision can have

enormous consequences on the quality of life for any individual (Royal National

Institute for the Blind, 2006). Being blind or partially sighted can lead to loneliness,

depression and loss of independence (Vale, 2004).

As a person becomes older, retro-orbital fat diminishes causing recession of the eye.

Loss of elastic tissue found in the eyebrow and the upper eyelid can cause an

occlusion of upper visual field, the same can occur to the lower eyelid, it can droop

and result in a separation of the lids from the eye and causes problems with the

usual drainage of tears. Tear production decreases, the eye becomes dry, the

conjunctiva and the cornea become thinner and changes occur with the iris and the

size of the pupil.

This can lead to difficulties with accommodation of light and hence potential

challenges which, for example, can impact on a person’s ability to read instructions

on medication labels.

The lens can thicken and lose flexibility, failing to change shape and adapt to near

vision (Farley et al, 2006); cataracts form and blurred vision can ensue, the person

experiences a lack of visual acuity.

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Olfaction (sense of smell) is the sense, along with taste, that is considered a chemical

sense; they are called chemical senses as they sense chemicals, and smells are

chemicals. Being able to use the olfactory system effectively allows the individual to

sense their environment and to gain information from it.

Anosmia is the term that is used to describe loss or disturbance of the sense of

smell. There is a reduction in the cells of the olfactory bulb situated in the brain as

well as the number of sensory cells in the nasal lining (Koch, 2001). Loss of the sense

of smell can bring with it loss of appetite (anorexia), anxiety and depression.

Herbert (2006) notes that there can be a reduction by two thirds in the number of

taste buds present between childhood and age 80 years. Loss of taste is exacerbated

by a reduction in the amount of saliva an older person produces and this can, in turn,

diminish the pleasures associated with eating. Saliva contains an enzyme amylase,

this chemical is responsible for beginning the process of digestion, and a lack of

amylase can cause nutritional problems. Loss of teeth combined with reduced

salivary output and associated impaired muscle mass, can cause difficulties with

chewing. It must also be remembered that neurological (including psychological)

problems can also impact on the ability to chew, swallow, taste, and enjoy food.

As we age, touch sensations can become affected. There is an overall reduction in

touch sensation in the finger tips, palms, soles and lower extremities (Sinfield, 2007).

Peripheral neuropathy (a disease of the peripheral nerves which causes muscle

weakness, atrophy, pain and numbness) can occur; this can result in danger as the

person may not be able to sense hot surfaces. Herbert (2006) states that as the

person becomes much older, they develop an increased sensitivity to pain as a result

of excessive thinning of the skin, allowing nerve endings to become more stimulated.

As the human body ages, the structures associated with hearing begin to decline.

The eardrum thickens and the small inner bones of the ear and other structures in

the ear become affected as a result of ossification, the auditory canal narrows.

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There is a reduction in the vibratory function of the tympanic membrane leading to a

decreased efficiency in sound conduction. There may be an increase in the

production of cerumen (ear wax), loss of hearing, impaired sound transmission and

tinnitus (Amella, 2004). The older person, as a result of changes associated with

hearing, may develop an increased sensitivity to loud noises. Conversely, the person

may not be able to hear as well as they could and they may have to increase their

efforts to recognise speech (Sinfield et al 2007).

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PSYCHOLOGICAL AGEING

As we age, processing of information becomes slower and as a result we become

less efficient at problem solving. There is also much decline now in working memory.

Most people at this stage of adulthood do not feel hampered by these changes.

Certain aspects of cognitive functioning seem to decline in late adulthood. Studies

indicate that performance on IQ tests is relatively stable up to around 60. After this a

steady decline is often noticeable in areas which measure psychomotor skills,

attention, memory, inductive reasoning and quickness of response. However, social

knowledge, verbal-conceptual ability and mathematical reasoning, do not appear to

be affected by the ageing process (Horn and Donaldson, 1960).

Late adulthood is seen by many theorists as a time of continuing psychological

growth. The development tasks of the older adult include adjusting to declining

physical powers and health, coping with retirement and limited income, and

adjusting to the death of a marriage partner.

Erikson’s Theory – during old age, according to Erikson (1968), the individual must

resolve the crisis he describes as ego integrity versus despair. As people approach

the end of their lives they tend to look back and evaluate the decisions they have

made and the actions which influenced their lives.

This review should ideally lead to feelings of satisfaction and acceptance that the life

one has lived is meaningful and important. Such feelings lead to high ego integrity.

The person whose life review reveals feelings of regret and disappointment that life

has been unsatisfactory and unfulfilling will experience feelings of despair.

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Learning

The ability to learn continues throughout life, although we may learn in different

ways as we age.

Older people often require more time and effort to absorb new information. We

may need to read instructions more carefully to be able to organise and understand

new information. As people get older, they tend to avoid learning things that are not

meaningful or rewarding, or that cannot be linked to one of the senses, such as sight

or hearing. The reasons for these changes in learning are not known, but they may

be partly caused by changes in sight, hearing, and other senses that we use for

memory.

Memory

Older people may have trouble remembering some things, but not others. Short-

term memory (i.e. less than 30 minutes) worsens as a person ages. Although we

often hear that long-term memory (weeks to months) also worsens as we age, this

may depend more on getting information into our memory, rather than

remembering it later.

Very long-term memory (months to years) is basically permanent, collected through

a lifetime of day-to-day education and experience. This type of memory increases

from the age of 20 to about the age of 50 and then remains essentially the same

until well after 70.

Most of us learn to adapt to changes in learning and memory. We slow down and do

things more carefully. We think about things a little longer to remember them. We

may avoid new or strange environments. As a result, any memory losses may not

even be noticed until we experience a major life change, such as moving or the

death of a spouse.

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Reaction time

As we age, we tend to process information at a slower pace. This means it takes

longer to figure out what is going on and what to do about it (if anything). Most of

this "slow down" is caused by changes in the nervous system over time.

We tend to slow down even further when doing tasks that require more thought or

are more complicated. When an event is a surprise, we are particularly slow to

respond. However, older people tend to make fewer mistakes in their responses

than younger people.

Intelligence

Whether intelligence declines as we age is greatly debated. Although overall

intelligence stays about the same throughout life, older people don’t do as well as

younger people on many standardised intelligence tests. In formal tests of

performance, older people also slow down with age – but, they make fewer

mistakes. This is because we learn to value correctness as we age. So although a

person may be slower to respond, their answers are more accurate. Older people

tend to be more cautious and less willing than younger people to make a mistake in

judgment, which is a valuable characteristic in many real-life situations.

Stresses & Worries

Older adults often must face a great number of stresses that can be caused by a

broad range of events and situations. Stresses can be physical or social. They can be

an ongoing part of day-to-day life, or caused by sudden traumatic events. Common

stresses for older people include the following:

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Diseases or health conditions, possibly chronic (eg, arthritis)

Perceived loss of social status after retirement

Death of a spouse

Stress often affects our physical health and can have an even stronger effect on our

mental well-being. Too much stress can be associated with a number of

psychological and physical conditions, such as anxiety, headaches, and ulcers.

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SOCIAL INCLUSION & THE ROLE OF STATUTORY &

VOLUNTARY AGENCIES

A socially inclusive society is defined as one where all people feel valued, their

differences are respected, and their basic needs are met so they can live in dignity.

Social exclusion is the process of being shut out from the social, economic, political

and cultural systems which contribute to the integration of a person into the

community (Cappo, 2002).

Social inclusion, community inclusion, social connectedness, normalisation, social

integration, social citizenship - all these are terms that relate to the importance of

the links between the individual members of our society and the role of each person

as a member of this group.

A relatively high proportion of older people, a majority of whom are women, are at

risk of poverty and social exclusion and this risk is exacerbated when they are living

alone. Income support and accessibility of services is critical to their quality of life.

The ageing of the population, including increasing longevity, leads to greater

demands for care for older people.

A new report funded by the Centre for Ageing Research and Development in Ireland

(CARDI), finds that while growing old in rural areas can be a positive experience;

there are also a number of factors which may lead to older people experiencing

social exclusion.

The research calls for more innovative ways to support local areas to assist and

engage older people in rural society and presents recommendations in order to

assist in this task and to reduce the potential for older people to be excluded in rural

communities.

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The report ‘Social Exclusion and Ageing in Diverse Rural Communities’, was

launched Monday, 20 February 2012 at NUI Galway by Ireland’s Minister of State for

Disability, Equality, Mental health and Older People, Kathleen Lynch TD, and

Northern Ireland’s Minister for Agriculture and Rural Development, Michelle O’Neill

MLA.

Led by researchers at the Irish Centre for Social Gerontology (ICSG) and Queen's

University Belfast, it identified five areas where older people living in rural areas

could be excluded. These domains of exclusion are:

(1) Social connections

(2) Social resources

(3) Services

(4) Transport and mobility

(5) Safety, security and crime

(6) Income and financial resources

Key Findings of the Report where:

Four factors were identified which can determine the extent that a person is

excluded: (1) individual capacities; (2) life-course trajectories; (3) place and

community characteristics; and (4) macro-economic forces.

Using these findings, ageing strategies being developed in Ireland and

Northern Ireland have the opportunity to develop new programmes to

combat social exclusion among rural dwelling older people.

Maximizing the autonomy, capacity and engagement of older people as well

as building inter-generational solidarity in rural communities, is the key to

tackling social exclusion.

Professor O'Shea made the following statement on the findings of the report;

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“Our findings suggest that an older person’s experience of exclusion across these

domains is influenced by such factors as individual disposition, life transitions,

place characteristics, and macro-economic forces. It is this influence that

determines the depth and extent of exclusion experienced.

We came across many older people living in what would appear to be difficult

circumstances, but a sense of belonging and keeping connected in their

communities helped to maintain their quality of life.” {Professor Eamon O’Shea, of

ICSG}.

In conclusion, older people in the study were generally happy with their lives and

with where they lived and were optimistic about the future. However, factors such

as service depletion, weak social connections and older people’s low expectations,

were highlighted as risk factors contributing to social exclusion among older

populations.

Over the years there have been a number of reports which have contributed to

health and welfare policies for the older person, the most notable of which are:

Care of the Aged Report (1968)

Planning for the Future (1984)

The Years Ahead (1988)

Shaping a Healthier Future (1994)

Health Promotion Strategy (1995)

The National Health Promotion Strategy (2000 - 2005)

Quality and Fairness - a System for You (2001).

Voluntary bodies such as the Alzheimer’s Society, St. Vincent de Paul Society, Friends

of the Elderly and various Church bodies, provide a wide range of social services for

the older person in the community and greatly enhance the State’s input in this

important area of care.

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In recent years, the impact resulting from public/private partnerships in the care of

older people, has been most evident in the areas of nursing care and housing.

Private funding, together with voluntary aid, has helped to highlight the needs of

older people.

In Ireland, services for older people are provided by a mixed economy of welfare

involving: the state and private enterprise voluntary bodies. Because the care

available was not sufficient, private nursing homes emerged in the 1960s alongside

the development of the health and social policies for the elderly, to inject much

needed private funds into the care of older people.

Nursing homes were an entirely new concept in the care of the older person and

quite novel at the time. Up to that time, nursing homes provided birthing facilities

for mothers who wished to enjoy private care. Because nursing homes were

privately owned and operated, fees were charged to their residents for nursing care

and maintenance.

This meant that only the middle income retiree could afford the service. As the 20th

century drew to a close however, private nursing homes were responsible for the

care of approximately fifty per cent of the older population in the Republic of

Ireland.

Nursing homes managed by voluntary church bodies and religious orders have

contributed enormously to the health and welfare of the older person in Ireland over

the years. The service they have given and are still giving is significant. Voluntary

bodies and religious orders look after the nursing needs of approximately 10% of the

elderly population.

An important service, which emerged following the 1970 Health Act, was the

Home Help Service in 1971. The main objective of the scheme was to assist and

encourage persons who can remain in their own homes to do so by providing them

with the necessary support.

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The tasks of the home help carer vary depending on the circumstances of the

person. The majority of home help carers were/and still are employed on a part-time

basis and the elderly are the main beneficiaries under this scheme. The length of

carer involvement was approximately two hours per day.

The carer’s remit would be to supervise the older person’s activities of daily living

and perhaps prepare a hot meal for him/her. Now the role of the home support

worker in the community is based solely on personal care and hours allocated are

greatly reduced.

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ATTITUDES & STEREOTYPING

Ageism is a word coined to mean the unwarranted application of negative

stereotypes to older people. Stereotyping is the name given to the thoughts and

views you may have about a group of people. This usually comes from stories,

impressions, and misunderstandings or from your own experience. All persons from

a particular group are judged to be the same. Phair (2003) tells us about the

powerful effects of stereotyping, for example our beliefs can affect our attitudes and

actions.

Phair (2003) points out that in order to work with older people; we must first think

about our own attitudes, in particular whether we value them as full and equal

members of society. We need to understand and explore our own feelings about

older people if we are to be true and sincere when offering them care and support.

If you thought that all old people were incontinent, then you would make sure that

the environment was adapted to cope with this, all the chairs had plastic covers. If

you thought that all older people were deaf, then you would raise your voice

whenever you spoke to an older person. If you know through your own experience

and education that neither of these are true, then you will treat the older person in

the same way you would the general public, taking into account that we are all

individuals.

Beckett (2002) points out people can become what others label them. Beckett

(2002) reminds us that labelling theory describes the way that people tend to live to

deviant labels that are applied to them. Attitudes to increasing age vary considerably

across cultures. In many traditional societies, chronological age is not a factor, partly

because the years are not counted. However, Keith (1990) found that in advanced

industrial nations, chronological age promotes social differentiation.

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Historical and anthropological evidence reviewed by Fry (1985) and Tout (1989)

shows, that in many societies, elderly people retain their status, authority and social

involvement.

Even within Western societies whose economic status is similar, policies and

attitudes towards the elderly vary. For example, in Greece there is a general view

that people retain their vigour well into their late 70s and should be cared for and

involved within the family (Amira, 1990). In Denmark, there is a policy of state

funded institutional support which ensures the care of the elderly, but which also

results in their separation from relatives and greater problems of loneliness

(Jamieson, 1990).

Stereotypes of the Elderly

In British and American societies, attitudes towards the elderly are somewhat

paradoxical. On the one hand, we respect the wisdom and experience of many

professional people, such as judges and politicians, who are past the normal age of

retirement. On the other hand, there are many negative attitudes associated with

ageing, and stereotypes abound in many areas of life. Schmidt and Boland (1986)

found a range of different stereotypes, from ‘perfect grandparent’ at the positive

end to ‘bag lady’ and ‘vagrant’ at the negative.

Stereotypes of the elderly tend to contain some negative components, whatever the

age group of the perceivers (even older people themselves). However, the most

negative stereotypes appear to be held by children and adolescents (Goldman and

Goldman, 1981). Over 800 children aged 5 – 15 from Australia, England, Sweden, and

the USA were interviewed about their perceptions of old age. Though there were

some variations among interviewees, there were two general patterns of response:

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Children of all ages were more likely to say negative things about the elderly

than positive; this kind of response was more likely as the age of the

respondents increased. Over 90% of 15 year olds described elderly people in

negative terms.

The researchers commented on the revulsion and often disgust expressed

about old age. Remarks about physical attributes (feebleness, wrinkled skin,

sickness, etc.) and psychological characteristics (bad tempered, slow to

understand or react, etc.) were common.

There may be many reasons why old age is perceived in such a negative way. Jackson

(1992) suggests that diminishing physical attractiveness may be one reason.

Attractiveness is highly prized in many societies. Durkin (1995) proposes that

another reason may be the older person’s changing status within the family and in

the world of work. When people retire, they no longer have ‘a clear economic role’

their income is reduced and their authority diminished.

As we have seen, there is compelling evidence that stereotypes exist in relation to

the elderly. However, on a positive note, it seems that few people extend the

stereotypes to all people that they actually know. For example, most studies find

that grandparents are generally valued and described in positive terms by children

and adolescents (Werner, 1991).

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THE RETIREMENT PROCESS

Retirement is often thought of as a life event which happens suddenly, usually in late

adulthood. However, some researchers view retirement as a developmental process

which takes place gradually over a period of time.

Atchley (1977, 1991) suggests that the process of retirement involves seven phases

though not all people necessarily pass through every phase.

❖ Phase 1 – The remote phase usually occurs during middle adulthood. At this

time most adults are immersed in their jobs and may have only vague

thoughts about retirement. Little or no preparation for retirement is made at

this time.

❖ Phase 2 – As the time for retirement approaches, people enter the near

preretirement phase. At this time much active thought and planning for

retirement occurs. The individual gradually disengages from some of the

duties and responsibilities of the job.

❖ Phase 3 – The actual retirement is often accompanied by feelings of pleasure

and anticipation – the honeymoon phase. Many of the activities previously

planned can now be engaged in.

❖ Phase 4 – Retirement activities often prove to be less satisfying than

previously anticipated. When this happens, the individual enters the

disenchantment phase and feels depressed and ‘let down’.

❖ Phase 5 – Disenchantment is usually followed by a reorientation phase

during which people face up to the reality of retirement.

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The individual contemplates the future and attempts to develop a realistic

view of the alternatives.

❖ Phase 6 – There next follows what Atchley terms the stability phase when

people settle to the routines of retirement with realistic awareness of their

own capabilities and limitations. In the stability phase, people can be said to

have fully adjusted to the role of the retired person.

❖ Phase 7 – The terminal phase occurs when for one reason or another the

retirement role ends. This may happen because individuals become ill or

disabled and can no longer care for themselves. For some people the role of

retiree is terminated when they seek out employment once again.

Atchley’s phases of retirement may not apply in the same sequence for everyone.

Individual differences in personality, variations in the age at which people retire and

the reasons why they retire, will all influence the process of retirement. However, his

model aids our understanding of the developmental tasks which are faced by older

people who are making the transition from the role of worker to that of non-worker.

Several factors influence when someone will retire (Kovar & LaCroix, 1987). First, the

age at which a person is eligible for receiving social security influences when many

people are able to retire. Economic and social conditions influence the decision to

continue working or to retire in late adulthood, as well as physical capabilities for the

work.

Traditionally, retirement has been viewed as a debilitating experience that people

dread. In this view, the work ethic is strongly ingrained in our culture as the primary

means for achieving and maintaining identity in adulthood, that retirement becomes

equal to social suicide (Beck, 1982; Brubaker, 1990). It is becoming apparent

however, what people miss when they retire, is the income from work rather than

the social status and interaction with others (Anrig, 1988; Kirkpatrick, 1989).

Care of the Older Person – Unit 1 5N2706

When people know they will be financially secure during retirement, they frequently

are more willing to leave the work force and to do so at earlier ages {Crone, 1990;

Flatermayer, 1991}.

Retirement is an important stage in life. Many people look forward to reaching this

stage and are well prepared; others however, do everything to avoid thinking about

it. Citizens information inform us that despite the misconception, there is no single

retirement age in Ireland, although 65 is generally regarded as the age most people

retire at. There are upper age limits that restrict entry for various activities, such as

entry to some professions.

Most contracts of employment have a mandatory retirement age - the age at which

you must retire. The usual retirement age in contracts of employment is 65. Many

employment contracts, however, make provision for early retirement from age 60,

(or in some cases, from age 55). Most also make provision for early retirement on

health grounds. When planning for retirement it is important to look at all aspects of

our lives, including the:

Physical

Emotional

Financial

Social

Some organisations offer employees the opportunity to go on pre-retirement

courses for both partners. There are also independent courses that people can

organise to go on themselves. Vernon (2008) reminds us that physical activity in

retirement has a broader dimension it not only keeps us healthy, but also has social

and emotional benefits. Beckett (2001) reminds us that retirement age represents a

key transition. This is due to the fact that it is at this age that most people will be

expected to stop working.

Care of the Older Person – Unit 1 5N2706

There is often an entitlement to financial benefit at this stage unless the person has

retired voluntarily at an earlier age. This represents many changes and adjustments

for the older person. These changes include:

Contributing to society

More time for other activities, or to think

Change of roles in families, i.e. maybe the spouse/partner is still working

and is now the main bread winner

Social life may will change, not meeting workmates, losing touch

Financial matters, loss of your role (job), this may leave the person feeling

they are no longer contributing to society.

Retiring often means building a new social life and this is often achieved through

leisure activities i.e. walking clubs, golf, bowling, becoming involved in voluntary

work and joining clubs etc. There is also a need to look at your relationship with your

spouse/partner. When a person retires, they may find that their partner has a

separate life and interests outside the home that they have little, or no interest or

involvement in. This can cause tension until the retired person develops new

interests and hobbies of their own. This is part of the normal adjustment phase.

Relationships with children and grandchildren can be a major source of enjoyment in

retirement, now you have time to spend with them. Helping your children through

babysitting can add to a person’s sense of worth and self-esteem. What you are

doing is important and you are contributing to the extended family.

There are great opportunities for continuing education available. Many older people

take on continuing education through night classes etc. This keeps the mind active

and gives the person a sense of achievement as well as having social benefits.

There are also changes in identity and roles, which accompany retirement. Our jobs

typically define much of our identity. Retirement from a job can create a gap and

affect self-esteem.

Care of the Older Person – Unit 1 5N2706

It is also not uncommon that seniors are faced with necessary changes in their living

situation. Health and safety issues may necessitate a move from a place that was

home for many years. There is then a loss of the familiar, of neighbours, of

possessions, of a place of worship, and so on. Transitions and losses associated with

moving can echo and intensify earlier losses of friends and family through death, or

through their also moving away.

In addition to the role change that occurs with retirement from a job, gradually, over

time, there is a role change that occurs between seniors and their children. Children

of adult seniors may begin to take over responsibilities for finances, physical well-

being, getting places and so forth. Neither senior parents, nor their adult children,

find this role reversal comfortable. For seniors, giving up decision-making and choice

is an affront to their self-esteem. For adult children, it may be embarrassing and

arouse anxiety to see their parent as dependant and vulnerable. It is a sensitive issue

– to know how much to take over and what to leave in the province of a senior

parent.

For adult children, there is also the challenge of balancing their own lives, families,

careers and social needs with that of their ageing parent. If not handled well, the

issue can lead to tension, frustration and conflict between adult children and their

ageing parent.

Wherever the older adult lives, they have an increase in available leisure time. The

goal is to fill time in a rewarding way rather than to have time hang on one’s hands.

Remember: many elderly people are as competent and capable as they were in their

earlier years. How engaged the older adult becomes in life is a key factor in how well

they will adapt. Coping skills are extremely important in dealing with change.

Planning for change will help the person deal more effectively with change. Vernon

(2008) tells us that ‘retirement’ means to go away or withdraw from something,

generally our formal work. It does not mean we have to withdraw from living during

a period of life that can be the most enjoyable and rewarding.

Care of the Older Person – Unit 1 5N2706

CULTURE & ETHNICITY

The numbers and proportions of older people of diverse racial and ethnic origins in

Ireland will, without doubt, continue to rise in the future, and thus healthcare

provision must be competent in delivering quality cultural care.

Older people from different racial and ethnic backgrounds, needing care , generally,

remain in the community and are cared for by family and friends. However, the

extent to which family and friends provide assistance varies across racial and ethnic

groups, reflecting both cultural and socio-economic differences.

The cultural diversity of those accessing health services is increasing (Jayaweera,

2010). Inadequate standards of care can result from health professionals failing to

take into consideration the different cultures of individual patients (Papadopoulos,

2006; Helman, 2007). Stereotypes—both positive and negative—can be based on

any observable or believed group memberships and can impede communication

between patients and health professionals (Jandt, 2001).

According to M Leininger {1978}, it can be defined as ‘ socially transmitted

knowledge of values, beliefs, norms, and lifestyles of a particular group that guides

their thoughts and behaviours.’

Racial distinctions are made on stereotypical beliefs about the innate characteristics

of a group. Race is socially constructed and is based on superficial biological

differences such as skin colour, bone structure and hair type. Racist beliefs are

grounded in the view that some races are superior to others.

As aforementioned, culture is the learned and shared values, beliefs, behaviours and

customs of a group of people. National groups, ethnic groups, religious groups and

other types of groups share a culture.

Care of the Older Person – Unit 1 5N2706

Therefore, a person in a health care setting, may carry aspects of several strands of

culture including national, ethnic and religious.

Minority ethnic group/community

This is a standard term used in the European Union to describe all groups whose

ethnicity is different from the dominant group, which in the case of Ireland is the

white Irish. This term can be used as a descriptor for a range of groups in Ireland

other than the dominant group, such as the Jewish Community, settled Asian

communities and more recently arrived communities from Africa, Eastern Europe,

etc. HSE (2009).

Throughout the centuries, nursing has been a dynamic, continuously evolving entity,

changing and adapting in response to a wide range of stimuli. Changes in societal

norms and expectations, discoveries of new medical treatments, developments in

highly sophisticated technical systems, and breakthroughs in pharmaceutical

treatments, have helped shape contemporary nursing practice.

Another recent trend that has influenced nursing considerably, is the consumer

mandate for culturally competent care in an increasingly diverse, multicultural

society. Culture is composed of beliefs about:

❖ Activity - how people organise and value work.

❖ Social relations - structure of friendships, gender roles and class.

❖ Motivation - the value and methods of achievement.

❖ Perception of the world - interpretation of life events and religious beliefs.

❖ Perception of self - refers to personal identity, value, and respect for

individuals.

Care of the Older Person – Unit 1 5N2706

Characteristics of cultural beliefs include:

❖ Culture is learned.

❖ Culture is not inherited or innate, but integrated throughout all interrelated

components.

❖ Culture is shared by all who belong to the cultural group.

❖ Culture is tacit (unspoken) and understood by all in the cultural group.

❖ Culture is dynamic.

Diversity requires an individual approach. Each client brings with them a history of

experiences they have gained throughout their life. Clients’ diverse natures will have

an effect on their religion, the language they use and the way they eat and dress. It

may also affect the way they spend their leisure time, or their beliefs on death or

dying, for example. To not recognise these cultures would be disrespectful and

offensive. Differences that carers need to recognise are:

Person's age

Person's gender

Person's race and ethnic origin

Person's social class

Person's religion

Person's sexual orientation

Person's ability.

Carers need to communicate with others who lead different lives from themselves,

in order to enrich their own lives (Moonie, 2000]. Knowledge of culturally relevant

information is vital in the delivery of competent care. One of the primary reasons to

study cultural awareness is to combat inequity and disparity in healthcare, not only

delivery in healthcare, but delivery throughout healthcare, or rather how we interact

with our peers. Another reason is to promote optimal healthcare which would entail

providing and assuring the HOLISTIC delivery of healthcare.

Care of the Older Person – Unit 1 5N2706

Traditionally, our society, dependent upon which culture is considered, may look

upon illness as just a passing in life’s continuum whereas in another culture, illness

may be looked upon as a punishment or a disturbance of some equilibrium.

Whatever the culture or the circumstance, the healthcare provider must take into

consideration the whole person. Making certain not to impose one’s own beliefs on

others, but to respectfully abide by the belief of others as long as it does not

interfere with the healthcare delivery. Remembering that cultural beliefs impact on:

❖ Birth

❖ Death

❖ Health

❖ Illness

❖ Health Care.

CULTURAL COMPETENCE achieves the following:

❖ Improved quality of care

❖ Enhances the workplace

❖ Reduce inequalities

❖ Legal obligations are addressed

❖ Responds to current and future demographic trends.

However, barriers exist in achieving cultural competency, these include the

following:

❖ Staff not adequately prepared

❖ Nursing care is based on medical model of care not transcultural models

❖ Lack of education and resources.

Older people living in Ireland have seen great change over their lifetime, as Ireland

has evolved from a predominately Catholic country, to being a multicultural society.

They may have difficulty in understanding what a health person is saying to them

may be a problem.

Care of the Older Person – Unit 1 5N2706

They may have difficulty in coping with the changing face of Ireland. They may have

difficulty in accepting other people’s beliefs and respecting them.

INTER-CULTURALISM

Inter-culturalism refers to the willingness and capacity of an organisation to ensure

that cultural difference is acknowledged, respected and provided for in a planned

and systematic approach in all systems, processes and practices. In April 2009, the

HSE circulated A HEALTH SERVICES INTERCULTURAL GUIDE {2009}. This guide sets

out the principles of patient safety. Quality care and value should guide all

interaction with people using the health service.

End of Unit 1.

Care of the Older Person – Unit 1 5N2706

NOTES: