MA Social Work Life Span Ageing PDF

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First year Masters (MA) Social Work notes. Explores health and well-being later in life, dementia, loneliness, ageing successfully, services for older people, age discrimination, theories of ageing, perceptions of ageing in the UK and European models....

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MA Social Work: Life Span & Human Development

Brunel University London

Health and Well-Being in later life ‘Health is complete state of physical, mental and social well-being, not just absence of disease or infirmity’ (World Health Organisation). In contemporary society, the number of older people is rising. - Defining old age is difficult, in Britain it is policy based when you can receive old age pension (60 when it first started, now 65). - Socially constructed concept just like youth, childhood etc. - Age gives us lots of opportunities but also restricts is from many things. Percentage of each age range (0-16, 16-64, 65+ for example) is different from 100 years ago. Much more older people living longer in 2014. Decrease in infant mortality rates. Triumph for public health. Life expectancy different in sex- females live longer. Also socioeconomic background- wealthy background live longer than those on lower end of spectrum and less privileged. Major indicator to measure health is deaths. BUT also morbidity, physical health and mental health. Self-rated health- quality of life, satisfaction. Mental health and well-being in later life Older people suffer from depression and anxiety, but less common than younger population. Dementia syndrome: Progressive and persistent functional deterioration of a broad range of intellectual, cognitive, personality and lifestyle areas. Global impact on memory, language, visual/ spatial skills. Alzheimer’s Dementia AND Vascular Dementia. Dementia is the umbrella of which different types fall under e.g.: Alzheimer’s. Loneliness: The cognitive deficit theory the difference between desired and actual social relations (Perlman and Pelau 1981). Either in quantity or quality of relationships (or both) or in the mode of contact. Living alone

Being alone Loneliness- emotional, social, existential.

Isolation

Solitude

Just because someone is alone does not mean they are lonely. Not an age related issue either, high in young adults then dips in middle life, before rising again in older age.

Active ageing- ageing successfully Old age- a social construct? Two groups?  Young-old Oldest old (80+) years (Baltes & Smith 2003, Cartensen & Fried 2012) OR three groups?  Entering old age Transition from healthy to frail Frail Older people services Origin of older peoples medicine in the care of chronic long stay institutions and workhouses (e.g.: Charcot in 1880’s) Margery Warren (1930’s) identified that many older people in workhouses could be rehabilitated and discharged. - Start of geriatric medicine in 1947 - Start of old age psychiatry in 1950’s. Why should we be interested? - Baby boomers reaching older age are healthier and more active - People are more highly educated and more interested in health matters. - People are living longer: 80,000 centenarians in the UK by 2033 (ONS 2010) - A decline in disability and institutionalism is socially and economically desired. - Older people are heterogeneous group. - One fifth of UK population is currently over 60 and will constitute one third by 2030. - There will be 1.2 billion people over 60 worldwide by 2025. - These global figures will have doubled by 2050, with 80% of older people living in developing countries. (WHO 2002) Age discrimination: - Direct age discrimination: where chronological age has been used to determine access, rationing and denial of services. - Indirect age discrimination: where older people are disproportionately discriminated against by policy, service provision or caregivers (e.g.: transport provision of services, taking risks, decision making). Attitudes to old age in the UK and the US: - Change in social attitudes post WW1 - The Great Depression in 1920’s- 30’s - Development of psychological testing across the lifespan - Development of Old Age medicine in 1940’s - Retirement pension to 65 year old men and 60 year old women in 1946. (Hirschbein 2001, Roebuck 1979) Healthcare sector: - Evidence of insensitive, disrespectful and patronising behaviour by staff. - Autonomy and dignity undermined in healthcare settings.

- Lack of regard for privacy - Lack of adequate information and opportunity to discuss diagnosis and make informed choices about their care. - “Do not resuscitate”. Attitudes of older people: - Older people can internalise ageist attitudes and believe that decline is inevitable - Ignoring older people’s contributions can lead to loss of role and self esteem. (Clarke 2005) - Many older people attribute new disability to old age and therefore do not seek intervention. (Sarkisian et al 2001) - Those with low expectations of ageing are less likely to seek health care (Sarkisian et al 2002). - Positive self image (and mental well-being) in older age: Self perception and functioning are inter-related in older people (Levy et al 2002). - Centenarians are highly motivated, self-disciplined with an adaptable and enthusiastic attitude to change (Antonini et al 2008). Theories of ageing: - Chronological ageing - Biological ageing - Psycho-social ageing - Bio-psycho-social ageing Biological ageing Are we programmed to live or to die? (Kirkwood 2003): - Hayflick Limit theory - DNA/ Mitochondrial/ Free Radical theories - Evolution/ genetic theories - Compression of morbidity hypothesis. Hayflick Limit Theory (Hayflick and Moorhead 1961): - The human cell is limited in the number of times it can divide. - Underfed cells replicate slower than overfed cells. - Cell division can be slowed down by diet (calorie restriction) and lifestyle. DNA theories: - Nuclear and Mitochondrial DNA damage due to oxidative stress from cellular activity (Ashok and Ali 1999) - Telomerase theory - Olivnokov’s clock (1973) where telomere length determines biological age. Free radical theory: - Free radicals are produced as a result of energy production from mitochondria. - Diet, lifestyle, drugs (tobacco and alcohol), radiation and pollution accelerate the production of free radicals. - A free radical molecule has an extra electron which reacts with healthy molecules in a destructive way. - Free radicals will attack cell membranes, creating waste products. - Anti-oxidants are said to transform free radicals and stabilise them. Genetic theories: - Senescence prevents overcrowding and overpopulation by a species.

- Is there an ageing gene? - Disposable Soma Theory (Kirkwood 1997) Evolution theories: - Nutritional/ Physical Activity/ Working patterns/ Absence of disease/ Healthy environment – Lifestyle 75% Genetics 25% What we know People are wanting to live longer in good health Health inequity  Social inequity (WHO 2008, Marmot Review 2010) - Unhealthy behaviours prevalent in older people - Poorly aligned health and social care systems for older people - Unsafe and/or impractical living environments - Multigenerational living on the decline - Care providers often untrained - 10% of older people victims of abuse Compression of morbidity (Fries 1980): - There will be a potential reduction of overall morbidity - Chronic illness will be postponed - The lifespan has not increased - Therefore morbidity will be compressed into fewer years before death. Psycho-Social Theories: - Erikson’s life stage theory - Activity theory (Havighurst and Albrecht 1953) - Continuity theory (Atchley 1971) - Disengagement theory (Cumming and Henry 1961) Life Stage Theory (Erikson 1963- 1968): - 8 stages of psycho-social development – each stage has 2 opposite characteristics - Development of strengths at the completion of each stage - Development is conscious and unconscious Eighth stage Ego Integrity vs. Despair Ninth stage Gerotranscendence (Erikson 1997) Disengagement theory (Cummings and Henry 1961): - People in old age will need to ‘disengage’ from roles, activities and friendships. - Universal concept of loss leading to withdrawal. - Function of society- supported and needed by society. Gerotranscendance theory (Tornstam 1989): - Development is a lifelong process - A progression towards maturation and wisdom - A shift from materialistic and embodied thinking to a transcendental and cosmic view of the world. - A redefinition of self and relationships with others. Activity theory (Atchley 1971): - Importance of maintaining active roles and relationships

- Inactivity accelerates deterioration and decline - New activity replaces old ones Continuity theory (Atchley 1971): - Continuous thread runs through our lives as we adapt and change - Intrinsic and extrinsic changes - Adjustments will be made in relation to our lifestyle and interests. Bio-psycho-social theories of ageing:  Active ageing (WHO 2002)  Successful ageing Active ageing  “the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age… continuing participation in social, economic, cultural, spiritual and civic affairs, not just the ability to be physically active or participate in the labour force…” (WHO 2002:12) Perceptions of active ageing in the UK (Bowling 2009): - Active ageing = having health, fitness, exercise, psychological factors, social roles and activities independence, neighbourhood and enablers. - Significantly fewer ethnically diverse older people felt that they had aged actively but they were less likely to define ageing in terms of physical health and fitness. Key areas of work - Promotion of active and healthy living- physical activity and nutrition - Training primary care workers in old age care - Preventing older/elder abuse - Implementation of ageing friendly standards. European model of ageing well - A non-medical approach to promoting health and well-being: *physical health and functional status *material security *social support resources *daily life activity (ESAW 2003, Hawkins 2005) European Study of Adult Well-being (2003) = - Participation in life activities for social integration and individual well-being: younger group tend to participate in outdoor activity (dependant on income, education, good health) older age group participate less. - However participation negatively impacted upon by being single, a member of a minority ethnic group, lower income, education and living in more rural areas. Successful ageing  - Avoidance of disease, disability and maintenance of physical and cognitive function and engagement in social and productive activities (Rowe and Kahn 1997). - A multi-factorial concept, involving biomedical and psychosocial approaches. (Bowling and Dieppe

2005) - Successful ageing can be predicted by variables assessed before the age of 50 BUT these are under personal control and can be manipulated (Valliant and Mukamal 2000). Successful ageing in the UK  “Success compromises the social and physical activities that people do, mediated by the confidence to do them. It emphasises particularly the importance of personal resilience and continued involvement in physical and social activities. Far from retiring, engagement with life and society should be the norm for ageing problems.” (Doyle et al 2010:5) Physical activity in older people: - Improves depressive symptoms (Mather et al 2002) - Enhances cognitive functioning (Angevara et al 2008) - Reduces risk of cognitive impairment in 85+ (Sumic et al 2007) - Improves cognitive functioning in those with reported memory problems (Lautenschlager et al 2008, Middelton et al 2008). Levels of physical activity in England (NICE 2012) - 61% of men and 71% of women aged 16+ do not meet minimum requirements for physical activity. - 16% of men and 12% of women aged 65+ DO meet the recommended level of physical activity. - These percentages are lower for Asian and black African adults and black Caribbean women. (Sproston and Mindell 2006). - Physical activity levels for people with disability is not known. Retirement  - Period of substantial lifestyle changes - Renegotiation of roles and relationships. - Opportunity to gain new roles - Men and women have different experiences of retirement. (Barnes and Parry 2004) Can also be a time of loss, of status, routine, role, social contacts, relationships, home and of place. (Jonsson et al 2000, Wythes and Lyons 2006.) A life-course approach to ageing - There is a greater understanding that ageing well requires a life course approach from both a physiological and sociological perspective. - For example, activity patterns of older people seem to be dependent upon experiences and opportunities in earlier life. - Indeed take up of physical interventions (E.g.: falls management) also seems to be influenced by experiences of physical activity in teenage or young adult years. Challenges to client centred practice Practioners Risk assessment and prevention. Lack of evidence base. Implicit or explicit discrimination. Tension between the ideal and reality in practice.

Older People Health status- sensory changes, Co-morbidity and frailty. Attitudes- ageism, health beliefs, under reporting of health conditions. Life experience. Environmental vulnerability.

Person centred care (Epp 2003) - Holistic care that is value driven, focuses on wellbeing and independence, empowerment of client and family. - Assessment that is non-judgemental, recognises client’s choices. - Care and activities centred on remaining abilities, emotions and cognitive abilities. - Use of various means of communication. - Use of biographies and personal profiles. - Culturally sensitive. Person centred care in Dementia - First described by Kitwood by 1990’s. - Dementia is not a biomedical entity but a social construction and can be worsened by “malignant social psychology”. - All humans have absolute value and therefore should be treated with respect. - People with dementia can live fulfilling lives (social psychology). End of life – dying well  Is dying an integral part of successful ageing or a failing? - End of life policies (e.g DH 2008) identify the need for: Appropriate care in individual’s place of choice. Effective and appropriate pain relief. Individual’s wishes (and carers) taken into account. Advanced care planning. - Health and social care professionals should: Enable people at the end of life to live meaningful lives and not be overwhelmed with self-care tasks or medical interventions. Act as advocate/key worker. Facilitate relief from symptoms of disease, provide comfort, adapt the environment and educate carers....