HEALTHSCI 2711

Health Issues in Aging

Define social health

\-A characteristic of society and of individuals

\-Our ability to interact and form meaningful relationships with others

\-Hard to measure

\-Multifacited

What are four indicators of social health in a society?

1. Existence of the ‘rule of law’
2. Equity
3. Public accessibility to the decision-making process
4. Level of social capital (Eg. civic engagement, sense of belonging, quality of interpersonal relationships)

What is the ‘rule of law’ in regards to social health?

Socioeconomic, political, and cultural factors associated with a person’s health outcomes (Eg. socioeconomic status)

What makes a person feel socially healthy?

\-Ability to access available social resources

\-Ability to contribute to society

What is the issue of ‘structural lag’?

\-Refers to the mismatch between changes in the aging process and societal structures

\-Current social structures do not have the capacity to deal with more functional older adults

What are six aspects of social health in old age?

1. Integration into communities (Eg. longer life, faster recovery from disease)
2. Aging in place
3. Aging friendly communities
4. Facilitation of social networks
5. Support (Eg. family, community)
6. Direct impact of care they receive

What are leisure activities key to achieving/improving in old age?

Social, physical, and mental health

What are some ways to facilitate leisure activities in Senior Centre?

Offer leisure activities along with…

\-Meals

\-Socialization/networking

\-Volunteer opportunities

\-Ambulatory healthcare services

What are two issues associated with Senior Centres?

1. They should remain a center and not a transition point to a long-term care residence
2. Hard to offer extensive diverse programs that meet the self-interests of a diverse population

Why is the Internet essential to social life and leisure in old age?

\-Helps people stay connected

\-Networking

\-A place for events and ads for programs/activities online

What is a realistic projection for 2025 and Internet use in age 65+ groups? Should we invest in training older adults in the use of the Internet?

\-There will be higher internet use in older adults as their knowledge increases

\-We don’t need to invest a lot in older people in society because as current 20-year-olds age, they’ll already know about technology when they are 50

What is the trend of religion as a leisure activity in older adults? Do people get more religious as they age?

\-Declining, but still older age groups show the highest rates of participation in religious activities

\-No study that shows people get more religious as they age

\-However, older people are more open to new spirituality/religious ideas (as they reflect on the meaning of human life)

What are five examples of religious leisure activities?

1) Yoga

2) Tai chi

3) Prayer

4) Meditation

5) Reading scripture

Which age group contributes the most to volunteerism?

The age group of 65-74 has the highest average annual volunteer hours

What are three benefits of volunteer work in old age?

1) Stronger social networks

2) Provides a sense of purpose

3) Increases life satisfaction, well-being, psychological health, physical health

What are the risks of volunteer work in old age?

\-Some older adults’ social life is limited to volunteerism (as it is overemphasized)

\-Eg. if you do not like to volunteer this could lead to your social isolation

What are the goals of learning/education at a younger age?

\-Finding work

\-Workforce/development training

\-Establishing social capital

What are the goals of learning/education in older age?

\-Leisure

\-Self-development

\-Personal enrichment

What is the purpose of learning/education at a younger age?

\-Social mobility

\-Career preparation

\-Society-subsidized

What is the purpose of learning/education in old age?

\-Individual reasons (Eg. extra courses/training required for your current job)

\-Learning for its own sake

\-Individual pay-off (Eg. improve social and physical health)

What are some examples of passive leisure?

\-Watching T.V

\-Listening to the radio

\-Going for a drive (for pleasure only)

What are some examples of active leisure?

(Typically seen in healthier individuals)

\-Going to see a movie

\-Playing cards

\-Socializing

\-Physical activity

What is the Life Course Respite Hypothesis?

The belief that older people have more flexibility in how they can spend their time (Eg. the middle-aged are usually occupied watching thier children)

What are expanders?

People who had not stopped any activities in the past year and had added at least one new outdoor activity since age 65

Define Gerotranscendence

Refers to when the self begins to expand its boundaries and the person begins to reflect on the meaning of human life

What is the WHO definition of health?

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

What is the WHO definition of healthy aging? What does it involve?

\-The process of developing and maintaining the functional ability that enables well-being in older

\-Involves the society

Healthy aging consists of having the ability to…

\-Meet basic needs

\-Learn, grow, and make decisions

\-Be mobile

\-Build and maintain relationships

\-Contribute to society

What is the goal of healthy aging?

To improve the functional ability of all older people, whether they are robust, care-dependent, or inbetween

What are two reasons for the differences in the capacity of individuals in old age?

1) Cumulative (life-course) impacts of advantages and disadvantages across people’s lives

2) Relationship with the environment (Eg. factors such as sex, age, ethnicity, family, education, and financial resources)

What does a good intervention consider?

The big picture!

Define sucessful aging. What does it NOT mean?

\-Refers to individual health

\-High mental, physical, and social functioning

\-Low chance of chronic conditions and disability

\-Does not mean experiencing the natural process of aging

What does ‘aging well’ involve?

Policy makers

What does a Comprehensive Model of Successful Aging include?

Aspects of physical, mental, and social health

What are five indicators of healthy aging?

1. Functioning and disability
2. Physical activity
3. Cognitive capability
4. Prevalence of chronic diseases and multi-morbidity
5. Social enagement and contribution

What are the five Guiding Principles of healthy aging (identified by the National Framework on Aging)

1. Dignity
2. Independence
3. Participation
4. Fairness
5. Security

In regards to the ‘Vision of Healthy Aging’ what are the five selected areas of focus?

1. Social connectedness
2. Physical activity
3. Healthy eating
4. Falls prevention
5. Tobacco control

(Behavioral intervention)

Define aging in place

\-A policy to keep established social connection

\-The ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level

\-Older adults strive for this

What are three ways aging in place works?

1. Adaptations needed as health, financial, and family situations change (Eg. redesigning bathrooms/kitchens)
2. Sometimes occurs naturally (Eg. a whole community ages together)
3. Mostly needs (some) interventions (Eg. planned retirement communities)

What are the steps to design and evaluate an intervention?

1. Determinant studies (Eg. determining that a lack of walkable places exists in the community)
2. Efficacy studies (Eg. perform an experiment to see if walkable places influence activity)
3. Effectiveness studies (Eg. are the findings so far generalizable at the population level?)
4. Dissemination and implementation studies (Eg. using findings to create a policy and applying it to popualtions)

What are three reasons interventions do not work?

1. Evidence is wrong
2. Implementation is wrong
3. Wrong modifications

What are the four characteristics of a good intervention?

1. Clear and specific goals
2. Focuses on a particular sub-population of older adults
3. Intervention is clearly defined (Eg. duration, method of delivery)
4. Outcome is measurable

What does our current healthcare system primarily focus on?

Focuses on cure rather than health promotion and diease prevention (very medicalized)

What are three mechanisms that can be used to pursue the Vison Framework for Action to achieve healthy aging?

1. Supportive environments
2. Mutual aid
3. Self-care

Define mutual aid

Refers to the actions people take to support each other emotionally and physically, and by sharing ideas information, resources, and experiences

What are two components of evidence-based programs?

1) Therapeutic element

2) Delivery mechanism

Define usual aging

Usual aging is age-intrinsic, nonpathological but high risk, and focuses on physiological functions and the normal delcine of functioning with inrceasing age

Define healthcare

Services provided to individuals or communities by agents of the health services or professions to promote, maintain, monitor, or restore health (not limited to medical care)

What is the Medical Model of Healthcare?

\-Focuses on the treatment of diseases and injuries

\-Medicalizes patients

\-Favours surgery/drug therapy and rehabilitation through physical therapies

\-Usually in the physician's office, hospital, or formal healthcare institution

\-Influenced by the payment system (Eg. doctors must be paid well)

What is the Social Model of Healthcare?

\-Sees medical care as one part of a complete healthcare system

\-Includes personal/family counseling, home care, long-term care, and adult day care programs as part of the healthcare system

\-Tries to keep older people in their own homes (aging in place)

\-Multidisciplinary

\-Care takes place in the community

What is Long Term Care?

Combines medical/nursing care with social and community services

(Note: The Canadian Health Act doesn’t include all nursing home care costs in its definitions of covered services)

What is the Health Promotion Model of Healthcare?

\-Aims to prevent disease through lifestyle change, increased knowledge about healthy behavior, and environmental improvement

\-Includes programs that promote fitness and those that warn about the risks of unhealthy behavior (Eg. smoking or excessive drinking)

\-Saves the healthcare system money in the long-run!

What is the Canadian Health Act (1984)? What are the five criteria that must be achieved as part of this act?

Refers to publicly funded Health Care Insurance


1. Public (non-profit) Administration (Eg. the healthcare system is not a business)
2. Comprehensiveness (Eg. outpatient and inpatient care)
3. Universality (universal coverage)
4. Portability
5. Accessibility

What is the main reason for the growth in healthcare expenses?

\-Expensive (new) medical interventions (Eg. drugs, technology, more tests)

\-Not the population aging!

What three things cause the inequality of access to healthcare? How are these inequalities amplified?

1) Geography

2) Socio-economic status

3) Cultural issues (Eg. language barrier)

\-Inequities amplify when age is added as a factor

Why are more healthcare dollars spent on seniors?

Due to their disproportionate use of hospital services and longer time spent using services

(Note: the spending on seniors has been stable over the years and is not growing faster than spending for the population at large)

Define continuum of care

Refers to the array of services that range from institutional care to little or no institutional contact

\-Eg. geratric day hospital to home care

What are geriatric day hospitals?

\-A hospital program that offers a full range of hospital services to older people who live in the community

\-Individual need is accessed before setting up a healthcare plan

What are Adult Daycare Programs (ADC)?

\-Refers to programs that provide non-institutional support for people who cannot stay in their homes without it (offers fewer medical services and more social and recreational services)

\-Eg. hot meal programs

What is assisted living?

\-Refers to housing that provides personal care services and other supports to frail seniors to help them live independently in the community

\-Eg. 24-hour emergency services with staff on site

Define home care. What does it combine?

\-A range of social and medical services designed to help people live independently in the community

\-Blends medical and non-medical care

What is the Health Feild Concept according to the Lalonde Report?

\-The belief that four sets of factors contribute to the health of populations

1) Human biology

2) Lifestyle

3) Environment

4) Healthcare organization

What does social participation in old age depend on?

The availability and quality of social networks

Define social networks

Refers to a set of social actors (Eg. individuals, organizations, etc.) and the social relationships that connect them to each other in a larger structure

What is the Eco-social Conceptualization Model?

\-Describes the theoretical models of individual behavior change, and how individual health and population health interact

\-Strong and healthy social networks provide opportunities for both participation and support in society, which then influences health behaviors (Eg. alcohol use) psychological well-being (Eg. self-esteem), and physiological pathways (Eg. immune system function)

What is the Personal Recourse Model?

\-Conceptualizes lifestyle including social participation

\-A more individualized model that focuses on personal decisions

\-Make lifestyle decisions based on the social/familial, fiduciary, and physiological/psychological resources you have

What are individual-level constraints that affect social participation in old age?

\-Health (Eg. physical mobility)

\-Decline in financial resources

\-Transportation issues (Eg. inability to drive)

\-Lack of a partner/friend

What are social-level constraints that affect social participation in old age?

1. Lack of programs
2. Discouraging culture/negative stereotypes (Eg. older people who go to bars are pedophiles)
3. Unfavorable public transportation
4. Unfavorable built environment (Eg. lack of green spaces)
5. Unsafe neighborhoods
6. Only ‘able’ older adults can use them

What are the four kinds of social support?

1) Instrumental and financial

2) Informational

3) Appraisal

4) Emotional

Define informal care. What does level of informal care depend on?

\-Unpaid care, from family, friends, or neighbors

\-Level of informal care relates to the resources within the social network (size, quality, proximity)

\-Will decrease in the future due to smaller family sizes

Define social capital

The amount of available social support and resources you have from your social network

The level and type of received care depend on two things, what are they?

1) Age

2) Health status

Why do seniors receive more formal care as they age?

\-Because they are losing their social networks as they age

\-Formal care compensates for informal care when people dont have a social network

As the health status of seniors declines, which type of care (formal or informal) do they rely on more?

Seniors with poorer health receive more care of both types (formal and informal) regardles of their age

What is the result of seniors who are unsatisfied with the quality of their social network?

Results in them not using it (the decrease in informal care use), however, this doesn’t increase their use of formal care

Define elder abuse. Who are typically the perpetrators of men and women?

\-Any action or inaction by any person that causes harm to an older person (most victims are women)

\-Perpetrators of women: family

\-Perpetrators of men: strangers or acquaintances

What is the Task Specificity Model for informal support?

The idea that different groups of people have different abilities and offer different types of support

\-Each group plays a specific role in supporting the person/senior

\-Eg. family members vs. friends

What is the Hierarchical Compensatory Model for informal support?

The idea that people choose all types of support first from their inner family circle, then they move outward to get support from less intimate people

\-Eg. if their spouse becomes unavailable go to first child for support

What is the Functional Specificity of Relationships Model for informal support?

\-This idea recognizes that a relationship between a son and mother can lead to different kinds of support depending on the circumstance

\-People negotiate their relationships/support based on the history of their relationships

\-Eg. Do a mother and son share a close bond?

What is the Convoy Model for informal support?

\-This idea sees people as having a dynamic network of close ties with family and friends

\-Inner circle consists of your closest relationships

\-Outer circle consists of your ties that are less close

\-Your convoy can change or grow over time depending on circumstances

Define generational stake

The idea that compared to their children, older people have a greater investment in their relationship with thier children

What trajectory does death commonly follow?

A slow trajectory that entails a long (and possibly painful) time when people are aware of death in the near future

Define palliative care. What is the goal?

\-Specialized medical care for people living with serious illness

\-Goal: to provide relief from symptoms, pain, physical, mental, and social distress of a terminal diagnosis and improve the quality of life for both the person and the family

What is the holistic approach to care?

\-To provide support aimed at the whole person, not just at physical or mental illness

\-Promotes physical, emotional, familial, societal, and spiritual aspects of wellbeing

True or false, is the type of disease a factor for the location of death?

True

\-Eg. Cancer= home

\-Eg. Dementia= nursing home/hospital

What are the five stages of psychological reactions to dying?

\-Not linear

1) Denial

2) Anger

3) Bargaining (Eg. with God, hospital staff, etc.)

4) Depression

5) Acceptance

Define grief

A sense of deep sorrow after a loss

Define mourning

Refers to the expression of grief in public

Define bereavement

The state of having recently experienced grief

Define anticipatory grief. Who is it common in?

\-When grief starts before and in anticipation of the death

\-Common in partners of older adults with a fatal disease

Define disenfranchised grief

\-Greif that is deemed illegitimate and therefore unacknowledged (not fair!)

\-Eg. when there is an insignificant relationship between the grieving person and the deceased

Define complicated grief

Long and severe grief which results in the inability of the individal to recover and resume thier life

Define assisted sucide

Asking for a lethal medicine, but you take it yourself

Define active voluntary euthanasia

When the health care professional administrates the medicine

What are advanced directives in healthcare?

\-These documents state a person’s healthcare wishes and other preferences for the end of their life

\-Includes who has the right to make end-of-life decisions if the patient is incompetent to do so

\-Ensures you get the care you want

What is the Activity Theory in regard to dying and death?

The idea that people want to stay active throughout their lives and substitute new roles/activities for ones they lose as they age

(higher life satsifaction when you find new things to do as you get older)

What is the Disengament Theory in regard to dying and death?

The idea that people want to disengage from social roles as they age as death disrupts society less if older people slowly socially disengage

Define policy

\-A course or principle of action adopted or proposed by a government, party, business, or individual

\-Can play a role in making communities healthy

What are six ‘aging’ issues that pertain to public policies?

1) Policies are designed for young people

2) Rely on the assumption that old adults are dependent and in need of help

3) Contradict the healthy aging/communities philosophy

4) Reactive not proactive

5) Equity is not addressed (Eg. policies can perpetuate social inequalities)

6) Only address needs (not rights)

What is an argument for the idea of universal systems of support (universal policies)?

Universal policies promote equity and enhance the dignity of all circumstances because a means test for eligibility is not required