Caring For The Elderly

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Age Statistics

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According to Administration of Aging (2010), “The older population (65+) numbered 38.9 million in 2008, an increase of 4.5 million or 13.0% since 1998” (par).

The Administration of Aging (2010) states that “since 1900, the percentage of Americans 65+ has tripled (from 4.1% in 1900 to 12.8% in 2008), and the number has increased more than twelve times (from 3.1 million to 38.9 million). The older population itself is increasingly older. In 2008, the 65-74 age group (20.1 million) was over 9 times larger than in 1900. In contrast, the 75-84 group (13.0 million) was 17 times larger and the 85+ group (5.7 million) was 47 times larger” (ddd).

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Gender

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According to the Administration of Aging (2010), “In 2008, there were 22.4 million older women and 16.5 million older men, or a sex ratio of 136 women for every 100 men”

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Race

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The Administration of Aging (2010) states that “in 2008, 19.6% of persons 65+ were minorities--8.3% were African-Americans. Persons of Hispanic origin (who may be of any race) represented 6.8% of the older population. About 3.4% were Asian or Pacific Islander, and less than 1% were American Indian or Native Alaskan”

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Population Growth

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According to the Administration of Aging (2010), “by 2030, there will be about 72.1 million older persons, almost twice their number in 2007. Minority populations are projected to increase from 5.7 million in 2000 (16.3% of the elderly population) to 8.0 million in 2010 (20.1% of the elderly) and then to 12.9 million in 2020 (23.6% of the elderly) . Between 2008 and 2030, the white population 65+ is projected to increase by 64% compared with 172% for older minorities, including Hispanics (224%), African-Americans (120%), American Indians, Eskimos, and Aleuts (153%), and Asians and Pacific Islanders (199%)”

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Gerontology vs. Geriatrics

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Gerontology: the study of old age. Many developmentalists who study the life span find that late adulthood is a continuation of earlier life, it is influenced by the same factors that affect children and younger adults. Gerontologists see late adulthood as very similar to younger ages, with gains/losses, similar influences. Gerontologists conclude that aging is not a problem unless society sees it as a problem (Berger, 2008). Berger (2008) gives an example of this idea, “with the inevitable declines that accompany aging, older people walk more slowly than younger ones; this is not a problem unless someone else is in a hurry or a red light is timed for faster-moving pedestrians” (p. 616).
Individuals working in geriatrics identify aging with illness because the individuals they work with meet that criteria (Berger, 2008). Geriatricians spend most of their time helping patients cope with chronic, disabling diseases. Gerontologists, on the other hand, seek to increase the joy in the elderly (Berger, 2008).
Discussion: Do you understand the different between Gerontology and Geriatrics? How do you see yourself seeing the elderly.

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Dependence and Idependence

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Berger (2008) defines the dependency ratio as “the ratio of self-sufficient productive adults to dependents (children and the elderly) in a given population” (p. 618). According to Berger (2008), most industrialized countries have a dependency ration of 2:1. This means that there are two independent adults for every one dependent. The question that has most people alarmed is how the dependent individuals are going to be cared for since that number continues to rise in relation to the available independent individuals (Berger, 2008).
Discussion: How do you think this would affect the public

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Difference between young old, old old, and oldest old

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Berger (2008) states that is ageist to put all older people in one category. Therefore, gerontologists have a way of distinguishing among this population (Berger, 2008).
Young-old: “Healthy, vigorous, financially secure older adults (generally, those aged 65-75) who are well integrated in to the lives of their families and communities” (Berger, 2008, p.620). Most older adults fit into this category (Berger, 2008).
Old-Old: “Older adults (generally, those age 75) who suffer from physical, mental, or social deficits” (Berger, 2008, p.620).
Oldest-Old: “Elderly adults (generally, those over age 85) who are dependent on others for almost everything, requiring supportive services such as nursing homes and hospital stays” (Berger, 2008, p.620). Only 10% of older people fit into this category (Berger, 2008).
Discussion: How do you see this way of categorizing older people as a positive thing?

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Ageism

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Ageism: Berger (2008) defines ageism as “a prejudice in which people are categorized and judged solely on the basis of their chronological age” (p. 615)
Examples of ageism:

• employers refusing to hire an older person because of their age
• speaking to a older person like they were a child
• service providers treating older adults in a paternalistic way
• advertisements where older adults are depicted as slow, out of date, and lacking knowledge about new technologies.
• one of the most common expressions of ageism is “elderspeak”. This is a condescending way of speaking to older adults that resembles baby talk, with simple and short sentences, exaggerated emphasis, repetition, and a slower rate and higher pitch than normal speech. This is often used by service providers that only know the age of the patient and not the person. Not only is the condescending, but it is ineffective. Lower pitch is more audible that higher pitch; stretching out words makes it harder to understand them.
Discussion for class: Do you have any prejudice or stereotypes toward the elderly? Can you think of other example of ageism?

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Ego Integrity vs. Despair

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this is the final stage of Erickson’s developmental sequence, where older adults try to integrate their unique life experiences with their vision of community. Some may feel pride and contentment with their story and others may feel sad, disappointed, angry, or frustrated with their story…they may feel that “time is now too short, too short for the attempt to start another life and to try out alternate roads to recovery” (Erickson, 1963).

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Stratification Theory:

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Stratification Theory: This theory states that social forces are what limit an individual’s choices and abilities to function later in life. The factors are not within the individual but are found in the culture and societal forces that limit choices and direct the stages of life (Berman, 2008). The main categories involved with stratification are age, gender, and ethnicity (Berger, 2008). So we’re looking at how a society organizes people.
Example: Age/ Industrialized nations are more likely to segregate older people; younger and older people are less often in places where they are equals (examples: communities that exclude residents over 55, someone forced to retire early, and so on).
Discussion: How do you think our society organizes people? Do we treat older people different? If so, how?

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It’s not all negative:

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It’s not all negative: Many older adults keep active by continued education (some seek advanced degrees, others study things such as carpentry or quilting). Older adults may participate in volunteer work, participate in religious activities, or get involved with politics (AARP) which his the organization of people aged 50 and older, that advocates for the elderly.

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the frail elderly

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The Frail Elderly: decline in self-sufficiency: some elderly people will become frail and unable to perform the activities of daily life. The term “frail elderly” refers to those who people over the age of 65 who are very ill or cognitively impaired. We need to remember that frailty is not something that inevitable just because someone gets old or sick. Often times, the caregivers for the frail elderly are a spouse or a family member. This role brings is a major sacrifice for the individual. Stress is a major factor that can sometimes lead to abuse, in which case the elderly person is best cared for in an assisted living setting or nursing home where they will receive better care.

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financial abuse

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Financial/Definition (Pooley, 2006): this means that the assets of an elderly person are stolen. This form of abuse can range from stealing small amounts of cash from impaired elders, shortchanging them at a store to actually inducing them to deed over a house. 1/3 of all cases of elder mistreatment include financial abuse.

There are quite a few indicators that financial abuse is present, here are a few:
• unusual activity in a bank account
• bank statements or canceled checks no longer going to the elder’s home
• documents are drawn up for the elder’s signature, but the elder can’t understand what they mean. Examples: power of attorney, will, joint tenancy of a bank account, or deed to their house.
• Personal belonging such as art, silverware, or jewelry are missing
• A caregiver or recent acquaintance promises the elder lifelong care in exchange for the elder deeding all property and bank accounts over to the caregiver.
• The caregiver has no visible means of financial support
• There are questionable explanations about the elder’s finances by the caregiver, elder, or both.

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4 predictable cases of abuse

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There are four predictable cases associated with financial abuse. The one similarity between all of them is that someone whom the elder trusts is handling the finances of the elderly with or without authority.
Case 1: “financial prisoner” in this case the elder is physically and possibly psychologically dependent on the caregiver and isolated by that person. This caregiver handles all the assets. At which point, the elder loses the ability to say “no” to the caregiver. Typically, this type of abuser has a strong personality and can be very convincing.
Case 2: “slipping” in this case the elders who are slipping and whose ability to handle their financial affairs has been lost as a result of a physical impairment. Eventually, some else assumes responsibility for the handling of the elder’s affair, but the responsibility is informal and the elder has little or no understanding of what is happening and the consequences it brings.
Case 3: “widow/widower” this case involves elderly widow and widowers. The deceased spouse was the one who handled the financial affairs or the couple and the surviving spouse doesn’t know what to do. Usually, these elders are relieved when someone comes into the picture and helps them with their finances. Unfortunately, they are incapable of determining if that person is trustworthy.
Case 4: this occurs when an elder adamantly refuses help and financial advise from a reasonable, trustworthy individual…they may be relatives or not. This elder is so suspicious and even paranoid that they usually end up placing control of their finances to a complete stranger, feeling they can trust this person.

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Indicators of abuse by the family or caregiver

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Indicators of abuse by the family or caregiver:
• The elder is not given an opportunity to speak for themselves without the caregiver being present
• the caregiver fails to provide proper assistance or necessary devices for the frail elder.
• There are too many “explained” injuries, or explanations of inconsistent over time.
• The caregiver or family withholds security or affection from the elder, teases them in cruel ways, or uses nursing home placement as a threat.
• There is flirtation or coyness between the elder and the caregiver which may indicate inappropriate sexual relations.
• The family members/caregivers have an attitude of indifference or anger toward the elder.

Regardless of the case, practitioners can sense that something isn’t right. There are usually clues in the behavior of the family or caregiver that are suspicious or unsettling. Detecting elder abuse/neglect involves putting all the pieces together and coming up with a definite diagnosis.