Classification and Characteristics of the
Elderly
Concepts and Issues
Andrea M McPherson
UWISON Jan 13, 2014
Objectives
At the end of the 2 hour session, students will be able to:
 Outline the important reasons for the study of older adults
• Define terminologies related to the ageing population
• Outline the classification of ageing
• Identify the characteristics of ageing
• Describe the socio-cultural issues impacting the older adult
• Describe the political, ethico-legal/frameworks of geriatrics
• Identify common ethical issues
Gerontology versus Geriatrics
Gerontology – study of the processes of aging;
all aspects
(logy – study of ; gero - Greek term elders)
Geriatrics – specialty which includes:
the study of disease in later life
and the
care and treatment of older persons
Association for Gerontology in Higher Education (2004)
Gerontology and Geriatrics
Differing emphasis but same goal:
 Understanding aging


Helping people maximize their functioning
…Achieve highest quality of life
Why Study Gerontology?
DEVELOPING COUNTRIES:
- expected rise in proportion of older persons
from 8% to 19% by 2050
CARIBBEAN: fastest growing ageing population
JAMAICA
 Population estimated at 2,705,800 in 2010
Demographic transitioning *– intermediate stage where age
composition of population is changing
Greater number of older females are living longer than men
Why Study Gerontology?
“Revolution in longevity” – people are living
longer
 Globally:
- proportion of older persons is growing at a
faster rate than the general population

Average life expectancy at birth
– increased by 20 yrs. since 1950 to 66 yrs;
- expected extension of 10 years by 2050
Desk Review: The situation of older persons in Jamaica (2011)
Why Study Gerontology?
JAMAICA (Cont’d)
Findings of particular concern:
Large proportion of elderly live in
multigenerational households
The oldest old (>80 years); fastest growing group
Desk Review: The situation of older persons in Jamaica (2011)
OLD AGE
Old age is not a status we choose
to become; it is a status that we
inherit simply by the virtue of
living, not dying.
Holstein, 2006, 317[46]
http://www.lco-cdo.org/en/older-adults-lco-funded-papers-charmainespencer-sectionII
Terminologies
 Age: chronological, biological, social, functional
(slide below)
 Ageing
 Elderly
 Senescence
 Ageism
Definition of Age
 Number of years since birth
Other :
 Chronological Age
 Biological Age
 Social Age
 Functional Age
Mr. Calendar is 85, but is as healthy and
active as his son who is 65 years old. Which
definition of age would this best refer to ?
80%
A. Social
B. biological
C. functional
D. Psychological
15%
3%
Ps
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2%
Mrs. Calendar retired at age 65. Age in
this context is
A. Psychological
7%
B. Functional
12%
3%
C. Biological
D. Social
78%
Psychological
Functional
Biological
Social
Characteristics of the Older Adult
Population
 Young - old
60 – 74 years
 Middle –old
75 - 84 years
 Old – old
85 – 100 year
> 100 years
• Centenarians
(Tabloski 2010)
Characteristics of Ageing
• Physically & mentally well (described by functional ability)
 Chronic disease
 Majority live in private households
 Support – two way process
 Gender: different health problems
female: 3-4 year advantage
 Life expectancy has increased from mid fifties (1950’s)
to mid seventy’s (2005).
Classification of the Older Adult
• Independent seniors
• Dependent seniors
• Seniors with disability
• Seniors near end of life
Ageism
 Prejudice and stereotyping applied to any age
group (e.g. older people)
 “a process of systematic stereotyping or
discrimination against people because they are
old
 younger generation to see the older people as
different than themselves; subtly cease to
identify with their elders as human beings
 http://www.lco-cdo.org/en/older-adults-lco-funded-papers-
charmaine-spencer-sectionII
Emerging Themes from Ageism
Negative Ageism: prejudice & discrimination
against the aged
•Terms used : ‘infirm’; ‘senility’; ‘getting old’ ‘dirty’
‘being like a child’
•Expected to accept ‘facts of aging’
•Discrimination: e.g. compulsory retirement over
elders at age 65 years
Emerging Themes from ageism
Positive Ageism: prejudice and discrimination in
favour of the aged
e.g. Provision – national health insurance
NB Ageism violates basic democratic and ethical
principles.
……..(Prejudice and discrimination are seen as
undemocratic and wrong)
Socio-cultural influences
The conceptual understanding of old
age is strongly influenced by sociocultural factors
Socio-cultural
Increased older persons in population
indicates policy successes in:
 public health
 social stability**
 education
https://www.un.org/ageing/documents/papers/guide.pdf
Social-cultural Influences
 Culture
 Home and living setting
 Family
 Personal image of the
older person
 Education
 Ascribed roles
Culture
 Ancient Chinese believed that attaining old age
was a wonderful accomplishment that deserved
honour
 Egyptians dreaded old age and experimented on
potions to aging
 Ancient Romans had limited respect for their
elders
Cultural
 MYTHS
 Being old means being sick
 Older people are set in their ways and can’t learn
new things
 Health promotion is wasted on old people
 The elderly do not pull their own weight
 Its too late now to change my bad habits
 Older people have no interest in sex
Economic issues
• Pension & financial concerns
Other
 Work force related issues
 Older workers & an ageing work force
 Workplace wellness programmes
 Day care issues for middle aged workers with
older relatives
 Post retirement health insurance
 http://caribbean.scielo.org/scielo.php?
Economic issues
 Retirement age
 Costs of providing care/support
 Maintaining the adequacy of pension funds
 Extending pension coverage
Considerations
 Recognition of aging and definition of limitations
 Redefinition of physical and social life space
 Substitution of alternative sources of need satisfaction
 Reassessment of criteria for evaluation of the self
 Reintegration of values and life goals
Factors Contributing to Longevity
 Positive state of health can contribute to longevity
 Exercise is a good ingredient to longevity
 Laughter causes a relief of endorphins.
 Faith: strong faith, church attendance and prayer life
 Empowerment: powerlessness diminishes self care
 Stress management
Nursing Implications
 Assist patients in experiencing health, fulfillment and
a sense of wellbeing.
 *Nurse’s philosophy of aging influences the care she
delivers.
Political frameworks for
Geriatric Care
1982 – first World Assembly on Ageing (Vienna)
* did not focus on the developing world
Ageing placed on Health Ministers agenda
1986 – Dr Eldermire – Shearer: established
contact with WHOs Ageing & Health
Unit
Political frameworks for
Geriatric Care
1988 – Eldemire- Shearer made contact with an
NGO – Help Age International
* focus – developing countries
1989 - 60+ survey - basis for the Jamaica
National policy on Ageing
1999- UN Year of the older person
* ageing introduced into under/
postgrad programmes
Political frameworks for
Geriatric Care
1999- the UN Year of the Older person
2002- Madrid International Plan of Action*
on Ageing and political declaration adopted
at 2nd World Assembly ………..
** progress – beyond protection to
empowerment & inclusion
in national development
agenda
Political frameworks for
Geriatric Care
THE MADRID INTERNATIONAL PLAN OF ACTION ON
AGEING
Addresses opportunities and challenges of ageing in the 21st
century;promoting development of society for all ages
• Secretariat: United Nations
• 2 core concepts :
1. developmental approach to population ageing
2. intergenerational life approach to policy
https://www.un.org/ageing/documents/workshops/Vienna/issues.pdf
Political frameworks for
Geriatric Care
Issues covered by the MIPAA:
 Older persons and development
 Advancing health and well-being into old age
 Enabling and supporting environments
 Implementation and Follow- up
Non-Governmental (NGOs)
Help Age International
 consultancy status with UN and WHO
 Helps older people:
 claim their rights
 challenge discrimination
 overcome poverty
(works through Senior Citizens Clubs)
 http://www.dogoodjamaica.org/organizations/helpage_international_ja
maica
Legislative & policy framework
Government Ministries:
• Ministry of Justice
• Ministry of Labour and Social Security
http://www.ohchr.org/Documents/Issues/OlderPersons/Subm
issions/Jamaica.pdf
Legislative & Policy framework
Ministry of Labour and Social Security
- effects policies surrounding ageing issues
- agency - National Council for Senior Citizens
(NCSC)
Highpoints
• NCSC - national infrastructure for older person
- established long before 1st World Assembly 1982
- role of NCSC
Legislative & policy framework
National Policy for senior citizens
• Health -**NHF , JADEP
• Social activites
• Income security
• Education
Legislative and policy framework
VISION 2030:
-Jamaica’s first comprehensive development
plan
-Review: Assessed for the extent to which it
addresses leglislative & policy issues related to the
elderly
Desk Review: The situation of older persons in Jamaica (2011)
Ethical framework
ICN Code of Ethics
Inherent in nursing is respect for human rights
- right to live
- right to dignity
- right to be treated with respect
2009 – UN Report of the Expert Working Group
on “Rights of the Older Person”
Ethical Framework
Increasing Awareness /Ethical Dilemmas:
• Greater number of older adults
• Medical technology
• Fiscal constraints
• Expanded role of nurses
Ethics for the Elderly:
- relates to how they want to be treated & allowed to make
their own decisions
Eliopoulous, 2010
Principlism: Ethical Framework
 Autonomy:
respect for the elder’s choices
 Beneficence: do good
 Nonmaleficence: do no harm
 Distributive justice
 Sanctity of life
Rules of Ethical Care
 Veracity
 Confidentiality
 Fidelity
Utilitarianism
 Goal oriented and dictates that in all situations
 One must act to provide the most good for the most
people
 The end justifies the means.
Ethical and Legal Issues
Ethico-legal Issues
Existing infringements
• Ageism
• Abuse
• Neglect
• Violence
http://www.un.org/esa/socdev/ageing/documents/egm/bonn09/re
port.pdf
Ethico-legal Issues
Recommendations:
•Ageism: policies and public statements
•Abuse: enhance awareness; self-reporting
•Neglect, abuse , violence – data collection
towards preventive strategies
•Infrastucture to support mistreatment
•Advocacy and empowerment; access to services
•http://www.un.org/esa/socdev/ageing/documents/egm/bonn09/
report.pdf
Ethico-legal Issues
Common Issues confronting elder care providers:
 Actual conflicts of interest
spouses & their wishes versus the elder’s wishes & interests
care provider’s business interests versus the elder’s interests
Potential conflicts of interest
Confidentiality
Decision making capacity
•http://www.ensignlaw.com/Ethical%20Issues%20and%20Elderly.html
Potential Legal Liability Acts
 Assault
 Invasion of privacy
 Battery
 Larceny
 Defamation of character
 Libel & slander
 Negligence*
 Malfeasance
 Misfeasance
 Nonfeasance
 Criminal negligence
 False Imprisonment
 Fraud
Malpractice
 All of the following must be present for malpractice to
exist:
 Duty
 Negligence
 Injury
Duty
 A relationship between the nurse and the patient in
which the nurse has assumed responsibility for the
care of the patient.
Malpractice
 Negligence is:
 Failure to conform to the standard of care (i.e.
malpractice).
 Injury:
 Physical or mental harm to the patient or violation of
the patient’s rights resulting from the negligent act.
Other Ethico-Legal Issues
 Decision making
 Client’s ability
 Appropriate surrogate
 Care and treatment
 Level of care
 Basis of function
decision maker
 Termination of
 Disclosure of
information to make
informed decisions
treatment at end of life
 Abuse
Types of Abuse
 Physical abuse
 The willful infliction of physical pain or injury
 Financial abuse
 Theft or mismanagement of money or resources
 Social abuse
 Infliction of debilitating mental anguish and fear
Abuse
 Neglect
 Failure of caregiver to provide necessary services
 Services for physical and mental health
 Violation of individual rights
 Unreasonable confinement
 Deprivation of services
 Exploitation

The illegal use of a person or resources for another’s profit
Elder Abuse
Complex:
 Family arrangements
 Carer issues
 Socio-cultural issues
Advanced Medical Directives
Advanced Medical Directives
 Client’s wishes in different situations
 Documented preferences
 Living will
 Clients wishes re: medical treatment should s/he
become terminally ill
 Durable medical power of attorney
 Someone is designated to make health care decisions
when s/he is unable to do so
Scenario
 Two months ago, Mr M.T. (80 years old) and his wife
were involved in a severe auto accident. Mrs. A T died.
Mr. M.T. previously told his 3 children that should he
ever become seriously injured or ill and unable to live his
life as he has in the past, he doesn’t wish to be treated
with extraordinary measures to continue his life.
Scenario
 Two of the children agreed that their father would not
want to live with the residual effects of his injuries should
he recover. The third child, emotionally distant from the
father until the last 6 months, desperately desires any
relevant treatment for her father to allow his possible
recovery even if it means he has decreased quality of life.
Steps in the Process
Identify the issue
Whose decision is it?
Does an ethical dilemma
exist?
Identify ethical
principles
Yes
Does an ethical
issue exist?
Relate principles
to facts
Appeal to an
ethical theory
No
Resolve using
usual problem
solving methods
Identify
alternatives
Utilitarian ism
Predict
consequences
Identify positive
and negative
consequences
Appeal to an
ethical principle
Identify
alternatives
Deontology
Rank ethical
principle(s) of
case
Resolution
Questions to consider?
 What are the ethical principles and duties related to
appropriate actions by the nurse and other health care
professionals?
 What things are optional actions?
 What are the obligatory actions?
References
 II. Ageism: Concepts and theories http://www.lco-
cdo.org/en/older-adults-lco-funded-paperscharmaine-spencer-sectionII
 Biological theories of aging: Psychology of aging
(2005).
http://flash.lakeheadu.ca/~mstones/Biological%20the
ories%20of%20aging.pdf
 Canning, D. (2011). Program on the global
demography on ageing. Working paper series - the
causes and consequences of the
demographic
transition
References
 Ageism: Concepts and theorieshttp://www.lco-cdo.org/en/older-adultslco-funded-papers-charmaine-spencer-sectionII
Aging in the 21st century: A Celebration and a challenge
http://www.google.com.jm/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved
=0CDkQFjAC&url=http%3A%2F%2Fwww.helpage.org%2Fdownload%2F50af6e
9c8f44b%2F&ei=BXOzUp6MBYPZkQebgYGwCA&usg=AFQjCNEOpxGzPhzfWr
tQfQDMkAoeONvSiw&sig2=HF6fZKB4_zXEmuKH99vIvw
References
Desk Review: The situation of older persons in Jamaica (2011)
UNFPA and HelpAge International. Retrieved from http://
caribbean.unfpa.org/webdav/site/caribbean/shared/
publications/2011/Jamaica
Finalized_TheSitOlderPersonsInJamaica_UNFPA_030811-2.doc
•Eldemire-Shearer,D. (2008). Ageing. The response: Yesterday,
Today and Tomorrow. Retrieved from
http://caribbean.scielo.org/scielo.php?
script=sci_arttext&pid=S0043-31442008000600009
Eliopoulos, C. (2010). Gerontology Nursing. Philadelphia: Wolters
Kluwer Health/ Lippincott Williams & Wilkins.
References
 Jamaica’s older person’s call for protection
http://www.jamaicaobserver.com/news/Jamaica-solder-persons-call-for-protection_12667661

 Mainstreaming ageing into national policy frameworks: An
Introduction. Retrieved from
https://www.un.org/ageing/documents/workshops/Vienna/issue
s.pdf
 Palmore, E., (1999). Ageism:Negative and positive.
Springer Publishing Co. 2nd ed. Retrieved from http://
books.google.com.jm/books?
id=Cg4_DTUuV4IC&dq=ageism+negative+and
+positive&source=gbs_navlinks_s
References
• Perspectives on aging.(2007).
http://www.sagepub.com/upm-data/15090_Chapter1.pdf
 Political declaration and Madrid International Plan of action on
ageing.(2002). Second world assembly on aging. United Nations,
New York
 Stewart, T.(2009). The elderly: sixty years and beyond.
2nd
ed. National Library of Jamaica
Thank you
 Happy Ageing !!