The Challenges in Ageing - Essay Example

Challenges of Ageing 2009 Challenges of Ageing Introduction The current tendency toward the continued increase in the numbers of elderly in Australia and other countries was forecasted long time ago. The current share of 65+ population is approximately 13 per cent these days, and according to the recent estimates it will increase to almost 30 percent by the middle of this century. The growth is due to the increased life expectancy which is currently 77 years for men and 83 years for women in Australia (Australian Bureau of Statistics, 2002). On the one hand, such longevity is an sign of steady social and economic development. The increase of the elderly population - an inevitable outcome of the aging tendency - has considerable implications for the healthcare practices with care professionals increasingly involved in working with aging patients (Murphy, 2004). Understanding of the nature of major challenges associated with the ageing population is becoming an increasingly critical aspect of modern health care system. Main Body A considerable body of evidence is now available to show that the process of aging is largely due to molecular damage caused by reactive oxygen species, electrophiles, and other reactive endobiotic and xenobiotic metabolites (McEwen et al. 2005). Ageing is associated with the degeneration of functional capacity in all parts of human body, and at all levels of organisation from molecules to complete organ systems. This process is normally referred to as 'senescence' and comprises genetic and external factors (Mera 1992). Quality of life of elderly patients depends more on ageing-related disease than solely on chronological characteristics. 'Natural' transformations in the status of the organism during the process of ageing, such as the changes in the immune, cardiovascular and endocrine systems (Martin, & Sheaff 2007), occur simultaneously with pathological processes associated, in their turn, with variety of age-related diseases, such as wear and tear of skin, muscles, and skeleton (Freemont, & Hoyland 2007), cardiovascular system (Greenwald 2007), etc. These two types of changes interact closely in various types of age-related diseases such as hearing loss, noise damage, skin damage, hypertension, increased body mass index, etc (Martin, & Sheaff 2007). At the cellular level the process of ageing is associated with chromosomal, nucleic acid, protein and other changes (Terman et al. 2007). The pathways involved in these changes have been revealed to possess common features with disease processes. This discovery is very essential for it enables the researchers to identify and describe some mechanisms that play the key role in the interaction between which natural and abnormal ageing-related changes. Specifically, the interactions between environment, nutrition, disease and the process of ageing have become the focal point of research intended to reveal the basic mechanisms of the pathogenesis of age-related disorders (Martin, & Sheaff 2007). Sensory impairments, especially those related to hearing and vision, often substantially limit elder adults' intellectual functioning and ability to interact with their environments (Baltes & Lindenberger, 1997). Many of the illnesses and chronic physical conditions that are common in late adulthood tend to have substantial impacts on particular aspects of cognition, as do many of the medications used to treat them. Accumulation of these factors may produce a noticeable decline that elder adults experience in intellectual functioning, as opposed to the normal process of growing old (APA, 2003). In addition to sensory integrity and physical health, psychological factors such as affective state, sense of control and self-efficacy, coupled with active use of information processing strategies and continued practice of existing mental skills may influence elder adults' level of cognitive performance (APA, 2003). Over the last two decades, the importance of professional psychological services has been increasingly recognized in care of ageing patients. Thus, while in 1986 psychological practice in nursing homes was almost non-existent, after only ten years psychological services became very common in those institutions. Simultaneously, practitioners and researchers started to accumulate specific knowledge related to the unique principles of psychological care of older adults (APA, 2003). The existing data in the field of geriatric care allows identifying the basic psychological principles and concepts understanding of which is critically important for care professionals to be effective in their work with elder patients. Elder patients have in common a special sensitivity to the psychological quality of care provided by health professionals. This sensitivity is largely due to the perceived biologic vulnerability and decreased ability to cope with stress observed in elder patients (Neugarten, 1984). Therefore, psychological geriatric care requires from care providers to observe several specific principles which help address the unique psychological needs of elder patients. The psychological view on the process of aging has transformed seriously over the course of the last century. These days ageing is viewed as a dynamic process that challenges the individual to make continuing behavioral adaptations rather than a static condition that leaves the individual no opportunity for better life (Diehl, Coyle, & Labouvie-Vief, 1996). However, while majority of modern theorists tend to view aging as a complex dynamic developmental process, the most essential difficulty is changing the traditional perceptions as for the nature of this process. Although many psychological issues in late adulthood are similar to problems at earlier stages of life (e.g. life transitions, sexual difficulties, social discrimination, isolation, traumas, etc), late life is also characterized by some unique difficulties. Adaptation to age-related physiological changes, including health problems (Schulz & Heckhausen, 1996), meeting the need for integrating with the individual's achievements and failures (Butler, 1963) and the effects of social and cultural attitudes toward the elder people (Kite & Wagner, 2002) are the most common among them. Loss is one of the unique characteristic of the elderly patients. Loss of spouses, friends, relatives, animals, belongings, social roles, physical independence, mental capabilities, health, etc. often triggers problematic reactions, especially in people initially predisposed to depressive moods or/and other mental disorders (Sternberg & Lubart, 2001). However, despite the multiple potentially stressful factors associated with late adulthood, older adults have a lower incidence of psychological disorders than younger adults. Therefore, a psychologist working with elder patients should be aware of the following things: this group of people has much in common with younger adults; many old adults possess their own strengths and capabilities to cope with many of the emerging problems; and finally, what is very essential they have opportunities for effective application of skills developed over the lifespan for continued psychological growth in late stages of life (APA, 2003). Changes in perception of well-being represent another specific feature of late adulthood. For example, although people of all ages reminisce about the past, older adults are more likely to use reminiscence in psychologically intense ways to integrate experiences, to maintain intimacy and to prepare for death (Webster, 1995). Dimensions of well-being that are useful for psychologists to consider include self-acceptance, autonomy, and sense of purpose in life. Later-life family, intimate, friendship and other social relations as well as issues pertaining to relationship between generations should be considered adequately in psychological geriatric care (APA, 2003). One recent theoretical perspective postulates that aging normally results in a sharpened awareness of the limitations associated with the individual's remaining time and opportunities. This leads to heightened selectivity in the individual's social relationships, goals, coupled with increased concentration on those persons and relationships which bring the most emotional satisfaction (Carstensen, Isaacowitz, & Charles, 1999). As a result, the network of social contacts and relationships shrinks with age: often family and relatives remain the only members of this network and play critical role in the psychological care involving seniors (Antonucci, 2001). Psychologists should appraise the social support context in detail and try to find such solutions and interventions that strike a balance between respecting the dignity and autonomy of the elder patients and simultaneously recognize perspectives of the remaining social network members on the patient's needs for psychological care (APA, 2003). Diversity of the elder adults is another important principle to be considered in psychological geriatric care. The cultural, social, economic and demographic variations in the elder population are reported to surpass those observed in younger populations (Crowther & Zeiss, 2003). Consequently, the psychological issues and needs of seniors are likely to differ significantly depending upon such factors as age cohort, culture, ethnicity, gender, residence, educational background, economic and social status, sexual orientation, etc. The picture of syndromes and symptoms in different members of this age group often reflect interactions among these factors and/or characteristics of the setting in which care is provided (APA, 2003). Another essential aspect of psychological care of the elderly is the influence of so-called generational factor. Each generation of people is born to a unique set of historical circumstances which play the decisive role in shaping collective psychological perspectives of the whole generation throughout the lifespan. Thus, these days's population of US elder adults witnessed such major events as the economic depression of the 1930's and World War II during the early stages of their lives. This experience contributed to formation of a strong ethics of self-reliance (Elder, 1999). However, these people were also brought up in social and cultural environment characterized by openly negative attitudes toward issues associated with mental health. Consequently, this attitude is often extrapolated on the professionals whom provide psychological care: the current generation of American elder adults is likely to demonstrate more reluctance than their younger counterparts in relation to psychological services (APA, 2003). The ethnic and cultural aspects of aging are likely to play increasingly important role in psychological geriatric care. Although the population of seniors is largely white nowadays, the projections say that non-white older adults will constitute approximately 35 percent of this age group in the United States by 2050 (Gerontological Society of America Task Force on Minority Issues in Gerontology, 1994). This factor must be taken into account because earlier experiences of such elder adults are often affected by specific ethnic or racial identity. For example, some of them faced discrimination in various fields of their lives such as work, healthcare, or housing, etc. Consequently, these elder adults are likely to have more mental and physical health issues than the majority group (APA, 2003). The demographic data demonstrates that the number of women among the elder adult population exceeds the number of men: this is explained by greater average longevity of women. The prevalence of elder women has several important implications for a health care professional. Firstly, most elder women are likely to experience widowhood and be at increasing risk for dementia and other health conditions associated with late adulthood. Secondly, the current generation of elder women had not the opportunity to engage in competitive employment which the younger generation had. Consequently, these elder women tend to have less economic resources in late adulthood life than their male counterparts. Women's issues frequently arise as concerns to be dealt with throughout the processes of assessing and treating older adults. Consideration of special issues affecting older men is similarly germane, though many of these have not been sufficiently researched (APA, 2003). Residence is also reported to affect the experiences of late adulthood. Thus, elder adults from rural areas often have difficulties accessing major resources associated with late adulthood (e.g., transportation, meals programs, community care centers, etc.). These limitations result in largely negative experiences of social support and care, and much higher levels of isolation as compared with representatives of the same age group residing in urban areas (Guralnick et al, 2003). Urban seniors also take advantage of better access and quality of mental health services, while the professional level of mental health specialists in urban nursing homes is reported to be better too (Coburn & Bolda, 1999). And finally, representatives of sexual minorities are likely to possess very specific psychological images. Typically, these people faced harsh discrimination from the majority, including the mental health professionals, which previously labeled sexual variation as psychopathology and utilized psychological and biological treatments to try to alter sexual orientation (APA, 2003) Prior history of developmental disorders such as mental retardation, autism, brain injuries, seizure disorders, and other, coupled with the physical issues which typically develop at late adulthood such as deafness, blindness, cardiovascular and musculoskeletal issues, etc. also has serious implications for psychological care involving elder adults. Due to the recent advances in medicine life expectancy for people suffering from such conditions and disabilities almost equals with the average life expectancy of healthy population (Janicki & Dalton, 1999). Conclusion The life expectancy of Australian population has substantially increased over the last decade, largely due to changes in the principal causes of death. These days, people have more chances to die of ageing-related diseases rather than of the infectious diseases which has turned into more common causes of death in younger population (Ebrahim, 2002). Improved understanding of ageing-related processes and mechanisms at various levels will definitely contribute to further advancement in effective/intervention to prevent ageing-related diseases. Psychological services represent a serious challenge for health care professionals. The stable tendency toward higher longevity of life suggests the share of elder adults will steadily increase over the next decades. Several specific requirements have to be mentioned in this regard. Firstly, fighting the effect of obsolete age-related stereotypes and biases is crucial for a psychologist working with seniors. A qualified professional must be aware of the negative consequences of prejudiced attitude toward the patient simply because he is socially and culturally defined as 'old' otherwise effectiveness of care will be seriously undermined. Secondly, qualified psychological care of elder patients should be firmly based upon the notion that aging is an ongoing, dynamic process, not a static condition or downhill slope inevitably characterized by poor qualify of life. Apparently, the process of mental development of elder adults differs in many ways from the same process in childhood and adolescence, but both processes are dynamic and positive. These major requirements have serious implications for unique aspects of psychological care associated with elder population: Physiological and health-related aspects of aging differ from those in younger age groups; Importance of social support networks; Greater influence of such factors as age cohort, culture, ethnicity, gender, residence, educational background, economic and social status and sexual orientation; Specific cognitive changes and disorders associated with late adulthood; Currently, the focus of health care system is treatment of disease. However, prevention rather than treatment shall be given consideration in the ageing society. Although the importance of treatment can hardly be understated, prevention of disease seems to be the key element in terms of expenditures planning. References Australian Bureau of Statistics. Deaths, 2002. Canberra: ABS, 2003. (Catalogue No. 3302.0.) American Psychological Association (2003). 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