Older Adults in Society - Assignment Example

 Sr. # Topic Pg. # 1. Introduction 3 2. Ageing and ageism 4 3. Ageism in the health care sector 6 4. Methods for tackling ageism 9 5. Conclusion 14 References 15 “Ageism is the form of prejudice experienced most commonly by people in the UK and that seems to be true pretty much across gender, ethnicity, religion, disability - people of all types experience ageism, and indeed people of all ages experience ageism.” BBC, 2005 Introduction and Background: There have been growing incidences of discrimination among people on the basis of their age. The term ‘ageism’ was first coined by Robert Butler in the year 1969, and was used to define a process or incident which was related to a ‘systematic stereotyping, prejudicial attitudes and direct or direct discrimination against people because they are old’ (Butler, 1969). It represents a set of beliefs, with regard to ageing process which tends to be potentially fatal for the health and well-being of the aged. It leads to various negative repercussions, for instance, it may lead to the development of fear and belittling among the aged; cause stereotyping and baseless presumptions with regard to the competence and the need of the aged for protection and health care. Accroding to Bytheway and Johnson (1990), ageism “legitimates the use of chronological age to mark out classes of people who are systematically denied resources and opportunities that others enjoy, and who suffer the consequences of such denigration, ranging from well‐meaning patronage to unambiguous vilification’. They further state that it may also give rise to various inherent negative beliefs concerning older people as well the whole process of ageing in general, beginning with well-intentioned benefaction to unequivocal disparagement (Bytheway, 1995). Ageing and Ageism: The concept of Ageism, contrary to popular beliefs is a far wider concept and encompasses wider range of issues as compared to mere discrimination on the basis of age. Such beliefs are created socially, which are then reinforced and assimilated within our societies, and are experienced in our social lives (Hewstone 1989, in McGlone and Fitzgerald 2005). The term ageism is mostly used to describe the various prejudices and stereotypes which exist in our societies today, with regard to older people on the grounds of their age. It also describes the behaviour which is directed towards the older population either directly or indirectly (Ray et al., 2006). The author has identified various types of age related discrimination. These include under representative i.e. passive or indirect form of discrimination; positive or protective discrimination which includes giving extra or special treatment to the said age group; and negative or overtly harmful discrimination, which is also known as direct discrimination. Direct discrimination occurs when any individual is given differential treatment on the basis of his/her age, while in case of indirect discrimination although care is provided it is offered in such a way that the older people cannot exploit the services offered for their ultimate benefit, and instead have to suffer due to disproportionate provisions of services (Roberts and Robinson, 2000). According to Adams et al (2006), indirect discrimination occurs when the medical practitioners or organizations responsible for providing health care services adopt ageist attitudes with respect to decision-making and service provision. The policies thus implemented in such a way have little or no regard to the needs and requirements of the older section of the population, as their health care needs are given lower priority than required. Thus, due to such an attitude of the health care providers, the aged people find themselves with very few alternatives to seek health care. Such type of ageism, although quite common and rampant, is difficult to challenge and address, especially given its discreet or covert nature. According to Hagestad and Uhlenberg (2005) ageist attitude is related to various factors such as the cultural and social stereotypes; prejudices against the old; as well as stigmatization. While differentiation on the basis of age is a consequence of deep rooted understanding and perception of individuals and mostly occurs as a result of a considerate acknowledgment of the age-related differences. Definition: The concept of ageism is wide and includes a wide range of issues. However, the most general definition of the term includes a deep-rooted negative attitude towards the older section of the population and the ageing process in general. Such beliefs and attitudes further gives rise to discrimination on the basis of age. It has been confirmed by various authors in their research that ageism is a function of socially created stereotypes (Hewstone, 1989). According to Butler (1969) “Ageism reflects a deep-seated uneasiness on the part of the young and middle-aged, a personal revulsion to and distaste for growing old, disease, disability, and a fear of powerlessness, ‘uselessness’, and death. Ageism in the health care sector: Although the problem of ageism has been clearly identified, as is documented through various research and studies, the actual identification of the same is a relatively difficult task, since it occurs in various forms and across various levels. For instance in areas such as health policies; social / religious customs and practices; the attitudes and perspectives of the general population; the surrounding environment; the type of information available at the disposal of those concerned; as well as in staffing. However, rather than the blatant instances of ageism, which indicate its existence, it is the subtle expressions which exist within our societies, that make it difficult to address and deal with. The lack of information available to the older population, makes it even more difficult to deal with issues of ageism. For instance, these services may be those regarding dealing with such prejudices and ascertaining the quality and credibility of the services provided to them, and whether such services are adequate enough to address their specific health related needs. Furthermore, there are various age-related implicit or explicit barriers which are deeply rooted in our societies, which make it difficult to identify and address the problems related to ageism. According to studies conducted by Dey and Fraser (2000) it was observed that covert discrimination on the basis of age, is a invasive characteristic trait within the field of clinical practice, hence, those involved in eliminating or reducing the age-related barriers cannot solely rely on decision-making at the clinical level, where although discrimination exists, but is relatively difficult to challenge or address. Research on ageism in healthcare and its effects on the targeted population is wide and deep rooted, and hence must be addressed by way of substantive measures. The gravity of the issue can be ascertained from one such research conducted by the Expert Group on Healthcare of Older People (NHS Scotland, 2001). It was observed that ageism is one of the most severe problems faced by older people in Scotland, which has given rise to cases of discrimination against the old, and the subsequent health disparities between younger and older people in the country. With regard to the ageist attitudes towards people, Levy (2001) argued that ‘every person who has internalised the age stereotypes of their culture is likely to engage in implicit ageism, and it is for this reason that much ageism is hidden’ (in Adams et al., 2006). While Berkman et al., (1994) stated that ‘health care professionals are particularly susceptible to ageist stereotyping and negative attitudes toward the elderly because they lack training in caring for older people’. It has been documented through various studies that the ageist attitudes and beliefs of health care providers may have a serious and negative long-term impact on the aged population, since such attitudes tend to influence their decisions with regard to the services and treatment offered to them. There are also various reports substantiating the lack of adequate health care facilities available to the older people, which is mainly attributed to the lacklustre approach and sheer negligence towards the actual needs and requirements of such section of the population. In several cases, the majority of the blame is on the healthcare professionals, who are primarily responsible for providing effective and appropriate care to the aged (BBC News, 2009). According to a study conducted by Billings (2006) to study the perceptions and attitudes of staff with regard to the ageist practices in a clinical setting, it was observed that older people were far more likely to receive prejudicial treatment bordering on insensitive – such as deliberate exclusion from conversations or abusive / rough language; or being patronized. In a majority of instances, it was observed that ineffective and inappropriate communication with the older people was a key characteristic trait within a clinical setting. Furthermore, their needs and requirements were not studied carefully by the staff and their health assessment was highly based on pre-conceived notions, false presumptions and beliefs. Also there is substantial amount of evidence based on past research which suggests the healthcare professionals tend to undervalue the care givers, who are involved in providing care services to older people. This includes social workers, physicians, psychologists as well as nurses. Thus the differential treatment is meted out not only to the aged people but also to those directly involved in providing care services to them. It is on account of such a differential treatment, that various health care professionals tend to avoid involving in or contributing to health care services aimed at the older people. It has also been observed that there is a serious lack of fiscal incentives with regard to care-giving related to older people. All such factors contribute to a serious lack of professional health care services and attitudes of nurses, and others involved in offering health care services to the said population (Rosowsky, 2005). A similar study was conducted by Kearney et al., (2000) to study the impact of ageism on older people. This study was conducted at a Cancer Center, where the attitudes of oncology healthcare professionals were studied and observed. It was concluded that there was a persistent neglect of the elderly patients, irrespective of their other socio-cultural background as well as their gender and / or profession. Although there was no major difference with regard the attitudes of health care providers between such aspects such as gender, profession or clinical experience. However, although such attitudes are observed to be prevalent across all sections within the field of healthcare, a complete elimination of the same is impossible to achieve so far, and the same is regarded as a critical barrier towards improving the healthcare service provision to the elderly people. Methods for tackling ageism: One of the most severe consequences of ageism is the disproportionate provision of services, to the elderly, which leaves them with no access to effective healthcare. Access to appropriate healthcare services refers to the actual potential of the healthcare providers to use and execute the provision of optimum health care services to the elderly, to the best of their capabilities, which according to various studies, seems to be highly underutilized and hence inadequate. This is mainly on account of the various barriers which exist within the society which prevents the elder population from accessing the healthcare services directed at them. These barriers include availability of healthcare services; accessibility; affordability; as well as accommodation of the target population. Although, no common consensus has yet been developed so far, with regard to the specific meaning of the terms mentioned above, but the general meaning of what constitutes ‘appropriate’ services, states that it includes a service which ensures high degree of accessibility to the elderly people. It refers to the provision of essential services in accordance with the need and requirements of the said population group, at the right time and at the right place (Chapman et al 2004). The older people face various disadvantages due to such apparent lack of availability of proper services and neglect by the health care professionals, with regard to their needs and requirements. Another significant problem faced by the elder people on account of the ageism is the lack of physical accessibility with regard to health care services. A majority of the people who can be described as ‘aged’ fall under the age group of 65 years, on an average. Studies suggest that due to their specific health care needs, they visit the clinics and healthcare centres approximately seven times annually, as opposed to four times in a year by young adults. The visits to healthcare centres requires an effective transport system, which are observed to be highly inadequate and hence act as a deterrent, thus making the accessibility of health care services highly difficult among the older people. Such an observation was made on the basis of a study conducted by Acheson, which concluded that the accessibility of transport services is disproportionately experienced by the elderly population. Such severe lack of services limits their access to critical services (Acheson, 1998). A similar study conducted by Age Concern (2006) showed similar results, stating that lack of appropriate transport services aimed at the elderly people, tends to severely restrict their access to critical life-saving services, and makes them highly dependent on others to reach the clinics. Also everyday routine chores such as personal visits to doctors; or going to a pharmacy to buy medicines becomes a highly impossible on account of lack of personal transport. According to yet another study conducted by Manthorpe (2008) aimed at studying the viewpoins and experiences of elderly people particularly in the rural communities, it was observed that there were more or less similar patterns with regard to discrimination based on age. There was hardly any difference between the primary health care services; and provision of centralized out-of-hours healthcare services in rural and urban areas. Most of the difficulties faced by the elderly were related to lack of transport, and effective primary care services. Also, there were other difficulties and obstacles faced by the elderly due to ageism, such as making appointments. According to a survey conducted by Age Concern (2008) to study the experiences of the elderly people, with regard to the problems and difficulties faced by them while making appointments it was observed that most of them had great difficulties in contacting the clinics due to the automated services due to their health and weak eyesight. Furthermore, they also reported that they are usually made to stand in queues for long hours or wait in the waiting area for various hours, which makes it difficult for them to access the services (BOPF 2007). Furthermore there is a significant number of elderly people who live in care homes. It has been observed that a majority of the older people living in such care homes find it highly difficult to initiate a referral for a medical review, and are largely dependent on the staff to act on their behalf. Most of their critical health related decisions are hence taken by the staff, making them highly reliant on them for their health related assessment and diagnosis (McMurdo and Witham, 2007). Ageism across all levels of healthcare system, leads to a severe lack of appropriate primary health and palliative care, and hence resulting in increase in the levels of anxiety and unpredictability. Also, the general lack of implementation of appropriate policies and leadership within the domain of clinical practice, the provision of good quality services to the aged in care homes remains an unattainable target (Morris et al., 2007). Although there are various instances of an efficient health care system, the difficulties encountered by the older people are far and wide and hence need to be addressed promptly, in order to eliminate the disparities in health care. This entails a detailed and comprehensive study of the needs and requirements of the older people, rather than relying on haphazard policies based on presumptions, false beliefs and stereotypes. Such a comprehensive study will pave way for ascertaining with reasonable accuracy, the exact needs of the older people and overcome failures and setbacks with regard to provision of such services, thus meeting their unmet and unsatisfied needs in the process (Bowman, 2007). Active steps must be taken to improve the access to healthcare services, and accomplishment of such an objective must be the top priority of the National Health service providers (Chapman et al., 2004). This includes developing new and innovative methods of delivering health care services to the older people, which ensures easy accessibility with very little or no interventions, and which are highly effective in reaching such age groups. It is also of utmost significance for the policy makers, to take into consideration the needs and requirements of the older people, while developing health policies directed at them. It has also been observed through various research that although walk-in health centres serve as a highly effective alternative for the younger people, it serves as a barrier to the older population, who are highly dependent on others such as their family for commuting to and from the health clinics or on the public transport system. Provision of health care system, in order to be effective must be hence, suitably modified to include personal home visits by health care professionals, and depending on the specific health care needs of the older people (Age Concern 2008). Furthermore, it has been documented through research and surveys that older people have expressly showed their support and willingness to provision of home visits, as an essential and integral part of health care services directed at them. Conclusion: There is evidence based on studies conducted in the past which suggests that the attitudes of health care professionals – such as the health care practitioners, nurses, and care givers play a great role in influencing ageism, and hence the same must be targeted to eliminate such prejudicial practices and beliefs, in order to attain better health care services for the older people. Research suggests that the use of effective means of communication within the health care provision, also significantly improves the quality of health care among the older people. This is because it ensures better accessibility to vital health related information, and greater awareness among the older people; further leading to elimination of stereotypes and negative attitudes towards them (Bull 1994; Stevenson et al., 2000). Bringing about a positive change in the healthcare system can be achieved through transforming the health and social services sector. This in turn, can be achieved through introduction of positive policies and practices aimed at enhancing care giving to the older people; restructuring the existing systems; restoring and developing the existing resources and staffing requirements; and through spreading awareness by way of promotional campaigns and other such similar activities. Restructuring the service provision policies directed at the older people, in a planned and systematic manner, will help in achieving both short-term as well as long-term health related goals, and eliminate health disparities between the young and the old. References: Acheson D (chairman) (1998) Independent Inquiry into Inequalities in Health: report, London: The Stationery Office Adams A, Buckingham C D, Arber S, McKinlay J B, Marceau L and Link C (2006) The influence of patient's age on clinical decision‐making about coronary heart disease in the USA and the UK, Ageing and Society 26 (2) : 303‐322 Age Concern England. 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(Rethinking ageing series), Buckingham: Open University Press Bytheway B and Johnson J (1990) On defining ageism, Critical Social Policy 10 (2) : 27‐39 Chapman J L, Zechel A, Carter Y H and Abbott S (2004) Systematic review of recent innovations in service provision to improve access to primary care, British Journal of General Practice 54 (502) : 374‐381 Dey I and Fraser N (2000) Age‐based rationing in the allocation of health care, Journal of Aging and Health 12 (4) : 511‐537 Hewstone M (1989) Causal attribution: from cognitive processes to collective beliefs, Oxford: Basil Blackwell Kearney N, Miller M, Paul J and Smith K (2000) Oncology healthcare professionals' attitudes toward elderly people, Annals of Oncology 11 (5) : 599‐602 Manthorpe J, Iliffe S, Clough R, Cornes M, Bright L, Moriarty J and Older People Researching Social Issues (OPRSI) (2008) Elderly people's perspectives on health and well‐being in rural communities in England: findings from the evaluation of the National Service Framework for Older People, Health and Social Care in the Community 16 (5) : 460‐468 McGlone E and Fitzgerald F; National Council on Ageing and Older People, Ireland (2005) Perceptions of ageism in health and social services in Ireland: report based on research undertaken by Eileen McGlone and Fiona Fitzgerald, QE5, Dublin: National Council on Ageing and Older People McMurdo M E T and Witham M D ( 2007) Health and welfare of older people in care homes, British Medical Journal 334 (7600, 5 May 2007) : 913‐914 Morris J, Barrett J, Tadd W, Chambers N, Hurst P, Wardle J, Wagg A, Gladman J and Holmes P (2007) Better‐targeted health care will ensure care home residents human rights and dignity, British Medical Journal NHS Scotland. 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Age prejudice 'ubiquitous in UK' [Online] Available at: http://news.bbc.co.uk/2/hi/science/nature/4220228.stm [Accessed: July 26, 2011] BBC News (2009) Stroke care 'failing the elderly', http://news.bbc.co.uk/1/hi/health/8000642.stm [Accessed: July 27th, 2011] Read More