Ageism and Racism Faced By Older People in Health and Social Care Sector in UK - Essay Example

Introduction As an individual ages, he climbs from one social identity to the other which brings about a different set of obligations and expectations. The ageing process form social identities along with gender and race or ethnicity and these are apparent in differing experiences and perception obvious in an ageing individual (Hockey et al, 2003). The most apparent indicator of changes ageing brings is the withering physical body and its respective health care demands. Definitions of age and ageing usually revolve around biological grounds. Most often, age is simply defined as the measure of years from birth to demise with a huge disregard to the fact that age plays an important role in how an individual is perceived by himself and the others. Age implies various social and moral obligations that resulted from accumulated loads of cultural and ideological inputs. Many expectations on an individual are determined by age as well as those which they are denied of (Hockey et al, 2003). This perception has huge implications on how heath care is delivered to the older portion of the population. Age play a significant factor on what kind of health care is given and denied to a patient. Since age is central in determining the identity of an individual, it should be expected that tensions between age and identity will inevitably occur. The definition of age and ageing varies across societies and periods in history. Age is defined by some as a negotiated collection of ideas and views within the spectrum which ‘age’ competes against other parameters such as gender, class and race (Hockey et al, 2003). While ageing opens doors to some social experiences that may not be available to younger individuals, it also closes doors on others. There are also new expectations towards the individual as his age identities change through time. We are familiar with the stereotypes of age identities from where we distinguish individuals. Age-based identities have been explored and recognized by various social sciences but there is still a dearth of knowledge on how age contributes to social identity. There is still more to know about the variety of identities based on age and on how these identities are used in the wide social and cultural norms of ageing. There is a need to theorize the processes complicated social processes and experiences involved in the transition from one age identity to the other (Hockey et al, 2003). This knowledge is important to research but is also important to understanding how health care is provided, or should be provided, to older people. Age discrimination is continually occurring in all parts of the UE society, posing threats and significant problem to an increasingly ageing population. By definition, age discrimination is an action that unfavorably affects older persons because of their chronological age and manifests in indirect or hidden forms. Old people are observed to spend longer hours in waiting while being offered fewer treatment options and receiving inferior care quality compared to younger patients. In effect, most of the older people are avoiding institutions, such as nursing homes and hospitals which do not treat them as individuals and people (Castledine, 2008).Institutions do not explicitly put age limits in health care but there are the inherent doubts if older people will maximize benefit from treatment (Wait, 2006). Dilemmas in Health Care The United Kingdom’s National Health Service (NHS) outlined three principles in providing health care. These principles state that health care is universal, is free at the point of delivery and grants good quality service for everyone in need of health care. Such principles have been dominating the expectations of NHS since it was conceived in 1948. But these ideals resulted in certain dilemmas in providing health care (Komaromy, 2001). There are also strong evidences that show the confusions over the definition of core NHS services (Carvel, 2001). Among these continuing dilemmas is the tensions in the ideologies of health care provision. Ideology, as Komaromy (2001) defines, is a doctrine made up of ideas that are used to inform and justify actions. In NHS health care provision, ideologies are in play in NHS’s pursuit of providing quality service to every individual regardless of race and age (which is one of its core principles) and in the government’s effort to facilitate its role in the health care according the political ideologies it aims to uphold. These demands by the NHS and the ideologies of political parties are often in conflict. Since it is perceived that it is the governments’ role to make these conflicting ideologies fit, NHS manner of health care has been greatly influenced and determined by the political policies of governments since 1948. However, even if we assume that the government intervention is immaterial, many dilemmas will still occur in the sites of care delivery (Komaromy, 2001). Another dilemma is the structure of health care. Health care structure largely determines how health care is going to be delivered. Knowledge on the health care structure will provide insights on the magnitude of influence political and social factors have in framing the mentioned structure. Consequently, it will point to areas that can be changed as well. Examples of changing structures are health and economic policies while those immutable structures include age and sex. In UK, it is observed that health needs increase with age and many of the help care demands come from the older people. The issue of who will provide cares arose, since few among the younger generations are willing to be carers. Moreover, financial contributions (e.g. through national insurance) for health care tend to be extensive on the younger people than on the older people (Komaromy, 2001). This is the root of the debates on who will pay for long term-care (Baird, 1996). The kind of health service NHS should provide is also a dilemma. Highly debated are the suggestions to limit resources allocated for health care. Even the scope of health care and the mere definition of ‘health’ also spark debates. Some define health as the mere absence of disease while others look at it as a state of completeness and well-being of the individual. There are also the debates on whether NHS is becoming more of a sickness service, in a sense that they are more towards treating diseases rather than preventing them and promoting health (Komaromy, 2001). Current scenario UK has made its efforts to root out age discrimination in all aspects of health and social care by launching the National Service Framework (NSF) for Older People. Age equality was being promoted in various areas of social policy that included healthcare in all eight European countries (Wait, 2006). Among the efforts is the dispelling of some myths such as the one that maintains older patients cost more, a common theme across all EU countries. There are notions that providing care for the aged portion of the populace will cause bankruptcy to the health care systems. However, when researchers from the UK and Germany examined the costs older patients incur in hospitals, it was revealed that they actually incur les costs compared to younger patients with a similar diagnosis. In addition, overall levels of disability among older Europeans are decreasing instead of increasing. Thus, the ageing population is should not be singly blamed for the increasing health expenditure trends. It this myth is dispelled, it is already a step move forward to reversing negative attitudes towards older people (Wait, 2006). There are many forms of ageism. It may manifest from the home to the political system of a country. At home, there is ageism when the adult child treats the ageing parent as a child. When policies, decisions and negotiations disregard the impacts older members of society, there is ageism (www.cnpea.ca, 2009). In clinics, there is ageism when the old client is being treated in a paternalistic manner (www.cnpea.ca, 2009). There are times when older people are denied of treatments and clinical trials that may benefit the future adults there is also ageism. A report by Devlin of the BBC News (2009) cited a specific example in his article that maintains younger stroke patients were five times more likely to receive an MRI scan than elderly patients. These hi-tech scans are not being offered to them due to ageism. It was also noticed that one procedure was common in older people while the tests to determine if its necessity were more common on younger people. Only 13% of the older patients were given advices on how to lose weight while 30% of the younger patients got these advices from the doctors (Devin, 2009). Racial issues are also pressing, A report from BBC news cited a research from the Policy Studies Institute (PSI) that tackled on the prevalence of racial harassment inside the health service. It stated that 37% of the black nursing staff and 37% of Asian nursing staff had been having problems with colleagues for ethnic reasons while 60% of the black nursing staff and 50% of the Asian nursing staff have been encountering problems with patients for ethnic reasons (BBC News, 1998). On a separate BBC news (1999), the British Medical Association (BMA) admitted that the NHS has been suffering from institutionalised racism for decades. While racism is two-way (the medical practitioners discriminate against that patients and the patients against the practitioners), there are many instances where racism manifests in health care. This is something BMA admitted to the BBC news. Sometimes, based on ethnicity, the patient is treated less kindly. There are also instances that the minority patient is having a hard time explaining their health concerns. If efforts on long-term improvements in the health of population are to be exerted, understanding the socioeconomic status (SES) of the populace is an indispensable tool for success since socioeconomic status is deemed to have powerful and complex impacts on health. Health is strongly influenced by socioeconomic status along with other factors including racial and ethnicity status, historical development, maintenance of health disparities (Andresen et al, 2005). For many policymakers, a major concern in health care is ageing and racism. Policies in the field of ageing are continually challenged to create appropriate social and health services for elders particularly to those from diverse ethnic communities. Such pressure was a result of significant barriers to care that ethnic elders have been facing. However the multicultural practices and policies dealing with ethnic communities has been less focused in exposing and dealing with the imperative changes in institutional structures and power relations that are characterized by racism. The antiracist agendas poorly advanced in the practice of geriatrics (Brotman, 2003). In recent reports by the Healthcare Commission, the NHS watchdog, many health care services were found to have failed in addressing the needs of millions of people aged over 65 with mental health problems (Nursing Older People, 2009). The first report, Equality in Later Life, identified psychological treatment, the access to out-of-hours crisis services and alcohol services as areas in health care that need improvement (Wise, 2009). Most mental health trusts are hardly making progress although there are evidences of high quality care in some areas as result of good integration of health and social services. Older people were denied access several health services that younger adults may enjoy. Discrimination against older people is rampant in two thirds of England’s six specialist mental health trusts as per the commission (Nursing Older People, 2009). Moreover, The UK Medical Research Council even claimed that the NHS are discriminating old people by denying them some of the treatments and excluding them from clinical trials that could benefit the future elderly (Mihill, 1994). Hurst (2009) acknowledged that such action is a step towards closing in the social gaps and inequalities in health care where wealth, education and social status are important. However, he discouraged giving priority to socioeconomically disadvantaged individuals in health care because such will result in reversed discrimination. Solutions Although there are evidences that quality health care are being provided for older people in the UK, there are still room for improvements particularly in the areas of ageism and racism. Health structures characterized by discrimination on the age and races need to be overhauled to uphold the principle of making quality health care available to everyone regardless of age and other socioeconomic parameters (Brotman, 2003). However, it should be remembered that giving too much priority to socioeconomically disadvantaged individuals, such as elder people, in expense of the other will also result in discrimination in a reversed sense, although this is not much of a problem yet in UK (Hurst, 2009). Wait (2006) said that among the factors that determine how care is given to older patients include the attitude of the staff, constraints in resources, standards of practice, and the preferences of the patient and the carer. It is unlikely that age equality can be achieved by simply deracinating age discrimination, although this is the first step. What should occur is a shift in the values system of those involved in providing health care which include managers, doctors, nurses, carers and even patients. The practices adopted should also be based on reliable and updated evidences. This step is difficult to rouse (Wait, 2006). Age equality does not call for the denial of the realties of ageing since it may at times encourage dependency and disability to some older patients, though, nonetheless the fact stands that about 33% of the citizens of UK aged 65 and up are either physically dependent mentally impaired (The Lancet, 1988). The main objective is to provide the health care that is attuned to the needs and preferences of the patient (Wait, 2006). All being said, the issue of age discrimination does not only lie in the government agenda and polices, nor in the professional clinical practices but also it is deeply rooted within every individual. Ageism influences our perspectives and behaviors. This inherent ageism in all of us is the one that needs to be deracinated the most (Wait, 2006). References Ageism. (n.d.) www.cnpea.ca. http://www.cnpea.ca/ageism.pdf. 1. Andresen, E.M.,  Miller, D.K., 2005. The Future (History) of Socioeconomic Measurement and Implications for Improving Health Outcomes Among African Americans. The Journals of Gerontology: Series A Biological sciences and medical sciences, 60A(10), 1345-50.  Baird, R. 1996, Who cares for our old people? The Guardian, 36.  Carvel, J.  2001,  Doctors breaking free NHS principle: Thousands of old people in care homes charged for visit from GP. The Guardian, 1.5.  Castledine, G. 2008, Achieving dignified care. British Journal of Nursing, 17(2), S35.  Collaboration in Helping Old People, 1988 The Lancet 8613, 754. Darley, M. 2003, Dilemmas in UK Health Care, 3rd edition. Journal of Advanced Nursing, 42,1, 97. Devlin, K. 2009, Older stroke patients missing out on hi-tech scans due to ageism. Telegraph. http://www.telegraph.co.uk/health/elderhealth/5158750/Older-stroke-patients-missing-out-on-hi-tech-scans-due-to-ageism.html. 17 May 2009. Drive to stamp out NHS racism . 1998. BBC News. http://news.bbc.co.uk/2/hi/health/236986.stm. 1 Hockey, J. , James, A. 2004, Social Identities across the Life Course, Journal of Sociology & Social Welfare, Vol. 31. Hurst, S.A. 2009, Just care: should doctors give priority to patients of low socioeconomic status? Journal of Medical Ethics, 35(1), 7. Lois, B. 2009, Physical restraint in acute care psychiatry: a humanistic and realistic nursing approach. Journal of Psychosocial Nursing & Mental Health Services, 47, 3, 41-7. Mihill, C. 1994, Sick elderly denied some treatments. The Guardian, 14.  NHS welcomes race scrutiny. 1999. BBC News. http://news.bbc.co.uk/2/hi/health/285581.stm. 1. Over 65s denied access to full range of mental health care. 2009. Nursing Older People, 21(4), 5. Thursday, December 17, 1998 Published at 12:10 GMT Wait, S. 2006, From age discrimination to age equality in health care: a European overview. Working With Older People, 10(1), 26-29. Wise, J. 2009, Mental health services must tackle age discrimination. British Medical Journal, 338(7698), 794. Read More