Ageism in a Societal Context - Essay Example

 Ageism has been perceived and defined by many philosophers as a mode of thinking but in a pessimist manner, so that one has to believe in a negative manner about the process of becoming old. Though ageism itself is what the society believes and what extent it embeds ageism in culture but still it cannot deny to have a profound effect on how people view themselves and others who are aging. Despite the fact that negative stereotypes about ageism are considered, health care providers are not immune to these sinister stereotypes (Grant 1996). Aging in a societal context likely affects the choices people make to present themselves and the decisions they make about those choices. If a society allows older people or let say people, this means it is giving confidence to people who want to believe, in fact who want to believe themselves. This belief can go along a long way to prevent any sort of inevitable deterioration, and older people gain the confidence of likely to be more active in their own self-care. When we talk about society we of course not leave behind the role of health care providers who believe that elderly people are valuable and equal members of our society. Health providers have no doubt done a great deal of progress in the efforts to end the stereotypical myths surrounding the aging process, there are still some powerful images that govern both policies and programs dealing with older people. No perspective of ageism is more manifest than the stereotypical picture that older people are getting increasingly dependent and are becoming a desperate object of protection. It is through such stereotyped images of older people that help in creating enormous barriers to the development of policies based on the strengths of the individual and his or her right to self-determination. Age based decline is negatively estimated as most stereotypes create an image of an incompetent, woeful and dependent older person who only survive through the defences of hostile counter-attack or dissociation as according to negative stereotypes only such are the pathological ways of avoiding the awful reality of age-based decline. On the contrary positive stereotypes create an idealised elder who is competent to live a decent life style as he or she is experienced enough to confront the challenges of the world and knows a better place to be called upon for guidance as needed by the powerful young. Unfortunately, our society is governed and influenced by negative images when it comes to application of an aged person and may flip into a corresponding negative one when the illusion of immortality or perfection is shattered by poor health or as Hepple & Sutton (2004) suggests the assertion of the needs of the older person over the demands of the young (Hepple & Sutton 2004: 47). Effects of Ageism on older people Irrespective of the stereotyped images that ageism presents before us, there are people who are affected in variance by aging effects. There are different categories to which we can place older people, people who are fragile or frail enough to make their own decisions, people who are in need of protection from exploitation by other family members, relatives or even friends. However, majority of older people does not find them capable of self-determination and insist on maintaining their independence and dignity, even when they confront physical difficulties. The main reason behind this is that older persons consider to be like everybody else seeking autonomy and participation in decision making. Even at times they do not perceive themselves as clients or patients, which is evident whenever they are asked to abandon their judgment for the judgment of others, they deny because they want to maintain control of their own destiny. In a critical scenario, ageism affects the person in several negative and positive ways, however negative effects are more likely to occur in aged people. For instance the practitioner or health care that is designated to a particular patient understands the patient's values and wishes so that appropriate decisions are made on behalf of the patient or vice versa. Often it is clear to the health care provider and patient’s family that he is not able to participate in the decision-making process since he is diagnosed with advanced dementia or any other long term brain disease. However, at times patient is unable to make his own decisions therefore in such situations the practitioner feels liable to formally assess the patient's capacity to make decisions regarding his or her own health care. Decision making capability of every health care varies in accordance with an appropriate decision which is not necessarily taken by the patient. It could be taken by his health care provider as well depending upon the situation. Such a decision-specific capacity is not necessarily to be taken by the patient in case when he or she lacks capacity for a particular decision at a particular time and under a particular set of circumstances (Burke & Laramie 2000: 6). Ageism affects older people in various ways which include changes in social, psychological and mental attitudes. It is often observed that some older persons do not experience satisfaction or contentment as soon as they enter the era of 60s, and that their internal emotional reactions are unrelated to their objective life circumstances. What distinguish these older people from others is their attitude and way of thinking toward their life situation. These attitudes are not created on their own but are the results of psychological factors related to empowerment, such as locus of control, self-efficacy, and self-concept. By ‘locus of control’ we mean to refer those responsibilities that teach a person the ways to evaluate personal responsibility for events in his or her life. Aged individuals who experience an internal locus of control are rare for they perceive themselves responsible for controlling the events in their personal lives, while those with an external locus of control see themselves as having little or no control over external circumstances which seem to determine the events in their lives. There is a sense of personal power that distinguishes older people from that of younger ones. Younger persons possess the courage and determination to make decisions while as they grow older, they are apt to experience changes over which they have less control and which lead them in undesired directions. For example, older people usually experience more losses as compared to younger people resulting in a loss of health, income or spouse therefore their locus of control may move from internal to increasingly external as they objectively re-evaluate their ability to influence major events in their lives (Thursz et al 1995: 112). The Problem Health care service providers after a long journey to elderly care have identified the problem statement. The desire to control the older people either directly or indirectly is considered among one of the most altruistic motives in the eyes of the service providers but the same concept is not appreciated by the older people when it comes to exercise some control or power. This problem is recently been highlighted by Dr. Charles D. Cowger, an associate professor at the School of Social Work, who defines the problem as an economic and social issue that entirely deals not with dysfunction and therapy metaphors, but with the clinical practice exercising power and power relationships (Thursz et al 1995: xiii). This perspective denies what older people expects from service providers or doctors and marks the significance of client empowerment as central to clinical practice and client strengths as providing the fuel and energy for that empowerment. Older person empowerment is characterised by two interdependent and interactive dynamics that hinders in the way to achieve success of health care providers, one that gains the older people personal confidence and the other that helps them improve social empowerment. Since both the notions deviate from what health care providers seek, therefore the problem remains there. Many other health practitioners suggests that personal empowerment of older person is similar to the traditional clinical notion of self-determination, because here the older people are given authority to direct their helping process, take charge and control of their personal lives, instead of practitioners getting control of them. What older people seek is to get help from health care but in a different manner, manner in which they retain their independency by learning new ways to think about their situations, and adopt new behaviors that give them more satisfying and rewarding outcomes. Clinical practitioners regarding the issue believe that old age wants contribution to empowerment, but in a manner that is related to societal resources and opportunity. Practitioners believe that clinical practice ensures confidence and empowerment to the older people only when they make choices that allow them more control over their presenting problem situations. Ageism and Older people care with respect to health policies Before discussing modern day health policies, it is essential to discuss various perspectives which through examining one feel the need to identify vulnerabilities of contemporary older care. Today increased physical and social mobility in health settings is shifting people from the traditional patterns of family to those trends in present day economic and social policies that escort to deterioration in the family, and thereby results in an unimproved well-being of older people (Thursz et al 1995: 5). Health policies initiate with the problem of care homes for the elderly, which are preferred by most of the older people in comparison with living out their lives in their own homes or with relatives in the community. Various social policies have already highlighted on the issue and support people older people living at home for as long as possible (Torrington 1996:1). National Service Framework for Older People: NSF emerged as a theoretical solution which aimed a step ahead of driving up standards by alleviating unacceptable variations in health and social services, particularly in older care. NSF for the first time provided practical standards to the commissioners and providers of healthcare to adopt while providing them an edge to meet the standards by pressurising them through continuous monitoring by the Healthcare Commission (AOP, 2009a). Emerged in 2001, NSF for older care heralded a major commitment to modernise the NHS and social services, so that these agencies work together to provide integrated services to improve the quality of life elderly care. NSF continued progress with a fast pace and by July 2001 was able to get hold of cancer, heart disease, diabetes, mental health care and other long term conditions for older people. NSF along with the Department of Health set out various modes of action programs through which they reform to address the failure to meet the needs of older people and to deliver higher quality services. To many health communities the program served as the role model in providing the first ever comprehensive strategy to ensure fair, quality oriented, integrated health and social care services for older people (Leathard 2003: 350). Therefore NSF emerged as a responsible state model who reshaped older standards of NHS by setting new national standards, although practical to the extent where they could be easily monitored but and service models of care across health and social services for all older people, whether they live at home, in residential care or are being looked after in hospital. The Loopholes Health care in UK is sheltered under three core processes i.e., assessment, treatment and care (Foote & Stanners 2002: 89). Despite providing improved care to the disabled older people, NSF still lacks the technology and advancement to make proper assessment which is significant on all levels of the elderly care. It ignores even the minute interventions that could be helpful in simplifying hefty issues concerning about older health. Issues like automated telephone messaging with respect to age-sensitive design and language factors must not be taken for granted as they simplify the process of older health care activities. Automated Messaging: There is ample evidence that make us think in versatile way to simplify automated messaging, as it has the potential to inform, to support decision making, and to promote preventive and self-care health practices (Rogers & Fisk 2001: 180). Therefore such messaging system must be used while keeping it as user friendly as possible so that older patients find the technology easy to understand and use. In context with providing the latest equipment, NSF has remained unable to gain good remarks from the Audit Commission who reported nearly a million aged people in need of the equipment to survive independent of their community; however the demand for disability equipment was never fulfilled as it kept on increasing as a result of widening the gap between the ageing population and advances in technology and medical science (NSF, 2009a). Instead of providing the necessary equipment for older care, NSF has again made promises to increase its funding in the IT sector which has drawn significant boundaries between health and social care services resulting in an inefficient service and delays in providing equipment. The Assessment Problem Although NSF is good at two core processes, but underestimates the assessment phase which is the main key to enter the other two phases. Ageism indirectly depends on human factors that are related to the design of automated telephone messaging systems. Such systems are inclusive of software and hardware and must be compatible with proper arrangement of buttons on touch pad, they must be capable to detect voice depth in case of emergency and must understand the speech rate and dialog structure. No doubt NSF is good at policy making and implementation but still it does not practice what it takes to solve the traditional problem-focused medical assessment, which today has become ineffectual in assessing the multiple, complex needs of the older patient. It does not take into account for those older patients who require practitioners’ focus to identify on the core specific diagnosis instead of diagnosing multiple complexities. That indicates that NSF fails to recognise the real issue that prompt the older patient to seek medical attention, with respect to the impact of the diagnosis on his or her daily functioning. Ageism requires the recognition of the complex medical, social, and mental health problems and resulting functional disabilities which are the core issues of many frail elderly persons and which has led to the development of a multidimensional, interdisciplinary approach to the evaluation of this population. Assessment Directives Although NSF aims to provide advance care planning and keep its word by suggesting policies and treatment for persons facing life threatening illnesses, but it lacks the credibility to predict when a previously healthy person may suffer an acute, life-threatening event. Of course no practitioner or health care provider can claim to predict but then it never forgets to discuss preferences regarding health care and desired outcomes with everyone. With proposals of supporting evidence NSF. NSF along with its community service emphasises on decision support services, thereby considering the notion that older people’s views are properly taken into account while decision making. In making decision capabilities NSF is ‘need-oriented’ rather than ‘age-oriented’. It is good to keep the word for providing services not on the basis of availability, but rather on the basis of what an older person needs and to fully involve older persons and their informal caregivers in the assessment of their need for services, and the design, implementation and review of those services once delivered. But does that not mean the neglect of the requirements that incur with respect to ‘age’. That is where NSF lacks the understanding of the subject Unlike other care providers, NSF ignores ‘age-oriented’ concerns that believe the goal is to get older patients to ‘be active’ and assumes any action taken means that the patient is participating and thereby empowered, as well. Participation is encouraged by NSF health policy and may range from sharing information, being involved in decision making, or actually taking part in one’s own physical care. On the other hand there is no concept of self-actualisation, which promotes social values among individuals in gaining a true sense of power over one’s own life. Literature reveals that while UK has made successful strides in modifying its health care system, there is simply no mandate in the law of its health care policy to do more than involve, or encourage the participation of, older persons and caregivers in decisions about their own future. Heumann et al (2001) suggests that “Involvement in the decision-making process is limited and to some extent is the same as having the authority or the resources to act on the decisions made that is, it does not require users and caregivers to be empowered in the same way as consumers of other types of goods and services” (Heumann et al 2001: 21). Inefficient management of health service coordination can intrude on older people personal privacy and eliminate their remaining independence and disrupt or eliminate natural informal support bonds with family and friends. These are all limitations that lead to degeneration of remaining older peoples’ skills and the will to retain whatever independence remains. Health care communities often forgo focus on ageing perspective that limits individual control over lifestyle, housing and care management and retaining or obtaining support settings of choice that fit the preferences of each frail individual, rather than on political empowerment directly. Methods to improve ageism effects on older people’s care Research based evidence suggests that in order to reduce aging effects, the foremost step is to increase awareness of the experiences of older people in order to decrease stereotyping. There is a need for the health care workers to value older adults as youth is valued in our society so that their complaints of physical difficulties or behaviors related to these are minimised or dismissed (Schuldberg 2005). Reduce Negative Stereotyping: Stereotyping matters; therefore in order to seek better ways to reduce negative aging effects, there is a need to understand older attitudes to aging that can have applied value in adding quality of life and health to increased years. It was found in a study that older adults, who hold negative attitudes about aging, were less likely to engage in recreational activities or opportunities. On the contrary adults with positive views about aging though rare, are found to be more creative or influential to get engage in more healthy lifestyles including exercise and diet behaviors (Nussbaum & Coupland 2004: 31). Increasing Social Networks: Social relationships in old age refer certain changes to older people to whom the family as a social group indicate the desirability of a broader understanding of social relations in old age. Health care practitioners must consider this fact in a conceptual way that influences old age in a variety of ways in sociological perspectives on family life (Phillipson et al 2000: 21). The main obstruction between health care practitioners and older people need to be alleviated through acknowledging the growing desire for independence and autonomy on the part of older people. There are various modes of carrying on with an effective relationship between practitioners and older people or with other members of the society. Relationships are not dependant upon face to face communications and can be easily maintained over the telephone in ways which would have been unimaginable in the previous decades; therefore older people community may be maintained in a variety of forms that are not limited to traditional face-to-face relationships. Promoting Individual Empowerment: In order to reduce negative aging effects, it is essential for our practitioners to understand the ultimate goal of empowerment. This goal refers to enable older persons to live in a manner that maximises their ability to develop independent, positive, satisfying lifestyles and can be achieved through focusing on two sets of factors, the set of factors that are external to the individual and those that are internal. The external set of factors entitles empowerment through groups, agencies, organisations, and governmental policies and is responsible for combining with other older people that turns them into vulnerable personalities to a loss of power that affect all members of the older population. At the same time, the processes of aging have their internal psychological impacts on individual older people which are the need of groups and societies that promote positive stereotyping. Health care service providers and National Frameworks that promote older care must consider the significance of ‘Individual empowerment’ as a psychological solution to resolve ageism side effects. National Framework must understand individual psychological factors in aging which, when combined with societal and environmental negativities escorts to a condition entitled with lack of empowerment in an independent person. According to Thursz et al (1995) “The interaction between individual and societal changes in older age sets the stage for a negative, self-perpetuating cycle of ‘disempowerment’ which at the same time, reveals implications for reversing the negative spiral downturn upwards toward a positive spiral of ‘re-empowerment’” (Thursz et al 1995: 111). Promoting Nutritional awareness and physical fitness: The negative stereotyping of aging effects can be minimised by considering those economic contemplations and mobility that place the aged in nutritional jeopardy. Older people are observed prone to the eating habits since childhood, and specific dietary preferences and ethnic diets, while favored by a health care provider, may not seem to provide the best nutrition. Since aged people do not consider the advice of community members, they frequently depend on fast foods, prepared foods, and soft foods because of their convenience and the ease with which they can be carried and chewed. However, such foods are more expensive in terms of additional calories with high amounts of salt, fats, and sugar which are itself not recommended by dieticians even to younger adults. Aged people have low calorie needs but with the same nutrients as needed by youth. Food taken by older people must be selected and taken into account toward the highest nutritional density. There is a need for the older people to possess some kind of nutritional awareness, which could be promoted through conducting proper counseling sessions, so that the aged can learn to select and use ‘live’ food in endless ways (Ebersole & Hess 1998: 70). Along with nutritional education, older people must possess the awareness of being physically active and consider the fact that inactivity is a serious health threat to young and old alike. Counselors must teach older people the hazard of being inactive that could result in hypertension, various coronary artery diseases and inadequate flexibility. Aged people should be taught to exercise regularly, the counselor must negate the idea that they are too old to begin or participate in an active fitness program, except for in severe chronic conditions. Aged people are governed by the desire to enjoy their retirement life without added medical or health problems. Therefore they must be given proper attention and care in terms of counseling and health perspectives, as they are an experienced asset of our society. References Burke M. Mary & Laramie A. Joy, 2000 Primary Care of the Older Adult: A Multidisciplinary Approach: Mosby: St. Louis, MO. Ebersole Priscilla & Hess Patricia, 1998 Toward Healthy Aging: Human Needs and Nursing Response: Mosby: St. Louis, MO. Foote Christopher & Stanners Christine, 2002 Integrating Care for Older People: New Care for Old, a Systems Approach: Jessica Kingsley: London. Grant D. Lynda, 1996 “Effects of Ageism on Individual and Health Care Providers' Responses to Healthy Aging” In: Health and Social Work. Vol. 21: 1. pp. 9. Hepple Jason & Sutton Laura, 2004 Cognitive Analytic Therapy and Later Life: A New Perspective on Old Age: Brunner-Routledge: New York. Heumann F. Leonard, Mccall E. Mary & Boldy P. Duncan, 2001 Empowering Frail Elderly People: Opportunities and Impediments in Housing, Health, and Support Service Delivery: Praeger: Westport, CT. Leathard Audrey, 2003 Interprofessional Collaboration: From Policy to Practice in Health and Social Care: Brunner-Routledge: New York. Nussbaum F. Jon & Coupland Justine, 2004 Handbook of Communication and Aging Research: Lawrence Erlbaum Associates: Mahwah, NJ. Phillipson Chris, Bernard Miriam, Phillips Judith & Ogg Jim, 2000 The Family and Community Life of Older People: Social Networks and Social Support in Three Urban Areas: Routledge: New York. Rogers A. Wendy & Fisk D. Arthur, 2001 Human Factors Interventions for the Health Care of Older Adults: Lawrence Erlbaum Associates: Mahwah, NJ. Schuldberg Jean, 2005 “It Is Easy to Make Judgments If It's Not Familiar: The Use of Simulation Kits to Develop Self-Awareness and Reduce Ageism” In: Journal of Social Work Education. Vol. 41: 3. Thursz Daniel, Nusberg Charlotte & Prather Johnnie, 1995 Empowering Older People: An International Approach: Auburn House: Westport, CT. Torrington Judith, 1996 Care Homes for Older People: E & FN Spon: London. AOP, 2009a accessed from NSF, 2009a accessed from Read More