by Dr PHUA Kai Lit
School of Medicine and Health Sciences
Monash University Sunway Campus
Bandar Sunway, Malaysia
Myths about the Elderly (see graphic below!)
INDIVIDUAL VERSUS POPULATION AGEING: Individual ageing: There is "chronological ageing", "normal ageing" and "pathological ageing". Chronological ageing refers to a simple increase in age. Pathological ageing refers to the ageing of the body due to an unhealthy lifestyle, disease etc.
Population ageing: This occurs when the % of elderly in a population increases from 3% to about 25%. Due mainly to declining fertility (low birth rates).
CHANGING DEFINITIONS OF THE ELDERLY: In some societies, a person in his or her 40s would be considered "elderly". In Malaysia, the retirement age is 55 while in America, it is 65. Thus, a person is not considered as "elderly" until after age 65 in the USA.
The definition of "elderly" within one society can also change over time, e.g., if the retirement age is raised from 55 to 60, people between 55 and 60 would no longer be regarded as "old".
The experience of being "elderly" can be very different in different societies, e.g., in some societies, the elderly have a lot of power and are treated with great deference. In other societies, they may be stereotyped and experience age discrimination ("ageism")
WHO ARE THE ELDERLY?: The "young-old" versus the "old-old" ( > 80 years old). The old-old require more health AND other social services. Also at greater risk of being bed-ridden. There are more elderly women than elderly men (especially in the oldest age groups). This is because women tend to live longer than men on the average.
WHAT IS MEANT BY THE TERM "QUALITY OF LIFE"?
1. Physical well-being
2. Emotional well-being
3. Social well-being
4. Ability to do ADL (Activities of Daily Living) and maintain independence
HOW TO MEASURE QUALITY OF LIFE?
1. Generic measures e.g. SF36 questionnaire
2. Disease-specific measures e.g. Arthritis Impact Measurement Scale
* You can measure either "objective functioning" or "subjective well-being"
USES OF QUALITY OF LIFE MEASURES
1. To decide betwen treatment regimens
2. To monitor impact of treatment
3. To plan care (especially care of patients with chronic disease)
* Note that both the DISEASE as well as the TREATMENT can affect a patient's quality of life. For example, in the treatment of breast cancer, radical mastectomy will have a stronger negative impact on the quality of life compared to a lumpectomy. Radical mastectomy can have a strong negative impact on the patient's emotional well-being.
ACTIVITIES OF DAILY LIVING (ADL)
Basic ADL
Getting out of bed
Toilet
Dressing and Grooming
Eating
Walking
Bathing
Instrumental ADL
Using the telephone
Shopping
Cooking
Housekeeping
Taking medicine
Handling money
IMPAIRMENT, DISABILITY AND HANDICAP
Impairment: abnormality of body
Disability: functional deficit arising from impairment
Handicap: resulting social and economic disadvantages, e.g., discrimination from others, stigma, difficulty in getting a job etc
Example: a person who is partially blind suffers from a degree of visual impairment. This gives rise to the disability of difficulty in seeing and reading. If employers will not hire the person although the job does not actually require good eyesight, this discrimination would give rise to a handicap.
NEED FOR ASSISTANCE AND SERVICES
Medical services
Help with ADL - depends on degree of disability & limitations on mobility
Social services --> in-home care/day care/nursing homes
Economic support --> family/work/savings/pension/investments/Government/charity
Psychological support
Special categories: the destitute elderly, the socially isolated elderly, the chronically ill elderly
WHO WILL CARE FOR THE ELDERLY?
Changes in family structure and the larger society affect care of the elderly:
More singles - who will care for them when they grow old?
Elderly widows
Decrease in fertility implies fewer descendants to take care of the elderly
Migration of young adults to the cities or overseas implies that more elderly people will live alone
Female relatives working outside the home
Self-Help Groups e.g. PJ Community Centre
Relatives
Commercial help
The Community, e.g., Non-Governmental Organisations or NGOs
The Government, e.g., social welfare programmes
HEALTHY AGEING AND PRODUCTIVE AGEING
Most of the elderly are relatively healthy. People can take action so that they will stay healthy as long as possible ("compression of morbidity" into the last few years of one's life i.e. by having a healthy lifestyle, one can stay healthy into old age. Thus, one will only suffer from serious sickness during the last few months or last years of one's life). "Healthy ageing" through a healthy lifestyle and prevention of disease.
Productive ageing: contribute to society in old age (family, paid work, volunteer work), maintain dignity and independence
SOCIETY AND AGEING
Raise the retirement age
Make age discrimination illegal
Compulsory savings for old age
Compulsory support from relatives (as in Singapore)?
Income transfers to the aged
Subsidised services for the aged
New jobs for the aged
"Compression of morbidity"
Extending "active life expectancy"
* How to pay for healthcare costs of the elderly?
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