Models of ageing

Models of ageing There are many ways of considering ageing and the perspective taken has an influence on how we consider and explain the process. These ways of considering have been termed models and theories of ageing. For the purposes of your study in this unit these terms will be used interchangeably. In this module we are going to look at three models of health that have been applied to Ageing. 1. Biomedical 2. Biopsychosocial 3. Sociocultural We will begin by viewing two lectures. The first contrasts a Biomedical and Biopsychosocial model in relation to Angina. This video is not specific to ageing but does illustrate the two models. The second discusses Ageing from a Sociocultural perspective. We will then read a summary of each model. WATCH: Gill Furze - Biomedical vs. Biopsychosocial treatments: The example of Angina Age, aging and 'growing old': Socio-cultural perspectives Biomedical models of ageing Biomedical Model of Ageing Biomedical models focus on biological factors and exclude psychological, environmental, and social factors in discussions of illness, health and ageing. Physiology, pathology and biochemistry are core areas of investigation. As such, biomedical models form the basis of traditional western medicine, and the model under which most health professionals continue to primarily be taught and practice. Within a biomedical model disease is considered to be an organic condition that may be eradicated or cured by medical intervention targeted at physiology, pathology and biochemistry. Disease is something that is experienced by a person, that person then becomes the object of treatment by the medical professional. As treatment is provided after symptoms appear, we can consider traditional western medicine under a biomedical model to be primarily reactive rather than preventative. Treatment is typically provided in a medical environment (hospital or Drsoffice) out of the context of the persons own personal environment. Biomedical models have in the past and continue to make an enormous contribution to health and well-being. It is through a biomedical model that we have been able to map and understand the anatomical and neurophysiological structures of the body, and to explore genetics. However the model does not come without its shortfalls. Failing to consider the impact of individual differences, life circumstance, environmental and psychological impacts on health and well-being, the biomedical model is insufficient in facilitating well-being and global quality of life, is insufficient in providing holistic treatment, is insufficient in targeting public health and global health issues, and insufficient in promoting, healthy, active and successful ageing across the lifespan. Under a biomedical model a distinct power imbalance is also seen between the 'object' of treatment (people - patients - consumers) and the provider of treatment (the health professional). Here we have an emphasis on people as passive recipients of care provided by the health professional with the knowledge to tell us 'what is best, what we need'. Without consideration of factors outside of physiology, pathology and biochemistry, the opinion, concerns and circumstances surrounding the illness are not given equal weighting. Here are some topics currently under discussion within the Biogerontology field that are consistent with a biomedical model of ageing. Telomeres The shortening of telomeres has been described as the molecular clock of ageing. A link has in fact been found between the age and telomere length such that shorted telomeres are associated with shorter life expectancy. Mitochondrial damage Changes in mitochondrial Fe homeostasis cause a decline in mitochondrial function. Decline in mitochondrial function causes neuromuscular degenerative disease and tissue dysfunction. Micronutrient inadequacy Inadequate micronutrient intake leads to metabolic changes that can increase the chance of DNA damage leading to increased risk of cancer, immune dysfunction, cognitive decline and accelerated ageing due to mitochondrial decay. Immunological Point of view Change in immune system function is a key characteristic of ageing and one key reason why older people are more prone to chronic and degenerative health conditions. Reactivity of dendritic cells to self-antigens can be characteristic of ageing, this over-reactivity may then induce lymphocyte T proliferation leading to higher risk of autoimmune diseases WHAT DO THESE CHANGES MEAN FOR US? Have a look at this animation of for a quick and very simplistic but effective summary of changes to our body we can expect as we age. We will also briefly summarise some below: Eyesight As we age our eyesight does decline, for some this decline may result in no noticeable functional loss of vision. Others may be aware that they must hold the newspaper a little further away to read, may need to read larger print, or notice it takes longer to focus on smaller objects. Conditions impacting vision common in older people include presbyopia, cataracts, and macular degeneration. Hearing Hearing loss related to ageing is called presbyacusis and results in a loss of hearing across all frequencies. Your ability to detect changes in pitch reduces, listening in background noise becomes harder, wax production reduces, your eardrum thickens, the bones (ossicles) that transfer sounds to your inner ear may move less easily, you have also accumulated a lifetime of damage to your inner hair cells that transmit sounds as nerve impulses to your brain for processing causing issues with the perception of sounds particularly complex sounds such as speech. Ageing and Taste Taste receptors detect sweet. salty, bitter and sour tastes. Saliva helps us to dissolve food and drinks and therefore release the flavour producing chemicals and substances in food, the odours from these chemicals and substances waft up to your nose where you then 'smell' your food. Whilst the taste receptors on your tongue are quite resilient with age, your sense of smell declines and as this occurs so does your ability to 'taste'. In addition many older people experience loss of saliva production which in turn reduces our ability to breakdown our food and release those flavour producing stimulants. It also reduces our ability to ingest and digest our food. Many medications commonly used by older people can also impact on taste sensation including blood pressure and arthritis medication, chemotherapy and radiation treatments. Metabolic Changes Gaining weight as we age whilst common is NOT inevitable. Body fat starts to increase from around 25 years of age however muscle mass and body water decrease. Hence, you may gain weight or lose muscle tone. What does happen as you age is that you have a lower basal metabolic rate, so in short you burn less calories. Our nutrition needs change as we age. If we still eat in our older years, what we did when we were 17, it is likely we will gain weight. Respiratory Changes As we age, our lungs become less elastic, and our chest wall stiffens. Our trachea expands which results in decreased surface area in our lungs meaning we cannot cough as forcefully and therefore have more difficulty clearing residue in our lungs. Aspiration pneumonia is a common cause of death in older adults involving food, fluid or saliva entering the lungs and causing infection. This can be related to obvious swallowing difficulties or silent aspiration of saliva and bacteria in the oral cavity either during waking hours or more commonly while asleep. Good oral care is essential in reducing the prevalence and negative consequences of aspiration pneumonia in older people. Lung capacity and function reduce as we age however maintaining a healthy lifestyle including aerobic exercise helps to keep our respiratory system healthy. Pulmonary related disease is a leading cause of illness and death in older people. HAVE A LOOK AT: Some relatively recent statistics regarding biomedical risk factors for older people Also look at the National Institute on Ageing: Biology of Ageing Pharmacodynamics The effects of medicines in older adults The effects of medications in the body are considered in relation to pharmacokinetics (how the drug is absorbed, distributed, metabolised and excreted) and pharmacodynamics (how the body is affected by the drug at the level of the cell and organ). As people age the manner in which their bodies absorb, metabolise and eliminate medications changes and is usually slowed and diminished. Therefore, such considerations as rate of absorption in the gastrointestinal tract, body fat to lean mass ratio and hepatic and renal function are important considerations for older adults. Therefore, it is important to consider not only the actions and side effects of medications but the physical functioning of the person taking them. Polypharmacy In addition, as people age the number of medications they take is inclined to increase and this raises the potential problem polypharmacy and adverse drug interactions. For this reason medications need to be kept to a minimum and reviewed and discussed regularly with the older person to promote optimum efficacy and medication adherence. (Hunter, S. 2012, Miller's Nursing for Wellness in Older Adults, Chapter 8 Medicines, Lippincott Williams & Wilkins, 110-139). Biopsychosocial models of ageing Biopsychosocial Model of Ageing The Biopsychosocial model dates back to 1977, theorised by psychiatrist George Engel. Engel argued that their was a need for treatment extending beyond a traditional medical model, to include in addition consideration of treatment from a psychological and social viewpoint. Engel viewed the traditional medical model as reductionistic, viewing disease as nothing more than deviation from normal “measurable biological variables.” Engel acknowledged the enormous contribution of the biomedical model in advancing the science of medicine however argued that the model is insufficient to understand and treat the presentation and impact of disease on individuals and society. The World Health Organization (WHO) has recognised health as biopsychosocial in nature since 1946 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'. Today the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) provides a biopsychosocial model of health and classification system by which all health professionals can strive to achieve care that addresses biological, psychological and social (including social determinants of health) influences on health and the impact of disability on individuals, groups and care givers (the impact of one persons disability on another is called third party disability). Lets have a look at the ICF below: As you can see from the diagram above, relationships between components of the model are bidirectional. They are also dynamic, changing with circumstance and complex due to the many factors that influence the experience of disability. Hence one person may have the same impairment (the same disease process and stage) but may experience significant differences in the degree of disability and handicap due to their individual life circumstances, the situation at hand (what they are trying to engage in and the level of support they are receiving), and their own psychological state and perception of their impairment in their current circumstance. In summary, the ICF; 1) is hierarchical in nature consisting of two components “Functioning and Disability’ and ‘Contextual Factors’ with each of these consisting of two further components, classifying health and health related conditions from the perspectives of ; ‘Body Functions and Structures’ (The impairment/disease, what we would look at from a biomedical perspective) and ‘Activities and Participation’ (How does the impairment impact the persons ability to complete a particular activity, and what impact does this have on the persons overall functioning and participation in life); and ‘Personal Factors’(socioeconomic factors, ethnicity, psychological health, general approach to life, life goals, activities of importance to the person) and ‘Environmental Factors’ (social determinants). You SHOULD have heard about the biopsychosocial model many times before in your studies. If you are new to your degree you will hear about it many times again. It is the model on which 'active ageing' and 'successful ageing' are based. If you have a particular interest in the application of biospychosocial models of health to ageing READ the following interesting but slightly heavy article: Scherer, M.J., Federici, S., Tiberio, L., Pigliautile, M., Corradi, F., &Meloni, F. (2012). ICF core set for matching olderadults with dementia and technology. Ageing International, 37(4), 414-440. Sociocultural models of ageing Sociocultural Models of Ageing There are many different social and socio-cultural models relevant to ageing. The basic premise of these models is consideration of society on a persons functioning and health. Under these models a person's experience of disability is as much shaped by the society and culture in which they live as it is by the disease they experience. Lets have a brief look at some of the models that fall under this domain in no particular order. Disengagement theory As we age we experience decline, as we decline with age we become increasingly disengaged from society and preoccupied with our own world. As we do so we 'hand over', or transfer power to the younger generation. This theory has been discounted by most people in the field of ageing. Role theory Role theory is based on the view that who we are, our self concept, our behaviour, is defined by the roles we play. The roles we expected to play differ across the life course. In our older years we may lose some of our earlier roles and be socialized into new roles. As this occurs we experience role loss which may be accompanied by loss of identify and self-esteem. Activity theory As we age, the more active we remain, the greater our life satisfaction, more positive our self-concept and smooth our transition into ageing will be. Adjustment will be easier and we will be better able to adjust to our new roles in society. Political Economy of Ageing Throughout the life course a persons's access to resources is determined by their social class. socio-economic constraints, gender, sexual orientation, functional ability and race. Hence all of these factors shape an individuals experience of ageing. Many difficulties older people face are socially constructed. Continuity theory Individuals do not change significantly as they age but maintain consistent patterns of behaviour. Shifts in roles still encompass similar roles, a persons approach to life and adaptation to change remains relatively consistent, and personality across the lifespan similar. A persons satisfaction in life is determined by consistency across the lifespan in activities and lifestyles. As we age we solidify and clarify our younger selves with central personality characteristics and our core values becoming more pronounced. Age Stratification theory In society we talk about and divide people into groups based on age. Young, middle aged, old etc. Out classification of people into these cohorts shapes our expectations of the roles individuals take, individual experience, and our expectations of people. Along with these roles and expectations our concept of life satisfaction differs across age groups, the experiences of these cohorts differs with historical periods and events. These different experiences then shape how different cohorts think, behave and contribute to society. Social Exchange theory Social exchange theory underpins the argument between older people as a 'burden' vs 'resource'. A persons contribution to or worth in society is weighed up against the cost of supporting them. This process of weighing up determines a persons status in society and associated satisfaction with life. Under the resource argument, older people may have less financial and material resources to contribute to society but have wisdom, life experience, love and time to give back to society. Gerotranscendence theory As we age we begin to shift from a materialistic view of the world to a more spiritual or transcendent one. We explore our inner selves, are less self-centered, contemplate more and focus on wisdom, spirituality and solitude. Life Course Perspective How we age is shaped by our cohort, culture, history, location, individual development and experience of life events, our relatedness to others, and human agency. We are impacted by intergenerational transmission, shared and individual experience. Social Phenomenology Emphasis is placed on understanding ageing through the meaning of experience rather than on objective factors. How we age is dependent on the meaning we attribute to our life and social experiences in the context of everyday life. Social Constructivism Similar to social phenomenology, how we make meaning of our individual experiences and the ageing process shapes how we age. The realities of ageing and age-related concepts are however socially constructed through interpersonal relationships such that how one views a relationship is more important than the objective nature of the relationship. Feminist Perspective Views current theories of ageing as insufficient as they fail to adequately address gender differences in the process and experience of ageing, with the experience of women ignored. Postmodernist Theories Views knowledge as socially constructed, affected by situation, circumstance and individual point of view and therefore no form of meaning should be taken as truth. Value is instead placed on individual choice and autonomy including as we age. You may have found this page a little daunting given the number of different slants to the sociocultural model presented here. For the purpose of this unit and clinical practice in general it is important to have a brief understanding of the key points presented by these models. That is the need to consider the influence of he society, culture and individual circumstances surrounding illness. As clinicians we often 'think' we are working under a biopsychosocial model however the 'social' side is often what we neglect. We focus our attention on the impairment, then we ask ourselves 'How does our patient seem to be coping with this illness (psychological consideration), then we may give brief comment or thought to how they cope when they go home'. That is usually where we stop. When working under a biopsychosocial model, EACH of the components must be given EQUAL consideration. It is for this reason that we as health professionals of all disciplines must step out of our scientific comfort zone to gain a much deeper understanding of social determinants of health and ageing and what we can do to make a positive impact on these determinants. IF YOU ARE INTERESTED IN SOCIOCULTURAL THEORIES OF AGEING READ (Optional): Consedine&Skamai (2009). Sociocultural considerations in ageing men's health: Implications and recommendations for the clinician. Journal of Mens Health, 6(3), 196-207. Assessment outline Case Scenario One: June Carter is an independent, socially active and fit 75 year old woman who takes great pride in her appearance. She has three adult children and five grandchildren and has been widowed for ten years. She visits her local GP to discuss her plans to commence a sexual relationship with Jim (65 years) and her concerns about her sexual function. In relation to this scenario consider and discuss the perspectives of June, June's GP and June's adult children and possible courses of action from these perspectives. Be sure to discuss and evaluate the theories and beliefs about ageing that may shape the beliefs and attitudes of the different people involved. In doing this analyse the manner in which age is intersecting with other social categories in this scenario. Also, include a discussion of the physical and biological changes that may have an impact on June's situation. Structure for the presentation 1. Brief introduction about my presentation give outline what I’m going to talk about 2. Give definition of the aging, active aging 3. Give the perspective A. June perspectives( looking for book or research talk about old ladies want to start new relationship ) Some of it o Feeling lonely o Losing body function o Think what the society think about her relationship for example her children o Does she really care what they think because we don’t know form which culture she is? (find research which culture support or against society o Normally older don’t go to gp to talk about sexual activity so she seem well education B. GP perspectives o Normally they don’t talk about it feel shy or uncomfortable o Usually they don’t talk about sexual functioning and sexual diseases C. Children perspectives o They might think that she is too old to have sex o They might think that hersexual interest kind of behavior problem rather a basic human need for love and intimacy o If she get married and die she might loss her probity and Jim get it ( fear of losing inheritance) 4. the theories and beliefs about ageing such as a. Biomedical b. Biopsychosocial c. Sociocultural 5. analyse the manner in which age is intersecting with other social categories in this scenario 6. Discussion of the physical and biological changes that may have an impact on June's situation. 7. Pharmacodynamics and nutritional considerations 8. Conclusion Your presentation should: 1. Include references for the material included in each slide and a reference list in accordance with APA. 2. Be between 5 and 8 minutes in length 3. Everything used should have in text reference In this project presentation you will address the following Learning Outcomes: 1. discuss and evaluate a range of theories of ageing and their influence in shaping beliefs about ageing, older people's health care needs and experiences as well as the contribution they make to maintaining active ageing societies; 2. examine critically how age, as a social category, intersects with other social categories such as gender, class, ethnicity and sexuality; 3. explain how the ageing body is constructed, understand the ageing of body systems, differing pharmacodynamics and nutritional considerations in different social, cultural and biological discourses and the bearing this brings to health and health care practices. Books might use Older People: Issues and Innovations in Care Nay, R. and Garratt, S., Churchill Livingstone/Elsevier 4th ed. 2013 A Bitter Pill: How the Medical System is Failing the Elderly Sloan, J., Greystone Books 2009 Aging in European Societies Powell, J.L. and Sheying, C., Springer 2013 I Feel Great About My Hands: And Other Unexpected Joys of Aging Graydon, S., Douglas and McIntyre 2011