Term
| Suicide (risk factors and rational suicide) |
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Definition
Suicide – rates of attempted and successful suicide increase among the oldest old; women are more likely to attempt suicide but men are more successful, suicide rates higher among whites than non whites
o risk factors= suffering and loss leading to depression; physical illness, pain, and disability; alcohol and drugs (including medication)
o Rational suicide= defined as suicide made in good mental health; controversial; supported by “right to die” (or death with dignity); includes physician assisted suicide |
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Term
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Definition
| Crime= increased media attention on older victims; older adults are victimized at a lower rate than younger adults; (violent crime like robbery and rape; 65+ 4 per 1000; age 12-24 82 per 1000) |
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Term
| Most common crime, prevention, and older adult crimes |
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Definition
o Most common types= most are victims of property crimes; personal larceny (like purse snatching, pocket picking), home burglary, auto theft
o Preventing crimes against elders= local and state efforts; special training for police units; neighborhood watch “granny squads”; escort services
o Crimes by older adults= only minority of crimes are by elders; most crimes by elders are misdemeanors; often causes are not economic (psychological = stress, fear, need for attention) (physiological = dementia, other disorders) |
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Term
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Definition
Older adults in prison= 16% of US prisoners
o Types of older convicts = chronic offenders; those serving long mandatory terms; and first time offenders
o Issues facing older prisoners= increasing # of older prisoners; prisons not equipped for aging in place (design unstable for older adults, lack of medical care, long term care, and need for special diets and therapies) tax payers are reluctant to pay for changes |
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Term
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Definition
Elder abuse=
o Physical= use of force to inflict pain and injury
o Psychological abuse= threats, intimidation, and verbal abuse
o Financial/material abuse= improper use of an elders funds, property or assets
o Violation of rights= taking away rights (voting, due process, etc)
o Neglect= caregivers failure to provide adequate care for older people
o Self-neglect = failure to provide ones own care (includes drug abuse) |
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Term
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Definition
| Types of fraud= telemarketing scam, door to door sales, estate rip off, con games, Medicare fraud (abuse of Medicare system by doctors and pharmacists, exaggerated claims for reimbursement; unnecessary procedures, over billing, fraudulent claims) |
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Term
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Definition
| Drug abuse= mostly legal drugs; prescription drugs; over the counter drugs; alcohol |
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Term
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Definition
| Alcoholism= lower % of elders than the other age groups; strain on body greater on older adults; risk factors in later life include – family and personal history –pain and insomnia –depression) |
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Term
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Definition
| Consumer education= (resources for seniors? Include adult protective services (APS) adult education, videos books and magazines, consumer action groups) |
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Term
| Fear of Death vs. death anxiety |
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Definition
| Fear of Death vs. death anxiety= the term fear of death is usually used when such apprehension has a specific identifiable source….death anxiety describes feeling of apprehension and discomfort that lack an identifiable source |
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Term
| 5 stages of dying= (Kubler-Ross) stages don’t have to be sequential; people can move in and out of stages; help understand the process of dying |
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Definition
1. Denial and shock- reaction to finding out they have a terminal illness, necessary to give them time to come to terms with the reality of impending death
2. Anger- following the initial shock, people are filled with resentment of those whose lives will continue “why me?”
3. Bargaining- an attempt to postpone the inevitable, people say if life can only be extended until they can do the one thing they’ve always wanted to or amend a relationship with someone, then they promise to accept death
4. Depression- when terminally ill patients can no longer deny an illness because of its advancing symptoms, a profound sense of loss is experienced (loss may be of physical parts of the body removed by surgery, of money that is being spent on treatment, of functions that no longer can be performed, or of relationships with family and friends
5. Acceptance- most people ultimately move into a weak, quiet state of submission to that which fate has to offer (no longer depressed or angry) |
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Term
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Definition
| Life Review= according to Erikson and Butler reminiscence provides a source for like satisfaction for the elderly; allowing for the integration of past experiences (who I was then and who I will be/what will happen to me) process can bring new meaning to life, reduce anxiety, prepare one for death |
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Term
| Care of the dying in hospitals= |
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Definition
Care of the dying in hospitals= medical anthropologist Sharan Kaufman identifies a conflict between medicalization paradigm to individualism and autonomy paradigm, she suggests it is this conflict that is the source of the problem of frailty in old age
• Medicalization Paradigm= belief in scientific answers to health
• Individualism and autonomy paradigm= belief in non interference in personal choice |
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Term
| Terminally ill patients: levels of awareness= Barney Glazer and Anselm Strauss (1966) |
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Definition
• Closed awareness- patient does not yet know that he/she is going to die; the physician in charge decides to keep the patient from knowing or suspecting the actual diagnosis
• Suspicion awareness- patient suspects the truth but no one will confirm his/her suspicions; because the patient is afraid to ask outright questions he/she receives no answers (patient tries to interpret what the staff says, eavesdrops, peeling and medical charts and so on)
• Ritual drama of mutual pretense- 3rd type of awareness, both patient and staff know that death is impending but both choose to act like its not. Patient tries to project a healthy well groomed appearance and behaves as if he/she will be leaving the hospital soon; staff makes comments like “looking well today, etc.” blatant events that expose the mutual pretense are ignored
• Open awareness- may or may not extend to the time of death and mode of dying but both patient and staff openly acknowledge that the patient is dying; game playing is eliminated
• Disconnection- doctors and nurses who have daily encounters with dying and it causes them to have painful emotions, become distant and tense with dying people; to face a dying person it reminds them that they are a failure at keeping the person alive as well as their own mortality |
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Term
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Definition
| Palliative care= pain control; is the core of the hospice practice, in which an individual’s death is neither hastened nor prolonged. It provides “aggressive comfort care” |
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Term
| Hospice= the term hospice can be any organization that provides support services to dying patients and their loved ones in the place where that care is given (home, hospital or nursing home) |
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Definition
• Philosophy of hospice care- doesn’t prolong or hasten death, it provides comfort and helps patients with the pain
• Interdisciplinary team- (nurses, health aides, counselors, physical therapists, nutritionists, chaplains, volunteer visitors, doctors, and long term care administrators)
• Medicare payment of hospice care- hospice got a boost in 1982 when Medicare payments were authorized to cover care for terminally ill patients (in 1989 a federal law raised disbursement rates for hospice services by 20% and another surge of interest occurred) |
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Term
| Physician assisted suicide= |
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Definition
Physician assisted suicide= “mercy” killing of terminally ill patients; pioneered by Dr. Jack Kevorkian in 1980’s
• Legal in two states- Oregon and Washington
• Dr Jack Kevorkian |
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Term
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Definition
| legal rights of dying) until late 20th century physicians made all informed decisions of patients today patients have the right to choose (issues with right to die- who should make the decision? At what point should the decision not prolong the life be made? Does the terminally ill patient have the right to choose to die? |
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Term
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Definition
| Informed consent= based on 3 principles: 1. patients are competent 2. Patients give consent freely 3. Patients understand their options |
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Term
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Definition
| Advance directives= legal documents signed by an individual about future treatment choices; state your wishes if you are in a coma or persistent vegetative state; give directions on whether to accept or refuse treatment |
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Term
| Advance Directive Examples --> |
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Definition
• Examples= use/non-use of life sustaining procedures (feeding tubes, respirators, medication) use/non-use of health care facilities
• Advance directives=
• Health care power of attorney (HCPA); a document that designates someone to be your advocate; this person makes your treatment choices when you are incapacitated; this person decides whether to accept or refuse treatment
• Living will; if you do not want to appoint a person to be your advocate; a document stating your treatment choices in case you become incapacitated
• Do-not-resuscitate order (DNR); a living will for specific treatment choices; a document that states “if my heart or breathing stop, no person can attempt to resuscitate me;” extraordinary life-saving measures are avoided |
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Term
| Patient Self Determination Act |
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Definition
| Patient self-determination act= passed in 1991; Medicare and Medicaid providers must honor advance directives; applies to doctors, hospitals, long term care, etc. |
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Term
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Definition
| Funerals and Burial= majority of Americans who die are buried; an increasing # are being cremated; funeral cemetery costs can be high; pre-planning can lower costs and reduce family conflict |
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Term
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Definition
| Bereavement= mourning for the loss of a loved one; majority are resilient within 2 years; some suffer chronic serious problems |
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Term
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Definition
Complicated mourning=
• chronic grief reaction-lasts several years and does not lead to resolution;
• masked grief reaction- absence of grief accompanied by substitute complaints
• exaggerated grief reaction- repressed grief, erupting in response to current loss |
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Term
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Definition
Aging and diversity= increase focus on older women and older minorities
Older women= considered a minority group, not in numbers but in status; experienced both sexism and ageism, disadvantages in income distribution and self-image
• historic gender inequalities in the US- education, labor force participation, politics
• income distribution- older women among the most poor in the US; unmarried women 3-4 times more likely to be poor than married women; social security reflects work and marital history
• Poverty: single women, widows, divorced women= single= 3-4 times more likely to be poor than married, divorced are most likely to be poor
• Double standard of aging- self-image is a double standard; higher standard for women’s appearance than for men; exploitation of fears: cosmetic surgery, diet/eating disorders, age discrimination |
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Term
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Definition
| Ethnic minority groups= minority groups in # and status; groups that experienced discrimination due to physical and cultural characteristics; non white elders experience both racism and ageism |
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Term
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Definition
African Americans- largest minority group; 34.7 million; 8.1% are age 65+; largest group of non-white elders; deep class divisions, elders in inner cities and rural areas most vulnerable
• Income and housing- compared with white elders have less adequate income housing and healthcare
• Life expectancy- less likely to use formal long term care (like nursing homes)
• Family support and religiosity |
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Term
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Definition
| Hispanics- 35.3 million; 4.9% are age 65+; fastest growing group of non white elders, diverse. Diverse-some with non US origin others have lived in US for generations; higher % of elders below poverty level and with inadequate health care; less likely to use HCBS (ex: senior centers); Language barrier |
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Term
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Definition
| Asian Americans- most diverse minority group; 10.2 million 7.8% are age 65+; culturally diverse, history and religion, language, values; life expectancy and income are similar to that of white elders; less likely to use formal long term care and government centers; languages and cultural barriers(few bilingual staff), discrimination, also stronger filial piety |
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Term
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Definition
| Native Americans- most deprived minority group, 2.5 million 5.6% are age 65+; smallest group of non white elders; most likely to suffer from chronic illness, disability; many problems due to poverty not age; access to health care and long term care is insufficient on US reservations |
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Term
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Definition
| Filial Piety- custom ..family members to respect and care for elders; traditionally stronger in Asian cultures (less use of formal long term care); weaker among younger Asian Americans |
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Term
| Groups assisting minority elders |
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Definition
| Groups assisting minority elders- include: National Caucus and Center on Black Aged, Association National Pro Personas Mayores, National Pacific/Asian Resource Center on Aging |
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Term
| Older adults in other countries- status varies based on public policy, cultural values, demographics |
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Definition
Aging public policy in other countries-
• (income) social security= most developed countries have public pension programs, (Germany, UK, Canada, Japan), in developing countries elders rely on families for financial support
• Medicare= national health care, in US for age 65+, in other developed countries for everyone, in developing countries none
• Programs and services= in US state and local government provides home and community based services, in other developed countries national gov. provides HOBS, elders in developing countries rely on private charity values, vary from culture to culture, shape society’s views, older adults and aging, can be continuous or discontinuous |
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Term
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Definition
| Modernization theory- status of older adults declines when 1) modernization increases 2) social change increases |
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Term
| Demographic of global aging= |
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Definition
| Demographic of global aging- world’s elderly population increasing by 795,000 each month; Europe is the “oldest” region in the world, Africa is the “youngest;”population aging is fastest in East and southeast Asia |
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Term
| Global population aging- % of age 65+ rising due to 2 factors: |
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Definition
Global population aging- % of age 65+ rising due to 2 factors: 1) lower fertility rate 2) lower mortality rate
• Decline in fertility rate- biggest factor in global population; lower fertility since late 1920 has led to smaller size of each birth cohort
• Decline in mortality rate- contributing factor to population aging; rapid decline if developing world; better treatment of diseases; lower childhood mortality; result is more people survive to old age |
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Term
| Developed countries/ Developing countries |
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Definition
Developed countries- population aging trends: face population aging today (shortage of working age adults) EX: Italy has highest % of older adults (18.1%)
Developing countries- population aging trends: face population aging in the future (by 2050) lack resources for older adults; EX: China has largest # of older adults (88 million) |
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Term
| Why study other cultures? |
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Definition
| Why study other cultures? Helps us to understand status of older adults around the world, public policy options for the United States |
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Term
| Politics and Policy in the US |
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Definition
Politics and policy in the US- key decisions in aging politics and policy= 1930s Great Depression, 1960s Civil Rights area, 2000s Demographics change
1930s: effects of pension movement- 1st political effort to organize older adults, early proposals were not adopted but led to passage of social security, 1st aging interest groups in the US
(before social security-Townsend plan, end poverty in CA (EPIC) Ham and eggs) |
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Term
Ham and eggs/
End poverty in California/
Townsend plan |
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Definition
• Townsend plan-Dr. Francis Townsend, California doctors (born in Nebraska) proposed a monthly pension for older adults (age cot) “Townsend clubs” spread across the US in early 1930s
• End poverty in California- (EPIC) Upton Sinclair writer of the jungle, ran for governor of California in 1934, proposed a monthly pension for everyone
• Ham and eggs- started in 1930s also in CA, proposed issuing a “scrip” to older adults, not money; “scrip” to be used for groceries, etc. |
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Term
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Definition
1960s civil rights era- Medicare, Medicaid (1965) older Americans act (1965) Age discrimination in Employment act (1967) focus on needy groups, new programs for older adults, rise of “Senior power”
• Senior power- increased political activism in 1960s, demonstrations for aging and non aging issues, interest groups are organized |
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Term
| 2000s- demographic changes, aging policy expands: Medicare part D, Social security privatization is proposed, political power of seniors increases |
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Definition
Political power for older adults increasing- increasing in terms of voting, office holding, and interest groups
Voting- older adults are more likely to vote than younger adults, voter turnout, is there an old age voting bloc? 2004 73% turnout among age 65-74 ( highest among all age groups), senior vote vital to political candidates |
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Term
| Office holding- political power: president, congress, supreme court |
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Definition
• President- minimum age is 39 (no max. age), limited to two terms, 2 elected at age 65+= William Henry Harrison and Ronald Reagan, Recent presisdents= Baby Boomers- Bill Clinton born 1946, George W Bush born 1946, Barack Obama born 1961
• Congress- elected officials no mandatory retirement, no term limits in US congress, many US senators and representatives have served into the 80s and 90s, Strom Thurman= turned 100
• Supreme court- tend to be older, no mandatory retirement serves as long as health allows, oldest is John Paul Sevens (86 years old) |
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Term
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Definition
Interest Groups- groups protect the special interests of individuals of businesses, interest groups lobby political officials to achieve their goals, aging interest groups act on behalf of seniors (gray lobbying) “lobby” on behalf of older adults include: AARP and Gray Panthers; increasing in number and effectiveness
• AARP- founded in 1947 by Ethel Percy Andrews, today 32 million members may join for benefits members are age 50+
• Gray Panthers- founded in 1970 by Maggie Kuhn, small group more focused on political issues, members are all ages
• Alliance for retired Americans- founded in 1961 leadership comes from labor unions (AFL-CIO) lobbied for creation of medicare (1965) |
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Term
Medicare prescription drugs-
Privatized social security- |
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Definition
Medicare prescription drugs- AARP: yes Alliance for retired Americans: No Gray panthers: No
Privatized social security- AARp: No Alliance for retired Americans: No Gray panthers: No |
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Term
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Definition
Older Americans act- (OAA) 1965 ensures that need of older adults are met, created a nationwide aging network of programs and services, OAA programs are funded through public and private sources
• OAA programs- include: nutrition, transportation, employment, education, Other programs= Not a part of OAA: Elderhostel, generations united, senior corps |
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Term
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Definition
| Elderhostel- education and travel program for persons age 65+, started in 1975 summer program on US college campuses, flat fee for room and board scholarships available Elderhostel today= 8000 educational programs, all 50 states 90 countries, year round |
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Term
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Definition
| Generations united- international organization raises awareness of: grandparents raising grandchildren; environmental protection; service learning |
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Term
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Definition
Senior Corps- established in 2002 as a part of USA freedom corps, volunteer programs for Americans age 55+ (seniors get small stipend), older adults serve 15-40 hours per week 3 types of services:
• 1. Foster grandparents- volunteer age 60+, provide mentorship for disadvantaged or disabled youth, support children with exceptional needs
• 2. Senior companions- volunteers are age 60+, provide assistance and companionship for other seniors, support for frail elders and for caregivers
• 3. RSVP- volunteers are age 55+, work in community service opportunities in public and private sector, Examples: building homes, planting gardens; Neighborhood watch programs; disaster relief programs |
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Term
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Definition
Senior Corps- established in 2002 as a part of USA freedom corps, volunteer programs for Americans age 55+ (seniors get small stipend), older adults serve 15-40 hours per week 3 types of services:
• 1. Foster grandparents- volunteer age 60+, provide mentorship for disadvantaged or disabled youth, support children with exceptional needs
• 2. Senior companions- volunteers are age 60+, provide assistance and companionship for other seniors, support for frail elders and for caregivers
• 3. RSVP- volunteers are age 55+, work in community service opportunities in public and private sector, Examples: building homes, planting gardens; Neighborhood watch programs; disaster relief programs |
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Term
| Future status of older adults- demographic changes; health care- acute care and long term care; programs and services |
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Definition
• Demographic changes- population aging- lower fertility and lower mortality; increasing diversity; changing cohorts- silent generation and baby boomers
• Changing health care- changes to acute care= shorter hospital stays for Medicare patients; greater use of home health agencies; greater emphasis on preventative care changes to long term care= more residential options; nursing homes, assited living, CCRCs, greater use of HCBS
• Innovations to the aging network (targeting, cost-sharing, improving services) increasing demand for targeting and cost sharing; improving services for convenience and diversity |
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Term
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Definition
| Generational equity- criticism of old age programs (social security, Medicare); “greedy geezers” demand services at expense of children Is there generational equity? No; programs are funded by different sources; aging programs benefit the young as well |
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Term
| Contract Between Generations |
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Definition
| Contract between generations- intergenerational support is a traditional value in the US; basis for aging policy in 20th century; generational equity issue has called this into question |
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