challenge

1. Social Gerontology
Lecture 13 – New Insight of the
Elderly Need

2. Autonomy and end-of-life
decisions
Issues to be addressed
1. Competency and autonomy in
end-of-life decision making
2. Physician / clinician
assessment of competency

3. Competency and autonomy in
end-of-life decision making
- Competent vs incompetent,
conscious vs unconscious,
terminally ill vs chronically ill, life
sustaining medical treatment vs
futile medical care, palliative
care vs assisted suicide, and
legally authorized representative
vs no surrogate decision maker.

4. Competency and autonomy in
end-of-life decision making
Law of end-of-life
1. To support the decision of
competent individuals
2. To protect the rights and
interests of incompetent
persons

5. Competency and autonomy in
end-of-life decision making
- Competency reflects an
individual’s autonomy to make a
range of treatment and care
choices at the end of life
- Incompetency represents loss of
autonomy and results in more
limited options in end-of-life
decision making

6. Physician / clinician assessment
of competency
- Physician judgments currently
represent the accept criterion in
medical and legal practice for
determining capacity to consent
to treatment.
- Physician and other clinicians
have generally not been well
prepared to make competency
decisions.

7. Physician / clinician assessment
of competency
2 issues to be addressed
1. The consistency of physicians’
judgments of competency
2. The value of education and
training in competency
assessment

8. The consistency of physicians’
judgments of competency
- For example, how consistent are
experienced physicians in
judging the medical decision-
making capacity of dementia
patients?
- Physicians’ assessment of
competency is currently a
subjective, incompetent

9. The value of education and
training in competency
assessment
- Research showed that
competency judgment
agreement is enhanced by
training and education.
- Judgment consistency
increased when physicians’
judgments were based on and
guided by application of specific
capacity standards.

10. The future of family responsibility
- Longer lives and fewer children,
high divorce rates and the
increase in single parent
families, the movement of
mothers into the labor force and
greater economic insecurity

11. The future of family responsibility
Issues to be addressed
1. Changes in the age structures
of nations
2. Changes in family structures
and relationships

12. Changes in the age structures of
nations
- Lower fertility and increase
longevity are altering the age
structures of all nations.
- .

13. Changes in the age structures
of nations
- Shifts in population age
structures generally result in
changing service demands and
economic needs. With an
increasing older age structure
comes change in the relative
numbers of people who can
support public health and
pension programs for elderly
people.

14. Changes in family structures and
relationships
- Wachter (1997) estimated the future
availability of kin for family members.
He found that while low fertility rates
in the late twentieth century will lead
to a shortage of kin for those
reaching retirement around 2030,

15. Changes in family structures
and relationships
- the effects of divorce,
remarriage, and family blending
are expanding the numbers and
types of step-kin, thus endowing
the elderly of the future with kin
networks that are at once
problematic, risk and varied.

16. Policies and politics of
generational responsibility
Education in the years
- The most frequently cited benefits of
continued learning in later life are
these: promoting a knowledgeable
citizenship, enabling people to make
new friends, helping to offset
depression and isolation, providing a
sense of purpose and meaning,
filling leisure time, helping people
keep physically and mentally fit.

17. Policies and politics of
generational responsibility
- The policy process often
focuses on immediate problems,
without much consideration of
the long-term view as new and
different cohorts move through
the age structure of society.

18. Health and wealth
1. Conservative policy – social
security as retirement savings
2. Progressive policy – social
security as social insurance

19. Conservative policy – social
security as retirement savings
- Social security is facing a substantial
funding shortfall unless some
modest tax increases and benefit
cuts are made.
- From the British experience, it is safe
to assume that in the long run partial
privatization would reduce the
burden on the Government, but in
the short-term the burden on the
Government would increases
substantially.

20. Progressive policy – social
security as social insurance
- Social insurance schemes have
been created to cover a number
of risks to income in modern
societies, including disability,
work injury, and the loss of
income associated with old age
and retirement.

21. Aging in a changing social
world
 Rethinking old age and the life
course
 Changing family structures
 The uniqueness of aging in each
cohort