ageism, caregivers, retirement, social theories of ageing, abuse, successful ageing

1. Sociology of Ageing
Dr. Doha Rasheedy Ali
Associate professor of Geriatrics and
Gerontology
Faculty of medicine
Ain Shams University

2. Topics
• Elderly rights
• Social theories of ageing
• Successful ageing
• Retirement
• Living alone
• Ageism
• Caregiving related issues
• Elderly abuse

3. RIGHTS OF OLDER PEOPLE

4. the United Nations Principles for Older
Persons (1991)
1. Independence: Includes access to basic needs, health care,
work, education programs, the right to live at home as long
as possible in supportive, safe environments.
2. Participation: In social activities and opportunities to share
their knowledge and skills with their community.
3. Care: That maintains their optimum level of physical, mental
and emotional wellbeing and includes access to social and
legal services.
4. Participation: To realise their potential and access
educational, cultural, spiritual and recreational resources.
5. Dignity: To be treated fairly, to be valued in their own right,
to live in dignity and security, to be free of exploitation,
physical and mental abuse, to be able to exercise personal
autonomy.

5. Other rights include:
1. Confidentiality
2. Be consulted
3. Involve an advocate to assist you to regain
control of your life
4. Have access and control over your own money
5. Make a complaint.

6. Social theories of ageing

7. Social theories of ageing
• Although ageing is a biological process, it does not
occur in a social vacuum, so it can also be
understood as a social experience and in sociological
terms
• Social theories on aging examine the relationship
between individual experiences and social
institutions e.g., aging and retirement; aging and
institutional care; aging and government policy etc.
• All have limitations, and some can be considered
more than others when attempting to understand
social changes in aging.

10. 1. Role Theory (Rosow):
• The hypothesis: Our roles define who we are,
determine our self concept and affect our
behavior.
• Roles become more vague with aging and
therefore there is a decrease in self concept.
• Because people are not socialized to ageing, this
results in role loss and uncertainty accompany
the aging
• as we enter old age (when ever that may be) we
relinquish roles previously accumulated in adult-
hood.

11. Criticism
• There is great variation in terms of how older
persons manage their aging experience.
• Not all cohort members experience a role-less
role that persists through aging.

12. 2. activity theory
Rowe and Kahn's
• viewed the maintenance of activity, health and social
engagement as characteristic of successful ageing.
Based on the hypothesis that
1. Active older people are more satisfied and better
adjusted than those who are not active
2. An older person’s self-concept is validated through
participation in roles characteristic of middle age,
and older people should therefore replace lost
roles with new ones to maintain their place in
society.

13. Criticism
• the categorizing of older people as successful or unsuccessful
agers was criticised as ignoring the socioeconomic context of
individuals. Not everyone had access to resources to ensure
'successful ageing’.
• Family, gender, education, sex and occupational background
influence activity level in aging.
• Most important is to understand the source of inactivity i.e.,
voluntary or involuntary i.e., reversible or irreversible.

15. 3. Modernization Theory
• Durkeim and Weber
Identifies 4 factors that stimulated economic
advancement.
1. Urbanization
2. Mass education
3. Technological changes and improvement
4. Advances in growth in economic production
• As a consequence of this advancement the argument
states that in traditional societies elderly played active
and vital roles while in modern industrial societies
elderly lost position, status and power.

16. criticism
• Most useful in understanding a specific time
period during which societal beliefs about
production of goods and family participation
in the distribution of income changed thus
shifting the role that elders played in
maintaining and supporting the family and
society’s economic vitality. Atchley (1993)
contends that Modernization Theory is most
useful in understanding social change prior to
WWII.

18. 1. Disengagement theory
• Henry and Cumming
• it is expected that elders would disengage from
certain roles (employment being a prime example)
in exchange for exemptions from certain
responsibilities and societal obligations.
• It was thought that this process was a mutually
satisfying preparation for the final disengagement
of death.
• In their original study, the significant number of
older people who maintained their occupational
and other roles were deemed as 'unsuccessful
disengagers'.

19. • because of inevitable declines with age,
people become decreasingly involved with the
outer world and become more interior in
anticipation of death.
• disengagement is useful for society
because it fosters an orderly transfer of
power from older to younger people

20. Criticism
• This perspective did not explain the
variation, creativity and types of activity
that many elderly experience during aging.
• It also did not address the severe distress
experienced by those elderly forced to
withdraw from social contact.
•

22. 2. CONTINUITY THEORY
• Based on the hypothesis that central
personality characteristics become more
pronounced with age or are retained through
life with little change;
• people age successfully if they maintain their
preferred roles and adaptation techniques
throughout life

24. 1. SYMBOLIC INTERACTION
• Hypothesis is: interactions of factors like
environment, relationship with others can
affect how people experience aging.
• Emphasis is on reciprocity with the social and
physical world as a measure of how we age.
• Self concept is affected by how people interact
within their social world i.e., define us and
react to us.

25. 2. Age Stratification Theory
• This is a move away from the individual with a
focus on understanding groups of older
persons
• Examination of the relationship between older
people and historical events in their lives.
• Focus on structural, demographic and
historical characteristics tell us how different
age groups respond to social change.

26. 3. POLITICAL ECONOMY OF AGING
• A theory based on the hypothesis that social class
determines a person’s access to resources
• hat dominant groups within society try to sustain
their own interests by perpetuating class
inequalities
 Lack of social infrastructure support for elderly
of lower social economic status.


27. 4. life course perspective
• A life course perspective then began to emerge to
conceptualise ageing.
• The hypothesis is: The aging experience is shaped by
multiple, complex forces i.e., history, cultural
meanings, socio economic status, cohort group, social
contexts.
– There is a diversity of role and role changes across the life
span which are very dynamic and multidirectional.
– From beginning to end of life we develop and change.
• being older was not a discrete stage of one's life, but
rather a phase that reflected the accumulation of life's
experience and circumstance.

28. 5. Social Exchange Theory
– Hypothesis is: individual status is defined by the
balance between the contributions that people
make to society and the costs to support them.
– Variables that impact what society defines as
“contribution” are affected by age, gender, social
class, education and ethnicity.

30. Social Phenominology and Social
Constructionists
• The hypothesis is: Each one of us construct
our own social experience and reality.
• Thus the “reality” of aging is subject to change
in definition depending on who is doing the
defining.

31. Feminist Perspective
• The hypothesis is: The experiences of women
are often ignored in understanding the human
condition.
• Research that supports womens’ experience
in aging especially those conditions which
have the greatest impact on the lives of
women.

32. Social Justice Theory:
• Identifies the type of support elderly are entitled to by
virtue of their contribution related
sacrifices/responsibilities made on behalf of society.
• Argues that the process of modernization cost the elderly
as a social category and that programs developed to return
their status to them are based on social justice theory.
– This perspectives offers a more pragmatic explanation of how
older people were identified as a social category needing
support and assistance.
– Social Justice Theory (“just due” theory)
• Does not focus on what elderly contribute or the position they hold.
• Focus is on the contribution that elderly have made to society over a
lifetime

33. OTHER THEORIES

34. Sick Role Theory
• Parsons
• Sick Role-Medical Term=the social aspects of falling ill
and the privileges and obligations that accompany it
• Sick Role Theory two rights of a sick person and two
obligations
Rights:
1. The sick person is exempt from normal social roles
2. The sick person is not responsible for their condition
Obligations:
1. The sick person should try to get well
2. The sick person should seek technically competent help
and cooperate with the medical professional

35. Social Theories
• Labeling Theory (Howard S. Becker)
– that deviance is not inherent to an act,
– but instead focuses on the linguistic tendency of
majorities to negatively label minorities or those
seen as deviant from norms. The theory is
concerned with how the self-identity and behavior
of individuals may be determined or influenced by
the terms used to describe or classify them

36. How to use theories
• In:
1. Prevention
2. Intervention
3. rehabilitation

37. • Disengagement:
When to stop driving
• Activity:
How to plan retirement(find alternative roles,
paid or volunteer0

38. SUCCESSFUL AGEING

39. How to define successful ageing
Being:
• Disability free???
• Good health???
• Disease free/ morbidity free???
• Cognitively intact?????
• QoL, sense of wellbeing???
• Adaptive capacity, functional reserve, and
resilience????
Being:
MULTIDIMENSIONAL???????

40. Biomedical theories
• Biomedical theories define successful ageing
largely in terms of the optimisation of life
expectancy while minimising physical and
mental deterioration and disability.
• They focus on: the absence of chronic disease
and of risk factors for disease; good health;
and high levels of independent physical
functioning, performance, mobility, and
cognitive functioning.

41. Psychosocial theories
• Sociopsychological models emphasise life
satisfaction, social participation and
functioning, and psychological resources,
including personal growth.
• Satisfaction with one’s past and present life
has been the most commonly proposed
definition of successful ageing, and is also the
most commonly investigated.

42. older people’s views
• Their definitions include mental,
psychological, physical, and social health;
functioning and resources; life satisfaction;
having a sense of purpose; financial security;
learning new things; accomplishments;
physical appearance productivity; contribution
to life; sense of humour; and spirituality.
• Not all captured adequately by theoretical
models.

43. Rowe and Khan model
• They confirmed the three components of
successful ageing as absence or avoidance of
disease and risk factors for disease, maintenance
of physical and cognitive functioning, and active
engagement with life (including maintenance of
autonomy and social participation).
• Rowe and Khan (1987, 1997) summarized ageing
in three categories: “usual”, “pathological” and
“successful” ageing.

46. factors important in successful
aging
• Genetics
• Environment (physical,emotional)
• Economics
• culture, spirituality
• Self-Efficacy. — Self-efficacy and the related
concepts of mastery and control are consistent
predictors of sustained activity in old age.
• Allostatic load(the cost of compensating for and
adapting to stressors)

47. Genetics
• Specifically, genes such as APOE, GSTT1, IL6, IL10, PON1, and SIRT3
may to have individual effects on the likelihood of aging
successfully.
• Additionally, the genes contributing to successful aging can be
grouped in several main categories (ontologies):
1. Genes involved in the maintenance of cholesterol, lipid or
lipoprotein levels. Their ability to metabolize and transport
molecules such as cholesterol relates to cardiovascular health,
which could directly influence physical activity levels and
longevity.
2. Genes related to cytokines, which influence inflammation and
immune responses. These genes could influence successful aging
by regulating cellular senescence, determining susceptibility to
age related cancers, or other mechanisms.
3. Genes involved in drug metabolism and insulin signaling.
4. Genes related to age associated pathological processes (e.g.,
Alzheimer’s disease.)

49. Criticism
• The heterogeneity of the older population
means that it is difficult to measure the
concepts of successful and active aging.
• The expectations for active aging are typically
framed by policy makers and researchers, who
tend to define activity according to middle-
aged or youthful perspectives that may not be
congruent with the experiences of older
people

50. Assessment
• Most researchers have measured whether a person has
successfully aged by assessing all its dimensions (primarily
through the use of self-reports)
1. Physical health : number of chronic conditions and self-
rated health (SRH)
2. Physical functioning ADL, IADL, AADL
3. Cognitive functioning MMSE
4. Social relations frequency of contact with the nine most
important network members with whom they had regular
contact other than their partner, with the question “How
often are you in touch with…?”. Answers were coded as
total number of daily contacts.

51. 5. Coping was assessed in terms of participants’ sense of
mastery, i.e. the extent of perceived control over their own
lives and ability to manage on-going events and situations.
Mastery was measured with a five-item abbreviated version
of the Pearlin Mastery Scale (Pearlin/Schooler, 1978).
Response categories ranged from (1) “Strongly agree” to (5)
“Strongly disagree”. The total score ranged from 5 to 25,
with a higher score indicating a stronger sense of mastery.
6. Financial health, or having sufficient income, was
measured by asking respondents to evaluate their income
with the questions “Are you satisfied with your income
level?” and “Are you satisfied with the living standard you
enjoy on your income?”. Response categories ranged from
(1) “Dissatisfied” to (5) “Satisfied

52. • 7. Activity participation:
– social and leisure activities and physical activities.
Participation in social and leisure activities was assessed by
asking participants for how many hours during the last year
they had engaged in visiting activities or meetings of
different types of organisations (e.g. senior associations,
organisation for leisure or hobby, church), and how often
they participated in seven types of leisure activities (e.g.
going to the cinema, doing sports, shopping for pleasure).
– Physical activity was measured by asking participants for
how many minutes during the last two weeks they had
been walking outside, bicycling, doing work in the garden,
doing light household work, doing heavy household work
and engaging in sports activities, with a maximum two
sports.

53. • 8. General well-being : satisfaction with life, positive
emotions, and absence of loneliness.
– Satisfaction with life was measured with the question:
“Taking everything into account, have you been satisfied
with your life lately?” Response categories ranged from (1)
“Dissatisfied” to (5) “Satisfied”.
– Positive emotions were assessed with four items from the
validated Dutch version of the Center for Epidemiologic
Studies Depression Scale (Beekman et al., 1997; CES-D;
Radloff, 1977). The four items were “I felt I was as good as
other people”, “I felt hopeful about the future”, “I was
happy” and “I enjoyed life”, with response categories
ranging from (0) “Rarely or never” to (3) “Mostly or
always”.
– Loneliness was measured with the De Jong Gierveld Scale
(De Jong Gierveld/Kamphuis, 1985), a widely used 11-item
scale to assess level of loneliness. Total scale scores ranged
from (0) “Never lonely” to (11) “Very lonely”.

54. Successful vs. productive ageing
• Productive aging adopts a broader approach than that
of successful aging.
• It is concerned to make it possible for the increasing
numbers of people who are living longer and healthier
lives, under changes in the circumstances of retirement
and in the nature of work, to make significant social or
economic contributions, rather than simply retiring to
a state of leisure.
• Again the focus is on social engagement, with
productive aging going beyond conventional meanings
of economic productivity to include volunteering and
civic participation

55. Successful vs. Active ageing
• For example, falls are assumed to happen to
people who lack some physical control.
Prevention programs therefore advocate «
active ageing », individual behavioral changes
such as exercise regimes (and residential
modifications like better lighting).

56. Social support
• refers to the various sources of help and resources
obtained through social relationships with family,
friends, and other care providers.
• Types of social support include:
1. emotional (including the presence of a close
confidante),
2. instrumental (help with activities of daily living,
provided through labor or financial support),
3. appraisal (help with decision making)
4. informational (provision of information or advice)

57. Social networks
• Social networks are the ties that link
individuals and groups in social
relationships. Various characteristics can
be measured, including size, density,
relationship quality, and composition.
• 1

58. Social engagement
• represents an individual’s participation in social,
occupational, or group activities, which may
include formal organized activities such as
religious meetings, service groups, and clubs of
all sorts. More informal activities such as card
groups, trips to the bingo hall, and cultural
outings to see concerts or galleries can also be
considered as social engagement.
• Volunteerism is often considered separately,but
can also be seen as an important measure of
social engagement.

59. Social isolation
• is another term that is encountered in the literature
relating social circumstances and health. It is related to
ideas of loneliness, reduced social and religious
engagement, and reduced access to social supports.
• It may also incorporate properties of the older person’s
environment, such as difficulty with transportation. As
with many other social factors, social isolation can be
“subjective” (as perceived by the older person
themselves, e.g., loneliness) or “objective” (based on
outside measures or assessments by others).

60. RETIREMENT

61. • Retirement involves leaving the workforce
with a plan never to return. It can happen at
any age, but most people retire in late
adulthood, or the time of life after age 65.
Retirement is a big adjustment. For many
people, work has been the main part of their
lives for decades, and once they retire, they
have to figure out what they will do with all
their time. People react to retirement
differently

62. • The questions most people think about before
retirement are "How much money will I
need?" and "Am I saving enough?" But while
financial security is certainly critical, people
need to amass more than money for a
successful retirement, experts say. They need
to stockpile their emotional reserves, as well.

63. HOLISTIC CONSIDERATION
• Retirement may bring changes in multiple
areas of your life:
1. Social
2. Emotional
3. Psychological
4. Financial

64. • Emotional Challenges can include:
1. Finding purpose or meaning in life
2. Assessing Self-Worth
3. Shift/Change in Identity
4. Evolving relationships

65. • A successful transition to retirement takes not
only financial and logistical planning, but also
emotional and psychological planning. This
can lead to greater resilience and well-being
during and after the transition

66. RETIREMENT IS A TRANSITION

67. • Late life is commonly a period of transitions
(eg,retirement,relocation)and adjustment to losses.
• Retirement is often the first major transition faced by
the elderly. Its effects on physical and mental health
differ from person to person.
• About one third of retirees have difficulty adjusting to
certain aspects of retirement, such as reduced income
and altered social role.
• Some people choose to retire, having looked forward
to quitting work; others are forced to retire (eg,
because of health problems or job loss).
• Appropriate preparation for retirement and counseling
for retirees and families who experience difficulties
may help

68. COMMON EMOTIONS EXPERIENCED
DURING TRANSITION
• Excitement
• Joy
• Freedom
• Accomplishment
• Peace of mind
• Optimism
• Anxiety
• Boredom
• Restlessness
• Uselessness
• Loss, especially of
identity
• Sadness/Grief
• Physical/Mental
sequelae of aging

69. Before You Retire
• Important ideas to consider:
1. Who am I?
2. What do I really want to do?
3. What is meaningful to me?

70. WAYS TO ESTABLISH NEW IDENTITY
1. Find activities that are satisfying (Mind/body
fitness)
2. Create new social ties/network
3. Learn new skills
4. Become involved in community issues

71. TRANSITIONAL STAGES OF
RETIREMENT
1. Pre-retirement: Planning Time Focus on getting
to retirement rather than on what happens
afterwards
2. The big day: Smiles, Handshakes, Farewells
Shortest stage in retirement, day when work
actually ceases. Should be marked by a
ceremony of some sort.
3. Honeymoon phase: I'm Free!: Initial freedom
enjoyed. Time spent doing the things that
“never could be done because of work.” Lasts as
long as person has activities planned

72. 4. Disenchantment: So this is it?: Novelty of the
honeymoon phase wears off “What do I do now?”
Typical feelings include disillusionment or
disappointment, boredom, and anxiety
5. Reorientation: Building a New Identity: Often the
hardest phase, involves building a new identity. Takes
time and conscious effort. Self examination questions
that must be answered again.
• Who am I?
• What is my purpose?
• What is important to me, and how do I get it?
6. New Routine: Moving On
1. New daily and weekly schedule established.
2. New patterns become firm.
3. Adjustment to new lifestyle.
4. Negative emotions fade.

73. the criteria of successful retirement
Post retirement life with :
1. New roles in life
2. Unaffected relationship
3. Perfect self satisfaction
4. Suitable life style
5. Supportive groups
6. Ideal time usage

74. Factors affecting success of retirement
process
1. Health condition
2. Financial status
3. Family support
4. Planning before retirement

75. STRATEGIES FOR A SUCCESSFUL
TRANSITION
1. Increase your awareness
2. Visualize who you want to become‹
3. Gradually implement lifestyle changes ‹
4. Share your new plans and goals with family,
colleagues, and friends‹
5. Use your emotional intelligence by
recognizing it takes conscious effort, time,
and perseverance to evolve

76. • saving up enough money, for instance, is easiest if
you start in your 20s (financial plan)
• Retirement Life Style
• Social Security
• Involvement in social activities.
• Eating moments were shared with working
colleagues
• working activity, paid or volunteer. Encourage
working after retirement

77. • Planning for retirement should be a life long
plan

78. LIVING ALONE

79. • In the US, nearly 29% of the 46 million
community-dwelling elderly live alone.
• About half of the community-dwelling oldest
old (≥ 85 yr) live alone.
• About 70% of elderly people living alone are
women, and 46% of all women age ≥ 75 yr live
alone.
• Men are more likely to die before their wives,
and widowed or divorced men are more likely
to remarry than are widowed or divorced
women.

80. • The high percentage of older people living
alone reflects the household changes resulting
from:
1. death of a spouse (or their entry into long
term care) and Changing family structures
2. the trend for older people and adult children
to live independently.
3. transformations of cultural values, as reflected
in higher incomes, better health, lower
fertility rates, and a growing preference for
privacy.

81. The disadvantages
• It can be challenging in the areas of access to
health care, social interaction, and meeting
one’s daily needs.
• The disadvantages of elderly people living
alone range from their safety and health to
their psychological well-being.

82. Negative outcomes
• Increased risk and complications of falls
• Dehydration
• Hyponatremia
• Malnutrition
• Infections
• Physical injuries
• Worsening of symptoms of diseases (unnoticed)
• Non compliance
• Loneliness
• Depression
• sleep problems
• Use more formal home-care services
• Higher mortality

83. • There are four distinct but interrelated
concepts: being alone, living alone, social
isolation and loneliness.
• These terms are often used interchangeably,
although conceptually it is important to
distinguish between them.

84. loneliness
• is the subjective counterpart to the objective
measure of social isolation or the perceived
deprivation of social contact, the lack of
people available or willing to share social and
emotional experiences.
• Self reporting underestimates the problem
due to the stigmatization of loneliness may
make people unwilling to identify themselves
as lonely and makes denial a possibility.

85. social isolation
• has been defined as the lack of meaningful and
sustained communication, or as having minimal
contact with either the family or the wider community.
• The nature of a person’s social network has been
identified as key to the level of social isolation that
they experience. Networks are described as ‘identified
social relationships that surround a person, their
characteristics, and the individual’s perceptions of
them’. Social networks can be identified by size
(number of people in the network), density (the degree
to which members of the network are interrelated) and
the accessibility and reciprocity of the relationships.

86. • The interrelationships between isolation,
loneliness and living alone are complex. The
presence of a large social network does not
necessarily imply the presence of a confiding
relationship or the absence of loneliness (and
vice-versa).
• However, living alone is not necessarily
synonymous with being alone or loneliness,
although the link with isolation is much closer
(i.e. not all those who live alone are isolated,
whilst most of the isolated live alone).

87. Lonelines, Aloneness
• Loneliness is a negative state of mind , a
feeling that something is missing, a pain, a
depression, a need, an incompleteness,
miserable ,worried,dependence .
• Aloneness is a positive state ,happy ,
celebrating , joy of being, . You are complete.
Nobody is needed , independence

88. Positive outcomes
• Independence
• Privacy
• Familiar environment
• committed to maintaining home

89. Independence
• Despite these problems, almost 90% of elderly
people living alone express a keen desire to
maintain their independence.
• older adults who value privacy strongly prefer
their own residence
• Many fear being too dependent on others
and, despite the loneliness, want to continue
to live alone.

90. Familiar environment
• The sense of self appears to be connected to
the home environment, and some elderly feel
an attachment to the home that they are
committed to maintaining for as long as
possible. Homes give meaning to their lives,
and maintaining a home is key to
independence

91. When Living Alone is Unsafe
1. Medication management issues
2. Poor eyesight
3. Social isolation
4. dementia
5. Forgetting appointments
6. Unable to keep up with daily chores and
housekeeping
7. Poor nutrition or malnutrition
8. Home safety hazards such as poor lighting and loose
carpeting
9. Unable to pay bills on time

92. How to minimize risks
• First the goal is to keep the elderly at his home as long as
possible with independency and safety:
1. creating opportunities for social interaction, such as attending social
programs, even via telephone. Hobbies and social groups maintain
social connections and physical fitness.
2. enhancing social supports by family members or friends (regular visits)
3. Provision of home care
4. Home safety assessment, Technology allowing monitoring elderly
safety at home, neighborhood safety
5. nutrition programs Meal on wheel
6. Assisted Living if needed
7. engaging regular physical and mental activities
8. assistive devices, grab bars
9. Visiting nurses, labelling of drugs
10. emergency response device
11. classes on health-related topics, computer training, or exercise classes.

93. Ageism

94. Primitive categories
• humans automatically categorize others in
social perception. Some categorizations—
race, gender, and age—are so automatic that
they are termed “primitive categories”.
• As we categorize, we often develop
stereotypes about the categories.
• As with race and gender, we rely on physical
cues for categorizing people based on age.

95. making assumptions

96. What physical characteristics do you associate
with older or elderly people?
1. Wrinkled skin
2. gray or white hair
3. flexed posture
4. slow movement
• all assist rapid identification of people based
on their (old) age.
• The labels we give to these social categories
vary but include old people, elders, seniors,
senior citizens, and the elderly

97. Stereotyping based on age
• This stereotyping can be so prevalent in
society that it is almost invisible, but it can
perpetuate negative attitudes that influence
behaviors.

98. Ageism
• Ageism is a process of systematic stereotyping, harmful
attitudes and direct or indirect discrimination against
people because they are old.
• Ageism, a term first used by Robert Butler in 1969, is an a
ttitude of mind which may lead to age discrimination.
• Age discrimination, on the other hand, is a set of actions
with outcomes that may be measured, assessed and com
pared.
• ageism is used to describe stereotypes held about older
people on the grounds of their age.
• Age discrimination is used to describe behavior where
older people are treated unequally (directly or indirectly)
on grounds of their age.’ (Ray, Sharp and Abrams, 2006)

99. • A one-part definition of ageism is “prejudice
against older persons” or the “association of
negative traits with the aged”
• Or using the traditional three components of
attitudes:
• (1) an affective component such as feelings one
has toward older individuals;
• (2) a cognitive component such as beliefs or
stereotypes about older people;
• (3) a behavioral component such as
discrimination against older people

100. Ageism is a set of beliefs … relating to the ageing pr
ocess.
• Ageism generates and reinforces a fear of the
ageing process, and stereotyping presumptions reg
arding competence and the need for
protection.
• In particular, ageism legitimates the use of
chronological age to mark out classes of people wh
o are systematically denied resources and
opportunities that others enjoy.

101. Butler (1969) proposed that ageism
has three components:
• a cognitive component (beliefs and
stereotypes about older people)
• an affective component (prejudicial
attitudes towards older people)
• a behavioural component (direct and
indirect discriminatory practices).

103. Emotional reactions to the elderly
• Pity and sympathy were the most common emotions felt
about the elderly.
• Old people also prompt a range of negative feelings in others,
and chief among those is anxiety.
– Researchers have found that anxiety is a common response to
older people among the young, and the main reasons seem
to be that old people remind us what may, or likely will, happen
to all of us eventually. The elderly remind us that youth and
beauty will fade; that illness and disability, along with the social
isolation they can cause, are likely; and that death is a certainty
for everyone.
– Another explanation for the anxiety and threat posed by the
elderly to younger people trades on the stereotypic beliefs that
old people are sick and feeble and therefore more likely to catch
and carry illnesses that can be caught by others.

104. • anxiety about older people predicted attitudes and behavior:
Participants who reported more anxiety also attributed more
negative characteristics to older people and reported less
willingness to help the elderly.

105. Manifestations of Ageism in Daily Life
Patronizing Language:
• Two major types of negative communication
have been identified by researchers:
overaccommodation and baby talk.
• In overaccommodation, younger individuals become
overly polite, speak louder and slower, exaggerate
their intonation, have a higher pitch, and talk in
simple sentences with elders (Giles, Fox, Harwood,
& Williams, 1994).
• This is based on the stereotype that older people
have hearing problems, decreasing intellect, and
slower cognitive functioning (Kite & Wagner, 2002).

106. • Baby talk is a “simplified speech register high
pitch and exaggerated intonation” (Caporael &
Culbertson, 1986).
• As the term implies, people often use it to talk
to babies (termed primary baby talk) but such
intonation is used, also, when talking to pets,
inanimate objects, and adults (termed
secondary baby talk).

108. Examples of ageism in health care
• Reversible causes of problems such as memory loss,
incontinence, and immobility: are often overlooked because of a
misconception that they are an unavoidable part of aging.
• An interim report in 2002, identified the following areas of explicit
negative discrimination in policy in secondary care.
– Resuscitation , Hospital admission policies ,
Access to day surgery , Gastroenterology screening ,
Osteoporosis screening ,Adverse clinical incident reporting ,
Transplant policy , Prescribing ,
Colorectal cancer screening ,Anaesthesia guidelines ,
Breast screening ,Cervical cancer screening ,Coronary heart
disease clinical guidelines , Immediate stroke care
(Department of Health, 2002, Policy document)

109. Ageism & Healthcare:
• Aging inevitably involves an increased demand for
healthcare services at some level and at some point
• Healthcare professionals do not receive enough training in
geriatrics to properly care for many older patients.
• Older patients are less likely than younger people to receive
preventive care.
• Older patients are less likely to be tested or screened for
diseases and other health problems.
• Proven medical interventions for older patients are often
ignored, leading to inappropriate or incomplete treatment.
• Older people are consistently excluded from clinical trials,
even though they are the largest users of approved drugs.

110. Impact of ageism
• Ageism promotes the idea that older people are a
burden and this can lead to neglect and social
exclusion.
• It can also reduce older people’s self-esteem, reduce
their participation in society and restrict the types and
quality of services available to them.
• Research by Sargeant (1999) reported that victims of
ageist prejudices experience being discounted, ignored,
treated with disdain and denied the opportunity to be
recognised as individuals with civil rights and
responsibilities.
• Older adults in the United States tend to be
marginalized, institutionalized, and stripped of
responsibility, power, and, ultimately, their dignity
(Nelson, 2002a).

111. Co-occurrence of Ageism and Abuse:
• The negative attitudes that lead to ageist
behavior also make it easier for the
perceiver to regard the welfare and
humanity of older adults as less important
than that of younger adults.
• As such, ageism may indeed be a
contributing factor that leads some
younger adults to neglect, exploit, or
otherwise abuse older adults.

112. Why Ageism Occurs?
Many theories have been proposed as to
why ageism occurs at individual, societal
and organisational levels:
• According to Butler (1969) and Lewis
(1987), ageism allows the younger
generation to see older people as
different from themselves and thereby
reduce their own fear and dread of
ageing.

113. • A second factor contributing to ageism is the
emphasis on youth culture in western society
(Traxler, 1980). The media places an emphasis on
youth, physical beauty and sexuality, while older
adults are primarily ignored or portrayed negatively
(Martel, 1968; Northcott, 1975).
– For example, a cornerstone of the birthday greeting card
industry is the message that it is unfortunate that one is
another year older. While couched in jokes and humor,
society is clearly saying one thing: getting old is bad. A
recent survey found that approximately 90 million
Americans each year purchase products or undergo
procedures that hide physical signs of aging (National
Consumer’s League, 2004).

114. • Thirdly, the emphasis in western culture on
productivity contributes to ageism, where
productivity is narrowly defined in terms of
economic potential (Traxler, 1980).
– The industrial revolution demanded great mobility in
families—to go where the jobs were. In light of this new
pressure to be mobile, the extended family structure (with
grandparents in the household) was less adaptive. Older
people were not as mobile as younger people. These jobs
tended to be oriented toward long, difficult, manual labor, and
the jobs were thus more suited to younger, stronger workers
– great advances in medicine, extending life expectancy
significantly. Society was not prepared to deal with this new
large population of older adults. Society began to associate
old age with negative qualities, and older adults were
regarded as non-contributing burdens on society

115. Levels of ageism
• Personal ageism: is defined as ideas, attitudes,
beliefs, and practices of individuals that are biased
against persons or groups based on their older age.
Examples include exclusion or ignoring older persons
based on stereotypic assumptions, and stereotypes
about older persons and old age.(gerontophobia,
gerontophilia)
• Institutional ageism: is defined as missions, rules and
practices that discriminate against individuals and/or
groups because of their older age. Examples include
mandatory retirement, and devaluing of older persons
in cost-benefit analysis .(gerontocracy)
• .

116. Types of ageism
Unintentional ageism: is defined as ideas,
attitudes, rules, or practices that are carried out
without the perpetrator’s awareness that they
are biased against persons or groups based on
their older age.
This type of ageism is also known as
inadvertent ageism .
Examples include absence of procedures to
assist old and vulnerable persons, lack of built-
environment considerations (ramps, elevators,
handrails), and language used in the media.

117. • Intentional ageism: is defined as ideas,
attitudes, rules, or practices that are carried
out with the knowledge that they are biased
against persons or groups based on their older
age. Examples include marketing and media
that use stereotypes of older workers;
targeting older workers in financial scams; and
denial of job training based on age

118. • Positive ageism: For example, Palmore ( 1990 )
de fined ageism as “any prejudice or
discrimination against or in favor of an age
group” (p. 4). As examples of positive ageism,
older persons might be seen as wiser, more
capable of grasping the big picture as opposed to
details of a specific problem or situation, and
happier than younger persons.
• negative/overtly harmful – direct discrimination.
Assumptions based on positive or negative
ageism may lead to responses that are
biased

119. The way forward
Discrimination in old age must be made visible and tackled
at every level:
Social ageism:
• As individuals we must challenge against attitudes and
behavior wherever they occur.
• Discrimination in old age should be prohibited in national
legislation and existing discriminatory laws revised.
• Universal prohibition of discrimination in old age in a
human rights instrument would provide a definitive, universal
position that age discrimination is morally and legally
unacceptable.

120. • Health care ageism:
• Health education about normal ageing
• Improve access to care
• Improve quality of care
• Clinical trials for the aged.

121. CAREGIVERS

122. Who is the caregiver??
• A caregiver or carer is an unpaid or paid person
who helps another individual with an impairment
with his or her activities of daily living.
• Any person with a health impairment might use
caregiving services to address their difficulties.
• Caregiving is most commonly used to address
impairments related to old age, disability, a
disease, or a mental disorder.

123. • With an increasingly aging population in all
developed societies, the role of caregiver has
been increasingly recognized as an important
one, both functionally and economically.
• Many organizations which provide support for
persons with disabilities have developed
various forms of support for carers as well.

124. Rewarding
• it gives their life meaning and produces pride
in their success as a caregiver.
• Caregivers can generate a stronger bond with
the person they care for.
• set a standard of “giving” and become more
sensitive and responsive to the needs of
others.

125. • Caring for a loved one can be very rewarding,
but it also involves many stressors. Caregiver
stress can be particularly damaging, since it is
typically a chronic, long term challenge.
• Sources of stress:
1. PARENT-CHILD ROLE REVERSAL
2. Physical disability

126. Types of caregivers
• Primary Caregiver: assistance for ADL, decision making.
• Secondary Caregiver: provide assistance to the primary
caregiver.
• Crisis caregivers provide help in the event of a fall or
hospitalization – some type of crisis where the primary
caregiver needs additional support.
• Working caregivers help with physical care like bathing
and with routine tasks like bills, but maintain employment
outside the home.
• Long distance caregivers arrange repairs, pay bills,
schedule visits and research other healthcare options
from miles away. They are behind the scenes offering
support and assistance.
• Paid/ informal

127. Primary caregiver
may be:
1. a family member
2. a trained professional
3. another individual.

128. • The physical, emotional and financial
consequences for the family caregiver can be
overwhelming.
• Once burnt out, caregiving is no longer a
healthy option for either the carer or the
elderly. So it’s important to watch for the
warning signs of caregiver burnout and take
action right away when you recognize the
problem.

129. Risk factors for
caregiver
stress
factors of
care recipients
factors of
caregivers
Caregiving
related factors

130. Risk factors for caregiver stress
carer
• Old age
• Women
• Poor health
• Lack of financial resources
• Lack of social support
• Number of helpers
• Education of signs of stress
elderly
• functional decline
• Cognitive impairment
• Level of caregiver burden
• Cause to need care
• Disease progression(rapid
e.g. stroke)
• Social network
the relationship between the caregiver and the care-recipient

131. • Common signs and symptoms of caregiver
stress:
1. Anxiety, depression, irritability
2. Feeling tired and run down
3. Difficulty sleeping
4. Overreacting to minor nuisances
5. New or worsening health problems
6. Trouble concentrating
7. Feeling increasingly resentful
8. Drinking, smoking, or eating more
9. Neglecting responsibilities
10.Cutting back on leisure activities

132. • Common signs and symptoms of caregiver
burnout
1. less energy, constant exhaustion, even after
sleeping or taking a break
2. inability to relax and enjoy things
3. neglect their own needs, (no time, don’t care
anymore).
4. their life revolve around caregiving, but it
gives a little satisfaction
5. impatient and irritable with the elderly
6. helpless and hopeless

133. How to prevent and deal with
caregiver stress
• Assess amount of help needed and compare to available resources
• Maintain a life outside of caregiving
• education of caregiver of resources and best ways of caregiving
• Respite care
• Recruit others to help with responsibility
• Get help and find support. Join a support group
• Stress management techniques, exercise, meditation, deep
breathing
• Maintain good health and nutrition
• legal and financial plans
• Community sources : visiting nurse, home care, transfer to other
levels of care

134. Elder Mistreatment

135. Elder mistreatment:
Involves acts of commission or omission
that result in harm or threatened harm to the
health or welfare of an elderly person by a
caregiver or other trusted person

136. OR
• “Intentional actions that cause harm or
create a serious risk of harm (whether or
not harm is intended) to a vulnerable elder
by a caregiver or other person who stands in
a trust relationship to the elder.
OR:
• “Failure by a caregiver to satisfy the elder’s
basic needs or to protect the elder from
harm”

137. • The definitions exclude violence by strangers.
• There must be a trusting relationship between
an older person and the abuser.
• Willful (attempts harm) non- willful (lack of
skill, burnt out caregiver)

138. Who is the abuser?
• Partner, adult child or other relative.
• Friend, neighbour or visitor
• Patient or resident
• Health care provider, caregiver or other social
or support worker.
• Person managing an older person’s affairs (e.g.
Attorney or guardian).
• Self (self neglect)

139. Where does elder abuse take place?
• Home.
• Nursing home.

140. Epidemiology
• Increases as world is ageing.
• Ranges from 1.5 – 6% across different
population.
• Underreporting ? (only less than 10% cases
are reported)
• Abuse is manifested differently in different
culture and ethnic groups.

141. Barriers to report elderly mistreatment
 Lack of awareness (especially among health care professionals).
 Health care workers may feel uncomfortable discussing the topic with
their patients or may fear offending their patient’s caregivers.
 Knowing that there are few effective avenues to address the problem once
it is identified. lack of satisfaction with the response by the authorities
 Ageism and negative stereotyping of the elderly.
 It is often difficult to distinguish subtle symptoms of mistreatment from
symptoms of chronic physical and mental illnesses.
 Social isolation of the patient, Cognitive impairment.
 The elderly person's fear of threatening the relationship with the
caregiver and feeling that there is nowhere else to go, that nothing can be
done to help.
 The shame in admitting abuse by one's own family.

142. Risk Factors For Elderly Mistreatment
• Factors in the victim.
• Factors in the abuser.
• External factors as living arrangements, external
stress and social isolation
But, THERE IS NO EXCUSE FOR ABUSE

144. Types of Abuse
• Physical
• Psychological
• Sexual
• Violation of Rights
• Neglect
• Financial exploitation

145. Physical abuse
• Physical abuse is the use of force that results
in physical injury, pain, or impairment and
may include hitting, shoving, shaking,
slapping, kicking, pinching, and burning.
Additionally, the inappropriate use of drugs
and physical restraints, force feeding, and
physical punishment.

147. SEXUAL ABUSE
• nonconsensual sexual contact of any kind or sexual
contact with a person incapable of giving consent. It
includes unwanted touching, sexual assault, and
sexual battery.
• Primary evidence of sexual abuse includes bruising of
the perineal region or presence of semen. Secondary
evidence includes new onset of a sexually
transmitted disease, blood, or purulent discharge

148. PSYCHOLOGICAL ABUSE
• infliction of anguish, emotional pain, or
distress through verbal or nonverbal acts. It
includes verbal assaults, insults, threats,
intimidation, humiliation, , name-calling or
harassment, silence treatment.
• Psychological abuse also includes statements
that humiliate or infantilize the elderly person.

150. TYPES OF NEGLECT
• Active Neglect: intentional failure of a care-
giver to fulfill his/her care–giving
responsibilities
• Passive Neglect: Unintentional failure of a
care-giver to fulfill his/her care–giving
responsibilities
• Self Neglect: The older person not providing
his/her own essential needs

151. VIOLATION OF RIGHTS
• Abandonment: desertion of an elderly person
for whom one has agreed to care for,
“dumping” a cognitively impaired elder at an
emergency room with no identification
• denial of privacy
• participation in decision-making.

152. FINANCIAL EXPLOITATION
• is the illegal or improper use of an elderly
person’s funds, property, or assets.
• It may include cashing checks without
authorization, forging an elderly person’s
signature, misusing elderly person’s money or
possessions, deceiving an elderly person into
signing a document such as a contract or will,
or improper use of guardianship or power of
attorney, medical fraud.

153. Is Elder Abuse a Crime?
• Physical, sexual, and financial/material abuses
are considered crimes.
• Certain emotional abuse and neglect are
subject to criminal prosecution.
• SELF-NEGLECT IS NOT CONSIDERED A CRIME.

154. Indicators for elder mistreatment
Physical Signs:-
• Multiple injuries, especially of different ages; bruises, welts,
cuts, abrasions;
• Scalds & burns, especially sock & glove patterns;
• Genital Injuries
• Poisoning especially if recurrent
• Sexually transmitted diseases;
• Patterned bruising;
• Unexplained failure to thrive;
• Poor hygiene;
• Dehydration or malnutrition;
• Fractures, especially if in specific patterns;

155. Behavioral Indicators
• Fear of particular person
• Appears worried and/or anxious
• Becomes easily irritable or upset
• Appears depressed or withdrawn
• Avoids physical eye or verbal contact with carer or
service provider.
• Difficulty in walking or sitting
• Pain or itching in genital area
• Recoiling from being touched
• Fear of bathing or toileting

156. Indicators of Financial Abuse
• Lack of money for necessities
• Depletion of savings
• Disappearance of possessions
• Sale of property by older person who seems
confused about the reasons for the sale

157. Indicators of Neglect & Acts of Omission
• Malnourishment or dehydration
• Poor personal hygiene
• Clothing in poor repair
• Absence of appropriate dentures, glasses or
hearing aids
• Left unattended for long periods
• Medicines not purchased or administered

158. Indicators of Self Neglect
• Reclusive, filthy and unhealthy living
environments
• Collecting and/or hoarding rubbish
• Poor personal hygiene
• Inappropriate or unusual clothing
• Menagerie of pets

159. INSTITUTIONAL ABUSE
failure of an organization to provide an appropriate
and professional service.
Indicators:
• Low staff morale
• High staff turnover
• High sickness rates
• Excessive hours worked and frequent use of agency staff
• Lack of consideration for Privacy
• Lack of care with personal clothing (including loss of clothes, being
dressed in other peoples’ clothes, dirty or unkempt, spectacles not
clean, wearing other peoples’ spectacles, hearing aids or teeth)

160. • Poor hygiene with noticeable smell of urine
• Residents in dirty clothing and/or bed linen
• Inappropriate use of equipment
• Over reliance on sedating medication,
catheterisation and enemas
• Lack of communication between staff, staff
and residents and staff and relatives

161. INTERVENTION

162. • Effective management requires a
multidisciplinary approach that covers broad
areas of
• medical treatment,
• mental health care,
• social services, and
• legal assistance.

163. Prevention
• Education is the cornerstone of preventing elder abuse.
• Respite care essential in reducing caregiver stress
• Social contact & support the elderly, family members &
caregivers.
• Counseling for behavioral or personal problems in the
family play a significant role.
• If there is a substance abuse problem, treatment is first
step in preventing violence against older family member.

164. Identification of suspected cases
• Physicians should learn to recognize the common
signs and symptoms of elder abuse, many of which
can be subtle.
• Health care provider may be the only contact of the
elder other than the abuser.
• When the physician suspects a problem, he should
conduct a thorough history and physical exam, and
the caretaker should be asked to leave the examining
room during the interview.

165. • Victims may not expose truth immediately,
instead asking directly, physician should begin
with questions about nature of relationship
with the caregiver, conditions of the home,
and circumstances surrounding her physical
signs and symptoms.
• Assess patient safety , if unsafe hospital
admission is warranted.
• Develop a plan-of-care to promote functional
independence

166. Assessment
• Medical
• Cognition
• Mood
• Functional
• Decision making capacity.
• Home assessment
• Documentation of signs of abuse

167. • Reporting
• APS
• Community services
• guardianship

168. Provide the Pt:
Education: Promote the social attitude that no one should be subjected to
violent, abusive, humiliating, or neglectful behavior. Educate about the special
needs and problems of older adults and about the risk factors for abuse.
Provide resources accessible for geographic areas and on-going and emergent
support.
 Respite care: Temporary rest and “time off” is essential in reducing caregiver
stress, a major contributing factor in elder abuse.
 Social contact and support: Encourage being part of a social circle or
support group. Having other people to talk to is an important part of relieving
tensions. Many times, families/ friends can share solutions and provide informal
respite for each other. Abuse is less likely to go unnoticed when there is a
larger social circle, “more eyes” on the Pt.
 Counseling: Encourage changing lifelong patterns of behavior and finding
solutions to problems emerging from current stressors. If there is a substance
abuse, behavior problem in the family, treatment is the first step in preventing
violence against the older family member. Address mental illness issues.
Professionals and Community should:
 Keep a watchful eye out for family, friends, and neighbors who may be
vulnerable.
 Get educated and understand that abuse can happen to anyone.
 Speak up if you have concerns. Trust your instincts! Know what to look for.
 Keep reporting any suspicions you have of abuse to helping agencies.
 Spread the word. Share what you’ve learned to friends, family and people you
work with.

169. Instructions to a caregiver:-
If the caregiver overwhelmed by the demands of caring for
an elder, instruct (he /she ) to do the following:
 Request help, from friends, relatives, or local respite care agencies, so you
can take a break, if only for a couple of hours.
 Find an adult day care program.
 Stay healthy and get medical care for yourself when necessary.
 Adopt stress reduction practices.
 Seek counseling for depression, which can lead to elder abuse.
 Find a support group for caregivers of the elderly.
 If caregiver is having a problems with drug or alcohol abuse, get help.

170. The Right to Refuse Help

171. • Despite your best efforts to identify elder
abuse and offer assistance, the suspected
victim may refuse help.
• Whether abused or not, competent adults
have the legal right to refuse medical and
social services.

172. THANK YOU