Lifespan, Gender

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Lifespan, Gender Culture

• HEALTH OF OLDER AGE
• Catherine Sykes
• C.Sykes_at_City.ac.uk

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Outline

• Some facts about older age
• Predictors of morbidity (path analysis)
• Health Risks in older age
• Health Promotion in older age

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Older Age

• Life expectancy in industrialised countries is
  on the increase
• 1970 - average life expectancy 71.4 years
• 1997- average life expectancy 77.7 years
• 1970- average infant mortality rate 20 per
  1,000 live births
• 1997 - average infant mortality rate 6 per
  1,000 live births
• source Human Development Report 1999

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Quality of life -objective methods

• morbidity and dependency (Walker, 1982)
• dependency - used in at least 4 different ways
  physical, psychological, political, financial
• Woods and Britton (1985)
• should use multimethods - discussions with
  carers, patients, careful observations,
  evaluation of control over life

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Older Age

• On a global scale, most people on this planet
  die before their fifth birthday.
• In least developed countries
• 1970 - life expectancy 43.4 years
• 1997 - life expectancy 51.7 years
• 1970 - infant mortality rate 149 per 1,000 live
  births
• 1997- infant mortality rate104 per 1,000 live
  births

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Older Age

• Major myths
• Elderly homogeneous group of people
• Aging synonymous with disease
• Elderly burden on society

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Older Age

• Giles and Coupland (1991)
• older people often play into the steorotype
  -using a language which focuses on the frailty of
  their body
• Johnson (1986)
• forecasts a new climate of ageing spurred on by
  the demands of a rising number of people who have
  experienced relative prosperity.

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Older Age

• What images are associated with ageing in your
  culture?

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Older Age

• Social, psychological as well as biological
  timetables govern the sequence of change.
• Social -how satisfactorily an individual adheres
  to the social roles, habits and attitudes which a
  society expects of someone that age
• Psychological- how well an individual can adapt
  to the demands made by a changing environment
• Biological - relative conditions of the
  individuals organ and body systems
• Source Birren and Renner (1977)

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Older Age

• Predictors of morbidity
• Psychosocial
• Locus of control
• Social support
• Life stresses
• Demographic
• Age
• Gender
• Education
• Marital status

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• Structural model

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Health Risks

• Cigarette Smoking Cigarette smoking
  remains the leading preventable cause of
  morbidity and premature mortality in the West
• Older individuals who continue to smoke greater
  risk of cerebral and cardiovascular
  complications, osteoporosis, loss of mobility and
  reduced physical function
• nonsmokers and former smokers have higher levels
  of physical function compared with continuing
  smokers

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Coronary Heart Disease

• CHD is higher and fallen less than in many
  countries
• CHD exemplifies inequalities in health
• National Service Framework CHD
• blueprint for tackling CHD
• range of measures to improve care, step up
  prevention and reduce inequalities
• see http//www.doh.gov.uk/nsf/coronary.htm

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Health Risks

• Falls
• Reduced muscle strength, bone strength and joint
  mobility leads to heightened susceptibility of
  older individuals to falls
• A fall can lead to a cycle in which one fall
  leads to another
• Most severe consequence of a fall is hip
  fracture
• Most falls are avoidable

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Health Risks

• PolyPharmacy
• In the USA and Northern Europe older people use
  more prescription and nonprescription drugs than
  do younger people
• The high rate of polypharmacy places elders at
  risk for potentially serious physical and
  behavioural adverse drug reactions
• The need for caution and clear communication in
  prescribing and monitoring even routine
  medication use among older people

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Socio-economic barriers to health promotion

• Patterns of ageing and quality of life of old
  people are closely related to the economic and
  social health of society at large
• Elderly women enter old age poorer than elderly
  men
• Ethnic minority elderly in the west are
  particularly disadvantaged
• Use of preventive services by older people is
  strongly influenced by poverty

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Health Promotion

• Individual -Level
• Models of health behaviour change currently used
  as a basis for clinical research and practice
  have been derived from social cognitive theory
• Variation in success
• Individual models have also failed to consider
  issues of relevance to elders

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Health Promotion

• Community Based Models
• creation of supportive environments in which
  healthy living can take place
• health promotion at the community level is shared
  between individuals and systems
• Weakness cost, level of commitment, little
  success in minority groups

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Health Promotion

• Clinical Intervention, Clode-Baker et al 97
• RCT of a pre-admission intervention
• No significance in hospital anxiety, depression,
  Nottingham health profile and stress arousal
  checklist
• Intervention group were more likely to know as
  much as they wanted to know, less confronted by
  information, saved nursing staff time

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Conclusions

• Old people are not a homogeneous group but have
  individual life histories and needs
• Social support seems to be a good health
  promotion mechanism in older people yet more
  longitudinal studies are needed to test this
• Health promotion in older people can improve
  their quality of life
• The rapid pace of growth in the number of older
  people from diverse ethnic origins means more
  effort is needed in HP to target this group