This essay will analyse and examine the theories of ageing, which would include an overview of the recent changes in the ageing population and also in compare the health care provided for older people both within the community and in practice setting. It also sets out to demonstrate a comprehensive knowledge about modern day government policies and their overall impact on the care or older people in practice settings. Furthermore, the practical limitations that may be experienced due to the physical, social and psychological features associated with ageing will be highlighted.
This essay will also explore the Key role of communication amongst interagency bodies and health care providers. Lastly, the ideas surrounding ageing, multiple pathology and other common physical and mental health challenges faced by older people will be examined.
Bowen et al (2004) expressed that ageing signifies the development of changes in people over a period of time; this incorporates physical, social, natural and mental changes. According to the World Health Organisation by 2050 the figures for the over 60 population would have risen from 15 to 22 percent (WHO, 2015).
The reason for this can be tied to two factors, which is the increase in life expectancy largely because of better survival rate at younger ages. The same report by WHO on ageing and health attributed the current trend of population increase to the exceptional socioeconomic growth that has occurred worldwide within the last 50 years (WHO 2015). For example in Japan in 1985, a 60 year old woman could look forward to living an extra 23 years and 30 years more by 2015, this is a drastic spike of increase considering that until the second world war the same country was lagging behind by as much as 30 years (John et al, 2007).
By and large better nutrition, sanitation, education and medicine linked to increased wealth are positive markers for decreased early mortality and long term health for mankind (John et al, 2007). This trend varies from country to country as older people are experiencing increased life expectancy in high income nations than those of lower nations .The other reason for an ageing population is the drop in fertility levels. Christensen K et al (2009) this has been linked to a higher rate of survival in children, a shift in gender values and growing access to contraception. Regardless of the drop in fertility levels, Africa still remains relatively high at 4 births per woman (Chritensen et al, 2009).
David Oliver (2017) mentioned that current life expectancy in the UK at age 65 for male and female stands at 83 and 86 years respectively. The universal growth in life expectancy at birth goes a long way in affecting the composition of population by presenting unique opportunities as well as tests, which challenges the way we live and how resources are allocated (Beard et al 2012). The consequence of individuals living longer into their old age directly impacts the burden of scarce and available resource. Low and middle income countries as expected would have their health services stretched to the limit however, according to Mclntyre et, al (2004) reports from sub- Saharan Africa showed that in spite of older people suffering from a number of diseases they rarely visit health services. And the reason behind this may be associated with issues of barriers to access, the lack of appropriate services, cost etc. WHO (2015) report mentioned cost as one important reason for example in Ghana and China research showed that older people could not afford transportation cost to hospitals, compared with high income nations where the largest obstacle report by older people was the bad service received from healthcare professionals in the past or older people thinking they are not sick enough to need treatment (WHO,2015) Theories of ageing continue to change and evolve, however, since inception none completely stands out to explain or cover the process of ageing.
Biological ageing is described as the gradual, progressive, structural and efficient modification that occurs at the tissue, cellular and organ areas, eventually affecting the overall performance of the human body. Modern day biological theories of ageing are categorised into two key areas: error or damaged theories (wear and tear) and programmed theories. Programmed theories asserts that ageing maintains a natural schedule (controlled by adjustment in gene form that shapes the body, charged with preservation, repair and protection responses), and damage theories captures the reason for ageing as human body engaging in continuous environmental attacks that may cause considerable harm at various levels (Jin.K 2010). The latter, is also known as non- programmed theory hinges on Darwins theory of evolution where ageing is described as the failure of an organism to accurately block the usual declining process. Whereas, the programmed theory considered ageing as a consequence of a genetic system or method that facilitates or wear and tear or even death by limiting the optimum lifespan of an organism, to reach the necessary evolutionary goal (Goldsmith, 2012).
British zoologist Peter Medawar in 1952 modified Darwin theory, suggesting that the necessity to live longer diminishes considerably with the age upon which an organism is initially able to reproduce and several external and internal conditions that are synonymous with certain species for example development time mating period, seasonal attraction and predation. Besides, the key distinction in lifespan observed in various species under indifferent conditions, appears to demonstrate that there is no pre-decided course of events for ageing. Subsequently, under specific conditions, it might be conceivable to delay lifespan, prompting the theory that ageing isnt programmed, but rather the final product of wear and tear (John et al, 2007).
.Birren and Renner, (1977) described the psychology of ageing as the studies that concerns the regular transition in behaviour of a young adulthood. Psychological age-related changes are closely connected with the nature of stress and coping patterns during ageing. They echoed that this type of ageing is based on two levels of life perspectives: aging due to psychological transformation and development or ageing that is void of ability to battle losses attached with physical regression. For example, the application of cognitive activities to age related change which also includes the use of various ways to make up for these differences (Hooyman, et al, 2010). Psychological theory demonstrates the relevance of positive effects and how it translates to promotion of wellbeing and personal self esteem by adopting the idea of emotional self guidance (Hearn S, et al. 2012). This is based on the premise that younger people identify with their emotions differently from older people and this may affect their mental or physical wellbeing (Chatterji. S et al 2010). Halpern (2010) mentioned that certain subjective experiences can assist older people in living their daily lives efficiently, and also they can learn to change their personal perspective by learning new ways of becoming more accepting (Reed, et al 2014). Halpern (2010) also highlighted the possibility of educating older people to accept the inevitable changes of ageing but at same time they can still try to change whatever they can (Halpern, 2010)
Sociological theory of ageing according to Giddens (1993) was formed around the analogy that since the human body is a sum of all parts organs working together to achieve wellbeing, so also does a society require the combination of education, government, labour, family etc in order to function at an optimal level (Goldsmith, 2014). Disengagement theory alludes to an obvious divide in the connection between an individual and other members of the community. This steady withdrawal may be implemented in parts or in full and in addition either the individual or the society can initiate this process (Phillison and Baars, 2007). In 1961 Elaine Cumming and William Earle Henry put forward this theory, even though it was the first of its kind geared towards providing an explanation for the ageing population. Nonetheless, it was well scrutinized for not recognising and accommodating a significant size of the ageing population that chose to stay active and not withdraw or retire from the society (Aspinal, 2016). Active theory focuses on the importance of consistent social involvement. Furthermore, it suggests that the self esteem of a person is linked to the status in the society, which means being retired may not be unfavourable in as much as the person regularly engages in other functions such as charity jobs, volunteering jobs etc. In order to maintain constructive sense of self and attain wellbeing, one must endeavour to search out new roles whenever old ones are lost (Goldsmith, 2014).
These three theories are different from one another in terms of definitions however; all theories claim to impart the gradual ageing process in various ways with one general connection which is the human body. According to Tischler (2013) analysing the psychology of ageing predictably leads, though ever so slightly to sociological concerns. Sociological theory is recognises an individuals environment; for example the availability of food, support from family and friends or the mental and physical activities that stimulate the mind and body. Psychological theory on the one hand deals with the cognitive function of the human mind and how this relates to well being and the ageing process and lastly biological theory concerns the activities that happens insides the body such as the tissues, cellular and organs and how they affect the ageing process of the body (Baltes et al, 1992).
Dillaway and Brynes (2009) attributed the improvement in health, socioeconomic prosperity and technology for a rise in the number of older people who chose to remain active in todays world, also creating ways for them to stay healthy and helpful to the society.
The continuous increases in number of the ageing population worldwide have not been matched with the required health care strategies and system (WHO, 2015). Generally as individuals get older they acquire some of the age related characteristic and the impact they have on functional ability and intrinsic capacity (Godwin.et, al, 2013). Some of these health characteristics like movement functions with increasing age, muscle mass is likely to decline, and this can be linked with a decline in strength and musculoskeletal capacity. The use of the strength in hand grip is how muscle function is estimated, this is independent of any disease related elements and a firm judge of mortality (Godwin.et, al, 2013). Men are known to have better grip strength than women (Rantanen et al, 2003). Similarly bone mass is likely to decline more in women experiencing menopause. This can eventually lead to a risk of fracture (osteoporosis). Hip fractures have become more predominate in the developed world with a projection of 4.5m by the year 2050 (WHO, 2015). Sensory functions: the decline in sight and hearing are also functions of ageing, however, the point at which an individual may have this experience varies. The presence of genetic tendency and environmental exposures for example noise: coupled with a flexible way of life can affect hearing (Olusanya et,al, 2014) Over 180million people aged above 65 experience hearing difficulties that obstructs the basic comprehension when having a conversation( Gates et al, 2005). When visions become blurry people encounter challenges trying to register close objects this is known as presbyopia sometimes affecting people of middle-age (Parham et, al, 2011). The daily activities and lives of the older population can be severely altered because of the changes. If the hearing loss is left untreated it may contribute to loss of autonomy, social isolation, poor communication, depression and a decline in cognitive functions (Parham et, al, 2011). Social isolation, loneliness and poor communication are a result of sociological ageing.
Cognitive function: a number of cognitive activities start to decline at a young age with various functions declining at different stages. Memory speed and rate of processing information often form part of the challenges for older people (Baltes et, al 2005). For example on dementia the WHO report in 2015 estimates that by 2030 the population living with dementia would rise from 47million to 75million and that value expected to triple by 2050. Moreover, dementia is not an inevitable result of ageing contrary to prevalent beliefs. It is a condition that impedes the section of the brain that controls memory, language, recognition and thought, and that meddles primarily with the capacity to function in daily activities (NHS UK). The pathophysiology of the diseases is unique in itself as it can be caused by several diseases, many of which gather to form an abnormal number of proteins in the brain, which in turn causes the nerve cells to function below par and eventually die off. However, various areas of the brain start to shrink due to the nerve cells dying off (NHS UK). The most widely recognized sorts of dementia are Alzheimer’s and vascular dementia. For an individual with Alzheimers there are two types of protein involved known as amyloid and tau both are responsible for the build up in the brain. This reduces the level of neurotransmitters responsible for passing information, or signal between brain cells. People with Alzheimers often have a significantly low level of acetycholine which is one of the neurotransmitters (NHS UK). Vascular dementia is a result of low level of blood flow to the brain. Given that the brain requires nutrients and oxygen function properly so when there is a shortage the brain cells begin to die (NHS UK). This drop in blood flow is caused by thinning of small blood vessel inside the brain (subcortical vascular dementia): this generally is common with individual with high blood pressure or diabetes and smokers (NHS UK).
Nevertheless, not all memory can deteriorate with age for example procedural memory and personal (riding a bike, reading, and vocabulary) last for a lifetime (Baltes et, al 2005).The cost of dementia across every level of the society is enormous, varying from a rise in long term care cost communities, governments, families, and general drop in productivity levels. A global cost estimate of $604bn as was spent as at 2010 which is one percent of global GDP (WHO,2015). More so, dementia in recent times have begun to generate a certain level of attention required (Larson.et al, 2013). The national challenged to tackle dementia was launched in 2012 by David Cameron the then prime minister and figures released showed that men and women who were 85 or over accounted for an increase of 230 percent and 178 percent of deaths respectively (ONS, 2017). Stroke: the most common type is the ishaemic stroke and this happens as a result of blood clot preventing the movement of oxygen and blood to the brain (NHS UK). They occur mainly because of the hardening of the arteries (atherosclerosis) when the arteries are blocked due to the presences of fatty acids around the lining known as plaques. As we experience ageing the arteries starts thinning however, there are other factors that can speed the process up such as diabetes, smoking obesity and hypertension. The cost to the UK economy per year is around ?4billion in terms of informal care, productivity and disability and ?3 billion to the NHS (NHS England, 2017).
Functions of the skin: this part of the body endures progressive damage with age attributed to constant sun exposure, physiological means and genetic tendency. On a cellular level the changes experienced due to ageing can lead to a number of results, including decreasing the capability to act as a barrier sometimes fails. Patients can be left vulnerable to dermatitis, pressure ulcers and so on due to the absence of collagen and certain elastic fibres found in the dermis (Farage et.al, 2009). The consequence of this can be very damaging for an individual causing emotional health instability and issues that may lead to withdrawal from social participation (Farage et.al, 2009). Frailty: can be regarded as a dynamic age-related decrease in physiological frameworks that leads to weakened reserves of inborn limit, which gives outrageous exposure to stressors and builds the risk of various adverse health results (Cesari, 2016).
On the global stage, two international policy instruments have been pivotal guides on action on ageing since 2002. Madrid International plan and Political declaration for action on ageing,(UNO) (2002) and World Health Organisation policy framework on active ageing (2015). Both documents are afforded by the human rights law and are well positioned within its international legal framework. The significance of health in old age is clearly highlighted in each document, creating avenues where policies can help in activating change and also guarantees security for older people (WHO, 2015). The importance of life expectancy is demonstrated and also the opportunities for older people to be resourceful instruments for future growth (WHO, 2015). The policy framework for WHO outlined six important determinants of active ageing: physical environment, economic status, personal health, social health, social services and behavioural reactions. This framework also suggested four components required for the success of a health policy: reduce and avoid the burden of disabilities, premature deaths and long-term diseases: Promote wellbeing in the society and tackling the causes associated with chronic diseases: provide age-friendly centres for older people and affordable health services: encourage and support caregivers by providing training and education (WHO, 2015).
The Department of Health launched the Centre for Policy on Ageing (CPA) in 2009 to act as a watch dog on the primary health care in the UK by collecting and recording data regarding practise and policies on age discrimination. The importance of this results is to address age discrimination disparity, adhering to the Equality Bill (April 2009) and the European Commission Draft Directive (July, 2008). The increasing level of poverty in Europe and the UK led to a collaborative research by the office of national statistics (ONS) and Eurostat conducted in 2015, which revealed amongst other things the poor socioeconomic conditions faced by the over 65s in England between the period of 2010-2014(ONS, 2015). Furthermore, the 2017 Marmot health indicators highlighted the steady decrease from year 2010 levels, on life expectancy at birth and at age 65 continued to drop beyond the previous levels observed in early years Institute of Health Equity (IHE, 2017).This report, also expressed concerns about resources being overstretched primarily on health care and social care (IHE, 2017). For example the prevailing impact of multi-morbidity disease where older patients spend more time in hospital settings. And also the issue of bed blocking, which the report associated with socioeconomic conditions like poverty and deprivation, sighting winter heating cost on older people living alone and loneliness etc, the result is an increase on the burden of healthcare professional and resource (IHE,2017).