P.Lecture 11

Aging Week 11 Lecture Introduction Population aging: a growth in proportion of older people, typically 65 and over. 65+ years: now 12%; in 2041, 23%. Life expectancy: Women 81 years and men 76 years. Geriatrics: physiological aspects of aging. Gerontology: physical, psychological, and social aspect of aging. (2005, Education Canada) Stereotypes Related to Aging Negative [these are some of the negative mental images associated with people who are old, i.e. they are sick, lonely, ignored, and isolated] Sick Isolated Ignored Lonely Positive Marathon running World travelling (2005, Education Canada) The Study of Aging Approaches: Aging as a process Older persons Emphasis Comparison of older with other aged groups Age effects or maturation: changes that are a result of aging Period effects: because of living at a specific time (2005, Education Canada) Sociological Theories In relation to Aging! Functionalism Disengagement theory: withdrawal from working life is functional for society. Activity theory: the best prescription for successful old age is to remain active. Age-stratification perspective: young and middle-aged tend to be favoured. Society is age-graded: each cohort must go through a system of expectations and rewards. (2005, Education Canada) Conflict Exchange theory: focuses on the weak bargaining position of older people. Political economy of aging: older people lose power, depending on class, gender, ethnicity/race. Life course perspective: connects the lives of older people to earlier lives, emphasizing the link between individual and society. Feminist: aging as a woman’s issue. (2005, Education Canada) Symbolic Interactionism Social constructionist perspective: a micro level approach stressing. the subjective experience of older persons their ability to negotiate with others How a life is lived in old age is the result of the lifetime interplay between social structure and individual action. (2005, Education Canada) Profile of Older Canadians Provincial differences in percent of older people: Saskatchewan high, Alberta low. Aboriginal elderly are a small percentage. Ratio of women increases with age. Personal income of women is lower than men’s except single older women. Older men are more likely to live with a spouse. Institutional living for 75-84 years: 6% of men and 10% of women. (2005, Education Canada) Family Ties and Social Support Most 65+ people are married, but with age women are less likely to be married. Growing proportions will be divorced. Married women are likely to retire early to retire at the same time as usually older husbands. This could lead to a later disadvantage. Women are more likely to be caring for an ill partner Widowhood and divorce can leave women at a financial disadvantage and men isolated. (2005, Education Canada) Family Ties and Social Support Single women tend to fare better than single men. Gays and lesbians are able to deal with aging challenges, because of dealing with other challenges. Intergenerational ties: Solidarity perspective: family ties are strong Social problems: focus on shortcomings Ambivalent: family members are torn between love and demands (2005, Education Canada) Family Ties and Social Support Most older persons have living children. Children provide support, but seniors provide support for them, as well, e.g., baby sitting, money, housing. Dealing with older parents Daughters are consult siblings Sons deal with parents Divorce of parents or children limits assistance. (2005, Education Canada) Family Ties and Social Support Childless older persons have same subjective well-being as parents. Idea that children prevent loneliness may not occur. Siblings are important as close friends for most elderly, closeness increases with age. Sandwiched – caring for young children and elderly parents = financial, physical and emotional strain! (2005, Education Canada) Aging and Health Women live longer and have higher rates of morbidity than men. Aging brings physiological decline, e.g., senses. A function of age or disuse? Chronic illnesses increase: arthritis, hypertension, heart-related problems, diabetes, etc. Health care of elderly: will it cause a crisis? But, new old will be fitter; drugs and diagnostic services are needed by all; and high cost is in last months. (2005, Education Canada) Retirement Individual issues: Personal planning Decision to retire Adjustment to retirement Societal issues: Social policy and legislation Impact of social and economic trends Impact on pensions and responsibility for benefits (2005, Education Canada) Government Income for Older Canadians Canada/Quebec Pension Plans (CPP) Old Age Security Pensions (OAS) Living in Canada 40 years after age 18 Guaranteed Income Supplement (GIS) Income-tested supplement Spouse’s Allowance? Widowed Spouse’s Allowance Benefits for those aged 60-64 (2005, Education Canada) Macro Level Costs of retirees: objectives are ensuring: an adequate basic income Adequate standard of living in retirement Majority of Canadians depend upon public pensions Mandatory retirement at 65 years. Individual justice: support flexibility Comparative justice (group rights): mandatory Avoids assessment of performance (2005, Education Canada) Macro Level Men are retiring earlier than 65 years. Recently, women are remaining longer at work. Retirement is difficult for those who Have fewer financial resources Have fewer interests or friendships Rely on a job for self-worth Have poorer health Women have ties, but financial problems. (2005, Education Canada) Social Policy and Future Directions Canadians have traditionally favoured more collective solutions to problems than Americans. More women working helps their financial position, but who cares for elderly? Cutbacks in services by governments place a greater strain on the family. Mandatory retirement requires public responsibility for support. Intergenerational equity will be a future issue. (2005, Education Canada) Looking Ahead Older population will be healthier, wealthier, and better educated. Will women have poorer pensions benefits? How will divorce affect social support? Canadians 65 can expect to live 18 years. 9 years disability-free 3 years of slight, 3 years of moderate, and 3 years of serious disability (2005, Education Canada) Heath and Medicine Consequences of Social Inequality in Canada Health and Medicine Health is a state of complete physical, mental and social well-being (WHO) Medicine is a social institution that focuses on combating disease and improving health Selected Leading Causes of Death, by Gender, Canada, 1997 Selected leading causes of death, by sex   1997   Number % Total Males Females     Rate1 All causes 215,669 100.0 658.7 844.0 521.6 Cancers 58,703 27.2 181.5 229.7 148.5 Diseases of the heart 57,417 26.6 173.0 230.8 129.7 Unintentional injuries 8,626 4.0 27.6 37.8 17.9 Pneumonia and influenza 8,032 3.7 23.7 31.5 19.2 Diabetes mellitus 5,699 2.6 17.4 20.6 14.8 Suicide 3,681 1.7 12.0 19.5 4.9 Chronic liver diseases and cirrhosis 2,030 0.9 6.4 8.9 4.2 Neurotic disorders, personality disorders and other nonpsychotic mental disorders 1,163 0.5 3.5 4.8 2.5 HIV infection 626 0.3 2.0 3.6 0.5 1 Age-standardized mortality rate per 100,000 population. Source: Statistics Canada, Health Statistics Division. Last modified: 2005-02-17. Canadian Health Statistics Self-rated health 63% = excellent/very good; 9% = fair/poor Infant Mortality rate 5.6/1000 (Japan, 3.8/1000) Life Expectancy 78.6 (males 75.7; females 81.4) Income and Health Canadians with low incomes are more likely to suffer illness and die early. Only 47% report their health as excellent/very good, compared to 73% of highest income group It is estimated that more than one-fifth of years lost before 65 could be prevented (as compared to highest income group) Aboriginals and Health Aboriginal people are at a higher risk for poor health and early death. Infant mortality rates are twice as high for Aboriginal people, compared to the Canadian population Life expectancy is significantly lower for Aboriginal people Prevalence of all major chronic disease is higher in aboriginal communities Chronic Diseases 81% of those over 65 report living with at least 1 chronic illness No significant differences according to gender, or urban compared to rural Highest among low income Canadian Most prevalent among Aboriginal people First Nation/Canada Ratio of Prevalence for Selected Chronic Diseases, 1997 Disease Ratio Men Ratio Women Diabetes 3:1 5:1 Heart problems 3:1 3:1 Cancer 2:1 2:1 Hypertension 3:1 3:1 Arthritis/rheumatism 2:1 2:1 Depression Higher for women compared to men Young women ages 15-19 were most likely to experience depression For both men and women, risk of depression was highest about the lowest incomes Suicide In 1996 there were 3941 suicides in Canada, almost 11/day Males are 4 times more likely than females to commit suicide Rates are 2-7 times higher among Aboriginal people Smoking and Health As a cause of early death, smoking outweighs suicide, motor vehicle crashes, AIDS and murder COMBINED (Ellison et al. 1998) Estimated to be responsible for ¼ of deaths for people between 35-84 More than 45,000 deaths in 1995 Summary Not just economic deprivation, but susceptibility to disease related to: stresses of disadvantage, coping skills, and threats in the physical environment Difficulty to achieve equality in health status Equitable access to opportunity and support Address inequality in wider society