This is a
node your homework entry.. my first. It is an essay I wrote on ageism for my
Nursing V (
ethics in nursing) class last year.
Ageism is an ongoing problem in
modern society, suffered by the majority of older people within the lower
socio-economic classes, but not confined to this bracket. It occurs in every social area, and in every area of the
holistic healthcare system. This essay focuses on ageism in
nursing homes, an area where the huge majority of clients suffer from both direct and indirect ageism.
Ageing and Ageism in a Care of the Older Person Unit
Introduction
With the advancement of
industrialization in society the working environment shifted from the home and into a factory basis. Before this, with small businesses run from home, and a self-perpetuating knowledge base built from generation to generation and only gained through experience, the older members of society commanded the greatest respect. Through their experience they had accumulated a vast base of knowledge and wisdom pertaining to work, and handed it down to their respectful apprentices. In entertainment, as most stories were passed by word of mouth, the older generation had an accumulated wealth of different tales, both gathered over their lifetime and inherited over many generations. With this command over society, is it any wonder that with age came respect, the village elders often making the decisions regarding the future of their citizens.
With the industrial age, however, the work became much more physical, so the worker base shifted to a much younger age group; the more physically fit, the longer they could work. With the introduction of business hierarchies and management, the older persons place within the working environment became more and more obsolete. As the industrial age advanced with new inventions and techniques appearing so rapidly, the knowledge basis that an older person had acquired in their lifetime quickly became obsolete and out-moded. This heralded the shift of the older person from the leaders of society to the rejects of society, and began the social ageism that is such a problem today.
Ageism is discrimination against an individual on the basis of their age. It is a huge problem in contemporary healthcare and nurses have been fighting for the last half-century to promote the positive aspects of ageing, alongside the ideas of
independence,
dignity,
respect and
belonging. In this essay I will be discussing the problems surrounding the integration of these ideals into contemporary care within a care of the older person residential facility and the importance of empowerment in the battle against ageism.
Recognizing ageism:
Many of the problems associated with ageism and the exclusion of older people from mainstream culture is due to the retirement age. In
Ireland the
mandatory retirement age is 65, at which forced retirement is the only reward for the life service of a
dedicated individual. At the age of 65 the older person finds that they suddenly have no income bar a modest
pension, much reduced
social contact, and nothing to fill their days. There is a marked increase in
morbidity in the older person immediately post retirement, as the effect of this drastic change in
lifestyle is for the person to become
despondent and for their daily activities to become much more home orientated. Some older people will take up hobbies post-retirement, such as golf or bingo, or will move away to a ‘retirement spot’ where the change in location facilitates the change in
lifestyle. For many, however, these post-retirement activities are not an option, whether due to financial restraints, family ties or declining health.
One of the biggest catalysts of ageism were the advances made in
media in the last century such as television, magazines and the internet. Due to the ability of these medias to reach a large number of people at any one time the target audiences have been generalized. Most media is targeted towards either the teenage bracket, pre-teen bracket, or the thirties to forties
homecare bracket. With these shifts in focus to the younger and younger members of society, the cultural focus is also changing to the young. Folk and
traditional music, traditionally enjoyed by young and old alike, has been almost completely replaced within national culture with the pop industry, directing it’s advertising and sales towards the pre-teen market, using sex as a driving force. The look of advancing age, once a sign of wisdom and knowledge, has been replaced by the look of innocence and sexual appetite as the new cultural role model.
Advertising is using increasingly younger models, and selling more and more products to ‘ward off’ advancing age, drilling it into the public consciousness that ageing is bad, and something that should be avoided at all expense.
All these factors have increasingly attached a
negative stigma to the elder person’s role within society, creating
stereotypes depicting the older person as a shambling buffoon, telling long-winded boring stories and often being confused. This loss of individuality is known as ageism, as Butler (1975) describes; “a process of the systematic stereotyping of, and discrimination against people because they are old.”
Ageism does not just affect the older people living in society, it also has a huge effect on those living in residential long term care facilities, or care of the older person units. Ageism is
institutionalized in healthcare practice. It is an ageist attitude that all older people are unable to change, learn or develop in any way, so it is assumed that their knowledge and experience is outdated and they have no ability to learn to control their life in their new environment in a healthcare facility. It is also assumed that the older person has less needs than the younger members of society, and can therefore be looked after in an institutional environment with a minimum of treatment and individual needs.
In order to combat these attitudes it is necessary to promote
empowerment and the positive aspects of ageing within these facilities, to help the older person retain their individuality and quality of life.
Promoting the positive aspects of ageing:
For most people retirement is a major transition, with the total restructuring of established daily routines and a strong loss of status, retirement can have sever social, economical and psychological repercussions for both the individual and their family. There are many theories as to how people should treat oncoming old age. Williams (1990) states “people like the
functionalists,
idealists and critics believe people have a responsibility to fight off old age and remain active.” Other views include the
disengagement theory, used as a social control mechanism to segregate the older members of society from the younger and contributing heavily to ageist attitudes; “The gradual disengagement from mainstream activities is seen as normal, natural and inevitable characteristics of old age.” (Cunningham & Henry 1961) This eliminates social obligations to the older person by providing a legitimate form of social
redundancy.
With this exclusion from society, the older person needs to make a much greater effort to reintegrate themselves post-retirement. Very often with advancing illness or social exclusion, the older person may be installed in a care of the older person residential unit, where up until the last half-century, that was the end of their socially fulfilling lives. Within the last fifty years, great strides have been made in recognizing ageism and promoting the positive aspects of ageing within these facilities.
In order to fulfill the holistic needs of the older person in a healthcare facility, the approach to ageism and the empowerment of the individual must be a
multi-disciplinary effort. The collaboration of all people involved with the care of the older person is needed, including medical and nursing staff, social services and the informal sector, including care workers and family. There is a great need for
education for all parties to combat ageism. Staff must be educated in the needs and rights of the older person as an individual, social services and the informal sector should recognize the older person as an individual in need of as much social care and support as any other age bracket, and the patients themselves need to be educated in empowering themselves to take control of their own care within a care of the older person unit. These units are homes, not institutions designed to extricate older people from society.
With this in mind, the nursing staff address the positive side of ageing to the patients, retaining their sexuality and social desires in the way they dress and socialize with the other patients, maintaining the dignity and independence of the individual, and keeping respect as a value in the highest
esteem within the nurse-patient relationship.
Promoting independence, dignity, respect and belonging:
According to a study by Pursey & Luker (1995) on the attitudes of nurses towards elderly patients, “The image conveyed by working on a ward dedicated to care of the older person is one of low status.” Due to the nature of caring for patients in a long-term residential care unit, both students and senior nurses have developed a strong negative attitude towards care of the older person. This is due mainly to the ‘routine geriatric style’ (Baker 1978) which focuses more on the strict organization of the care of the patients in a daily routine than providing care that caters to the individual needs of each patient. This results in an inability of the patient to have any part in the organisation of their daily activities,
timetable, surroundings and ultimately, their own care. For patients living in long term residential units, these care facilities are their homes. In order for the client to maintain come semblance of dignity and independence, they must have control over their living conditions within these facilities.
Within the setting of a care of the older person unit, it is important to remember that the residents are all human beings, and all still retain the basic human rights of independence, dignity and respect. These all combine to give the older person a sense of belonging, the necessary feeling for a holistically healthy residency in
long-term care.
Age Action Ireland believe there are five main areas of rights of the older person; independence, care, participation,
self-fulfillment and dignity. If the older person has control over their lives in these main areas, the result is a sense of belonging.
Since the aim of a care of the older person unit is to provide a long term home for the patient while maintaining the acute facilities, it can be very difficult to maintain the patients belief that they are in their own home. The clinical environment is often non-conducive to the ideas of respect and dignity. The residency of patients in personalized bedrooms, for example, helps to maintain the dignity and privacy of patients, while promoting the independence of the patient in socialisation and the format of their day.
Staff should also enhance the patients feeling of belonging by showing an interest in the activities of the patient, conveying a friendly, open
attitude, and providing a quick response to a request for help, both medical and social. This helps to provide an easy atmosphere within the care facility that can help the patient feel that they can confide in staff, revealing critical concerns before they may come apparent to the staff, whose attention may be distracted due to their responsibility in providing care to a large number of residents.
The help of the relatives in the care of the older person is invaluable. “The involvement of the family after admission of a
relative to a home may influence the quality of life for the resident as well as quality of visits for relatives.” (Linsk et al. 1988, Hertzberg & Ekman 1996) The communication between the family and the patient can enhance the communication of vital matters within the care facility, as the patient may feel that they still have the freedom of expression created within the family
boundaries, if not necessarily within the nurse-patient relationship, helping to bring the family into the multi-disciplinary team.
Empowering older people to make choices surrounding their care:
The empowerment of the older person to make choices surrounding their own care is one of the main ideas pushed in the development of the care of the older person facility. In order to combat ageist attitudes within the care environment and to respect the dignity and rights of older people as individuals, they must have all the input into the orchestration of their own care that they would have in their lives at home.
The issues of the older patients rights to empowerment are highlighted in the media at the moment by the ongoing
debate concerning whether or not the patient should have a say in their own resuscitation in the event of
unforeseen circumstances.
There are arguments surrounding
empowerment where it is stated that the empowerment of both the patient and of the nurse would not work due to the nature of caring as the nurse’s function. Caring includes
altruism, control and
paternalism as related concepts, and it is thought in some areas that this directly opposes the idea of empowerment of the patient. It is proven however, that the empowerment of both the nurse and the patient has led to a partnership in care.
Empowerment improves the holistic well-being of the patient, helping to increase the sense of security that the patient has within the care environment and raising the patients
self-esteem, providing the resources, skills and opportunities to develop a sense of control. With the knowledge that they have control in partnership with the nurse, the older person no longer feels that the care facility is a prison, with the routines and activities decided for them without their contribution, but that it is more like their own home, where their activities are a compromise between their needs and that of those around them.
Respect is a vital antecedent to the empowerment process. “Nurses must have an awareness of and respect for the older persons beliefs about his/her destiny, which is often rooted in issues such as locus of control and health beliefs.” (Janz & Becker 1984) With the respect of the multi-disciplinary team towards the patient, the quality of life within the caring environment can be hugely increased. Also a vital component of this relationship is
trust. “The empowered must trust individuals ability to make decisions, accept responsibility and act for themselves.” (Manthey 1992)
With the successful implementation of a trusting and respectful nurse-patient care partnership the older person should have the self-esteem to set out and achieve their own healthcare goals.
Conclusion
Ageism is a compound problem in society that has been building up and establishing its stereotypes for hundreds of years. The extent of the problem is evident in so many peoples acceptance of ageism as a natural societal element. It is still being perpetuated in the media, mainly with society’s youth. It is therefore extremely important to educate the youth of today in ageism and stop the trans-generation spread of prejudice.
Today’s youth is tomorrow’s
healthcare team.
Ageing is our reward for a life of work, a process to be looked forward to, and one of the things that all members of society deserve is to age with dignity and respect. Organizations such as Age Action Ireland help to promote these ideals and to raise awareness of the needs of the older person within contemporary society.
Within healthcare it is our responsibility as nurses to ensure promotion of the dignity and respect of the older person, to promote trusting and beneficial nurse-patient relationships, and to empower the older person to take control of their own care. With this help, great strides can be made in achieving independence for the older person, assuring them their own place in the community. With healthcare professionals upholding these values, we will in time see a shift in the attitudes of society towards the older person, and see the end of a
prejudice that has affected societies throughout the world for hundreds of years.
References:
Baker D. (1983) ‘Care’ in the geriatric ward: an account of two styles of nursing. In
Nursing Research: Ten Studies in Patient Care (Wilson-Barnett J. ed.), Wiley & Sons, Chichester, pg 111-118
Butler R.N. (1975)
Why Survive Being Old In America, Harper Row, New York
Cunningham E. & Henry W.E. (1961)
Growing Old: The process of Disengagement, Basic Books, New York
Hertzberg A. & Ekman S.L. (1996)
How Relatives of Elderly Patients in Institutional Care Perceive the Staff, Scandinavian Journal of Caring Sciences, 10, pg. 205-211
Janz N.K. & Becker M.H. (1984)
The Health Belief Model: A Decade Later, Health Education Quarterly, 11, pg. 1-47
Linsk N., Miller B., Plaum R. & Ortigara-Vicik A. (1988)
Families, Alzheimiers Disease and Nursing Homes, Journal of Applied Gerontology, 7, pg. 331-349
Manthey M. (1992)
Issues in Practice: Empowerment for Teachers and Students, Nurse Educator, 17, no.4, pg. 6-7
Pursey A. & Luker K. (1995)
Nurse’s Work with Older People, Journal of Advanced Nursing, 22, pg. 547-555
Note: Thanks to gwenllian for pointing out that ageism is actually only a relatively recent development in the first world, and relatively unknown in many third world cultures. Nonetheless it remains a huge problem in the first world perpetuated by advertising and the modern trend towards plastic surgery. With mass media being introduced worldwide though, unless it is stopped now ageism will become a worldwide problem, penetrating all cultures.