Aging Post Midterm Exam Notes PDF

WEEK 6: SOCIAL STRUCTURES & SOCIAL INEQUALITY --------------------------------------------- **How does aging factor into social stratification?** - **[Social structures:]** patterned relationships that rank individuals according to characteristics related to privilege and power, such as...

WEEK 6: SOCIAL STRUCTURES & SOCIAL INEQUALITY --------------------------------------------- **How does aging factor into social stratification?** - **[Social structures:]** patterned relationships that rank individuals according to characteristics related to privilege and power, such as age, gender, ethnicity, and social class - **[Age structures:]** socially structured relations among individuals that affect the lives of people as they age (social dimensions of age that affect individuals and society) - e.g., 'old age' is socially constructed **Social Structures and Aging** - Our social position in social structures (age, gender, class, etc.) varies by power, privilege, SES, etc. - Social inequality connected to one's social position influences life chances and lifestyles - e.g., health, opportunities, education, etc. - Our lives, identities, and social structures intersect with one another (intersectionality) - Age intersects with everything from social class, income, gender, race, ethnicity, religion, etc. **Social Class & Age** - **Economic inequalities increase over the life course** - Strong link between SES in childhood and health in later life - Link between SES as a child and whether you are likely to have good health as an older person **Gender & Age** - Gender is socially constructed - When age and gender intersect to create gendered social processes and outcomes across the life course, **WOMEN ARE GENERALLY MORE DISADVANTAGED THAN MEN** - Gender inequalities are most **cumulative and visible among older women** - Women are more likely to experience poverty in later life - Women tend to have lower income, more responsibility for unpaid labour, and more poverty - **[Cumulative disadvantages]** appear in later life and can be linked to early life experiences - By the time you are older, you have ACCUMULATED disadvantage or privilege and experience aging differently **Race, Ethnicity, and Age** - Ethnicity and race intersect with age to create unique experiences - E.g., many **racialized older women experience** inequalities across the life course **Age Structures** - Age structures are fundamental to the aging process **[Cohort:]** everyone born in a specific period (e.g., 1960-1965) **[Generation:]** unique grouping of adjacent birth cohorts, many of whom have experienced socio-historical events (e.g., war or economic depression) and whose members tend to think and behave in a similar way (e.g., baby boomer generation) **[Generational Unit:]** unique subgroups in a generation (e.g., youth generation of the 1960s) **Social Processes and Age Structures** 1. **[Cohort analysis:]** the use of quantitative or qualitative methods to study the characteristics of a ***specific birth cohort*** in order to study social change and stability over time 2. **[Generational analysis:]** comparison of ***specific birth cohorts or groups of adjacent cohorts that comprise a generation*** on the basis of socio-historical experiences in order to understand how cohorts maintain continuity in the existing social order 3. **[Lineage effects:]** similarities, differences, or conflicts among ***generations in an extended family*** **Age grading and Age norms** - **[Age grading:]** the process by which chronological age influences elements of social life such as **social positions, roles, norms, and relationships** - Age grades provide a **definition of the expected rights, behaviour, and responsibilities of an individual at a particular age** - Age grading results from a **system of age stratification** - Age grades provide a definition of the expected rights, behaviours, and responsibilities of an individual at a certain age **Age Structures -- segregated or integrated?** - We are moving away from an **age-segregated society** to a more **age-integrated society** - There have been changes in the shape of the age structure and in the prestige of positions within in - In the past, the ***oldest men held the most prestige*** and 40+ was considered old; in modern societies***, prestige has shifted to middle age*** and the definition of old age has shifted toward 80 - Social meanings based on age vary from one culture and historical period to another **Aging and social change** - **[Structural lag:]** policies and programs lag behind changing definitions and needs of older adults - E.g., few employment opportunities for people over 65 - ***Cohorts and generations age in different ways and can introduce social change*** **Aging Activism** - Older cohorts are becoming increasingly involved in age-related advocacy and activism (especially baby boomer women) - E.g., raging Grannies **Generational Gaps** - When inter-generational strain arises, it can lead to generation gaps or inequities and lead to actions and change - Generation gaps exist at family level (lineage gaps) or societal level (cohort gaps) WEEK 8: THE LIVED ENVIRONMENT ----------------------------- **Aging, wellness, and place** - Wellbeing/QOL are influenced by physical and social factors **(SOCIAL DETERMINANTS OF HEALTH OR OF AGING)** - Older peoples must adapt to changing physical AND social environment - Public policy needs to accommodate needs of older adults in shaping-built environments (buildings, sidewalks, roads) - E.g., dwellings built with design features to meet older peoples' needs and age-friendly communities - Mobility considerations **Community -- Multiple Definitions** - **[Community:]** can be defined by **geographical boundaries or by social relationships** - Communities can be physical (streets, neighbourhood) but can also be social (LGBTQ community) - Communities may be **age-integrated (people of varying ages) or age-segregated (people of similar ages like in a retirement home)** - Most older people favour age-integrated communities - Old people who are able to live independently have three general choices of where to live: 1. Remain in family home where they lived for years (older people prefer this option) 2. Move to another unit in the same community 3. Migrate to another community - **[Aging in place:]** getting older in your home/community as long as you are able - Aging in place allows older people to maintain a sense of autonomy - This is an 'ideal' promoted by our governments to relieve strain on LTC - AIP becomes hard when a person loses the ability to walk, drive, perform ADLs, etc. - Family, neighbourhoods, friends, may be needed to alleviate some of these challenges (e.g., making home adaptations) - Aging in place does not work for people without financial resources and strong social support networks - **Alternative to AIP is Aging in the Right Place** - **[Aging in the right place (AIRP):]** recognizes that secure and optimal housing for older people should support an individual's unique lifestyles and vulnerabilities - Recognizes that aging in place often does not meet older people's needs **Aging in rural or remote communities** - **[Advantages to living in a rural community:]** proximity to inexpensive food, proximity to friends/family, familiarity with community - **[Disadvantages to living in rural community:]** lower income opportunities, lack of public transit, fewer health/social services **Overhousing** - Many older adults end up living in home where they are **[OVERHOUSED]** - **When an older person/couple lives in a home that is too big for them or has too many bedrooms** - Happens when people remain in their long-term home for too long - People are deeply attached to their homes and cannot always afford to move homes **Gentrification** - Process by which **inner-city houses are purchased renovated, or demolished with new and more expensive houses being built in their place** - This process can increase home values and push people out (e.g., lower income families) **An Ecological Model of Aging: Person-Environment Interaction** - Ecological model explains the links between aging individuals and their environments - Adaptation involves interaction of ***individual competence and environmental press*** - **[Individual competence:]** an individual's physical/cognitive functioning - **[Environmental press:]** assessment of one's personal (e.g., family), group (e.g., social norms), supra-personal (e.g., neighbourhood), social (e.g., cultural values), and physical environments that can create demands for older people - How does our individual competence interact with stressors - Individual competence can vary from low to high; degree of environmental press (stressors) can range from weak to strong - **[Environmental press includes]** - ***[Objective elements]*** (e.g., physical structure of house, your street) - ***[Subjective elements]*** (e.g., how you feel about your home, neighbourhood, etc.) - Interaction between competence and environment influences adaptive behaviour - **[Adaptive behaviour:]** making changes/decisions to adjust our relationship with our environment **Falls and Injuries** - **Falls are leading cause of injuries for older adults** - **20% of falls result in serious injury** - **Most common:** hip and other bone fractures - Falls are major reason why older people lose their independence - **[Three types of risk factors related to falls and injuries:]** 1. **Personal** (loss of balance, cognitive impairment) 2. **Home** (e.g., poor lighting, too many stairs) 3. **Community** (e.g., sidewalks, ice, construction) - **[Preventative measures:]** exercising to improve balance, using assistive devices, grab bars and railings, etc. **Private and public transportation** - Accessible and affordable transportation allows older people to maintain quality of life and independence - Increasing attention on the habits and risks associated with older drivers - Should policies be based on age or competence? - Whose responsibility is it to revoke older people's driver's licences - Older adults in rural and remote communities do not have public transportation networks **Victimization and fear of crime** - **Rates of crime against older adults are relatively LOW (especially violent crimes)** - Older adults are more likely to experience certain types of crime like **financial fraud/financial elder abuse** - Older adults are less likely to be victimized **BUT 50% say they fear being victimized** - Safety vs **[perceived safety]** (if you perceive yourself to be unsafe then you may detach yourself from the community) **[Technology Use ]** - **Mechanical and technological aids** contribute to a safer and more functional environment and enable older people to remain living in their home (e.g., zoom calls with doctors) - Not all older people are able or willing to use new technology, but there has been a general increase in internet usage among older adults **Homelessness among Older Adults** - **Growing number of older people** live and sleep in public shelters (especially in large cities) - Between **10-20% of homeless population is aged 55+** - Overrepresentation of **minorities and veterans** -- more likely to become homeless **Living Arrangements in Later Life** - Most older Canadians who are not in institution either live with a family member (usually spouse) or live alone - **Older women are more likely to live alone than older men** - Ethnicity, gender, and immigration status are important factors affecting living arrangements - **Men are less likely to live alone than women** (**men are more likely to remarry**, live with a woman, or with a family) - Immigrant seniors are less likely to live independently than Canadian-born due to cultural values and economic factors **Housing Alternatives in Later Life** - Many types of housing are available to older Canadians from private housing to LTC settings - Can be categorized as: 1. ***Independent*** (living alone) to dependent (LTC) 2. ***Age-integrated*** (neighbourhoods) to ***age-segregated*** (LTC homes) 3. ***Low to high quality*** **[Independent Housing ]** - Majority of older Canadians are homeowners who 'age in place' in the family home - Symbol of independence - Familiar/supportive environment - Link to community **[Independent/Supportive Housing ]** - Supportive living (e.g., **retirement homes**) is a form of **housing that combines shelter, usually in the form of rented units, with a variety of services (meals, housecleaning, and personal care, as needed)** - Supportive living may be **privately or publicly funded** - Retirement homes are a middle ground between independent living and fully dependent LTC homes - **Informal support:** - 'accessory' apartment (people set aside place in their home for their older parents to live with them, Granny suite) - **[Home-sharing:]** older adults share homes with other people (e.g., students) **[Dependent/Institutional Living ]** - Multiple options for older adults with diverse health and mobility needs to live in **institutional, congregate settings** - **Long term care facilities (nursing homes)** - Around the clock care - Can be operated by **provincial governments, charitable organizations, or for-profit organizations** - Over 400,000 older adults in Canada live in an institutional setting - **32% women and 20% of men 85+** - Unlike retirements homes which are operated by private sector and NOT regulated, **nursing homes are subsidized and regulated by provincial governments in Canada** **[Moving houses in later life]** - Retiring, becoming widowed, or experiencing a significant change in health status results in change of living arrangement WEEK 9: LATE-LIFE WORK, RETIREMNT, & ECONOMIC SECURITY ------------------------------------------------------ **Work and Retirement** - In past few decades, baby boomers have **experienced losses in economic investments and pensions**, and **are working longer**, causing shifts in: - Timing/patterns of transitions into and out of workforce (people are retiring later than they did before; people are entering workforce later in later because they are attending school for longer) - Meaning of work - Nature of careers - Economic security in later-life **Changing patterns of work across the life course** - In last century, the traditional **age-segregated pattern of the life course** was considered normative - Education (childhood, adolescence) \> work (adulthood) \> retirement (older age) - **However, since 1980s, work trajectories have become less permanent and more complex:** - Transition to work life is delayed as younger people spend more time in school - Once someone enters the labour force, working life may include period of unemployment and job changes - Many people are employed in 'non-standard' work (part-time, intermittent employment) which has long-term consequences - **Many older people are remaining in the workforce and for longer periods:** - Labour shortages created by aging baby boomers (people are being incentivized to keep working longer to avoid labour shortage) - Longer life expectancies (people live longer and work longer) - Small pensions (many people have to keep working for financial reasons) - Post-pandemic recession **A changing and greying labour force** - **Since 1980s/1990s, trend towards early retirement has reversed** (average age of retirement increased) - The labour force is aging because people are working longer than before - Older workers continue to make up higher proportions of the labour force - People most likely to work in later-life are ***men, people with higher education, and the self-employed*** **Women and Work Histories** - More women are getting educated and are getting employed in male-dominated occupations - Careers for women are linked to family and work responsibilities (caregiving and maternity leave cause income inequalities) - Women sacrifice their career to care for family - Some male peers are becoming more involved in caregiving and family responsibilities which has helped to create more equitable opportunities in the labour force - Gender differences remain more pronounced among people of lower status - **Female baby boomers are a GENERATION AT WORK (70-80% employed)** - Women are more likely than men to leave the labour force to care for a frail parent - Single (divorced or widowed) women are more likely to work, to work full-time, and to work later in life compared to married women - Women have different economic circumstances in later life due to different work trajectories - Older women are more likely to live below the poverty line - Older women are less likely to work in later life - Older women are more likely to live alone and in housing insecurity **[Retirement:]** the act of leaving one's job or ceasing work; the period of one's life after ceasing work **The process of retirement** - Institution of retirement emerged with the **establishment of social security programs, growth of industrialization and unionization, and importance placed on leisure** (idea that retirement should be a period of rest and leisure) - **Retirement is an economic institution but also an event, process, and stage in life** - Retirement is shaped by political, economic and social forces (economic crises, unemployment rates, pension policy) throughout an individual's life - Your retirement and economic status in later-life is not determined exclusively by your working life or lifetime earning/savings **"New Retirement"** - Recently, the transition from work to retirement has become blurred in what is called the **'new retirement'** - Some retire fully - Some become part of the **'contingent' workforce** (those with higher education/managerial experience) working casually through short-term contracts (i.e., BRIDGE EMPLOYMENT) - Some people start a business - Some older adults continue to work out of necessity BUT **financially secure older adults are more likely to remain employed** - Higher education makes it easier for people to find employment **Adjusting to retirement** - Usually, retirement is a manageable process - Transition to retirement is easier for those who have good health/wealth, retirement voluntarily, have support of family, and continue to participate in social activities - Individual adaptive strategies after retirement include replacing roles/activities, adjusting to perceived loss of identity/self-worth, changing spending habits, re-establishing social relationships (begin to derive meaning from social relationships rather than work) - If retirement involves unstable exit (e.g., 'bridge' jobs or chronic unemployment), there can be negative health effects - **'Sliding' into retirement in harmful** **Women and retirement** - Women reach retirement with fewer financial resources, less preparation for retirement, and a different work and family history - **This leads to poorer economic security in later life** - Factors influencing timing of retirement and women's adjustment to retirement: - Change in marital status (e.g., divorce or widowhood, which can result in LATER retirement) - Retirement of partner (which may lead to early retirement) - Unexpected need to care for elderly parent (which may also lead to early retirement) - Caregiving responsibilities often fall onto older women **Economic security in later life** - **Economic security in later life is both a private (individual) issue and public (government) issue** - Economic security is achieved through individuals' employment trajectories and social support programs (e.g., public pensions, healthcare housing subsidies) - ***[At the INDIVIDUAL LEVEL]*** economic status in later-life is affected by job loss, divorce, disability, or unexpected retirement - ***[At the SOCIETAL LEVEL,]*** economic status may be affected by inflation, market collapse, shift in government policies (e.g., government's choice to cut pensions) - Importance changes in coming years: - Decrease in size of labour force (as baby boomers retire) - People are living longer so people need to work longer to save up enough money for retirement - Changing policies around the role of the state vs. individual to provide retirement income **Retirement Income in Canada** - **The Canadian pension system is designed to replace only about 70% of a person's pre-retirement income** - Economic status among older people is related to education, work history, gender, marital history, year of immigration, minority status, savings patterns, and employment status in retirement (e.g., social determinants of health) - **[Canada's retirement support system has three levels (mix of government pensions and individual savings/private pensions:]** 1. ***Public-sector programs*** (paid by tax dollars): Old Age Security (OAS), Guaranteed Income Supplement (GIS), and 'the Allowance' 2. ***Government-based Canada/Quebec Pension Plans*** (you pay into these yourself): 3. ***Private pensions and individual savings*** (e.g., employer pension plan; RRSPs) a. **CPP/QPP only replaces 25%** of pre-retirement earnings b. **Only 40% of workers have private (employer) pension plans** c. After OAS/GIS and C/QPP, you are expected to build up the rest with individual savings and private plans **The economic security of older Canadians** - Economic status of older Canadians has steadily improved since 1960s - Incomes are improving because of public and private pension reform, greater incentives to save/invest, tax benefits for retirees, **increased participation in private plans ESPECIALLY BY WOMEN** - Income in later life is influenced by education, work history, marital history, and gender - Although the economic situation of older women is improving, there is many older women who are at risk for poverty - **Older age poverty is most likely to occur among women who are widowed or divorced or who live alone** - Fewer older people today live below poverty (low-income cut off) line - Lower poverty rates result from increased benefits from OAS/GIS, and more women being eligible for C/QPP and private pensions (due to increased labour force participation) WEEK 10: AGING, HEALTH STATUS, & HEALTH CARE TRANSITIONS -------------------------------------------------------- **Defining health** - **Health is a multidimensional** concept involving physical, psychological, and social dimensions - It is NOT merely the absence of disease - Many factors and determinants shape our health at all ages (e.g., social determinants) - **[WHO defines health:]** absence of disease, presence of well-being, and capacity to perform ADLs **Health is a cultural concept** - Different cultures define health differently - Cultural practices shape health, treatments, meaning associated with illness/wellness - **There is NO single/objective definition of health** **Are older Canadians healthy?** - Incidence of acute and chronic illness varies as people age - **The longer people live, the greater their risk of experiencing disease or cognitive impairment** - **[Acute:]** illnesses affecting you over the short-term (broken arm) - **[Chronic:]** illnesses affecting you over the long-term (heart disease) - Health depends on how we measure it **Models of healthcare** - Two interrelated models of health care in Canada: medical and social - **[Medical model (20^th^ century when LE was shorter)]** - Focuses on causes and treatment of disease with surgery, medications, rehabilitation, and long-term nursing care - Idea that health is caused by physiological and biological systems (too dependent on formal healthcare) - Led to advances in modern healthcare - Institutionalization of healthcare (e.g., care offered in hospitals, and professionalization of medicine via physicians and nurses) - **[Social model (bio-psycho-social model)]** - Health as having a social (one's support network), psychological (stress), and biological/genetic basis - The medical model SHOULD just be one part of this system - Emphasizes role of the individual, prevention, continuum of health care (in home, community, residential facilities) - **[Health Promotion Model (HPM):]** promotes healthy behaviours by targeting individuals or groups in a community - Messages that strive to PREVENT poor health and PROMOTE health - **[Population health model (PHM):]** developed in 1990s to identify determinants of health for entire populations - **[Population health promotion model (PHPM):]** identifies key domains and mechanisms of change and places them within a health policy/institutional framework - Emphasizes determinants beyond an individual's control - Used to identify ways to promote healthy aging **Is the older population healthier over time?** - **Health status among older persons has improved in most industrialized nations** - Improved healthcare, public health, nutrition, housing conditions, etc. - **[Morbidity compression hypothesis:]** onset of disease has compressed into shorter periods at the end of life; thus, health of older people has improved - While people are free of disability for longer periods before death, there are patterns of increasing chronic conditions among older people - **[Health paradox:]** lower risk of disability, higher risk of disease **Centenarians** - Increase in survival to 100+ is linked to reduction in mortality among those in their 80s and 90s **Dimensions of health and illness** - Factors associated with risk of death (morbidity) and with the reaction to an illness in later life: - ***Personal factors:*** adaptation to stress and pain and coping strategies, health behaviours - ***Social factors:*** availability of social support system - ***Structural factors:*** gender, age, class, and the healthcare system - ***Cultural factors:*** ethnic/religious health beliefs **Chronic conditions & multimorbidity** - Chronic conditions are long-term health problems that can restrict self-care, mobility, and social interaction - **Multimorbidity:** when a person experiences **more than one chronic condition** (e.g., diabetes diagnosis with hypertension diagnosis) - Results in increasing vulnerability - Associated with experiencing frailty in later life (frailty is NOT a normal part of aging) - **[Life course Model of Multimorbidity Resilience:]** three interlocking multimorbidity resilience domains (**functional, social, psychological**) **Mental Health** - **[Mental health:]** the capacity of each of us to **feel, think, and act in ways that enhance our ability to enjoy life** and deal with the challenges we face - Includes the state of our feelings (emotions), thoughts (cognitions), and actions (behaviours) - **[Mental illness:]** characterized by **alterations in thinking, mood, or behaviour associated with some significant distress and impaired functioning** - E.g., disorders like schizophrenia, anxiety, personality disorders, etc. - Definitions of mental illness change overtime **Mental health and aging** - **About 20% of older adults have a mental health issue** - **Depression, delusional disorders, and dementia** are most common (dementia = family of neurodegenerative cognitive disorders) - **Older women have a slightly higher rate of mental illness** - Decline in mental health status results from: - Disease progression - Challenges with stress/coping - Mental health disorders are often undiagnosed or misdiagnosed in older adults - Older adults are not always referred to mental health professionals - Many older people do not seek help for mental illness because of stigma - **There is a relationship between physical and mental health (delirium and UTI)** **Depression** - Affects **2-5% of older people** - **Higher rates for women** - **Higher rates among LTC residents** - 12-42% - Two types - **[Major depression]** -- significant depressive episodes - **[Dysthymia]** -- mild depressive symptoms over a longer period of time - Dementia is often followed by or associated with depression **Delirium** - **Temporary/short term cognitive disorder** - Fluctuation in consciousness, an inability to focus, hallucinations, periods of disorientation, and bizarre behaviour - Often undiagnosed - **Most common in LTC** **Dementia** - **Long term, degenerative disorder** - Impairs memory, thinking and behaviour - Risk increases with age - **Prevalence higher among women and increases with age** - Most common type is **Alzheimer's disease** - Degenerative disease of the brain - Begins with short-term memory and progressively destroys cognitive functioning **Suicide** - **Males 85+ are at most risk** - Rates are rising as longevity increases **Health care in Canada** - Universal health care system - Funded through taxes - Administered by provinces/territories NOT at the federal level - Private health insurance is available and covers services outside of the public system - Dental care, medication, physio care - Highly fragmented system - Each province/territory operates differently - **Federal oversight + provincial delivery + regional/local authority (e.g., Hamilton health services) = confusing jurisdictions** - Complex system creates challenges with system navigation - **[Alternative level of care (ALC)]** used to describe patients that are receiving a higher level of care than they need (e.g., people living in hospitals rather than in LTC beds because LTC beds are full) - **Older people account for 45% of health care expenditures** - There has been a decrease in the length of acute-care hospital stays among older adults - Faster recoveries - More day surgeries (vs. in-patient surgeries) - Better availability of home care (people finish recovery at home instead of recovering in hospital) **Health care funding** - **Mostly funded via federal, provincial, and corporate taxes** - Personal/private insurance plans also technically fund the health care system in Canada **Population aging and health care utilization** - Population aging can increase pressure on the healthcare system - **However, population aging accounts only for 10% of rising health care costs in Canada** - Primary reasons for rising health care costs include increased hospital costs, new expensive technologies, and new pharmaceuticals - Medication usage increases with age - **[Issued related to increased medication use ]** - Drug costs - Need research on drug interactions - Education surrounding drug usage and management (especially for people who take multiple medications) **Drug use, misuse, and abuse** - **[Challenges for older adults taking medications ]** - Over medication - Non-compliance - Problems with dosage - Problems with efficacy **Barriers to Health Care** - Lack of transportation, minority membership, cultural barriers, cognitive deficits and decline, language barriers **Integrated model of health care** - **[An integrated model:]** - Create more seamless delivery system for older people - Combines health, housing, and social services - **Improves coordination between acute care (hospitals), continuing care (home care) and LTC (nursing homes) to make up for a fragmented health care system** WEEK 11: FAMILY TIES, RELATIONSHIPS, & TRANSITIONS -------------------------------------------------- **What is Family?** - **Family is a major social force in our lives** - Family provides: - Stability, support, financial assistance, social interactions, and socialization - It is the structure in which we experience major life transitions (marriage, having children, empty nest, widowhood) - Some have supportive family experience others have conflict, but most fall in between extremes **The Concept of Family** - **Today, family structures are fluid and diverse due to:** - Divorce, single parenting, remarriage, cohabiting partnerships, childlessness, never marrying - Blended families and step relationships - **Most older people prefer living independently but close enough to visit family and adult children** - Older people view co-residence as a burden to their family - Old people of some ethnic groups prefer to live with their children due to cultural traditions **Changing Family and Kinship Structures** - First half of 20^th^ century, multi-generation families were NOT common because old people had lower life expectancies - Grandparents rarely survived to see grandchildren marry or have children - **Recently, six major changes in family/kinship structures:** 1. Kinship systems became larger 2. Kinship structures shifted from ***'age-condensed'*** (narrow age difference between children/parents/grandparents) to ***'age-gapped'*** (larger age gap between children and parents as people get married and have children later in life) 3. Truncated families (***family lineage disappears when the youngest generation is childless***) 4. Increased number of blended families from remarriage 5. More common for older adults to cohabit as partners (common-law) 6. Increase in same sex partnerships in middle and later adulthood **Factors Influencing Family Relationships** **Four dimensions of family relationships central to intimate ties between/within generations in later life:** 1. ***Number of relatives available*** and nature of their relationship to the older person (e.g., spouse, child, sibling, grandchild) -- availability and types of assistance an older adult receives 2. ***Past and present patterns of contact and interaction*** between older persons and kin -- families who maintain contact find it easier to provide care for older adults in the family 3. ***Quality of family relationships*** across the life course -- warm relationships = better care 4. ***Type of communication and support given and received*** between members of generations -- direction of care depends on cultural norms - Gender, class, race, and ethnicity influence family relationships across the life course - ***Gender*** -- women take on more caregiving responsibilities; **men are more likely to contribute financially rather than providing care** - Class -- high income families have more opportunities for professional caregiving - ***Race/ethnicity*** -- some **cultures** expect adult children to live with their aging parents leading to more intergenerational co-residence **Family Ties and Relationships** - Diversity of family relationships among: - ***Couples*** - ***Siblings*** -- bonds shaped by shared experiences, rivalry, can provide strong support systems - ***Parents and children*** -- fundamental family relationship, bond can vary depending on personal and cultural factors - ***Grandparents and grandchildren*** -- unique bond with intergenerational support/wisdom; can be primary caregivers - ***Single and childless people*** -- make connections outside of the family structure **Marital Status and Marital Relationships** - 55% of people 65+ are married - **66% of older men are married while just 46% of older women are married** - **This gender difference is more pronounced at ages 80+ (more men than women are married)** - Marital satisfaction increases with age - **Men report higher levels of marital satisfaction than women** **Sibling Relationships** - **Siblings who are close throughout early life tend to remain close in later life** - Ties are stronger between sisters than brothers **Relationships between Older Parents and their Adult Children** - **Aside from a spouse, adult children provide the greatest source of support to people of advanced age** - Most older people have at least one living child - Recent changes in relations between parents and adult children resulting from divorce, single-parenting, geographical mobility, and remarriage, which may weaken parent-child relationships - **Most intergenerational tensions (e.g., during adolescence and early adult years) are temporary and do not lead to lifelong conflict or estrangement between parents and children** - Crises (e.g., acute illness, death of one parent, move to LTC) can increase parent-child interaction - In early life stages, flow is from parent to child; in later life, the flow shifts as children give more to aid their parents **Grandparent-Grandchild Relationships** - Grandparents provide kinship continuity and contribute to the preservation and perpetuation of family rituals and history - As people have children later in life, grandparents have a declining role - Older people in future will have fewer biological grandchildren - **Most grandparenting is performed by the grandmother who has more contact (KIN KEEPER) with adult children and their children** - Maternal grandparents are generally more involved with their grandchildren - When grandparents move to a residential-care facility, the relationship between grandchild and grandparent changes and active grandparenting ceases **Family Ties, Relationships, and Transitions** **Older adults who have never married** - About 7% of older adults in Canada have never married (and do not live common law) - We assume that when we get older, and are ill, we can have a spouse, or an older child take care of us - This is true for a lot of people but not true for everyone - People who are not married and do not have children do not necessarily have these supports available to them - **Women live longer than men, so they are more likely to be widowed because their husbands usually die before them** - Most older adults who have never married report that they are not lonely or socially isolated because they have developed friendships with non-relatives or extended family - **Older, never-married women tend to be well educated/financially secure while their male counterparts tend to have lower education/financial insecurity** **Childless older adults** - **Childless people will increase in the future because of later marriages and individuals choosing not to have children** - Childless older people report high levels of well-being and have sufficient support networks and are just as socially active as older people with children - Older adults without children receive support from family and friends - **Once over the age of 85, they are less likely to have someone close who can provide personal care especially if they are widowed** - **The risk of being admitted to LTC is HIGHER among childless older adults** **Life transitions in a family context** - Family life can change drastically when we experience **[major life transitions:]** - Marriage, birth of child/grandchild, empty/refilled nest, divorce, remarriage, retirement, widowhood, remarriage, etc. **Empty/Refilled Nest** - Empty nest stage relieves people of domestic responsibilities associated with raising children (relief from chores and caregiving responsibilities) - Reduction in financial responsibilities - Marital satisfaction may increase during empty nest stage - Most parents experience empty nesting positively - **Many adult children return to family home (nest) which can REFILL the nest** - **[Boomerang kids:]** move out but then return home **Divorce in middle and later life** - Divorce most often occurs in earlier rather than later life (late life divorces are increasing though) - **Higher rates of divorce among women than men** - **Men experience a higher risk of depression, health decline, following divorce** - **Women are more likely to experience financial strain after divorce (on average, they make less money than men)** **Widowhood in later life** - **Generally, more female widows than male** (due to differences across men and women in life expectancy) - Rates are declining because of longer life expectancies and more divorces - **Widowhood is often preceded by periods of caregiving and institutionalization of a partner** - Widows (women) often fare better than widowers (men) and widowers (men) are more likely to cohabit, or re-marry **Dating, co-habitation, and remarriage** - **Majority of older men have partners while majority of older women do not have partners** - When a relationship ends, men are more likely than women to try and find a new partner - Cohabitation (common-law) and remarriage is becoming more common - **Divorced people and men are more likely to remarry/cohabitate than widowed men and women** WEEK 12: SOCIAL CONNECTION, PARTICIPATION, AND LEISURE ------------------------------------------------------ - **[Social Isolation:]** occurs when a person has minimal social contact with good, fulfilling social relationships - People who experience social isolation lack meaningful social engagement with their communities and do not feel a strong sense of belonging **Loneliness vs. Social Isolation** - Related but DISTINCT concepts - Loneliness is a subjective feeling -- a desire for more social connection or contact - **Mismatch between desired social connection and actual social connection** - **[Loneliness:]** **subjective evaluation** (unpleasant feeling) of lacking relationships - Loneliness more common amongst: - Limited family engagement/social activity - Poor health - 85+ - Financial difficulties - Living alone or in institutionalized setting - **[Social isolation:]** an objective evaluation (i.e., number of relationships) **Aging along the spectrum of isolation to engagement** - Majority of older adults do not live in isolation or feel lonely - **Loneliness and isolation are not normal parts of aging (it affects a slim minority)** - Older adults are increasingly contributing to society in diverse ways (volunteering, caregiving, and engaging in civic activities) - An active social life integrates individuals into family and community, helps maintain social identity, and stimulates cognition and emotion - Major life events can affect social connection or support (e.g., mobility changes, widowhood, divorce, illness, etc.) **[Social network:]** networks of people we have in our lives (friends, family, colleagues, neighbours) - Type (family, friendship, work) - Size (number of people in the network) - Heterogeneity (diversity of members) - Composition (number in each type) - Density (degree to which individuals in the network interact with one another) - **Stage in life and personal chances affect these social networks more significantly than chronological age** **Social networks over the life course** - **Networks for older people tend to be large, kin-centered, and dense** - Networks shrink when transitions occur (retirement, widowhood) **Volunteerism** - **Includes voluntary involvement in organizations or through informal contributions including caregiving, social support, and donating money to family and friends** - Membership in voluntary associations is **curvilinear** (upside down U shape) - **Peak involvement within 10 years of retirement** - Older people are LESS likely to volunteer than younger people, but they contribute more hours and in different ways - Younger people volunteer more for job experience (internships) **Political Participation (Civic Engagement)** - **Civic engagement in the political process** - **Curvilinear relationship** between age and civic activity (especially for voting behaviour) **Religious Participation** - Religion and spirituality are positively related to health, well-being, and social support in later life - **Religious events/communities can create social ties that provide support** - Attendance at religious services remains stable across the life course - **For old people there can be a decrease in public religious participation which is compensated by increased private worship** **Media Consumption** - Media provides **indirect contact with the social world** - This contact can help to reduce loneliness - Many older adults use at least one social media platform **Lifelong Learning and Social Participation** - This century is largely knowledge-based and continued learning is critical - Lifelong learning linked with rapid change in technology and social connection opportunities - **Increased education increases health literacy** **Travel and Tourism** - as people are living longer and more well, they are travelling more in retirement - **older women are the fastest growing segment of the travel industry** - RV life for older adults becoming more popular **Leisure and Aging** - The types of activities that people enjoy for leisure may vary across the life course - Changes in preferences of leisure activities change based on preferences, abilities, health, and societal constraints - **Usually there is consistency in interest** (e.g., transition from tennis to pickleball which is less intense) - **Adapting a leisure activity in early life often influences interests in later life** WEEK 13: END OF THE LIFE COURSE ------------------------------- **End-of-life transitions** - End of life is a period of life (several years) not just one instance - It is a ***time of enhanced social and health needs*** - Complexities surrounding finances, relationships, housing, healthcare, family, etc. - Planning and preparing for end-of-life period (e.g., drafting will to determine who receives your financial and physical assets when you die) - Important to recognize the ***importance of end-of-life supports and systems*** - E.g., hiring lawyers to deal with wills, hiring nursing staff, is expensive, so we should improve social welfare systems to help with these services **In an ideal world** - Healthcare and other social supports would enable people to age and die with dignity - ***This requires an investment in a continuum of supports*** - **[Age and die with dignity:]** adequate supports in place to prevent people from dying on the streets or in homeless shelters, etc. - **[Hospice centres:]** hospitals that support people who are actively approaching death due to an illness **Ideal continuum of informal and formal care** - **Informal assistance (from friends, family, neighbours, etc.) \> Formal care by paid employees (e.g., home care, personal care, mobility care) \> 24/7 care in institutions when needed (e.g., retirement homes, LTC, nursing homes** - As we age, we are likely to need assistance with daily life and daily functioning - A continuum of care (informal and formal care) is needed to support independent living **Family responsibility + elder care** - **Most care received by older adults is provided by family** (\*most of the time, it is their adult child who cares for them) and depends on: - Quality of the adult child's relationship with parent - Gender (**most family caregivers are women**) - Marital status - Employment status (full-time jobs may get in the way of providing care) - Geographical location of caregiver (distance makes caregiving difficult) **Public responsibility + elder care** - Emphasis on family responsibility for elder care is NOT sustainable - We must shift responsibility for older care back to the public rather than on individuals and families - Not everyone has family to rely on, so we must build an effective public support system for the aging population - We should have a continuum of options to ensure equitable access for everyone regardless of income or SES - Also develop better supports for family caregivers - We do not support family caregivers enough **Social support + caregiving** - **Social support helps achieve a good person-environment fit** - Social support includes - Emotional support - Help with household chores - Caregiving assistance to maintain independence - LTC for highly dependent persons - **Ideal social support system involves FORMAL (paid workers) and INFORMAL (family, friends, neighbours) support** - One person/supporter should NOT be responsible for providing all care to someone else - We cannot rely solely on formal or informal care for adequate support **Informal social support** - ***[Informal support]*** is provided in home or community by family, friends, neighbours, or volunteers (e.g., meals on wheels) and may involve monitoring quality of care and assisting with care in LTC - Family members serve as 'case managers' and as buffers against formal bureaucracy of an institution - E.g., family members manage doctor appointments, etc. - **Most informal support is provided by women** - Adult daughter - Daughters-in-law - An older adults' son's wife provides care to her mother-in-law - Wives - Sisters - More men are becoming involved as caregivers as gender roles change and more women are employed full-time - Giving and receiving of informal support in old age is influenced by cultural beliefs, practices, and values of specific ethnic, religious, and racial groups - Informal care is challenging and has many costs (adverse effects) - **Some caregivers provide 60+ hours of care per week!!!** **Formal Social Support** - ***[Formal support:]*** provided to dependent/frail adults by government, not-for-profit, or private organizations in home or institutions (provided by **paid workers** or organizations) - Formal support services provide a safety net and operate through community and in-home programs, adult day-care centres, retirement homes, and LTC facilities - Includes **home-based** (e.g., monitoring people who live alone); **community-based** (outreach programs to locate at-risk persons) , **technology-based** programs (phone apps for older adults); and **employer-based** (working from home, parental leave policies, etc.) - **Generally, use of formal services by older adults is relatively low** - Just because formal supports are available for older adults, many people might not know how to access them, might be stuck on a wait list, may be unable to pay for them, may be reluctant to accept formal care, etc. - Some people may not want (desire to remain independent) or know how to access formal care services - **Older adults who live alone (especially women) or those age 75+ with complex health care needs are most likely to use formal care services** - These are heavy formal care service users **Home care** - **[Home care services:]** a blend of health and social support programs that allow people with limiting functional or cognitive challenges to live at home, thus ***preventing or delaying long-term or acute hospital care admission*** - Established in 1990s to relieve overburdened hospitals/LTC facilities and overburdened/untrained informal caregivers - **Purpose of home care is to delay having to be admitted into LTC** - Receiving care at home can push reliance on LTC until it is actually needed **Types of Home Care** 1. ***[Nursing support services]*** (and related support like physiotherapy at home) a. **Medical supports** b. Treatments by homecare nurse c. Medical check-ups a few times a week in the home 2. ***[Home support services]*** (e.g., bathing, meal prep, transportation; help with **ADLs and IADLs**) d. Support with bathing, home-prep, etc., e. Personal Support Workers (PSW) f. Assistance with non-medical activities - ***Society's goals of homecare:*** efficiency, cost effectiveness, and equity in access - ***Individual goals of homecare:*** therapeutic (prevent further health deterioration), and compensatory (promote comfortable daily living) goals - There can be government funded homecare and private homecare (private business, corporations, etc.) **Caring for the carers** - We need to support caregivers and care providers - To support caregivers and mitigate psychological strain of caregiving we should include: - ***Support programs for caregiver*** (e.g., emotional, social, education support like help circles) - ***Financial incentives*** (e.g., tax credits) to offset the financial costs of caregiving - ***Private or publicly supported care*** within or outside the home (publicly funded homecare is often not enough so we need to enhance these programs to alleviate burdens on informal caregivers) - **[Respite care:]** temporary care provided by professions to give the caregiver a break - For a day, weekend, etc., - Can be provided in home (care worker moves in) or in a facility like an adult daycare **Coordinated and integrated care** - Assistance to older people is provided by both formal and informal caregivers, so services need to be ***COORDINATED in an integrated continuum of care*** - We should be able to ***transfer smoothly from homecare to LTC***, etc. (this demonstrates an integrative model) - Integrative models of care are designed to meet the changing needs of older adults and to **connect home, community, and residential-care services so that a person can be transferred seamlessly from one level to the next** **Elder Abuse & Neglect** - ***Elder abuse*** occurs in situations in which a frail/dependent person is cared for by a person in a position of trust like a relative or employee of an institution where a person lives - **Most occurs in family settings** and is perpetuated by someone is a position of trust (most often perpetuated by someone you know) - Types of elder abuse include ***physical, psychological, financial, and sexual abuse*** - ***Elder neglect: failure or refusal to perform necessary caregiving*** or monitoring responsibilities for an older adult - **May be intentional or unintentional (usually it is intentional neglect)** **Dying with Dignity** - Most older people die over a period of time that ranges from a few months to a few years - It is important that every person has the resources and supports needed to die in a dignified way - **[Dying with dignity:]** person maintains a sense of control, respect, and comfort at the end of their life **Options for end-of-life** - Palliative care in other than primary health care facilities - Support groups for family and paid caregivers - Flexible supports for older persons who may not meet traditional hospice eligibility criteria **Advance Directives** - Many **older adults express preferences in advance** (i.e., living will) about how/when to die and the use of life-support systems and resuscitation - **[Powers of attorney]** can protect and support people as needs and abilities change - Gives authority to someone they trust to make decisions on their behalf - **[Medical power of attorney]** authorized someone to make decisions about medical care for a person who is incapable of making such decisions - **[Medical assistance in dying]** (assisted suicide or euthanasia) involves complex legal, ethical, medical religious, and philosophical arguments - In Canada, medially assisted suicide is legal **Palliative care** - Designed for people with terminal illness **to improve quality (not quantity) of life and provide support for caregivers** - Emphasis on **pain management and comfort** - Most facilities intended for death related to cancer and less equipped for dementia **Death, bereavement, and cultural rituals** - **Social values, beliefs, and practices about death and dying** are changing - More open discussion about and acceptance of death, more advance directives are written - Greif management is a long process especially for **intimate elderly partner and for women who disproportionately bear burden of a loss**