Final Content Flashcards by Brayden Unknown

Healthy Aging

The process of developing and maintaining the functional ability that enables well-being in older age

Ability to…
- Meet basic needs
- Learn, grow, and make decisions
- Be mobile
- Build and maintain relationships
- Contribute to society

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Key Considerations in Healthy Aging

1 There is no typical older person

A large proportion of differences in capacity in older age is due to the cumulative (lifecourse) impacts of advantage and disadvantage across people’s lives
Intervention is possible
Focus on improving quality of (remaining) life rather than only lengthing life

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Different Concepts of Aging

Successful Aging: Individual health

Healthy Aging: Involves the society

Aging Well: Involves policymakers

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Aging Successfully

Does not mean not experiencing the natural aging process of aging

Minimizing risk of disease and disability
High mental, physical, and social functioning

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Indicators of Health Aging

Functioning and disability

Physical activity

Cognitive capability

Prevalence of chronic diseases and multi-morbidity

Social engagement and contribution

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The Vision of Healthy Aging - Framework

Guiding Principles
- Dignity
- Independence
- Participation
- Fairness
- Security

Supportive Strategies
- Supportive environments
- Mutual aid
- Self-care

Selected Areas of Focus/Behavioural Intervention
- Social Connectedness
- Physical Activity
- Healthy Eating
- Falls Prevention
- Tobacco Control

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Aging in Place - Policy Approach

A policy that helps older adults maintain established social connections and continue using familiar resources, minimizing the need for intensive individual-based interventions

Key Elements
- Older adults prefer to stay in their homes
- Established ties are central: People, physical/built environment, community
- Provides a sense of identity and security

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How Aging in Place Works

Adaptations are Needed
- As health, financial, and family situations change

Can Occur Naturally
- Entire communities can age together

Often needs Interventions
- Planned retirement communities
- Various types of housing
- Societal-level planning

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Design and Evaluation of an Intervention Process

Determinant Studies
- Identify root cause of issue
Efficacy Studies
- Test if the intervention works under ideal, controlled conditions
Effectiveness Studies
- Evaluate real-world impact at population level
Dissemination and Implementation Studies
- Translate findings into policy and adapt interventions to specific populations

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Why don’t some Interventions Work?

The evidence is wrong
Implementation is wrong
Wrong modifications

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Criteria for a Good Intervention

Has clear and specific goals
Focuses on a particular sub-population of older adults
Intervention is clearly defined
Outcome is measurable

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Healthcare

Services provided to individuals or communities by agents of the health services or professions to promote, maintain, monitor, or restore health

Not limited to medical care; extended to home care and self-care

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The Medical Model

Focuses on the treatment of diseases and injuries

Favours surgery/drug therapy, and rehabilitation through physical therapies

Usually in a formal and regulated healthcare institution

Influenced by the payment system

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The Social Model

Sees medical care as one part of a complete healthcare system

Includes personal/family counselling, home care, and adult daycare programs as part of the healthcare system

Tries to keep older people in their own homes (Aging in place)

Includes long term care, which combines medical/nursing care with social and community services
- Multidisciplinary

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Healthcare as a Social Service - Flowchart

Global Level
- Trade
- Governance
- Technology

National Level
- Infrastructure
- Employment
- Policies

Community Level
- Social services
- Environment
- Resource allocation

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The Health Promotion Model

Focuses on prevention and self-care
- Aims to prevent disease through lifestyle change, increased knowledge about healthy behaviour, and environmental improvement

Includes programs and actions that most people do not associate directly with healthcare
- Easily intergrateable into the social model

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Levels of Care with Matching Healthcare Services

Self-care, community programs, public health
- Broadest reach, lowest cost, prevention-focused
Primary Care (Local)
- First point of contact, most of the population, focuses on early detection and management
Secondary Care (District)
- Specialist or hospital services for some of the population, moderate cost
Tertiary Care
- Advanced treatment for complex conditions, smallest group, highest cost

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Canadian Healthcare System

Mixture of 3 models
- Medical
- Social
- Health promotion

Although, still highly medicalized

Main Challenges
- Wait time
- Issues with continuity of care and transition to long-term care

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Canadian Health Act (1984)

Established publicly funded health care insurance

Sets national standards for each province and territory

5 Main Criteria - Must be Achieved
1. Public (non-profit) Administration
2. Comprehensiveness
3. Universality
4. Portability
5. Accessibility

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Organization of the Health System in Canada - Overview

Federal Government
- Oversees funding and standards

Provincial Government
- Delivers and manages care

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Healthcare Costs

Nearly 12% of GDP and increasing
- Mostly for medical costs

Older people accounted for 44% of all provincial and territorial government health spending
- See specialists and generalist practitioners more often than younger people
- More likely to be hospitalized and spend longer in the hospital

Proportion of health system expenses spent on seniors has been stable over the last decade
- Population aging is not the main reason for growth in healthcare expenses

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Inequity in Healthcare Access

Geography
Socio-economic status
Cultural issues

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Addressing Needs of Older Adults

Key: Continuity of care

More homecare
Transfer from acute care to chronic or long-term care
- Not fully covered by OHIP (Impacts poorest)

Long-term Care in Old Age

The proportion of older adults who live in a long-term care facility increases with act

The Canada Health Act does not include all nursing home care costs in its definition of covered services
Costs vary considerably by province

Criteria not achieved
- Comprehensiveness
- Universality
- Accessibility

Social Participation: Opportunities for Older People

Volunteerism Political Religious Cultural All depends on the availability and quality of social networks

The Big Picture - Social Networks and Health

Macro Level: Social conditions (e.g. culture, inequality, policies) shape social networks. Mezzo Level: Network structure and ties (size, contact, intimacy) influence social interactions. Micro Level (Psychosocial Mechanisms): - Support (emotional, financial) - Influence (norms, peer pressure) - Engagement (activities, bonding) - Access (jobs, housing, healthcare) These impact health through: - Behavioral (e.g. diet, smoking) - Psychological (e.g. stress, self-esteem) - Physiological (e.g. immune, heart function)

Personal Resource Model

Explains how lifestyle choices are shaped by resources and context Exogenous Factors - Micro: Genetics - Meso: Social position (class, age, gender, etc.) - Macro: Culture, policies, economy Personal Resources - Physiological/Psychological - Social-familial - Fiduciary (financial/legal) Choices & Lifestyle: - Resources affect the range of options available - These shape perceived choices - Leads to subjective and objective lifestyle patterns

Social Participation - Constraints

Individual Level - Health - Decline in financial resources - Transportation - Lack of a partner/friend Social Level - Lack of programs - Discouraging culture/negative stereotypes - Unfavourable public transportation - Unfavourable built environment - Unsafe (socially or physically) neighbourhoods

Sources of Support for Older Adults

Children Childless seniors (usually) create a network of supportive family and friends - Tend to be wealthier

Social Capital

Amount of available social support

Level and Type of Received Care (Formal vs Informal)

Depends on... 1. Age 2. Health status

Age and Care

Health Status and Care

Quality of Social Network and Care

Caregivers

Mostly women family members

Informal Care Providers by Age

Women provide a greater proportion of informal care at every age except when around 75+ 3 Main Reasons 1. Women live longer than men, so fewer women have spouses to take care of 2. Widowhood - Older women are more likely to be widowed 3. Culture - Men are less likely to be caregivers at younger ages, but step up in old age

Informal Care - Issues

Policies are not based on realities Only some governmental support Burden (~3 million Canadians 45+ give care to a senior) Abuse

Economic Costs of Caregiving

Non-Economic Costs of Caregiving

- Women suffer more - Socio-economic and cultural variations - Caregiving can give feelings of satisfaction and accomplishment

Elder Abuse

Any action or inaction by any person that causes harm to an older person Most victims are women Perpetrators (more likely) - Women: Family - Men: An acquaintance or stranger Problem: Under-reported

Palliative Care

Providing relief from the symptoms, pain, physical, mental, and social distress of a terminal diagnosis Goal: Improve quality of life for both the person and the family - Part of medical model

Stages of Psychological Reactions to Dying

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance People may skip, go back and forth, or overlap stages

Grief

Sense of deep sorrow after a loss

Mourning

Expression of grief in public

Bereavement

The state of having recently experienced grief

Complex (Maladaptive) Grief

1. Anticipatory Grief 2. Disenfranchised Grief 3. Complicated Grief

Anticipatory Grief

Grief starts before and in anticipation of the death

Disenfranchised Grief

Deemed illegitimate and therefore unacknowledged

Complicated Grief

Long and severe Inability of recovering and resuming the normal life

Risk Factors for Maladaptive Grief

Lingering and severe disease Closeness and nature of relationship Socio-economic status

Assisted Suicide vs Active Voluntary Euthanasia

Assisted Suicide: Asking for a lethal medicine, but you take it yourself Active Voluntary Euthanasia: The health care professional administers the medicine

MAID

Medical Assistance in Dying - Can be either assisted suicide or active voluntary euthanasia

Healthy Communities

A place friendly with aging With consideration of... 1. Complexities of place-person relationships 2. Special needs of older adults Healthy community makes individuals healthy - Contextual effect Healthy individuals make a community healthy - Compositional effect

Policy

A course or principle of action adopted or proposed by a government, party, business, or individual Guidelines for actions

Public Policy Issues

Reactive not proactive - Treatment vs prevention Equity Addressing rights not only needs