The Active Ageing–concept translated to the residential long-term care

Purpose

Active Ageing (AA), as described by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5), is an important concept in gerontology. Since the AA-concept has not been examined in the context of residential long-term care facilities, our study addresses this gap by describing the determinants of AA within this setting.

Methods

A qualitative study with semi-structured focus groups, followed by a thematic analysis, was conducted. Through purposive sampling, four focus groups of either residents of long-term care facilities (n = 8), children of residents (n = 8), community-dwelling older people (n = 8) and gerontologists (n = 6) were formed.

Results

The thematic analysis yielded nine determinants of AA. Seven correspond to those identified by the WHO: Culture, Behaviour, Psychological Factors, Physical Environment, Social Environment, Economic Characteristics and Health and Social Care. Two new determinants were identified: Meaningful Leisure and Participation. The determinant Participation is seen as crucial to AA in residential care.

Conclusion

This study points to a more extensive set of determinants of AA than those identified by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5). Staff of long-term care facilities can make use of these determinants to promote AA in their residents.     

‘Healthy Ageing’ policies and anti-ageing ideologies and practices: on the exercise of responsibility

This paper explores how the exercise of the ethics of ‘responsibility’ for health care advanced through ‘healthy ageing’ and ‘successful ageing’ narratives in Western countries animates an array of ‘authorities’, including the ‘anti-ageing medicine’ movement as a strategy to address the anxieties of growing old in Western societies and as a tool to exercise the ethos of ‘responsibility’. The choice of this type of authority as a source of guidance for self-constitution and the exercise of the ‘responsible self’, this paper will argue, enables the enactment of a type of late modernity notion of citizenship for ageing individuals based on principles of agelessness, health, independence and consumption power. Through interviews with anti-ageing consumers, however, it is also possible to argue the existence of tensions and contradictions that such a rigid model of self-constitution in later life produces, and the potential forms of resistance and contestations that may emerge as a result. In this way the current ‘war on anti-ageing medicine’ (Vincent 2003) becomes also symptomatic of bigger ‘wars’ taking place not only between institutions competing for control over knowledge and management of ageing, but between those in favour and against the homogenisation of life under the language of universal science, reason and market rationality.     

Ageing societies--new priority for public health research?

Population ageing, caused by longer life spans and low fertilityrates, has changed the demographics in Europe and around theworld. Older people not only are becoming a larger portion ofthe population, but also face a prolonged period of life inwhich a majority is relatively healthy, especially so in the‘third age’ that ranges typically from the mid-50sto the early 80s. Nevertheless, ageing is associated with increasedrisks of chronic     

Ageing Britain: can we cope? The words and the reality of that happy old age

Author opens our major eight-part series with an assessment of the growth in size and need of our elderly population and, more importantly, Britain's attitude to this need. Is Britain able, and willing, to meet the challenge of the eighties?     

Ageing with telecare: care or coercion in austerity?

In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. ‘Telecare’ technologies are heavily promoted to assist ageing‐in‐place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the ‘telehome’ as the solution to the problem of the ‘age dependency ratio’. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of ‘technogenarians’ and ‘shared work’ to illuminate our analysis of telecare in use. Drawing on European‐funded research we argue that home‐monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non‐use and ‘misuse’ in daily practice. We propose that re‐imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co‐production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.     

Prevalence of thyroid disorders among older people: results from the São Paulo Ageing & Health Study

This study aimed to estimate prevalence of thyroid disorders in the S?o Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of S?o Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of thyrotropic hormone and free-thyroxine. Among 1,373 people (60.8% women), prevalence rates (95% confidence interval) for thyroid dysfunction (%) were: overt hyperthyroidism, 0.7% (0.2-1.1)[women: 0.8% (0.2-1.5); men: 0.4% (0.01-0.9)]; overt hypothyroidism, 5.7% (4.5-6.9) [women: 5.9% (4.3-7.5); men: 5.4% (3.5-7.3)]; subclinical hyperthyroidism, 2.4% (1.6-3.2) [women: 2.8% (1.6-3.9); men: 1.9% (0.7-3.0)]; and subclinical hypothyroidism, 6.5% (5.2-7.8) [women: 6.7% (5.0-8.4); men: 6.1% (4.1-8.2)]. There was no difference in prevalence rates according to gender, but almost 40% of women were diagnosed and under treatment compared to 9% of men. The burden of thyroid disorders in this sample is high and most participants were not aware of them.     

Ageing of population and health care expenditure: a red herring?

This paper studies the relationship between health care expenditure (HCE) and age, using longitudinal rather than cross-sectional data. The econometric analysis of HCE in the last eight quarters of life of individuals who died during the period 1983-1992 indicates that HCE depends on remaining lifetime but not on calendar age, at least beyond 65+. The positive relationship between age and HCE observed in cross-sectional data may be caused by the simple fact that at age 80, for example, there are many more individuals living in their last 2 years than at age 65. The limited impact of age on HCE suggests that population ageing may contribute much less to future growth of the health care sector than claimed by most observers.     

Ageing Britain: how long must workers continue to wait in hope?

Despite frequent demands for better trained care staff for the elderly, residential workers are still considered the poor relations of social workers. Author looks at the reasons for this low status and urges care staff radically to review the way they see their role.     

Pathophysiology of Vascular Calcification and Bone Loss: Linked Disorders of Ageing?

Vascular Calcification (VC), low bone mass and fragility fractures are frequently observed in ageing subjects. Although this clinical observation could be the mere coincidence of frequent age-dependent disorders, clinical and experimental data suggest that VC and bone loss could share pathophysiological mechanisms. Indeed, VC is an active process of calcium and phosphate precipitation that involves the transition of the vascular smooth muscle cells (VSMCs) into osteoblast-like cells. Among the molecules involved in this process, parathyroid hormone (PTH) plays a key role acting through several mechanisms which includes the regulation of the RANK/RANKL/OPG system and the Wnt/ß-catenin pathway, the main pathways for bone resorption and bone formation, respectively. Furthermore, some microRNAs have been implicated as common regulators of bone metabolism, VC, left ventricle hypertrophy and myocardial fibrosis. Elucidating the common mechanisms between ageing; VC and bone loss could help to better understand the potential effects of osteoporosis drugs on the CV system.     

“Primary” Rationing of Health Services in Ageing Societies—A Normative Analysis

While most of the debate on rationing in health care focusses on the distribution of scarce medical resources among competing needs, which we propose to call secondary rationing, this paper is concerned with primary rationing, i.e., the conscious decision by society to limit the amount of resources devoted to a collectively financed health care system. Based upon a number of transparent normative criteria, we analyze whether primary rationing should be performed and, if so, what type should be chosen (hard vs. soft, explicit vs. implicit). Finally we discuss whether age should be used as a criterion in any systematic attempt at primary rationing of health care.     

Is the self of the infant preserved in the adult?

Medicine, Health Care and Philosophy - What does a confrontation between philosophy and psychoanalysis look like? My task is a philosophical investigation of a psychoanalytic concept. Thus, I offer...     

Is the future in the cards?

Smart cards have yet to catch on in health care. Applications for data security and marketing, however, could boost their use.