Paul Nash

Valuing Older People: Time for a Global Campaign to Combat Ageism

Today, for the first time in history, most people can expect to live into their sixties and beyond. By 2050, the worlds population aged 60 years and older is expected to double to nearly 2 billion people, 80% of whom will live in low-and middle-income countries. The health of older people is unfortunately not keeping up with increasing longevity. The World report on ageing and health highlights great diversity in health and functioning in older age and marked health inequities in this group. (1) There is little evidence to suggest that people today are experiencing older age in better health than previous generations. (1) Pervasive misconceptions, negative attitudes and assumptions about older people are serious barriers to developing good public policy on ageing and health. Negative attitudes and stereotypes about older adults as frail, out of touch, burdensome or dependent are ubiquitous. A recent analysis carried out by the World Health Organization (WHO) using world values survey data of 83034 adults from 57 countries found low respect for older adults. (2) Sixty percent of participants reported that older adults are not well respected, with respondents from higher income countries being more likely to report so. Stereotyping and discrimination against individuals or groups on the basis of their age is called ageism. (1) Unlike other forms of discrimination, including sexism and racism, ageism is socially acceptable, strongly institutionalised, largely undetected and unchallenged. (3,4) Ageism limits the questions that are asked and the way problems are conceptualized. Recent analysis suggests that ageism influences the development of global health policy and targets. (5) The authors highlight that age limits placed on global goals to prevent and control noncommunicable diseases and the use of premature mortality thresholds, including in the sustainable development goals (SDGs), may be used to discriminate against older adults in the allocation of health resources and data collection. (5) Changing public discourse around population ageing, which largely depicts older people as burdens on public spending and economic growth, can help to capitalise on the great human capacity that older people represent. Although most older people will eventually experience multiple health problems, older age is not the most significant driver of health care costs and does not imply dependence. For example, in a period of unprecedented population ageing in the United States of America (1940-1990) ageing contributed to around 2% of the increase in health expenditures, compared to 51% related to technology innovation in medical practice. (6) Older adults make significant social and economic contributions to their societies. In the United Kingdom of Great Britain and Northern Ireland, the contributions older people made through taxation, consumer spending and other economically valuable activities were worth nearly 40 billion pounds sterling ([dollar]), more than expenditure on them through pensions, welfare and health care combined. …

The Continuation of Prejudice: Addressing Negative Attitudes in Nurse Training and Continuing Professional Education

Measures of attitudes to ageing typically examine only explicit attitudes, treating attitude holders as a homogeneous group with regards to education levels. Implicit attitudes (i.e., the immediate attitudinal response before conscious processes amend that attitude to an explicit attitude) have been less commonly examined. The current study examined both explicit and implicit attitudes towards ageing in four groups: nurses with high exposure to older patients; nurses with exposure to a broader patient age range; nursing students at the start of training and nursing students at the end of training. There were no significant differences in explicit attitudes, but implicit attitudes were significantly less negative in the student groups relative to the practicing nurses groups. The argument that training and experience have little effect on attitudes is discussed.

Training Older Volunteers in Gerontological Research in the United Kingdom: Moving Towards an Andragogical and Emancipatory Agenda

In the UK, very few studies have engaged older people in two or more elements of the research process (design, conduct, dissemination). Although there is a body of work on educational gerontology, there are few publications that specifically focus on training older people as coresearchers. This paper reports upon the training program undertaken as part of the Rural North Wales Initiative for the Development of Support for Older People (RuralWIDe). The RuralWIDe training program was built upon principles of andragogy: the art and science of teaching adults. The trainers used lecturing; modeling (observation of another person conducting a task); and active participation (structured guidance, instructions or trial and error, during which the student discovers for him or herself how to perform the task) to teach older volunteers social gerontology, research methods, interview techniques, and data analysis. This paper describes the methods used in RuralWIDe and highlights instances when these were both effective and ineffective. It assesses the study against Rachals (2002) criteria for andragogy (voluntary participation, adult status, collaboratively determine objectives, performance-based assessment of achievement, measuring satisfaction, appropriate adult learning environment, and technical issues), and it describes when pedagogical assumptions were made by the research team.

Sexual health and sexual activity in later life

The population is ageing and the rights, welfare and wellbeing of this age cohort are becoming more globally prominent and the focus of much policy development. Whilst research is leading the way and informing this in many spheres of an older persons life, this is not the case for sexual health. Campaigns of sexual health literacy and intervention are targeted at ‘at-risk’ cohorts, largely ignoring those over 60 years of age. With increases in sexually transmitted infections (STIs) in this age group and the potentially serious nature of untreated conditions, this review highlights the need for increased research, health literacy and targeted interventions. Social, societal and physical barriers preventing older adults engaging with safer sex have been identified, highlighting the extent of the attitudinal and policy shifts required to provide age parity.

The Role of Food Antioxidants, Benefits of Functional Foods, and Influence of Feeding Habits on the Health of the Older Person: An Overview

This overview was directed towards understanding the relationship of brain functions with dietary choices mainly by older humans. This included food color, flavor, and aroma, as they relate to dietary sufficiency or the association of antioxidants with neurodegenerative diseases such as dementia and Alzheimer’s disease. Impairment of olfactory and gustatory function in relation to these diseases was also explored. The role of functional foods was considered as a potential treatment of dementia and Alzheimer’s disease through inhibition of acetylcholinesterase as well as similar treatments based on herbs, spices and antioxidants therein. The importance of antioxidants for maintaining the physiological functions of liver, kidney, digestive system, and prevention of cardiovascular diseases and cancer has also been highlighted. Detailed discussion was focused on health promotion of the older person through the frequency and patterns of dietary intake, and a human ecology framework to estimate adverse risk factors for health. Finally, the role of the food industry, mass media, and apps were explored for today’s new older person generation.

Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners

Abstract Aim: The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners’ perspectives on the practices that constitute high quality hip fracture rehabilitation. Methods: Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners’ perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach. Results: Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration. Conclusions: Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners’ perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners’ perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation. While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers. Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.

The impact of supported living environments on social resources and the experience of loneliness for older widows living in Wales: An exploratory mediation analysis

Extracare sheltered housing has been marketed in Wales as a positive housing choice in later life. This exploratory paper examines the relationship between marital status, social resources and loneliness for older people in Wales in three different settings: residential care, extracare sheltered housing and in the community. The results showed that extracare environments provided the conditions for increased social interaction, and this was particularly effective for older widows. However, there was no difference in the levels of loneliness between the three environments. Although the level of social interactions was greater in extracare settings, the exchanges did not necessarily lead to high-quality and emotionally satisfying social relationships. Older widows who talked about friends referred to those people with whom relationships had been developed outside of the facilities. The paper concludes with some implications for families and formal care providers in terms of supporting older people to maintain long-term friendships.