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Social, Cultural and Psychological Issues Related to the Ageing Population

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INTRODUCTION
It is obvious that we are faced with an aging population. Within three decades individuals aged 65 years or older are expected to make up 23% of the Australian population (Australian Bureau of Statistics, 2013). This is a stable increase from 13% in 2007, emphasising Australia as an aging country (Australian Bureau of Statistics, 2013). This is evident not only within the demographic regions of metropolitan and rural cities and towns of Australia but also among other countries in the world. It is with this discrepancy that presents such a large challenge within the population and from a health perspective. This essay will explore the social, cultural and psychological health related issues linked with growth in the aging population and will focus on the baby boomer generation and the co-morbidities that are notably prevalent in the elderly. This essay will also consider the future role of the nurse and how their profession will be impacted in response to these trends.

WHY DO WE FACE AN AGING CRISIS?
As fertility rates decline and longevity increases we are coming to face a shift in population distribution with a greater proportion of older adults (Anderson and Hussey, 2013). It is important to note that this increase is due particularly to the Baby Boomer generation growing older and associated aging co-morbidities on the rise. The Baby Boomer generation consists of those born from the years 1945-1964 (Berman et al., 2012). As this generation grows older the world is faced with a huge increase in older adults, greater than any generation before them. Because the population is living longer they are faced with a number of co-morbidities that are particularly prevalent in older adults.

The elderly will experience physical deterioration more commonly than the younger to middle aged population. Changes in the sensory functioning are increasingly noticeable in later life. (Berk, 2009). The elderly will experience declines in their eye sight, hearing, taste, smell and in some cases may also experience touch sensitivity decline. (Berk, 2009). All systems in the body are affected as one ages. As the nervous system declines in later life, mental deterioration may become a significant issue. The older adult may experience slower processing speeds, memory loss and mental disorders such as depression. (Berk, 2009). These examples of mental deterioration are related to the process of aging and form the basis of the psychological issues linked with the increase in the aged population.

PSYCHOLOGICAL ISSUES RELATED TO THE INCREASE IN THE AGED POPULATION
With the increase in the aging population and the extended life expectancy individuals are faced with a number of debilitating psychological issues. Dementia is one of great significance when it comes to the older adult. Dementia is a mental disorder that has many characteristics such as personality disintegration, confusion, disorientation, decline in intellectual capacity and in particular impairment of control of memory. (Harris, Nagy and Vardaxis, 2011). Dementia is a highly prevalent disorder particularly in the elderly. By 2050 it is predicted that the number of Australians experiencing this disorder will exceed 730,000 people. (Berman et al., 2012). This is a significant increase of four times the amount of sufferers since the year 2000. (Berman et al., 2012). This large increase may be due to the aging crisis that we are already beginning to face and the fact that people are living to a much older age. The neurodegenerative changes that occur as a result of dementia will eventually lead to a ‘loss of self’ in sufferers of the disorder. (Stein-Parbury, 2011). This loss of self can

mean that individuals who suffer from dementia will experience a lower quality of life due to the understanding that they are no longer who they once were. Often patients who suffer from dementia are unable to recognise their family members and have trouble recalling details relating to their life prior to the onset of the disorder. This unawareness of self, experienced by dementia suffers can ultimately lead to depressive symptoms or depression as a disorder.
Depression and suicide in the elderly is particularly notable when it comes to the psychological issues that correspond with the increase in the aging population. In some cases depression in the older adult may stem from dementia and the understanding that they are no longer themselves due to the disorder however in some cases depression is looked at as an entirely separate disorder of its own. Dementia and Depression are the most recurrent psychiatric disorders experienced by the elderly population. (Müller-Spahn and Hock, 2009). Depression may occur more frequently in the older adult due to life changes such as the loss of a partner, retirement, social isolation and loneliness. (Müller-Spahn and Hock, 2009). Suicide is an important issue when it comes to the older adult. Depression, chronic illness, hopelessness and despair are contributing factors to suicide (Zanni and Wick, 2010). In 2009 males aged 85 years and older experienced the highest suicide rate above any other age group in Australia, which was 28.2 suicides per 100,000 deaths whereas females experienced 6 suicides per 100,000 deaths. (Australia Bureau of Statistics, 2013). These psychological issues of the older adult contribute to other factors that put pressure on society.

SOCIAL ISSUES RELATED TO THE INCREASE IN THE AGED POPULATION
Society plays an important role in the elderly population. As the population of elderly adults increases so to does their risk of developing ill health. The World Health Organisation (WHO) defines health as “A state of complete physical, social and mental wellbeing and not '

merely the absence of disease or infirmity.” It is evident that older people use more health care than younger people and that the proportion of older people in the population is increasing. Parallel to the aging co-morbidities and this increase in the life expectancy, health-care expenditure has amplified to cater for these needs of the elderly. (Breyer, Costa-Font and Felder, 2010). The government is providing more care for the elderly than they have ever needed before. This can be seen in the provision of services such as the aged care pension, the pharmaceutical benefits scheme, bulk billing medical centres and providing hospital beds to accommodate to the needs of the older adult should they face ill health. Not only are their costs on the government but too costs on themselves and their families.
Families of the elderly that are still capable of living at home are faced with financial difficulties when it comes to looking after their elderly. The vast majority of elderly people are unable to drive themselves so they often rely on family members to take them places that they need to go. This may mean driving to the shops to do the groceries or the pharmacy to pick up their medications. As the population is growing older there is a larger gap between the time they retire and they time they pass away which may mean a lot of their money from their working years is used up and they are relying more so on their small pension that they receive from the government. Other social issues beyond costs also impact the aged population. A massive 41% of older adults report feeling unsafe walking in their neighbourhood for fear of crime against the elderly. (Berk, 2009). In urban areas there is a great proportion of females aged 65 years and over that have been victims to crimes such as pickpocketing and purse snatching as perpetrators see older adults as a target that they can easily overpower. (Berk, 2009). This may put great fear in the frail elders of physical injury and financial consequences for those with low incomes. Apart from the social and

psychological issues that impact the elderly there are also cultural issues that need to be addressed.

CULTURAL ISSUES RELATED TO THE INCREASE IN THE AGED POPULATION
Australia in particular is a largely multicultural country. In 2011 it was estimated that 27% of Australia’s overall population was born overseas and the proportion of people that immigrate to Australia is much greater than those who emigrate from Australia. (Australia Bureau of Statistics, 2013). A vast majority of those who migrate to Australia consist of middle aged to older adults thus increasing the proportion of older adults compared with younger generations. Some cultures view their elders as wise and they are highly respected within that culture. The people of Botswana, Africa are a prime example of this. When older adults in Botswana decline physically they still retain positions of seniority and are treated with respect. The hierarchy in Botswana makes the oldest man and his wife leaders in the village. (Berk, 2009). Other cultures also view their elders as having great authority in their home towns due to their length of residence and their knowledge of their own community. However life for elders in some cultures is often less appealing, particularly in western societies. Older people in western society are granted very little special status due to seniority and they occupy few valued roles in their communities. (Berk, 2009). In societies like this being old limits integration into community life and physical deterioration brings with it many negative consequences. This may lead to social isolation linking back to depression and suicide in the elderly population. The psychological, social and cultural issues that correspond with the aging population may increase with time and it is important for nurses to prepare for these increasing trends.

FUTURE ROLES OF THE NURSE
There will be a number of future roles that the nurse will need to undertake in response to the aging crisis that countries all around the world are beginning to face. In the future, as people who migrate to Australia increases, nurses will need to cater for all religions and cultures that they are faced with. As an example, some Muslim men may find it embarrassing to have a female as their nurse. In this case the nurse must attempt to understand their cultural needs and work towards a solution to make the Patient feel more comfortable (Holland and Hogg, 2010). Apart from this it is important to note that we face an inevitable aging crisis and steps must be taken by the nurse to prepare for this. In order to prepare for this, the nurse may choose to focus on the Social Model of health and in particular empowering individuals and communities to work on preventative measures to reduce the number of illness, injury and disease that burden the elderly. This may include but is not limited to setting up community programs for the elderly to prevent social isolation that may in turn lead to depression and education older adults in the prevention of the most prevalent illnesses, injuries and diseases in the elderly.

CONCLUSION
In conclusion, Australia and other countries of the world are experiencing an aging crisis and proactive measures need to be identified to care for older adults in the future. This essay aimed to identify why we are faced with an increase in the aging population by outlining the comorbidities most widespread among the elderly and the fact that the Baby Boomer generation is a significant contributing factor to this steady increase in the aged population. The psychological issues that are related to the aging crisis compromise the majority of the health issues related to the older adult, with depression and dementia being the

most prevalent mental disorders seen in this age group. Social and Cultural issues are also seen to influence the aging population with high costs on the government to care for the elderly and Australia as a largely multicultural country with migrants contributing to a vast majority of the elderly population. It also aimed to outline the roles that the nurse will need to undertake in the future, such as catering for all religious and cultural needs and working on preventative measures in response to these trends.

REFERENCE LIST:

Anderson, G. F., & Hussey, P. S. (2013). Population aging: a comparison among industrialized countries. Health Affairs, 19(3), 191-203. Doi: 10.1377/hlthaff.19.3.191

Australian Bureau of Statistics. (2013). Population Projections, Australia, 2006 to 2101 (3222.0). Retrieved from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/3222.0

Berk, L. E. (2009). Development through the lifespan (4th ed.). Sydney, NSW: Pearson.

Berman, A., Snyder, S., Kozier, B., & Erb, G. (2012). Kozier & Erb’s Fundamentals of Nursing (2nd ed.). (vol. 1-3.). Frenchs Forest, NSW: Pearson.

Breyer, F., Costa-Font, J., & Felder, S. (2010). Aging, Health and Health Care. Cambridge Journal of Economics, 26(4), 674-690. Doi: 10.1093/oxrep/grq032

Harris, P., Nagy, S., & Vardaxis, N. (2011). Mosby’s dictionary of medicine, nursing and health professions (2nd Australian & New Zealand ed.). Chatswood, NSW: Elsevier.

Holland, K., & Hogg, C. (2010). Cultural Awareness in Nursing and Health Care. Retrieved from http://books.google.com.au/books?id=Sp1nKIn3onsC&pg=PA1&lpg=PA1&ots=PmXmJvu9q-&dq=different+cultures+in+healthcare&lr=

Müller-Spahn, F. & Hock, C. (2009). Clinical Presentation of Depression in the Elderly. Karger Medical and Scientific Publishers, 20(1), 10-14. Doi: 10.1159/000213615

Stein-Parbury, J. (2011). Person-Centered Care in Residential Dementia Care: Evidence into Practice. Retrieved from: https://stti.confex.com/stti/congrs11/webprogram/Paper46995.html

The World Health Organisation, (2013). Health Topics: Mental Health. Retrieved from http://www.who.int/topics/mental_health/en/

Zanni, G. R., & Wick, J. Y. (2010). Understanding Suicide in the Elderly. The Consultant Pharmacist, 25(2), 93-102. Doi: 10.4140/TCP.n.2010.93

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