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McMaster University
Health, Aging and Society
Anju Joshi

Lecture 4: Research Methods Feminist Theories • Gender defines Social Interaction and Life Experiences • Feminist Theories have addressed issues such as widowhood, home care, care-giving, Life assault, elder abuse, retirement, poverty, “Feminzation of Aging” Moral Economy Theory  Looks at Shared Moral Assumptions held by members of society  How values like justice and fairness affect social policies  Social Consensus-generational issues, pensions, health care, taxes Research Design Cohorts cohort includes all individuals born within 
 the same period of time (age or birth) or who enter a system at the same time e.g. Baby Boom cohort between 1946 and 1966 Age Differences Results from comparisons of people who are different ages at the same moment in time Age Changes/Effect Occur in the same individual over time Response time is an age change Period Effects Differences resulting from measures having been taken at different time periods – effects on all Historical or Major Events (WW or Dep) Age Effect: The effect of a time period on an individual depends on how old the person is when he or she experiences that period. **Age and Period Effects Interact ! Types of Research Design Cohort experiences differ Computers: Cohort effect – older people did not grow up with computers Period Effect – recession and income Age effect – ability to handle mouse Types of Studies and Methods Qualitative Quantitative Examples: Surveys, Interviews, focus groups, participant observations, analysis of data sets, lab tests/performance tests Cross-Sectional Design (Most Common) *Looks at different groups of individuals at one point in time (data based on observations or responses)
 *Measures age differences but does not provide reason for the differences Pros: Quick to do Relatively low cost Draws attention to 
 patterns of behaviour that vary by age group Cons: Does not tell us anything about changes due to aging Longitudinal Research Design *Looks at a single group of people at two or more points in time ( over time) Pros: A truer picture of change over time Cons: Can take years to compete research Expensive to set p and maintain Problem of loosing members of sample (drop-out, moving away, death) Can lead to a biased sample Affected by environmental/period changes. Time-Lag Study * Examines different groups of people of the same age at different points in time -
 (e.g. 70 year olds in 1960, 1970, 1980, 1990) Pros: Lecture 9: Psychology of Aging changes that may occur in personality, memory, learning, intelligence and creativity It also includes coping strategies and adaptation to change (specifically the changes associated with the aging process) Involves the interaction of individual cognitive and behavioral changes with social and environmental factors that affect our psychological state. Changes in learning ability, memory, and creativity occur across the life course Life Span Development Perspective Sees the individual as continually changing from birth to death – no end point or goal, change is constant A dialectical process – interaction of individual with society Varied patterns of aging Dialectical Process Interpretive Perspective Aging is multi-dimensional (physical, psychological, social and historical) – change in one dimension impacts others 
 Dealing with change (sometimes crisis) leads to growth and development The process of the individual changing in response to societal demands and society changing in response to the individual‟s action and adaptation Three Types of Environmental Effects Non-Normative Events unexpected (if an 80yr old‟s child dies before them) History Graded Events historical
 Normative Age-graded events Socially sanctioned- age related (war etc) 5 Physical Functions Associated With Aging 1. Memory
 2. Learning
 3. Intelligence 4. Personality 5. Creativity Major Psychological Changes A general decline is observed in the speed of psychomotor performance, cognitive functioning, and sensory and perceptual processes. Particularly noticeable when: Rapid decision making is required Abstract reasoning is required
 Task is complex Anything requiring episodic or working memory recall (specific time and place; processing) However, decline in cognitive function is not inevitable for everyone! Normal aging does not significantly alter older people‟s ability to solve problems (experience and knowledge compensate for speed). Range of intellectual abilities Harvard – Bruce Yankner (Prof. of Neurology) 
 showed that between the ages of 40 and 70 the DNA of aging brains differed (a wide range) Memory Episodic memory: acquired at specific time & place, specific knowledge of an experience e.g. recall of words on a list, where you parked your car Non-episodic memory: general knowledge of the world, familiar information, semantic memory (facts and language-based) Latency: the length of time a person takes to respond or react (processing time). Older people need more time to retrieve information from both their long and short-term memory. The Contextual Approach A multi-factorial view of memory Many conditions influence memory: physical, psychological, & social contexts of the event knowledge, abilities, characteristics of the individual situation in which the individual is asked to remember What people BELIEVE and FEEL about their memory may be as important as their actual memory Can improve memory through practice and intervention Learning Learning and memory linked - memory involved in retrieval of information (among other processes). • Older adults can learn new skills, ideas, and concepts if adequate personal and situational conditions are present. • Individual differences between and within cohorts in learning ability • Older adults have the capacity to learn but it often takes them longer to search for information, code, recall and respond. Optimizing learning conditions: -Eliminate distractions
 -Set own pace of learning - Enable the person to learn -Health Intelligence Fluid vs. Crystalized CRYSTALLIZED --> refers to the use of stored information, learning (education & experience). Usually measured by direct & pragmatic questions e.g. why should we pay our taxes? FLUID --> refers to reasoning, abstracting, concept formation, problem solving (synthesizing new material). Tests for fluid intelligence require the student to manipulate unfamiliar material Personality Stability or Change across the life course? Longitudinal studies --> suggest stability is a normal pattern (traditional view). Personal characteristics such as presentation of self, attitudes, values, temperament and traits. Creativity What does it mean to be creative in later life? Making something: production of art, practicing skills, cognitive process underlying creative activity CREATIVITY AS: both a way of thinking and a way of doing Thinking about things in a unique way: use of one’s mind, generating new ideas. Focus on self and not final product. Psychological Aging Does NOT proceed in the same way for all people Is greatly affected by environmental, social and personal determinants such as stressful life events (loss of spouse, 
 divorce, loss of leisure activities) - also social support from 
 community and family. Is influenced by cultural differences and how older people are 
 valued. The psychological make-up of an individual continues to develop and change across their life-span *A Study in the journal Psychology and Aging showed that playing real time video games (such as Rise of Nations) can help older adults maintain and even improve their ability to reason and their short term memory Lecture 10: Movie on Psychology of Aging *aging is all in the brain *older rat experiment: when rats are in their cage there brain was not very intelligent; when they were taken out of their cage and placed in the „rat Disneyland‟, they‟re neurons and dendrites grew (and the number of synapses increased) *some rats exercised they‟re bodies, while other rats exercised they‟re minds, however both cases of rats both improved *dendrites retract a lot more easily than they grow, and as soon as you stop being active those dendrites will immediately start to retract *brains with more synapses give clincical resistance to diseases such as Alzheimer‟s 4 factors to successful aging: *intellectual enrichment is very good for the brain *plenty of exercise increases blood flow to the brain *health *sense of control *the need to continually learn, increase brain synapses *Arabic activity/physical activity increases blood flow to the brain Midterm Which one of the following are not true questions All of the above/ a or b etc. Textbook questions- 1 question may be about 4 diff chapters Questions may incororporate both textbook questions and lecture questions all in one Lecture 11 Models of Health Care 1. MEDICAL MODEL: * Treatment of diseases, illnesses, and injuries *Body as machine-fix *Physicians have a great deal of control-provide treatment & act as gatekeepers to other health care services *Relies heavily on use of hospitals, drugs, surgery & rehab 2. SOCIAL MODEL * In Canada we don‟t pay as much attention to it as sweden *Medical care only one diemension of health care *Physician one memer of a health care team *Focus is on a 3. HEALTH PRMOTION MODEL *Focus on prevention and self care *Lifestyle changes/ environmental improvements *Examples: anti-smoking, physical fitness, work place safety, pollution control, seatbelts, fall prevention 4. POPULATION HEALTH MODEL *Takes broad view of health and illness. Factors which influence health stats include: -Gender -Income inequality/class status -Social integration Factors influencing health care use by older people: *redisposing or Structural Factors- age, gender, beliefs, attitudes, ethinicity *Enabling Factors- presence or absence of a spouse or family, rural or urban place of residence, availability of health care personnel *Need Factors- subjective perception objective diagnosis Current Trends: *Decrease in acute hospital stays among older people in recent years *Greater use of drug and other non-surgical kinds of treatment *More self-care *More day surgery *An increase in the availability of home care or private care during convalescence *“bed blockers”- take up bed in hospitals due to the fact that not a lot of long term care facilities are available to them Health care Utilization *Health care utilization and costs rise with age *Older people have more hospital days * A small majority of older persons account for a large majority of older persons account Manitoba Longitudinal Study on Aging *Showed that rural seniors had higher hospitalization Health Reform Lecture 12 Diversity in the Structure of Canadian Families  SOCIAL and DEMOGRAPHIC changes since 1950‟s have shaped „family‟  Increased longetvity, decreased fertility ”beanpole family”  Diversity in family forms, norms  Continuity & change in family roles and relationships  Definitions and structures are fluid (these structures can change) Diversity in Canadian Families Across the Life course  Families without children (Childless vs. Child-free Reasons?)  Blended families (Only half of children born today will live in a household with their original parents)  Single parent families „Family Decline‟ Hypothesis  Argument: there has been a decline in family structure and function since 1960  Break up of nuclear family Evidence: Limitations: does not recognize 1. diversity in families; 2. support function of grandparents, other family members; 3. multi-generational bonds becoming more important (longer years of „shared lives‟)  Over past two decades, there has been a decline Marriage in Later Life  Most men and women who have a partner in old age Couples married 50+ yrs tend to:  Share similar values and beliefs  Negotiate changing roles together  View spouse as closest companion Remarriage  Only small % of older people remarry  More men than women  (Men more)Why?- for emotional support that they get from a relationship  (Women less) Why?- women enjoy the freedom; don‟t want to get into another relationship Benefits of Marriage in Later Life  Social Support  Financial resources  Larger social networks  Linked to loner life (*men)  Most report marital satisfaction Widowhood  Difficult transition for both men and women  Loss of most significant companion (*men)  Men-fewer social supports, more likely to remarry Family as a „fluid‟ system  Family o childhood „becomes‟ family of mid-life.. Longer years of shared lives across generations Challenges:  More years of caregiving  More years of conflict in difficult ties  More complex family demands  More complex family relationships The Sandwich Generation  In need of constant care Lecture 13 Examples of Community Services  Information & referral  Outreach programs to identify people at risk  Suport groups  Transportation (DARTS, subsidized Three current trends in Home Care: 1. Medicalization of home care o Low priority to long-term supportive home care to seniors o Priority to acute/sub secute 2. Offloading of public responsibility for care: o Change entitlements to supportive home care o More provided by private market, families and informal supports 3. Human resources crisis in home care workforce: o Poor working conditions o Recruitment and retention issues New Developments  Aging At Home  Behavioural Supports  Intensive geriatric support workers Lecture 15 Institutionalization of retirement *For retirement to become institutionalized. Conditions that must be present: 1. A l
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