Australia’s population, like that of most Western.countries, is ageing as a result of sustained low fertility and increasing life expectancy. Over the next several decades, population ageing is projected to have significant implications for Australia, and particularly for the institution of health care and allied industries. In the 12 months to 30 June 2010, Australia’s population increased by 377,100 people, reaching 22,342,000. The annual growth rate for the year ended 30 June 2010 (1.7%) was lower than that recorded for the year ended 30 June 2009 (2.2%) Australian Bureau of Statistics (2013). Between 2000 and 2050, the proportion of the world’s population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period, World Health Organization (WHO) (2013) Christensen et.al (2009) contend that, if the pace of increase in life expectancy in developed countries over the past two centuries continues through the 21st century, most babies born since 2000 in countries with long life expectancies, like Australia, will celebrate their 100th birthdays.
Although trends differ between countries, populations of nearly all such countries are ageing as a result of low fertility, low immigration, and long lives. A key question is: are increases in life expectancy accompanied by a concurrent postponement of functional limitations and disability? Research suggests that ageing processes are modifiable and that people are living longer without severe disability. This finding, together with technological and medical development and redistribution of work, is important for our chances to meet the challenges of ageing populations. With the evolution of health Psychology in recent decades and particularly the treatment planning and implementation guided by the Bio psychosocial model, populations are entering older age in a state of better preparedness with a potential outlook of an improved quality of life, however it may be argued that not enough emphasis has been placed on transitioning into older age in a relatively fit state.
Butler (1991) defines it in terms of four forms of fitness: physical, intellectual, social, and purpose fitness. Physical fitness refers to bodily strength, resilience, and ability. Intellectual fitness refers to keeping the mind engaged and active. Social fitness involves forming and maintaining significant personal relationships. The functional capacity of an individual’s genetic system reaches its peak in early adulthood and naturally declines thereafter. The rate of degeneration is determined, at least in part, by our behaviours and contact across the whole life course. These include what we eat, how physically active we are and our exposure to health risks.
The Australian Bureau of Statistics (A.B.S.) identifies a range of genetic, social, economic and environmental factors are recognised as increasing the risk of developing a particular health condition. Selected lifestyle and related factors which have been identified as negatively impacting health and which are reported include; being overweight or obese, smoking, poor diet and nutrition, and blood pressure. Information about these selected health risk factors and behaviours can be used along with information about other health and population characteristics to enable a better understanding of Australia’s overall health and how it can be improved. It can also be used to predict future trends in a range of chronic diseases associated with these risk factors which may lead to better health related outcomes and more sustained health over a lifetime.
The leading cause of health related issues and death in the world and in particular Australia is Ischaemic heart disease, which includes angina, blocked arteries of the heart and heart attacks. Ischaemic heart diseases were identified as the underlying cause of 21,513 deaths, 14.6% of all deaths registered in 2011, Australian Bureau of Statistics (2013). Whilst Ischemic heart disease represents the number one category for death in world wide ageing populations, diseases which manifest as chronic and particularly debilitating are the health conditions which are encompassed by Dementia. Access Economics was commissioned by Alzheimer’s Australia to develop estimates and projections of dementia incidence and prevalence for the year 2000 up to 2050). In 2009 and then later in 2010, Access Economics updated age-gender dementia prevalence projections for the year up to 2050. Due to the lack of epidemiological data, a number of studies have explicitly estimated dementia prevalence in Australia. In addition, implicitly estimated the incidence and prevalence of Alzheimer’s disease and Vascular dementia in their burden of disease and injury report for Australia. Economics, D. A. (2011).
These studies have used meta-analyses performed on a set of epidemiological studies undertaken in Europe to estimate prevalence rates by age and gender in Australia. However, this is not ideal as the data used in these studies are relatively old (from the mid-1980s to the mid-1990s) and imply that Australia has the same dementia incidence and prevalence rates as Europe. To date, there has been no national study of dementia prevalence in Australia using clinical diagnoses. Although the Disability, Ageing and Carers Surveys undertaken in Australia by the Australian Bureau of Statistics provide an estimate of dementia prevalence within Australia, it relies on self-reported identification, leading to severe under reporting due to an individual’s limited capacity to recognise mild and moderate dementia if not formally diagnosed. Worldwide, there will be a dramatic increase in the number of people with dementias such as Alzheimer’s disease, as people live longer. According to the WHO (2013) the risk of dementia rises sharply with age with an estimated 25-30% of people aged 85 or older having some degree of cognitive decline.
Older people with dementia in low- and middle-income countries generally do not have access to the affordable long-term care their condition may warrant. Often their families do not have publicly funded support to help with care at home. One consideration not highlighted by either the WHO or the ABS is the integral role played by the interactions with social networks which are intertwined in ageing populations referred to as the process of Productive ageing i.e., those aged 70-89 years have the highest overall life satisfaction of those surveyed, as well as comfort with their standard of living and feelings of freedom about decisions regarding how they live their lives. This is despite having poorer self-reported health than younger counterparts. Furthermore, the quality of their social interactions is important in explaining this cohort’s higher wellbeing. Data from the 1997 National Survey of Mental Health and Wellbeing of Adults (McLennan, 1998) suggest that mental health problems decrease with age, with a prevalence of 6.1% in those aged 65 years and over.
Mental health disorders included in the survey were anxiety, depression, and substance use disorders. Conversely, depression in older persons may increase the risk for incident disability. This excess risk is partly explained by depressed persons’ decreased physical activity and social interaction. Penninx et al (1999). The role of other potential stressors such as lack of companionship was also more commonly cited by this age group than amongst people aged above 70-89 years. Both emphasize engagement by older adults in the economic, social, and physical environment as well as the importance of elders having direction, structure, purpose in life, engaged in activity, and accomplishing tasks. Assets, resources, capacities, and skills of older adults are underscored rather than problems, deficiencies, and needs, Productive Ageing Centre (2013). A productive ageing paradigm is seen to transcend the physical or functional status of the older person and have direct implications for health and human service personnel assuming an expanded set of professional functions in both traditional and non-traditional community service settings such as the emerging necessitation of Health Psychology and the Bio psychosocial model.
Psychologists in Australia currently have a very limited to non-existent role in aged care (Snowdon, Ames, Chiu & Wattis, 1995; Snowdon, Vaughan, & Miller, 1995) or with older people in general, while their presence in other areas of aged care is limited. This is frequently attributed to the lack of proper training for psychological work with older people (Helmes & Gee, (2003). Two programs have been started specifically to train psychologists for work with older people, the first at Edith Cowan University, which is no longer active, and the second at James Cook University. Health Psychology and the Bio Psychosocial model of treatment engages strategies such as Promotion of; Maintaining a positive attitude- If you can make choices and have control over important aspects of your life, and take part in and enjoy activities, you are more likely to feel good about yourself and get more out of life, Staying connected, Keeping the brain active, Managing stress, Volunteering or seeking part-time employment, Engaging in physical activity, Having regular medical check-ups, Eating a healthy diet, cessation of unhealthy habits.
The role of Health Psychology is to adopt a holistic perspective in the treatment of individuals and is widely considered to be the most effective treatment for identifying and advocating the necessity to view a person’s mind body and environment as inextricably interdependent. Each area has the ability to impact upon another and so should be treated as components of a whole system. Health Psychology advocates for pro-active, dynamic, and responsible behaviours in individuals which promotes self- management of one’s own health. This is referred to as an Internal locus of control and promotes the individual’s ability to make decisions and be involved in their own health outcomes by placing these health related decisions in the hands of both practitioner and service user alike. This definition represents a paradigm shift for service providers, to encompass empowerment as a process involving self-awareness, self-determination, and resource.
Gibson (1991) notes that it is easier to consider factors which hinder its attainment and features of behaviour which demonstrate its absence; powerlessness, helplessness, hopelessness, paternalism, dependency, and an external locus of control. Gibson views empowerment as a process of recognising, promoting, and enhancing people’s ability to meet their own needs, solve their own problems, and mobilise necessary resources in order to feel in control of their own lives. Psychologists in specialist areas such as Health Psychology and GeroPsychologists alike may need to develop greater flexibility in their assumptions about optimal service delivery modes.
Many health professionals have a narrow view of what psychologists can do, and often conceptualise psychological services as pertaining to mental health assessment and interventions. And an over-emphasis on assessment can sometimes hinder access to assistance and services. The failure to listen to consumers has been shown to negatively impact on their wellbeing. For example, research conducted by Gething, Fethney, and Blazely (1998) at a major Sydney rehabilitation hospital for older people revealed that older people and health professionals often stated different desired outcomes for treatment, and that professionals were unaware of the client’s goals. Older people reported that they felt unconsulted about their needs and that the treatment they received did not meet these needs or prepare them for a successful return to community life.
However psychologists also have a role to play in addressing behavioural risk factors for physical illnesses, in designing health promotion programs for older people, and in developing and evaluating local Health And Community Centres services by considering quay criteria including; Do emotional supports play a similar role in the personal relationships of both men and women and those representing different ethnicities and nationalities? Is what counts as effective, sensitive, emotional support the same for everyone? And when seeking to provide emotional support, do members of distinct social groups pursue similar or different goals? Burleson, (2003). Whichever way societies describe the process of ageing well, principles which promote healthy, successful, positive ageing in a culturally diverse society must stay in the foreground of community consciousness.
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