Will you be there when I'm old?

Karima Velji lectured on "Ethical Considerations Relating to Aging" this afternoon, for the 4th annual Sue MacRae Lecture presented by the U of T: Joint Centre for Bioethics. With considerable detail she described the statistics around the demographic and economic reality of aging. She covered very concisely the issues in long term care in a short hour, and, among the things she spoke of, I enjoyed this talk and found her mentions of mental health and keeping the aged in the community most note-worthy.

Mental Health Care

She talked about how the majority of residents are placed in long term care facilities as a result of cognitive impairment but that the reality was that few facilities had adequate onsite mental health care.

She mentioned the lack of staff or specifically trained staff that is appalling and would be considered intolerable if the same conditions were seen in paediatrics.

Moreover, she highlighted that 1 in 6 residents were being placed on an antipsychotic drug that they were not taking prior to residency in a long term care facility, with inadequate diagnosis and lack of continued follow-up to treatment. Provincially, 32% were prescribed antipsychotics with no diagnosed conditions, largely for sleeping and behaviour control. Essentially, these were restraining measures.

She put forth the question: Are we “protecting” people from their own autonomy?

She suggests we reframe our socialized beliefs about aging and begin a new system of care that enables and enhances mobility (beyond “fall prevention” that tends to lead to restrictive measures) and also build better delirium management programs.

To clarify, delirium and dementia are NOT the same thing. Delirium is a acute (sudden, abrupt) state of confusion, it can be brought on by a whole gamut of things, such as fever, pain, drug toxicity, to name only a few. It is perfectly reversible in almost all cases and requires a careful assessment of cause and rectifying the cause. While, on the other hand, dementia is a progressive and chronic loss of cognitive ability.

Staying in the Community

Perhaps I should start by saying that I do agree that it is best for the aged to stay in their homes and out in the communities for as long as they can, because institutions are hardly homes and are only meant to be a transient set-up for the final months.

That said, I was thrown off when I felt she highlighted in one slide the caregiver burden that is largely felt by women, but did not address this when talking later about tax incentives for the families of elderly (defined as over 65) who are cared for at home.

The problem is that women are the first to take up where public health care slacks, caring for their parents, their spouse’s parents, and so on. And, to add to that, there continue to be significant wage gaps between men and women, and a larger number of women living in poverty. I fear that unless gender inequities and home care incentives are considered interrelated in policy-making, the latter will only further the former. I thought I’d show you some statistics I uncovered in a project for a class in Women’s Health.

It is not unusual for women to take time away from paid work, either to care for their children or their older relatives (Hunter et al., 2002, Sugar, 2007). In a study using the 2002 General Social Survey, Williams (2004) examined the “sandwich” generation, aged 45 to 64, caring for elderly while they still have children at home. It was noted that 3 in 10 Canadians are “sandwiched,” that is 712 000 of the Canadian population, of which 83% who were also employed. Not surprisingly, “sandwiched” women spent twice as many hours caring for elderly than men.

“Reentry women” is the term used to describe women, generally between the ages of 25 to 54, who experience interrupted work patterns (Hunter et al., 2002). Caregiving often requires that women cut back on their work hours, giving up important opportunities for promotions and, with extended interruptions, skills may deteriorate, resulting in lost income (Budig & England, 2001; Fast & Pont, 1997; Hunter et al., 2002; Williams, 2004).

It is important to also remember that this is not just about wages, this is also about retirement and the problem really goes full circle.

- Budig, M. J., & England, P. (2001). The wage penalty for motherhood. American Sociological Review , 66(2), 204-225.
- Fast, J., & Pont, M. D. (1997). Changes in women's work continuity. Canadian Social Trends, 46(2), 2-7.
- Hunter, S., Sundel, M., & Sundel, S. S. (2002). Work, personal finances, and income security. Chapter 5 in Women at Midlife: Life Experiences and Implications for the Helping Professions (pp. 107-133). Washington: NASW PRESS.
- Sugar, J. A. (2007). Work and retirement: challenges and opportunities for women over 50.
Chapter 9 in V. Muhlbauer, & J. Chrisler (Eds.), Women over 50: Psychological Perspectives (pp. 164-181). New York: Springer.
- Williams, C. (2004). The sandwich generation. Perspectives on Labour and Income , 5(9), 5-12.