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In few places in American society are adults so dependent on others as in nursing homes. Minimizing this dependency and promoting autonomy has become a major focus of policy and ethics in gerontology. Yet most of these discussions are divorced from the day-to-day reality of long-term care and are implicitly based on concepts of autonomy derived from acute medical care settings. Promoting autonomy in long-term care, however, is a complex task which requires close attention to everyday routines and a fundamental rethinking of the meaning of autonomy. This timely work is based on an observational study of two different types of settings which provide long-term care for the elderly. The authors offer detailed descriptions of the organizational patterns and routine practices that erode autonomy of the elderly. Their observations lead to a substantial rethinking of what the concept of autonomy means in long-term care. The book concludes with suggestions on how the autonomy of elderly individuals in long-term care institutions might be promoted.
This book pioneers evidence-based research on healthy aging through the application of self determination theory (SDT). Its uniqueness is located in the fact that to date, no other work has applied SDT to the empirical study of aging populations. The authors focus on how SDT drives healthy, successful and active aging, and note that the motivation factors underpinning healthy aging are often neglected, or altogether absent, in the existing literature. This edited volume is particularly timely given the expanding aging crisis in many North American, European and Asian contexts. The collection of chapters meets this challenge head-on in comparing these contexts vis-a-vis a broad international scope, and subsequent discussions on important specialty issues in aging, such as hearing and memory loss. The work offers global perspectives on aging, autonomy and associated life challenges, as well as factors relating to the sustainability of healthy aging in terms of physical and mental well-being. This book will be highly relevant to researchers in the SDT community, as well as specialists in aging and gerontology. It will also be of interest to lifespan psychologists and developmental psychologists.
This volume assesses the importance of autonomy to quality of life in long-term care facilities. First addressing conceptual issues, the editors then pose such questions as: What is autonomy and what does it mean in the context of physically and/or cognitively impaired elders? What is the effect of nursing home financing and federal regulations? How does the traditional medical model, which casts residents as "patients", affect autonomy? How does the physical environment make a difference? The contributors then go on to describe six successful models of care that provide a more meaningful quality of life through promoting autonomy. Contributors include Robert and Rosalie Kane, Keren Brown Wilson, and Bart Collopy.
Johnson addresses ethical issues in aging in a variety of contexts—the social cultural environment, physical health care, mental health care, social health care, legal care, and spiritual care. Because long-term aging has created a new generation of older adults, some new issues are emerging which need to be addressed from an ethical perspective—elder abuse, physician assisted suicide, dementia, intergenerational equity, guardianship, and living wills. A wide range of experts including physicians, philosophers, lawyers, social workers, nurses, sociologists, public health persons, theologians, historians, and ethicists share their insights on the ethical issues and dilemmas older adults in American society are facing or are likely to face over the life course. Of interest to undergraduate and graduate faculty and students in sociology, social work and social services practitioners, policymakers, and academic and professional libraries.
To meet the needs of the rapidly changing world of health care, future physicans and health care providers will need to be trained to become wiser scientists and humanists in order to understand the social and moral as well as technological aspects of health and illness. The Social Medicine Reader is designed to meet this need. Based on more than a decade of teaching social medicine to first-year medical students at the pioneering Department of Social Medicine at the University of North Carolina, The Social Medicine Reader defines the meaning of the social medicine perspective and offers an approach for teaching it. Looking at medicine from a variety of perspectives, this anthology features fiction, medical reports, scholarly essays, poetry, case studies, and personal narratives by patients and doctors--all of which contribute to an understanding of how medicine and medical practice is profoundly influenced by social, cultural, political, and economic forces. What happens when a person becomes a patient? How are illness and disability experienced? What causes disease? What can medicine do? What constitutes a doctor/patient relationship? What are the ethical obligations of a health care provider? These questions and many others are raised by The Social Medicine Reader, which is organized into sections that address how patients experience illness, cultural attitudes toward disease, social factors related to health problems, the socialization of physicians, the doctor/patient relationship, health care ethics and the provider's role, medical care financing, rationing, and managed care.
Improvements in health care in the 21st century mean people are living longer, but with the paradox that chronic illness is increasingly prevalent. Dementia, a term used to describe various different brain disorders that involve a loss of brain function that is usually progressive and eventually severe, is a condition associated with an ageing population and is becoming increasingly common. Worldwide there are approximately 25 million people with dementia, expected to rise to 63 million by 2030, and 114 million by 2050. Inevitably, people living with dementia will die, but their needs at the end of life are not well known. This book describes what might be achieved if the values and best practice of both dementia care and palliative care are brought together, to achieve quality end of life care for this specific group of patients. It explores what is known about the experience of dying with dementia, using a narrative approach, and develops a model that draws together a 'person-centered' approach to care. The book examines the possibiities and the challenges faced when trying to improve quality of life for people with dementia, and presents examples of good practice from across the world.
Professor Dickson provides students with examples of a legal way of thinking about significant issues in social policy. This book can be used in policy and practice courses in the fields of mental health, child welfare, the family, developmental and physical disabilities, and professional ethics. Provides excellent selection of relevant court decisions along with clearly articulated questions and issues for discussion.
As the global population ages, disability demographics are shifting. Societal transformation and global health inequities have changed who is likely to reach old age, who is likely to live with disability, and the relationship between aging and disability in various socio-cultural and geopolitical contexts. The Aging–Disability Nexus breaks new ground by bringing gerontology and disability studies into dialogue with each other through a variety of empirical, conceptual, and pedagogical approaches. Contributors explore the tensions that shape the way disability and aging are understood, experienced, and responded to at both individual and systemic levels, while avoiding the common tendency to conflate these overlapping elements and map them onto a normative, faulty notion of the human life trajectory. This perceptive work analyzes the distinction between aging with a disability and aging into disability, and reveals how multiple identities, socio-economic forces, culture, and community give form to our experiences.
Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.