Geriatric Social Work

Module II- Problems of Ageing

• Socio-Economic Problems: Family Living, Retirement and Dependency
• Psychological Problems : Isolation, Alienation, Depression, Social Insecurity, Maladjustment, fear of death,
lack of love and affection
• Cultural Problems : Changing Cultural Practices, Values and Morals

• Health Problems: Physical Impairment, age related morbidity patterns

• Elderly Abuse : Exploitation, Inequality

Old age is viewed as an unavoidable, undesirable and problem ridden phase of life. Problems of aging usually
appear after the age of 65 years.
Socio-Economic Problems
The elderly population suffers high rates of morbidity and mortality due to infectious diseases. The
demographic transition in India shows unevenness and complexities within different states. This has been
attributed to the different levels of socio-economic development, cultural norms, and political contexts.

Seal :( 1979) has divided the problems of the aged into national, special (community and family) and personal
(physical, psychological and socioeconomic). The problems of the aged not only differ between younger-old
and old-old but also from country to country on the sociocultural background.

VenkobaRao: (1979) has indicated that as to how the prevalent cultural conditions are affecting or
contributing to the problems of the aged.

Socio Economic Problems referred to the problems that elderly faced from the society and also the financial
issues faced by the elderly. As the productive ages seizes they are viewed as unproductive and helpless by
the society and also the income source of the elderly decrease which make them fall to debt and dependency.
Their social life is narrowed down by loss of work associated, death of relatives, friends and spouse and weak
health which restricts their participation in social activities. The home becomes the centre of their social life
which gets confined to the interpersonal relationship with the family members. Due to loss of most of the
social roles they once performed, they are likely to be lonely and isolated severe chromic health problem
enable them to become socially isolated which results in loneliness and depression. The Major problems
include

a) Family Living
Geriatric Social Work

The immediate family circle of the aged is becoming more and more restricted. Your attention may be drawn
to two such important problems. First, the interpersonal family ties in relation to the aged are becoming
increasingly difficult even when the aged are living with their married sons, especially in the urban areas. In
the past, when the family’s resources were controlled by the aged, the sons were dependent upon their parents.
The situation is being reversed nowadays, and more and more parents are becoming economically dependent
on their sons, which is damaging to the self-respect of the aged. Second, the number of caregivers available
in the family is diminishing. In their sons households the aged can no longer take for granted the services of
their daughters-in-law who were their traditional caregivers. In the developed societies the care-giving ability
of the families for the aged has become much weaker and the place of the family is taken up to some extent
by larger institutions such as the homes for the aged and day-care centres.

FAMILY LIVING

Family living, also known as Life sharing, supports individuals with intellectual disabilities to live with
qualified unrelated adults who provide support in their home. Family need to provide care to elderly people.
They assist and help in variety of physical task such as bathing, dressing, giving medication and feeding
them. family support is a key source of assistance, care, and advocacy, resulting in better care for nursing
home residents. Provide support for the elderly so that they may continue living• in their own homes as long
as possible. These supports may include home maintenance, rental assistance etc. Provide barrier free
community integrated accommodation and• public facilities for the elderly in cities, towns, and villages,
national housing policies should pay due respect to the requirements of ageing. Promote community
education on personal security in the• home and community which will address accident prevention and
security against crime and elderly abuse. Promote, enhance and support family care giving, housing and•
rental subsidies for multigenerational families, provision of respite care, remuneration for unpaid long term
care giving. Develop and enhance skills whereby elder men and women may• fulfill their roles as family
leaders, counselors and care givers

b) Retirement- most retirees have a difficult time adjusting to what they may perceive as a life without
purpose. While you may have been waiting for this moment, the actual change can affect both your
physical and mental health. No longer feeling productive or useful is difficult to come to terms with.
Even with a specific plan, you may experience mild uneasiness that comes with uncertainty. It is
essential to understand that such feelings are normal and think of the best ways to deal with them.
Here are a few common problems that you need to consider:
Geriatric Social Work

- Loss of Identity-It is important not to associate your profession with your identity and consider
defining interests and activities that can become your focus in your senior years, even if you
choose to move into a retirement community.
- Boredom- It is one of the common causes of retirement anxiety. Consider creating a bucket list
with short-term and long-term goals based on your interests
- Losing Personal Value- Even after retiring from your professional work, you can hone your skills
and use your talent in a different way that makes you feel good about yourself.
RETIREMENT
Retirement is the withdrawal from one's position or occupation or from one's active working life. 65
is the conventional 3 choice for many people, although some work until much later.. Chronic health
problems such as arthritis, rheumatism, and hypertension increasingly interfere with the quality of
life of most individuals as they age.
* Dealing with loneliness: Retirement coincide with the time children move out and get involved in
their own families. Being alone is difficult to cope with at any age and even more so in our senior
years. While this is the ideal time to spend with family and friends, they may live far away or not
have the time. The resulting social isolation can lead to depression and cause seniors to withdraw
which is detrimental to their physical, mental and emotional well-being.
* Transitioning to retired life: Research shows that most retirees have a difficult time adjusting to
what they perceive as a life without purpose. While most have been waiting for this moment, the
actual change can affect both their physical and mental health. The feeling of no longer being
productive or useful is a difficult one to come to terms with. Whether it is volunteer work or getting
involved in their house of worship, retirees need to find ways to be occupied and feel useful again.
c) Dependency- Elderly in their late years develop dependency. The definition of dependency is broad,
but it could be summarized as dealing with people who need help to carry out their daily lives.
Number of

DEPENDENCY In their old age , they suffer from various psychosocial and environmental problems
including feeling of neglect, loss of importance in the family, loneliness and feeling of unwantedness
in family as well as society, feeling of inadequacy and obsolescence of skills, education. In traditional
joint families there is hierarchy and respect for the elders and their opinions. But in nuclear families,
where the older people are looked upon as simply dependents with no useful role, they may not be
consulted or included in the family discussions or policy decisions. This gives them a feeling that
they are not wanted and are a burden on the children. This leads to depression.dependents will
multiply with the aging of the population, a trend that is unstoppable.
Geriatric Social Work

Psychological Problems : Isolation, Alienation, Depression, Social Insecurity, Maladjustment, fear of death,
lack of love and affection
Mental health problems are common among seniors and may include isolation, affective and anxiety
disorders, dementia, and psychosis, among others. Many seniors also suffer from sleep and behavioral
disorders, cognitive deterioration or confusion states as a result of physical disorders or surgical
interventions.

Isolation:- Isolation is most common among elderly people. The greatest cause of social isolation is the
inevitable death of significant others. Retirement comes with reduced social prestige and loss of purpose. It
is now being challenged as being against the charter of Rights and Freedoms. Older adults are at increased
risk for loneliness and social isolation because they are more likely to face factors such as living alone, the
loss of family or friends, chronic illness, and hearing loss. Loneliness is the feeling of being alone, regardless
of the amount of social contact.

Alienation:- A growing distance between older people and the rest of society, and older people’s
disintegrating identity in society. A withdrawing or separation of a person's or a person's affections frim an
object or position of former attachment. The term alienation means 'separation from." Marx has conceived
of alienation as a phenomenon related to work. The elderly often feel left alone from the family and the
society.

Depression:- Some estimates of major depression in older people living in the community range from less
than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older
hospitalized patients. Untreated late-life depression can lead to decreased quality of life, decrease in ability
to perform self-care activities, less social interactions, and increased health care needs.

Social Insecurity:- Social security is defined by the International Labour Organization (ILO) as ‘the
protection which society provides for its members, through a series of public measures to prevent the social
and economic distress that would otherwise be caused by the stoppage or substantial reduction in earnings
resulting from sickness, maternity, employment injury, unemployment, invalidity, old age and death; the
provision of medical care and the provision of subsidies for families with children. The elderly are often
denied the social security measures, and are prone to an insecure state.
Geriatric Social Work

Maladjustment:-Changes of living, faulty diet, malnutrition, infectious, intoxications, gluttony, inadequate

rest, emotional stress, overwork, endocrine disorders and environmental conditions like heat and cold are
some of the common causes of maladjustment. Symptoms of maladjustment include: Extreme restlessness,
constant day-dreaming, absent-mindedness, abnormal fears, destructive tendencies, tendency to bully others,
feelings of inferiority, etc

Fear of death:- Fear of death, or death anxiety, is a common phenomenon in all societies and is often regarded
as the prime motivation for human behaviour. Additionally, fear of death is now generally regarded as a
multidimensional concept. The best interpretation of existing findings is that fear of death declines over the
years of middle adulthood but does not continue declining in old age. This seems paradoxical in that one
might expect elders to have a greater fear of death than younger people in view of the fact that increasing age
and frailty render them ever more vulnerable to death.

Lack of love and affection:- Intimacy refers to a close feeling shared between 2 people, based on knowledge
of and familiarity with the other person. It includes emotional, social (based on shared experiences), and
physical intimacy (eg, touching, cuddling, sexual intercourse).

Reasons includes

- Loss of a partner: Loss or absence of a partner is probably the most common age-related barrier
to intimacy.

- Disorders: Various disorders that become more common with aging can interfere with physical
intimacy. Vascular disorders and diabetes can cause erectile dysfunction; arthritis can limit
movements and make them painful.
- Use of drugs: Older adults are more likely to take drugs (eg, antihypertensives, psychoactive
drugs) that can cause problems affecting intimacy (eg, erectile dysfunction, reduced libido).
- Age-related changes: Levels of sex hormones decrease, causing changes (eg, vaginal atrophy,
reduced vaginal lubrication) that make sexual intercourse uncomfortable or difficult. Libido may
decrease.
- Reluctance to discuss effects of aging: If older people develop problems that interfere with
physical intimacy or if they feel embarrassed about changes in their body (eg, wrinkles, sagging
flesh), they may not want to discuss these changes with their partner or with a health care
practitioner, who may be able to suggest solutions.
- Discrepancy in expectations of partners: One partner may want certain physical expressions of
intimacy, but the other does not.
Geriatric Social Work

- Lack of privacy: Older people who live with family members or in a long-term care facility have
fewer opportunities for privacy, which are necessary for physical intimacy.
- Shift to other forms of intimacy: Some couples grow to prefer other forms of intimacy (eg,
touching, massaging, kissing, verbal expressions of affection) that express familiarity, caring, or
engagement with their partner.

• Cultural Problems
Culture involves sharing values, traditions and lifestyles within a group or community. Our customs are the
ways in which we do things in our everyday life. Often these are determined by tradition, or the historical
ways we have developed of doing things. People who share a culture tend to associate with each other. The
degree of commitment to cultural values varies from person to person and is particularly influenced
by age, gender, social layer and peer group influences
Changing Cultural Practices:- the elderly face it difficult to adjust to the changes in cultural practices. The
elderly faced it difficult to adjust to the food patterns and technological upgradations.
Values and Morals:- Moral understanding is not the only thing that changes as people mature. People's
values tend to change over time as well. Values that suited you as a child change as you become a young
adult, form relationships and make your way in the world. What makes sense to you as a single person no
longer makes sense when you are married, or have children. What makes sense to you as a parent no longer
makes sense to you when you retire. Many themes remain the same across the years, to be sure, but not all
of them do.

• Health Problems
Physical Impairment- Common conditions in older age include hearing loss, cataracts and refractive errors,
back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and
dementia.
Age related morbidity patterns - The aged population has specific health problems that are basically different
from those of adults or young persons. Most diseases in the aged are chronic in naturecardiovascular, arthritis,
stroke, cataract, deafness, chronic infections, cancer. Disease process is usually multiple.

• Elderly Abuse
The 7 most common types of elderly abuse include physical abuse, neglect, emotional abuse, financial
abuse, sexual abuse, self-neglect, and abandonment. Any of these elder abuse types can be devastating to
older people and their families.
Exploitation is the misuse, mismanagement, or exploitation of property, belongings, or assets. This includes
using an older adult’s assets without consent, under false pretense, or through intimidation and/or
manipulation. The term “exploitation” refers to the act or process of taking advantage of an elderly person
by another person or caregiver whether for monetary, personal or other benefit, gain or profit.