The view on aging and the challenges received globally

Ageism can be use as general statements about a group, which may or may not be based on fact, or generalizing from the group to the individual. Ageism also functions as older persons’ invisibility, disregarding, and social rejection. Meaning that older people do not fit the supposed social norm, and they are treated as less valued and less visible.

Consequently, their needs and their lives are treated as if they do not matter as much compared to the individuals who are not old and are treated as the norm and the more valued group.⁶⁵ In spite of variances in the countries approach when caring for elderly, there is great similarity in the way health care affects the attitude for elderly care in each country. That social care and institutional actions for care of the elderly are extremely insufficient and also not unexpected, in part from negative and poor perceptions of elderly people’s needs. Apparently, one could appeal to further clarifications for the poor attention to the elderly, and add that because overall humankind’s are not ready to face a hint or an image of destinies that elderly are expecting. In the face of this negative insight of the elderly, some expressions of the social manners reveal a mixed view, and these differ with location.⁶⁶

At the end of 1980s to 1990s, Great Britain for example, suggests a perceptions modification when the media described the elderly as negative stereotype, then later on it shifts the perception to more genuine and positive one. Likewise, in the Netherlands, a caring attitude toward the elderly is notable.⁶⁷ In fact, the elderly in many countries are experiencing special privileges, such as the protection of laws prohibiting discrimination based on age, as well as discounts on transportation, utilities, and housing. But these reports also imply an underlying ageism that is not readily agreeable to broad policy

solutions. For example, in spite of a positive view of the elderly the Netherlands reports pressures to “give new generations a chance”; having an elderly person as the head of a business makes one look conservative or lacking in initiative. In sum, the elderly’s social status in the Western countries would seem to be as the United States report describes,

“ambiguous and full of contradictions.” Yet, strict approaches can endorse more positive treatment and care of the elderly by younger generations.⁶⁸

In the past, life expectancy for the 40 years old people was 50, but now the

average life expectancy has almost doubled, and 50 years old appear somewhat young. In fact, old age has no date; some people choose to be old at there 65, some others possibly at 80. Although, it is essential to keep in mind that older people are not an identical group, ⁶⁹ they are more likely to be living with disability, unhappy life and many health problems. They often feel isolated, poor social networks, neediness and discrimination due to their age. The origins of many of their problems are social; and most of the time social isolation goes unaddressed. Health and mobility problems increase older people’s feeling of social segregation and the loss of independence; still there are clear relations between increasing age and the need for support, the experience of vulnerability rather than age alone are what defines the older person.⁷⁰ Evidently, every patient has the right to be respected and treated as an individual, but older patients are more likely to be categorized rather than treated as individuals, which can lead to discrimination.

Being old creates a different profile as compared with the young and middle-aged.

This profile includes the potential for an increase in physical, mental, relational, and professional losses. The study of ethical issues in aging is complicated by the fact that there are individual differences among older adults that come from a number of sources,

from peculiarities in personality to culturally rooted behaviors. Some older adults are strong willed and have managed to be in control all their lives. Others may be willingly submissive because they feel overwhelmed by making decisions. Having recognized that the needs of older adults are like those of others in many ways and different in other ways, we assume that their participation in the community such as their rights and obligations is not any different from that of other members. We would expect them to be much invested in their destiny, to avoid dependence when they can, and to be their own advocates through the life course. At the same time, we would expect them to reciprocate and honor the same circumstances for others.⁷¹ Therefore, when we examine ethical issues in aging, we must view the older adult as a part of a constellation of

intergenerational and community relationship bottom up and top down. The older adult’s well-being cannot be assessed apart from the community, nor can those in the community detach themselves from the older adult. Therefore, each and every individual in this setting, i.e. the older adult, family, friends, neighbors, and professionals is expected to pursue ethical rights as well as duties in a network of reciprocal encounters. Despite differences in labeling ethical phenomena, we shall begin by framing ethics per se and providing a method for mapping meaning.⁷²

In light of demographic projections and epidemiological developments, the demand for care is determined not solely by demographic process but by other social processes as well. The most important of these processes are the values and norms attached to old age,⁷³ and medicalization, which can be defined as the process by which human existence is increasingly understood in terms of health and disease, and it is characterized by an increasing utilization of medical services decreasing availability of

informal care. This will very likely continue to increase in the coming decades because of the continuous growth of medical knowledge on the one hand and the increasing public awareness of the possibilities of this technology on the other hand.⁷⁴ The demographic moves and social developments in Islamic countries have generated new realities in an unexpected growing of the elderly population, such as prompt urbanization, a decline of extended families and scientific innovations make ageing in the Middle East a critical ethical dilemma. A lot of successful measures that promote independence, respect for autonomy and preserving dignity are settled from the medical technology revolutions and community organization, e.g., transportation and physical rehabilitations, assistive

hearing and visual technology.⁷⁵ At this end, it is necessary to guarantee the best achievable quality of life for the utmost number of elderly.

One of the most important aspects for the well-being of elderly is family ties. The lack of love and caring forces many old people to turn to self-destruction. The availability of informal care given by family members or neighbors also affects the level of demand for medical care.⁷⁶ As a result of the ongoing individualization of society and the

breakdown of traditional forms of solidarity, the willingness to provide informal care has reduced. Children are moving away from their parents to other cities, having their own families or living alone. They have a more individualistic lifestyle with norms and values that are different from those of their elder parents. Moreover, population living

arrangements have shifted from the traditional family to living in institutions. ⁷⁷ The values and norms attached to old age are also playing an important role in the demand for care. Though the elderly are very often willing to work longer and to make themselves useful for society, they are forced to leave the workforce at the age of 65 or

earlier. In general, the elderly are expected to disengage from society, making room for younger generations. It can be expected that the difference between the aspirations of the elderly, on the one hand, and the unwillingness of society to respond to these aspirations on the other, will result in lower responsibility for health and a decline in subjective health status.⁷⁸

It is undeniable that a society can be judged based on how it manages to take care of its elderly, whether by delivering health care directly in institutions or by supporting home caregivers, eventually, society could show its appreciation to the entire generation.

Delivering good care for the elderly is an ethical obligation and it should be provided in an ethical way. Assuring a good care for the elderly is in the interest of both the elderly and the younger generations.⁷⁹ A well and comfortable old age, either at home or in an organization would display to the all generations their human potentials, and that they have plenty of time left in life to attain their desires, as well as teaching them the meaning of life and respect. A good old age can present real meaning to the remarkable extension of the life span that medicine now makes possible. Furthermore, a good old age can help on building other balanced model for younger generations. Giving the marvelous

technical development with which a 10 years old is more familiar than a 70 years old, it might be true today that the old cannot claim much special knowledge that the younger ones would seek to learn from them.⁸⁰

Some existentialist philosopher used to say “separate me from my body and I am divorced from my community.”⁸¹ In other words, our body helps us to maintain our identity and control of our world, thus we use our feet to walk and our hands to work, etc.

and with a move into an institution, the control we have is greatly diminished and the use

of the body is different, because now it is someone else’s orbit. The textured world of home becomes a weak world of an institution and a sense of identity is lost. Furthermore, a 93 years old German philosopher name Hans-Georg Gadamer, said, “I am a living anachronism, because I don’t belong to this world any more, but I am still here.”⁸² He indicates that social homes for the aged are perfect sets for rapid aging. Also, surveys were informed by elderly show a similar view. Some Hungarian health providers call them “the places for collective dying”; some others signify them as “houses for the poor or forgotten people.” ⁸³ It is well known that a sense of self-govern is connected with several positive outcomes, including a better health status. Therefore, even with the difficulties in delivering care for the elderly, we have to keep in mind that we might all get old and should be guaranteed better situations, thus, it is our integral obligation to be the voice of our community. Therefore, only a good old age can help on restoring respect for the wisdom that can be passed on from generation to generation.⁸⁴ A culture of caring for old age is needed in order to have self-esteem, upholding dignity and meaningful human relationships.⁸⁵

Gerontologists and liberal ethicists have claimed that every age has its own aims and no one can decide for another whether his life is accomplished or his natural lifetime has been reached. According to Moody, there are serious fears that an age paradigm will ever be acknowledged in modern society.⁸⁶ Truthful information on the conditions and needs of older people is decisive for planning health service development and training of personnel. Given the growth of the ageing population, the need for continuous care will certainly breed, including nursing services and home care.⁸⁷ Most Islamic countries have increased emphasis on the importance of improving healthcare. However healthcare

systems in the area have ignored the elderly care needs. The frail and dependent old person will need a variety of professional care, as will their families. The delivery of best care for the ageing population is subject to the understanding of their views and values on end of life subjects. Therefore, it is important to understand that home care and

institutional services are complementary. Caring for elderly patients need to be dignified and respectful to their autonomy, also it is a shared responsibility of both families and health care providers. Geriatric knowledge should be part of the education of all health professionals. Also, institutions and living sites should keep in mind the physical needs for elderly people.⁸⁸ The final part in this chapter elaborates the duties of health care professionals and their relationship with elderly patients and how these relations changed today.