Joint Disorders Study in Elderly Population Essay

Joint Disorders Study in Elderly Population Essay

The population of the world is getting older. In 2010, worldwide, there were about 524 million
people over the age of 65; by 2050, over 1.5 billion people will be in this age group. This shift in
population will not affect only developed countries, however—much of this increase in the elderly
population will occur in low- and middle-income countries. As populations age, low-income
countries will need to invest in health care for older adults and in disease prevention programs to
prevent or delay the onset of non-communicable diseases (such as heart disease, stroke, and
cancer). Past research on population-level health in the developing world has been widely Joint Disorders Study in Elderly Population Essay


hindered by a lack of high-quality longitudinal data. My dissertation uses recently-collected
longitudinal data to gain insight into overall trends in health in low- and middle-income contexts.
My first chapter uses a multi-state life table approach to investigate the overall level of health and
functional ability (the ability to carry out tasks of daily life) among the rural population in Malawi. I
find that this population experiences a substantial burden of disability in later life, and that these
high levels of disability greatly limit work efforts among older individuals. In my second chapter, I
conduct a cross-national comparison of health and disability-free life expectancy using data from
recent longitudinal surveys in Costa Rica, Mexico, Puerto Rico, and the US. I find that current
disability-free life expectancy at age 65 is comparable across these populations, though future
trends are uncertain. My third chapter investigates how Malawi’s 2008 rollout of Anti-Retroviral
Therapy (ART) to rural clinics affected overall population health and mortality. I find that the
introduction of ART led to substantial declines in mortality and an increase in adult life
expectancy, and that population morbidity also decreased after the introduction of ART.

In recent years, Brazil and the world are undergoing changes in the population pyramid with the increasing number of elderly people and consequent prevalence of chronic degenerative diseases, including rheumatoid arthritis.1-3 Joint Disorders Study in Elderly Population Essay

Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune, systemic, progressive disease with unknown aetiology that causes progressive damage to the musculoskeletal system, involving small and large joints and leading to pain, deformity and even an irreversible bone and cartilage destruction.4-6

RA attacks approximately 0.5% to 1% of the world population, with predominance of 2-3 times more in females. It affects all age groups, but is more prevalent among 40-60-year people.4,5 In Brazil, a prevalence of up to 1% was found in the adult population; it is estimated that 1.3 million of people are affected.4

In addition to problems related to pain and inflammation that arise from the disease, patients with RA are also affected by psychological problems such as anxiety and depression. Studies show that the development of RA is closely related to increases in anxiety and depression, with prevalence of 13%-47%, and these disorders are 3 times more prevalent in patients with RA.7,8

Patients with RA exhibit significant functional impairment, with a consequent reduction in quality of life (QoL).3-5 Studies show that patients with RA have a lower QoL, when compared to those without the disease. Apparently, QoL is affected in the physical and mental components, as well as in the functional capacity. These studies also relate worse QoL with those patients with very active disease, a more intense pain and functional disability.9-16 Joint Disorders Study in Elderly Population Essay

Quality of life is a multidimensional concept that incorporates all aspects of human life, including physical, functional, emotional, social and spiritual dimensions.17 It relates the self-perception of the individual expectations, standards and concerns within the context of the culture and value systems in which these people live.18

Knowing that RA can lead to profound changes in people’s health and autonomy, especially in a growing and vulnerable group as the elderly, the assessment of QoL in this population deserves to be considered. Thus, this study aims to analyze and compare the QoL of adults and elderly patients with RA followed-up at an outpatient rheumatology service in a teaching hospital, in order to identify the influence of age on the QoL of patients with RA.


A cross-sectional quantitative study on a sample of patients with RA at an outpatient specialized service of a university hospital in Marília, São Paulo, was performed.

In the study, we included only patients of both genders, users of Brazilian Unified Health System [Sistema Único de Saúde (SUS)], and with enough health condition to take part in the study, including cognitive and physical abilities. Patients with some type of comprehension deficit that would limit the interview – for instance, those with hearing or visual disabilities and limited mobility (i.e., wheelchairs users) – were excluded.Joint Disorders Study in Elderly Population Essay

The study was approved by the Ethics Committee in Research of the Faculty of Medicine of Marília (Protocol number 477/12).

After the informed consent, a questionnaire concerning sociodemographic aspects of patients and clinical aspects of the disease. Next, the questionnaires of QoL evaluation, functional capacity, disease activity and depression were applied.

To assess QoL, the generic instrument SF-36 was used. To assess functional capacity the HAQ, a specific questionnaire for patients with rheumatoid arthritis, was applied. The 6MWT was used to assess the physical fitness of the patients. Other instruments used were: the DAS-28, which assesses disease activity, and the BDI, which shows the presence of depressive symptoms.

As to the analysis of data, to detect differences between the means of the two study groups (adults and elderly), we used the Student’s t test. The scores with p-value <0.05 were tested to assess whether there is a linear relationship with increasing age, through linear regression. The analyses were performed with the software SPSS v20. A significance level of p <0.05 was considered.Joint Disorders Study in Elderly Population Essay


In this study, 99 (61 adults and 38 elderly) patients with a diagnosis of RA according to the American College of Rheumatology (ACR) criteria were studied.4 We considered as elderly subjects aged 60 years or more, according to the WHO classification of elderly people for developing countries, and as adults those between 18 and 59 years.

In the description of the sociodemographic characteristics listed in Table 1, it appears that in both groups there is a predominance of white race, female and married individuals. As for the level of education, most adults completed elementary school, and many elderly people have never studied.

The physiological benefits of exercise are well documented and include reduced risks of: (ref 1)

coronary artery disease
serum lipid abnormalities
colon cancer
Physical activity is essential to optimizing both physical and mental health and can play a vital role in the management of arthritis. Regular physical activity can keep the muscles around affected joints strong, decrease bone loss and may help control joint swelling and pain. Regular activity replenishes lubrication to the cartilage of the joint and reduces stiffness and pain. Exercise also helps to enhance energy and stamina by decreasing fatigue and improving sleep.(ref 2) Exercise can enhance weight loss and promote long-term weight management in those with arthritis who are overweight.Joint Disorders Study in Elderly Population Essay

Exercise may offer additional benefits to improving or modifying arthritis. As Dr. Steven Blair, Exercise Epidemiologist and Director of Epidemiology at the Cooper Institute for Aerobics Research in Dallas TX notes “Skeletal muscle is the largest organ in the body and is intricately tied with protein turnover and synthesis and many other metabolic and biochemical functions. Activating skeletal muscle has many important health benefits we are only beginning to understand.”

Psychological Benefits
The psychological benefits of exercise are equally compelling.(ref 1)

In the short-term (i.e., immediately after exercising) exercise:

decreases anxiety
improves mood and well being romotes a state of relaxation
A growing body of empirical research also suggests that exercise has long-term effects on well being as well. Improvements in mood and well being have been reported by regular exercisers in both clinical and non-clinical populations and with most types of exercise. Baseline levels of anxiety are lower in individuals who exercise regularly as compared with sedentary adults. Thus, exercise appears to be a potent stress reducer as well. In at least one major clinical trial sponsored by the National Institutes of Health, exercise and group counseling is being tested by clinicians (who are qualified to assess and monitor the disorder) as a primary treatment for mild depression. Because depression is a concern for individuals with arthritis, physical activity is an important psychological adjunct to treatment. Though more research is warranted to confirm these findings, preliminary studies suggest that moderate-intensity lifestyle exercise, such as walking, is as effective as traditional vigorous aerobic exercise in improving mood.Joint Disorders Study in Elderly Population Essay

This paper is prepared for Anatomy and Physiology 2530
Taught by Professor Susan Saullo

Osteoporosis is a prevalent chronic disease in the United States and worldwide (Curtis & Monicka, 2012; Curtis & Monicka, 2012) the biggest problem with osteoporosis are fractures. Fractures occur because of bone reabsorption versus bone build up. Remodeling involves the osteoblasts that create new bone and osteoclasts that destroy bone; the process of remodeling to make room for new and stronger bone.
First problem Miss Mary’s case she has osteoporosis at her age 84 years old it is crippling what independence she has left. Miss Mary is managing her degenerative diseases by trying to plan ahead until she can hopefully get some assistance.
Second problem for Miss Mary is osteoarthritis. Osteoarthritis is an inflammation of the cartilages around the joints. The joints mostly affected are the wrist, vertebrae, phalanges, knees and neck. In addition, from the pain and stiffness Miss Mary moves her joint as little as possible which result in some muscle atrophy. Miss Mary suffers throughout the day when she does activities like: shopping, bathing, meal preparation dressing she manages her day with great difficulty.Elderly or seniority comprises of ages nearing or surpassing the normal life range of individuals. The limit of seniority can’t be characterized precisely on the grounds that it doesn’t have the same significance in all social orders. Individuals can be viewed as old in light of specific changes in their exercises or social parts. Additionally old individuals have restricted regenerative capacities and are more inclined to malady, disorders, and ailment as contrasted with different grown-ups. Joint Disorders Study in Elderly Population Essay
In 1950, the world populace aged 60 years or more was 205 million (8.2 for every penny of the populace which expanded to 606 million (10 for every penny of the populace) in 2000. By 2050, the extent of older people of 60 years or more is anticipated to ascend to 21.1 percent, which will be two billion in number. Asia has the biggest number of world’s elderly (53 percent), trailed by Europe (25 percent). This weight of expanding quantities of elderly will increase in the following 50 years.
In spite of the fact that the logical investigation of maturing issues in India was endeavored as ahead of schedule as the 1960s, the World Assembly on Aging held in 1982 gave noteworthy force to gerontological examination; this has as of late picked up significance. Further, declarations of approaches like National Health Policy, National Population Policy what’s more, National Policy on Older Persons have additionally made significantly more mindfulness and awareness among scientists, arrangement producers and others, bringing about an expanded spotlight on age-related issues.
Problems of the Aged:
‘ Economic issues, incorporate such issues as loss of work, salary insufficiency and financial shakiness.Joint Disorders Study in Elderly Population Essay
‘ Physical and physiological issues, incorporate wellbeing and medicinal issues, dietary insufficiency, and the issue of sufficient lodging and so on.
‘ Psycho-social issue which cover issues related with their mental and social maladjustment and in addition the issue of senior misuse and so on.
International Provisions:
The subject of maturing was initially bantered at the United Nations in 1948 at the activity of Argentina. The issue was again brought by Malta up in 1969. In 1971 the General Assembly requested that the Secretary-General set up an exhaustive report on the elderly and to recommend rule for the national and global activity. In 1978, Assembly chose to hold a World Conference on the Aging. As needs be, the World Assembly on Aging was held in Vienna from July 26 to August 6, 1982 wherein an International Plan of Action on Aging was received. The general objective of the Plan was to fortify the capacity of individual nations to bargain successfully with the maturing in their populace, remembering the extraordinary concerns and needs of the elderly. The Plan endeavoured to advance comprehension of the social, financial and social ramifications of maturing and of related compassionate and created issues. The International Plan of Action on Aging was embraced by the General Assembly in 1982 and the Assembly in ensuing years approached governments to keep on implementing its standards and suggestions. The Assembly asked the Secretary-General to proceed with his endeavors to guarantee that catch up activity to the Plan is completed viably. In 1992, the U.N.General Assembly received the announcement to watch the year 1999 as the International Year of the Older Persons. The U.N.General Assembly has proclaimed “Ist October” as the International Day for the Elderly, later rechristened as the International Day of the Older Persons. It later on December 16, 1991 received 18 standards which are composed into 5 bunches, to be specific autonomy, cooperation, care, self-satisfaction, and respect of the more established persons. These standards give an expansive structure to activity on maturing. A percentage of the Principles are as per the following:Joint Disorders Study in Elderly Population Essay
(i) Older Persons ought to have the chance to work and decide when to leave the work power.
(ii) Older Persons ought to stay incorporated in the public arena and take part effectively in the definition of approaches which impact their prosperity.
(iii) Older Persons ought to have admittance to social insurance to help them keep up the ideal level of physical, mental and passionate prosperity.
(iv)Older Persons ought to have the capacity to seek after open doors for the full advancement of their potential and have entry to instructive, social, otherworldly and recreational assets of society.
(v) Older Persons ought to have the capacity to live in pride and security and ought to be free from misuse and mental and physical misuse.
National Provisions:
Constitutional Protection:Joint Disorders Study in Elderly Population Essay
Art 41: Right to work, to instruction and to open help with specific cases: The State might, inside of the cutoff points of financial limit and improvement, make viable procurement for securing the privilege to work, to training and to open help with instances of unemployment, seniority, infection and disablement, and in different instances of undeserved need.
Art. 46: Promotion of educational and economic interests of and other weaker sections : The State should advance with exceptional consideration the instructive and monetary hobbies of the weaker segments of the general population and might shield them from social shamefulness and all types of misuse.
Be that as it may, these procurement are incorporated into the Chapter IV i.e., Directive Principles of the Indian Constitution. The Directive Principles, as expressed in Article 37, are not enforceable by any court of law. Be that as it may, Directive Principles force positive commitments on the state, i.e., what it ought to do. The Directive Principles have been announced to be essential in the administration of the nation and the state has been set under a commitment to apply them in making laws. The courts however can’t implement a Directive Principle as it doesn’t make any justifiable right for any person. It is most tragic that state has not made even a solitary Act which is specifically identified with the elderly persons.
Under The Code of Criminal Procedure:
Before 1973, there was no procurement for maintenance of parents under the code. The Law Commission, in any case, was not for making such procurement. As indicated by its report:
The Cr.P.C is not the correct spot for such a provison. There will be significantly trouble in the measure of upkeep honored to parents distributing amongst the youngsters in a synopsis continuing of this write. It is attractive to leave this matter for mediation by common courts.Joint Disorders Study in Elderly Population Essay
The procurement, be that as it may, was presented without precedent for Sec.125 of the Code of Criminal Procedure in 1973. It is additionally crucial that the guardian builds up that the other party has adequate means and has dismissed or declined to look after his, i.e., the guardian, who can’t look after himself. It is essential to note that Cr.P.C 1973, is a common law and administers persons having a place with all religions and groups. Girls, including wedded dughters, likewise have an obligation to keep up their guardians
Parents and Senior Citizens Bill, 2007
India’s accomplishment in expanding future has prompted a bigger number of the elderly in the nation. The Registrar General of India estimates the offer of more aged persons (age 60 years or more) in the aggregate population to ascend from 6.9% in 2001 to 12.4% in 2026. Issues identified with the money related and government managed savings of more old individuals will turn out to be progressively vital. Without a doubt, the National Policy on Older Persons expresses, “Some areas of concern in the situations of older persons will also emerge, signs of which are already evident, resulting in pressures and fissures in living arrangements for older persons.”
The Maintenance and Welfare of Parents and Senior Citizens Bill, 2007 looks to make it a lawful commitment for children and beneficiaries to give adequate upkeep to senior residents, and proposes to make procurements for state governments to build up maturity homes in each locale.
Under Clause 5(1) of the Bill, a senior citizen or a guardian may apply for maintenance under Clause 4 of the bill. (A senior citizen is an Indian citizen who is at least 60 years old. A parent could be father or mother, whether biological, adoptive or step father or step mother, whether or not the father or the mother is a senior citizen).On the off chance that the senior national or guardian is unable, some other individual or an intentional association approved by the senior resident or guardian can apply for upkeep for their benefit. The Tribunal may take perception suo motu (that is, it can follow up on its own discernment). These two procurements are welcome subsequent to most senior citizens or parents don’t have the vitality (they don’t have the cash in any case) to apply for maintenance.Joint Disorders Study in Elderly Population Essay
The said Tribunal may, when a procedure in regards to month to month remittance for the support under this area is pending, request such youngsters or in respect to pay a month to month stipend for the break upkeep of the senior subject including guardian. The State government is required to constitute inside of a time of 6 months from the date of beginning of the law (Act), Tribunals with the end goal of settling and choosing the request for upkeep under Clause 5.
As indicated by Clause 4(1), the senior resident including guardian is qualified for apply for According to Clause 4(1), the senior citizen including parent is entitled to apply for maintenance under Clause 5 if he is unable to maintain himself from his own earnings or out of the property owned by him. A parent or grand-parent can make an application for maintenance against one or more of his children who are majors (‘children’ includes son, daughter, grandson and grand-daughter). The obligation of the children to maintain his or her parent extends to the needs of such parent either father or mother or both, as the case may be, so that such parent may lead a normal life. A childless senior citizen, on the other hand, can make an application against his relative (“relative” means any legal heir of the childless senior citizen who is a major and is in possession of or would inherit the property after the childless senior citizen’s death; property means property of any kind, whether movable or immovable, ancestral or self-acquired, tangible or intangible and includes rights or interests in such property).Joint Disorders Study in Elderly Population Essay
Thus Clause 4 makes a reference to grand-parent while Clause 5 does not. In other words, Clause 5 is silent about how the application for maintenance should be made by a grand-parent (who is not yet 60) under Clause 4. I wish the learned law-makers took notice of this inconsistency lest vested interests should exploit this well-intended provision.
If the senior citizen has transferred by way of gift or otherwise, his property, subject to the condition that the relative shall provide the basic amenities and basic physical needs to the senior citizen and such relative refuses or fails to provide such amenities and physical needs, Clause 23 (1) says the said transfer of property shall be declared void by the Tribunal, if the senior citizen so desires. This is a welcome provision since it protects na”ve senior citizens from exploitation by relatives who intend to renege on their promise subsequently.
The State government is also required to prescribe a comprehensive action plan for protecting the life and property of senior citizens. This is also a welcome provision since the vulnerable senior citizen can be easily harmed or hurt. In fact the senior citizen may be even carted away somewhere to ensure that none else including the voluntary organization and the Tribunal come to know of their whereabouts. Fortunately Clause 24 of the Bill takes care of this aspect. According to this Clause, ‘Whoever, having the care or protection of senior citizen leaves, such senior citizen in any place with the intention of wholly abandoning such senior citizen, shall be punishable with imprisonment of either description for a term which may extend to three months or fine which may extend to five thousands rupees or with both’. The Bill does not cover maturity annuity maybe on the grounds that State governments are actualizing the Old Age Pension Scheme. Be that as it may, the measure of benefits and the qualification criteria are not uniform over the States, under the said Scheme. The Bill ought to have commanded the State governments to pay maturity annuity to the senior natives satisfactorily and consistently the nation over.. It needs to deny wage charge sops to the individuals who don’t keep up parents /grandparents/relatives; it needs to deny seniority benefits to those folks/fantastic folks/relatives who are being kept up by their children’s/relatives.Joint Disorders Study in Elderly Population Essay
Ultimately, the legislature, while drafting Bills, utilizes “may” (rather than the word ‘shall’) even where provisions of a compulsory nature are included. What prompts this howler? Is it obliviousness or absence of conviction with respect to the administration?
Union Social Justice and Empowerment Minister Meira Kumar tabled the Maintenance and Welfare of Parents and Senior Citizens Bill, 2007 in the Lok Sabha. The Bill proposes to make it obligatory on the persons who inherit the property of their aged relatives to maintain them. It also aims to make provisions for setting up old age homes to take care of indigent older persons. It aims to set up an appropriate mechanism for need-based maintenance to parents and senior citizens, better medical facilities and old age homes in every district. It seeks for institutionalisation of a suitable mechanism for the protection of the life and property of older persons. Describing ageing as a major challenge and the need to give more attention to the care and protection of the older person, the statement of objects and reasons said many older persons, particularly widowed women, are now forced to spend their twilight years all alone and face emotional neglect and lack physical and financial support. Though the parents can claim maintenance under the Code of Criminal Procedure, 1973, the procedure is both time-consuming as well as expensive. Hence, there is need to have simple, inexpensive and speedy provisions to claim maintenance, the statement said.
The Himachal Pradesh Maintenance of Parents and Dependents Act, 2001
The state of Himachal Pradesh enacted a similar law in 2001. That law, the Himachal Pradesh Maintenance of Parents and Dependents Act, 2001, requires adequate maintenance for parents and dependents that are unable to take care of themselves.
Application for Maintenance
The Bill places an obligation on children and relatives to maintain a senior citizen (anyone above the age of 60 years) or a parent to the extent that they can live a ‘normal life.’ This obligation applies to all Indian citizens, including those residing abroad.Joint Disorders Study in Elderly Population Essay
A senior citizen who is unable to maintain himself based on his own earnings or property shall have the right to apply to a maintenance tribunal for a monthly allowance from their child or relative. If he is incapable of filing the application on his own, he may authorise any other person or registered voluntary association to apply on his behalf. The maintenance tribunal may also, on its own, initiate the process for maintenance.
The Bill defines ‘children’ as sons, daughters, grandsons and granddaughters and ‘relative’ as any legal heir of a childless senior citizen who is in possession of or would inherit his property upon death. Minors are excluded from both definitions. ‘Parents’ include biological, adoptive or step parents.
In cases in which more than one relative will inherit the property of a senior citizen, each relative will be responsible to pay the maintenance fee in proportion to the property they will inherit.
Maintenance tribunals
The state government may establish one or more maintenance tribunals per sub-division to decide upon the order for maintenance. The tribunal will be presided over by an officer not below the rank of sub-divisional officer. The tribunal shall have all the powers of a civil court. No civil court shall have jurisdiction in respect of any matter dealing with any provisions of this Bill.
If the tribunal is satisfied that the senior citizen is unable to take care of himself and that there is neglect or refusal of maintenance on the part of the children or relative, it may order children or relatives to give a monthly maintenance allowance to the senior citizen. The maximum maintenance allowance shall be prescribed by the state government, and shall not exceed Rs 10,000 per month.
Before hearing an application, the tribunal may refer the case to a conciliation officer to reach amicable settlement within one month. If such agreement is reached, the tribunal may pass that order.
The tribunal may order children or relative to make a monthly allowance as interim maintenance while the application is pending. The application shall, as far as possible, be disposed of within 90 days.Joint Disorders Study in Elderly Population Essay
The maintenance allowance shall be payable from either the date of the order or the application, to be deposited within 30 days of the order. A simple interest payment between 5% and 18% on the monthly allowance from the date of the application may also be required.
The tribunal may alter the allowance for maintenance on proof of misrepresentation or mistake of fact or a change in the circumstance of the senior citizen or parent receiving the monthly payment.
Any maintenance order made by the tribunal shall have the same force as an order passed under Chapter IX of the Code of Criminal Procedure, 1973 (CrPC), which also provides for maintenance of senior citizens. If a senior citizen is entitled for maintenance under both Acts, he can claim maintenance under only one Act.Joint Disorders Study in Elderly Population Essay
Appellate tribunals
The State Government may establish one appellate tribunal per district to be presided over by an officer not below the rank of District Magistrate. The appellate tribunal shall try to pronounce its order in writing within one month of the appeal.
Offences and penalties
On failure to comply with the maintenance fee, the tribunal may issue a warrant for collection within three months of the due date. Should the fee remain unpaid, the accused may be imprisoned for up to one month or until payment, whichever is earlier.
Punishment for abandoning a senior citizen shall include an imprisonment of up to three months or fine of up to Rs 5,000, or both.
The tribunal can declare a transfer of property (as gift or otherwise) from a senior citizen to a transferee as void if the transfer was made under the condition of maintenance, and the transferee neglects the agreement. A registered voluntary organization may take action on behalf of the senior citizen if he or she is unable to enforce these rights.
Representation in tribunals
A party before a maintenance or appellate tribunal shall not be represented by a legal practitioner. A senior citizen may choose to be represented by the maintenance officer (a district social welfare officer).Joint Disorders Study in Elderly Population Essay
Other provisions for grey population
The state government may establish and maintain at least one old age home per district with a minimum capacity of 150 senior citizens per home. The state government may also prescribe a scheme for the management of such homes. The scheme shall specify standards and services to be provided including those required for medical care and entertainment of residents of these old age homes.
The state government shall ensure that government hospitals and those funded by the government provide beds for all senior citizens as far as possible. It shall ensure separate queues for senior citizens, expand facilities for treatment of diseases and expand research for chronic elderly diseases and aging. Every district hospital shall also earmark facilities for geriatric patients.
The state government is responsible for publicising the provisions, as well as ensuring that government officers undergo periodic sensitisations and awareness training on issues relating to the Bill. The district magistrate shall be responsible for implementing the provisions of the Bill.
Some New Schemes for Old Age Income Security
Reverse Mortgages: The 2007 Budget speech announced the introduction of reverse mortgage for senior citizens by The National Housing Bank (NHB). The NHB Draft Guidelines state: The scheme involves the senior citizen borrower(s) mortgaging the house property to a lender, who then makes periodic payments to the borrower(s) during the latter’s lifetime.
New Pension Scheme: The New Pension Scheme (NPS) seeks to provide old age security for all individuals, including the unorganised sector by creating a mechanism to enable them to save through their working lives. Under NPS every subscriber is to have an individual pension account, portable across job changes. The amount (including income on the investments) will be available at the age of 60 years, with at least 40% to be converted into monthly payments for the rest of their lives.Joint Disorders Study in Elderly Population Essay
Financial independence: The goal of old age security programmes is to ensure the financial independence and dignity of senior citizens. In addition to this Bill, there are some financial schemes that also attempt to achieve old age security. Two such schemes are the recently announced reverse mortgage concept and the New Pension Scheme.
The Bill sets the maximum cap for monthly maintenance allowance for senior citizens at Rs 10,000 per month, which is significantly higher than what is given by both the central and state governments under the National Old Age Pension Scheme (NOAPS). Under NOAPS, central assistance amounts to Rs 200 per month and state government pensions range from Rs 75 per month in Andhra Pradesh to Rs 400 per month in West Bengal.Joint Disorders Study in Elderly Population Essay
The research concentrates on the regulations and conditions in seniority homes and day care and the path in which they advance or break down the privileges of elderly. Besides, an endeavour will likewise be made to understand the status of elderly in joint and nuclear families and the treatment they get in their family members. This undertaking will comprehend the degree of acknowledgment of the human rights the matured and the glaring infringement of their rights, if any. The study tosses light upon the quality and responsibility of the laws, arrangements and programmes provided to this specific age gathering of persons.
It may be conclude by saying that the problem of the elderly must be addressed to urgently and with utmost care. There is urgent need to amend the Constitution for the special provision to protection of aged person and bring it in the periphery of fundamental right. With the degeneration of joint family system, dislocation of familiar bonds and loss of respect for the aged person, the family in modern times should not be thought to be a secure place for them. Thus, it should be the Constitutional duty of the State to make an Act for the welfare and extra protection of the senior citizen including palliative care. The government has tried its best to provide for the upliftment and protection of older persons (that could make their everyday living better) by drafting various governmental concessions, schemes and policies specifically for them. However the implementation of this well-intended instrument is very poor.Joint Disorders Study in Elderly Population Essay
The other concern that has not been adequately addressed by legal instruments is the increased crime rate against the elderly populace on the streets and within the confines of their homes, robbery and dacoit being the primary reasons for their attack. Proper police patrolling, SOS facilities seem to be the urgent needs of this hour along with the implementation of the instruments that are already in place.Joint Disorders Study in Elderly Population Essay

Role of the orthopedist
Orthopedists use medical, physical and rehabilitative methods as well as surgery and are involved in all aspects of heath care pertaining to the musculoskeletal system. It is a specialty of incredible breadth and variety. Orthopedists treat a immense variety of diseases and conditions, including fractures and dislocations, torn ligaments, sprains and strains tendon injuries, pulled muscles and bursitis ruptured disks, sciatica, low back pain, and scoliosis knock knees, bow legs, bunions and hammer toes, arthritis and osteoporosis, bone tumors, muscular dystrophy and cerebral palsy, club foot and unequal leg length abnormalities of the fingers and toes, and growth abnormalities.Joint Disorders Study in Elderly Population Essay

In general, orthopedists are skilled in the:

Diagnosis of your injury or disorder
Treatment with medication, exercise, surgery or other treatment plans
Rehabilitation by recommending exercises or physical therapy to restore movement, strength and function
Prevention with information and treatment plans to prevent injury or slow the progression of diseases
Typically, as much as 50 percent of the orthopedist’s practice is devoted to non-surgical or medical management of injuries or disease and 50 percent to surgical management. Surgery may be needed to restore function lost as a result of injury or disease of bones, joint, muscles, tendons, ligaments, nerves or skin.

The orthopedist also works closely with other health care professionals and often serves as a consultant to other physicians. Orthopedists are members of the teams that manage complex, multi-system trauma, and often play an important role in the organization and delivery of emergency care.

A field known for innovation
Like other branches of medicine, remarkable technological advances have significantly shaped the field of orthopedics in recent years.

Arthroscopy – the application of visualizing instruments to assist in the diagnosis and surgical treatment of internal joint diseases – has opened new horizons of therapy
Exciting cellular research may enable orthopedic surgeons to stimulate the growth of ligaments and bone in patients someday in the future
Great advances have occurred in the surgical management of degenerative joint disease. For example, orthopedic surgeons can replace a diseased joint with a prosthetic device (total joint replacement)Joint Disorders Study in Elderly Population Essay
Research is progressing on “growing” articular cartilage in joints, which may one day reduce the need for some people to get joint replacements
While most orthopedists practice general orthopedics, some may specialize in treating the foot, hand, shoulder, spine, hip, knee, and others in pediatrics, trauma or sports medicine. Some orthopedists may specialize in several areas.


Orthopedic patients have benefited from technological advances such as joint replacement, and the arthroscope that allows the orthopedist to look inside a joint. But your visit will start with a personal interview and physical examination. This may be followed by diagnostic tests such as blood tests, X-rays, or other tests.

Your treatment may involve medical counseling, medications, casts, splints, and therapies such as exercise, or surgery. For most orthopedic diseases and injuries, there is more than one form of treatment. Your orthopedist will discuss the treatment options with you and help you select the best treatment plan to enable you to live an active and functional life.Joint Disorders Study in Elderly Population Essay

The 2002 Census in Ireland showed 136,000 people with disabilities over the age of 65. This represents 42% of the disabled population and more than one-third of people over 65. The population aged 65 and over in Ireland could increase from its present level of 436,000 to about 1 million in the next thirty years. The population aged eighty years and over is projected to increase three-fold in the same period, to over 300,000 (Punch 2005).

These simple facts give rise to questions about a possible ‘common agenda’ between people with disabilities and older people. Do people with disabilities and older people have similar health, housing, social, and transport service needs? Do they want similarly structured services? Do they prefer separate or integrated services? Do they experience similar types of social exclusion? Do they have similar concerns when seeking to claim their social, cultural and economic rights? A number of current trends make these questions relevant: projections of population ageing and a growing number of late-onset disabled people, the ageing of the disabled population, the higher proportion of women in paid work and concerns over the capacity of current support systems to cope with increased demand.Joint Disorders Study in Elderly Population Essay  Within the Irish health and social services people with disabilities and older people are constructed as two distinct client groups. Services are managed under two different National Care Group Managers within the Health Service Executive, and each group has a distinct budget. Similarly, differences in the social welfare entitlements of the two groups create anomalies in welfare provision. Given the boundaries set up by such administrative structures, questions arise as to how best to address the needs of people whose issues relate to both ageing and disability.

The National Disability Authority (NDA) is the statutory body charged with advising the Minister for Justice, Equality and Law Reform on disability policy. The NDA recognises that older people with disabilities form a significant proportion of the people on whose behalf the NDA works. The National Council on Ageing and Older People is an advisory agency to the Minister for Health and Children and others on all aspects of ageing and the welfare of older people. The NCAOP recognises that an age friendly society will also be a disability friendly society, given the numbers of older people who have a disability and the numbers of people with a disability who are old.Joint Disorders Study in Elderly Population Essay

In 2004 the NCAOP and the NDA came together to begin to address these questions. Through the following discussion paper our two organisations hope to initiate constructive dialogue about the ageing population with disabilities in order to develop, with Government and stakeholders, a positive national strategy for full participation and support of older people with disabilities, and to promote the implementation of such a strategy.Joint Disorders Study in Elderly Population Essay

The following discussion provides an overview of developments on ageing and disability. Chapter One defines the key terms of ‘disability’, ‘ageing’ and ‘dependency’ within the context of current social policy debates. Chapter Two describes the key policy themes arising in current international policy and practice literature. Chapter Three considers disability data collection practice in Europe, Australia and Ireland and ageing data collection in Ireland. Chapter Four provides an overview of the situation in the Republic of Ireland for older people with disabilities. Chapter Five discusses ways that positive social policy for older people with disabilities can be implemented in Ireland.Joint Disorders Study in Elderly Population Essay

Ultimately, two questions should guide our thinking: How can we create a society that enables the full participation of older people with disabilities, and how do we ensure that older people with disabilities receive the support they need in the manner they prefer.

Chapter One: Defining Disability, Ageing and Dependency
The National Disability Authority Act, 1999 defines “disability” to mean “a substantial restriction in the capacity of a person to participate in economic, social or cultural life on account of an enduring physical, sensory, learning, mental health or emotional impairment.” Disability has traditionally been equated with physical, sensory and/or intellectual impairment. The classic ‘medical model’ locates disability as an individual problem, directly caused by disease, trauma or other health condition. Treatment is conceived of in terms of medical care (WHO 2002a, p.8). The ‘social model’ of disability originated in the disability movement in the U.K. and the U.S.A. The Union of Physically Impaired Against Segregation defined disability as

The disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities.Joint Disorders Study in Elderly Population Essay

(Union of Physically Impaired Against Segregation (UPIAS) 1976).

This social model distinguishes impairment, which is a condition of the body, from disability, which is a situation of social exclusion caused by the organisation of society. The model thus places the focus of change on social institutions and the environment, rather than on the individual. It also stresses the role of empowerment, participation and leadership of disabled people in effecting change. Though differences in interpretation of the social model exist, the influence of social factors on the experience of disablement has now been widely accepted, as evidenced in the WHO’s International Classification of Functioning, Disability and Health (WHO 2002a). A ‘post-social’ model of disability that incorporates aspects of both the social model and the medical model will form the basis for the upcoming post-censal National Disability Survey.

Ageing and the Life Course
Ageing is often equated with chronological age. Concern about population ageing, in chronological terms, has resulted in widespread debate on an impending ‘demographic timebomb’ and increased ‘dependency ratios’. Connell and Pringle (2004) define ‘dependency ratio’ as “the ratio of those in the population considered to be dependent (below 15 years and above 65 years), to those considered to be of working age (15-64 years)” (p.82). Leeson (2004) identifies 5,500 economic evaluations of the costs of an ageing population, but argues that mortality and health care expenditure is increasingly linked not to chronological age, but to life style, behaviour and diet. The limitations of chronological age as a basis for social planning have been identified in international policy, where chronological age has been described as a “crude tool” for identifying needs of particular population groups (United Nations Population Fund 1998). Characterisations of the ageing population in terms of “dependency ratios” project negative images of ageing as dependency and do little to define the diverse needs of older people (See NCAOP 2005a, pp.31-32). In addition, such characterisations serve to hide the valuable contribution older people make to society.Joint Disorders Study in Elderly Population Essay For example, grandparents provide a substantial amount of unpaid care to the 54,000 families in Ireland whose parents both work, while in 2002 over 16,000 people aged over 65 identified themselves as primary carers (Good & Fitzgerald 2005, p.25). Though statistics about demographic change have value in highlighting the changing formation of our population, it is important to distinguish chronological age as a statistical fact from the process of ageing as a complex phenomenon with physical, psychological, cultural and social aspects.

Ageing has traditionally been associated with physical and mental decline. It is conceptualised in terms of loss of faculties. Kennedy & Minkler (1998) discuss the origins of this linkage in relation to industrialisation. In the late 1800’s, political, economic and other social forces resulted in a gradual devaluation and medicalisation of old age (p. 769). Critical gerontology theorists argue that old age is increasingly being conceptualised as a medical problem (Robertson 1997, p. 427). Hannah McGee claims, however, that we need to distinguish the medical conditions of older people from the prejudice and discrimination which operates through our economy and society (McGee 2005, p.30).Joint Disorders Study in Elderly Population Essay

More recently, ageing has been conceptualised in terms of a life cycle, or life course. As Bigby states, “ageing is a process, not an event” (2004, p.19). According to a life course approach, generational categories of ageing shift over time, are embedded within culture and are shaped by structural processes of social change (Priestley 2003, p.21). The life course approach focuses on how the organisation of society creates generational categories. For example, Priestley and others have argued that both disability and ageing are produced in society through labour market exclusion (Ibid., pp. 143, 146). Both people with disabilities and older people are often excluded from work. For older people, their identity as a distinct category has been underscored by the development of pension policies that require retirement at a fixed age. Similarly, disability theorists have argued that the category of ‘disabled people’ has arisen out of the exclusion of people with disabilities from the adult labour market as a result of industrialisation (Oliver 1993, p.253).Joint Disorders Study in Elderly Population Essay

It is suggested that life course categories are more useful in analysing ageing and disability than chronological categories. Bigby points out that the definition of “older person” differs between disabled and older people’s services; services for people with disabilities may define persons aged 50 and over as old, whereas services for older people are often designed for people over the age of 75 (Bigby 2004, p.245). A life course approach enables analysis of the diversity of ageing experiences by examining the different trajectories of transition from adulthood to old age for different social groups.

Recent social policy statements have sought to re-define ageing in a positive way. The World Health Organisation (WHO) defines ‘active ageing’ as “the process of optimising opportunities for health, participation and security in order to embrace quality of life as people age” (WHO 2005). The term ‘active ageing’ emphasises the continuing participation of older people in the social, economic, cultural, spiritual and civic affairs of society (WHO 2002b, p.12). The WHO’s policy document Active Ageing: A Policy Framework (2002) supports a life course approach to ageing, and sets out the key determinants of active ageing which are social, environmental, behavioural, economic, personal and health/social service related.Joint Disorders Study in Elderly Population Essay

‘Successful ageing’ is a concept developed in part through the MacArthur Foundation study on ageing. It is also sometimes referred to as ‘positive’ ageing, or ‘productive ageing’. The Successful Agingreport defines successful ageing in terms of the ability to maintain three key behaviours or characteristics: low risk of disease and disability, high mental and physical function and active engagement with life (Rowe & Kahn 1998, p. 53). While social participation is connected with one of these factors, it can be seen that this definition is heavily reliant on physical and mental health. Kennedy & Minkler have criticised the association of successful ageing with physical health, arguing that such a linkage “not only reinforces the valuing of people primarily in economic terms, but further marginalizes groups such as caregivers and the elderly, who are already excluded from the labor force” (Kennedy & Minkler 1998, p. 772). By seeking to affirm the value of older people through a commitment to healthy ageing, policymakers may undermine the value of people with disabilities. In so doing, some ageing activists may have “traded earlier, limited views of ageing for an even more limited view of what it means to be old and disabled” (Ibid., p.769). The NCAOP has argued that older people should not be constrained by a single version of ageing, either the ‘deficit’ model, which sees old age as an illness without cure, or the ‘heroic’ model, which suggests that to age successfully you must maintain the appearance, capacities and perspectives of youth and middle age (NCAOP 2005a, p.31). When considering ageing policy it is important to ensure that frameworks promote the inclusion of all older people, whether or not they have impairments.Joint Disorders Study in Elderly Population Essay

The Australian Institute of Health and Welfare (2000) defined dependency as “a state in which an individual is reliant on others for assistance in meeting recognised needs”. Such a definition of dependency presupposes that disablement is located in the individual and that disablement necessarily leads to dependency. Morris (1999) describes how dependency, like disability, has been associated with being helpless, powerless and vulnerable. This view of dependency focuses on loss of control and leads to a biologically-based association between dependency and impairment. From this perspective, dependency is often viewed as a necessary consequence of chronological age. The focus on dependency ratios within international debates concerning the ageing population presumes that people of a certain chronological age will require substantial support. Discussion then focuses on how to increase the numbers of younger people in work to provide enough funding for long-term care (see for example, the European Commission’s Green Paper “Confronting demographic change: a new solidarity between the generations”, 2005). Robertson (1997) uses the phrase “apocalyptic demography” to describe “the prevailing belief … that an increasing ageing population inevitably means increasing demands on the resources of society, including health care resources, in the face of competing interests and diminishing, or at best finite, resources” (p. 426). This view has been challenged by recent evidence which shows a decline in the proportion of older adults who report certain activity limitations (Singer & Manton 1998). So too, Manton, et al. 1997 reported statistically significant declines in chronic disability prevalence rates in the elderly United States population between 1982 and 1989. This new evidence has led to suggestions that there may be a compression of morbidity, rather than a lengthened duration of disability amongst the older population. It highlights the diversity in the dependent population and the need for more complex analyses of dependency.Joint Disorders Study in Elderly Population Essay

Rather than dependency being equated with the need for assistance, it should be understood as the consequence of a failure to provide the means for effectively negotiating assistance. Bould, et al.’s definition of dependency is helpful in this regard, as it distinguishes dependency from loss of self-determination. Dependency is “a loss of self-determination that results from requiring the help of others but being unable to negotiate the terms of the help received” (Bould, et al. 1989).

Dependence, Independence and Interdependence
The Independent Living Movement has sought to break the association between dependence and being able to do things for oneself. They have challenged the idea that to rely on others for physical help inevitably means a loss of choice and control. Morris (1999) argues that this is due to socially constructed unequal power relationships within care. Giving individual people with disabilities purchasing power over care through direct payment schemes fundamentally changes care relationships from those of dependence to independence (pp. 11-13).Joint Disorders Study in Elderly Population Essay

Recently Good & Fitzgerald (2005) drew a distinction between ‘necessary dependency’ that is an integral part of being human, and ‘social dependency’ that is a product of the interaction between the individual’s life situation and the structures and systems within which that individual lives. This distinction has parallels with the social model of disability as described above. Like the social model, a social conceptualisation of dependency puts the focus on society’s role in producing dependency. The suggestion is that dependency can be reduced through changes in attitudes and in the physical environment. Social dependency focuses on whether society has created structures and supports that facilitate and maximise independence.Joint Disorders Study in Elderly Population Essay

Some writers have suggested that a focus on dependence and independence unnecessarily portrays the issue of care in terms of two extremes. According to this view, modern society is rooted in a ‘radical individualism’ bestowed upon us from Enlightenment thinkers (Robertson 1997, p. 435). This individual actor regards interpersonal interactions in terms of the social contract and envisages him-self as a self-reliant, self-sufficient being (p. 435). But Formosa (1997) describes the reality for older people as an ‘interdependent lifestyle’ which involves reciprocal care between friends, neighbours and families. Robertson (1997) argues in favour of a ‘moral economy of interdependence’. She suggests that “the fact that we live in community means that we are ‘ipso facto’interdependent”, and that this is evidenced by a modern welfare state which institutionalises reciprocity (p. 437). She argues that what is needed is a recognition that we are all interdependent. The moral economy of interdependence would allow for moral discussion on the issue of need (p. 438). It would also require that we decommodify reciprocity, acknowledging that much of what is undertaken in caring cannot be measured (p.439). This suggests that only by taking into consideration our universal interdependence can the pervasive informal labour of care be adequately understood.Joint Disorders Study in Elderly Population Essay

Summary of Key Points:
Both ageing and disability have traditionally been associated with physical, sensory, intellectual and/or mental impairment. Policy on the treatment of both has historically focussed on institutional arrangements of medical and social care.
For both older people and people with disabilities, theorists and policy-makers increasingly recognise the social factors that influence their situation. In the ageing sector, such discussions focus on a life course conceptualisation of ageing, while within the disability sector this is framed in terms of a social model of disability.
The issue of dependency is one that impacts on older and disabled people, both of whom have been conceptualised in public policy as especially reliant upon others. Both groups can benefit from a conceptual distinction between necessary dependency and social dependency that can shift social policy towards facilitating greater independence.
Recognition of the universality of interdependence may provide a way to underpin greater connectedness and reciprocity within communities for all people.
Chapter Two: Key Themes in International Policy & Practice
An international review of literature on ageing and disability has generated the following key themes. A number of these represent common or overlapping issues for the two groups. Certain issues are discussed that arise differently for people with early-onset disabilities and people who acquire disabilities in old age. In general, it is evident that joint working between the ageing and disability sectors is relatively new.Joint Disorders Study in Elderly Population Essay  There are examples of good practice in a number of countries, but there is as yet little evidence of a thoroughly integrated approach to policy towards older people with disabilities. It is also evident that older people with disabilities are treated by-and-large as a homogenous group, with little recognition of diversity issues. The issue of gender is neglected. In the policy literature reviewed below, little or no mention was made of the fact that the majority of older people with disabilities are women. Also missing from the policy literature are discussions of the issues for older people with disabilities who come from other socially excluded groups. Walsh & LeRoy’s qualitative research on older women with intellectual disabilities provides evidence of the differing place of people with disabilities and of older people within different cultural contexts (2005). However, their work is unusual, and in general policy literature on ageing and disability does not articulate the issues for people from different ethnic groups living within a country. Neither are the issues for older gay, lesbian and bi-sexual people addressed in the literature reviewed.

Comparison of the UN Principles for Older Persons (1999) with the UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities (1992) shows a number of overlapping concerns. The UN Standard Rules outline key preconditions for equal participation of people with disabilities in society. The Rules assert that persons with disabilities have the right to remain within their local communities (UN 1992, para. 26). Similarly, the UN Principles assert that older persons should remain integrated in society (UN 1999, para. 7). Both documents call for actions to support independence and autonomy (UN 1992, Rule 3, UN 1999, para. 12). Both documents call for services to assist people to reach their optimum level of function (UN 1992, Rule 3; UN 1999, para. 11). Both documents assert the right of people to accessible environments (UN 1992, Rule 5; UN 1999, paras. 5 & 6). Both documents support the fundamental right of all people to participate in society.Joint Disorders Study in Elderly Population Essay

Very little literature seems to address the relationship between rights claims of people with disabilities and older people. Priestley & Rabiee (2002) have conducted research on this area in the U.K. Their research examined older people’s views on disability issues through a survey of older people’s organisations. Issues of common concern included mobility and transport, accessible housing and independent living. For example, groups representing older people have advanced similar claims to people with disabilities about the right to live in the community (p. 603). A particular instance of the two movements working together occurred in the winter of 2000, when a campaign launched by Disability Nowfor the extension of cold weather payments to disabled people over 65 was supported by older people’s groups (p. 607). Priestley contends that very little attention has been paid to the political significance of the common claims of older people and people with disabilities (Priestley 2002, p.362). He describes how self-advocacy among both older people and disabled people is increasingly common. Concluding that there are good reasons for collaborative working on rights issues, he also acknowledges that there are distinct orientations within each group which may create barriers. Priestley argues that the promotion of ‘active ageing’ by older people’s organisations in the UK signifies a desire to distance themselves from images of physical frailty, and may discourage support of disability issues (Ibid., p.368). On the other hand, the focus in disability campaigns on participation in work offers little to retired older people.Joint Disorders Study in Elderly Population Essay

Independent Living (Consumer-Direction)
The desire to be independent has been expressed by both older people and people with disabilities. In Priestley & Rabiee’s study of older people’s organisations in the UK, independent living was rated as “very important” by more organisations than any other issue (2002). In Ireland, the NCAOP’s survey research shows that older people would prefer to remain in their own homes (2005a). So too, the American Association of Retired Person’s survey of people aged 50-64 living with disability says that their number one fear is loss of independence (AARP 2003). Disabled people have advocated the independence of people with disabilities from exploitative relations of care since the 1970’s. The Independent Living Movement has defined Independent Living in terms of the right of all persons to participate and reside in the community and control and make decisions over their own lives (The Canadian Association of Independent Living Centres 2003). As discussed above, the Independent Living Movement has highlighted the distinction between ability and dependency (Morris 1999).Joint Disorders Study in Elderly Population Essay

The international literature shows the increasing influence of independent-living concepts on ageing policy. This is most evident in the USA, where the Independent Living Movement originated in the 1970’s. In this setting, the terminology ‘consumer-directed services’ is prevalent. The use of the term ‘consumer’ is contested in Ireland; it may misrepresent the Irish context of formal care that is predominantly within citizen-supported statutory services. However, discussion in the American literature uses the term ‘consumer’ to refer to service users. Simon-Rusinowitz (1999) claims the ageing community in the USA increasingly accepts the need for consumer-directed services (p. 2). In one survey, results projected that between one-third and one-half of older consumers would be interested in a cash benefit consumer-directed option (Ibid., p. 6). Similarly, Simon-Rusinowitz’s survey of policy experts in the field identified a large upsurge in interest by researchers and policymakers in the ageing sector regarding consumer-direction. They also cited numerous examples of joint implementation initiatives between ageing and disability services (Ibid.,p. 7). Policy experts identified three key factors in increased implementation of consumer-directed services for older people:Joint Disorders Study in Elderly Population Essay

Hopes that consumer-direction would result in lower-cost services;
Leadership from the Clinton Administration’s Health Care Reform Task Force that resulted in both dissemination of information about consumer-directed services and funding for pilot projects; and
Changing demographics, i.e. the ageing population, and a growing emphasis on consumerism and empowerment generally (Ibid., pp. 8-10).
The American Association of Retired Persons published a report in 2003 on independent living and disability. Based on a survey of people over 50 with disabilities, it finds that older people with disabilities want more direct control over their long-term support services (p. 8). It describes a number of innovative programs to enhance independent living. ‘Cash and Counseling: Demonstration and Evaluation’ is a study of consumer-directed personal assistance services for older people and younger people with disabilities. Using a cash benefit, consumers choose who provides personal assistance services. The benefit can also be used to buy other services to facilitate independence such as transportation, home modifications, and assistive devices. Joint Disorders Study in Elderly Population Essay  Counselling and bookkeeping support is offered to assist consumers in decision-making and management of the services (University of Maryland 2002). In a project on assistive technology in Massachusetts, case managers identified suitable clients, helped clients to order equipment and trained them in using it (Gottlieb & Caro 2001). It is useful to note that Simon-Rusinowitz identifies a number of problems with the implementation of consumer-directed programs in the USA. There is still limited knowledge about how to implement consumer-direction (Simon-Rusinowitz 1999, p.11). Policy experts identify fraud and abuse, quality assurance, consumer capacity to manage services and resistance by provider agencies as issues of concern (Simon-Rusinowitz et al. 1999).

The AARP Report also describes recent developments in Europe. Germany had the largest user-directed service program in Europe in 2003. There the Government introduced a social insurance program for long-term care that includes a cash benefit option. Uniquely, participants are allowed to use this cash benefit to pay informal caregivers as well as formal services. In the Netherlands, beneficiaries receive a budget that must be used to buy services. France provides a cash allowance, but most of it must be used to pay for external assistance. Austria, France, Germany and the Netherlands all allow beneficiaries to either hire or pay family members to provide assistance, and this is allowed in certain USA programmes as well (AARP 2003, pp. 171-172. See also Wiener, et al. 2003).Joint Disorders Study in Elderly Population Essay

Ireland has an active independent living movement, with 27 Centres for Independent Living. The Centres support people with disabilities to achieve independent living, choice and control over their lives. First established in Ireland in 1992, the Centres may offer a valuable resource of experience to the ageing sector.

An Age Friendly Society and A Disability Friendly Society
The NCAOP has recently called for an ‘Age Friendly Society’. Their Position Statement states that an ‘Age Friendly Society’ seeks to optimise the opportunities for health, participation and security of citizens as they age. Such a society will enable the achievement of productive, positive and successful ageing, while acknowledging those who have other aspirations. An ‘Age Friendly Society’ makes older people the key stakeholders in determining the supports they need to enhance their potential. It supports positive images of ageing (NCAOP (2005a), pp.26-27). An ‘Age Friendly Society’ “will also be a disability friendly society,” and “will do all in its power to reduce the social and physical isolation of both older people and disabled people of all ages.” (Ibid., p.39).Joint Disorders Study in Elderly Population Essay

‘Livable Communities’
Recent policy in the USA and the Netherlands demonstrates thinking that integrates the needs of older people and of people with disabilities around the development of a society for all ages. Policy literature in the USA by both older people and disability organisations has focussed on the idea of ‘livable communities’. The National Council on Disability published a report on livable communities that emphasised the common needs of people with impairments of all ages, and that built on earlier work on “elder-friendliness” (NCOD 2004). Similarly, the American Association of Retired Person’s policy report for 2005 focuses on ‘livable communities’ (AARP 2005). In it, a ‘livable community’ is defined as

“one that has affordable and appropriate housing, supportive community features and services, and adequate mobility options, which together facilitate personal independence and the engagement of residents in civic and social life” (AARP 2005, p. 16).Joint Disorders Study in Elderly Population Essay

The report recognises that homes, neighbourhoods and transport affect the ability of people to engage in community life (Ibid.,p. 20).

By emphasising the connection between the physical organisation of a community and the ability to participate in it, such a statement highlights the link between an ‘Age Friendly Society’ and a ‘Disability Friendly Society’. Many of the characteristics required for ‘livable communities’, such as supporting home adaptation and universal design in home-building, developing accessible community public transport, and providing access to health and social services are of benefit to both older and disabled people. The adoption of a life course perspective, by recognising the universality and continuous nature of the ageing process, leads to initiatives such as ‘livable communities’, as we recognise that ageing and impairment are common experiences of people living within our local communities.Joint Disorders Study in Elderly Population Essay

Such an approach is also evident in recent developments reported from the Netherlands. The Dutch Government is promoting the efforts of senior citizens to continue to live in their own homes, and promoting arrangements for informal and community-based care (Bakker, 2005, p.8). Effort has gone into physical adaptation of existing homes, and into integrated community designs for housing and care. The focus in the Netherlands is on building assisted-living complexes. These consist of modern apartments where tenants do their own house-keeping independently as much as they are able. Complexes include a day centre for those needing structured support, as well as physical therapy space. A key difference between this and older community residences is that the services in the complex are intended for use by the neighbourhood inhabitants. Older people with dementia are accommodated in small-scale housing groups in ordinary neighbourhoods. Both of these types of housing are part of what is called a ‘home-care zone’ or ‘home-service zone’. These zones cover about 10,000 inhabitants, with a central multifunctional building containing core services and high-support accommodation, and accommodation for people with varying levels of need radiating outwards from this facility (Bakker 2005, p.17).Joint Disorders Study in Elderly Population Essay

‘Ageing in Place’
The concept of ‘ageing in place’ is relevant for both older people and people with disabilities when talking about ‘livable communities’. Ageing in place refers to the ability of people to remain in their homes and communities as they develop impairments. It means deferring transition to institutional care for as long as possible. It also means enabling the social integration of people who develop impairments (see UN Human Settlements Programme 2002). Responding to the preferences of people who develop impairments means providing an accessible environment and supports to allow them to continue to live in their communities. It is also important to recognise that ‘ageing in place’ for people with early and mid-onset disabilities may mean remaining in disability-specific residential and community services. For people who have developed long-term relationships within disability services, the transfer to older people’s services may not reflect their needs or desires. For some people, ‘ageing in place’ means providing adequate ageing supports and care within disability services. In all cases, the decision to ‘age in place’ should be made by the person with a disability.Joint Disorders Study in Elderly Population Essay

Gender, Ageing & Disability
The 2002 census statistics show that 62% of people with disabilities over the age of 65 are women. Yet, as stated above, there is very little discussion in the literature on the particular issues for women ageing with a disability. Matthew Janicki has recently stated that “much of the extant ageing research and literature has ignored the needs of women with disabilities and has not offered insights into their particular challenges and the means many have used to overcome their problems” (Janicki 2004). Women with Disabilities Aging Well: A Global Viewreports on qualitative research with women with intellectual disability across 18 countries. This research begins to describe the experience of ageing for women with intellectual disabilities, and to distinguish the differences in this experience within various cultures (Walsh & LeRoy 2004). It is difficult to extrapolate particular policy implications for Ireland from this report, given that its conclusions are based on information from both developed and developing countries around the world. One valuable insight is that older women with early-onset disabilities do not live out the same life trajectories as women who develop disabilities in later life (Ibid., p.7). Such women may be socially excluded from an early age and may be less likely to have children who will care for them in old age. It is also important to consider gender when reviewing statistics on morbidity. Statistics show that women live longer with impairment, and have fewer morbidity-free years than men (Ibid., p.12). It should also be acknowledged that older men with disabilities may encounter distinct difficulties. The social isolation experienced by older men with disabilities may be qualitatively and quantitatively different from that of women, and there may be some differences in the supports and services needed.Joint Disorders Study in Elderly Population Essay

Mental Health and Ageing
Policy in mental health and ageing is relatively under-developed. Mental health problems are common amongst older people. In the UK, estimates are that 40% of GP attendees, 50% of general hospital patients, and 60% of care home residents have mental health problems (DH 2005, p.1). In the US, older men experience the highest rate of suicide compared with all other age groups (President’s New Freedom Commission 2003).Joint Disorders Study in Elderly Population Essay

The UK’s National Service Framework for Older People contains guidance on national standards for service delivery for older people with mental illness (DH 2005, Appendix 2). Their Department of Health has recently launched a new joint initiative between the mental health and older people’s service divisions. This established a programme board for older adult mental health services with representation from both older people’s and mental health policy (DH 2005, p.1). A service development guide was planned for Autumn 2005.

In the United States, the President’s New Freedom Commission report on mental health highlights gaps in services for older people. It identifies shortages in workforce capacity in the areas of geriatrics and mental health and ageing. It confirms the high prevalence of mental disorder amongst older people, and a lack of preparedness on the part of services to cope with this growing population. The report emphasises that a greater degree of stigma against mental illness exists within the older population, and this deters older people from seeking treatment (President’s New Freedom Commission 2003). Guidance on mental health and ageing is also found in the Administration on Aging’s report Older Adults and Mental Health: Issues and Opportunities (2001), which contains in-depth discussion of the challenges and strategies for providing effective mental health services to older people. One policy development in the USA has been a joint initiative by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Council on the Aging, Inc. (NCOA) to highlight good practice. Their publication on partnerships between substance abuse, mental health and ageing services aims to promote linkages between these sectors by giving examples of successful programmes (DHHS undated).Joint Disorders Study in Elderly Population Essay

There is some evidence of discrimination against older people in the treatment of mental health problems. Lagana & Shanks (2002) found that many mental health professionals hold negative attitudes towards older people. Fischer, et al. (2003) examined treatment of older patients for depression in Primary Care. They found that providers were only 6% as likely to ask old-old depressed patients about suicide risk, about one-fourth as likely to refer them to a mental health therapist, about one-fifth as likely to ask if they felt depressed, and one-twentieth as likely to ask about a problem with alcohol as they were with young-adult depressed patients. They conclude that there is a possible pattern of under-attention to depression in the oldest population.

It is also important to acknowledge the long-term effects on mental health of the social exclusion experienced by people with early and mid-onset disabilities. The impact on mental health of social exclusion is well-documented. People with long-term disabilities are at higher risk of mental health difficulties in so far as they are socially excluded.Joint Disorders Study in Elderly Population Essay

Summary of Key Points:
The desire to remain independent has been expressed by both older people and people with disabilities.
The Independent Living Movement is increasingly influencing ageing policy in the USA and Europe. This influence has led to the provision of consumer-directed and personal assistance services to people with disabilities and older people.
Older people and people with disabilities have established common rights claims within the United Nations arena.
Research in the U.K. indicates scope for joint working on political issues, in particular mobility and transport, accessible housing and independent living.
The connection between the physical organisation of a community and the ability to particpate in it highlights the link between an ‘Age Friendly Society’ and a ‘Disability Friendly Society’. This is being operationalised internationally through ‘livable communities’ and ‘home-care zones’.Joint Disorders Study in Elderly Population Essay
There is a lack of discussion in policy literature about particular issues for older disabled women and men, for older people with disabilities from diverse ethnic groups, and from different sexual orientations.
Women represent 62% of the population of older people with disabilities, and live longer with disabilities than do men.
Policy in mental health and ageing is under-developed. Existing literature suggests a lack of service provision, poor co-ordination, poor access to services and a high level of stigma around mental health issues amongst older people.
Chapter Three: Disability Prevalence Data
Disability Data in Ireland
It is clear that policy makers and service providers need reliable indicators of service and other needs. The 1996 Commission on the Status of People with Disabilities identified that this was an area that needed to be addressed in the Irish context. Since 2001, the NDA has been working to ensure implementation of the Commission’s recommendations. Significant progress has been made, perhaps most importantly with the approval by Government of the first Irish National Disability Survey which will be carried out in September 2006 by the Central Statistics Office as a post-censal exercise. The questionnaire to be used in this survey is currently being finalised based on the pilot questionnaire developed by the NDA in 2003. The questionnaire will contain sections on impairments, on aids and supports both available and needed and on policy areas such as education, employment, training, transport and the built environment. Joint Disorders Study in Elderly Population Essay The National Disability Survey will cover all age groups within the population, including those over the age of 65. It will also cover both people living in private residences and those in institutions. The intention is that this survey will provide for the first time the baseline data required by policymakers and service providers. It is hoped that such surveys will be carried out at regular intervals, possibly every 10 years, as is the case in other countries. This will enable the Irish state to evaluate its progress towards equality for people with disabilities.

A further initiative in which the NDA is involved addresses the central challenge of disability data collection, and that is ensuring an agreed definition to underpin all data collection exercises within the EU. This project, entitled Measuring Health and Disability in Europe, is examining the World Health Organisation’s International Classification of Disability Functioning and Health (ICF) as a framework for disability data collection across the European Union. The MHADIE Project began in January 2005 and will continue until the end of 2007.Joint Disorders Study in Elderly Population Essay

The Health Information and Quality Authority (HIQA), as a newly-formed agency reporting to the Minister for Health & Children, will also have a key role to play in the development of better health information about older people and people with disabilities. The responsibilities of HIQA will include developing health information, promoting quality assurance and overseeing health technology assessment. The Minister for Health and Children has forwarded the National Standards for Disability Services to HIQA for consideration.


Pending the outcome of these initiatives, other developments since 2001 have given a partial picture of the situation for people with disabilities in Ireland. These include the 2002 Census, the Quarterly National Household Surveys, and the national intellectual and physical and sensory disability databases.Joint Disorders Study in Elderly Population Essay

The 2002 Census of Population included two direct questions on disability for the first time. When combined with the array of socio-demographic information collected through the Census, it was possible to examine extensive information on the situation of disabled people in the State. It provides quite extensive information on people with disabilities, including a detailed breakdown by age and type of disability. The information is based on self-assessment, and does not indicate the needs arising from the particular disability. Nevertheless, as a positive development it went some way to correcting the ‘silence of official statistics’ in Ireland on people with disabilities which had been noted by the Commission on the Status of People with Disabilities in 1996. The Quarterly National Household Survey carried out in the second quarter of the same year included a special module on disability. It focussed on whether people had any long-standing health problem or disability, the nature of that problem/disability, and the labour force status of those affected (Nolan, et al. 2003).

Statistics are also available from service providers through a number of national databases overseen by the Health Research Board (HRB). The National Intellectual Disability Database (NIDD) collects information on the users of services for people with intellectual disability. It currently has over 25,000 registrations. The database informs the regional and national planning of these services by providing information on trends in demographics, current service use and future service need. Data is reported regionally, including information on residential circumstances by age group and degree of disability.Joint Disorders Study in Elderly Population Essay

Like the NIDD, the National Physical and Sensory Disability Database (NSPDD) is a service planning tool that aims to provide a profile of people with physical or sensory disabilities who are receiving specialised health and personal social services and who are waiting for specialised health and personal services. Data is collected for service users who began their usage before the age of 66 and it currently has over 20,000 registrations. An important feature of the NSPDD is its incorporation of International Classification of Functioning concepts into the administrative form. This ensures that data is collected on important life areas such as education, as well as salient contextual factors that impact on impairment. The Long-Stay Activity Statistics reports annually on the number of people in statutory long-stay care facilities and in private nursing homes. Data is categorised by age, medico/social status and level of dependency.Joint Disorders Study in Elderly Population Essay

No comprehensive statistics exist for people with mental health difficulties. Usage of acute services is reported under the National Psychiatric In-Patient Reporting System maintained by the Health Research Board, however no equivalent service database that covers community-based treatment and support exists for people with mental health difficulties.

It is evident from the above that there could be questions about the extent to which the administrative databases reflect the full picture of needs for people with disabilities.Joint Disorders Study in Elderly Population Essay  Even the most complete of the three, the NIDD, does not take account of people with intellectual disabilities who, for whatever reason, have not come in contact with formal services. Participation in the databases is also a major issue affecting their reliability. A recent report on the NPSDD showed participation in some areas as low as 12%, while in other areas it was as high as 86% (O’Grady unpublished). The extent to which such databases can capture the full demand for services, and thus can be effective planning tools, must be of concern. In addition, it would be important for all health information datasets to be equality proofed to ensure that the data fully reflects the situation for people from disadvantaged as well as mainstream groups.

European Countries
The measurement of health status and disability prevalence in European populations has attracted attention at a cross-European level only since 1997 when Article 13 of the Treaty of Amsterdam gave the EU competence to deal with discrimination. The reference to non-discrimination in relation to disability accelerated co-ordinated approaches to measurement. However the majority of published work concentrated on people aged less than 65 years in line with European Union prioritisation of employment policy. According to Meltzer (2000) the rationale behind the incorporation of a disability module in the Labour Force Survey is ‘to meet the need for a comprehensive and cohesive dataset on the labour market situation of disabled people among Member States’ (Meltzer 2000, p. 3). Meltzer describes disability data in the context of employment as opposed to disability and ageing generally. Malo (2001) provides an analysis of the employment status of people with disabilities using the European Community Household Panel Data. This provides an analysis on participation and non-participation rates of people with disabilities in the labour market and does not attempt to confront issues regarding the population over the working age of 64 or over.Joint Disorders Study in Elderly Population Essay

Most countries use several systems of classification and definitions of prevalence to cover a variety of circumstances governed by different Ministries or Government Departments. Examples are definitions used for social security and social assistance entitlements (social protection), employment and restrictions or supports in the labour force, legislative definitions, or health related issues to address health and medical needs of an ageing population. As a consequence there is no single agreed prevalence picture at national level in most countries. There is simply the prevalence data generated by specific definitions of disability/health status for a range of policy objectives and eligibility criteria. The European Commission (2002 and 2004) provides an overview of the definitions of disability of member states in the EU as well as Norway which are the definitions used in anti-discrimination laws in the respective countries. The anti-discrimination laws focus on the act of discrimination rather than the health status of the person.

Sharing an understanding of data issues has increasingly been facilitated by Eurostat. Grammenos (2003) highlights Eurostat (2001) data that outlines the prevalence of chronic illness or disability by age group in the EU and includes the 64 to 94 age groups. He discusses age and disability and states that chronic illness and disability tend to occur at an increasingly greater age with each generation. Repeated events (sickness, accidents) during adult life accumulate and generate the need for long-term care of the elderly and the author concludes that this does not mean that chronic illness and disability among the elderly is merely a consequence of chronological age – income, education, lifestyles and work are strong influences on health. Grammenos uses data from Nososco (2001) and discusses early retirement and older people with disabilities in terms of the age groups defined across Denmark, Finland and Sweden. The Commission (2001) examined ECHP data between work age cohorts of 16 – 64. The European Commission states that the clearest and most consistent relationship across countries is between age and disability. Higher age groups have higher disability rates as evidenced in Germany, Greece, Italy and Spain. In England and Wales, data collected between 1989 and 1994 on people aged over 65 showed a greatly increased prevalence of disability in the very old population, particularly women (AIHW 2000 citing Parker, et al., 1997).Joint Disorders Study in Elderly Population Essay

Australian statistics are much more comprehensive than those currently available in Ireland. The Australian Bureau of Statistics (ABS) has conducted a number of national disability surveys, health surveys, surveys of mental health and well being of adults as well as surveys of time use (this latter provides relevant information on, for example, the use of time for personal care and voluntary work). In spite of all the data available, the Australian Institute of Health and Welfare (AIHW) points out that there are limitations. In particular, it is difficult to make comparisons between population data and what it calls “administrative data” and between different administrative collections. The purposes of the data collection are many and varied and the definitions used vary. The surveys involve self-reported information on disability and health. Administrative data is mainly concerned with quantifying the numbers of recipients of services, and is produced by service providers AIHW highlights how people with early onset disabilities may remain unknown to disability service providers until they begin to require services in later life (AIHW 2000). Carey, Cole and Boldy (2002) point to a lack of longitudinal monitoring of disability impact, and a failure to collect data reflecting people with multiple disabilities.Joint Disorders Study in Elderly Population Essay

Ageing Data in Ireland
Like disability data, information on ageing in Ireland is also available from a number of national surveys and datasets maintained on behalf of the Department of Health and Children and other service providers. Important examples include the Census and Ireland’s main labour force survey, the Quarterly National Household Survey (QNHS), both of which are undertaken by the Central Statistics Office (CSO). In addition, useful data is provided by the Annual Health Statistics published by the DoHC, the Hospital In Patient Enquiry Scheme (HIPE), the two disability databases maintained by the Health Research Board and the Survey of Lifestyles, Attitudes and Nutrition (SLAN). As well as the current data that is provided in Irish sources, an increasing emphasis on long term planning has ensured that additional data has been made available, which projects the changing nature of Ireland’s older population. The NCAOP published such a study, Population Ageing in Ireland: Projections 2002-2021 (NCAOP 2004), which analyses ageing population projections at national and county level across the state.Joint Disorders Study in Elderly Population Essay

A huge increase in the number of persons aged over 65 living in the state in 2021 compared to 2002 has been projected and was highlighted earlier in this paper. Furthermore, the counties with the highest projections of increases are all found in the western half of the country, although in terms of absolute numbers, almost one quarter of all males and females aged over 65 will live in Dublin county and borough in sixteen years time. In addition, it is predicted that a marked shift will occur in relation to the marital status of older persons. In particular, it is projected that the numbers of married and separated people in this age category will increase significantly, compared to the current dominance of single and widowed persons. Finally, an additional projection estimates that the number of old people living alone will increase substantially from 114,000 people in 2002 to 211,000 by 2021 (NCAOP 2004, p.2-3).

Such substantial changes in the nature and numbers of old people living in the state makes the case for accurate and reliable information on the current situation of old people all the more important. However, currently there are significant deficiencies evident in datasets. The NCAOP’s conference paper The Older Population: Information Issues and Deficits (2005b) highlights the lack of person-centred data. The NCAOP argues that “the kind of data that is gathered for the main datasets reflects mainstream concerns with labour market participation” (NCAOP 2005b, p.36). The National Physical and Sensory Disability Database excludes those whose disability arises from age 66 onwards. Current datasets do not provide information on the causes of the increasing occurrence of impairment in old age. There is also lack of integration between datasets for different services, for instance between the Hospital In-Patient Enquiry Scheme (HIPE) and the Long-Stay Activity Statistics. Overall, there is a lack of population-based systems and registers to generate information on older people with disabilities. The datasets which are available operate as ‘islands of information’, tracking activities and events rather than individuals. There is also a need to distinguish between different groups within the older population, and to disaggregate age categories rather than utilise a single band of 65 years and over. (NCAOP 2005b, pp.37-38). Implementation of the Disability Act 2005’s needs assessment and reporting provisions may provide a more coherent data collection system than exists currently.Joint Disorders Study in Elderly Population Essay

Although there are limitations in national datasets, the NCAOP has conducted a number of studies about older people in Ireland. Health and Social Services for Older People (2001) reports results of a study into older people’s views of their health and social service needs. Population Ageing in Ireland: Projections 2002-2021 (NCAOP 2004) analyses ageing population projections at national and county level across Ireland. There is a large number of other reports published by the NCAOP covering specific information on the situation for older people in Ireland.Joint Disorders Study in Elderly Population Essay

Summary of Key Points:
It is evident from the above discussion that considerable knowledge gaps remain about older people with disabilities in Ireland. This situation parallels, to some degree, that of other European countries. However, the gaps in statistics about people with disabilities are considerably worse in Ireland than elsewhere.

Key Points
Currently there is no agreed definition of disability as a basis for data collection. Definitions differ between services within a country, between services, legislation and survey research, and between countries. Developments are underway to improve this situation, including the upcoming National Disability Survey 2006 in Ireland, and the Measuring Health and Disability in Europe project.
Most data collection on disability is focussed on the working-age population and thereby excludes older people.
Service usage data is likely to under-represent disability prevalence and, due to poor participation rates in some areas, understate demand.Joint Disorders Study in Elderly Population Essay
Information on people with mental health difficulties is particularly sparse due to the lack of a dedicated person-centred administrative database.
Datasets in Ireland operate as ‘islands of information’, tracking activities and events rather than individuals. For people with overlapping conditions of ageing and disability, administrative boundaries in data collection may hinder a comprehensive picture of their needs.
Datasets should be equality proofed to ensure that they reflect the diversity of the ageing population.
Chapter Four: Current Situation in Ireland
In Ireland the intersection of rights for people with disabilities and older people occurs within national equality legislation and in the Disability Act 2005. The Equal Status Acts 2000 to 2004 and the Employment Equality Acts 1998 and 2004 give protection against discrimination on the basis of age and of disability. The Equality Authority works on behalf of both groups in promoting equality, and has produced key policy documents for each, including Implementing Equality for Older People, as well as guidance on implementing equality such as Towards Age Friendly Provision of Goods & Servicesand Reasonable Accommodation of People with Disabilities in the Provision of Goods and Services. This suggests that building on existing joint working between the NDA, the NCAOP, the Equality Authority and the Human Rights Commission may prove productive for progressing the common equality and human rights agendas of these two groups.Joint Disorders Study in Elderly Population Essay

The other main piece of legislation affecting older people with disabilities is the Disability Act 2005. The Disability Act is part of the Agreed Programme for Government and a commitment in ” Sustaining Progress”. It is a key part of the National Disability Strategy being put in place by Government to underpin the equal participation of people with disabilities in society. The provisions of this legislation are intended to build upon the existing equality legislative framework and are available in addition to equality and human rights legislation.

The Act enables provision to be made for the assessment of health and educational needs for people with a disability. In the Act, disability is defined as follows: “disability, in relation to a person, means a substantial restriction in the capacity of the person to carry on a profession, business or occupation in the State or to participate in social or cultural life in the State by reason of an enduring physical, sensory, mental health or intellectual impairment.” The inclusion of participation in social and cultural life as well as the economy means that those with retired status are not precluded from the definition and therefore may come within the scope of the legislation. Part 2 of the Act provides for an independent assessment of need, an individual service statement, and redress. With regard to the provision of this Part, the Minister for Health and Children may fix different dates for implementation for different age categories. This means that the commencement dates for Part 2 with regard to older people may be earlier or later.Joint Disorders Study in Elderly Population Essay

Section 3 imposes a duty on public bodies to make public buildings accessible, as far as practicable, by 31st December 2015. This will be of benefit to people of all ages with impairments, including those who have not reached the threshold to come under the definition.

Another element of the Government’s National Disability Strategy is the Comhairle (amendment) Bill. The Comhairle (amendment) Bill puts in place personal advocacy services, specifically for people with disabilities who have difficulty obtaining, without assistance or support, a social service. This has the potential to improve access to services for older people.

It can be seen that a range of rights legislation is available in common for both older people and people with disabilities which can improve their participation in Irish society. Implementation of such rights depends partly on effective awareness-raising, a process which can be supported by organisations such as the NDA, the NCAOP, the Equality Authority and the Human Rights Commission.

Health Service Provision
Historically, services in Ireland have been organised around distinct client populations of older people, people with physical/sensory disabilities, people with intellectual disabilities and people with mental health difficulties. This category division persists in the new structure of the Health Service Executive, which assigns responsibility for these groups to three different “Care Group Managers”. The divisions are underpinned by separate budgets for each group. Separate funding militates against boundary-crossing of both professionals and clients, and creates a variety of difficult situations for older people with disabilities. For example, currently people with intellectual disabilities under 65 who develop dementia have no clear provision within the services. While the Psychiatry of Old Age professionals have expertise in dementia, they have no responsibility for services to this group (Wrigley & Loane 2004, p.36). On the other hand, people who have had long-term contact with the disability services may continue to receive services within the disability sector after the age of 65. The extent to which their needs as older persons are being met within these settings is unclear.Joint Disorders Study in Elderly Population Essay

The division between categorised client groups is also evidenced in the current disability sector co-ordinating committees. These advisory committees are chaired by the Director of Disability Services, with representation from Heads of Discipline of disability service provision, voluntary sector disability service providers and people with disabilities. In general there is no representation from older services. This despite the fact that, as stated at the start of this paper, older people represent 42% of the population with disabilities.

Services for older people in Ireland have historically been oriented around acute services, with very little provision for care in the community. O’Neill and O’Keefe (2003, p.1282) report that health and social services for older people were relatively poorly co-ordinated; the number of specialists was low by international standards, and older people were increasingly reliant on fully-subsidized beds in acute hospitals. Relative to other countries, community care services have been underdeveloped. For example, in 1993, only 3.5% of the Irish population used home help, compared to 14% in Northern Ireland and 19% in Sweden. As of their publication, there was also virtually no access to speech therapy, clinical nutrition or social work (Ibid.,p.1284).Funding and staffing levels for older people’s services has increased in recent years, and innovative programmes have been initiated such as the ERHA’s HomeFirst programme and Slan Abhaile project, both of which aim to support older people to remain in their homes. However, evidence is not available as to the extent of unmet need for community care services.Joint Disorders Study in Elderly Population Essay

In the mental health services, older people with pre-age 65 mental health difficulties are routinely discriminated against. The Inspector of Mental Health Services states that it is “common practice in most mental health services for the elderly to exclude people who have attended the general adult mental health services in a given period prior to referral” (MHC 2005, p.118). She has expressed concern that these exclusions are depriving significant numbers of elderly patients from appropriate care. She also cites numerous examples of poor quality care for long-stay patients in mental health wards, including the absence of care plans, activities, or any evidence of therapeutic direction for patients in certain locations (Ibid., pp.144, 154). In addition, elderly long-stay residents of psychiatric wards are being discharged to private nursing home beds and other settings that are unapproved for mental health care (Ibid., p.118).Joint Disorders Study in Elderly Population Essay

The picture which emerges in Ireland is one where the organisation of services on the basis of client groups, e.g. older people, disabled people and people with mental health difficulties, creates barriers to receiving appropriate, person-centred care and support. The Government’s Health Strategy, Quality and Fairness – A Health System for You, makes a commitment to a ‘holistic approach’ to the planning and delivery of care, and to a co-ordinated action plan to meet the needs of ageing and older people. A key issue, then, for future policy must be the development of mechanisms, protocols and funding which allow for cross-cutting, co-ordinated and integrated care for individuals on the basis of a holistic assessment of needs, not on the basis of membership of a client group.Joint Disorders Study in Elderly Population Essay

Health & Welfare Entitlements
Entitlement to many of the services which are relevant to older people and people with disabilities is discretionary. The provisions of the Disability Act 2005 apply to all people with a disability, but its provisions relating to needs assessment can be brought into force at different times for people of different ages. Everyone over the age of 70 is entitled to a medical card; this universal entitlement does not exist for people with disabilities aged between 65 and 70. Comhairle 2004 highlights problems with the current entitlements. For example, a couple aged 65-70 whose only income is an Invalidity Pension has an income above the current income guidelines. There is considerable confusion and lack of clarity about who is entitled to free or subsidised long-stay care (Mangan 2003). This situation has yet to be clarified by the Department of Health. Receipt of community care services such as community nursing and home helps is discretionary. The provision of aids and appliances such as walking aids and wheelchairs is also not clear-cut. The Mobility Allowance is not payable to anyone whose mobility problems start after the age of 66.Joint Disorders Study in Elderly Population Essay

A significant issue arises regarding the difference in access for people with early and mid-onset impairments versus people who acquire impairments after age 65. Given the low rate of participation in employment of people with disabilities of working age, it is less likely that people with disabilities will have access to private health insurance to fund their care needs. In practice, this means that most people with early-onset disabilities are entirely dependent on the state health services, whereas people with disabilities arising in old age may be able to avail of private medicine. In addition, people with disabilities are less likely to have paid PRSI and are therefore less likely to qualify for contributory payments. The lack of employment status of people working in sheltered workshops and their equivalent means that they never qualify for the usual benefits available to workers. Finally, in general women, who make up the majority of the ‘oldest old’ people with disabilities, have less work-based entitlements and pension arrangements than do men, given less continuous participation in work. Again, this suggests that women with disabilities will be more dependent upon statutory services than men.Joint Disorders Study in Elderly Population Essay

There are separate income maintenance payments for older people and people with disabilities. Two of the main weekly payments for people with disabilities – Disability Allowance and Disability Benefit – cease to be payable at age 66. Invalidity Pension and Blind Person’s Pension are payable after age 66 but from that age they are indistinguishable from Old Age (Contributory) Pension and Old Age (Non-Contributory) Pension respectively. The Household Benefits Package is available to all older people and to recipients of Disability Allowance and Invalidity Pension regardless of age. Social welfare payments to those over 66 are generally higher than those payable to persons under 66. People aged over 80 get an extra payment. The automatic entitlement of all over 70s to a medical card can also be seen as a recognition of the extra costs of ageing. The extra amounts payable to people aged 66 and over are not specifically related to the extra costs of ageing and there does not seem to have been any objective assessment of what those extra costs are or if the extra amounts bear any relationship to those extra costs. Joint Disorders Study in Elderly Population Essay