Images of embodied old age in contemporary Japan

Since the late 1980s, representations of Japanese national identity and Japanese old age have been deconstructed. Images of the resilience of traditional cultural and social institutions are shown to have over-emphasized social and cultural homogeneity, elided social differentiation and inequality and minimized the significance of historical transformation. Key institutions of the postwar modernization project, including the patriarchal seniority system and household structure, are being transformed through globalization and feminization. This thesis focuses on the problem of representing individual and collective ageing in Japan in the context of modernization. Research is focussed on the contradictions, within essentialist representations of Japanese collective and individual identity, between socially constructed policy forms of old age and collective identities. Contemporary trends towards individualization and diversification of identities, and discourses on the ageing/information society, indicate cultural distance between an instrumentally rational administration and the life world of old people. Research explores the concept of embodiment through its significance in debates on postmodernization of the lifecourse in accordance with the structural shifts towards a postindustrial structure. This study examines representations of old age in broader social and cultural processes. Images of the social and cultural trajectory of the lifecourse draw attention to the embodiment of individual identities and ultimately generational cultures in contemporary social and cultural spaces. This research is the result of analyses of old age, which have been informed by postmodern theory. It in turn informs sociological theorizations of cultural representations of old age in contemporary societies.

Old age in a new world

Five hundred early settlers of Victoria's Western District were studied in their old age. Findings about the place of the elderly in community formation, and about the many elderly who belonged to three generations of families all present early in white settlement, have added to existing knowledge of colonial society.

Socio-economic inequalities in mortality persist into old age in New Zealand : study of all 65 years plus, 2001-04

A number of studies have explored the relationship between socioeconomic status (SES) and mortality, although these have mostly been based on the working age population, despite the fact that the burden of mortality is highest in older people. Using Poisson regression on linked New Zealand census and mortality data (2001 to 2004, 1.3 million person years) with a comprehensive set of socioeconomic indicators (education, income, car access, housing tenure, neighourhood deprivation) we examined the association of socioeconomic characteristics and older adult mortality (65+ years) in New Zealand. We found that socioeconomic mortality gradients persist into old age. Substantial relative risks of mortality were observed for all socioeconomic factors, except housing tenure. Most relative risk associations decreased in strength with aging (e.g. most deprived compared to least deprived rate ratio for males reducing from 1.40 (95% CI 1.28 to 1.53) for 65-74 year olds to 1.13 (1.00 to 1.28) for 85+ year olds), except for income and education among women where the rate ratios changed little with increasing age. This suggests individual level measures of SES are more closely related to mortality in older women than older men. Comparing across genders, the only statistically significantly different association between men and women was for a weaker association for women for car access.

Assessing and managing old age psychiatric disorders in community practice

A shortage of specialised facilities means that general practitioners have a prominent role in community care of the elderly with mental illness.

Illness in old age is part of an individual's fate and must be approached with acceptance

Older members of the Greek community see aging and the ill health that may accompany it as an inevitable part of life. They associate illness very closely with God’s will, and largely believe their state of health is an aspect of fate and / or luck that they do not have control over and must simply accept. This paper, based on research conducted in Melbourne, Australia, describes the way in which the experience of old age is understood in the worldview of this group. The words fate and luck (τύχη = tyche; γραφτό = graphto) are often used by older Greeks to characterize their situation. Luck, to this group, is not random. The term (τύχη) was used in classical times to refer to a kind of minor deity that controlled the fortune of the Greek city states, and an element of this idea of intention remains today. In the modern context, luck comes from God, and for this group, is part of γραφτό, or destiny, something that is written. In its usual usage in Greek, γραφτό refers to something that must happen to a person because it is predetermined and cannot not occur. The meaning that these older Greek individuals give to the word luck in the modern world is manifested in their acceptance of the problems of aging and their approach to coping with their own experience.

The experience of old age in West Sumatra, Indonesia: Culture shift and cultural consonance in the modern era

The past four decades have seen enormous social change in Indonesia as the nation continues to experience rapid urbanization and social pressures in the globalized economy that have led to tensions between traditional cultures and the modern mainstream around the nation. This cultural shift has been felt strongly in West Sumatra, a region of Indonesia inhabited almost entirely by members of the matrilineal Minangkabau ethnic group. While the traditional social values of the area remain strong, they are eroding, and the Minang are becoming more like other Indonesians in terms of their family structure, occupations, and lifestyle. This has had a significant impact on the experience of old age as social and culture change has affected the traditional matrilineal structures that supported and ensured care for the elderly in past generations. This paper will describe the ways in which traditional institutions accommodated older individuals and describe how these systems have changed in the present day. Case studies across generations will be presented to illustrate the ways in which traditional matrilineal social structures are, and have been, perceived in the context of aging. Further, the paper will describe what this means for the elderly and their families in terms of cultural consonance in today’s society, and discussion will focus on the changing experience of old age in a society in transition against a backdrop of rapid urbanization and modernization.

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

We aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop a disability risk algorithm to estimate the risk of future disability for those aged 45-65 years.

Super Blooper? Time to halt the superannuation juggernaut?

The superannuation industry has increased almost exponentially in Australia over the past decade. The main reason for this is because government  regulation compels employers to pay a fixed portion of employees’ salary  towards superannuation. In this article we suggest that the unremitting  government policy of coercing money towards superannuation is flawed. Superannuation is wrong at two levels. First, on an economic analysis, the evidence does not suggest that (i) individuals who invest in superannuation are necessarily better off than those who apply their income elsewhere; and (ii) there is no evidence that absent a coercive superannuation scheme the government will be unable to sustain people into their old age. Second, at the human and societal level, studies of human well-being show that coercing people to make spending decisions is inimical to human happiness. People flourish best when they are in control of their activities, including their finances. Left to their own devices, many people will not save for a rainy day; however, on balance it is probably better off to be a bit poorer in retirement than to have been deprived of the opportunity to spend 9% of one’s income over the period of one’s working life – when one’s needs are the greatest. Compulsory superannuation should be abolished. Money currently paid as a compulsory superannuation contribution should instead be paid to the employee as a salary.

Lifetime sport and leisure activity participation is associated with greater bone size, quality and strength in older men

Introduction: It remains uncertain whether long-term participation in regular weight-bearing exercise confers an advantage to bone structure and strength in old age. The aim of this study was to investigate the relationship between lifetime sport and leisure activity participation on bone material and structural properties at the axial and appendicular skeleton in older men (>50 years).

Methods: We used dual-energy X-ray absorptiometry (DXA) to assess hip, spine and ultradistal (UD) radius areal bone mineral density (aBMD) (n=161), quantitative ultrasound (QUS) to measure heel bone quality (n=161), and quantitative computed tomography (QCT) to assess volumetric BMD, bone geometry and strength at the spine (L₁–L₃) and mid-femur (n=111). Current (>50+ years) and past hours of sport and leisure activity participation during adolescence (13–18 years) and adulthood (19–50 years) were assessed by questionnaire. This information was used to calculate the total time (min) spent participating in sport and leisure activities and an osteogenic index (OI) score for each participant, which provides a measure of participation in weight-bearing activities.

Results: Regression analysis revealed that a greater lifetime (13–50+ years) and mid-adulthood (19–50 years) OI, but not total time (min), was associated with a greater mid-femur total and cortical area, cortical bone mineral content (BMC), and the polar moment of inertia (I _p) and heel VOS (p ranging from <0.05 to <0.01). These results were independent of age, height (or femoral length) and weight (or muscle cross-sectional area). Adolescent OI scores were not found to be significant predictors of bone structure or strength. Furthermore, no significant relationships were detected with areal or volumetric BMD at any site. Subjects were then categorized into either a high (H) or low/non-impact (L) group during adolescence (13–18 years) and adulthood (19–50+ years) according to their OI scores during each of these periods. Three groups were subsequently formed to reflect weight-bearing impact categories during adolescence and then adulthood: LL, HL and HH. Compared to the LL group, mid-femur total and cortical area, cortical BMC and I _p were 6.5–14.2% higher in the HH group. No differences were detected between the LL and HL groups.

Conclusions: In conclusion, these findings indicate that long-term regular participation in sport and leisure activities categorized according to an osteogenic index [but not the total time (min) spent participating in all sport and leisure activities] was an important determinant of bone size, quality and strength, but not BMD, at loaded sites in older men. Furthermore, continued participation in weight-bearing exercise in early to mid-adulthood appears to be important for reducing the risk of low bone strength in old age.

The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.

Effectiveness of staff training programs for behavioral problems among older people with dementia

This paper reviewed studies on staff training programs to address the behavioral problems associated with dementia among older people in residential care. The papers were classified according to whether or not the studies included a control group in the research design. The results of the review demonstrate that there has been a wide range of psychosocial and educational interventions to reduce behavioral problems among older people with dementia, with inconsistent results being obtained. However, many of these studies suffer from problems in their research design that make it difficult to evaluate their effectiveness. Problems in conducting research in the nursing home setting are highlighted, and suggestions for future research in this area are discussed.

The evidence that exercise during growth or adulthood reduces the risk of fragility fractures is weak

There has never been, and will never be, a randomized double-blind placebo-controlled trial demonstrating that exercise in youth, adulthood or old age reduces fragility or osteoporosis-related fractures in old age. The next level of evidence, a randomized, controlled but unblinded study with fractures as an end-point is feasible but has never been done. The basis for the belief that exercise reduces fractures is derived from lower levels of ‘evidence’, namely, retrospective and prospective observation cohort studies and case–control studies. These studies are at best hypothesis generating, never hypothesis testing. They are all subject to many systematic biases and should be interpreted with extreme scepticism. Surrogate measures of anti-fracture efficacy are the next level of evidence, such as the demonstration of a reduction in risk factors for falls, a reduction in falls, a reduction in fractures due to falls, an increase in peak bone size and mass, prevention of bone loss in midlife and restoration of bone mass and structure in old age.

Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder.  Methods: The annual equivalent costs and consequences of a   biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99–400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

Environmental risk factors of young onset Parkinson`s disease: a case-control study

While the cause of Parkinson's disease (PD) remains unknown, recent evidence suggests certain environmental factors, such as well water drinking, herbicides and pesticides exposure, and neurotoxins, may trigger the chain of oxidative reactions culminating in the death of dopaminergic neurons in substantia nigra to cause parkinsonism. Most studies to date focused on PD with old age onset. However, there is a peculiar group of parkinsonian patients, the young onset Parkinson's disease (YOPD), in whom the age of onset is before 40. It is intriguing to know whether earlier exposure to the putative neurotoxin(s) may contribute to the earlier onset. We therefore conducted this case-control study in which 60 PD patients, 30 YOPD patients and the same number of age- and sex-matched young controls were included. Using logistic regression, we found well water drinking and head injury were risk factors for the development of YOPD. When YOPD patients were compared with PD, we found head injury and exercise were the significant predictors. Keeping all other variables constant, head injury was a risk factor and exercise appeared to be a protective factor. We conclude early exposure to well water drinking and head trauma may trigger and expedite the appearance of parkinsonian features, but such acceleration may be prevented through regular exercise.