Aging

The effective altruism movement aims to save lives in the most cost-effective ways. In the future, technology will allow radical life extension, and anyone who survives until that time will gain potentially indefinite life extension. Fighting aging now increases the number of people who will survive until radical life extension becomes possible. We suggest a simple model, where radical life extension is achieved in 2100, the human population is 10 billion, and life expectancy is increased by simple geroprotectors like metformin (...) or nicotinamide mononucleotide by three more years on average, so an additional 750 million people survive until “immortality”. The cost of clinical trials to prove that metformin is a real geroprotector is $65 million. In this simplified case, the price of a life saved is around eight cents, 10 000 times cheaper than saving a life from malaria by providing bed nets. However, fighting aging should not be done in place of fighting existential risks, as they are complementary causes. (shrink)

Does a single mechanism of aging exit? Most scientists have their own pet theories about what is aging, but the lack of generally accepted theory is mind-blowing. Here we suggest an explanation: evolution works against unitary mechanism of aging because it equalizes ‘warranty period’ of different resilience systems. Therefore, we need life-extension methods that go beyond fighting specific aging mechanisms: such as using a combination of geroprotectors or repair-fixing bionanorobots controlled by AI.

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM's goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion; while others think that HPM's practices should, like all other branches of medicine, aim at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that (...) if HPM's practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM's practices were to aim at health. According to the ars moriendi, flourishing at the end of one's life requires that one exercise her agency and pursue the goods most important to her. On this view, HPM's practices should promote patients’ health to enable them to pursue these goods. (shrink)

Philosophers have become newly interested in the ethics of sex. One promising feature of this new discussion is that it has been broadening our moral lens to include individuals whose sexual interests have historically been denied or ignored. One such group is the elderly. Contrary to popular belief, many elderly people want to have sex and see it as a regular part of their lives. If society harbors ignorance about or prejudice against elderly sexuality, it harbors stronger views against the (...) sexual expression of elderly people with dementia. People with dementia are often prohibited by nursing‐home staff, sometimes in extreme ways, from having sex with their partners. This prohibition is at least partly motivated by the goal of protecting the vulnerable. However, cutting people with dementia off from sex has negative health effects and is a needless restriction of their autonomy. In this article, I argue that the expanding moral lens in sexual ethics should include the sexual expression of elderly individuals with dementia and that their sexual expression should be respected. Specifically, I argue that many people with dementia are competent to consent to sexual activity with their long‐term partners. (shrink)

To assess the perception regarding the quality of life, a qualitative study was conducted on 20 old people of balance gender in Dhaka, Bangladesh. Most of the participants of our study were upper poor class and literate. Male participants were a little higher than females. The majority were between 60 and 65years. They were significantly more active, independent, and took part in productive work contributing in the country’s economy, and had significantly greater decision power than other age group. Quality of (...) life of the elderly is related to physical and, economical wellbeing and coping mechanism during old age. The government of Bangladesh has taken varying degrees of initiative to improve the elder condition, but that was not publicized well. Old age Allowance should be increased to BDT 5000/ ($50). Family attachment and emotional support is also related to the self-assurance, self-respect, and self-drive of the elderly. Parent's Care Act 2013 should be implemented for retrospective care of seniors. (shrink)

This chapter summarizes the conceptual foundations and research on emotional creativity. Emotional creativity is defined as a pattern of cognitive abilities and personality traits related to originality and appropriateness in emotional experience. This construct pervades human creative performance and represents an important link between emotional experience and cognitive processes. Empirical research in this field has revealed various links of emotional creativity to personality variables (e.g., openness to experience), positive affect, fantasy proneness, coping strategies, post-traumatic growth, better self-understanding, and one’s engagement (...) in practicing creative leisure activities. In the applied settings, emotional creativity has been found to be positively related to the intrinsic motivation of employees, the innovative performance of employees, teaching efficacy, and an increased awareness of professional roles. Interestingly, the available meta-analysis of past studies revealed that women showed significantly higher emotional creativity than men. Emotional creativity has also been found to be lower in older adulthood compared to younger age. Because the levels of emotional creativity were found to be sensitive to the decline of cognitive functions in older adults, their decrease can be considered as one of the indicators of cognitive aging. Recent research in clinical neuropsychology has also revealed that older adults in the early stages of Parkinson’s disease showed decreased emotional creativity compared to healthy older adults. (shrink)

Podstawowym założeniem artykułu jest uznanie, że złożoność wyzwań związanych ze starzeniem się populacji wymusza rozwój powiązań kooperacyjnych między podmiotami polityki publicznej reprezentującymi różne sektory. Innymi słowy: niezbędna jest bardziej intensywna i lepiej skoordynowana współpraca między organizacjami sektora publicznego, komercyjnego, pozarządowego, nieformalnego oraz sektora obejmującego podmioty gospodarki społecznej (np. spółdzielnie). Zasadnicze znaczenie ma w tym kontekście wdrażanie założeń teorii współzarządzania (governance), koprodukcji oraz mieszanej gospodarki dobrobytu (inaczej: wielosektorowej polityki społecznej). W konsekwencji artykuł wskazuje na wybrane wątki dyskursu dotyczącego relacji procesu starzenia (...) się ludności z przedsiębiorczością społeczną i innowacjami społecznymi. Tekst przytacza także przykłady dobrych praktyk i inicjatyw z obszaru gospodarki społecznej. Podsumowanie zawiera rekomendacje dla podmiotów polityki publicznej oraz proponowane kierunki dalszych badań. (shrink)

After expounding the conceptions of harmony that are central to Confucianism and the sub-Saharan ethic of ubuntu, I apply them to three major topics pertaining to age, namely, virtue, the value of life, and care. Roughly speaking, indigenous East Asian and African values of harmony both entail that only the elderly can be truly virtuous, that the elderly have a strong claim to life-saving resources, and that they are entitled to care from their children, views that I show are not (...) characteristic of moral thinking in the contemporary West, neither for prominent philosophies nor the cultures out of which they grew. I suggest that many Anglophone moral philosophers should be given pause by the existence of different perspectives on the part of at least two long-standing philosophies, and conclude by briefly proposing some ways that cross-cultural debate might be undertaken in the future. (shrink)

[This piece is written for those working in social gerontology and aging studies, with the aim of bringing insights from disability studies and philosophy of disability to bear on enduring debates in those fields.] The guiding question of humanistic age-studies—What does it mean to grow old?—cannot be answered without reflecting on disability. This is not simply because growing old invariably means becoming impaired in various ways, but also because the discriminations and stigmas involved in ageism are often rooted in ableism. (...) We here draw on research in the philosophy of disability as well as the interdisciplinary field of disability studies to explore the relationship between ageism and ableism. (shrink)

Dans notre société de plus en plus digitalisée, avons-nous vraiment le choix d’adopter ou non les technologies? Comment cette digitalisation impacte-t-elle les personnes âgées en particulier et son écosystème? Quels sont les enjeux éthiques soulevés par cette digitalisation? Ce texte vise à amener des éléments de réflexions en lien avec ces enjeux selon le point de vue de divers experts des domaines de la technologie, du vieillissement et de la bioéthique. Ces experts se sont rencontrés lors d’un symposium ayant eu (...) lieu à Angers, France, en octobre 2019. Le texte est un compte-rendu des échanges et points de vue de ces experts, ainsi que des discussions ouvertes qu’ils ont eues avec l’assistance, portant sur les principaux enjeux soulevés par cette digitalisation selon la perspective des personnes âgées, des proches-aidants, des soignants, de la société et de la recherche. (shrink)

Boredom has dominated discussions about longevity thanks to Bernard Williams’s influential “The Makropulos Case.” I reveal the presence in that paper of a neglected, additional problem for the long-lived person, namely alienation in the face of unwanted change. Williams gestures towards this problem but does not pursue it. I flesh it out on his behalf, connecting it to what I call the ‘curmudgeonly attitude to change.’ This attitude manifests itself in the tendency, amongst those getting on in years, to observe (...) that things are getting worse. Curmudgeonliness is typically met with dismissal because it often concerns changes that don’t radically inhibit the curmudgeon’s well-being or autonomy. I believe that taking the curmudgeonly attitude more seriously will provide insight into the longer-lived self and its relation to the future. Using Williams’s approach to longevity as the framework, I contend that—as with boredom—a sense of alienation born of curmudgeonliness can become terminal for the subject, rendering her unable to envision the future as a site of worthwhile activity. However, I also uncover ways in which this agential stasis is significantly distinct from boredom and constitutes a different worry and a different risk for the long-lived individual. (shrink)

There is a certain metaphor that has enjoyed tremendous longevity in the evolution of ageing literature. According to this metaphor, nature has a certain goal or purpose, the perpetuation of the species, or, alternatively, the reproductive success of the individual. In relation to this goal, the individual organism has a function, job, or task, namely, to breed and, in some species, to raise its brood to maturity. On this picture, those who cannot, or can no longer, reproduce are somehow invisible (...) to, or even dispensable to, the evolutionary process. Here, I argue that the metaphor should be discarded, not on the grounds that it is a metaphor, but on the grounds that this particular metaphor distorts our understanding of the evolution of ageing. One reason the metaphor is problematic is that it frames senescence and death as nature’s verdict on the value of older individuals. Instead, we should explore a different metaphor: the lengthy post-reproductive period in humans and some other animals is not an accident of culture, but designed by nature for the purpose of supporting and guiding younger generations. On this alternate picture, different stages of life have their own evolutionary rationales, their distinctive design features, their special mandates. (shrink)

Aging is accompanied by changes in general cognitive functioning which may impact the learning rate of older adults; however, this is often not controlled for in cognitive aging studies. We investigated the contribution of differences in learning rates to age-related differences in landmark knowledge acquired from route learning. In Experiment 1 we used a standard learning procedure in which participants received a fixed amount of exposure to a route. Consistent with previous research, we found age-related deficits in associative cue and (...) landmark sequence knowledge. Experiment 2 controlled for differences in learning rates by using a flexible exposure learning procedure. Specifically, participants were trained to a performance criterion during route learning before being tested on the content of their route knowledge. While older adults took longer to learn the route than younger adults, the age-related differences in associative cue knowledge were abolished. The deficit in landmark sequence knowledge, however, remained. Experiment 3 replicated these results and introduced a test situation in which a deficit in landmark sequence knowledge yielded an increased likelihood of disorientation in older adults. The findings of this study suggest that age-related deficits in landmark associative cue knowledge are attenuated by controlling for learning rates. In contrast, landmark sequence knowledge deficits persist and are best explained by changes in the learning strategy of older adults to acquire task essential associative cue knowledge at the expense of supplementary sequence knowledge. (shrink)

The COVID-19 pandemic has forced clinicians, policy-makers and the public to wrestle with stark choices about who should receive potentially life-saving interventions such as ventilators, ICU beds and dialysis machines if demand overwhelms capacity. Many allocation schemes face the question of whether to consider age. We offer two underdiscussed arguments for prioritising younger patients in allocation policies, which are grounded in prudence and fairness rather than purely in maximising benefits: prioritising one’s younger self for lifesaving treatments is prudent from an (...) individual perspective, and prioritising younger patients works to narrow health disparities by giving priority to patients at risk of dying earlier in life, who are more likely to be subject to systemic disadvantage. We then identify some confusions in recent arguments against considering age. (shrink)

Ageing is one of the main risk factors for Covid-19. In this paper, we delineate four alternative conceptualisations of ageing, each of which determines different understandings of its causal role to the susceptibility to Covid-19 as well as to the severity of its symptoms and adverse health outcomes.

Aging is an integral part of human existence. The problem of aging addresses the most fundamental coordinates of our lives but also the ones of the phenomenological method: time, embodiment, subjectivity and intersubjectivity, and even the social norms that grow into the very notion of aging as such. In my article, I delineate a phenomenological analysis of aging and show how such an analysis connects with the debate concerning personal identity: I claim that aging is not merely a physical process, (...) but is far more significantly also a spiritual one as the process of aging consists in our awareness of and conscious relation to our aging. This spiritual process takes place on an individual and on a social level, whereas the latter is the more primordial layer of this experience. This complicates the question of personal identity since it will raise the question in two ways, namely who I am for myself and who I am for the others, and in a further step how the latter experience shapes the former. However, we can state that aging is neither only physical nor only spiritual. It concerns my bodily processes as it concerns the complex reflexive structure that relates my former self with my present and even future self. (shrink)

Due to the increasingly heterogeneous trajectories of aging, gerontology requires theoretical models and empirical methods that can meaningfully, reliably, and precisely describe, explain, and predict causes and effects within the aging process, considering particular contexts and situations. Human behavior occurs in contexts; nevertheless, situational changes are often neglected in context-based behavior research. This article follows the tradition of environmental gerontology research based on Lawton’s Person-Environment-Interaction model and the theoretical developments of recent years. The authors discuss that, despite an explicit time (...) component, current P-E models could be strengthened by focusing on detecting P-E interactions in various everyday situations. Enhancing Lawton’s original formula via a situationally based component not only changes the theoretical perspectives on the interplay between person and environment but also demands new data collection approaches in empirical environmental research. Those approaches are discussed through the example of collecting mobile data with smartphones. Future research should include the situational dimension to investigate the complex nature of person environment interactions. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, and (...) health policy discuss if age should guide rationing decisions. (shrink)

Pandemic-related restrictions can be especially tragic for people whose lives are ending; it seems that the needs and desires of people who are dying should be given extra consideration. Given an additivist view of well-being, however, the last weeks of a person's life can only matter so much relative to the rest of the life they had. This article reflects on the end of my mother's life during the Covid-19 pandemic in order to make the case that the additive view (...) of well-being is part of a broader trend of dehumanizing emergency ethics. (shrink)

Tamamlayıcı ve alternatif tıp (TAT) uygulamaları temel tıbbi tedaviye ek ya da temel tıbbi tedavinin yerine kullanılan, uygulamaları genelde konvansiyonel tıp tarafından tedavi olarak kabul edilmeyen çeşitli tıbbi ve sağlık bakım sistemi, pratikleri ve ürünleri olarak tanımlanmaktadır (Hossein et al., 2014, Amira ve Okubadejo, 2007; National Institutes of Health [NIH], 2018). TAT konusunda yapılan araştırmalar Afrika, Asya ve Latin Amerika gibi gelişmemiş ya da gelişmekte olan ülkelerde hastaların bazı tedavi ihtiyaçlarını karşılamak amacıyla geleneksel uygulamalara başvurmaları doğrultusunda geleneksel tıp teriminin tamamlayıcı (...) ve alternatif tıpa karşılık gelecek şekilde kullanıldığını da göstermektedir. (shrink)

Wenn eine Person unter einer tödlichen Krankheit leidet und nicht über die Ressourcen für eine medizinische Behandlung verfügt, sind wir normalerweise dazu verpflichtet, ihr die notwendigen Ressourcen bereitzustellen. Wären wir aber in einem biotechnischen Zukunftsszenario, in dem die menschliche Lebensspanne durch Eingriffe in den Alterungsprozess erhöht werden kann, auch dazu verpflichtet, anderen Personen die notwendigen Ressourcen für solche Maßnahmen bereitzustellen? John Harris hat argumentiert, dass wir zu solch einer direkten biotechnischen Lebensverlängerung verpflichtet wären, da ein Leben zu verlängern das Gleiche (...) sei, wie ein Leben zu retten. Im vorliegenden Aufsatz wird gezeigt, dass Harris’ Argument nicht schlüssig ist, da entgegen seiner Prämisse ein begrifflicher Unterschied zwischen der Rettung und der Verlängerung eines Lebens besteht. Auf Grundlage von Harris’ zurückgewiesenem Argument werden dann aber zwei alternative Argumente für eine (prima facie) Pflicht zur direkten Lebensverlängerung konstruiert. Das erste Argument basiert auf der Überlegung, dass durch eine direkte biotechnische Lebensverlängerung trotz des begrifflichen Unterschieds mit einer substanziellen Wahrscheinlichkeit Leben gerettet werden würden. Das zweite Argument besagt, dass trotz deskriptiver Unterschiede eine moralische Äquivalenz zwischen der Rettung und der Verlängerung eines Lebens besteht, sofern durch die bloße Lebensverlängerung das Leben um die gleiche Dauer und Qualität verlängert wird wie durch die Lebensrettung. ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- When a person suffers from a deadly disease and is lacking the resources for a medical treatment, we are normally obliged to provide the necessary resources. But would we also be morally obliged to provide the resources for an extension of someone’s lifespan through anti-aging treatments which might be developed due to biotechnological progress? John Harris has argued that there would be an obligation to such a direct biotechnical life extension because extending a life is the same as saving a life. In the present paper, it will be shown that Harris’ argument is not sound since, contrary to his premise, there is a conceptual difference between extending and saving a life. On the basis of Harris’ rejected argument, though, two alternative arguments for a (prima facie) obligation to direct biotechnical life extension will be developed. The first argument is based on the idea that, despite the conceptual difference, one saves someone’s life with a substantial probability when extending it by direct biotechnical means. In the second argument, it will be argued that there is a moral equivalence between extending and saving someone’s life despite the descriptive differences as far as the additional lifetime has the same duration and quality in both cases. (shrink)

Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding who (...) gets scarce vital organs, I remind the readers that using chronological age as a proxy is problematic as well. Using age as a proxy could give wrong results and it is better, if possible, for states to use the vital information directly than use age as a proxy. (shrink)

Physical exercise is seen as the main ally for health promotion, preventing and protecting the organism from several diseases. According to WHO, there is a tendency of constant growth in the elderly population in the coming years. The regular practice of exercises by the elderly becomes relevant to minimize the deleterious effects of the aging process and to increase the fitness index. Recently, the world population started a confrontation against Corona Virus Disease (COVID-19), which is the most significant public health (...) challenge globally. Although social isolation is a reasonable measure in an attempt to stop contamination by COVID-19, this measure has limited the ability of individuals to exercise outdoors or in gyms and health clubs, which increased the risk of developing chronic illnesses related to a sedentary lifestyle. The critical point is that the recent recommendations on exercise prescription to combat the potentially harmful effects of COVID-19 failure to adequately address resistance exercise interventions as home-based exercise strategy. Thus, in this paper, we discussed the physical exercise as medicine if the training status is enough to protect the elderly against COVID-19 infection, about the role of physical activity on immunosuppression. Possible risks for COVID-19 infection, and the old training methods, such as no-load resistance training as possible resistance exercise strategies and high-intensity interval training, as new proposals of home-based exercise interventions, could perform during the current COVID-19 pandemic. (shrink)

This paper focuses on the question what constitutes aging with dignity. I argue that it is not least our lack of willingness to grant old age its own place in life that makes older people vulnerable for violations of their dignity. In this sense, dignity can also be a question of the correct anthropology.

In this paper, I answer the following question: suppose that two individuals, C and D, have been in a long-term committed relationship, and D now has dementia, while C is competent; if D agrees to have sex with C, is it permissible for C to have sex with D? Ultimately, I defend the view that, under certain conditions, D can give valid consent to sex with C, rendering sex between them permissible. Specifically, I argue there is compelling reason to endorse (...) the following thesis: -/- Prior Consent Thesis: D, when competent, can give valid prior consent to sex with her competent partner (C) that will take place after she has dementia, assuming that D is the same person as she was when she gave prior consent, meaning that, if D, when competent, gave prior consent to sex with C, then C may permissibly have sex with D. In section I, I explain both the background and the existing literature on this issue. In section II, I outline relevant stipulations about the kinds of cases I will be examining. In section III, I defend the Prior Consent Thesis. And, in section IV, I address objections to the Prior Consent Thesis. (shrink)

Recent disputes over whether older people should pay more for health insurance, or receive lower priority for transplantable organs, highlight broader disagreements regarding the legality of using age-based criteria in health care. These debates will likely intensify given the changing age structure of the American population and the turmoil surrounding the financing of American health care. This Article provides a comprehensive examination of the legality and normative desirability of age-based criteria. I defend a distributive justice approach to age-based criteria and (...) contrast it with two prevailing theoretical approaches to age-based criteria, nondiscrimination and discretion. I propose a detailed normative framework for the use of age-based criteria in health care, the lifetime justice approach, that considers the future life patients can gain from treatment and the past years of life they already have experienced. -/- This paper is available by open access from the Boston College Law School Digital Commons. (shrink)

My ambition in this paper is to provide an account of an unacknowledged example of blameless guilt that, I argue, merits further examination. The example is what I call carer guilt: guilt felt by nurses and family members caring for patients with palliative-care needs. Nurses and carers involved in palliative care often feel guilty about what they perceive as their failure to provide sufficient care for a patient. However, in some cases the guilty carer does not think that he has (...) the capacity to provide sufficient care; he has, in his view, done all he can. These carers cannot legitimately be blamed for failing to meet their own expectations. Yet despite acknowledging their blamelessness, they nonetheless feel guilty. My aims are threefold: first, to explicate the puzzling nature of the carer guilt phenomenon; second, to motivate the need to solve that puzzle; third, to give my own account of blameless guilt that can explain why carers feel guilty despite their blamelessness. In doing so I argue that the guilt experienced by carers is a legitimate case of guilt, and that with the right caveats it can be considered an appropriate response to the progressive deterioration of someone for whom we care. (shrink)

Insofar as many older adults fit some definition of disability, disability studies and gerontology would seem to have common interests and goals. However, there has been little discussion between these fields. The aim of this paper is to open up the insights of disability studies as well as philosophy of disability to discussions in gerontology. In doing so, I hope to contribute to thinking about the good life in late life by more critically reflecting upon the meaning of the body, (...) ability, and the variability of each. My central argument is that we should conceptualize age‐associated bodily variations and abilities not in terms of individual capacity, but in terms of what I call “the extended body.” It is in light of the meaning of embodiment and ability in general that we must think differently and more capaciously about the meaning of late life in particular. (shrink)

One of the most threatening effects of dementia is the experience of forgetting or losing one’s self. How can patients and their caregivers cope with this experience? Based on the example of Arno Geiger’s narrative about his father this paper suggests aiming at a joint re-interpretation of the patient’s personality. For this purpose it is essential to respect the patient as a person with practical significance.

Perspectives on old age are characterized by an antinomy of veneration and contempt. This paper explores how this antinomy is spelled in philosophical discourses and how it intersects with the antithesis of fool and sage. According to a Platonist or Antiochean account of ontogenesis, an individual’s development is conceived as an approximate instantiation of an ideal form of “man,” which tends to divide old people into successes and failures. In contrast to this, the Stoic theory of oikeiōsis envisages a continuous (...) process of self-constitution and self-integration that allows for continuous progress and a fundamental reorientation at any age. The elderly and ailing Stoic thus exemplifies not resignation but hope, that it is never too late to turn one’s life into a success story. (shrink)

It seems interesting to find out how the situation of the Polish ART practice is reflected in the medical students’ opinions. To answer this question we carried out a two-stage research adopting a data-driven methodology based upon the grounded theory, in which we collected a mixture of quantitative and qualitative data. Our study has revealed students’ high acceptance of IVF and most of the additional procedures, except for IVF in the case of women over 40 and postmenopausal ones. The students’ (...) main concerns were to be compatible with what is presented in medical literature and commonly accepted in medical practice, so the core categories they focused on in their argumentation were medical evidence and medical standards. Whereas the students were consistently trying to ground their reasoning on medical knowledge, their opinions reflected not only statements based on hard data, but also some gender stereotypes hidden in medical literature. (shrink)

Ronald Dworkin argued that Advance Directives informed by a principle of autonomy ought to guide decisions in relation to the treatment of those in care for dementia. The principle of autonomy in play presupposes a form of competence that is tied to the individual person making the Directive. This paper challenges this individualist assumption. It does so by pointing out that the competence of a patient is inherently relational, and the key illustrative case to make this point is the case (...) of music therapy. In music therapy, a relatively recent treatment modality in aged care, patients previously thought to be permanently unresponsive are shown on the contrary to be capable of significant levels of social agency. The conclusion to draw is that Advance Directives that fail to acknowledge the real possibility of such relational competence are misapplied. (shrink)

During the late 20thcentury numerical rating scales became central to the diagnosis of dementia and helped transform attitudes about its causes and prevalence. Concentrating largely on the development and use of the Blessed Dementia Scale, I argue that rating scales served professional ends during the 1960s and 1970s. They helped old age psychiatrists establish jurisdiction over conditions such as dementia and present their field as a vital component of the welfare state, where they argued that ‘reliable modes of diagnosis’ were (...) vital to the allocation of resources. I show how these arguments appealed to politicians, funding bodies and patient groups, who agreed that dementia was a distinct disease and claimed research on its causes and prevention should be designated ‘top priority’. But I also show that worries about the replacement of clinical acumen with technical and depersonalized methods, which could conceivably be applied by anyone, led psychiatrists to stress that rating scales had their limits and could be used only by trained experts. (shrink)

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walker's meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more autonomy (...) in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powell's story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community. (shrink)

Loss of self is widely regarded to be a consequence of dementia, and this perceived loss presents a variety of problems - not least because a clear understanding of the concept of self is elusive. This paper suggests a way to cut through problems that arise because we rely on conceptions of self in our understanding of the effects of dementia. It is proposed that we can avoid reliance on the concept of self through an approach based in in bio-phenomenology. (...) Such an approach would help us better understand the inner life of those with dementia and assist us to recognize that even in late stage dementia they are semiotic subjects with unique value. (shrink)

Biomedicine is today transforming the human condition, but how such transformation is to be understood is a matter of debate. I seek to contribute to the debate by focusing on recent developments within a relatively novel subfield of gerontology which is engaged in the bio-molecular and bio-demographic characterization of the processes associated with the development of the organism from birth to death. I argue that these developments aid understanding of the conceptual difficulties confronting neo-Darwinian biological thought and poststructuralist social theory (...) as one decentres the organism and the other the subject. (shrink)

Old age in the Indian context and facing it through Ayurveda.

Volume Four, as indicated by the anthology's subtitle, is in honor of Simone de Beauvoir (1908-1986) and Martin Heidegger (1889-1976). The chapters do not necessarily mention Simone de Beauvoir or Martin Heidegger. The 16 chapters (by professional philosophers and other professional scholars) are directed to issues related to death, life extension, and anti-death. Most of the 400-plus pages consist of scholarship unique to this volume. Includes index. -/- -/- The titles of the 16 chapters are as follows: -/- -/- 1. (...) Mechanism, Galileo’s Animale And Heidegger’s Gestell: Reflections On The Lifelessness Of Modern Science by GiorgioBaruchello -/- -/- 2. Simone De Beauvoir by Debra Bergoffen -/- 3. Existentialism by Steven Crowell -/- -/- 4. Time Wounds All Heels by William Grey -/- -/- 5. The Ethical Importance Of Death by Jenann Ismael -/- 6. The Poetics Of Death: Intimations And Illusions by Lawrence Kimmel -/- -/- 7. Death And Aesthetics by Keith Lehrer -/- -/- 8. Ageing And Existentialism: Simone De Beauvoir And The Limits Of Freedom by Shannon M. Mussett -/- -/- 9. Life Extension And Meaning by Carol O’Brien -/- -/- 10. Consciousness As Computation: A Defense Of Strong AI Based On Quantum-State Functionalism by R. Michael Perry -/- -/- 11. Reality Shifts: On The Death And Dying Of Dr. Timothy Leary by Carol Sue Rosin -/- -/- 12. Extraterrestrial Liberty And The Great Transmutation by Charles Tandy -/- -/- 13. A Time Travel Schema And Eight Types Of Time Travel by Charles Tandy -/- -/- 14. Boredom, Experimental Ethics, And Superlongevity by Mark Walker -/- -/- 15. Exopolitics: The Death Of Death by Alfred Lambremont Webre -/- -/- 16. Embryo Cloning: Current State Of The Medical Art And Its Far-Reaching Consequences For Multiple Applications by Panayiotis M.Zavos. (shrink)

Objectives: To investigate whether different methods of obtaining informed consent affected recruitment to a study of delirium in older, medically ill hospital inpatients.Design: Open randomised study.Setting: Acute medical service for older people in an inner city teaching hospital.Participants: Patients 70 years or older admitted to the unit within three days of hospital admission randomised into two groups.Intervention: Attempted recruitment of subjects to a study of the natural history of delirium. This was done by either a formal test of capacity, followed (...) by either a request for consent or an attempt at obtaining assent from a proxy, or a combined informal capacity/consent process.Main outcome measures: Prevalence and severity of delirium, and, as case mix measures, length of hospital stay and destination on discharge.Results: Recruitment of subjects through establishing formal capacity and then informed consent was less successful and, compared with those recruited through the usual combined capacity/consent approach, yielded a sample with less cognitive impairment, lower severity of delirium, lower probability of case note diagnosis of delirium and lower rate of entering a care home.Conclusions: Methods of obtaining informed consent may significantly influence the case mix of subjects recruited to a study of delirium. Stringent testing of capacity may exclude patients with delirium from studies, thus rendering findings less generalisable. A different method is necessary to achieve an ethical balance between respecting autonomy through obtaining adequate informed consent and avoiding sample bias. (shrink)

Phillips & Silverstein (P&S, 2003) have proposed that NMDA-receptor hypofunction is the central reason for impaired cognitive coordination and abnormal gestalt-like perceptual processing in schizophrenia. We suggest that this model may also be applicable to non-pathological (or normal) aging given the compelling evidence of NMDA-receptor involvement during the aging process that results in age-related change in higher-level perceptual performance. Given that such deficits are present in other neurological disorders such as autism, an argument for a systematic assessment of perceptual functioning (...) in these conditions may be posited. (shrink)

This article raises the question of ‘normality’ today and the fracturing of health ideals along new lines of enablement and function. In particular the study asks if ‘functional’ and ‘dysfunctional’ are displacing ‘normal’ and ‘pathological’ as master biopolitical binarisms, and if so, what distinctions can be drawn between them. The discourse of ‘function’ and ‘dysfunction’ is certainly ubiquitous in two areas of research and practice: gerontology and sexology. In the former case ‘functional health’ is linked to successful aging represented by (...) technical tests around activities of daily living (ADLs) and risk-assessment profiles. In the latter case, sexual function and dysfunction have become all-encompassing markers of heterosexual competence, now largely detached from reproductive imperatives, but refashioned as integral to responsible and successful self-management. Presenting examples from both cases, the article concludes that functionality, circulating under the signs of ‘normal’, ‘natural’ and ‘healthy’, furnishes economic, technological, educational, professional, pharmacological and policy fields with a rich intellectual, practical and regulatory resource. (shrink)