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Hastings Center Report

Tia Powell
In writing these essays, we were asked to consider, "What makes a good life in late life?" I thought instantly, perhaps like many people, of photos and stories of older people taking up new careers and new hobbies-running marathons and soup kitchens, starting organic farms. This response is right and proper. Older people can leverage wisdom and creativity to make wonderful contributions to their communities and should be celebrated for doing so. But this happy picture is incomplete. We live longer than ever before, and with that long life, many of us can expect disability...
September 2018: Hastings Center Report
Amanda Grenier, Christopher Phillipson
Population aging and longevity in the context of declining social commitments raise concerns about disadvantage, inequality, and the well-being of older people. In this short piece, we use the concept of precarity as a lens to understand new and sustained forms of insecurity that affect late life, and we illustrate how these risks, when experienced over time and in relation to conditions such as austerity, can deepen disadvantage.
September 2018: Hastings Center Report
Jennifer Molinsky, Ann Forsyth
At any age, the pursuit of a good life is easier in a physical environment that promotes health, supports activities important to self-fulfillment, and facilitates connections to the larger community. In old age, the home and neighborhood environments are particularly important: they are the locations where older people spend most their time, and they can have a great impact on independence, social connection, feelings of self-worth, and physical and emotional well-being. Within the urban planning field, home and neighborhood characteristics are important dimensions of debates about the measurement of human progress and quality of life, particularly as an alternative to purely economic measures...
September 2018: Hastings Center Report
Joel Michael Reynolds
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...
September 2018: Hastings Center Report
Bonnie Steinbock, Paul T Menzel
Aid-in-dying laws in the United States have two important restrictions. First, only patients who are terminally ill, defined as having a prognosis of six months or less to live, qualify. Second, at the time the patients take the lethal medication, they must be competent to make medical decisions. This means that an advance directive requesting aid in dying for a later time when the patient lacks decision-making capacity would be invalid. However, many people are more concerned about avoiding living into severe dementia for years-a time when they will lack decision-making capacity-than they are about preventing suffering or the loss of dignity or autonomy for a few months at the end of life...
September 2018: Hastings Center Report
Bruce Jennings
Aging brings about the ordeal of coping. Younger people also cope, but for those in old age, the ordeal is so often elegiac, forced upon the self by changing functions within the body and by the outside social world, with its many impediments to the continuity of former roles, pursuits, and self-identities. Coping with change can be affirming, but when what is being forgone seems more valuable than what lies ahead, it is travail. For most, the coping is managed more moderately by a sense of resignation. This is especially true for those who survive into profound old age, when one is viewed as if being old is one's essential identity and nature...
September 2018: Hastings Center Report
Michael K Gusmano, Kieke G H Okma
Many older people need external support for their daily living. A large minority of older adults with low or modest pension incomes face financial strains from the high cost of illness, and many older people in urban areas live in social isolation. Indeed, population aging has become a policy topic of concern. The policy debate since the end of the twentieth century about the future of public pensions and health and long-term care programs has increasingly framed the growing numbers of older people in alarmist terms...
September 2018: Hastings Center Report
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September 2018: Hastings Center Report
Tom Walker
We are living through a demographic transition from a world in which there were lots of young people and very few older adults to one in which the numbers in these age groups are becoming more evenly balanced. One reason for this is that more of us are living into our seventies, eighties, nineties, and beyond. That is the good news. Unfortunately, the chance of developing chronic illnesses (including diabetes, arthritis, and dementia) is typically higher for people in these older age groups than for those who are younger...
September 2018: Hastings Center Report
Michael Dunn
One central and unfortunately unavoidable characteristic of the aging process is its association with chronic physiological deterioration. Frailty, cognitive impairment, and physical conditions such as cardiovascular disease and vision and hearing loss are more frequent in this phase of life, and these conditions translate into an increasing need for care and support of multiple kinds. In traditional bioethical scholarship, these distinctive features of aging have been examined predominantly through a health-focused lens...
September 2018: Hastings Center Report
Lauren A Taylor
The health policy community has a growing interest in the impact of nonmedical determinants of health, such as housing, nutrition, and social supports, on both health outcomes and costs. This interest has been spurred by the Affordable Care Act's emphasis on prevention, Robert Wood Johnson's grant-making focus on a Culture of Health, and an uptick of research demonstrating the potential returns to health care from investments in social services. Much of this policy-making, grant making, and research has focused on older Americans...
September 2018: Hastings Center Report
Nancy Berlinger, Mildred Z Solomon
The ethical dimensions of an aging society are larger than the experience of chronic illness, the moral concerns of health care professionals, or the allocation of health care resources. What, then, is the role of bioethics in an aging society, beyond calling attention to these problems? Once we've agreed that aging is morally important and that population-level aging across wealthy nations raises ethical concerns that cannot be fixed through transhumanism or other appeals to transcend aging and mortality through technology, what is our field's contribution? We argue that it is time for bioethics to turn toward social justice and problems of injustice and that part of doing so is articulating a concept of good citizenship in an aging society that goes beyond health care relationships...
September 2018: Hastings Center Report
(no author information available yet)
No abstract text is available yet for this article.
September 2018: Hastings Center Report
Emily A Greenfield
Discourse on communities and aging traditionally has focused on the availability, accessibility, and quality of local services to support older adults in need of assistance. More recently, however, a growing worldwide "age-friendly" movement has pushed the conceptualization of community supports for an aging society beyond service provision. The term "age friendly" is used in considering how various aspects of a community facilitate or impede the health and well-being of individuals as they experience long lives...
September 2018: Hastings Center Report
Paul Osterman
The American system of long-term care is disorganized and expensive. Obtaining care for a loved one is a confusing and difficult journey. When it comes to paying for that care, a bit over half who receive care are supported at least partially by insurance, and those with no insurance pay entirely out of pocket. The costs are exorbitant. What makes the system function is reliance on unpaid family members, who care for their loved ones often at considerable cost to themselves. As the baby boom generation ages, this creaky system will become increasingly dysfunctional, and a likely shortage of caregivers will be at the heart of the difficulties...
September 2018: Hastings Center Report
Kate de Medeiros
I am a social gerontologist, broadly defined as a social scientist who studies how later life is experienced, structured, and controlled in a society and in social settings. Although gerontology is often confused with geriatrics (a medical specialty), gerontologists are typically not clinicians but may study issues related to old age and health care such as the societal conditions that shape how medical care is provided and financed and how early exposure to education relates to later life health. In this essay, I argue that thinking like a gerontologist is important when considering what makes a good life in late life...
September 2018: Hastings Center Report
Emi Kiyota
Working with elders around the world has taught me that those living in grass huts in Africa with children at their feet are often happier than people in assisted-living homes with a chandelier over their heads. My work in design consultancy and in fifteen years of running a nonprofit, Ibasho, that aims to co-create socially integrated and sustainable communities that value their elders has allowed me to learn much about how architects and designers can contribute to helping people live a good life in late life...
September 2018: Hastings Center Report
Daniel Callahan
I live on a short street in a small town, Hastings-on-Hudson, some fifteen miles up the Hudson River from New York City. Over the past decade a number of families have moved in, with about sixteen children among them. More than a bit housebound now because of old age and watching them romping about, I try to imagine what their world will be like when they have reached my present age, some eighty years from now. But I have a problem. I just can't imagine it. The demographic changes now appearing on the horizon will force unforeseeable changes...
September 2018: Hastings Center Report
Patricia Illingworth
In his well-researched new book, Solidarity and Justice in Health and Social Care, Ruud ter Meulen traces the history of the concept of solidarity and describes the important role that it can play in health care. He contrasts solidarity with other normative concepts, such as autonomy and justice. According to ter Meulen, solidarity entails a commitment and willingness to help others who are "in need of it due to circumstances out of their control" (p. 170). Thus, solidarity exists when people act for the sake of other people who are vulnerable in some way...
September 2018: Hastings Center Report
Emily A Largent, Holly Fernandez Lynch, Matthew S McCoy
To ensure that the information resulting from research is relevant to patients, the Patient-Centered Outcomes Research Institute eschews the "traditional health research" paradigm, in which investigators drive all aspects of research, in favor of one in which patients assume the role of research partner. If we accept the premise that patient engagement can offer fresh perspectives that shape research in valuable ways, then at least two important sets of questions present themselves. First, how are patients being engaged-and how should they be engaged? Second, which patients are being engaged-and which patients should be? This set has received relatively less attention, and the neglect is surprising, given that the "who" question is conceptually prior to the question of "how...
September 2018: Hastings Center Report
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