Rethinking Health Recommender Systems for Active Aging: An Autonomy-Based Ethical Analysis.

Health Recommender Systems are promising Articial-Intelligence-based tools endowing healthy lifestyles and therapy adherence in healthcare and medicine. Among the most supported areas, it is worth mentioning active aging. However, current HRS supporting AA raise ethical challenges that still need to be properly formalized and explored. This study proposes to rethink HRS for AA through an autonomy-based ethical analysis. In particular, a brief overview of the HRS' technical aspects allows us to shed light on the ethical risks and challenges they might raise on individuals' well-being as they age. Moreover, the study proposes a categorization, understanding, and possible preventive/mitigation actions for the elicited risks and challenges through rethinking the AI ethics core principle of autonomy. Finally, elaborating on autonomy-related ethical theories, the paper proposes an autonomy-based ethical framework and how it can foster the development of autonomy-enabling HRS for AA.

Análisis del concepto de Vejez, por el método Walker y Avant / Análise do conceito de Velhice, pelo método de Walker e Avant / Analysis of the concept of Old Age, by the Walker and Avant method

Objective: To interpret the antecedents, attributes and consequences associated withthe concept of old age by means of Walker & Avant's concept analysis method incorporating theintegrative literature review. Method: study carried out using Walker and Avan's concept analysis. Search strategy in databases: ProQuest, Redalyc, SAGE, Science Direct, Scopus, Medline,Lilacs, Springer, Oxford and Semantic Scholar and keywords: Investigation of aging AND/ORelder AND concept and in Spanish: vejez. Results: the approach to the concept of old ageshould be integrated from the psychological, chronological, biological and social dimensions,since it generates positive and negative changes to assume the stage. Conclusions: Recognizingthat old age does not imply only the time lived in years, the characteristics framed in the psychological dimensions imply the perception of old age, biological the natural process of the humanbeing, social its participation in society, provides an integral vision of the concept for interventions according to individual needs at this stage.(AU)

Objetivo: Interpretar los antecedentes, atributos y consecuencias asociados al conceptode vejez mediante el método de análisis de concepto de Walker & Avant incorporando la revisiónintegradora de literatura. Método: estudio realizado mediante el análisis conceptual de Walker yAvan. Estrategia de búsqueda en bases de datos: ProQuest, Redalyc, SAGE, Science Direct, Scopus,Medline, Lilacs, Springer, Oxford y Semantic Scholar y palabras claves: Investigation of agingAND/OR elder AND concept y en español: vejez. Resultados: el abordaje del concepto de vejezdebe integrarse a partir de las dimensiones psicológica, cronológica, biológica y social, puesto quegenera cambios positivos y negativos para asumir la etapa. Conclusiones: Reconocer que la vejez noimplica únicamente el tiempo vivido en años, las características enmarcadas en las dimensiones psicológica implican la percepción de la vejez, biológica el proceso natural del ser humano, social su participación en la sociedad, aporta una visión integral del concepto para intervenciones acordes alas necesidades individuales en ésta etapa.(AU)

Objetivo: Interpretar os antecedentes, atributos e conseqüências associados ao conceitode velhice utilizando o método de análise conceitual da Walker & Avant incorporando a revisãointegrativa da literatura. Método: estudo realizado utilizando a análise conceitual de Walker eAvan. Estratégia de busca em bancos de dados: ProQuest, Redalyc, SAGE, Science Direct, Scopus, Medline, Lilacs, Springer, Oxford e Semantic Scholar e palavras-chave: Investigação do envelhecimento E/OU ancião E conceito e em espanhol: vejez. Resultados: a abordagem do conceito de velhice deve ser integrada a partir das dimensões psicológica, cronológica, biológica esocial, pois gera mudanças positivas e negativas para assumir o estágio. Conclusões: Reconhecendo que a velhice não implica apenas o tempo vivido em anos, as características enquadradasnas dimensões psicológicas implicam a percepção da velhice, biológico o processo natural do serhumano, social sua participação na sociedade, proporciona uma visão integral do conceito deintervenções de acordo com as necessidades individuais nesta fase.(AU)

Ageism in COVID-Related Newspaper Coverage: The First Month of a Pandemic.

OBJECTIVES: Media sources have consistently described older adults as a medically vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic, yet a lack of concern over their health and safety has resulted in dismissal and devaluation. This unprecedented situation highlights ongoing societal ageism and its manifestations in public discourse. This analysis asks how national news sources performed explicit and implicit ageism during the first month of the pandemic. METHOD: Using content and critical discourse analysis methods, we analyzed 287 articles concerning older adults and COVID-19 published between March 11 and April 10, 2020, in 4 major U.S.-based newspapers. RESULTS: Findings indicate that while ageism was rarely discussed explicitly, ageist bias was evident in implicit reporting patterns (e.g., frequent use of the term "elderly," portrayals of older adults as "vulnerable"). Infection and death rates and institutionalized care were among the most commonly reported topics, providing a limited portrait of aging during the pandemic. The older "survivor" narrative offers a positive alternative by suggesting exceptional examples of resilience and grit. However, the survivor narrative may also implicitly place blame on those unable to survive or thrive in later life. DISCUSSION: This study provides insight for policy makers, researchers, and practitioners exploring societal perceptions of older adults and how these perceptions are disseminated and maintained by the media.

Culture Linked to Increasing Ageism During COVID-19: Evidence From a 10-Billion-Word Corpus Across 20 Countries.

OBJECTIVES: Older adults experience higher risks of getting severely ill from coronavirus disease 2019 (COVID-19), resulting in widespread narratives of frailty and vulnerability. We test: (a) whether global aging narratives have become more negative from before to during the pandemic (October 2019 to May 2020) across 20 countries; (b) model pandemic (incidence and mortality), and cultural factors associated with the trajectory of aging narratives. METHODS: We leveraged a 10-billion-word online-media corpus, consisting of 28 million newspaper and magazine articles across 20 countries, to identify nine common synonyms of "older adults" and compiled their most frequently used descriptors (collocates) from October 2019 to May 2020-culminating in 11,504 collocates that were rated to create a Cumulative Aging Narrative Score per month. Widely used cultural dimension scores were taken from Hofstede, and pandemic variables, from the Oxford COVID-19 Government Response Tracker. RESULTS: Aging narratives became more negative as the pandemic worsened across 20 countries. Globally, scores were trending neutral from October 2019 to February 2020, and plummeted in March 2020, reflecting COVID-19's severity. Prepandemic (October 2019), the United Kingdom evidenced the most negative aging narratives; peak pandemic (May 2020), South Africa took on the dubious honor. Across the 8-month period, the Philippines experienced the steepest trend toward negativity in aging narratives. Ageism, during the pandemic, was, ironically, not predicted by COVID-19's incidence and mortality rates, but by cultural variables: Individualism, Masculinity, Uncertainty Avoidance, and Long-term Orientation. DISCUSSION: The strategy to reverse this trajectory lay in the same phenomenon that promoted it: a sustained global campaign-though, it should be culturally nuanced and customized to a country's context.

Functional Limitations, Social Integration, and Daily Activities in Late Life.

OBJECTIVES: Disability in late life has been associated with increases in receiving care and loss of autonomy. The Disablement Process Model suggests that physical impairments lead to functional limitations that contribute to disabilities in managing household, job, or other demands. Yet, we know surprisingly little about how functional limitations are related to activities throughout the day among community-dwelling adults or the possible moderating role of social integration on these associations. METHODS: Community-dwelling adults (N = 313) aged 65 and older completed a baseline interview assessing their functional limitations, social ties, and background characteristics. Over 5-6 days, they answered questions about daily activities and encounters with social partners every 3 h on handheld Android devices. RESULTS: Multilevel logistic models revealed that functional limitations are associated with an increased likelihood of activities associated with poor health (e.g., TV watching, medical appointments) and reduced likelihood of social activities, or physical activities, chores, or leaving the home. Most moderation analyses were not significant; family and friends did not mitigate associations between functional limitations and daily activities, with the exception of medical appointments. Individuals with functional limitations were more likely to attend medical appointments when with their social partners than when alone. DISCUSSION: This study provided a modest indication that functional limitations in community-dwelling older adults are associated with patterns of activity that may lead to further limitations, disability, or loss of autonomy. Findings warrant longitudinal follow-up to establish subsequent patterns of decline or stability.

Attitudes toward people with dementia among communication science and disorders students.

The purpose of this study was to: 1) explore attitudes among Communication Sciences and Disorders (CSD) students toward people with dementia, 2) investigate factors that might be associated with the expressed attitudes, and 3) suggest a means for promoting positive attitudes among CSD students. 94 CSD students completed a three-section online survey via Qualtrics. First, participants provided demographic information in three categories: person, courses, and experiences. Second, they completed a 25-item quiz on aging and dementia. Finally, each participant submitted responses to the Scale of Attitude toward People with Dementia. A stepwise regression analysis revealed two factors that best predicted positive attitudes of participants toward people with dementia. The first factor was having completed more courses on gerontology and/or dementia and the second factor was having found the courses beneficial for their future career as speech-language pathologists. The findings of this study imply that providing CSD students with more courses in gerontology and/or dementia may foster more positive attitudes toward people with dementia. These findings indicate that maximum benefit may be achieved by designing courses on gerontology and dementia that include professional practice-oriented activities and assessments.

What if there's no such thing as "aging"?

Are diseases caused by aging? What are the mechanisms of aging? Do all species age? These hotly debated questions revolve around a unitary definition of aging. Because we use the word "aging" so frequently, both colloquially and scientifically, we rarely pause to consider whether this word maps to an underlying biological phenomenon, or whether it is simply a grab-bag of diverse phenomena linked more by our mental associations than by any underlying biology. Here, we consider how the presence of the colloquial word "aging" generates a cognitive bias towards supposing there is a unitary biological phenomenon. We ask what kind of evidence would support or refute that idea, and subsequently show clear evidence at multiple levels that aging is not a unitary phenomenon. In particular, the known aging pathways lead to heterogeneous outputs, not a single coordinated phenomenon. From levels ranging from cellular/molecular to clinical to demographic to evolutionary, we show how the supposition that aging is a unitary phenomenon can mislead and distract us from asking the best questions. For major sub-disciplines of aging biology, we show how going beyond the notion of unitary aging can hone the paradigm and help advance the pace of discovery.

Realizing the Potential of Robotics for Aged Care Through Co-Creation.

Socially assistive robots have the potential to improve aged care by providing assistance through social interaction. While some evidence suggests a positive impact of social robots on measures of well-being, the adoption of robotic technology remains slow. One approach to improve technology adoption is involving all stakeholders in the process of technology development using co-creation methods. To capture relevant stake holders' priorities and perceptions on the ethics of robotic companions, we conducted an interactive co-creation workshop at the 2019 Geriatric Services Conference in Vancouver, BC. The participants were presented with different portrayals of robotic companions in popular culture and answered questions about perceptions, expectations, and ethical concerns about the implementation of robotic technology. Our results reveal that the most pressing ethical concerns with robotic technology, such as issues related to privacy, are critical potential barriers to technology adoption. We also found that most participants agree on the types of tasks that robots should help with, such as domestic chores, communication, and medication reminders. Activities that robots should not help with, according to the stakeholders, included bathing, toileting, and managing finances. The perspectives that were captured contribute to a preliminary outline of the areas of importance for geriatric care stake holders in the process of ethical technology design and development.

Ageism and COVID-19: what does our society's response say about us?

The goal of this commentary is to highlight the ageism that has emerged during the COVID-19 pandemic. Over 20 international researchers in the field of ageing have contributed to this document. This commentary discusses how older people are misrepresented and undervalued in the current public discourse surrounding the pandemic. It points to issues in documenting the deaths of older adults, the lack of preparation for such a crisis in long-term care homes, how some 'protective' policies can be considered patronising and how the initial perception of the public was that the virus was really an older adult problem. This commentary also calls attention to important intergenerational solidarity that has occurred during this crisis to ensure support and social-inclusion of older adults, even at a distance. Our hope is that with this commentary we can contribute to the discourse on older adults during this pandemic and diminish the ageist attitudes that have circulated.

How Geographical Isolation and Aging in Place Can Be Accommodated Through Connected Health Stakeholder Management: Qualitative Study With Focus Groups.

BACKGROUND: In remote areas, connected health (CH) is needed, but as local resources are often scarce and the purchasing power of residents is usually poor, it is a challenge to apply CH in these settings. In this study, CH is defended as a technological solution for reshaping the direction of health care to be more proactive, preventive, and precisely targeted-and thus, more effective. OBJECTIVE: The objective of this study was to explore the identity of CH stakeholders in remote areas of Taiwan and their interests and power in order to determine ideal strategies for applying CH. We aimed to explore the respective unknowns and discover insights for those facing similar issues. METHODS: Qualitative research was conducted to investigate and interpret the phenomena of the aging population in a remote setting. An exploratory approach was employed involving semistructured interviews with 22 participants from 8 remote allied case studies. The interviews explored perspectives on stakeholder arrangements, including the power and interests of stakeholders and the needs of all the parties in the ecosystem. RESULTS: Results were obtained from in-depth interviews and focus groups that included identifying the stakeholders of remote health and determining how they influence its practice, as well as how associated agreements bring competitive advantages. Stakeholders included people in government sectors, industrial players, academic researchers, end users, and their associates who described their perspectives on their power and interests in remote health service delivery. Specific facilitators of and barriers to effective delivery were identified. A number of themes, such as government interests and power of decision making, were corroborated across rural and remote services. These themes were broadly grouped into the disclosure of conflicts of interest, asymmetry in decision making, and data development for risk assessment. CONCLUSIONS: This study contributes to current knowledge by exploring the features of CH in remote areas and investigating its implementation from the perspectives of stakeholder management. It offers insights into managing remote health through a CH platform, which can be used for preliminary quantitative research. Consequently, these findings could help to more effectively facilitate diverse stakeholder engagement for health information sharing and social interaction.

The Ethics of Socially Assistive Robots in Aged Care. A Focus Group Study With Older Adults in Flanders, Belgium.

OBJECTIVES: Socially assistive robots (SARs) need to be studied from older adults' perspective, given their predicted future ubiquity in aged-care settings. Current ethical discourses on SARs in aged care are uninformed by primary stakeholders' ethical perceptions. This study reports on what community-dwelling older adults in Flanders, Belgium, perceive as ethical issues of SARs in aged care. METHODS: Constructivist grounded theory guided the study of 9 focus groups of 59 community-dwelling older adults (70+ years) in Flanders, Belgium. An open-ended topic guide and a modified Alice Cares documentary focused discussions. The Qualitative Analysis Guide of Leuven (QUAGOL) guided data analysis. RESULTS: Data revealed older adults' multidimensional perceptions on the ethics of SARs which were structured along three sections: (a) SARs as components of a techno-societal evolution, (b) SARs' embeddedness in aged-care dynamics, (c) SARs as embodiments of ethical considerations. DISCUSSION: Perceptions sociohistorically contextualize the ethics of SAR use by older adults' views on societal, organizational, and relational contexts in which aged care takes place. These contexts need to inform the ethical criteria for the design, development, and use of SARs. Focusing on older adults' ethical perceptions creates "normativity in place," viewing participants as moral subjects.

The "Elderly" in Medicine: Ethical Issues Surrounding This Outdated and Discriminatory Term.

The objective of this study was to investigate and describe how the use of the term "elderly" contributes to bias and problems within the medical system. A systematic review of the relevant literature and history was conducted. The term "elderly" does not define age accurately and carries bias and prejudice that lead to harm through discriminatory practices, institutional prejudices, and "ageist" policies in society and medicine. Doctors and healthcare providers seldom intentionally try to harm any patient, but might do so through unconscious anti-elderly bias. Studies indicate that medical students already demonstrate anti-elderly bias; researchers may lump patients aged 65 and over together, confounding specific information needed for individualized treatments; and out of unwarranted concern, medical and surgical treatments may be denied, despite minimal increased risk of mortality. When the cost of healthcare rises, it is the elderly against whom rationing is suggested. The term "elderly" has no place in medicine. Anti-elderly health care rationing is as unethical as rationing targeted against any group. It is reverse paternalism to make rules that limit others' medical care, happiness, and life span without their consent. Medicine is the science and art of individual communication, evaluation and treatment. Once we deny care to any one group, we open the door to denial to others.

[Ethical challenges surrounding the ageing of HIV-positive patients]. / Enjeux éthiques autour du vieillissement des patients porteurs du VIH.

More and more HIV-positive people now belong to the 50+ age group. This ageing is accompanied by specific medical and psychosocial problems. In 2018, the French National Consultative Ethics Committee published a paper on the ethical challenges of ageing. Ageing is not easy in a society from which people living with HIV and the elderly feel excluded.

O envelhecer digno como direito fundamental da vida humana / El envejecer digno como derecho fundamental de la vida humana / Decent Aging as a Fundamental Right of Human Life / L'envelliment digne com a dret fonamental de la vida humana

O objeto do artigo volta-se para um exame crítico acerca dos quinze anos de edição do Estatuto do Idoso, sendo seu objetivo discutir a nova tutela da população idosa do Brasil, bem como do enfrentamento do problema social decorrente do envelhecer com dignidade, enquanto direito e garantia fundamental assegurado em nosso ordenamento jurídico. Para tanto, a abordagem teórica fundamenta-se no novo paradigma trazido pelo referido Estatuto, com base na dignidade da pessoa humana do idoso. No mesmo sentido, para se chegar à concretização de tal avanço legislativo em nossa realidade social, deve-se tratar de propiciar uma ressignificação dos papéis do idoso em nossa sociedade; juntamente às formas como socialmente percebe-se a velhice

El artículo es un examen crítico de los quince años de edición del Estatuto del Anciano, para discutir la nueva tutela de la población anciana de Brasil, así como del enfrentamiento del problema social derivado del envejecimiento con dignidad, en cuanto derecho y garantía fundamental asegurada en este ordenamiento jurídico. El enfoque teórico se fundamenta en el nuevo paradigma traído por el Estatuto, con base en la dignidad de la persona humana del anciano. En el mismo sentido, para llegar a la concreción de este avance legislativo en nuestra realidad social, se debe propiciar una resignificación de los papeles del anciano en nuestra sociedad; junto a las formas con que socialmente se percibe la vejez

The article focuses on a critical examination of the fifteen years of the Statute of the Elderly, with the purpose of discussing the new protection of the elderly population in Brazil, as well as addressing the social problem of aging with dignity, as a right guaranteed in our legal system. Therefore, the theoretical approach is based on the new paradigm brought by the Statute, based on the dignity of the human person of the elderly. In the same sense, to arrive at the concretization of such legislative advance in our social reality, we must try to provide a re-signification of the roles of the elderly in our society; together with the ways in which old age is socially perceived

L'article és un examen crític dels quinze anys d'edició de l'Estatut de l'Ancià, a fi de discutir la nova tutela de la població anciana de Brasil, així com de l'enfrontament del problema social derivat de l'envelliment amb dignitat, com a dret i garantia fonamental que garanteix aquest ordenament jurídic. L'enfocament teòric es fonamenta en el nou paradigma generat per l'Estatut, amb base en la dignitat de la persona humana de l'ancià. En el mateix sentit, per arribar a la concreció d'aquest avanç legislatiu en la nostra realitat social, s'ha de propiciar una resignificació del paper de l'ancià en la nostra societat, al costat de les formes amb que socialment es percep la vellesa

Intergenerational Contact Predicts Attitudes Toward Older Adults Through Inclusion of the Outgroup in the Self.

OBJECTIVES: With our rapidly aging population, it is critical to understand biases toward older people and what can be done to reduce ageism. Intergenerational contact can improve attitudes towards older people, but the effect of inclusion of outgroups in the self (IOS) in the context of intergenerational contact remains unexplored. In addition, stereotypes of warmth and incompetence may be affected differently by contact experiences and have different roles in effecting change in ageist attitudes. METHOD: In this study, we modeled the relationships between intergenerational contact, IOS, and stereotypes of warmth and incompetence in predicting attitudes towards older adults in a young community sample (n = 302; 18-30-year olds). RESULTS: We found that positive contact with one older adult reduced incompetence stereotypes both directly and through an increase in IOS, and both the increase in IOS and the decrease in incompetence stereotypes predicted better attitudes towards older adults. Incompetence stereotypes were a stronger predictor of age-related attitudes than warmth stereotypes. DISCUSSION: This suggests that interventions aimed at improving ageist attitudes through intergenerational contact should focus primarily on disconfirming incompetence stereotypes instead of merely increasing warmth perceptions, which could be done in part by increasing cognitive overlap with older adults.

Is Ageism Acceptable When it Comes From a Familiar Partner?

OBJECTIVES: This study investigated the perceived acceptability of benevolent and hostile ageist behaviors targeting older adults and whether the acceptability varied depending on the age of the perceiver and the relationship between the person engaging in the ageist behavior and the recipient of the ageist behavior. METHOD: Young, middle-aged, and older adult participants rated the acceptability of 13 benevolent and 17 hostile ageist behaviors targeting older adults for five different relationship types: younger family members, same-age family members, familiar service workers, unfamiliar service workers, and friends. RESULTS: Participants, regardless of age, rated benevolent ageism to be more acceptable than hostile ageism. Young adults were more accepting of hostile ageist acts than middle-aged and older adults were. However, overall acceptability of hostile ageist acts was low. Familiarity with the perpetrator also affected perceptions of the acceptability of ageist acts. DISCUSSION: Perceptions of the acceptability of ageism targeting older adults differed as a function of participant age, ageism type, and relationship type. Findings are discussed in light of social identity theory and intergroup contact theory.