Kiran Rabheru is a Full Professor of Psychiatry at the University of Ottawa and Geriatric Psychiatrist at The Ottawa Hospital. He serves as Medical Director of the Geriatric Psychiatry, Electroconvulsive Therapy, and the Behavioral Support Programs at TOH. He obtained his medical degree from the University of Western Ontario. He is a Certificant and Fellow of the College of Family Physicians of Canada (CCFP, FCFP). He went on to complete his specialty training in Psychiatry, subspecializing in Geriatric Psychiatry, in which he is Board Certified in Canada (FRCP) and the United States (DABPN).
He is designated as a Founder of the subspecialty of Geriatric Psychiatry by the Royal College of Physicians and Surgeons of Canada. He is recipient of the Outstanding Achievements in Geriatric Psychiatry in Canada award by the Canadian Academy of Geriatric Psychiatry (www.cagp.ca) and has served as its President of the CAGP He serves as Chair of the Board of the International Longevity Centre (www.ilccanada.org), Board member of the International Psychogeriatric Association (www.ipa-online.org ), and Chair of the Section of Positive Psychiatry of the World Psychiatric Association (https://www.wpanet.org/). Dr. Rabheru was honoured to be elected as Chair of the Steering Committee for the Global Alliance for the Rights of Older People (https://rightsofolderpeople.org), a network of over 380 members from over 80 counties worldwide, united in the work to strengthen and promote the rights and the voice of older persons globally.
Ageism- Its manifestations and impact on the mental health of older persons
Prof. Liat Ayalon is a clinical psychologist and a researcher in the school of social work at Bar Ilan University. Her main area of research concerns ageism. She is the coordinator of a Ph.D. program on the topic of ageism funded through the Marie Curie ITN network and served as the chair of a COST Action on the topic. She also serves as the director of an impact center on the topic of ageism at Bar Ilan University.
Dr Sorinmade is a Consultant in Od Age Psychiatry and Interpersonal Therapist as well as a trained mediator. He has special interest in Mental Health Law, especially the Mental Capacity Act (England and Wales); as well as in empowering the decisional autonomy of older adults and enabling people to live well even if they have dementia. He has publications in the field of old age psychiatry, mental health law and human rights, and has spoken at conferences both in the United Kingdom and Internationally on subjects relating to mental health law and human rights, especially as they affect the older adult population.
His research interest is on human rights, mental health law, empowering individuals with their decisional autonomy as well as improving the quality of lives of older adults.
MRCPsych, MSc, LLM, Consultant in Old Age Psychiatry, Interpersonal Therapist, Kent and Medway NHS &Social Care Partnership Trust, Mediator.
Dr. Verbeek is an Associate Professor at the Department of Health Services Research, within the Care and Public Health Research Institute of Maastricht University, the Netherlands. She is the Scientific Director of the Living Lab in Ageing and Long-Term Care. This is an interdisciplinary and formal partnership of Maastricht University with seven long-term care providers, Zuyd University of Applied Sciences and two vocational training institutes. For over 20 years the Living Lab has served as an infrastructure that drives scientific research in long-term care in co-creation with end-users, including older people and their relatives, health care professionals, policy makers and educators. The network covers approximately 110 long-term care facilities (e.g. nursing homes, assisted and group living facilities) as well as professional home care, and includes about 30,000 clients and more than 15,000 staff.
The research line of Dr. Verbeek focuses on innovations in long-term care for older people, especially dementia care. In particular, she studies effects of care environments (organizational, physical and social aspects) on clinical symptom presentation, taking a trans-disciplinary perspective (psychology, nursing science, gerontology). Examples include small-scale, homelike care environments and green care farms. Furthermore, she investigates effects on innovations in dementia care on staff and family caregivers and the broader societal impact. Methods used are both experimental (e.g. longitudinal clinical trials) and explorative (e.g. focus groups, interviews observations). Her research contributes to the development of evidence-based interventions and design in long-term care, and results facilitate training of front-line care staff, and supports policy makers in developing best practice strategies in organization of long-term care.
Dr Anne Wand is a senior consultant psychiatrist in Geriatric Psychiatry in Sydney Australia. She is a conjoint Associate Professor at the University of Sydney and conjoint Senior Lecturer at the University of New South Wales, Sydney, Australia. Associate Professor Wand is Deputy Chair of the Human Research Ethics Committee at Concord Hospital in Sydney. She is a clinician researcher, whose PhD qualitatively examined why older adults self-harmed from the perspectives of the older person, their carer and general practitioner. She has extensive clinical and research experience in the fields of old age psychiatry, psychosomatic medicine, and aspects of decision-making capacity and clinical ethics. She has led a number of translational research projects including on self-harm and suicide in older adults and delirium screening and prevention. She has published 69 articles in peer-reviewed journals and seven book chapters.
Dr Carlos A. de Mendonça Lima obtained his medical degree at the Federal University of Rio de Janeiro and achieved its equivalence in Portugal (University of Porto) and in Switzerland. He specialized in Psychiatry at the Université de Franche-Comté, France. He subsequently completed a Master degree in Epidemiology and Statistics and another one in Clinical Pharmacology and Pharmacokinetics at the University of Nancy I, France. He is PhD (Doctorate in Life and Health Sciences) by the Université de Franche-Comté, France.
He was a consultant of the Mental Health Division of the World Health Organization from 1992 to 1998. He started the collaboration between WHO and the University of Lausanne, Switzerland, where he helped to create the WHO Collaborating Centre for Psychiatry of the Elderly. He was its director between 1998 to 2004. After 2004, he continued to work with WHO as a consultant and reviewer of documents relating to this sub-specialty. More recently he was invited to join the Consultation Group on the Classification of Mental and Behavioural Disorders in Older Adults that is reviewing the ICD-10 diagnostic criteria from the perspective of Psychiatry of the Elderly.
In 1999 he was appointed to the Board of the World Psychiatric Association Section of Old Age Psychiatry. He was elected in 2008 as its Secretary, position he left in 2019 when he was elected as Chair of this section.
In 2002 he helped to create the Task Force on Old Age Psychiatry at the World Federation of Societies of Biological Psychiatry and has participated to the publication of several systematic reviews on topics related to mental health in the elderly.
He became member of the European Psychiatric Association Section of Geriatric Psychiatry in 2004. He was its Vice-Chair until 2010 when he was elected its Chair, a position he held until 2014. Now he is its Councilor. In 2013 he returned to Switzerland to take in charge the Unity of Old Age Psychiatry at the Center Les Toises.
He organized more than 80 symposia, conferences and events; he made more than 300 lectures in national and international conferences; he participated in 12 international clinical trials and was the promoter of three; he published about 260 articles, book chapters and abstracts of conference communications. In 2019 he published his first book as co-editor and author of 4 chapters (Primary Care Mental Health in Older People: a global perspective. Springer, 2019). He is the author of two Master’s monographs, 1 report of the research for the Fond Performance of the Vaud Canton, Switzerland, and 1 doctoral thesis.
Kiran Rabheru, International Psychogeriatric Association (IPA), Global Alliance for the Rights of Older People (GAROP), ILC-Canada, Professor of Geriatric Psychiatry, University of Ottawa, Canada
Liat Ayalon, Bar Ilan University, Israel
Oluwatoyin Sorinmade, Old Age Psychiatry, Kent and Medway NHS and Social Care Partnership Trust, United Kingdom
Hilde Verbeek, Maastricht University, the Netherlands
Anne Wand, University of New South Wales, Australia
Carlos A. de Mendonça Lima, World Psychiatric Association, Switzerland
Ominous trends in global aging, ageism, mentalism, and ableism, have been accelerated by the COVID-19 pandemic with widespread increases in brain health challenges. The International Psychogeriatric Association (IPA), the World Psychiatric Association-Section of Old Age Psychiatry (WPA-SOAP), the American Association of Geriatric Psychiatry (AAGP) and the International Longevity Centre of Canada (ILC Canada) are fully committed to support and promote a United Nations (UN) convention on the rights of older persons to safeguard that older persons with mental health conditions and psychosocial disabilities can live free from discrimination and are able to fully enjoy their rights.
This symposium will discuss the papers from a special thematic issue of the American Journal of Geriatric Psychiatry on “Viewpoints on human rights and the ethical determinants of mind/brain health of older persons” published in Fall 2021 followed by Q&A.
We will discuss the importance of transforming the narrative for older persons with mental health conditions and psychosocial disability with respect to several topics based on a number of published works available here.
Presenter #1, Kiran Rabheru
Prevention, Death and Dying, and Editorials
By using a human rights-based lens, this symposium aims to accelerate and build momentum for transforming the current global narrative with strong negativity bias to one where every older person is able to fully enjoy their life.
Many of society’s systemic implicit biases against older persons predate COVID-19. A perfect storm of these biases now rages against older persons much more explicitly and visibly during the COVID-19 pandemic. They comprise of blends of discrimination based on age (“ageism”), multiplied by the prejudice against persons with mental symptoms (mentalism), and by notions against persons with disabilities (ableism). We explore the evidence to better understand the drivers of these biases and ways to mitigate their impact. We also review strategies to alleviate the effects of ageism, mentalism, and ableism using a prevention model.
The human right to a good death and dying well is as important as the right to life. Older people with dementia, those with serious mental illness, and those with intellectual disability are vulnerable to “bad deaths” due to violations of these rights. We explore why this is so and examine existing and potential solutions.
Presenter#2, Liat Ayalon
Ageism, Employment, and Climate Change
This presentation will outline the manifestations of ageism and the state of older people with mental conditions during the pandemic and beyond in varied contexts and countries with a primary focus on the pandemic. Possible consequences of ageism with a focus on older people’s mental health and well-being are outlined and ways to overcome ageism and reduce its occurrence.
We will present the case for the right to work and access the labor market for older people with neurological conditions. The right to work is a basic human right that should be granted unrelated to chronological age, health or mental health status and disability including declining cognitive functioning. We outline interventions at the organizational, national, and international level to ensure the full participation of people of all ages and abilities in the workforce.
Climate change threatens the basic prerequisites for wellbeing, including clean air and water, food supply and the adequacy and security of shelter. There is a need to integrate the areas of older people and environmental sustainability to ensure that the rights of older people are preserved especially now, as the effects of the climate change crisis become more pronounced.
Presenter #3, Oluwatoyin Sorinmade
We explore barriers to enjoyment of human rights to sexuality of persons with dementia and remedies for addressing these. Enjoyment of sexuality is contingent upon actualisation of rights to dignity, autonomy, respect for will and preferences, abuse safeguarding and equitable access to highest standards of sexual health. Persons with dementia living at home or in care face systemic barriers to enjoyment of sexuality fueled by ageism, apathy and ignorance, compounded by complex legal barriers in relation to consent. Such challenges can be tackled with awareness raising and education of care staff, families and physicians, including training for capacity assessment with dimensional, non-categorical conceptualisation of capacity, leaving room for supported decision-making. These measures, together with strengthened legislative and human rights frameworks to cater to the specific needs of older people, may allow people to live well with dementia and exercise their human rights to enjoy sexuality in a safe and lawful manner.
Presenter #4, Hilde Verbeek
Inclusive Living and Women
Although older persons wish to age at home, many older persons with mental health conditions and psychosocial disability (MHC-PSD) spend the last few years of their life in residential facilities. We will examine the impact of ageism and human rights violations manifested in environmental design, specifically regarding social isolation, loneliness, inadequate psychosocial, environmental, recreational and spiritual support. We highlight two innovative initiatives from the Netherlands, which show that older persons’ rights can be maintained in innovative, collective living arrangements.
There is increasing emphasis in research and at the level of international human rights bodies such as the United Nations on the gendered contours of age-based disadvantage and discrimination, and the cumulative effects of gender inequalities over the life-course on outcomes in later life. In response, we aim to (i) elucidate the economic, social and cultural disadvantages and discrimination faced by older women living with mental health conditions; and (ii) identify opportunities to protect their human rights. We conclude that older women face inequalities and disadvantages at the intersections of age, gender, and mental health and wellbeing that compromise their capacity to age well.
Presenter #5, Anne P. F. Wand
Ageism and human rights violations may pervade each of the potential factors underlying suicidal ideation or behaviour in older persons, including physical and mental health, disability, relationships, and social factors. We outline how infringements of human rights and ageism may create or exacerbate risk factors associated with suicide in older persons. Strategies to address these issues are discussed to mitigate the impact of ageism on the risk factors for suicide will be addressed including tackling ageism, psychosocial interventions and education.
The factors underlying suicide in older adults are multiple and span all aspects of life, including physical and mental health, disability, relationships, and social factors. Ageism and human rights violations may pervade each of these parameters and lead an older adult to suicide. We outline how infringements of human rights and ageism may create or exacerbate existing risk factors for suicide in older adults. Strategies to address these issues are discussed, including tackling ageism, psychosocial interventions, education and suicide prevention programs which target older adults, and making human rights the standard for accountability across health and social systems utilised by older adults. We propose future studies to evaluate the effects of addressing ageism and human rights violations on suicide.
Presenter #6, Carlos Augusto de Mendonca Lima
Dignity, Justice, and Oral Health
The concept of dignity lies at the heart of human rights and must be a central concept integrated into public health and mental healthcare. Dignity in older persons is multi-dimensional and includes privacy, independence, inclusion, autonomy, etc. Frailty, dependence, sensory, cognitive impairment and socioeconomic vulnerabilities compromise dignity in the elderly and hence their fundamental rights. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach.
Older people experience poorer quality of life due to poor oral health and there continue to be barriers within health systems that contribute to poor oral health. We discuss how stakeholders can collaborate to meet the needs of this population, proposing recommendations to bring about change.
Older persons, particularly those with mental health conditions, face a significant ‘justice gap’ – the right to fair, prompt and responsive decisions by administrative decision-makers and equal access to courts and tribunals to obtain timely and effective remedies. International and national standards, both general and specific to older persons, have been shown to be inadequate to respond to this justice gap.