Pica Disorder: Causes, Effects and Treatment

Pica Disorder: Causes, Effects and Treatment Introduction This essay will discuss one of the feeding and eating disorder called the Pica Disorder. Specific reference will be made to a clear explanation of the disorder, epidemiology, etiology and clinical features. The essay will also look at the DSM-IV-TR, summarise the key problem areas in Pica DSM-IV-TR classification, pathology and laboratory examination. It will further discuss the differential diagnosis, the prognosis and the treatment. The pica disorder has been recognized and explained since ancient times. The disorder is observed in ethnic groups around the entire world, in both the olden days and recent or modernised cultures; for both male and female and for different age groups. The name of the disorder derives from the Latin term for magpie, a bird known for its unusual indiscriminate eating habits. Pica has also been looked at in other animals such as chimpanzees. The disorder affects everyone but it is most common in young children. It doesn’t only appear on its own, it can manifest in the present of another disorder. Pica is treatable, but when the disorder is ignored, it can lead to death. What is Pica Disorder? Pica is defined as a continuous eating of unhealthy and unbalanced substances for a maximum period of one month (Waugh, Markham, Kreipe Walsh, 2010). There are no characteristics associated with biological disturbances for Pica disorder. Pica is only picked up when there are physical signs that need medical attention such as stomach pains and infections. Pica can also be examined even when the signs appear in the present of another disorder such as autism spectrum, schizophrenia, or intellectual disability. However, the only time Pica can be diagnosed is when it is discovered to be serious and continuous to seek clinical attention (Sadock, Sadock Ruiz, 2015). Pica occurs in children, adolescents and adults. It is recommended by the DSM-5 that the diagnosis of Pica is primarily under the age of two and it is most likely to manifests in children than in adults. Pica appears in both boys and girls or men and women and is sometimes combined with the cultural belief in the spiritual gain of digesting unhealthy food. In this case, a diagnostic of pica is not applicable (Sadock et al., 2015). Pica is also found in mentally disturbed people as well as in pregnant women. In women that are pregnant it is found that it is caused by geophagia (intake of clay) and amylophagia (intake of starch), (Sadock Sadock, 2003). Pica is usually diagnosed after a maximum appearance of one month, but according to the recent DSM-IV criteria, it is not appropriate to children that are still developing and to not look into the fact that children have a habit of sucking and putting objects into mouth. The DSM-5 diagnosis Pica for children under the age of two (chronologically and mentally), with no limitation of older ages; and in adult it is classified as an example of ‘other eating disorder’. Even though the DSM-5 adds Pica as a disorder that often manifests in young children or teenagers, it is obvious in the studies that have been done and reported that Pica is first diagnosed in adults. The persistent induction of Pica being an illness of infants and young children in DSM-5 accredits careful attention in the light of data that has got to do with age of opening and of an identification of the disorder (Waugh et al., 2010). People with mental deficiency or other occurring developmental disorders such as autism, usually get pica as one of the signs of a larger domain of complicated actions. At the moment, DSM-5 criteria states that it is pretty much obvious for one to be diagnosed with pica, if there are an indication of abnormal behaviours and if it is in the present of another mental disorder that it immediately seek clinical or medical attention (Waugh et al., 2010). Pica can be recognized by health professionals. â€Å"Pica can be a manifestation of a range of medical conditions and can lead to a variety of complications including lead and nicotine toxicity, surgical intervention requirements, and parasitic infestation† (Ali, 2001). The literature gives an indication of the epidemiology, etiology and various complications in people suffering from intellectual disorders. The literature also views different medical, cultural and psychological theories that paly a huge role on etiology as well as on various complications. A variety of terms have also been looked at that best describe the occurrence of pica; â€Å"geophagia is the ingestion of clay; coprophagia is the ingestion of faeces; pagophagia refers to the ingestion of ice; and amylophagia is the ingestion of starch† (Ali, 2001). Pica is therefore labelled clearly if one of the terms is identified or is exaggerated in the study of indiscriminate pica (Ali, 2001). Epidemiology Pica has been found to occur in well functioning young and old people, but the majority lies within people who have severe health cases of intellectual disabilities (Bell and Stein, 1990). The popularity of pica is ambiguous. A study of a big clinic population concluded that only 75 percent of infants (12months old) and 15 percent of toddlers (2- to 3-year olds) had put things or objects in their mouth, which is absolutely normal and does not necessarily lead to or cause ingestion (Sadock et al., 2015). Research has concluded that 15 percent of people with serious mental disturbances suffer from pica. However, pica affects both male and female fairly (Sadock Sadock, 2003). Pica has been looked at in three core perspectives: in children, some social contexts as a culturally sanctioned behaviour, and idiosyncratically. Many idiosyncratic reports are made in normal people and in people who suffer from intellectual disability. From infancy till 18 months, pica is regarded as normal because it is a developmental stage where children place substances in their mouth and it is known as physiological pica. For infancy pica is associated with risky substances that are placed in the mouth and with children above 18months, pica may be associated with intellectual abilities or faced stressors (Ali, 2001) Cultural sanctioned pica is associated with clay eating in the African contexts and it is also found to be the most common in pregnant women. Many pregnant women reported that they are consuming clay and some reported that they consume it on different occasions. Pica is observed in normal functioning individuals and intellectual disability people. Research looks primarily on people suffering from other chronic disorders such as dementia on old people as well as people with unbalanced diets (malnutrition). Research found that pica is serious in intellectual people, however it decreases with age but manifests heavily after the age of 70 (Ali, 2001). Pica is also found to create problems in social interactions for people suffering from the disorder, usually children would undergo social experiences such shyness, loneliness, and feeling inferior (Troop Bifulco, 2002). Etiology Many theorists have been asked to explain the abnormalities of pica and none of their ideas have been credited. There’s a major possibility of pica occurring in the person with families that show significant signs of the disorder. Absence of well-balanced substances has been speculated to be the major contributing factor to pica; often the desire to consume substances that are not healthy arises from dietary deficiencies. This is usually the desire to have ice or unhealthy substances which are known to be linked with the lack of iron and zinc. A common case of caregivers abandoning and deprival has been linked with many incidents of pica (Sadock Sadock, 2003). The reason for not having any care for infants and toddlers, as well as lack of sufficient feeding, leads to high risk of pica (Sadock et al., 2015). The features and incidents of pica are found to be too complex to only be revealed as one sign or cause. Pica is not showing to be a â€Å"disease† as such but rather a symptom that can occur in various physical and psychological problems. Etiology of pica is found in psychological, cultural, and medical theories (Ali, 2001). Psychological Theories Pica can be classified as a learned behaviour from people suffering from intellectual disorders, as they couldn’t differentiate between appropriate substances to consume and inappropriate substances. This is however contradicted by the look of things from people who compiled a research on hostile people concentrating on a certain substance to ingest. From other psychological theories, this is taken as a type of aggression. Pica is found to be higher in communities with little interaction among the society (Ali, 2001). Cultural Theories Geophagia is the main cause of pica associated to cultural theories. Consuming clay seems to be normal in most African people. Eating clay has been used as a method of detoxification. Clay is used as traditional remedies in most societies; also used for healing other infections such syphilis, increasing breast milk production and guiding the birth procedure (Ali, 2001). Medical Theories Medical theories look at a variety of components that cause pica disorder. These causes are the role of mineral status and nutrition, neurological or neurotransmitter pathology and psychiatric disorders and the addictive quality of the substance digested. There are lost sources to the correlation of lack of iron and pica. There’s confusion in the literature on whether pica disorder causes the lack of minerals, or if the lack of minerals is the result of pica. The idea of the lack of minerals, particularly lack of iron is the result of pica regarded as â€Å"nutrient hypothesis†. According to this hypothesis, pica is regarded as the responded actions to the deficiency. The proof in the context is found in past medical records and cases that have been reported. Lack of zinc has also been found to be the cause of pica. â€Å"Alternatively, the view that pica could cause a mineral deficiency is based on the observation that certain clays have chelating properties, that is they bind the mineral and hence prevent its absorption† (Ali, 2001). It has been displayed that eating clay can prevent the intake of elemental iron. Diagnosis and Clinical Features Having intakes of inappropriate substances continuously for a period of 18 months of age is not normal, even though DSM-5 considers under 2years for a diagnosis of pica. Actions of the disorder may start in infants 12months to 24 months of age. Certain things that are digested may differ with their approachability, and they expand with the child’s ability of progression and the resultant increased autonomy and induced parental care. Infants may put things like hair, cloth, paint etc. in their mouth, while toddlers on the other hand may digest things like animal feces, dirt, small stones and paper. The substances that children digest may cause clinical complications and can be harmful to the individual. Other sever implications are lead poisoning from consuming lead-based paint, intestinal parasites after eating soil or feces, lack haemoglobin and lack of zinc after eating of clay, serious lack of iron after eating of larger portions of starch, and internal pains from digestion of hair balls, stones and gravel. Pica during pregnancy is often less to the pregnancy on its own (Sadock et al., 2015) Summary of Key Problem Areas in Pica in DSM-IV-TR Classification Pica manifest beyond the age domain implying its induction in the categorizing system has to be considered again. Its manifestation in older people is built in the present of its choice of words (e.g. the describing of schizophrenia in criteria), but it’s not apparent at the same time to the clinician based on the induction in the system. There are some considerations that pica might be best described as the â€Å"obsessive-compulsive spectrum disorder†. This consideration derives from the proof regarding the reaction to SSRI’s, and looking at compulsive, anxiety relieving components of the eating disorder. There’s a consideration that there may be two core types: â€Å"voluntary and involuntary†. This suggestion is not yet looked into and there’s some sort of proof that they will fall into subgroups. There must be changes on the induction of pica in the classification scheme so that it is not placed under the Feeding and Eating Disorder of I nfancy or Early Childhood (Waugh et al., 2010) Pathology and Laboratory Examination There has been no experiments showing a diagnosis of pica, but many experiments done in the lab are valuable as pica is usually linked with unnatural levels of lead. Levels of iron and zinc in serum must be established and rectified if little. In unusual instances when it is the causes, pica may vanish when oral iron and zinc are conducted. Haemoglobin level must be established to exclude anemia (sadock et al., 2015). Differential Diagnosis The various diagnosis of pica covers the avoidance of food, anorexia, or unusual lack of iron and zinc. Pica may happen in connection with a downfall to prosper, and be a dual diagnosis with schizophrenia, autism spectrum disease and kleine-Levin syndrome. Young ones also indicate unusual actions, involving the swallowing of toilet water, garbage and other unhealthy staff. Lead intoxication may be linked with pica. In terms of children who illustrate pica that requires clinical attention, along with another present disorder, both disorders must be coded based on the DSM-5 (Sadock et al., 2015). Course and Prognosis The prognosis of Pica is often well and, in children that are intellectually functioning, pica settles concurrently with several months. In young children, pica often undertakes with increasing age; in pregnant women pica is reduced due to the pregnancy and in adults, pica may continue for many years especially those suffering from autism and intellectual disabilities. Investigations on these people are too little to make valid conclusions (Sadock et al., 2015). The prognosis for people with pica differs, based on the kind and amount of substance taken, the extent of visible side effects and problems of pica may be turned back and if not treated, it may result to death (Encyclopaedia of Children’s Health, n.d.) Treatment When seeking for pica treatment, the first thing to be done is to look into the cause of pica at all times. When Pica manifest as malnutrition and lack of child supervision, it’s obvious that these incidents are avoided or stopped. There must also be an elimination of toxic substances such lead. No direct treatment available for pica as such, often treatment tries to achieve giving people lessons and modification of actions. Treatment includes various angles such psychosocial, environmental, behavioural and family supervision approaches. When lead is in the same environment as the child, it is only appropriate for the child to taken to a different surrounding. Behavioural shaping as well as behavioural models has been used to calm the disorder. Higher parental care, stimulation and emotional supervision will lead to positive outcomes. Research found that pica occurred from poor areas, and some sick people, rectifying the lack of iron and zinc removes pica. Medical conditions s uch lead poisoning must also be given medical attention (Sadock et al., 2015). Treatment of pica will rely on the etiology and the kind of pica. Conventional medical treatment may be relevant to some cases. For instance, certain pills with iron-containing vitamin have been proven to reduce the cause of seldom desires of substances to individuals who lack iron. Pica does not have exposed medical etiology in most instances; therefore it would be wise to utilize various methods of treatment such as therapy, psychoeducation, and ways to maintain good health (Encyclopaedia of Children’s Health, n.d.) Behavioural Treatments for Pica Self-Protection Device Self-protective devices (SPD’s) are used to get rid of any chance of getting into contact with pica. SDP’s include bags or jackets that cover the arms and helmets that prevent an opportunity to the person’s mouth. Overcorrection Overcorrection methods are used to educate appropriate actions through overestimated actions. Overcorrection involves the unforeseen circumstances of one of the following: Oral hygiene: people must brush their teeth for certain duration with a toothbrush immersed in a mildly aversive mixture. Personal Hygiene: people must be careful and also wash their hands, face and anus. Tidying: people must keep their places clean and empty rubbish bins. (Bell and Stein, 1990) Behaviour Treatment Programmes Treatment programmes involves hierarchal interventions, starting with positive support for substitution of behaviour. Various supports of possible and various supports of other behaviours are in all programmes; these include visual screening with goggles, personal hygiene, and unpredicted restraint (Williams, Sanchez, Enzinna, Dunn Karasack., 2009). Prevention The prevention methods of pica are unknown. As soon as the disorder is found or suspected, certain steps in reducing the symptoms are considered. Getting rid of a certain substance from readily available places may be wise. A person with pica may need to be under supervision to be able to avoid inappropriate behaviours (Encyclopaedia of Children’s Health, n.d.). Conclusion In conclusion, pica is a disorder that manifests after a continuous eating of non-nutritive substances for a maximum period of one month. The diagnosis is usually under two years of age according to the DSM-5 diagnosis criteria. Pica affects both male and female and it sometimes appears in the present of another disorder such as autism spectrum, schizophrenia and intellectual disorders. Pica is usually diagnosed after a maximum appearance of one month, but according to the recent DSM-IV criteria, it is not appropriate to children that are still developing and to not look into the fact that children have a habit of sucking and putting objects into mouth. People who suffer from pica are usually the ones that have severe health cases of intellectual disorders. It can be caused by various things and it is found in cultural, psychological and medical theories. There are various ways to treat the symptoms of pica, however, no prevention has been found for pica but the disorder can be reduc ed using various methods. Comparison of Ageing Policies: Australia and Canada Comparison of Ageing Policies: Australia and Canada The young disabled children should be provided with the special schools. The rights should be ensured for the disabled people. The disabled people should be given the employment options. Policies on aging in Australia As the populace in Australia ages there will be changes in expansive zones and an immense scope of issues should have been tended to. These include: A developing interest for matured consideration administrations and astounding and fitting wellbeing. The requirement for practical and sufficient measure of pay to backing the retirement living. The requirement for positive group disposition and individual for maturing. The requirement for backing from the group and base which is age-accommodating and the Australians to empower to stay joined and take part in the general public. The significance of more established individuals to stay free and sound for whatever length of time that conceivable. The objective for Australians national procedure for maturing is to convey all Australians with the best results paying little mind to age. It is the reaction for the national system which is the structure to the open doors and difficulties which will show the more established Australia. It is a vehicle which will draw in the Australian group in the administration which is continuous by the legislature of ward. POLICIES OF AGING IN CANADA : Canada has been a dynamic member and a pioneer in the usage and improvement for the rules for groups and urban communities which is age-accommodating. World Health Organization in 2007 added to the rules for urban areas which is age-accommodating and upheld by authorities and Canadian government subsidizing association. The national system for maturing under the government: Verify that maturing individuals have helpful and auspicious access to the expert health awareness they require. Build sheltered and powerful meds solution for seniors. Unite regions and procurements for the entrance to superb and home care administrations. To guarantee that relatives and companions have fitting backings on a casual premise who deal with their more seasoned friends and family. Build up a national wellbeing system with the collaboration of the areas to expand speculation and enhance support for parental figures. Similarities Both Australian and Canadian government are submitted in serving the maturing populace independent of their ethnic and social foundation. Both governments plan to organize a superior care crosswise over social and wellbeing administrations, and also diminish the weight on the frameworks of human services and bolster the individuals with solid maturing. Both governments permit their maturing populace to age effortlessly in their decision of homes climate it is a retirement town or their private homes. Both Australian and Canadian government gives reasonable lodging offers to the maturing individuals which is helpful in meeting the more established people groups evolving needs. Concerning their job strategies both nations have very comparative methodology like upgrade motivating forces so that more seasoned specialists can stay in workforce for more period. The data accessible to the people about their qualifications later on ought to be made strides DIFFERENCES : Both Australia and Canada use different instrument to understand and screen the current situation of their developing people. While Australia sees the home based thought maintained by the gathering to be a useful step for more settled people, the Canadian government pick pleasing hotel as an open entryway for acquisition of cabin especially for developing people. In Canada the advantages capability for more settled people is 65 years anyway it can be affirmed even at 60 years of age yet in Australia more prepared people can work in their old age in light of the way that the Australian government see the upsides of using more prepared people and assigned a boss for age isolation who advocates the benefits of more settled workers. Policies that operate in New Zealand (aging) New Zealands vision of positive ageing is where older people are recognised and are highly valued as an integral part of communities and their families. According to the positive ageing strategy which provides a framework for understanding and developing policy for positive ageing reflects the experiences and attitudes older people have about themselves and how todays younger generations view ageing which includes their own ageing. The strategy for positive ageing in New Zealand identifies ten goals for older people. Ageing in the community: older people to feel secure and safe and can age gracefully in their community. Income: adequate and secure income for older people. Housing: appropriate and affordable housing choice for older people. Health: accessible, timely, equitable, and affordable health care services for older people. Positive attitudes: all aged people should have positive attitudes to older people and ageing people. Rural services: older people who are living in the rural communities should not be disadvantaged while accessing the services. Employment opportunities: promotion of flexible working options and elimination of ageism. Cultural diversity: a range of appropriate cultural services allows older people to choose. Transport: appropriate and affordable options for the transport for older people. Opportunities for participation and personal growth: increase in opportunities for community participation and personal growth. Comparing the policies with New Zealand Australia and Canada have practically comparative approaches on work opportunities, wellbeing and lodging as New Zealand as to maturing. New Zealand has set a procedure arrangement for their maturing populace thus has Australia and Canada. Every one of the three nations addresses reasonableness without segregation. All the policies concentrated on providing the better facilities of the people of old age. Service Delivery Policies on disability in Australia Department of health National disability agreement funds a range of services under the Australian government which is related to disability. These services are designed to improve the lives of people who are suffering from disability and the service providers ensures that the people with disability have the opportunity to participate in their communities. The disability service commission is one such organization in Australia which is a government agency who is responsible for program development, policy and service planning which affects the needs and rights of Australians with disabilities. Service include: Individual and family support. Respite support for carers. Community based support and accommodation. Vocational development and post school skills. Equipment and aids. Resources to create a community which is accessible DEPARTMENT OF SOCIAL SERVICES Disability and carers support people who are suffering from disability through services and programs and also with payments and benefits. Disability and carers also help with mental health in Australia. Support are also provided through funding and grants for organisations who deliver services to people with mental health and disability. Service Delivery Policies on Disability in Canada Ministry of community and social services Under the ministry of community and social services program it helps people who are suffering from financial help for housing and food and living expenses. Ministry for social development and social innovation It provides assistance and employment programs for people with disabilities. The Canadian government offers a range of financial benefits and services to assist their family members and the people with disabilities. Service delivery policies in New Zealand on disability International Service Delivery Policy on Disability in New Zealand. Service delivery in New Zealand in Disability. The Ministry of Health The service of wellbeing has two principle parts with respect to the procurement of handicap bolster administration. The principal part is to give strategy counsel to the administration on the way of scope of requirements RHAs are obliged to address and second part is to screen the RHA consistence and execution with their agreement with the legislature. Core Service Committee The National Advisory Committee on center wellbeing and inability backing gives autonomous approach counsel to the Minister and the to the national warning advisory group on wellbeing and handicap on the accompanying matters: Public wellbeing issues, including fundamental the soundness of individuals and council. The advancement of general wellbeing The checking of general wellbeing Any different matters the national warning council on wellbeing and inability determines by the notification to the committee. Public Health Commission The general wellbeing commission was situated up to enhance and ensure the strength of New Zealand individuals. The commissions parts are to screen and investigate the condition of general wellbeing, counsel the priest of wellbeing on general wellbeing objectives, techniques and strategies, and buy general wellbeing administration. Comparing the policies (New Zealand) with the policies of Canada and Australia The service delivery policies in Canada focuses on the social life of the people with disability. They wanted to improve the lifestyle of the disabled people in accordance to their life in the society. On the other hand the policies of Australia and New Zealand were concentrated on the physical well being as well as the social well being of the person with disability. Service delivery policies of Australia on Aging; In order to make the life of aged people in Australia more comfortable and better, the kangaroo government has made many policies for them. Some of them are as follows: Residential cares : The government has established the number of aged cares centres in order to provide the best cares for the people in aged people. They are given the home based environment so that they can spend the rest of their life in peace and in comfortable manner. Home and Community Care (HACC): HACC administrations will be consumed into the Home Support Program, HACC administrations will be consumed into the Home Support Program, together with the National Respite for Carers program, Assistance with Care and Housing for the Aged, and Day Therapy Centres. HACC administration sorts, arranging areas and unit estimating will be explored, and another national charges strategy will be presented. Appraisal procedures will be audited, with an aim to adjusting together with the National Respite for Carers program, Assistance with Care and Housing for the Aged, and Day Therapy Centre. HACC administration sorts, arranging areas and unit estimating will be explored, and another national charges strategy will be presented. Appraisal procedures and will be audited, with an aim to adjusting. Role of social workers: The Australian Association of Social Workers (AASW) is the main national association for social workers in Australia, with more than 7,000 individuals, a large number of whom are included in the conveyance of matured consideration and carer bolster benefits in a scope of fields of work on including direct administration conveyance, promotion, administration arranging, administration, administration improvement and approach. Other social labourers are included in supporting more seasoned individuals in numerous different territories of practice connected with the social work calling including wellbeing, lodging, pay bolster, backing to Indigenous Australians, inability, workforce support and group advancement. Service delivery policies in Canada for aging: Some of the policies by the government of Canada for the people of old age are given below: Canadas retirement income system The retirement salary framework in Canada comprises of three columns two open and one private. Canadas two open benefits programs, Old Age Security and the Canada/Quebec Pension Plans, guarantee a base level of salary in retirement for Canadian seniors. The private column comprises of assessment conceded retirement funds in head honcho supported enlisted annuity arranges (RPPs) and individual enrolled retirement reserve funds arranges (RRSPs). The expense deferral gave on investment funds in these arrangements urges Canadians to put something aside for retirement to help keep up preretirement ways of life. Other money related help is accessible to seniors through the pay charge framework. Case in point, the Age Credit and the Pension Income Credit diminish the measure of assessment seniors owe. Old Age Security (OAS) OAS advantages give fundamental salary to Canadian nationals and inhabitants who meet age, habitation and legitimate status prerequisites. It is financed from Government of Canada general incomes and listed quarterly to the Consumer Price Index. Perceiving the troublesome monetary circumstances confronted by numerous seniors, OAS gives extra pay tried advantages for low-salary people through the Guaranteed Income Supplement (GIS), the Allowance and the Allowance for the Survivor. The GIS is a month to month advantage accessible to OAS beneficiaries with practically zero other wage. The measure of the advantage is subordinate upon conjugal status, home and salary. The Allowance is accessible to qualified 60 to 64 year-old companions and basic law accomplices of OAS/GIS beneficiaries. The Allowance for the Survivor is accessible to low-pay people matured 60 to 64 whose mate or regular law accomplice is expired and who neither remarried nor went into a typical law relationship. Canada Pension Plan (CPP) The CPP is together represented by Canadas elected and common governments and works all through Canada, with the exception of in Quebec that has its own tantamount arrangement. The CPP accommodates a mixed bag of advantages in light of life changes. Best known for its retirement benefits, the CPP likewise gives advantages to surviving accomplices and offspring of CPP donors, individuals with handicaps and their youngsters and an one-time most extreme advantage of $2,500 in the occasion of death. It is a contributory arrangement; supporters are representatives or independently employed persons between the ages of 18 and 70 who gain no less than a base sum amid a logbook year. Advantages are computed in light of how much and for to what extent a giver has paid into the CPP. The service delivery policies for aging in New Zealand Ministry of Health (New Zealand) The Governments principal advisor on health and disability: improving, promoting and protecting the health of all New Zealanders. They provide home support care services, residential care services and funding for special services. District Health Board District health boards (DHBs) are in charge for providing or funding the running of health services in their region. Disability and elderly support services and some health services are subsidized and obtained nation-wide by the Ministry of Health. Ministry of Social Development The Ministry of Social Development deals with various services for seniors. This is a complete means to describe these services and provide you with appropriate contact information, for instance rest homes and hospital. SuperGold Card Once you have been approved of New Zealand Superannuation the elderly over 65 years of age will be automatically send a Super Gold card. It provides discounts and gives a range of government and businesses concessions for example free off-peak public transport and including discounted services from the local council. The Residential Care Subsidy The Ministry of Health decides that if you get a Residential Care Subsidy, the following things needs to be present in order to qualified for a residential care subsidy, if you are considered for needing an long –term residential care in a rest home or hospital, if you need the care for an unlimited time, if the rest home or the hospital is approved and if you are 65 years or older and if you are below the age of 65 years than there are conditions that would apply. Also it depends on your spouse income or any asset that your partner may be having. Comparing the policies of these countries on aging: The policies of all the countries focused on providing the better facilities for the people with old age regarding their health and social life. In Australia the main point of focus was to provide the care in terms of their health and society. The Canada’s government is mainly concentrated on proving the better financial facilities for the people of old age. The policies of New Zealand mainly concentrated on proving the better facilities for the people in terms of their medications and lifestyle.