Knowing Old Age

 Knowing Old Age

Old age is the range of ages for people nearing and surpassing life expectancy. People of old age are also referred to as: old people, elderly, elders, senior citizens, seniors or older adults. Old age is not a definite biological stage: the chronological age denoted as "old age" varies culturally and historically. Some disciplines and domains focus on the aging and the aged, such as the organic processes of aging (senescence), medical studies of the aging process (gerontology), diseases that afflict older adults (geriatrics), technology to support the aging society (geotechnology), and leisure and sport activities adapted to older people (such as senior sport).

Old people often have limited regenerative abilities and are more susceptible to illness and injury than younger adults. They face social problems that relate to retirement, loneliness, and ageism.

In 2011, the United Nations proposed a human-rights convention to protect old people.

Definitions

Most developed Western countries set the retirement age around the age of 65; this is also generally considered to mark the transition from middle to old age. Reaching this age is commonly a requirement to become eligible for senior social programs.

Old age cannot be universally defined because it is context-sensitive. The United Nations, for example, considers old age to be 60 years or older. In contrast, a 2001 joint report by the U.S. National Institute on Ageing and the World Health Organisation [WHO] Regional Office for Africa set the beginning of old age in Sub-Saharan Africa at 50. This lower threshold stems primarily from a different way of thinking about old age in developing nations. Unlike in the developed world, where chronological age determines retirement, societies in developing countries determine old age according to a person's ability to make active contributions to society. This number is also significantly affected by lower life expectancy throughout the developing world. Dating back to the Middle Ages and prior, what certain scholars thought of as old age varied depending on the context, but the state of being elderly was often thought as being 60 years of age or older in many respects.

Sub-group definitions

Gerontologists have recognised that people experience very different conditions as they approach old age. In developed countries, many people in their late 60s and 70s (frequently called "early old age") are still fit, active, and able to care for themselves.  However, after 80, they generally become increasingly frail, a condition marked by serious mental and physical debilitation.

Therefore, rather than lumping together all people who have been defined as old, some gerontologists have recognised the diversity of old age by defining sub-groups. One study distinguishes the young-old (60 to 69), the middle-old (70 to 79), and the very old (80+). Another study's sub-grouping is young-old (65 to 74), middle-old (75 to 84), and oldest-old (85+). A third sub-grouping is young-old (65 to 74), old (74 to 84), and old-old (85+). Describing sub-groups in the 65+ population enables a more accurate portrayal of significant life changes.

Two British scholars, Paul Higgs and Chris Gilleard, have added a "fourth age" sub-group. In British English, the "third age" is "the period in life of active retirement, following middle age". Higgs and Gilleard describe the fourth age as "an arena of inactive, unhealthy, unproductive, and ultimately unsuccessful ageing".

Dimensions

Key Concepts in Social Gerontology lists four dimensions: chronological, biological, psychological, and social.  Wattis and Curran add a fifth dimension: developmental. Chronological age may differ considerably from a person's functional age. The distinguishing marks of old age normally occur in all five senses at different times and at different rates for different people. In addition to chronological age, people can be considered old because of the other dimensions of old age. For example, people may be considered old when they become grandparents or when they begin to do less or different work in retirement.

Senior citizen

Senior citizen is a common euphemism for an old person used in American English, and sometimes in British English. It implies that the person being referred to is retired. This, in turn, usually implies that the person is over the retirement age, which varies according to country. Synonyms include old age pensioner or pensioner in British English, and retiree and senior in American English. Some dictionaries describe widespread use of "senior citizen" for people over the age of 65.

When defined in a legal context, senior citizen is often used for legal or policy-related reasons in determining who is eligible for certain benefits available to the age group.

It is used in general usage instead of traditional terms such as "old person", "old-age pensioner", or "elderly" as a courtesy and to signify continuing relevance of and respect for this population group as "citizens" of society, of senior "rank".

The term was coined in 1938 during a political campaign. Famed caricaturist Al Hirschfeld claimed on several occasions that his father, Isaac Hirschfeld, invented the term "senior citizen". It has come into widespread use in recent decades in legislation, commerce, and common speech. Especially in less formal contexts, it is often abbreviated as "senior(s)", which is also used as an adjective.

Age qualifications

The age of 65 has long been considered the benchmark for senior citizenship in numerous countries. Bismarck's legislation set the retirement age at 70, with 65 as the age at which individuals could start receiving a pension. This age standard gradually gained acceptance in other nations and has since become deeply entrenched in public consciousness.

The age that qualifies for senior citizen status varies widely. In governmental contexts, it is usually associated with an age at which pensions or medical benefits for the elderly become available. In commercial contexts, where it may serve as a marketing device to attract customers, the age is often significantly lower.

In commerce, some businesses offer customers of a certain age a "senior discount". The age at which these discounts are available varies from 55, 60, 62 or 65 upwards, and other criteria may also apply. Sometimes a special "senior discount card" or other proof of age needs to be produced to show entitlement.

In the United States, the standard retirement age is currently 66 (gradually increasing to 67). The AARP allows couples in which one spouse has reached the age of 50 to join, regardless of the age of the other spouse.

In Canada, the Old Age Security (OAS) pension is available at 65 (the Conservative government of Stephen Harper had planned to gradually increase the age of eligibility to 67, starting in the years 2023–2029, although the Liberal government of Justin Trudeau is considering leaving it at 65), and the Canada Pension Plan (CPP) as early as age 60.

Signs

The distinguishing characteristics of old age are both physical and mental. The marks of old age are so unlike the marks of middle age that legal scholar Richard Posner suggests that, as an individual transitions into old age, that person can be thought of as different people "time-sharing" the same identity.

These marks do not occur at the same chronological age for everyone. Also, they occur at different rates and orders for different people. Marks of old age can easily vary between people of the same chronological age.

A basic mark of old age that affects both body and mind is "slowness of behaviour". The term describes a correlation between advancing age and slowness of reaction and physical and mental task performance. However, studies from Buffalo University and Northwestern University have shown that the elderly are a happier age group than their younger counterparts.

Physical

Physical marks of old age include the following:

·        Bone and joint problems: Old bones are marked by "thinning and shrinkage". This might result in a loss of height (about two inches (5 cm) by age 80), a stooping posture in many people, and a greater susceptibility to bone and joint diseases such as osteoarthritis and osteoporosis.

·        Chronic diseases: Some older people have at least one chronic condition, and many have multiple conditions. In 2007–2009, the most frequently occurring conditions among older people in the United States were uncontrolled hypertension (34%), arthritis (50%), and heart disease (32%).

·        Chronic mucus hypersecretion (CMH), defined as "coughing and bringing up sputum", is a common respiratory symptom in elderly people.

·        Dental problems: Older people may have less saliva and reduced ability to maintain oral hygiene, consequently increasing the chance of tooth decay and infection.

·        Digestive system issues: About 40% of the time, old age is marked by digestive disorders such as difficulty in swallowing, inability to eat enough and to absorb nutrition, constipation and bleeding.

·        Essential tremor (ET): An uncontrollable shaking in a part of the upper body. It is more common in the elderly, and symptoms worsen with age.

·        Eyesight deterioration: Presbyopia can occur by age 50 and it hinders reading, especially of small print in low lighting. The speed with which an individual reads and the ability to locate objects may also be impaired. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

·        Falls: Old age increases the risk of injury from falls. Every year, about a third of those 65 years old and more than half of those 80 years old fall. Falls are the leading cause of injury and death among older people.

·        Gait change: Some aspects of gait normally change with old age. Speed slows after age 70. Time with both feet on the ground ("double stance") increases. Old people sometimes move as if they were walking carefully on ice.

·        Hair usually turns grey and may become thinner. By age 50, about 50% of Europeans have 50% grey hair. Many men are affected by balding.

·        Women enter menopause.

·        Hearing loss: By age 75, 48% of men and 37% of women have lost at least some significant hearing. Of the 26.7 million people [where?] over age 50 with a hearing impairment, one seventh use hearing aids. In the 70–79 age range, partial hearing loss affecting communication rises to 65%, mostly in low-income men.

·        Hearts can become less efficient in old age, lessening stamina. Atherosclerosis can constrict blood flow.

·        Immune-function loss (immunosenescence).

·        Lungs may expand less efficiently, providing less oxygen.

·        Mobility impairment or loss: "Impairment in mobility affects 14% of those between 65 and 74, [and] half of those over 85." Loss of mobility is common in old people and has serious "social, psychological, and physical consequences".

·        Pain: 25% of seniors have chronic pain, increasing with age, up to 80% of those in nursing homes. Most pains are rheumatological, musculoskeletal-related, or malignant.

·        Decreases in sexual drive in both men and women. Increasing research on sexual behaviour and desires in later life is challenging the "asexual" image of older adults. People aged 75–102 do experience sensuality and sexual pleasure. Sexual attitudes and identity are established in early adulthood and change little. Sexuality remains important throughout life, and the sexual expression of "typical, healthy older persons is a relatively neglected topic of research". Other known sexual behaviors in older age groups include sexual thoughts, fantasies, and dreams; masturbation; oral sex; and vaginal and anal intercourse.

·        Skin loses elasticity and gets drier and more lined and wrinkled.

·        Wounds take longer to heal and are likelier to leave permanent scars.

·        Trouble sleeping and daytime sleepiness affect more than half of seniors. In a study of 9,000 people with a mean age of 74, only 12% reported no sleep complaints. By age 65, deep sleep drops to about 5% of sleep time.

·        Taste buds diminish by up to half by the age of 80. Food becomes less appealing, and nutrition can suffer.

·        Over the age of 85, thirst perception decreases, so that 41% of the elderly do not drink enough.

·        Urinary incontinence is often found in old age.

·        Vocal cords weaken and vibrate more slowly. This results in a weakened, breathy voice, "old person's voice".

Mental

Mental marks of old age include the following:

·        Agreeability: Despite the stressfulness of old age, the words "agreeable" and "accepting" are commonly used to describe people of old age. However, in some people, the dependence that comes with old age induces feelings of incompetence and worthlessness from having to rely on others for many different basic living functions.

·        Caution follows closely with old age. This antipathy toward "risk-taking" often stems from the fact that old people have less to gain and more to lose than younger people.

·        Depressed mood. According to Cox, Abramson, Devine, and Hollon (2012), old age is a risk factor for depression caused by prejudice. When younger people are prejudiced against the elderly and then become old themselves, their anti-elderly prejudice turns inward, causing depression. "People with more negative age stereotypes will likely have higher rates of depression as they get older." Old age depression results in the over-65 population having the highest suicide rate.

·        Fear of crime in old age, especially among the frail, sometimes weighs more heavily than concerns about finances or health and restricts what they do. The fear persists even though older people are victims of crime less often than younger people.

·        Increasing fear of health problems.

·        Mental disorders affect about 15% of people aged 60+, according to estimates by the World Health Organisation. Another survey taken in 15 countries reported that mental disorders of adults interfered with their daily activities more than physical problems.

·        Reduced mental and cognitive ability: Memory loss is common in old age due to the brain's decreased ability to encode, store, and retrieve information. It takes more time to learn the same amount of new information. The prevalence of dementia increases in old age from about 10% at age 65 to about 50% over age 85. Alzheimer's disease accounts for 50 to 80 per cent of dementia cases. Demented behaviour can include wandering, physical aggression, verbal outbursts, depression, and psychosis.

·        Stubbornness: A study of over 400 seniors found a "preference for the routine". Explanations include old age on "fluid intelligence" and the "more deeply entrenched" ways of the old. 

Perspectives

Middle age

Many books written by authors in middle adulthood depict a few common perceptions of old age. One writer notices the change in his parents: They move slowly, they have less strength, they repeat stories, their minds wander, and they fret. Another writer sees her aged parents and is bewildered: They refuse to follow her advice, they are obsessed with the past, they avoid risk, and they live at a "glacial pace".

In her book The Denial of Ageing, Dr. Muriel R. Gillick, a baby boomer, accuses her contemporaries of believing that by proper exercise and diet, they can avoid the scourges of old age and proceed from middle age to death. Studies find that many people in the 65–84 range can postpone morbidity by practising healthy lifestyles. However, at about age 85, most people experience similar morbidity. Even with healthy lifestyles, most 85+ people will undergo extended "frailty and disability".

Old age

Early old age can be a pleasant time; children are grown, work is over, and there is time to pursue other interests.  Many old people are also willing to get involved in community and activist organisations to promote their well-being. In contrast, perceptions of old age by writers 80+ years old tend to be negative.

Georges Minois writes that the first man known to talk about his old age was an Egyptian scribe who lived 4,500 years ago. The scribe addressed God with a prayer of lament:

O Sovereign, my Lord! Oldness has come; old age has descended. Feebleness has arrived; dotage is here anew. The heart sleeps wearily every day.
The eyes are weak, the ears are deaf, the strength is disappearing because of weariness of the heart, and the mouth is silent and cannot speak.
The heart is forgetful and cannot recall yesterday. The bone suffers from old age. Good is become evil. All taste is gone. What old age does to men is evil in every respect.

Minois comments that the scribe's "cry shows that nothing has changed in the drama of decrepitude between the age of the Pharaoh and the atomic age" and "expresses all the anguish of old people in the past and the present".

Lillian Rubin, active in her 80s as an author, sociologist, and psychotherapist, opens her book 60 on Up: The Truth about Aging in America with "getting old sucks. It always has, it always will." Dr. Rubin contrasts the "real old age" with the "rosy pictures" painted by middle-aged writers.

Writing at the age of 87, Mary C. Morrison describes the "heroism" required by old age: to live through the disintegration of one's own body or that of someone you love. Morrison concludes, "old age is not for the fainthearted". In the book Life Beyond 85 Years, the 150 interviewees had to cope with physical and mental debilitation and with losses of loved ones. One interviewee described living in old age as "pure hell".

Research has shown that in high-income countries, on average, one in four people over 60 and one in three over 75 feel lonely.

Societal and historical

"It is clear that, always and everywhere, youth has been preferred to old age. "Old age is an evil, an infirmity and a dreary time of preparation for death. Furthermore, death is often preferred over "decrepitude, because death means deliverance".

"The problem of the ambiguity of old age has ... it was both the source of wisdom and infirmity, experience and decrepitude, of prestige and suffering." Old age was reckoned as one of the unanswerable "great mysteries" along with evil, pain, and suffering. "Decrepitude, which shrivels heroes, seemed worse than death."

In ancient times, People were defined as "old" because of their inability to perform useful tasks rather than their years.

Aristotle wrote that "old people are miserly; they do not acknowledge disinterested friendship; only seeking for what can satisfy their selfish needs".- depicted old age as "cruel or weak".

 "Ageing Simulation." The workshop is adapted from Sensitising People to the Processes of Ageing. Some of the simulations include:

·        Sight: Wearing swimmer's goggles with black paper pasted to the lens with only a small hole to simulate tunnel vision

·        Hearing: Use earplugs to dull the sound of people talking

·        Touch: Trying to button a shirt or buckle a belt while wearing thick gloves

·        Dexterity: Unscrew a jar lid with tape around several fingers

·        Mobility and balance: Carry packages in one hand while using a walker

A group of geriatricians proposed a general definition of frailty as "a physical state of increased vulnerability to stressors that results from decreased reserves and dysregulation in multiple physiological systems".

Frailty is a common condition in later old age, but different definitions of frailty produce diverse assessments of prevalence. One study placed the incidence of frailty for ages 65+ at 10.7%. Another study placed the incidence of frailty in the age 65+ population at 22% for women and 15% for men.  A Canadian study illustrated how frailty increases with age and calculated the prevalence for 65+ as 22.4% and for 85+ as 43.7%.

Markers

Three unique markers of frailty have been proposed: (a) loss of any notion of invincibility, (b) loss of ability to do things essential to one's care, and (c) loss of possibility for a subsequent life stage.

Old age survivors, on average, deteriorate from agility in their early retirement years (65-79) to a period of frailty preceding death. This deterioration is gradual for some and precipitous for others. Frailty is marked by an array of chronic physical and mental problems, which means that frailty is not treatable as a specific disease. These problems, coupled with increased dependency in the basic activities of daily living (ADLs) required for personal care, add emotional problems: depression and anxiety. In sum, frailty has been depicted as a group of "complex issues", distinct but "causally interconnected", that often include "comorbid diseases", progressive weakness, stress, exhaustion, and depression.

Healthy humans after age 50 accumulate endogenous DNA single- and double-strand breaks in a linear fashion in cellular DNA. Other forms of DNA damage also increase with age. After age 50, a decline in DNA repair capability also occurs. These findings are in accord with the theory that DNA damage is a fundamental aspect of ageing in older people.

Care and costs

Frail people require a high level of care. Medical advances have made it possible to extend life, or "postpone death", at old age for years. This added time costs many frail people "prolonged sickness, dependence, pain, and suffering".

In addition to everyday care, frail elderly people and others with disabilities are particularly vulnerable during natural disasters. They may be unable or unwilling to evacuate to avoid a hurricane or wildfire.

About half of older adults have multimorbidity, that is, they have three or more chronic conditions. Medical advances have made it possible to "postpone death", but in many cases, this postponement adds "prolonged sickness, dependence, pain, and suffering", a time that is costly in social, psychological, and economic terms.

Most of the interviewees did not fear death; some would welcome it. One person said, "Living this long is pure hell." However, nearly everyone feared a long process of dying. Some wanted to die in their sleep; others wanted to die "on their feet".

The study of Older Adults' Views on Death fear about the process of dying was that it would prolong their distress. Besides being a release from misery, some saw death as a way to reunite with deceased loved ones. Others saw death as a way to free their caretakers from the burden of their care.

Psychosocial aspects

According to Erik Erikson's "Stages of Psychosocial Development", the human personality is developed in a series of eight stages that take place from the time of birth and continue throughout an individual's entire life. He characterises old age as a period of "Integrity vs. Despair", during which people focus on reflecting back on their lives. Those who are unsuccessful during this phase will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair. Those who feel proud of their accomplishments will feel a sense of integrity. Completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death. Coping is a very important skill needed in the ageing process to move forward with life and not be 'stuck' in the past. The way people adapt and cope reflects their ageing process on a psycho-social level.

Joan Erikson added a ninth stage in The Life Cycle Completed: Extended Version. As she wrote, she added the ninth stage because the Integrity of the eighth stage imposes "a serious demand on the senses of elders" and the Wisdom of the eighth stage requires capacities that the ninth stage elders "do not usually have".

Originally, the purpose of old age pensions was to prevent elderly people from being reduced to beggary, which is still common in some underdeveloped countries, but growing life expectancies and older populations have brought into question the model under which pension systems were designed. By 1990, the United States was spending 30 per cent of its budget on the elderly, compared with 2 per cent on education. The dominant perception of the American old age population changed from "needy" and "worthy" to "powerful" and "greedy", old people getting more than their share of the nation's resources. However, in 2011, using a Supplemental Poverty Measure (SPM), the old-age American poverty rate was measured as 15.9%.

·      QUOTES

·      “Ageing is not 'lost youth' but a new stage of opportunity and strength.” ...

·      “The longer I live, the more beautiful life becomes.” ...

·      “In the end, it's not the years in your life that count. ...

·      “Count your age by friends, not years. ...

·      “Ageing has a wonderful beauty, and we should have respect for that.”

·      The beauty of caring for seniors is realising that they are heroes in their own right.” – Karen Clark

·      “Growing old is not a disease, it is a triumph.” – Maggie Kuhn

·      “Ageing is not lost youth but a new stage of opportunity and strength.” – Betty Friedan

·      “Growing old gracefully is a thing of beauty when you have caregivers who love and support you.” – Unknown

·      “The longer I live, the more beautiful life becomes.” – Frank Lloyd Wright

·      “The glory of the elderly is their insight, their knowledge, and their wisdom.” – Lailah Gifty Akita

·      “The elderly are a source of wisdom, experience, and stability in a world that is constantly changing.” – Unknown

·      “Age is not a barrier to success; it’s a ladder to wisdom.” – Unknown

·      “We should give our elders the respect and dignity they deserve, for they have made our lives possible.” – Unknown

·      “The love, care, and attention we give to the elderly is a measure of our humanity.” – Unknown

·      “Ageing gracefully means being flexible, being open, allowing change, enjoying change, and loving yourself.” – Wendy Wasserstein

·      “You are never too old to set another goal or to dream a new dream.” – C.S. Lewis

·      “Grow old along with me! The best is yet to be.” – Robert Browning

· Ageing is not a curse but a privilege, and the good news is that we can all become better versions of ourselves with age.” – Mary Buchan

·      “The best thing about getting older is that you don’t lose all the other ages you’ve been.” – Madeleine L’Engle

·      “Old age is not a disease, it is strength and survivorship, triumph over all kinds of vicissitudes and disappointments, trials and illnesses.” – Maggie Kuhn

·      “The best and most beautiful things in the world cannot be seen or even touched – they must be felt with the heart.” – Helen Keller

·      “It is not how much we give but how much love we put into giving.” – Mother Teresa

·       “A society grows great when old men plant trees whose shade they know they shall never sit in.” – Greek Proverb

·      “Ageing is an extraordinary process where you become the person you always should have been.” – David Bowie

·      “If you want to lift yourself up, lift up someone else.” – Booker T. Washington

·      “It is not how old you are, but how you are old.” – Jules Renard

·      “Caring about others, running the risk of feeling, and leaving an impact on people, brings happiness.” – Harold Kushner

·      “I’m not ageing, I’m ripening to perfection.” – Unknown

·      “Getting older is like climbing a mountain; you get a little out of breath, but the view is much better!” – Ingrid Bergman

·      “I’m not old, I’m just well-seasoned.” – Unknown

·      “By the time you’re 80 years old, you’ve learned everything. You only have to remember it.” George Burns

·      “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.” – Mark Twain

·      “I’m not ageing, I’m just levelling up.” – Unknown

·      “Growing old is mandatory, but growing up is optional.” – Walt Disney