Understanding Old Age

 Understanding 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

Definitions of old age include official definitions, sub-group definitions, and four dimensions as follows. 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.

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.

Dimensions

Key Concepts in Social Gerontology lists four dimensions: chronological, biological, psychological, and social.  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. 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.

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.

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 behaviours 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. 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".

At about age 85, most people experience 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.
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 becomes evil. All taste is gone. What old age does to men is evil in every respect.

"Heroism" required by old age: to live through the disintegration of one's own body or that of someone you love. "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".

Misconceptions

In 85-year-olds and older, popular conceptions about old age are erroneous. Such erroneous conceptions include (1) people in old age have at least one family member for support, (2) old age well-being requires social activity, and (3) "successful adaptation" to age-related changes demands a continuity of self-concept. In their interviews, Johnson and Barer found that 24% of the 85+ had no face-to-face family relationships; many have outlived their families. Second, contrary to popular notions, the interviews revealed that the reduced activity and socialising of the over-85s does not harm their well-being; they "welcome increased detachment". Third, rather than a continuity of self-concept, as the interviewees faced new situations, they changed their "cognitive and emotional processes" and reconstituted their "self-self-self-self-representation".

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 ... been with us since the stage of primitive society; it was both the source of wisdom and of infirmity, experience and decrepitude, of prestige and suffering."

Old age was denigrated as a time of "decline and decrepitude". "Beauty and strength" were esteemed, and old age was viewed as defiling and ugly. 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."

Historical periods reveal a mixed picture of the "position and status" of old people, but there has never been a "golden age of ageing". "Old people were respected or despised, honoured or put to death according to circumstance."

In ancient times, those who were frail were seen as a burden and ignored or, in extreme cases, killed. People were defined as "old" because of their inability to perform useful tasks rather than their years.

Aristotle concurred in the dislike of old people, that "old people are miserly; they do not acknowledge disinterested friendship; only seeking for what can satisfy their selfish needs". Old age is "cruel or weak".

Joan Erikson observed that "aged individuals are often ostracised, neglected, and overlooked; elders are seen no longer as bearers of wisdom but as embodiments of shame".

Attitudes toward old age well-being vary somewhat between cultures. For example, in the United States, being healthy, physically, and socially active is a sign of good old age. On the other hand, Africans focus more on food and material security and a helpful family when describing old age well-being.  Additionally, Koreans are more anxious about ageing and more scared of old people than Americans are.

Research on age-related attitudes consistently finds that negative attitudes exceed positive attitudes toward old people because of their looks and behaviour. In his study, Ageing and Old Age, Posner discovers "resentment and disdain of older people" in American society. Harvard University's implicit-association test measures implicit "attitudes and beliefs" about "Young vis-à-vis Old" -  Blind Spot: Hidden Biases of Good People,  80% of Americans have an "automatic preference for the young over old," and that attitude is true worldwide. The young are "consistent in their negative attitude" toward the old. Ageism documents that Americans generally have "little tolerance for older persons and very few reservations about harbouring negative attitudes" about them.

Ageism is seldom the subject of public discourse.

 "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

Frailty

Most people in the age range of 65–79 (the years of retirement and early old age) enjoy rich possibilities for a full life, but the condition of frailty, distinguished by "bodily failure" and greater dependence, becomes increasingly common from around age 80. In the United States, hospital discharge data from 2003 to 2011 show that injury was the most common reason for hospitalisation among patients aged 65+.

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 worldwide study of "patterns of frailty" based on data from 20 nations found (a) a consistent correlation between frailty and age, (b) a higher frequency among women, and (c) that more frailty in wealthier nations was greater support and medical care increases longevity.

Bodily failure and greater dependence became prevalent in the 80+ years. The study calls these years the "fourth age" or "old age in the real meaning of the term". People in their 70s were mostly rated as good. In the 80–90-year range, the four levels of functionality were divided equally. By the 90–100 year range, 60% would be considered frail because of very poor functionality, and only 5% still possessed good functionality.

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 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 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. 

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".

Patients aged 65+ had the highest percentage of hospital stays for adults with multiple chronic conditions, but the second highest percentage of hospital costs in 2003–2014.

Medical treatments in the final days are not only economically costly, but they are often unnecessary or even harmful. 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.

Death

Old age, death, and frailty are closely linked, with approximately half the deaths in old age preceded by months or years of frailty.

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. "progressive terminal decline" in the year before death: constant fatigue, much sleep, detachment from people, things, and activities, simplified lives. 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 found that the more frail people were, the more "pain, suffering, and struggles" they were enduring, the more likely they were to "accept and welcome" death as a release from their misery. Their 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.

Religiosity

Generally speaking, old people have always been more religious than young people. At the same time, wide cultural variations exist.

The old people surveyed said that religion was "very important" to them, and a quarter said they had become less religious in old age.  The late-life rise in religiosity is stronger. In the practice of religion, a study of 60+ people found that 25% read the Bible every day and over 40% watch religious television.   In the age 65+ range, 75% of whites and 87% of blacks pray daily. When comparing religiosity, the individual practice may be a more accurate measure than participation in organised religion. With organised religion, participation may often be hindered due to transportation or health problems.

Demographic changes

In the industrialised countries, life expectancy and, thus, the old age population have increased consistently over the last decades. In the United States, the proportion of people aged 65 or older increased from 4% in 1900 to about 12% in 2000. In 1900, only about 3 million of the nation's citizens were 65 or older (out of 76 million total American citizens). By 2000, the number of senior citizens had increased to about 35 million (of 280 million US citizens). Population experts estimate that more than 50 million Americans—about 17 per cent of the population—will be 65 or older in 2020. By 2050, it is projected that at least 400,000 Americans will be 100 or older.

The growing number of people living to their 80s and 90s in the developed world has strained public welfare systems and has also resulted in increased incidence of diseases like cancer and dementia that were rarely seen in premodern times. When the United States Social Security program was created, people older than 65 numbered only around 5% of the population, and the average life expectancy of a 65-year-old in 1936 was approximately 5 years, while in 2011 it could often range from 10 to 20 years. Other issues that can arise from an increasing population are growing demands for health care and an increase in demand for different types of services.

Theories

Social theories, or concepts, propose explanations for the distinctive relationships between old people and their societies.

People are enabled to enjoy their old age without stress. This theory has been subjected to the criticism that old age disengagement is neither natural, inevitable, nor beneficial. Furthermore, disengaging from social ties in old age is not across the board: unsatisfactory ties are dropped, and satisfying ones are kept.

In opposition to the disengagement theory, the activity theory of old age argues that disengagement in old age occurs not by desire, but by the barriers to social engagement imposed by society. This theory has been faulted for not factoring in psychological changes that occur in old age, as shown by reduced activity, even when available. It has also been found that happiness in old age is not proportional to activity.

According to the continuity theory, in spite of the inevitable differences imposed by their old age, most people try to maintain continuity in personhood, activities, and relationships with their younger days.

Socioemotional selectivity theory also depicts how people maintain continuity in old age. The choice is for more harmonious relationships. The circumstances are loss of relationships by death and distance.

In the United States of America and the United Kingdom, 65 (UK 60 for women) was traditionally the age of retirement with full old age benefits.

In 2003, the age at which a United States citizen became eligible for full Social Security benefits began to increase gradually, and will continue to do so until it reaches 67 in 2027. The full retirement age for Social Security benefits for people retiring in 2012 is age 66. In the United Kingdom, the state pension age for men and women will rise to 66 in 2020, with further increases scheduled after that.

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%.