Old age

 Old age

Old age is a highly diverse experience, encompassing individuals from different classes and socioeconomic backgrounds, political status, levels of fitness, and degrees of power. Old age cannot be universally defined because it is context-sensitive.

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 age 80, they generally become increasingly frail, a condition marked by serious mental and physical debilitation.

The distinguishing characteristics of old age are both physical and mental.  A basic mark of old age that affects both body and mind is "slowness of behaviour". 

"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".

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."

Contemporary perspectives

In the modern period, the cultural status of old people has declined in many cultures. "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. Negative attitudes exceed positive attitudes toward old people because of their looks and behaviour. The young are "consistent in their negative attitude" toward the old.

Frailty

Frailty, distinguished by "bodily failure" and greater 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 deregulation in multiple physiological systems". Correlation between frailty and age, (b) a higher frequency among women, and (c) more frailty in wealthier nations, where greater support and medical care increase longevity.

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 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. " Additionally, patients aged 65+ had the highest percentage of hospital stays for adults with multiple chronic conditions.

Medical treatments in the final days are not only economically costly, but they are often unnecessary or even harmful. The frail are vulnerable to "being tipped over" by any physical stress put on the system, such as medical interventions.

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.

In Life Beyond 85 Years found that "progressive terminal decline" in the year before death: constant fatigue, much sleep, detachment from people, things, and activities, simplified lives.

 The frailer 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.

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

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 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.

Different types of people in this stage of life are the "young old," who are the healthy individuals who can function on their own without assistance and can complete their daily tasks independently, while the "old old" are those who depend on specific services due to declining health or diseases.

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.

Life expectancy

In almost all countries, women, on average, live longer than men. The disparities vary between 12 years in Russia to no difference or higher life expectancy for men in countries such as Zimbabwe and Uganda. If a person lived to an advanced age, it was generally due to genetic factors and/or a relatively easy lifestyle, since diseases of old age could not be treated before the 20th century.

Behavioural Changes -

The basic makeup of old age very in all. Mainly, it is the slowness of behaviour, understanding, and physical and mental task performance.

Physical marks of old age vary from person to person, including the following:

• Bone and joint problems - a stooping posture and a greater susceptibility to bone and joint diseases such as osteoarthritis and osteoporosis.
• Chronic diseases: uncontrolled hypertension (34%), arthritis (50%), and heart disease (32%).
• Chronic mucus hypersecretion (CMH), defined as "coughing and bringing up sputum",
• Dental problems: - tooth decay and infection.
• Digestive system issues: difficulty in swallowing, inability to eat enough and to absorb nutrition, constipation, and bleeding.
• Essential tremor: 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 (immuno-senescence).
• 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. 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".
• 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. 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".

Age is not a definite biological stage: the chronological age denoted as "old age" varies culturally and historically. Older people often have limited regenerative abilities and are more susceptible to illness and injury than younger adults. They face social problems related to retirement, loneliness, and ageism.

Old age is a highly diverse experience, encompassing individuals from different classes and socioeconomic backgrounds, political status, levels of fitness, and degrees of power. Old age cannot be universally defined because it is context-sensitive.

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 age 80, they generally become increasingly frail, a condition marked by serious mental and physical debilitation.

The distinguishing characteristics of old age encompass both physical and mental aspects.  A basic mark of old age that affects both body and mind is "slowness of behaviour". 

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 -  many have multiple conditions, 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: 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 for 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 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.

·        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 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.