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 referred to as "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". 

"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."

"Aged individuals are often ostracised, neglected, and overlooked; elders are seen no longer as bearers of wisdom but as embodiments of shame".

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".

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", for years at old time 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. Frail people 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 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.

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 complete 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.

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 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. At about 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. 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".

 

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 referred to as "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". 

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 old 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's toll on "fluid intelligence" and the "more deeply entrenched" ways of the old.

 

Contemporary perspectives

In the modern period, the cultural status of old people has declined in many cultures. 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 are signs of a 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, a book about the test, reports that 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.

Despite its prevalence, ageism is seldom the subject of public discourse.

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+.

Gerontologists note the lack of research regarding and the difficulty in defining frailty. However, they add that physicians recognise frailty when they see it.

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".

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.

Death

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

Older Adults' Views on Death is based on interviews with 109 people in the 70–90 age range, with a mean age of 80.7. Almost 20% of the people wanted to use whatever treatment might postpone death. About the same number said that, given a terminal illness, they would choose assisted suicide. Roughly half chose doing nothing except live day by day until death comes naturally without medical or other intervention designed to prolong life. This choice was coupled with a desire to receive palliative care if needed.

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.

The longitudinal interviews of 150 people aged 85+ years, summarised in Life Beyond 85 Years, found "progressive terminal decline" in the year before death: constant fatigue, much sleep, detachment from people, things, and activities, and 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.

In the United States, 90% of old age Hispanics view themselves as very, quite, or somewhat religious. The Pew Research Centre's study of black and white old people found that 62% of those in ages 65–74 and 70% in ages 75+ asserted that religion was "very important" to them. For all 65+ people, more women (76%) than men (53%) and more blacks (87%) than whites (63%) consider religion "very important" to them. This compares to 54% in the 30–49 age range

In the practice of religion, a study of 60+ people found that 25% read the Bible every day and over 40% watch religious television. Pew Research found that 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

The number of old people is growing around the world chiefly because of the post–World War II baby boom and increases in the provision and standards of health care. By 2050, 33% of the developed world's population and almost 20% of the less developed world's population will be over 60 years old.

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 an 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.

Of the roughly 150,000 people who die each day across the globe, about two-thirds—100,000 per day—die of age-related causes. In industrialised nations, the proportion is much higher, reaching 90%.

Psychosocial aspects

"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 complete 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. The way people adapt and cope reflects their ageing process on a psycho-social level.

Theories

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

One theory, proposed in 1961, is the disengagement theory, which proposes that, in old age, a mutual disengagement between people and their society occurs in anticipation of death. By becoming disengaged from work and family responsibilities, according to this concept, 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 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 focus of this theory is continuity sustained by social networks, albeit networks narrowed by choice and by circumstances. The choice is for more harmonious relationships. The circumstances are loss of relationships by death and distance.

Life expectancy

Life expectancy by nation at birth in the year 2011 ranged from 48 years to 82 years. Low values were caused by high death rates for infants and children.

In almost all countries, women, on average, live longer than men.

Before the surge in the over-65 population, accidents and disease claimed many people before they could attain old age, and health problems in those over 65 meant a quick death in most cases. 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.

In October 2016, a group of scientists identified the maximum human lifespan at an average age of 115, with an absolute upper limit of 125 years. However, the concept of a maximum lifespan of humans is still widely debated among the scientific community.

Benefits

Originally, the purpose of old age pensions was to open up jobs for younger unemployed people, and also 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. Some complained that "powerful" and "greedy" old people were getting more than their share of the nation's resources. In 2011, using a Supplemental Poverty Measure (SPM), the old-age American poverty rate was measured as 15.9%.

Assistance

In the United States in 2008, 11 million people aged 65+ lived alone: 5 million or 22% of those aged 65–74, 4 million or 34% of those aged 75–84, and 2 million or 41% of those aged 85+. The 2007 gender breakdown for all people 65+ was men 19% and women 39%.

Many new assistive devices made especially for the home have enabled older people to care for their own activities of daily living (ADL). Some examples of devices are a medical alert and safety system, a shower seat (making it so the person does not get tired in the shower and fall), a bed cane (offering support to those with unsteadiness getting in and out of bed) and an ADL cuff (used with eating utensils for people with paralysis or hand weakness).

Even with assistive devices as of 2006, 8.5 million Americans needed personal assistance because of impaired basic activities of daily living required for personal care or impaired instrumental activities of daily living (IADL) required for independent living. Projections indicate that this number will reach 21 million by 2030, when 40% of Americans over 70 will require assistance. There are many options for long-term care for those who require it. There is home care, where a family member, volunteer, or trained professional aids the person in need and helps with daily activities. Another option is community services, which can provide the person with transportation, meal plans, or activities in senior centres. A third option is assisted living, where 24-hour round-the-clock supervision is given with aid in eating, bathing, dressing, etc. A final option is a nursing home, which provides professional nursing care.

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