1 Normal Aging Flashcards
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Europe
Europe is the oldest continent of the world. Every 6th European is 65+. In 2050 the expectation is that every 4th European will be 65+.
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Gerontology
The study of human ageing. It draws from many scientific disciplines: sociology, economy, psychology, etc.
Gerontology is derived from two Greek words:
- Geron= Old man.
- Gerh= Growing up, maturing or ageing. This means that it refers to being old, and the process of ageing.
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What is old age?
It is not only a biological concept, but also a social concept.
- Society influences how we see ourselves, our opportunities and how our lives are structured as we age.
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Social and biological concepts
For a long time, the social and biological side of age went hand in hand. The age of 65
(which is the age that people retired) was often an age of health problems. This age was a marker of both social and biological old age. However, people now retire earlier and remain healthy until an older age. This means that 65 is now a poor marker for both the biological and the social aspect of old age.
Solution the development of new concepts=
- The third age (the young-old) = A period of freedom and good health.
- The fourth age (the old-old) =
A period of decline of both physical and mental health, the number of losses exceeds the number of gains (het aantal verliezen is groter dan de winsten).
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How old is Europe?
Europe is heterogeneous in many respects, and there exists diversity between and within countries. The oldest continent of the world is Europe (median age = 40), followed by Northern America. The youngest continent of the world is Africa. The medium age in Europe is 12 years more than the medium age in the world and 21 years more than the medium age in Africa.
Within Europe, the ageing is divided=
There are different shades of grey within Europe and also within the countries itself. The oldest population in Europe will be the West and the South of the continent, while the North and the East will hold the youngest populations. But these differences now a day are less crisp (minder scherp).
Countries with low median age=
For example; Iceland, Ireland, Albania, Moldova and Turkey.
Countries with median age on an intermediate level=
Sweden and Finland in the North, Germany and the Czech Republic, Italy and Greece. Portugal is an outlier in this group.
The highest medium age in Europe=
Many of these old countries are in Eastern Europe, others are in the North, South or West. Examples; Estonia, Spain, Norway and France.
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Differences between populations
The shades of grey do not stop at the country level. They also exist within countries, because the populations within countries do not age homogeneously. There are marked differences between population groups when it comes to how fast population ageing progresses. These differences originate from differences between population groups: gender, rural/city areas, migration patterns, etc.
For example=
There are more women than men in the higher age groups, and the population in rural areas often ages faster than the population in cities.
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The ‘older European’ doesn’t exist
only a little resemblance between older Europeans, but much more marked differences, due to:
- Country characteristic (politics, religion, etc.).
- Differences between individuals (gender, social-economic status, religion affiliation etc.).
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Individual differences
-Gender=
There are more women than men 65+.
This is the result of two factors=
- Woman live longer than man.
- Men fought as soldiers during WWII (reduction in the WWII generation of man).
-Social networks=
Social connections enhance well-being, health and support. The modernization had led to a loosening of kinship ties, but in the South and East of Europe, family ties are still very important. In the North, you see extended de-familization (in Scandinavia & Netherlands: highest memberships of clubs and voluntary organizations due to de- familization; meaning that friends and associations become more important).
-Socio-economic status=
A person’s social-economic status describes the position he or she has in society because of wealth, educational level and occupational prestige (rijkdom, educatieve niveau en beroepsmatige prestige).
-The wealth of older Europeans
High in continental countries (Belgium, Switzerland, France) low in east Europe (Poland, Czech Republic).
-The educational level and occupational prestige of Older Europeans
High in Northern and continental countries (Denmark and Austria), low in South Europe (Spain and Greece).
-Health status=
Good in northern countries, worse in the south and east of Europe. These health differences are partly due to life-style, partly to health care systems. Men have a better perceived health (zelf-waargenomen gezondheid), women have longer life expectancies (levensverwachting).
-In general=
The east of Europe has the least favourable circumstances (minst gunstige) with respect to healthy ageing. The west and the north of Europe have the bests circumstances with respect to healthy ageing.
-Country-profile=
First, we will describe Italy, which is one of the oldest countries in Europe. Then, we will look at Sweden, which has an average share of older people for European standards. Finally, we will look at Slovakia, which is one of the youngest countries in Europe.
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Examples of old age in different countries
-Old age in Italy=
The second oldest country of Europe (after Germany), and the 3rth oldest country in the world! Italians report that they think old age starts at 68, this is one of the highest reported ages of Europe. Older Italians have low levels of engagement in productive activities, sports, clubs and voluntary organizations. The employment rate of 55-64 old people i9s (2009) the lowest of Europe: 37%. There is a strong engagement in their families. The public care services are scarce and therefore the most care work is done by family or ‘badanti ‘(migrant care workers).
-Old age in Sweden=
Sweden has the highest percentage of older people (55-64) working for pay: 70%. Ageing seems to have only a little e ect on the labour market. Swedes report that they think old age starts at 67. They also live longer than the average European, and stay healthy until a really old age. Swedes are active until a late age and do much volunteer work. They are less active in volunteer organizations. They work until the age of 67.
-Old Age in Slovakia=
Slovakia is one of the youngest countries of Europe. The median age is 37. After the age of 65, only 3 more years in good health are expected. The overall life expectancy lies 3 years below the average of Europe. Slovakians report that they think old age starts at 58. The average retirement is around the same age. Pensioners are less likely to volunteer, but feel nevertheless integrated in society (voelen zich toch geïntegreerd in de samenleving).
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Definitions
Bio- and health gerontology=
Investigates the physical changes during the ageing process.
Aging=
Ageing is a complex process involving biological, social, psychological, environmental and spiritual components. Gerontology is the study of these components and their interrelations, with the subdisciplines bio- and health gerontology focusing on physical processes.
Bio-gerontology=
Focusses on the physical mechanisms of ageing. Studying ageing processes on a molecular level, exploring how the aging processes aspect organs and the entire body.
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Aubrey de Grey
Saw ageing as a disease, and ageing should therefore be possible to be cured. Other biogerontologists see this view of de Grey as too optimistic: no approach has ever been able to extend the life span of any organism. The main criticism of bio-gerontology is that it is a young discipline and therefore still needs a few decades to develop.
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Health-gerontology
Focusses on the health status and health care of older people. Focusses on the health status and health care of older people. It is the scientific field of doctors and epidemiologists. Studying populations cross-sectionally and longitudinally. It is closely linked to the environmental aspects of ageing.
The consequences of bodily changes (because of ageing) on daily living and the use of health care services. It underlines two levels of health-related interventions:
1. The individual level (for example focus on health promotion and disease prevention)
2. The level of populations (focus on poverty prevention, housing conditions and organization of health and social care systems). Both focus on the physical processes of older age and ageing.
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What is health in old age?
Health is the freedom of disease. As individuals age, diseases develop, so old age and good health were seen as mutually exclusive states.
This perception of old age can be explained with senescence=
Describes the process of biological ageing (senescence means that the body reacts more slowly to changes (with the consequence of recovering from diseases becomes more di cult). So: as someone becomes older, health declines and disease becomes more common.
Brody & Schneider: there are two reasons why older people have more health problems:
- Ageing itself causes health to decline.
- Disease requires a longer period of time to develop, so they can only manifest in old ages.
It is important to keep in mind that the presence of disease doesn’t necessarily mean that older people consider themselves in poor health, rather: older people have their own perceptions of their health (subjective).
A more positive approach=
The World Health Organization (WHO) has a broader understanding of old age and health.
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Health
Health=
A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
The difference with the traditional approach=
It includes also the subjective aspect of social well-being.
But what is social well-being?
Social well-being is closely related to a good quality of life (QoL).
Quality of Life has 2 dimensions=
- A health-related dimension (discomfort, pain, energy level, etc).
- A not-health related dimension (personal resources, as friendships, spiritual satisfaction, etc.) This suggests that there are two ways to maintain a good health in old age:
- Preventing disease;
- Enhancing personal resources.
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Expanding healthy life-expectancies -> new concepts within old age
- Active ageing=
The process of optimizing opportunities for health, participation and security in order to enhance QoL. - Successful ageing=
A combination of 3 elements: o The absence of disease;
o The maintenance of physical and cognitive abilities; o Engagement in productive activities
Both of these concepts underlie productive activities, but there is a difference=
Successful ageing does not draw attention to QoL. Instead, it gives ageing more a normative tone, suggesting that people can also ‘unsuccessfully’ age. Therefore, this term is not very useful.
Conclusion= Healthy ageing focusses on both active ageing and Quality of Life.
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3 possible ways to age healthy
- By slowing down ageing processes=
The process of ageing starts at birth. Adopting a healthy lifestyle at a young age is a central component of this strategy. Also, the use of anti-ageing medicine (without evidence that this works). - By learning from health promoting strategies (good diet, exercise..) =
The goal of this strategy is reducing the risks leading to one of the following 4 diseases:
- Cardiovascular disease
- Lung disease.
- Diabetes.
- Cancer. - By utilizing the potentials for preventive medicine.
Preventive medicine make use of two approaches:
- Slowing down the ageing process.
- Learning from health promoting strategies.
This strategy also places great importance on early diagnosis of disease (early diagnoses can help to ensure good health in old age.
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Health status of Europeans
The health status of Europeans differs widely across the continent.
The highest life expectancies=
The highest life expectancies are seen in the continental, north and south of Europe. The lowest in the East of Europe.
The healthy life expectancies=
The healthy life expectancies are the lowest in Slovakia, and the highest in Sweden.
Capabilities=
When older Europeans were asked whether they were severely limited in their everyday activities, several of them confirmed. Generally speaking, the number of people with limitations in their activities increases with age. When it comes to capabilities, there is no clear geographical pattern like the one in life expectancies.
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Frailty
The state in which people are especially vulnerable to fall ill, have accidents and die prematurely.
Someone is considerate frail when he or she has at least 3 of the following symptoms:
- Unintentional weight loss (4.5 kg in the past year);
- Self-reported exhaustion;
- Weakness (in grip);
- Slow walking speed;
- Low physical activity
There are two lifestyle factors responsible for the development of frailty=
- Smoking;
- Lack of physical activity.
