Neuropsychology of Ageing and Dementia
Week 1: Normal aging - Part I
Chapter 1: Introduction: Older People under the Magnifying Glass
(Old Age in Europe: A Textbook of Gerontology)
1.1 What is Gerontology?
Gerontology is the study of human aging, which draws from many scientific
disciplines such as sociology, economy, biology, psychology, and epidemiology. The word
‘gerontology’ is derived from the Greek words ‘geron’, which means ‘old man’, and ‘gerh’,
which means ‘growing up, maturing, or aging’. It, therefore, refers to the state of being old as
well as the process of aging.
1.2 What is Old Age?
Current gerontological discussions stress the diversity of the aging experience.
These discussions work with different understandings of old age side by side: some state
that people become old as early as 50, while others state that people only become old once
they reach 75 years. A common solution for handling the diversity of old age is as a
sequence of two separate and distinct periods of life, called the third and the fourth age,
respectively the young-old and the old-old. The third age is characterized by a period of
relative freedom and good health. People no longer have the responsibility for the upbringing
of their children, nor are they obliged to participate in the labor force. The fourth age is
characterized by accelerated decline of physical and mental health, and the number of
losses in physical health and social relationships exceed the number of gains. All the
different understandings of old age have their advantages and disadvantages, and their
usefulness depends on the context.
1.3 How Grey is Europe?
Europe is aging and this process will continue for the decades to come. The aging of
the European population, however, does not progress evenly. There are marked differences
between and within countries when it comes to the age-profile of Europe’s population. We,
therefore, need to have a closer look at the individual European countries and at the
different population groups within them, if we want to better understand how Europe is aging.
1.4 What Are Older Europeans Like?
The older European does not exist. Even though older Europeans resemble each
other to some degree, there are also marked differences between them. This variation is
caused by for example country-characteristics, and differences between the individuals
within a country.
Among Europeans aged 65 years and older, we find slightly more women than men.
The difference is marginal in countries such as Andorra, Iceland, and Macedonia. In Eastern
European countries such as Latvia, Estonia, and the Ukraine, however, two out of three
older people are female. This gender-difference is the result of two factors: 1) women live
longer than men; 2) mostly men fight as soldiers in wars, which means that war-related
deaths are particularly common among men.
, Another important difference between older Europeans concerns their social
networks, meaning their connections with friends and kin. Such connections are important
for older people, because they enhance their wellbeing and health, and they are an
important source of support in times of crisis. In the Nordic countries there is extended de-
familization, meaning that friends and associations become more important. In the South
and East of Europe, family ties are still very important.
A third dividing line between older Europeans is their socio-economic status. A
person’s socio-economic status describes the position he or she has in society because of
wealth, educational level, and occupational prestige.
A final important difference between older Europeans is their health status. The
inhabitants of the Nordic countries (Sweden, Norway, Denmark, Finland) report to be in
better health than the inhabitants of Southern (Portugal, Spain, Greece and Italy) and
Eastern European countries (Czech Republic, Hungary, Poland and Slovenia). Moreover,
men generally have higher levels of self-perceived health than women, whereas women
have higher life expectancies. These health differences are partly due to lifestyle, partly to
health care systems.
A more detailed insight into the situation of older Europeans can be gained when
focussing on individual countries. In the following sections, we will therefore describe the
situation in three European countries that differ dramatically when it comes to how far
population aging has progressed. 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.
1.4.1 Country-Profile: Old Age in Italy
1.4.2 Country-Profile: Old Age in Sweden
1.4.3 Country-Profile: Old Age in Slovakia
1.5 This Book…
Chapter 2: Bio- and Health Gerontology: How Ageing Changes Our Bodies
(Old Age in Europe: A Textbook of Gerontology)
2.1 Summary and learning goals
Bio- and health gerontology investigate physical change during the aging process.
While biogerontology focusses on the physical mechanisms of aging, health gerontology
discusses health status in old age and health care for older people.
2..2 What are Bio- and Health Gerontology?
Aging is a complex process involving biological, social, psychological, environmental
and spiritual components.
Gerontology is the study of these components and their interrelations, with the sub-
disciplines bio- and health gerontology focussing on physical processes. Biogerontology is
the scientific field of biologists and biochemists who study the aging process on a molecular
level, and who explore how this process affects organs and consequently the entire body.
Biological aging of the body is seen as the result of the appearance and disappearance of
,the cells of all organs. Cells die and are replaced by new cells, which is part of the normal
functioning of organs. Aubrey de Grey, a contemporary biogerontologists from Great Britain,
conducted a series of studies on the free radical theory and the role of mitochondria and,
based on his research, concludes that aging should be seen as a disease (that could be
cured in the future).
Health gerontology is the scientific field of doctors, who do clinical research, and
epidemiologists, who study populations either cross-sectionally or longitudinally. It is closely
linked to the social and environmental aspects of human aging. Health gerontology focuses
on bodily changes with age, the consequences of this change for daily living, and the use of
health care services. Some of its guiding questions are how one can increase healthy life
expectancy, and how one can help people to live longer and remain active.
2.3 Central Theories and Concepts in Bio- and Health Gerontology
2.3.1 What Is Health in Old Age?
In its traditional understanding, health is the freedom from disease. As individuals
age, their health deteriorates, and they develop diseases. In other words, old age and good
health were traditionally seen as mutually exclusive states.
The perceived opposition between health and old age can be explained with the
concept of senescence: describes the process of biological aging. With senescence, bodies
react to changes more slowly and, consequently, recover from illnesses and accidents with
more difficulty. Therefore, health declines in old age and diseases become more common.
Brody and Schneider (1986) pointed out that there might be two different reasons why older
people have more health problems: 1) aging itself causes health to decline; 2) diseases are
not caused by the aging process itself, but simply require a longer period of time to develop,
which means that they can only manifest in older ages.
Thanks to medical progress, many health problems can nowadays be cured. Chronic
health problems (e.g. rheumatism and diabetes), on the other hand, cannot be treated to
recovery. Only the symptoms of these health problems can be managed, which can allow
the affected individuals to lead a normal life in spite of the chronic disease.
2.3.2 A More Positive Approach
The WHO (1948) defined health as “a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity” (including the subjective
aspect of social well-being in its definition).
But what exactly is social well-being? Gerontologists equate it to a good quality of
life, and therefore consider health in old age as a question of quality of life. They argue that
quality of life has two dimensions: 1) health-related: refers to e.g. discomfort, pain, and
energy level; 2) not health-related: refers to personal resources such as the capability to
form friendships, appreciate nature and find spiritual satisfaction. The dual nature of well-
being suggests that there also are two ways to maintain good health in old age: preventing
diseases and enhancing personal resources.
According to the WHO (2002), “active aging is the process of optimizing
opportunities for health, participation and security in order to enhance quality of life as
people age. It allows people to realize their potential for […] well being throughout the life
course and to participate in society according to their needs, desires and capacities, while
providing them with adequate protection, security and care when they require assistance”.
Even though “successful aging” resembles the concept of “active aging” in some
respects, it received a much more critical reception. Rowe and Kahn (1997) described
, successful aging as a combination of three elements: 1) absence of disease and of risk
factors for disease, 2) maintenance of physical and cognitive abilities, and 3) engagement in
productive activities. Like active aging, also successful aging underlines the activities of
older people. Unlike active aging, however, it does not draw attention to quality of life.
Instead, it gives the discussion on how to age a normative undertone. For this reason,
discussions on healthy aging preferably focus on active aging and quality of life.
2.3.3 How Can We Facilitate Healthy Ageing?
The first approach to facilitate healthy aging is to slow down the aging process.
Aging is a life-long process that starts at birth, and possibly even earlier during the
gestational age, in a developmental approach. Likewise, healthy aging is a life-long process
for which the foundations are laid during one's childhood and youth. Adopting a healthy life-
style at a young age, therefore, is a central component of strategies that try to slow down the
aging process. Anti-aging medicines are also considered a potential means for slowing down
aging. These medicines can be very different in nature: they can be based on e.g. vitamins,
hormones, or herbal components. However, there is no convincing evidence that the
administration of any anti-aging medicine actually slows down the aging process.
The second approach to facilitate healthy aging is to learn from health promotion
strategies. The goal of health promotion strategies is to reduce the risks leading to four
diseases in particular: cardiovascular disease (including stroke), lung diseases, diabetes and
cancer. These diseases are currently the most common ones among older Europeans. To
prevent these diseases, a combined strategy of not smoking, moderating alcohol intake,
maintaining a responsible diet, and engaging in physical activities seems promising.
Additionally, a stable psychological and social situation seems important, because such a
situation helps people cope with the challenges of old age, such as the loss of loved ones.
The third approach to promote healthy aging is to utilize the potentials of
preventive medicine. Preventive medicine targets healthy individuals who have not yet
fallen ill. It strives to avoid that these healthy individuals develop diseases, which would
make curative medicine dispensable. Preventive medicine makes use of the two approaches
to healthy aging just described: slowing down the aging process, and learning from health
promotion strategies. In addition to these approaches, preventive medicine also places great
importance on an early diagnosis of diseases, because early diagnosis allows for more
effective treatments and higher chances of recovery.
2.4 What Do Bio- and Health Gerontology Tell Us about the Current State of Europe?
2.4.1 The Health Status of Older Europeans
The life-expectancy, and also the healthy life expectancy at age 65 varies
considerably between countries.
The countries with the highest remaining life expectancies at age 65 are
geographically dispersed, lying in Continental, Northern and Southern Europe. The countries
with the lowest life-expectancies at birth, in contrast, are geographically concentrated in
Eastern Europe.
The countries with the lower healthy life expectancies are concentrated in Eastern
and Southern Europe (lowest: Slovakia, 3y), the ones with the higher healthy life
expectancies in Continental and Northern Europe (highest: Sweden, 14y).
Generally speaking, the number of people with limitations in their activities increases
with age. In Switzerland, Denmark, and the Netherlands, for example, comparatively few
older people are limited in their everyday activities. Moreover, the age-differences in the
