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Summary articles and chapters Gerontology
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- Rijksuniversiteit Groningen (RuG)
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Summary Gerontology articlesLecture 1: Normal aging (part 1)
Introduction: Older People under the Magnifying Glass, Old age in
Europe (H1)
What is gerontology?
Gerontology is the study of human ageing, which draws from many scientific
disciplines such as sociology, economy, biology, psychology and epidemiology. It
refers to the state of being old as well as the process of ageing.
What is old age?
Old age is more than mere biological phenomenon, it is also a social one. Society
influences how we see ourselves, what opportunities we have, and how our lives
are structured. People often experiences health problems from around their
retirement age on, which made the age of 65 a marker for both, health problems
an retirement. This changed and 65 years is now a poor marker. This raises the
questions when old age starts and what exactly it is.
A common solution for handling the diversity of old age is as a sequence of two
separate and distinct periods of life. Third age (young-old) 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 obligated to
participate in the labour 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.
How grey is Europe?
Europe is older than any other region of the world. In 2009 16% of the European
population were aged 65 years or older. The forecast for the future is that the
age will increase. There are marked country-differences in how fast population
ageing processes and in how far it already progressed. This means that even
though all European countries deal with the phenomenon of population ageing,
this phenomenon has different levels of urgency and visibility for them. There are
also differences between populations groups when it comes to how fast
population ageing progresses.
What are older Europeans like?
The differences in on the one hand this variation is caused by country-
characteristics and on the other hand variation in Europe’s older population is
also due to differences between the individuals within a country. These individual
differences align, with gender, socioeconomic status, living arrangement, marital
status, and religious affiliation. Taken tighter, older Europeans present
themselves as a rather diverse and colourful group of people.
Gender Among Europeans there are slightly more women than men. The gender
difference is a result of two factors. First women live longer than men. As a result,
women are over-represented in the older age-groups. Second, mostly men fight
as soldiers in wars, which means that war-related deaths are particularly
common among men. This fact further reduces the number of men in the
generations that lived through WWII and similar conflicts.
Social networks, connections with friend and kin. Such connections are
important for older people, because they enhance their well-being and health,
and they are important source of support in times of crisis.
Socio-economic status It describes the position he or she has in society
because of wealth, educational level and occupational prestige.
,Health status Men generally have higher levels of self-perceived health than
women, whereas women have higher life expectancies. These health differences
are partly due to life-style, partly to health care systems.
Risk factors, like smoking, are also different throughout Europe
Difference between Italy (second oldest country), Sweden (eldest still working),
Slovakia (youngest country)
Introduction: Older People under the Magnifying Glass, Old age in
Europe (H2)
Bio- and health gerontology
What are Bio- and Health Gerontology?
Biogerontology is the scientific field of biologists and biochemists who study the
ageing 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. Health gerontology focuses on bodily changes with age, the
consequences of this change for daily living, and the use of health care services.
There are two levels of health-related intervention. Intervention at the individual
level and intervention at the level of populations.
Central theories and concepts in Bio- and Health Gerontology
What is health in old age?
The perceived opposition between health and old age can be explained with the
concept of senescence. The term senescence describes the process of biological
ageing. 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. There
are two different reasons why older people have more health problems. The first
reason is that ageing itself causes health to decline. The second reason is that
diseases are not caused by the ageing process itself, but simply require a longer
period of time to develop, which means that they can only manifest in older ages.
Due to senescence, especially older people are prone to suffer from chronic
diseases, often even from multiple ones at the same time. Older people might,
therefore, find it difficult to carry out everyday activities. But some elderly people
describe their own health status as good, even when they were diagnosed with
several diseases. This fact suggest that we need to also pay attention to older
people’s perceptions and self-assessments when we discuss health in old age.
A more positive approach
Definition WHO health: a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity (so also subjective
aspect). 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. The first dimension is
health-related. The second dimension is not health-related, and it refers to
personal resources such as the capability to form friendships, appreciate nature
and find spiritual satisfaction. There are two ways to maintain good health:
preventing diseases and enhancing personal resources. The expanding healthy
life-expectancy further contributes to give old age a positive image. This positive
image led to the development of new concepts of old age, most notably the
concepts of “active aging” and of “successful aging”. Successful ageing is a
combination of three elements: absence of disease and risk factors for disease,
maintenance of physical and cognitive abilities, and engagement in productive
activities. This draws no attention quality of life, so a discussion started
,“successful ageing without quality of life, then is successful aging is not ageing at
all”.
How can we facilitate healthy ageing?
- The first approach to facilitate healthy ageing is to slow down the ageing
process. Adopting a healthy life-style at a young age, therefore is a central
component of strategies that try to slow down the ageing process. Besides
life-style changes, also anti-ageing medicines are considered potential
means for slowing down ageing.
- The second approach to facilitate healthy ageing is to learn form 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. Additionally, a
stable psychological and social situation seem 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 ageing is to utilize the potentials of
preventive medicine. Preventive medicine targets healthy individuals who
did not yet fall ill. It strives to avoid that these healthy individuals develop
diseases, which would make curative medicine dispensable. In its efforts to
prevent diseases, preventive medicine makes use of the two approaches
to healthy ageing just describted: slowing down the ageing 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.
What do bio- and health gerontology tell us about the current state of Europe?
The health status of older Europeans
Europeans who had reached the age of 65 years in 2009 could expect to live for
15-21 more years, depending on the country in which they saw the light of day.
They therewith, reach an age of 80-86 years. The countries with the highest
remaining life expectancies at age 65 years are geographically dispersed, lying in
continental, Northern and southern Europe. The capability of older people vary
across Europe. 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. The country-defferences in life expectancies and in older people’s
capabilities are caused by a combination of many health problems and diseases.
The corresponding state in which older people are especially vulnerable to have
accidents, fall ill, or even die prematurely, is called “fraily”. Among Europeans
aged 65 years and older, ischaemic heart diseases, such as heart attacks, and
cerebrovascular diseases, such as strokes, are the most common cardiovascular
diseases. The second most important cause of death in Europe in cancer.
Europeans aged 65 years and older are particularly affected by cancer of the
lungs, breasts, prostate glands, and the colon. Another common disease in
Europe is diabetes. In addition to physical ailment, older people often also suffer
from mental health problems. Late-life depression is common among older
Europeans. A second common mental health problem in later life is the decline in
cognitive function, e.g. because of dementia.
Care for frail older Europeans
Care arrangements also need to change with older become populations. Older
people benefit from two kids of care arrangements: informal and formal ones.
- Informal care arrangements are situations in which individuals
habitually provide unpaid care to friends of kin. As population age, the
, share of older family members increases. Consequently, women (most of
the time) might have to provide care to a higher number of parents and in-
laws. However population ageing also entails that the share of children in
families decreases. This lowers the amount of childcare that needs to be
provided, which might ease the situation of informal care-providers.
Finally, individuals stay healthy until a later age, which means that older
family members might also provide informal care.
- Formal care arrangements are situations where paid professionals
provide care either in institutions, such as nursing homes, or in the homes
of frail persons. These professionals sometimes belong to the health care
sector, sometimes to the social care sector. This sector specializes in the
provision of care over longer periods of time, which is often necessary with
older service users whose health has deteriorated beyond recovery. These
older users usually suffer from several health problems, and their care
needs change over time. Consequently, they need services from different
health and social care providers. Guaranteeing a suitable combination of
care services is another challenge that social and health care services in
ageing populations have to meet.
Current debate in bio- and health gerontology: is a longer life desirable?
To decide whether longer lives are desirable, we cannot only look at the number
of life years gained. Instead, we also need to focus on the quality of these
additional life years. A central question in this context is whether the newly
gained live years are healthy or disease-ridden ones. Scholars discuss two
competing hypotheses about the relation between health problems (“morbidity”)
and longer lives:
1. The compression of morbidity hypothesis states that the more severe
health problems are concentrated in the last years of life.
2. The expansion of morbidity hypothesis states that the number of life years
in poot health increases with an increasing life-span
Empirical evidence shows that both hypotheses might be partly accurate. People
who can cope with chronic diseases can, therefore, have a pleasant and
satisfying old age, even when the life expectancy continues to expand.
College 2: Aging (part 2)
Gerontopsychology: Ageing is All in Your Head (H3). Old age in Europe
What is Gerontopsychology?
Gerontopsychology is the field of psychology which investigates stability and
changes of behaviour and experience of human beings in their later life. It
assumes that processes of development and change in the course of ageing are
not necessarily unidirectional decline processes, but rather can ben
multidirectional or stable. In contrast, Gerontopsychology focuses on the
developmental potentials of ageing individuals’ personal and environment
resources. Thus there is a shift in research from pathological to healthy ageing.
Central theories and concepts in Gerontopsychology
Cognitive health refers to “not just the absence of disease, but rather the
development and preservation of the multidimensional cognitive structure that
allows the elderly to maintain social connectedness, an ongoing sense purpose,
and the abilities to function independently, to permit functional recovery from
illness or injury and to cope with residual functional deficits”.
Quality of life (QoL) refers to the “integration of multiple subjective
representations of the functionality of ones’ resources. That is, QOL… is higher
the more strongly individuals represent their resources as being principally
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