Gerontology
Summary of all articles
Introduction: Older People under the Magnifying Glass (Komp & Aartsen, 2013)
Gerontology is a scientific discipline that studies human aging. The study draws from different
scientific disciplines like economy, sociology, psychology, epidemiology and biology. The word has
its origin in Greek. ‘Geron’ in Greek means old man and ‘gerh’ means growing up or aging. The word
‘gerontology’ was first used in the 19th century, but throughout the history, people have been
interested in gerontology.
Old age is not just a biological phenomenon, it’s also a social one. It is society that influences how
people see themselves, how their lives are structures and what opportunities certain groups have (e.g.
the retirement law).
Researchers did find a solution for the differences of opinions around the diversity of old age, and that
solution is to see old age as a sequence of 2 separate and distinct periods of life. These periods are
called the young-old age and the old-old age. These periods can also be called the third age and the
fourth age:
− The third age is a period in which people have a relative freedom and good health. People in
this age period don’t have the responsibility for the upbringing of their children and they also
don’t have to work
− The fourth age is a period in which there is an accelerated decline of mental and physical
health. People in this period have also losses in social relationships
All European countries are aging and in every European country the number of older people will get
bigger in the future. However, the level of population aging reached and the speed at which
populations age differs across the countries (e.g. North and West Europe were the oldest regions in the
1950s but by 2050, the oldest populations in Europe will be in the South and West).
Researchers found that there are more women than men in the higher age groups and that the
population in rural areas ages faster than the population in cities. Factors like migration and local
cultures can also cause some of these within-country differences in the population aging progress.
According to the writers of this article, the older European does not exist. Older Europeans resemble
each other to some degree, but there are many differences between them. The variation is to some
degree caused by country-characteristics (e.g. different political constellations, religious orientations,
individual differences).
One of the biggest differences between older Europeans is their gender. There are more women aged
65 years and older in Europe than men. This gender difference results from 2 factors:
1. Women live longer than men do
2. Mostly men fight as soldiers in wars
Another difference between old Europeans is in their social networks. Social networks are important
for older people, because they enhance their wellbeing and health. These days kinships are looser than
in the decades before, but there are differences between countries.
Another big difference between older Europeans is their socio-economic status. The socio-economic
status is determined from wealth, occupation and educational level. The wealth of older Europeans is
relatively low in Eastern European countries and relatively high in continental European countries.
The educational level is also higher in Continental Europe and Northern Europe than in Southern
Europe. Also, the occupational prestige of older people is higher in Continental and Northern Europe
than in Southern Europe.
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,It seems that in Eastern Europe, the circumstances of aging healthy are the least favorable. In those
countries, the level of resources for health care is the lowest and the people from those countries have
the highest prevalence of smoking and obesity. By contrast, in Northern and Western Europe, people
have the best health care and the lowest level of risk factors for diseases.
Italy is the third oldest country in the world. Because of this, researchers often look at Italy when they
want to know how societies change by aging. Italians think, on average, that old age starts at 68 years.
This age is one of the highest named in Europe. Old people in Italy have a low level of engagement in
productive activities. Also, older Italians don’t participate a lot in voluntary, political and religious
organizations or sports clubs and social clubs. Italians say that this is because the old people want to
engage more with their family and they often look after their grandchildren and therefore don’t have
much time to do other things.
In Italy, public care services are relatively scarce and it is therefore difficult to organize care provision
for older people who need it. Italians often hire migrant care workers (called badanti) to support the
family carers.
Sweden has a great labour market situation for old people. Aging in Sweden has little effect on the
pension schemes and labour market. The aging in Sweden is the European average. However, people
in Sweden live longer than averages Europeans do and they also stay healthy until an old age. Swedes
perceive old age starting at 67 years. This is relatively late, the European average is 64.
Sweden has one of the highest shares of volunteers in the 50 years and older age group. They also are
more likely to provide care and health than other older Europeans and because of this, researchers
conclude that old people from Sweden are still productive. They engage in different activities to
benefit society and their family. However, old Swedish people are less active than most Europeans in
religious organizations. The government of Sweden also helps with old people’s productivity by
providing health and social services and by providing a good pension scheme.
While Italy is one of the oldest countries in Europe, Slovakia is one of the youngest. The median age
in 2010 was 37 years. In Slovakia, the youthfulness is visible in different ways. People from Slovakia
who are 65 years old can expect to live three more years in good health and then 13 years in poor
health. This life-expectancy in good health is five years below the European average and eleven years
below the one in Sweden. Slovakians also have a more youthful understanding of old age than other
Europeans. They namely think that old age starts at 58 years.
Slovakia has also a distinct living situation. The mandatory retirement age in Slovakia is 62. Retired
Slovakians are less likely to volunteer than other European retired people. The low levels of
engagement in work and volunteering might be a result from the early health deterioration in Slovakia.
However, older Slovakians are socially integrated despite this low engagement and high health
decline. Researchers from Slovakia concluded that social and health care are a central issue in
Slovakian old age policies.
Bio- and Health Gerontology: How Aging Changes our Bodies (Ankri & Cassou, 2013)
The sub-discipline of gerontology which focuses on physical processes, is called bio- and health
gerontology. Some biologists and biochemists study the process of aging on a molecular level and they
try to figure out how the aging process affects organs and the entire body. The scientific field of that
study is called biogerontology. Biogerontologists see biological aging of the body as the result of the
appearance and disappearance of the cells of organs.
Dr Grey is a biogerontologist from Great Britain and he studied the free radical theory and the role of
mitochondria and concluded that aging can be seen as a disease. Dr Grey states that we have more and
more knowledge about medicine and that, because of this, we will be able to address aging just like we
address many diseases.
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,However, some gerontologists think that dr. Grey is being too optimistic because biogerontologists use
animals for their studies and it is not clear whether these results can be generalized to humans.
Doctors who do clinical research and epidemiologists are in the field of health gerontology. That field
is linked to the environmental and social aspects of human aging. This field tends to focus on changes
in the body as it ages, the consequences of this change for daily living and the use of health care
services. Some of the questions with which health gerontologists are concerned with are how one can
help people to live longer and how one can increase the healthy life expectancy. Health gerontology
looks at social inequalities when trying to answer these questions. This can be between different
educational levels or income groups.
In the field of health gerontology there are 2 levels of health-related intervention underlined:
− The individual level (e.g. health promotion and prevention)
− Population level (e.g. housing conditions and organization of social care systems)
Looking at the traditional definition of health, health is the freedom from disease. When people age,
their health deteriorates and people develop diseases. Old age and good health were therefore seen as
mutually exclusive states. This opposition can be explained with senescence (biological aging). Bodies
react to changes more slowly with senescence and as a consequence, they recover from illnesses with
more difficulty. Because of this, health declines in old age and diseases become more common.
Some scientists have pointed out that there are 2 different reasons why older people have more health
problems:
− Aging itself causes health to decline
− Diseases require a long time to develop and they will therefore only manifest in older ages
Because of senescence, older people are prone to suffer from chronic diseases. Sometimes even from
more than one disease at a time. Because of this, old people may have a hard time carrying out
everyday activities. What’s actually the most important, is how older people think about their health.
The presence of a disease doesn’t mean that one sees himself/herself in poor health. It seems that
people need to pay attention to older people’s perceptions when they discuss health in old age.
The World Health Organization (WHO) sees health as more than a physical state and the organization
therefore suggested a broader term. In 1948, they proposed that health is not only a physical state, but
also a social well-being state. They were the first to include the subjective aspect of social well-being
in the terminology of health. Gerontologists say that social well-being is a good quality of life.
According to them, quality of life has 2 dimensions:
1. Health related dimension (e.g. pain, discomfort)
2. Not health-related dimension: personal resources (e.g. capability to find spiritual satisfaction
or to form friendships)
Because of this dual nature, good health in old age can be maintained by preventing diseases and
enhancing personal resources. Strategies for promoting healthy aging need to look at both ways to be
healthy.
Because of the increasing healthy life-expectancy, old age has been given a positive image. There are
now new concepts of old age, for example:
− Successful aging: a combination of 3 elements: absence of diseases and of risk of disease,
engagement in productive activities and maintenance of cognitive and physical abilities.
Successful aging does not draw attention to quality of life
− Active aging: optimizing opportunities for health, participation of security and enhancing
quality of life
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,The term ‘successful aging’ can be seen as troublesome, because if successful aging exists, than
unsuccessful aging must also exist. According to Baltes, the concept of successful aging might be an
oxymoron, because the concept implies that people age successfully if they do not age at all. Because
of this problem, discussions on healthy aging do not really focus on successful aging, but on active
aging and quality of life.
The 3 most important approaches for reaching healthy aging are:
1. Learning from health promotion strategies: focus on reducing the risks leading to 4 diseases
in particular: lung diseases, diabetes, cancer and cardiovascular disease. The promotions
suggest that moderate intake of alcohol, not smoking, a healthy diet and enough physical
activity reduce the risk of getting these diseases. A stable social and psychological situation
also seems important because this situation helps people to cope with the challenges of old
age (e.g. losing a spouse)
2. Slowing down the aging process: adopting a healthy lifestyle at a young age, anti-aging
medicines (e.g. vitamin pills, hormones, herbal components). There is no conclusive evidence
that taking anti-aging medicine slows down the aging process
3. Utilizing the potentials of preventive medicine: this strategy tries to avoid that the healthy
individuals develop diseases. Preventive medicine makes use of the other 2 approaches
described above. It also finds an early diagnosis of diseases important, because it allows for
higher chances or recovery and more effective treatment.
There is a big difference in the health status of older people
across Europe. The countries with the highest remaining life
expectancies at age 65 lie in Northern, Southern and
Continental Europe. In Eastern Europe, the countries with the
lowest life-expectancies at birth lie. Continental and Northern
Europe have the highest healthy life expectancies and the
lower healthy life expectancies are concentrated in Southern
and Eastern Europe.
The capabilities of older people also vary across the countries
in Europe. Some older people confirmed that they were
severely limited in their everyday activities. What varies with
countries, is how many people are limited and how quickly the
limitations progress with age. However, there is no clear
geographical pattern when it comes to capabilities.
The differences between countries in life expectancies and capabilities of older people are caused by
diseases and health problems. The state of frailty is the state in which older people are especially
vulnerable to have accidents or fall ill. Frailty can be considered a disease if 3 or more of the following
criteria are present:
1. Self-reported exhaustion
2. Unintentional weight loss (4.5 kilograms in 1 year)
3. Low physical ability
4. Slow walking speed
There are 2 life-style factors that are often held responsible for diseases, premature death and frailty:
lack of physical activity and smoking. A lack of physical activity is especially common among
European women with a low educational level. Smoking is especially common among European men
with low income. Also, researchers have found that the further north older Europeans live, the more
physically active they are.
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,Certain diseases play an important role in older age. These diseases are related to the heath and blood
vessels (cardiovascular diseases), diabetes and cancer. Cardiovascular diseases are the leading cause of
death in developed countries. The most common cardiovascular diseases among Europeans aged 65
years and older are ischaemic heart diseases (heart attack) and cerebrovascular diseases (stroke). The
second most important cause of death in Europe is cancer. The most common forms of cancer that
affect Europeans aged 65 years and older are cancer of the breasts, lungs, colon and prostate glands.
Diabetes is also a common disease in Europe. Diabetes is a chronic disease and the prevalence will
also increase as populations age.
Older people do not only suffer from physical health problems, but also from mental health problems.
Among older Europeans, late life-depression is common. There are more depressed older Europeans in
Southern Europe than in Northern Europe. Possible causes for this late-life depression is financial
problems, social isolation, the death of loved ones and health problems. Another common mental
health problem in late life is the decline in cognitive function, because of dementia. People with
dementia lose a couple of their cognitive capabilities (e.g. language, memory and problem solving).
The health profile of Europe changes as the European population ages. Because of this, care
arrangements also need to change. There are 2 care arrangements older people benefit from:
− Formal arrangements: arrangements in which paid professionals provide care in the homes of
frail person or in institutions (e.g. nursing homes). These professionals can belong to the
social care sector, health care sector and (in a couple of countries) to a separate long-term
care sector. That sector is specialized in the provision of care over a longer period of time
− Informal arrangements: arrangements in which people provide unpaid care to relatives or
friends
More help is provided and given in Northern Europe than in Southern Europe. Also, older people help
out more than they receive help. This fact shows that old age is today a time of good health and
activity for many people.
Countries with high public health care expenses are located in Continental and Northern Europe. The
countries with the lower public health care expenses are located in Eastern Europe. There are also
more long-term care facilities in Northern Europe than in Southern Europe. Northern Europe has also
more long-term care workers than Southern Europe and Eastern Europe.
There is a discussion between researchers about the relation between health problems (called
morbidity) and longer lives. There are 2 hypotheses about this:
1. The compression of morbidity hypothesis: the most severe health problems are concentrated
in the last years of life. This means that living longer goes together with more years in good
health and health problems will arise in a higher chronological age
2. The expansion of morbidity hypothesis: the number of life years increases when the life-span
increases. This means that living longer will result in spending more years battling health
problems
Evidence has shown that both hypotheses might be in part accurate. It seems that the most severe
health problems are concentrated in the last years of life and the years before that are characterized by
chronic diseases which do not lead to disability. A person who can cope with chronic diseases can
have a pleasant old age. Health care professionals should look at attitudes and social factors when they
try to prolong lives. Longer lives can be something to look forward to when there is a good medical
care, a right attitude and a well-developed social network.
Gerontopsychology: Aging is All in Your Head (Martin, Theill & Schumacher, 2013)
Gerontopsychologists look at the effects of aging on the brain and the personality. They also look at
how cognitive functions change when people age and how individuals can cope with the changes to
maintain a high quality of life. One of the most important age-related cognitive changes is dementia.
This is a disease that causes memory loss and capability loss.
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, Gerontopsychology looks at the stability and changes of behavior and experience of people in their
later life. Gerontopsychology thinks that processes of development and change when one ages is not a
unidirectional decline process, but a process that can be stable or multidirectional. Gerontopsychology
looks at the developmental potentials of older people and at their environmental and personal
resources. The research has shifted from pathological to healthy aging.
The emphasis of this article will be primarily on cognitive aging. Important concepts in this are:
− Quality of life: looks at a person’s resources. Somebody who thinks that his/her resources are
functional to perform activities that serve goals, will have a higher quality of life
− Cognitive health: a person’s ability to adapt their cognitive performance to changes in the
environment and individual contexts
Both of these concepts look at the environmental and individual contexts. They also imply that
characteristics of a person’s resources are not the only thing important when measuring performance,
but that one also needs to look at the integration into social structures and the adaptation to different
situations.
Cognition consists of multiple abilities and these abilities have different developmental courses.
Usually, cognitive abilities are categorized into 2 types of intelligence:
− Fluid intelligence: the process speed, working memory, recall, verbal fluency and reasoning.
Research has shown that there is a decline in measures of fluid intelligence when someone
ages
− Crystallized intelligence: the experiences and culture-dependent performances that somebody
learns
In general, cognitive abilities decrease with increasing age, but some people maintain their cognitive
abilities in old age and some even increase the cognitive abilities.
There are 4 main theories which researchers use to explain the differential age-related changes in
crystallized and fluid intelligence:
1. Speed deficit theory (Salthouse): older adult’s cognitive deficits reflect a general reduction in
the speed of cognitive processes. There are 2 mechanisms involved in the speed deficit theory:
− Limited time mechanism: the time required by early operations reduces the time
available for later operations
− Simultaneity mechanism: the products of early operations are lost or irrelevant by the
time later operations are completed
There are 2 mechanisms that explain the speed deficit theory:
− White matter deterioration: deterioration of the myelin sheath around axons which
support the speed of neural transmission along axons
− Increase of neural network that supports cognitive performance
2. Resources deficit theory (Craik & Byrd): aging is associated with a reduction in the amount of
attentional resources. This results in a deficit in demanding cognitive tasks. The deficits are
smaller when the environment provides support.
− Research shows that when attentional resources are reduced in younger adults, they
tend to show cognitive deficits that resemble those of older adults
− Neuroimaging studies show that attention relies strongly on the prefrontal cortex.
Older adults tend to show decreased activation in a part of the prefrontal cortex that is
activated during attention tasks in young adults. Older adults also tend to show a more
bilateral pattern of prefrontal cortex activity during attention tasks (≈ HAROLD)
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