International Handbook of Positive Aging

Rachael E. Docking, Jennifer Stock, Rachael E. Docking, Jennifer Stock

• Publisher: Routledge
• Year: 2017
• Topic: Social Sciences
• eBook ISBN:
  9781317392125
• Subtopic: Geriatrics
• Index: Social Sciences

As our global demographic shifts towards an increasingly aging population, we have an opportunity to transform how we experience and think about getting older and embrace the diversity and contribution that this population can bring to society. The International Handbook of Positive Aging showcases the latest research and theory into aging, examining the various challenges faced by older adults and the ways in which we can bring a much-needed positive focus towards dealing with these.

The handbook brings together disparate research from medical, academic, economic and social community fields, with contributions from NHS partners, service users, universities across the United Kingdom and collaborations with international research leaders in the field of aging. Divided into sections, the first part of the book focuses on introducing the concept of positive aging before going on to cover the body over the life course, well-being and care delivery. All contributors recognise the fact that we are living longer, which is providing us with a tremendous opportunity to enjoy and flourish in healthy and fulfilling later lives, and this focus on the importance of patient empowerment is integral to the book.

This is a valuable reference source for those working in developmental psychology, clinical psychology, mental health, health sciences, medicine, neuropsychological rehabilitation, sociology, anthropology, social policy and social work. It will help encourage researchers, professionals and policymakers to make the most of opportunities and innovations to promote a person's sense of independence, dignity, well-being, good health and participation in society as they get older.

Part I

Introduction to positive aging

1
Introduction

Rachael E. Docking and Jennifer Stock

Demographics

We are anticipating a major shift in the demographic in the United Kingdom over the next 20–30 years. Over the past century there has been a significant increase in life expectancy and it is estimated that by 2031 the proportion of people aged >65 years in the United Kingdom will have increased from 16 to 22 per cent, exceeding the population <25 years of age (Greengross et al., 1997). For the first time in history, people aged >60 years now outnumber those aged <16 years in developed countries (Office of National Statistics, 2010). The latest projections are for 5½ million additional older people in 20 years’ time and the number will have nearly doubled to around 19 million by 2050. There are currently three million people aged more than 80 years and this is projected to almost double by 2030 and reach eight million by 2050. The pensioner population is expected to rise despite the increase in the women’s state pension age to 65 between 2010 and 2020 and the increase for both men and women from 65 to 68 between 2024 and 2046. In 2008 there were 3.2 people of working age for every person of pensionable age. This ratio is projected to fall to 2.8 by 2033.

With the older population the fastest growing part of our society and with the majority of the population expecting to survive until their eighth and ninth decade, the implications of this are far reaching upon health and social care; with already stretched services being stretched even further, the impact on society will be considerable. However, while an aging population brings with it a range of challenges for society, it is also an emerging phenomenon that should be celebrated along with better healthcare and healthier lifestyles; living longer is potentially one of the greatest opportunities.

Concepts of aging

In the health and care sector, across media outlets, and within society generally, aging is often approached and described with negative language. Older people, and the aging population, are often labelled with words with negative connotations, such as bed blockers, aging tsunami, ticking time bomb, frail, and vulnerable, to name just a few. Even words such as mature, senior, or pensioner are used to diminish how we perceive the value of older adults.

It is time for society to move away from old fashioned, stereotypical views of aging, which focus on chronological age. While our society is changing, with older people active and valuable members within this, attitudes and language around aging are still lagging behind.

We have an opportunity to transform how we experience and think about getting older, and it is therefore time to leave behind labels and relish in the diversity and contribution that an aging population can bring to society.

Opportunity

The experience of aging varies hugely across the population. A recent report by the Centre for Ageing Better (Ipsos Mori, ‘Later Life in 2015’), a not-for-profit organisation who aim to help people have a better later life by understanding what works and by making change happen, found that there are many ways in which people experience their later life. There are those who are ‘struggling and alone’ (12 per cent of those 50 years and over), who are characterised by having less money for their needs and are more likely to be in poverty. Many have a long-standing illness and suffer with frequent pain and most are socially isolated, which makes them feel dissatisfied with their life. However, the Centre for Ageing Better also found that three-quarters of people aged 50 and over report their general health as excellent or good, and report never or rarely feeling they have too little money to spend on their needs.

This research further found that the key dimensions to a good later life, as identified by older adults themselves, are health, financial security, and social connections. Within these, people have modest expectations, with their goals being to have ‘good enough’ health to maintain relationships and activities that they value, as well as enough money for essentials and to allow them to participate in activities socially and culturally, while also saving a little for the unexpected.

Society currently looks at older people as a burden; however, it is clear that the expectations and needs of this population are predominantly modest and it is essential for us to understand more about people’s priorities as they age.

Provided with the right opportunities, this portion of the older population could be contributing to society and the economy, if provided with the right support.

Conclusion

Positive aging is not necessarily a life completely free of challenges, illness, or disabilities; people’s expectations are not that they will live in perfect health. However it is about feeling a part of something, having a purpose, and being in control of one’s life.

This book aims to provide an introduction to the national and international research and theory, both current and developing, that focuses on the various challenges faced by older adults and the ways in which we can shift towards a more positive focus within these. It brings together NHS partners, service users, universities across the United Kingdom, and collaborations with international research leaders in the field of aging. All contributors to this handbook recognise that the fact that we are living longer is providing us with a tremendous opportunity to enjoy and flourish in healthy and fulfilling later lives.

References

Greengross, S., Murphy, E., Quam, L., Rochon, P. & Smith, R. (1997). Aging: a subject that must be at the top world agendas. British Medical Journal, 315, 1029.

Office of National Statistics. (2010). www.statistics.gov.uk/default.asp (accessed March 2011).

2
What is positive aging?

Jennifer Stock, Pat Schofield and Rachael E. Docking

This chapter discusses:

• A definition of positive aging
• The impact of negative attitudes towards aging
• The formation of attitudes towards aging
• What can be done to increase capacity for aging positively
• Interventions to improve attitudes towards aging
• Perspectives of positive aging
• Change at an organisational level
• Involvement of people with lived experience in research

A definition of positive aging

There are many terms that are used for aging-related initiatives including ‘active aging’ and ‘healthy aging’. The Centre for Positive Ageing at the University of Greenwich was conceived, set up and led by Professor Pat Schofield, which brought together multidisciplinary academics from faculties across the University with expertise in aging-related topics to develop worthwhile research projects. As part of this work we sought to develop a term which emphasises that the process of aging is not necessarily associated with activity or good health, but that ‘positive’ steps may be taken to make the best of any scenario; so whilst one may not be completely healthy or active, that does not necessarily mean one is not aging positively or well. To reflect this belief, the following definition was constructed jointly by our academic team, collaborators of the Centre, and most importantly, our older adults advisory group:

‘Positive Ageing’ denotes the aspirations of individuals and communities to plan for, approach and live life’s changes and challenges as they age and approach the end of their lives, in a productive, active and fulfilling manner. The focus embraces the idea of making the most of opportunities, innovations and research which promote a person’s sense of independence, dignity, well-being, good health and enable their participation in society.

(2015)

Attitudes towards aging

Previous studies have found that society has a generally negative perception of older people which in turn influences the behaviour of this population (Hale & Hewitt, 1998). Drennan et al. (2008) completed a review on public perceptions of older people and aging. Authors found that public perceptions of older adults can impact both positively and negatively on the lives of older people, in terms of access to health services and social/employment opportunities. Whilst there were some instances of positive attitudes towards aging, the majority of studies reviewed displayed some level of negative attitudes towards older people, from which the consequences are significant. A recent study found that attitudes towards aging held by young adults in the United Kingdom were significantly more negative compared to those held by young adults in China (Stock, 2014).

As our older population grows worldwide, it is essential we identify and target negative attitudes towards older adults in society. It is the public’s perceptions of aging and older adults that impacts on the development of social policies (Arnold-Cathalifaud et al., 2008; Musaiger & D’Souza, 2009). Zhou (2007) stated that good-quality care service and healthy relationships with older adults are necessary, but are unlikely if people’s views of older adults are negative. A 2009 Health Service Executive (HSE) report, “Open your eyes”, detailed how the attitudes of others can significantly impact negatively on the lives of older adults due to ageist attitudes which create a culture of age discrimination, devaluing, and disempowering.

The impact of negative attitudes towards aging

There is evidence that young adults’ attitudes towards aging affect how they engage with older adults. For example, negative attitudes from healthcare workers can also impact on quality of care provided (Levy, Slade & Kasl, 2002). Kemper (1994) found that nursing home caregivers with negative attitudes towards aging spoke to all older adults more slowly and used shorter words despite the varied cognitive abilities or physical health of the older adults they were addressing (Kemper, 1994). These interactions between young adults or caregivers and older adults provide social reinforcement for negative self-stereotypes of those older adults and there is evidence to suggest this has a priming and damaging effect on their physical and cognitive health (Meisner, 2012). This indicates that aging is not solely a biological process, but also a psychosocial process whereby attitudes, self-perceptions, and stereotypes of aging can affect cognitive and physical health outcomes (Levy, 2003). Negative priming of attitudes towards aging were found to elicit a three-times greater detrimental effect on health outcomes compared to the beneficial effect of positive age priming in older adults, either implicit or explicit. The detrimental effects of negative age priming on health outcomes included walking speed and gait (Hausdorff, Levy & Wei, 1999), cardiovascular responses (Levy et al., 2000), memory performance (Levy, 1996), and mental health (Levy, Pilver & Pietrzak, 2014). The aforementioned evidence suggests that ageism and negative attitudes towards aging impact negatively on cognitive and physical health outcomes and also the quality of care for older adults, thus it is essential that negative perceptions about aging across society are targeted.

Formation of attitudes towards aging

Young adults’ attitudes towards aging become internalised when they reach older adulthood and manifest as self-perceptions of aging (Levy, 2003; Luborsky & McMullen, 1999; Sokolovsky, 1993). Young adults’ stereotypes of older adults affect how they feel about aging and how they perceive their own future (Lowin, Knapp & Mccrone, 2001; Seefeldt et al., 1977). This could influence their perceived control of future health and the degree to which they believe age-related decline is inevitable. Longitudinal studies have demonstrated that negative self-perceptions of aging predict participation in preventative health behaviours (Levy & Myers, 2004) and functional health decline, even after controlling for baseline functional health (Levy, Slade & Kasl, 2002). Attitudes towards aging that are formed when younger have been found to predict health outcomes in later life, for example up to 38 years later for cardiovascular events (Levy et al., 2009). Positive attitudes towards aging were associated with living on average 7.5 years longer – measured up to 23 years earlier – (Levy et al., 2002) and a decline in self-perceptions of aging over time was related to an increased risk of mortality at 16-year follow-up (Sargent-Cox, Anstey & Luszcz, 2013) even after controlling for demographic characteristics and physical health. Negative attitudes towards aging also independently predicted poorer memory performance (Levy et al., 2011) and hearing loss after controlling for other established predictors (Levy, Slade & Gill, 2006).

What can be done to increase capacity for aging positively?

Interventions to improve attitudes towards aging

Drennan et al. (2008) suggested a number of recommendations following their review; one of these was that positive aging education programmes are needed and these should be targeted at all levels of society but specifically those who hold less favourable attitudes towards aging (e.g. young adults and men). The ‘impressionable years’ hypothesis proposes that individuals are highly susceptible to attitude change during late adolescence and early adulthood and that this susceptibility drops after this and remains low (Krosnick & Alwin, 1989). The ‘increasing persistence’ hypothesis proposes that individuals become increasingly resistant to change as they age. Evidence of the stability of political attitudes supports the impressionable years hypothesis but not the increasing persistence h...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of contributors
• Part I Introduction to positive aging
• Part II The body over the life course
• Part III Well-being
• Part IV Care delivery
• Part V Conclusion
• Index