Reading: Growing Old

As human beings grow older, they go through different phases or stages of life. It is helpful to understand aging in the context of these phases. A life course is the period from birth to death, including a sequence of predictable life events such as physical maturation. Each phase comes with different responsibilities and expectations, which of course vary by individual and culture. Children love to play and learn, looking forward to becoming preteens. As preteens begin to test their independence, they are eager to become teenagers. Teenagers anticipate the promises and challenges of adulthood. Adults become focused on creating families, building careers, and experiencing the world as independent people. Finally, many adults look forward to old age as a wonderful time to enjoy life without as much pressure from work and family life. In old age, grandparenthood can provide many of the joys of parenthood without all the hard work that parenthood entails. And as work responsibilities abate, old age may be a time to explore hobbies and activities that there was no time for earlier in life. But for other people, old age is not a phase that they look forward to. Some people fear old age and do anything to “avoid” it by seeking medical and cosmetic fixes for the natural effects of age. These differing views on the life course are the result of the cultural values and norms into which people are socialized, but in most cultures, age is a master status influencing self-concept, as well as social roles and interactions.

Through the phases of the life course, dependence and independence levels change. At birth, newborns are dependent on caregivers for everything. As babies become toddlers and toddlers become adolescents and then teenagers, they assert their independence more and more. Gradually, children come to be considered adults, responsible for their own lives, although the point at which this occurs is widely varied among individuals, families, and cultures.

As Riley (1978) notes, aging is a lifelong process and entails maturation and change on physical, psychological, and social levels. Age, much like race, class, and gender, is a hierarchy in which some categories are more highly valued than others. For example, while many children look forward to gaining independence, Packer and Chasteen (2006) suggest that even in children, age prejudice leads to a negative view of aging. This, in turn, can lead to a widespread segregation between the old and the young at the institutional, societal, and cultural levels (Hagestad and Uhlenberg 2006).

Dr. Ignatz Nascher and the Birth of Geriatrics

In the early 1900s, a New York physician named Dr. Ignatz Nascher coined the term geriatrics, a medical specialty that focuses on the elderly. He created the word by combining two Greek words: geron (old man) and iatrikos (medical treatment). Nascher based his work on what he observed as a young medical student, when he saw many acutely ill elderly people who were diagnosed simply as “being old.” There was nothing medicine could do, his professors declared, about the syndrome of “old age.”

Nascher refused to accept this dismissive view, seeing it as medical neglect. He believed it was a doctor’s duty to prolong life and relieve suffering whenever possible. In 1914, he published his views in his book Geriatrics: The Diseases of Old Age and Their Treatment (Clarfield 1990). Nascher saw the practice of caring for the elderly as separate from the practice of caring for the young, just as pediatrics (caring for children) is different from caring for grown adults (Clarfield 1990).

Nascher had high hopes for his pioneering work. He wanted to treat the aging, especially those who were poor and had no one to care for them. Many of the elderly poor were sent to live in “almshouses,” or public old-age homes (Cole 1993). Conditions were often terrible in these almshouses, where the aging were often sent and just forgotten.

As hard as it might be to believe today, Nascher’s approach was once considered unique. At the time of his death, in 1944, he was disappointed that the field of geriatrics had not made greater strides. In what ways are the elderly better off today than they were before Nascher’s ideas gained acceptance?

Biological Changes

Each person experiences age-related changes based on many factors. Biological factors such as molecular and cellular changes are called primary aging, while aging that occurs due to controllable factors such as lack of physical exercise and poor diet is called secondary aging (Whitbourne and Whitbourne 2010).

Most people begin to see signs of aging after fifty years old, when they notice the physical markers of age. Skin becomes thinner, drier, and less elastic. Wrinkles form. Hair begins to thin and gray. Men prone to balding start losing hair. The difficulty or relative ease with which people adapt to these changes is dependent in part on the meaning given to aging by their particular culture. A culture that values youthfulness and beauty above all else leads to a negative perception of growing old. Conversely, a culture that reveres the elderly for their life experience and wisdom contributes to a more positive perception of what it means to grow old.

The effects of aging can feel daunting, and sometimes the fear of physical changes (like declining energy, food sensitivity, and loss of hearing and vision) is more challenging to deal with than the changes themselves. The way people perceive physical aging is largely dependent on how they were socialized. If people can accept the changes in their bodies as a natural process of aging, the changes will not seem as frightening.

According to the federal Administration on Aging (2011), in 2009 fewer people over sixty-five years old assessed their health as “excellent” or “very good” (41.6 percent) compared to those aged eighteen to sixty-four (64.4 percent). Evaluating data from the National Center for Health Statistics and the U.S. Bureau of Labor Statistics, the Administration on Aging found that from 2006 to 2008, the most frequently reported health issues for those over sixty-five years old included arthritis (50 percent), hypertension (38 percent), heart disease (32 percent), and cancer (22 percent). About 27 percent of people age sixty and older are considered obese by current medical standards. Parker and Thorslunf (2006) found that while the trend is toward steady improvement in most disability measures, there is a concomitant increase in functional impairments (disability) and chronic diseases. At the same time, medical advances have reduced some of the disabling effects of those diseases (Crimmins 2004).

Some impacts of aging are gender-specific. Some of the disadvantages aging women face arise from long-standing social gender roles. For example, Social Security favors men over women, inasmuch as women do not earn Social Security benefits for the unpaid labor they perform (usually at home) as an extension of their gender roles. In the healthcare field, elderly female patients are more likely than elderly men to see their healthcare concerns trivialized (Sharp 1995) and are more likely to have their health issues labeled psychosomatic (Munch 2004). Another female-specific aspect of aging is that mass-media outlets often depict elderly females in terms of negative stereotypes and as less successful than older men (Bazzini and Mclntosh I997).

For men, the process of aging—and society’s response to and support of the experience—may be quite different. The gradual decrease in male sexual performance that occurs as a result of primary aging is medicalized and constructed as needing treatment (Marshall and Katz 2002) so that a man may maintain a sense of youthful masculinity. On the other hand, aging men have fewer opportunities to assert their masculine identities in the company of other men (for example, through sports participation) (Drummond 1998). And some social scientists have observed that the aging male body is depicted in the Western world as genderless (Spector-Mersel 2006).

Aging and Sexuality

It is no secret that people in the United States are squeamish about the subject of sex. And when the subject is the sexuality of elderly people? No one wants to think about it or even talk about it. That fact is part of what makes 1971’s Harold and Maude so provocative. In this cult favorite film, Harold, an alienated young man, meets and falls in love with Maude, a seventy-nine-year-old woman. What is so telling about the film is the reaction of his family, priest, and psychologist, who exhibit disgust and horror at such a match.

Although it is difficult to have an open, public national dialogue about aging and sexuality, the reality is that our sexual selves do not disappear after age sixty-five. People continue to enjoy sex—and not always safe sex—well into their later years. In fact, some research suggests that as many as one in five new cases of AIDS occurs in adults over sixty-five years old (Hillman 2011).

Supplemental Material

Read the article “A Study of Sexuality and Health among Older Adults in the United States.” You will find it online at the New England Journal of Medicine.

In some ways, old age may be a time to enjoy sex more, not less. For women, the elder years can bring a sense of relief as the fear of an unwanted pregnancy is removed and the children are grown and taking care of themselves. However, while we have expanded the number of psycho-pharmaceuticals to address sexual dysfunction in men, it was not until very recently that the medical field acknowledged the existence of female sexual dysfunctions (Bryant 2004).

Aging “Out:” LGBT Seniors

How do different groups in our society experience the aging process? Are there any experiences that are universal, or do different populations have different experiences? An emerging field of study looks at how lesbian, gay, bisexual, and transgender (LGBT) people experience the aging process and how their experience differs from that of other groups or the dominant group. This issue is expanding with the aging of the baby boom generation; not only will aging boomers represent a huge bump in the general elderly population but also the number of LGBT seniors is expected to double by 2030 (Fredriksen-Goldsen et al. 2011).

A recent study titled The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults finds that LGBT older adults have higher rates of disability and depression than their heterosexual peers. They are also less likely to have a support system that might provide elder care: a partner and supportive children (Fredriksen-Goldsen et al. 2011).

As they transition to assisted-living facilities, LGBT people have the added burden of “disclosure management:” the way they share their sexual and relationship identity. In one case study, a seventy-eight-year-old lesbian lived alone in a long-term care facility. She had been in a long-term relationship of thirty-two years and had been visibly active in the gay community earlier in her life. However, in the long-term care setting, she was much quieter about her sexual orientation. She “selectively disclosed” her sexual identity, feeling safer with anonymity and silence (Jenkins et al. 2010). A study from the National Senior Citizens Law Center reports that only 22 percent of LGBT older adults expect they could be open about their sexual orientation or gender identity in a long-term care facility. Even more telling is the finding that only 16 percent of non-LGBT older adults expected that LGBT people could be open with facility staff (National Senior Citizens Law Center 2011).

Think It Over

What is your relationship to aging and to time? Look back on your own life. How much and in what ways did you change in ten years and in twenty years? Does a decade seem like a long time or a short time in a life span? Now apply some of your ideas to the idea of aging. Do you think older people share similar experiences as they age?

Practice

 1. In Erik Erikson’s developmental stages of life, with which challenge must older people struggle?
  1. Overcoming despair to achieve integrity
  2. Overcoming role confusion to achieve identity
  3. Overcoming isolation to achieve intimacy
  4. Overcoming shame to achieve autonomy

2. For individual people of a certain culture, the life course is ________.
  1. the average age they will die
  2. the lessons they must learn
  3. the length of a typical bereavement period
  4. the typical sequence of events in their lives