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| Current Issues | No.65 October 2013 |

Healthy Aging in the 21st Century
Karin Volkwein-Caplan

Abstract

The importance of place and space will be examined in regards to healthy aging in the 21st century. A recent study with Russian immigrant women who have moved to the USA over the last 20 years, exemplifies the importance of access to physical activities, which does not only provide ample access to improve one’s fitness level, but also provides the important parameters to social and mental stimulation, all of which are extremely beneficial in fostering a healthy aging process. This qualitative study based on in-depth interviews with a cohort of 20 women serves as an example of parameters needed to ensure a healthy aging process. It is crucial for communities to provide availability of and access to health promoting behaviours.

Introduction

In the near future, there will be an exponential growth of older adults in the world. The growing population of older adults in Europe and North America has put a strain on the health care systems of the industrialised world. Older adults sometimes need specialised and long-term care for such pernicious disorders as cancer, heart disease and stroke, and Alzheimer’s disease. These conditions also create social and economic strains on friends, partners and other family members, often young and middle-aged adults, who become economic and social caregivers for their aging parents.

The spectre of “old age” also has a cultural dimension. We often associate “old age” with physical and mental decline. Old people are often seen as physically and mentally incapable of looking after themselves. They are depicted in stereotypical ways, walking with canes, shuffling in walkers and moving along in wheelchairs. They are perceived as cognitively impaired, unable to competently function in the contemporary technological world. These images are, of course, cultural stereotypes based on prejudice. They form the bedrock of what many commentators have called “Ageism,” a body of attitudes and practices that discriminate against older adults (Butler, 1989). A review of several decades of research in gerontology, of course, presents a fuller and more nuanced account of the social and economic lives of older adults. Advances in medical care have not only extended the life spans of contemporary men and women, but have increased the emotional and physical quality of later life. In fact, research results indicate that in the past several decades, an increasing percentage of men and women lead active and healthy lives well into later life.

This paper considers how older adults pursue well-being in later life. The role of physical activity and fitness will be examined and the influence on both physical and emotional health. Fitness and emotional health, of course, cannot be considered in isolation. Therefore the social, cultural and economic parameters associated with aging will be analysed and how they affect health and well-being. Using this macro-context, interview results of recent research will be presented with a specific group of people – women in the Russian Diaspora.

An Aging World and Health Challenges

As mentioned at the outset, the population of older adults is expanding in every region of the world. Although life expectancy varies from region to region, most people are not only living longer but also having fewer children. This trend means that the average age of the world population is increasing. One hundred years ago, average life expectancy in the United States was 47.3 years, today it is 77 (Hoyer & Roodin, 2009). Although people are living longer in most places, there are still great variations in life expectancy. People tend to live longest in Japan with a life expectancy of 82.9 years, the United States is ranked number 19 in life expectancy.

Considerable ethnic and cultural differences exist in the domains of life expectancy and health and well being. Studies in the United States have found, for example, that African Americans and Hispanics tend to have a higher rate of chronic illness and lower life expectancy than European Americans. Substantial gender differences have also been documented: white women tend to live an average of 6 years longer than other older adults, but these women tend to struggle with a greater number of health concerns. Those with the lowest income are more likely to struggle with poor health and have a lower life expectancy.

In the past, people tended to live longer in the industrial societies of Europe and North America. In those societies, technological sophistication, which provided better nutrition, sanitation and healthcare, produced populations with high percentages of people over the age of 65. By the year 2050, in fact, one-third of the world’s population is expected to be over sixty. Along with increasing age, we will face specific health challenges. Although prevention methods and improved treatments have helped to prolong life, we are also faced with an increase in chronic disease and debilitating illness as well as a wide range of disabilities.

The exponential increase in obesity among all age groups is another important health challenge in the 21st century. Obesity is a wide-spread epidemic, especially in the USA. According to the 2007 National Health and Nutrition Examination Survey, more than 64% of US adults are overweight or obese (www.cdc.gov/nchs). Although women and men share similar percentages of obesity, women are more often socially sanctioned for their weight. They are subjected to age, gender and weight bias (Fontane, 1996).

So, the world is ‘greying’ at a faster rate than previously anticipated. Given this tectonic change, what social and psychological challenges will older adults face in the coming years? What will it take to help these elders maintain a positive quality of life? One way to maintain well-being as we age is to be physically and socially active. Indeed, later adulthood can be, according to a variety of studies, an active and productive time of life (Baltes & Carstensen, 1996; Diener, Diener & Diener, 1995). Accordingly, it seems that an increasing number of older men and women are living healthy and productive lives, often well into their eighties. Ironically, advances in life expectancy have lead to a dramatic decrease in social appreciation of older adults. The various sources of media are flooded with negative images of aging and older men and women.

Ageism and Physical Activity

Cross-cultural studies have found that older adults today are subjected to multiple sources of discrimination. Among the most prominent of these is ageism, which is widespread around the world. It may seem surprising, but studies in the United States have found that the majority of older adults say that they have been subjected to some form of ageism (Palmore, 2001). Ageism is a process of systematic stereotyping and prejudice against older men and women (Butler, 1963). This form of prejudice results from a widespread and deep-seated fear of the aging process, which also compels younger people to distance themselves from older men and women (Palmore, 2001). Scholars have called this distancing “aging anxiety,” which centers on the anticipation of loss as we age. Fear about aging usually begins early in life and continues across the life-span. Concomitantly, ageism has a negative impact on the self-images of older men and women.

Older women especially, are often subjected to what Susan Sontag (1972) called “double jeopardy”—the double whammy of ageism and sexism combined! With the increase in the number of elders with various needs, many of the positive attitudes about age have eroded and ageism has spread from the industrialised world, especially due to the global reach of the Internet and television programmes from the west. Images on the Internet and television tend to value youth and denigrate age and ageing.

Indeed, social theorists have linked modernisation to the loss of elder power. Atchley (1994) contends that modernisation theory helps to understand social change and aging. In this early theory of modernity, much attention is focused on the status of elders. In more traditional societies, older men and women played an active and vital role. In societies in which processes of modernisation have unfolded, older adults have experienced losses of position, status and power. In other words, there tends to be an inverse relationship between the status of elders the processes of modernisation and technological advancement.

Films, commercials, books and magazines depict older adults as depressed, unattractive, ill, disabled, lonely, decrepit and even ready to die (Haught, Walls, Laney, Leavell & Stuzen, 1999). These images reinforce social attitudes that “old age” is the time of life when one loses physical and mental competence. The reality of what it means to be older in the 21st century, of course, presents a very different picture. Changes in patterns of activity, robust lifestyles, improved health care and increased life expectancy mean that greater numbers of older adults present living and breathing challenges to the traditional images of old age as a sedentary period of life, as a time to sit on a rocking chair and relax, as a time to shrivel up and die. Older men and women are staying physically, socially and sometimes sexually active well into their nineties. They are healthier, happier and more economically potent than ever before.

Clearly, perceptions of age and older adults are not connected to the reality of what it means to be an elder in contemporary societies. Younger people may think older people are old and decaying. The economic, social, cultural and political processes that constitute globalisation will play an increasingly important role in how “society” perceives older adults. Indeed technological innovations triggered by the flows of the global economy will help define new processes of aging as well as the positive and negative attitudes society holds toward older men and women. Changes in roles and attitudes about aging will influence the entire developmental process and extend to the arenas of employment, health care, lifelong learning and social services in developing countries as well as in developed nations (Weaver, 1999; McConatha, 2002).

As the population of older adults expands exponentially, one wonders how this will impact the spread of ageism. By the year 2050, demographers estimate that nearly one third of the world’s population will be over 60 years old (www.ilcusa.org). Western Europe, Italy, Greece, Germany, Spain, France and other countries in Europe currently have populations in which least 16% of the people are over 65 years of age (www.ilcusa.org). With nearly 38 million Americans currently older than 65 years old, health promotion for this population is an important area of social and political consideration (www.census.gov). Numerous studies have found that staying active leads to increased well-being and happiness in older adulthood. People who are physically and socially active seem to be most likely to maintain their physical and psychological health (Atchley, 1989). Thus, it is of critical importance that older adults have access to places and spaces in which they can be active, an access that would ensure a more graceful and healthy aging process.

Health Promotion and Physical Activity

The Healthy People 2010 campaign in the United States seeks to increase life expectancy and quality of life. The campaign promotes information so that every individual can have the opportunity to make informed decisions about their health. This programme encourages educators, politicians and social leaders to increase access to health care for all Americans. It is particularly interested in promoting healthy environments, vital neighborhoods and vibrant communities that can foster well-being regardless of age, gender, ethnicity and social class.

Through their health outreach programmes, non-profit organisations around the country have begun to urge older adults, especially immigrants such as the group of interviewees from the Russian Diaspora, to increase their physical activity, eat healthier foods, manage their stress and engage in preventive health care. In order for a health promotion programme to be successful, outreach activities need to be designed in a sensitive and culturally appropriate fashion. Such activities need to incorporate an understanding of the values, religion, diet and beliefs about health and illness of the populations they are attempting to reach.

A recent study of health and well-being among women in the Russian Diaspora asked about health promotion and access to physical activities in the greater Philadelphia area. A qualitative research methodology was used when conducting extensive semi-structured interviews. This case study approach focused on 20 older women (65-85 years old). Questions asked included: How are their health needs met? What sources of support are available to them? What are their existential struggles in a country that is socially, culturally and linguistically alien to them? The majority of women indicated that there was support from various governmental agencies as well as social workers, including translators, to help them cope not only with the transition to start a new life in a different culture, but also with information regarding health promotion availability and fitness programmes offered in the sponsored housing complex where they resided. However, it was evident that their well-being at large depended on their adaptive success; that is, how well they were able to maintain social, physical and spiritual engagement.

As this study of Russian immigrant women suggests, globalisation has put an increasing number of older men and women into situations of economic, social and cultural marginalisation. These older adults may be ill or disabled, live in rural or underserved areas, lack education or suffer from the impact of poverty. They may also hold a different set of beliefs about health and illness and culturally varied thoughts about how to manage health and well-being. These diverging beliefs on health promotion present a considerable challenge to health promotion researchers and practitioners, who at any given moment may be faced with the challenge of confronting a culture of resistance to health promoting behaviour change.

Health promotion is the art and science of helping people discover the synergies between their core passions and optimal health. In so doing they become motivated to strive for optimal health, a dynamic balance of physical, emotional, social, spiritual and intellectual health. Such lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation and build skills and most importantly create supportive environments that provide opportunities for positive health practices (O'Donnell, 2009). In this study, the subjects had access to healthy breakfast and lunch options in their building as well as daily exercise programmes in a near-by fitness center. They also had ample opportunity to walk outside on the large residential property as well as in near-by shopping centres. This availability encourages walking rather than driving to do errands.

Health promotion strategies are not limited to a specific health problem or to a specific set of behaviours. Recognising the difficulties of outreach, The World Health Organization (WHO) has addressed the problem of health promotion, suggesting that the principles of and strategies for health promotion should be fine-tuned for a variety of population groups, risk factors, diseases and in various settings. Health promotion outreach, WHO suggests, should be sponsored in schools, community development organisations and should be highlighted in health policy, legislation and regulation. Such outreach efforts should be also applied equally to the prevention of communicable diseases, injury, acts of violence and mental health.

In this research study it was found that the well-being of the Russian women results from their ability to maintain social, physical and spiritual engagement. It is suggested that their ability to maintain this engagement is, to a large extent, dependant on their sense of cultural competence, a state that results from their participation in communities of like-minded people who share their socio-political history, language and culture. On one hand, this shared experience provided them with a sense of connection in an alien and alienating world. On the other hand, it was also found that shared experience may also hinder their adaptability to the larger social and cultural environment.

The key to successful aging, following the results of gerontological research, is a sense of well-being, a process involving a person's physical, mental, spiritual and social dimensions. The difference between a successful and unsuccessful aging experience depends, to a large extent, on how people are able to successfully engage in health promoting behaviours that maintain a sense of well-being. In other words, health care providers believe that health promotion, or outreach, should be holistic—an ecological approach that focuses on understanding the person in the context of his or her environment (Stokol, 1992). From this perspective, each person’s health and well-being can be best understood by considering the interaction of an individual’s genetic predispositions, personality, along with his/her social and cultural circumstances. Indeed the social and cultural environment plays an important role that helps or hinders a person’s ability to age with energy and grace. When an environmental context deteriorates into unstable political situations, unsafe streets, or poverty stricken neighbourhoods, the atmosphere not only increases individual stress but also hinders an aging person’s ability to engage in health promoting activities.

Aging well through Physical Activity

Regular physical activity can be an important moderating variable that influences the detrimental effects of aging. Regular physical activity can lower the risks for various chronic illnesses and is one among several preventative behaviours that healthcare professionals promote. Others include consuming a healthy diet, avoiding excessive use of alcohol, not smoking, reducing stress as well as sustaining satisfying relationships and accessible social support. They also include having a personality that is optimistic and resilient. Regular physical activity seems to create a positive context that reinforces these health promoting behaviours. Physical activity can increase social interaction, improve stress management and even increase cognitive functions such as memory and problem solving (Lemme, 2006).

Studies have found that social and cultural environments that enable older adults to remain physically active can significantly influence the overall quality of life. Among the most important supports for physical activity is a safe walking trail. Statistics indicate that by the age 75, one in three men and one in two women do not engage in any regular physical activity. Research has indicated that knowledge, attitudes, beliefs about health and fitness and perceived barriers to physical well being influence to what extent older adults exercise (Dishman, 1994). For example, if an older man or woman feels unsafe in their neighbourhood, they are less likely to walk. If they do not have the resources to join an exercise facility, they are less likely to maintain physical activity. If they feel anxious about possible injury, they may be more likely to be sedentary. There are currently 38 million Americans who are over the age of sixty five. Although the benefits of physical activity have been proven, it is estimated that 47% of adults 65 to 74 years of age are sedentary. Educational information as well as programme planning can be beneficial in increasing the number of older men and women who incorporate physical activity into their routines. Participation in regular physical helps to slow the gradual decline in physical functioning associated with age (Centers for Disease Control and Prevention, 2005). For those who do maintain a level of activity, walking and gardening are the most popular physical activities.

The benefits of regular physical exercise have been widely known for years. In 1959, WHO defined the health of older adults in terms of fitness rather than pathology. The Duke University Centre for the Study of Aging and Human Developmental has concluded that regular exercise appears to reverse some of the physical and psychological changes associated with aging (Fontane, 1996). Clearly, there is overwhelming evidence that physical activity is key to successful aging (Sawatzky, Liu-Ambrose, Miller & Marra, 2007; Tahmaseb McConatha & Volkwein-Caplan, 2010).

Medical advances have enabled people to live longer, healthier and happier lives. Despite medical advances, though, older adults require more medical and long-term care services than any other segment of the population. With the growing number of older adults, it becomes increasingly important to address health behaviours and lifestyles that can improve the quality of life in later adulthood and help decrease the millions of dollars spent each year on medical care. Indeed, one of the great social and cultural issues of our time is how society will adapt to the expenses of an increasingly aging and interconnected population?

Conclusion

Well-being in later adulthood is greatly dependent on community support – the places and spaces people live in. This study indicated that support from a cohort of like-minded individuals is an important factor that concomitantly increases feelings of competence and self-worth and diminishes feelings of loneliness and isolation. Supportive communities can enable people to solve their problems and buffer their feelings of cultural isolation and dislocation, especially for older immigrants. A sense of control, feelings of competence, subjective health, spirituality and the availability of and satisfaction with social and emotional support are important factors that promote well-being. The maintenance of a regular exercise or fitness programme is an important resource that ensures an active and healthy aging process. Whether the physical activity is simply based on functional activities, such as gardening or household chores or walking to the store or in a park, research results of the last 30 years have significantly suggested: “use it or lose it”. In the end, we strongly suggest that scholars and policy-makers concentrate on the availability of and access to health promoting behaviours. It is important for communities to provide places and spaces that ensure healthy aging.

Contact

Karin Volkwein-Caplan
West Chester University of Pennsylvania
USA

http://www.icsspe.org/