Psychological and Social Issues

Definition

As the population of the United States—and the world—ages societies face a multitude of challenges. As individuals seniors may confront social issues ranging from the need for adequate income, living arrangements, and healthcare to potential loneliness, isolation , and even abuse. However in recent years a large body of research has shed a positive light on the neurological changes and psychological development that accompanies healthy aging.

Description

Social aspects

As of 2007 64% of Americans could expect to live until at least age 75 and 35% to at least 85. People over 85 are the fastest-growing segment of the U.S. population. The U.S. Census Bureau projects that by 2030 there will be 72 million Americans over the age of 65—almost 20% of the projected population. With Americans living longer and the “baby boom” generation approaching retirement age, scientific and sociological research, business, politics, and the media have brought issues of aging to the forefront of societal concerns.

Americans are not only living longer lives, they are living healthier lives and suffering fewer disabilities than previous generations. Studies indicate that among physically active seniors, physical, cognitive, and sensory limitations are decreasing. Among the reasons:

• greater financial security
• better nutrition
• increased awareness of the benefits of physical and intellectual activity
• decreased smoking
• improved healthcare and medical treatments.

Healthcare is perhaps the most important social issue for seniors. Out-of-pocket healthcare expenses consume 19% of the income of the average American aged 65 or older. For low-income seniors who don't qualify for Medicaid , the figure is an astounding 49% of their total income. The costs of long-term care for the elderly are astronomical and homecare places a heavy burden on family members, particularly women.

Other factors can make life difficult for even the healthiest of seniors including:

• poverty
• living alone
• changes in living situations
• loss of loved one(s)
• abuse or neglect.

Most older Americans live in the community—including 78% of women and 88% of men aged 85 and older. Older adults living alone are more likely to live in poverty. By age 65 one third of women live alone. By age 75 more than one half of women are living alone. As the population ages there will be an ever-increasing need for housing that can accommodate varying levels of physical ability. The need for public transportation and alternatives will increase as the elderly are forced to stop driving. Most seniors want to stay in their own homes and society will have to develop innovative means of accommodating them.

Psychological aspects

Advances in neurobiology beginning in the 1990s have uprooted older assumptions about the aging brain. Scientists have discovered that the brain is far more flexible and adaptive than previously believed and that as people age, their brains not only make new connections among neurons but grow new cells. Researchers have also found that, like muscle, the brain grows stronger with use. One of the most surprising discoveries is that older brains function in very different ways than younger brains—older people begin to utilize both hemispheres of the brain in a much more balanced fashion to accomplish the same tasks for which younger people use only one hemisphere.

In tandem with advances in the neurobiology of aging have come advances in psychology indicating that psychological development continues throughout life. Studies of adult development have demonstrated that from middle age on most people experience a diminishment in their drive to achieve and an increase in their need for community and belonging. Beginning about their early 50s adults begin to undergo profound emotional changes—often referred to as the process of attaining maturity—and some studies have indicated that mental health actually improves in later years.

One of the most noticeable changes that accompanies aging is increased emotional equanimity. Numerous studies have found that older people moderate their emotional responses more effectively than younger people, approach problems with a more balanced attitude, and behave more appropriately. Older adults are less prone to:

• impatience
• ill temper
• negativity
• anger
• aggressiveness
• bitterness.

Studies have shown that older adults pay more attention to positive than to negative emotional stimuli and are more likely to remember positive emotions than negative ones. Although learning and experience play an important role in the development of this emotional control, it may also be due to the age-related decrease in the activity of amygdalae—structures in the brain that are responsible for intense emotions, particularly negative emotions.

Some studies have found that the ability to solve everyday problems becomes much stronger in later life. This ability, which has been called “pragmatic creativity” or “crystallized intelligence,” may reflect the lifelong accumulation of problem-solving strategies. Studies that have looked at coping effectiveness and life satisfaction among different age groups have found no differences among the middle-aged, young-old, and oldest-old regardless of health.

Neuroscience research has also indicated that the human brain has an amazing ability to influence its own aging. In addition psychological factors can have a profound influence on the immune system and overall health. Studies have repeatedly shown that strong social and community connections and physical activity are among the most important components of successful aging. Researchers have found that older adults who engage in activities that provide them with a sense of control and mastery have better health than those who do not and that this effect increases with age. Older adults live longer, happier, healthier lives if they:

• maintain social connections
• practice hobbies, particularly those that involve social and physical activities
• volunteer
• continue their education
• maintain spiritual or religious connections.

Religious communities are the largest source of social support for older adults outside of their families and by far the most common form of voluntary social activity among seniors.

Anthropological studies have indicated that in many societies gender shifts occur with age, with women becoming more assertive and dominant and men moving away from aggressiveness toward problem-solving and peacekeeping roles. Other studies have found that as men age they tend to become more socially connected. Meanwhile older women tend to broaden their social connections beyond family and friends, addressing issues of social justice and the world at large.

Societal roles

In many human societies elders play very special—and often highly respected—roles. Dr. Gene D. Cohen, director of the Center on Aging, Health & Humanities at George Washington University, argues that the human lifespan evolved to extend past reproductive age because of the irreplaceable role of elders in teaching and transmitting skills, experience, and wisdom—a function that has perhaps become even more crucial in today's complex global society.

The traditional view of retirement is becoming outmoded. Perhaps the most significant development in the lives of American seniors is that they are continuing to work. Some 80% of baby boomers say that they expect to work either full- or part-time after age 65, either out of choice or necessity. Although continuing to work into their later years may be difficult for many manual laborers, the American workforce is primarily knowledge-based and more than 4 million of that workforce are aged 65–74. Mandatory retirement has been outlawed in most jobs and many employers, foreseeing a severe shortage in experienced workers, are developing programs to bring back retirees. The United States has one of the highest percentages of employed people over 64 in the world. Between 2002 and 2012 the number of workers aged 55 and older is expected to increase by 49% while the number under 55 will increase by only 5%. It is estimated that by 2031 there will be 49.9 million American workers over age 64. As the complexities of the workplace and the world increase, the decades of learning and experience accumulated by older workers are irreplaceable. Many professions—from science, law, and medicine to counseling, management, and politics—require a lifetime to master.

Of those who do retire, about one third have difficulty coping with the change in lifestyle. This is particularly true for those:

• forced to retire because of job loss or illness
• whose work was the most important aspect of their lives or constituted their primary identity
• unprepared for the loss of income
• who have not planned for an active, financially secure retirement.

People who spent the early years of their careers attempting to prove themselves and achieve success and the later years being rewarded by the significance of their work, often find that as seniors they want to use their experience and maturity to give back and make a difference in the world. For many seniors this takes the form of volunteerism. A 2003 national AARP study found that 40% of survey participants aged 70 and older were involved in formal volunteer activities. If informal volunteerism was included the proportion rose to 80%. More than one fourth of people in their early 80s continue to volunteer.

Many seniors take on grandparenting as their primary role. As of the early 21st century more than 4.5 million American children, or 6.3% of those under 18, lived in homes headed by grandparents and the number was increasing. In addition 21% of all preschool children of working mothers were cared for by grandparents.

More seniors than ever before are returning to school and participating in educational travel opportunities. They are retiring near colleges and universities to take advantage of educational opportunities and cultural events.

Seniors have a great deal of what might be called “social capital.” They are better educated, better traveled, better read, and more aware than any previous generation in history. They have political clout and are more likely than younger people to read newspapers, follow civic affairs, vote, and volunteer in the community. They are much less likely to commit crimes. Finally seniors have a tremendously important role as keepers of the culture, passing on stories, knowledge, talents, and skills that would otherwise be lost.

Viewpoints

MacArthur Foundation Study

The MacArthur Foundation Study of Aging in America followed more than 1,000 well-functioning seniors over the years. They found that lifelong physical activity and the maintenance of social and intellectual connections were the most important factors for healthy aging—significantly more important than factors such as diet or nutritional supplements .

Andrew Weil's psychology of healthy aging

Weil points out that there are three general concerns that most seniors have in common:

• They don't want to suffer.
• They don't want to be burdens on others.
• They want to live out their lives with meaning.

Weil advises seniors to deal with the first concern by discussing with doctors and family their wishes should they face a life-threatening illness or become incapacitated. The second concern requires advanced preparations with family, lawyers, and financial planners. The third concern involves choosing activities that increase one's sense of self-worth, such as volunteer service or creative endeavors. Weil and others have pointed out that e-mail and the Internet provide important new opportunities for seniors to maintain social and intellectual connections.

Some research suggests that sexually active seniors have better physical and emotional health. Weil points out that although the desire for sexual intercourse may fade with age, the desire for intimate touching does not. However older people may have fewer opportunities for physical contact with others. Weil suggests that massage can help fulfill this need.

Seniors often have sleep disturbances. Weil contends that rest, sleep, and dreaming are important components of healthy psychological aging. He suggests:

• a daily period of rest
• a short daily nap
• spending time outdoors exposed to sunlight
• having dinner followed by some stimulating activity in the early evening
• spending up to an hour in dim light before going to sleep
• sleeping in a completely dark room
• using valerian as a natural sleep aid
• taking melatonin supplements to regulate biorhythms and wake/sleep cycles since the body's production of melatonin decreases with age.

Harvard Study of Adult Development

The Harvard University Study of Adult Development is probably the most far-reaching study of aging. The mental and physical health of three groups of people selected as teenagers was followed for 60–80 years, including:

• 90 middle-class intellectually gifted women born around 1910
• 268 socially advantaged male Harvard graduates born about 1920
• 456 socially disadvantaged inner-city men born about 1930.

The study found that the following factors present before age 50 predicted successful aging at 75–80:

• no heavy smoking
• no alcohol abuse
• healthy weight
• moderate exercise
• education
• a stable marriage
• a widening social sphere
• mature defenses or adaptive coping that prevent disabled people from feeling disabled.

Other factors that predicted enjoyable aging included:

• good people encountered at any stage of life
• the capacity for gratitude and ability to forgive and to bring people into one's life
• a capacity for play and creativity in retirement
• the ability to replace older lost friends with younger ones
• subjective good health—not feeling sick even in the presence of illness.

Factors that predicted unsuccessful aging included major depressive order or alcohol abuse ; the latter, in part, because it impeded future social support systems. Among the study's more interesting findings was that enjoyable aging appeared relatively unrelated to:

• a happy or unhappy childhood
• unfortunate events
• low cholesterol levels at age 50
• retirement income
• good physical health.

George E. Vaillant, the study's director, found that mastery of what he calls “generativity”—the capacity for leadership, mentoring, or giving of oneself to help succeeding generations—tripled the chances that one's 70s would be a joyful decade. Vaillant also found that one's role as a “keeper of the meaning”—teaching succeeding generations about the past, as in the universal example of empathetic grandparents—was another predictor of senior happiness. Perhaps the most significant predictors of successful aging were social and emotional maturation, which Vaillant describes as “the development of increasingly adaptive coping mechanisms,” and which include:

• sublimation of pain
• mature humor for the transformation of pain
• altruism for the transformation of conflict
• suppression or postponement of gratification.

Emotional maturation

Like other researchers Laura Carstensen and her coworkers found that emotional functioning continues to improve in old age. They found that:

• Older adults were less neurotic and had better emotional control than young people.
• They were better at maintaining highly positive states and this skill improved with age.
• Even the oldest old were less likely to have persistent negative emotions.
• Their emotional experiences were more complex and they were more likely to make subtle distinctions between emotional states.
• Older people experienced more poignancy—having simultaneous positive and negative feelings.

Development in later life

Based on his studies of more than 3,000 older adults Gene Cohen delineated four developmental stages of later life:

• Midlife reevaluation usually occurs between the ages of about 40 and 65 when people begin asking profound questions about their lives.
• Liberation comes with increased self-confidence as people in their late 50s into their 70s experiment, innovate, and free themselves from inhibitions, limitations, and social constraints.
• Summing up is the process of reviewing, resolving, and giving back by people in their late 60s through their 80s. This may be in the form of volunteerism, philanthropy, shared wisdom, genealogy, autobiographical expressions such as memoirs, oral histories, or photo albums, or dealing with unfinished business or unresolved conflicts. Psychologists believe that the process of reviewing one's life is a part of normal aging that can lead to greater self-awareness and self-acceptance.
• Encore lasts from the later 70s to the end of life and is the desire to maintain vitality even in the face of physical and emotional loss, and which can lead to new creativity, sociability, and entirely new perspectives.

However Cohen stresses the later life is the time when people differ the most from others of a similar age and so the timing, sequence, and elaboration of development stages in seniors varies more than at any other age.

According to Cohen the thinking of older adults becomes more “flexible and subtle” and they develop the ability to accept uncertainty. Wisdom, or Cohen's term “developmental intelligence,” describes the integration of “cognition, emotional intelligence, judgment, social skills, life experience, and consciousness” in the mature brain. According to Cohen advanced developmental intelligence is characterized by:

• relativistic or dialectical thinking—the recognition that knowledge can be relative rather than absolute
• dualistic thinking—recognizing and resolving contradictions and holding mutually exclusive views
• systematic thinking—seeing the broader picture and developing new perspectives.

Many of the older adults in Cohen's studies had very positive outlooks on life, which he attributed to their better sense of self, acceptance of reality, adaptability, and long-term perspective. They viewed their later years as an opportunity for:

• activities and interests for which they previously had no time
• increased engagement
• deeper relationships
• intellectual growth
• fun.

Research has shown that creativity and intellectual activity have a profoundly positive effect on both psychological and physical health and Cohen points out that folk art in the United States is dominated by older adults across all racial and ethnic groups. His study of a community arts program for older adults found that after one year those in the arts program, in comparison to the control group:

• were in better health
• made fewer doctor's visits
• used fewer medications
• were more socially active
• were less lonely
• were less depressed
• had better morale.

Gerotranscendence

Lars Tornstam developed the theory of gerotranscendence, in which the second half of life provides the opportunity to distance oneself from earlier materialism and rationalism, leading to an increase in life satisfaction. In his extensive research he found that senior's experiences included:

• decreased materialism
• greater appreciation of the distinction between self and one's role in life
• growing interest in nature and connections within the living world
• pleasure in flouting silly social norms
• more selectivity in relationships, fewer superficial social contacts, increased desire for solitude
• decreased self-centeredness and a transition from egoism to altruism
• the discovery of new aspects of one's self, both positive and negative
• a greater appreciation of the gray areas between right and wrong and increased reluctance to give advice
• a rediscovery of childhood and its pleasant memories
• an increased interest in genealogy
• blurring of the boundaries between time and space, past and present
• decreasing fear of death.

Resources

BOOKS

Cohen, Gene D. The Mature Mind: The Positive Power of the Aging Brain. New York: Basic Books, 2005.

Rowe, Jack, and Robert Kahn. Successful Aging: The MacArthur Foundation Study of Aging in America. New York: Pantheon Books, 1998.

Tornstam, Lars. Gerotranscendence: A Developmental Theory of Positive Aging. New York: Springer, 2005.

Vaillant, George E. Aging Well: Surprising Guidelines to a Happier Life from the Landmark Harvard Study of Adult Development. Boston: Little, Brown and Company, 2002.

Weil, Andrew. Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being. New York: Alfred A. Knopf, 2005.

PERIODICALS

Arrison, Sonia. “80 Is the New 65; Live Longer and Watch Society's Problems Multiply.” Los Angeles Times (March 13, 2007): A17.

Carstensen, Laura L., et al. “Emotional Experience in Everyday Life Across the Adult Life Span.” Journal of Personality and Social Psychology 79, no. 4 (2000):644–55.

Gawande, Atul. “The Way We Age Now.” New Yorker 83, no. 10 (April 30, 2007): 50.

Johnson, Dirk. “At Last There's Time to Defend the Barricades.” New York Times (April 10, 2007): H6.

Kadlec, Dan. “Homeward Bound.” Time 169, no. 17 (April 23, 2007): 66.

Kirshenblatt-Gimblett, Barbara, et al. “The Grand Generation: Folklore and the Culture of Aging.” Generations 30, no. 1 (Spring 2006): 32–7.

Rosenthal, Jack. “Wellderly.” New York Times Magazine (July 22, 2007): 16.

Ryan, Andrea Kay, and Fern K. Willits. “Family Ties, Physical Health, and Psychological Well-Being.” Journal of Aging and Health 19, no. 6 (December 2007): 907–20.

ORGANIZATIONS

AARP, 601 E Street NW, Washington, DC, 20049, (888) OUR-AARP, http://www.aarp.org.

Administration on Aging, 1 Massachusetts Avenue, Washington, DC, 20201, (202) 619-0724, (800) 677-1116, [email protected], http://www.aoa.gov/.

American Society on Aging, 833 Market Street, Suite 511, San Francisco, CA, 94103, (415) 974-9600, (800) 537-9728, (415) 974-0300, [email protected], http://www.asaging.org.

International Federation on Aging, 4398 Boul. Saint Laurent, Suite 302, Montreal, QC, Canada, H2W 1Z5, (514) 396-3358, (514) 396-3378, http://www.ifafiv.org/en/accueil.aspx.

National Council on Aging, 1901 L Street NW, 4th Floor, Washington, DC, 20036, (202) 479-1200, (202) 479-0735, [email protected], http://www.ncoa.org/.

National Institute on Aging, Building 31, Room 5C27, 31 Center Drive, MSC 2292, Bethesda, MD, 20892, (301) 496-1752, (301) 496-1072, http://www.nia.nih.gov/.

Margaret Alic Ph.D.