Grow old actively!

Critical perspective: to expand the understanding of the term "active aging"

Article by Kim Boudiny and Dimitri Mortelmans A Critical Perspective: Towards a Broader Understanding of ‘Active Aging’
published in January 2011 in the E-Journal of Applied Psychology.
Translated by Evgenia Ryabtseva

This article explains the origin of the concept of "active aging", as well as the definitions that have been different from each other since its first appearance. In general, there is a distinction between a narrow view of active aging (that is, focusing on work, caring for loved ones and other "traditional" activities) and a broad perspective. The article discusses the dangers associated with the use of a narrow point of view. Such approaches apply more to people of early old age, while the distinction between active and passive behavior is very ambiguous. The article also discusses research and strategic approaches to expanding the concept of "active aging".

IntroductionIn the 50s of the last century, the sociogerontological literature described various aspects of the idea that there is a positive relationship between an active lifestyle in old age and personal life satisfaction (Katz, 2000).

Later this point of view acquired the name "activity theory". The "liberation theory", which appeared in 1961, implies the opposite concept of old age: the gradual and inevitable mutual separation between aging people and society is useful both to people themselves and to society (Lynott & Lynott, 1996). Despite the critical statements made about both theories, the question of how to describe the place of an elderly person in society, which served as a prerequisite for their appearance, remained open.

Sociogerontological literature and public debates have traditionally focused on the limited capabilities of aging people. From this point of view, learning, work and rest were described as three strictly sequential stages of life, known as the "division of life into three parts" (Kohli, 1986). The third stage was understood as a stage of dependence, decline and loss (Townsend, Godfrey, & Denby, 2006). This negative description of elderly people corresponds to the so-called inferiority model, which justified the trend towards early retirement from the workforce, to which aging men in most developed countries of the world tended in the post-war years (Jacobs, 2004; Verte & Dewitte, 2006; Walker, 2006). For example, in the 70s and 80s of the last century, the state policy of many European countries, in response to the growing unemployment of the young population, encouraged early withdrawal from the labor market (Van den Heuvel et al., 2006). During the 1990s, the issue of global "graying" led to the elimination of the schematic concept of the course of life, which equated the last phase of life with rest. In the changing demographic conditions, such a phase of rest was simply unacceptable. Within this context, the concept of active aging has emerged. Rooted in the theory of activity, the concept of active aging is aimed at encouraging the continued participation of elderly people in the life of society. It includes an element of "perceptions of competence": instead of focusing on what elderly people can no longer do (that is, their inferiority), it is based on the competence and knowledge they possess (Daatland, 2005; Jacobs, 2004).

The World Health Organization (WHO) approved the term "active aging" in the late 1990s. She should be given credit for the rapid introduction of the term into research, strategic and practical activities (Walker, 2006; WHO, 2002). In its main reports, WHO openly offers a broad approach that implies the interpretation of "the word 'active' as continued participation in social, economic, cultural, spiritual and civic activities, and not just the ability to be physically active or participate in working life" (WHO, 2002, p. 12). While today the concept has already entered widespread use, there has not yet been a general agreement on the exact meaning of this term (Ranzijn, 2010). This paper outlines several approaches used to determine active aging, and also explains the dangers associated with some of the prevailing concepts. The purpose of this is to fulfill the conditions necessary for the development of effective policies by clearing the way to a consensus that would allow an accurate definition of active aging.

From narrow definitions of active agingThe results of studying the literature on active aging clearly indicate the problem of definition.

The authors' attempts to define the concept are not consistent with each other. The prevailing interpretation of the concept of active aging within the framework of an exclusively economic system. Many researchers pay special attention to participation in working life (for example, Guillemard & Argoud, 2004; Van den Heuvel et al., 2006). The Governments of many industrialized countries also continue to consider economic aspects as a central element of their policies aimed at promoting active aging (Clarke & Warren, 2007; Walker, 2010). This is not surprising, especially considering that the roots of the concept go back to the aging of the population and the associated worries about the viability of our social security systems. Despite this, it is not enough to focus exclusively on employment, as this reduces the complexity of the concept of aging to one component (Giorgi, 2005). With this approach, people who do not have paid employment do not have the opportunity to age actively, and the valuable contribution that they could still make to the life of society risks being ignored. The use of the concept of active aging in such a limited perspective generally negates the concept of "productive aging" that preceded it. While there are various definitions of productive aging, most of them are limited to the contribution of older people to the economy, their participation in the production of products and services (Walker, 2006). To eliminate such a narrow definition, the term "active aging" was introduced.

Several experts in the field of aging recognize the possibility of participation of elderly people in unpaid work. For example, at the 1997 Denver Summit, active aging was defined as the desire and ability of many elderly people to continue to participate in both economically and socially productive activities (U.S. Department of Health and Human Services, 1997). McKenna (2008) also, in addition to professional employment, considers volunteering, nursing and participation in social service organizations as activities within the framework of active aging. While these definitions have succeeded in resisting the stereotypes that older people are unproductive and dependent, they retain too close a relationship with the concept of productive aging. A number of authors (for example, Rowe & Kahn, 1997) apply a somewhat broader definition, recognizing activity as productive in cases where it leads to the creation of social value, regardless of whether it is rewarded or not. A limited view of productive activity neglects leisure as an important option for spending time, especially for elderly people, and, accordingly, leaves few opportunities for alternative personal and social development options other than those provided by paid or unpaid work (Biggs, 2001), despite the positive influence of leisure in the elderly. Activation of participation in activities in free time can improve physical health, protect against the development of cognitive function disorders and increase life satisfaction. It can even compensate for social or physical problems: active participation in recreational activities has the most pronounced positive impact on the quality of life of elderly people in the context of the death of a spouse, weak intra-family contacts or deterioration of functional abilities (Silverstein & Parker, 2002). The prevailing lack of leisure in the definitions of active aging indicates that this concept is often approached, taking into account mainly the interests of society. In fact, a qualitative study of active aging demonstrates that productive activity is not necessarily beneficial for the elderly themselves: "Having freed themselves from certain responsibilities, such as work or caring for family members, many participants returned to reality" (Clarke & Warren, 2007, p. 481). This observation was also confirmed by quantitative studies of the effect of care. While the response of individuals to patient care varies widely, some of the caregivers do experience a positive impact (for example, an increased sense of purpose in life). However, many studies have shown that patient care negatively affects the physical and mental state of caregivers, and the severity of this depends on situational factors such as the severity of the conflict between work and family, as well as the nature of the relationship with the ward (Morrow-Howell, 2000). In short, "there may be tension between strategic approaches, one of which focuses on aging and the other on elderly people. They are not the same" (Carstairs & Keon, 2007, p. 13).

From this point of view, we support the approach promoted by Avramov & Maskova (2003), which takes into account not only the productive activities mentioned above, but also homework and active recreation, education and social contacts. Houben, Audenaert & Mortelmans (2004) complement productive activities with sports and active entertainment outside the home (for example, participation in club life, attending cultural events and listening to courses). Thus, they pursue the goal of including in the strategy activities that require the expenditure of physical and/or mental strength and have a social component, since leisure activities at home are definitely excluded. While limiting leisure activities to "active" activities may seem appropriate when conducting research on active aging, a closer, more critical examination of the exact meaning of the word "active" may lead to important discoveries. The boundary between active and passive recreation is characterized by a certain degree of ambiguity. Many researchers are inclined to retain the label "active" for elite leisure activities, leaving the definition of "passive" for non-demanding physical activities that have a low status of occupations (Ruuskanen, 2004). The most common example is watching TV shows. Both Avramov & Maskova (2003) and Houben et al. (2004) regard such a pastime as passive. Despite the fact that such a definition is automatically given by many researchers (for example, Gauthier & Smeeding, 2003; Sayer & Gornick, 2009), the specified definition of this way of spending time can be questioned. Watching television programs can be active in cases when they are informative or stimulate mental activity, which is typical for educational programs (Katz, 2000; Ruuskanen, 2004).

Elderly people can also be divided into groups depending on the content of the television programs they watch. News broadcasts occupy a special place (Pettigrew & Roberts, 2008). The arbitrary nature of classifications is also evident in other examples (for example, reading). Avramov & Maskova (2003) consider reading as an active activity, which makes it part of the concept of active aging. A number of other studies devoted to the study of the nature of time spent by elderly people also recognize reading as an active activity (for example, Gauthier & Smeeding, 2003). Houben et al. (2004), on the contrary, exclude reading from their list of parameters of active aging. Reading has also been defined as a passive activity by a number of other researchers (for example, Allen & Chin-Sang, 1990). Such disagreements clearly illustrate the decisive influence of the interpretation criteria used by researchers on the formation of these disagreements (Katz, 2000). An interesting fact is that elderly people perceive reading as an active rather than a passive pastime (Pettigrew & Roberts, 2008). This may lead to the thought: isn't the distinction between active and passive really just an erroneous split? According to the definitions formulated by Houben et al. (2004) and Avramov & Maskova (2003), visiting the opera house should be considered as an active activity. Compare, however, a stockbroker who follows the warnings about declining profits shown on TV and a stockbroker who visits the opera house, and imagine which of the activities is more "active" for him (Ruuskanen, 2004). In other words, "the same type of activity carries a different burden for different people or even for the same person at different time periods" (Hooker & Ventis, 1984, pp. 478-479). Therefore, it is informative only to determine the significance of activities for a particular person (Allen & Chin-Sang, 1990).

At this stage, we have distinguished three main areas of development of the concept of active aging. The first approach is aimed solely at stimulating participation in work, while the other two imply that active aging implies maintaining the activity of elderly people in various spheres of life.

Given that the health and financial well-being of elderly people living in industrialized countries has improved significantly over the past decades, the resources these people have to continue to participate in society have increased significantly. Based on this, at first glance, active aging is quite a suitable option for modern elderly people (Jacobs, 2005, p. 3). However, this conclusion changes when we take into account the variability of age in the elderly population. One important critical point that applies to all the approaches discussed here is that they mainly apply to people of early advanced or elderly ("third") age (Daatland, 2005; Jacobs, 2005) – a stage of life that begins at the age of about 55 and ends somewhere between 75 and 85 over the years and gradually passing into the senile period, or the "fourth age", characterized by a significant increase in the likelihood of serious deterioration of cognitive and physical potential (Baltes & Smith, 2003). Regarding the narrowest definition of active aging, such a critical point of view is self-evident. While the goal of modern strategic measures is to raise both the actual and official retirement age, the estimated age is not even approaching 75 years. Despite the fact that the amount of time devoted to caring for children and the elderly, volunteering, sports and entertainment outside the home may stabilize or increase immediately after retirement, the results of a number of studies indicate a subsequent decline, which, as a rule, is especially pronounced at the age of about 75 (for example, Broese van Groenou & Van Tilburg, 2010; Erlinghagen & Hank, 2006; Jacobs, 2005; Verbrugge, Gruber-Baldini, & Fozard, 1996; Wilson, Spoehr, & Mclean, 2005). Since the decisive influence exerted by the state of health on participation in all these activities has been demonstrated, it is safe to say that poor health is the main limiting factor. In addition to the changes observed in a person's abilities and state of health, the nature of the activities undertaken by him also changes with aging due to changing preferences and the appearance of constraining factors (Verbrugge et al., 1996). For example, contributing factors are the age of compulsory retirement that still exists in many countries and the upper limit of the age for participation in volunteer activities (Gill, 2006; Walker, 2006). Therefore, it is not surprising that Houben et al. (2004) found that men and women aged 75 and older spend on average less than 3 hours a week on the activities listed in their list (i.e., sports, caring for someone, paid work, volunteering and outdoor activities).

The promotion of such demanding activities as the only way to age actively is dangerous. It not only exposes the policy of active aging to the risk of neglecting the potential of this concept in relation to more vulnerable people of very old age; the latter may even experience a sense of "failure" and, as a result, a decrease in self-esteem (Ranzijn, 2010), which, in turn, may reduce their participation in society. As for the fight against the deterioration of the body, the results of a number of studies really indicate the importance of having a relative in a more deplorable condition, which increases the results of social comparisons important for a sense of well-being (Kessler, Rakoczy, & Staudinger, 2004).

Towards a broader understanding of active agingDespite our criticism of the activities traditionally included in the definitions of active aging, they remain an important component of the active aging strategy.

Thus, a study by Carstairs & Keon (2007) indicates the positive effects of such activities as, for example, sports and participation in socio-cultural events on maintaining mental and physical health and quality of life. Such preventive potential can be used in two directions. Firstly, a healthy lifestyle should be promoted from childhood. Contrary to popular belief, the concept of active aging applies not only to elderly people, but also to all other age groups. This means realizing the perspective of the course of life, taking into account the important influence of experience gained in the early stages of life on the nature of human aging (Walker, 2006). Secondly, the interpretation of these traditional activities should be expanded. For example, instead of introducing age restrictions for volunteering, it is necessary to adapt volunteer work in such a way that it can be performed by elderly people. As a positive experience of providing disabled elderly people with volunteer opportunities, we can cite the friendly support telephone service established in Camden (Great Britain). Initially, volunteers called lonely elderly people who could not leave home, after which more than two-thirds of them became volunteers themselves. This allowed even the most infirm old people to enjoy the positive effects of volunteering – for example, an increased sense of psychological well-being (Gill, 2006).

In addition to the revision of traditional activities, the concept of active aging should also include alternative activities. Earlier, arguments were given explaining a certain ambiguity of the distinction between activity and passivity. The compilers of many modern definitions of active aging made an arbitrary decision, the result of which was the neglect of precisely those activities that are most important for the most aged people. Such people devote much more time to classes inside the house and leisure time with their family (Gauthier & Smeeding, 2003; Verbrugge et al., 1996). This fact is not necessarily negative at all. The results of a quantitative study indicate that the change of a large network of social connections to maintaining close emotional relationships does not necessarily affect life satisfaction, since not the quantity, but the quality of social contacts is of paramount importance for people of the most advanced age (Berg, 2008). The results of a qualitative study also demonstrate that elderly people consider the pleasure derived from daily activities (such as crossword puzzles and reading) as a more important indicator of their life activity than participation in activities with a pronounced social or physical orientation (Clarke & Warren, 2007; Ranzijn, 2010). The main strategy for them is to avoid the feeling of "old age", which can be considered as the opposite of active aging (Jacobs, 2005), consists in "maintaining interest even in cases when the ability to move outside the house decreases" Townsend et al., 2006, p. 893).

Therefore, it is not necessary to persistently adhere to a strategy aimed at promoting traditional "active" activities, especially if we are talking about people with significant disabilities who are simply unable to engage in them. Instead, active aging should imply a strategy that allows elderly people to age while maintaining a sense of happiness, regardless of the limitations they experience. In this regard, it is useful to pay special attention to activities that can potentially compensate for the lost opportunities associated with age. An example is the use of the Internet. Since the physical capabilities necessary to use the Internet are generally limited to fine motor skills, it can be assumed that most of the most infirm elderly people are able to engage in this type of activity. The data obtained as part of the 2006 phase of the Health and Retirement Study (HRS, 2011; RAND HRS, 2009) – a multi–faceted panel study reflecting all strata of US residents over the age of 50 - support this assumption. Table 1 presents data on the regularity of Internet use depending on physical capabilities, estimated as the number of elementary self-service actions (taking a bath, dressing, eating, the ability to get into bed and get out of it, as well as walk through the room), which the participant noted as causing him difficulties. Despite a clear tendency to deterioration of physical abilities with age, even in the least physically healthy groups, a significant number of people continued to use the Internet regularly. It is expected that in the future the difference between the most and least physically healthy groups will smooth out, since there is a significant relationship between the deterioration of physical capabilities and age (p < 0.001), and the share of Internet users among older age groups will continue to increase as a consequence of the greater prevalence of Internet addiction among younger cohorts of the population at present.

Table 1. Internet usage by elderly US residents
depending on the ability to perform basic self-service actions (EMF) (n=16 008)
Source: Health and Retirement Study, 2006 data (stage 8), author's own calculations.

Interpretation: 25.4% of 1,404 survey participants experiencing difficulties in performing one of the elementary self-service actions regularly use the Internet.

Internet users provide themselves with a whole range of possibilities. Traditional forms of communication and social support can be supported and reinforced through applications such as email and social networking sites (Czaja & Lee, 2007). The results of a small experiment (Fokkema & Knipscheer, 2006) point to the decreasing sense of loneliness of the impact of Internet use by lonely people with disabilities. It also provides an opportunity to train cognitive function, for example, through education accessible to many in numerous organizations that provide training services via the Internet. The results of a recent study indicate that the search for information on the Internet itself can stimulate mental activity even more than reading books. During an active online search for information, experienced Internet users register high activity in brain regions that are not activated while reading printed text (Small, Moody, & Siddarth, 2009). Using the Internet can stimulate a sense of mental and social well-being against the background of overcoming physical limitations.

As soon as a person begins to accept this way of thinking and the importance of adapting to existing opportunities, a whole set of alternative activities immediately arises in front of him. This also applies to people living in nursing homes, traditionally perceived as an obstacle to healthy aging (Jacobs, 2004). A successful solution was found in Belgian nursing homes, whose residents can communicate with their families through a social network site. To reduce the difficulties associated with using the Internet, the site works through televisions installed in residents' rooms, on the screens of which they can view photos and read messages from family members using a remote control, since this device is much more familiar to them than a keyboard (Van Braeckel, 2011). Thus, social activity is stimulated despite physical limitations.

DiscussionThis critical review of approaches to the concept of active aging demonstrates that the existence of different ideas can have multidirectional consequences.

The negative description of elderly people, which has dominated both politics and science for a long time, has been criticized for discriminating against this stratum of the population and neglecting the high degree of heterogeneity observed in it. The idea that elderly people make up a single homogeneous passive group is too pessimistic. The goal of the shift towards more positive approaches was to create a more diverse policy (Townsend et al., 2006). However, when creating the concept of active aging, researchers and politicians should refrain from the opposite extreme, which can manifest itself by voicing an overly optimistic view of elderly people. For many representatives of this group, sports, work and other traditional activities are beyond the limits of possibilities. Political approaches aimed exclusively at such activities also ignore the heterogeneity that exists in the population of elderly people, but in diametrically opposite terms. Paradoxically, such a narrow approach is generally equivalent to praising youth, usually surrounded by a negative attitude towards old age, disguised as a positive attitude, since these activities are usually associated with middle age, not old age.

In compiling this article, we tried to contrast several traditional concepts of active aging, formed by researchers and politicians, with the perception of elderly people themselves, which has been done in the framework of several recent qualitative studies. Such a comparison reveals a clear discrepancy between what elderly people themselves consider active aging and what many politicians and scientists mean by this term. While the latter set relatively high standards for active aging, older people, especially the most elderly, are characterized by less ambitious aspirations: they mostly want to keep an interest in the world around them and, thus, feel their participation in life.

From our point of view, a prerequisite for active aging is awareness of the differences that exist between elderly people. Since people of different subgroups (for example, different ages, different ethnicities) are likely to have different needs and priorities and live in different conditions, the perception of what makes life active can also vary significantly. In addition, the differences between aging people should be taken into account. For example, physically incapacitated elderly people can continue to solve intellectual tasks and enjoy social contacts. Approaches to the strategy of active aging should provide these people with the opportunity to meet their psychological and social needs, despite physical limitations, and not further exclude and restrict them from society by applying a narrow approach to active aging (Ranzijn, 2010). As a result, a special form of "successful infirmity" may form (Kriebernegg, Maeirhofer, & Mortl, 2011). We identified the use of the Internet as a typical activity that can give elderly people (even the most infirm and dependent) additional opportunities to participate in society. Further qualitative studies of how elderly people, especially the most elderly, interpret the concept of active aging can become the most valuable source of information about how this concept evolves as a person ages. Therefore, in the future, studies should include people who have reached the most advanced age, as well as those living in nursing homes, since representatives of these groups were not included in the samples analyzed in recent studies (for example, Cloos et al., 2010; Jacobs, 2004).

ConclusionThe purpose of compiling these arguments is to promote the following key point of view: in order for the paradigm of active aging to be an effective political tool, it should be a dynamic, life-changing concept that coincides with the perception of people and allows them to create their own activities, instead of listing a predetermined limited number of options, usually formed by "from the point of view of specialists" (Bowling, 2005; Walker, 2010).

The list of references is given on a separate page.

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