Obzornik zdravstvene nege, 53(3), pp. 188-193.
Leading article / Uvodnik
Acceptance and perceptions of old age and aging
Sprejemanje starosti in staranja ter odnos do njiju
Mateja Lorber
Modern times are marked by major social developments brought about by the changes in the fields of economy, politics and population structure. The longstanding trends of declining fertility, growing life expectancy and migration have resulted in an accelerated process of population aging and the associated challenges and opportunities. Demographic data show that, on average, life expectancy is increasing across the globe. Over the course of the 20th century, it rose by 20 years, and Kontis and colleagues (2017) predict that many countries will see a further increase by 2030. This study ranks Slovenia among the top five European countries with the highest projected life expectancy at birth for women in 2030, namely 87.4 years (Kontis, et al., 2017). The World Health Organization [WHO] (2011) highlights the fact that population aging is a global trend and that in Europe alone, the percentage of those aged over 65 will almost double over the following 50 years. It is estimated that by 2030-2035, over 25 % of Europeans will be over 65 years old. Population aging is therefore a universal and global problem affecting developed societies. Changes in the demographic structure of the population affect all areas of economic and social life. Morgan and Kunkel (2016) note that the social institutions most affected by the aging population are those of education and the economy. Awareness of the impact of demographic changes in most European countries on people's behaviour has sparked intense research interest by the United Nations, the Organisation for Economic Cooperation and Development (OECD) and the European Union.
Each individual's experiences related to old age and aging depend on the quality of contact with other people, the specific time and place of residence, and are determined solely by one's life experiences (Domanjko & Pahor, 2009). Consequently, one might say that the importance of age and aging is predominantly socially conditioned. Morgan and Kunkel (2016) maintain
that it is only by taking into account individual social contexts that the exact point in time when aging begins can be determined. It can be argued that the core values of a society are most clearly reflected in its attitudes towards its elderly. At the same time, attitudes towards aging vary - people may either accept aging as a fact of life, or instead place greater emotional reliance on their partner and children. They may even resort to work so as to avoid facing the processes of aging. What seems to be of key importance in overcoming age-related problems are the attitudes towards aging one has developed over the course of one's life, as well as a healthy lifestyle, and acceptance of aging. As stated by Eržen (2008), a person's attitude towards one's age depends on one's age bracket. He adds that it is very difficult to accept the fact that one has grown old, as we all seem to perceive other people as old, but not ourselves. Ramovš (2014) also points out that maintaining and promoting health in old age is highly dependent on how one perceives and experiences one's own aging process. According to Ramovš (2014) each individual should ponder on the question whether they perceive aging as something difficult, or, conversely, accept it as a fact of life one should adapt to while uncovering the importance and meaning of life. What seems to be an obstacle in understanding the process of aging is a general lack of awareness thereof until one reaches a certain age, as, according to Little (2014), each culture and society has a certain set of expectations and assumptions related to aging.
Although the WHO (2007) defines aging as a lifelong process which begins even before birth and continues throughout one's lifetime, according to Kuhar (2007), old age and hence also aging are still taboo to people of all generations: the younger and middle generations may not wish to think about old age and aging, while the elderly do not wish to accept it. Spence and Radunovich (2007) find that the growing number of
Assistant Professor Mateja Lorber, PhD, MSc, BSc, RN; University of Maribor, Faculty of Health Sciences, Žitna ulica 15, 2000 Maribor, Slovenia
Correspondence e-mail / Kontaktni e-naslov: mateja.lorber@um.si
Received / Prejeto: 13. 8. 2019 Accepted / Sprejeto: 17. 8. 2019
https://doi.org/10.14528/snr.2019.53.3.2992
Lorber, M., 2019. / Obzornik zdravstvene nege, 53(3), pp. 188-193.
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older people and incessant negative representations of aging lead to negative views of the elderly. As stated by Domanjko and Pahor (2009), in Slovenia as well, there is a prevailing belief that old age is accompanied with illness and loss of independence, while an aging population represents a social obligation. There are also common misconceptions equating aging with a decrease in physical, mental and social abilities and functionality. At this stage of life, we are generally faced with potential and actual limitations, which modern culture has failed to prepare us for. We should learn to slow down, to distribute our energy economically, to be kind to ourselves, and to contemplate life (Schmid, 2015). Old age should not be perceived only as the last stop, but should become a form of art informed by the knowledge of the mysteries of aging associated not only with our body and outer appearance, but also imbued with a deeper meaning, which encourages us to turn inward and devote ourselves to discovering our inner wealth (Grün, 2010). Skela-Savič and colleagues (2010) find that quality aging depends not only on having lived a meaningful life. What is also important in addition to health and longevity is the person's degree of vigour or proactiveness, their ability of introspection, social inclusion, health-related perceptions, financial and social capacity, level of educational attainment, as well as the level of development of health-care system. Similarly, Hvalič Touzery (2014) stresses that the concept of active aging must be taken into consideration even at very old age, and that the promotion of the quality of life in old age incorporates an optimal degree of seizing the given opportunities associated with health, social engagement and security.
In the past, the elderly were perceived as an important part of society, often representing an economically significant factor, and were primarily seen as a sign of healthy social relationships within a common space characterised by a high culture of living and intergenerational coexistence (Mlinar, 2010). For a society consisting of younger, middle and older generations to function as a whole, there must be cooperation and coexistence in harmony between all three generations. Spence and Radunovich (2007) highlight the need for people to maintain contact in order to more easily avoid prejudices and stereotypes. Bengston and Oyama (2007) define intergenerational solidarity as "social cohesion between generations", whereby the authors point out that intergenerational cohesion and solidarity can only be created through dialogue, whose main objective for the young and middle generations is to obtain new experiences and for the elderly to be given a sense of respect and appreciation. We should all strive to achieve a higher level of coexistence between generations. Železnik (2014) also points out that living in a shared household with one's children and grandparents creates much better intergenerational harmony. Unfortunately, as stated by Spence and Radunovich (2007), in its current
state, our society is not inclined towards promoting intergenerational harmony, and the inadequate systemic solutions may even lead to intergenerational conflicts. Moreover, the importance of youth is more heavily emphasised than that of old age.
Today, we know many stereotypes about aging and the elderly. Ory and colleagues (2003) define them as assumptions and generalisations about how people of a certain age should behave and what they are likely to experience regardless of individual differences and unique circumstances. Research (Levy, 2003; Packer & Chasteen, 2006) have shown that age-related prejudice can be detected already in young children. In some extreme cases, we can even talk about ageism, which means systematically stereotyping and discriminating against people because of their age (Morgan & Kunkel, 2016). Ramovš (2010) defines ageism as a dislike of old people and their personal or social denigration. The term also refers to personal rejection of aging and old age. Kotter-Gruhn and Hess (2012) find that when people are confronted with negative messages regarding old age, their desire for youth increases. This desire is present already in young and middle-aged adults. Eržen (2008) points out that the political and media discourses most often accentuate the costs associated with an aging population. Such messages contribute greatly to negative social perceptions of aging and the elderly and influence people's attitudes towards old age and aging. Rozanova (2010) notes that older people are still underrepresented in the media; Vickers (2007), too, observes that most people in the media are young and energetic. It should be kept in mind that negative attitudes towards aging and old age and the presence of age-related stereotypes represent a problem to the elderly, as the activation of negative stereotypes about aging can greatly affect their lives (Kotter-Gruhn & Hess, 2012). Conversely, research shows that a positive attitude to aging is associated with greater prosperity and longevity (Levy et al., 2002; Uotinen, et al., 2005), a higher level of life satisfaction (Brothers, et al., 2015), better health (Beyer, et al., 2015) and well-being (Levy, 2003), and better social networking (Menkin, et al., 2017). We can certainly speak of the longevity revolution (Applewhite, 2017), which can actually be regarded the most important phenomenon of our time, a tremendous opportunity to solve virtually all of our problems, and perhaps the highest achievement in human history, which will fail to be recognised as such unless we see the true meaning of old age. The fact remains that old age is still devalued and tabooed as something inferior, undesirable and marginal (Milavec Kapun, 2011).
We can conclude that old age affects each and every one of us. It is therefore important to recognise aging as a part of life, a process associated with specific changes and challenges we must all face - as individuals, societies, states, government institutions, professions and scientific disciplines. Perceptions of age and aging
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also have a major impact on the individual's and hence the society's attitudes towards older people. However, to better understand old age and aging and thus improve the attitudes towards older people, some key changes need to be made in the direction of their acceptance; it is necessary to conduct activities aimed at eliminating prejudices and stereotypes concerning old age and the elderly. Such changes can only be achieved through adequate information and research and cooperation between all stakeholders -decision-makers at private or public levels, schools, universities, trade unions, professional associations, and in particular public media. This is the only way for people of all generations to come to understand old age and aging, and, what is most important, recognise all the positive aspects they bring.
Slovenian translation / Prevod v slovenščino
Današnji čas zaznamujejo velike družbene spremembe, ki so posledica razvoja gospodarskih in političnih dejavnikov ter sestave prebivalstva. Zaradi dolgoletnega trenda zniževanja rodnosti, daljšanja življenjske dobe, preseljevanja, migracij se srečujemo s pospešenim procesom staranja prebivalstva ter z njim povezanimi izzivi in priložnostmi. Demografski podatki kažejo, da se povprečna življenjska doba podaljšuje v vseh državah sveta. Od začetka do konca 20. stoletja se je povišala za 20 let; Kontis in sodelavci (2017) pa ugotavljajo, da se bo do leta 2030 v mnogih državah še zvišala. Glede na ugotovitve se je Slovenija uvrstila med pet držav v Evropi z najvišjo pričakovano življenjsko dobo ob rojstvu za ženske leta 2030, in sicer 87,4 leta (Kontis, et al., 2017). Svetovna zdravstvena organizacija (World Health organisation [WHO], 2011) izpostavlja, da je staranje globalen trend in da naj bi se samo v Evropi v naslednjih 50 letih število starejših od 65 let skoraj podvojilo. Že v letih 2030-2035 naj bi bilo več kot 25 % Evropejcev starejših od 65 let. Staranje prebivalstva je torej eden izmed univerzalnih in globalnih problemov, s katerim se soočajo razvite družbe. Spremembe v demografski sestavi prebivalstva vplivajo na vsa področja gospodarskega in družbeno-socialnega življenja. Morgan in Kunkel (2016) izpostavljata, da sta prav izobraževanje in gospodarstvo dobra primera družbenih institucij, ki jih močno prizadene rast starejšega prebivalstva. Zaradi zavedanja vpliva demografskih sprememb na vedenje ljudi v večini evropskih držav v prihodnjih letih se s problematiko staranja prebivalstva intenzivno ukvarjajo in jo proučujejo Združeni narodi, Organizacija za gospodarsko sodelovanje in razvoj (Organisation for Economic Co-operation and Development [OECD]) in Evropska unija.
Izkušnje, povezane s starostjo oziroma staranjem posameznika, so odvisne od povezanosti posameznika z drugimi ljudmi, časom in krajem bivanja ter določene izključno z že preživetimi leti (Domanjko & Pahor,
2009). Glede na to bi lahko rekli, da je pomen starosti in staranja pretežno družbeno pogojen, saj kot navajata Morgan in Kunkel, je le ob upoštevanju družbenih kontekstov možno ugotoviti, kdaj se staranje za nekoga začne. Z odnosom do starejših družba izkazuje svoje temeljne vrednote. Odzivi na staranje so različni: ljudje se lahko sprijaznijo s staranjem ali pa se čustveno opirajo na partnerja in otroke. Lahko so predani delu in bežijo pred soočenjem s starostjo. Pri premagovanju težav, povezanih s starostjo, so pomembni lasten odnos do starosti, ki ga v življenju razvije posameznik, zdrav način življenja in sprejemanje staranja. Eržen (2008) navaja, da je posameznikovo gledanje na lastno starost odvisno od njegovega starostnega obdobja. Dodaja, da ljudje zelo težko sprejmemo dejstvo, da smo stari; največkrat velja, da so starejši v naših očeh drugi ljudje. Tudi Ramovš (2014) poudari, da sta ohranjanje in krepitev zdravja v starosti zelo odvisna od tega, kako človek svoje staranje sprejema in doživlja. Ob tem naj si vsak posameznik zastavi vprašanje, ali sprejema staranje kot nekaj težavnega ali pa ga doživlja kot življenjsko stvarnost, ki se ji prilagaja ter ob tem odkriva nov pomen in smisel življenja. Ovira za razumevanje staranja je, da ga ljudje redko razumemo, dokler sami ne dosežemo starosti, saj imata, kot navaja Little (2014), vsaka kultura in družba nabor pričakovanj in predpostavk o staranju.
Kljub temu, da je Svetovna zdravstvena organizacija (WHO, 2007) opredelila staranje kot vseživljenjski proces, ki se začne, še preden se rodimo, in traja vse življenje, sta po mnenju Kuharja (2007) starost in s tem tudi staranje še vedno tabu vseh generacij: mlada in srednja generacija o starosti in staranju ne želita razmišljati, medtem ko ju starejši ne želijo sprejeti. Spence in Radunovich (2007) ugotavljata, da naraščajoče število starejših in nenehna sporočila o staranju kot nečem slabem vodijo do negativnih misli o starejših. Na žalost tudi v Sloveniji, kot navajata Domanjko in Pahor (2009), še vedno prevladuje misel, da starost prinese bolezen in nezmožnost za samostojnost, staranje prebivalstva pa družbeno obveznost. Zmotno mišljenje ljudi staranje navadno enači tudi z zmanjševanjem telesnih, miselnih in socialnih sposobnosti ter zmogljivosti. Značilno je, da se v tem času ljudje soočijo z možnimi in dejanskimi omejitvami, na kar nas sodobna kultura ne pripravi, vendar se je treba naučiti upočasniti samega sebe, gospodarno razporediti svoje moči, biti prizanesljiv do samega sebe in premišljevati o življenju (Schmid, 2015). Starost naj ne bo le zadnja postaja, temveč naj z znanjem o skrivnostih staranja postane umetnost, ki ne zadeva le naše zunanjosti oziroma telesa, ampak nosi v sebi tudi smisel, ki človeka obrača navznoter, da se posveti samemu sebi in odkrije svoje notranje bogastvo (Grün, 2010). Skela-Savič in sodelavci (2010) ugotavljajo, da za kakovostno staranje ni dovolj le smiselno življenje, temveč so poleg zdravja in dolgega življenja pomembni tudi delavnost oziroma aktivnost, sposobnost samoopazovanja, socialna vključenost, odnos do lastnega zdravja,
Lorber, M., 2019. / Obzornik zdravstvene nege, 53(3), pp. 188-193.
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finančna in socialna zmožnost, izobrazba ter razvitost zdravstvenega sistema. Hvalič Touzery (2014) poudarja, da je tudi v visoki starosti treba upoštevati koncept aktivnega staranja, ki vključuje optimalno uresničitev danih možnosti posameznikovega zdravja, udeležbo v družbi in varnost z namenom spodbujanja kakovosti življenja v starosti.
Dejstvo je, da so bili v preteklosti stari ljudje pomemben del družbe, neredko tudi gospodarsko pomenljiv dejavnik, predvsem pa znamenje zdravega družbenega odnosa in skupnega prostora, ki je odražal sožitje, visoko kulturo življenja in medgeneracijskega sožitja (Mlinar, 2010). Da bi družba, ki jo sestavljajo mlada, srednja in tretja generacija, delovala kot celota, morajo vse generacije sodelovati in bivati v sožitju. Spence in Radunovich (2007) izpostavita potrebo po ohranjanju stikov, da bi se tako lažje izognili pojavu predsodkov in stereotipov. Bengston in Oyama (2007) opredelita medgeneracijsko solidarnost kot socialno povezanost med generacijami ter izpostavita, da se medgeneracijska povezanost in solidarnost lahko ustvarjata le skozi pogovor, katerega glavni cilj za mlado in srednjo generacijo je pridobitev novih izkušenj, za starejše pa občutek spoštovanja in cenjenosti. Vsi bi si morali prizadevati za doseganje boljšega sožitja med generacijami. Železnik (2014) izpostavlja še, da se ob skupnem življenju z otroki in starimi starši pojavi veliko boljše medgeneracijsko sožitje. Žal pa današnje stanje v družbi, kot navajata Spence in Radunovich (2007), ni naklonjeno spodbujanju medgeneracijskega sožitja, saj lahko neustrezne sistemske rešitve privedejo do medgeneracijskih konfliktov. Poleg tega se bolj poudarja pomen mladosti kot starosti.
Dandanes poznamo številne stereotipe o staranju in starejših, ki jih Ory in sodelavci (2003) opredelijo kot predpostavke in posplošitve o tem, kako naj bi se ljudje v določeni starosti vedli in kaj bodo verjetno doživeli, ne glede na posamezne razlike in edinstvene okoliščine. Nekateri avtorji (Levy, 2003; Packer & Chasteen, 2006) ugotavljajo, da je starostne predsodke mogoče zaznati že pri otrocih. V nekaterih skrajnih primerih govorimo celo o starizmu (staromrzništvu) ali ageizmu, ki pomeni sistematično stereotipizacijo in diskriminacijo ljudi zaradi njihove starosti (Morgan & Kunkel, 2016). Ramovš (2010) staromrzništvo definira kot odpor do starih ljudi in njihovo osebno ali družbeno podcenjevanje. Nanaša pa se tudi na oseben odpor do staranja in starosti. Kotter-Gruhn in Hess (2012) ugotavljata, da se takrat, ko so ljudje soočeni z negativnimi informacijami o starosti, poveča njihova želja po mladosti. Ta želja je prisotna že pri odraslih mladih in tistih v srednjih letih. Eržen (2008) izpostavi, da se politiki in mediji pogosto ozirajo na stroške, ki so povezani s staranjem prebivalstva. Tak pogled veliko prispeva k negativni podobi staranja in starajočih v družbi ter vpliva na odnos ljudi do starosti in staranja. Rozanova (2010) ob tem ugotavlja, da starejši ljudje še vedno niso dovolj zastopani v
medijih; že Vickers (2007) je izpostavil, da je večina ljudi v medijih mladih in živahnih. Zavedati se je treba, da negativen odnos do lastnega staranja in starosti ter prisotnost starostnih stereotipov pri starejših predstavlja problem, saj lahko aktivacija negativnih stereotipov o staranju vpliva na njihovo življenje (Kotter-Grühn & Hess, 2012). Raziskave kažejo, da je pozitiven odnos do staranja povezan z večjo blaginjo in dolgoživostjo (Levy, et al., 2002; Uotinen, et al., 2005), višjo stopnjo zadovoljstva z življenjem (Brothers, et al., 2015), boljšim zdravstvenim stanjem (Beyer, et al., 2015), boljšim počutjem (Levy, 2003) in boljšo socialno mrežo (Menkin, et al., 2017). Vsekakor lahko govorimo o revoluciji dolgoživosti (Applewhite, 2017), ki je pravzaprav najpomembnejši pojav našega časa, izjemna priložnost za rešitev skoraj vseh naših težav ter morda najvišji dosežek v zgodovini človeštva, ki pa ne bo prepoznan kot tak, če ne bomo videli smisla starosti. Ta je namreč še vedno razvrednotena in tabuizirana kot nekaj manjvrednega, nezaželenega in obrobnega (Milavec Kapun, 2011).
Zaključimo lahko, da starost doleti vsakogar izmed nas, zato je pomembno zavedanje, da staranje predstavlja del življenja, povezanega s spremembami in izzivi, s katerimi se moramo soočiti vsi: posameznik, družba, država, vladne ustanove, stroka in znanost. Sprejemanje starosti in staranja v največji meri vpliva tudi na odnos posameznika in s tem celotne družbe do starejših ljudi. Da bi lažje razumeli starost in staranje in s tem izboljšali odnos do starejših ljudi, so potrebne spremembe predvsem v razumevanju, sprejemanju in odnosu do njiju; izvajati je treba aktivnosti za odpravo predsodkov in stereotipov, ki se nanašajo na starost in starejše ljudi. Te spremembe lahko dosežemo le z ustreznim informiranjem in raziskovanjem ter skupnim delovanjem vseh deležnikov: tistih, ki odločajo na zasebni ali javni ravni, šol, univerz, sindikatov, poklicnih združenj, še posebej pa javnih občil. To je namreč edini način, da bodo starost in staranje razumele vse generacije, predvsem pa spoznale vse pozitivne vidike, ki jih prinašata.
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Cite as / Citirajte kot:
Lorber, M., 2019. Acceptance and perceptions of old age and aging. Obzornik zdravstvene nege, 53(3), pp. 188-193. https://doi.Org/10.14528/snr.2019.53.3.2992