GERONTOLOGY

Reflection:

“Gerontology is studying and taking care of old people.” That was my perception of Gerontology before I found myself pursuing a post baccalaureate in it because I had electives to fill and I wanted another certificate to add to my resume. Little did I know, Gerontology is much more than I ever thought to imagine. It is a relatively new, yet extremely complex discipline and profession that some would argue isn’t even a discipline. I believe that Gerontology is its own discipline that encompasses many other disciplines to cover biological aging, psychological aging, and social aging.

I have been passionate about health and wellness throughout my entire college career and have dedicated most of my life to incorporating them into my life and the lives of others. I have mostly worked with college aged students and middle aged members of the community through teaching yoga. I never had thought to work with older adults until I got a job at a hospital teaching group fitness classes to members aged 50 years old and up. That was my first exposure to this population and it has helped me open my mind to all the possibilities that I have loved involving older adults,

While working through my Masters of Public health, we have electives we must take to graduate. At first I decided I wanted to do my electives in worksite wellness, something familiar to me. During my fall semester I received an email that mentioned an online course on dementia taught by a professor at Duke offered during the spring. Since it was only 7 weeks long and my grandmother has dementia, I wanted to try it out. I thought the class could at least give me some insight into how I could help my grandmother while also knocking out an elective. I instantly fell in love with everything I was learning in the class. The neuroscience, the aging aspects, the need for more research, all intrigued me and I wanted to find a way to incorporate nutrition and physical activity into preventative measures for dementia. I decided then that I would pursue the classes in the gerontology post baccalaureate so I could find out more about preventative measures in aging.

The classes I took fall semester were pools of knowledge. Theoretical foundations of aging and critical issues of aging complemented each other so much and helped me relate things back to public health. Gerontology is an incredible transdiscipline that I could see myself doing in a public health position. I am especially interested in studying pro-inflammatory cytokines that increase age related chronic diseases and how we can work on preventing them through physical activity and aging. This inquisition stemmed through the Inflammation and Aging Theory I learned about in GRO651. GRO602 made me very aware of retirement ages and social security and whether or not we as a society can afford to keep things going as they are. Should the age of retirement increase now that people are living longer? SHould we have a limited amount of years an individual can have social security? All of these are questions I never would have considered if I had not decided to pursue a Gerontology route.

Everyone is aging. Not everyone will get old. Being “old” is a state of mind, it is not determined by a physical age. You are only as old as you believe you are and I would like to help reduce the ageism happening in society. I realized I have lived in a very ageist state of thinking for most of my life but now I feel differently about aging. It should not be ridiculed and seen as a negative. Older adults are here with a purpose and I would like to help in their purpose and to use preventative healthcare to reduce chronic diseases in aging populations.

Aging is a new concept. 2500 years ago, the average life expectancy was around 25 years old. During the beginning of the 20th century it was around 47 years old. Aging wasn’t a concept people thought about because, quite frankly, people died before they could get old. Retirement was never an idea or dream. Now, the life expectancy is almost 78 years old in the US. Chronic diseases that come with aging like Alzhemier’s, Hypercholesterolemia, and Osteoarthritis were not a problem because people did not live long enough to experience them. According to Dr. Ken Dychtwald, our world is catered to the young population (American Society of Aging). From the furniture in buildings, targets of receiving education, fashion, food palates, technology, even our medical system, all are geared to younger people. Despite a world catered to the youth, two-thirds of the entire population of people in history who have lived past 65 years old are alive at this moment. In fact, by 2050, the median age will be 46 years old. This fits the first interrelated factor of “need”.
As birth rates keep dropping and life expectancy increases, Gerontology is becoming a much more needed interdiscipline. This longevity revolution is showing that we do not really understand older populations. What is their purpose and how can they achieve a sense of purpose? To say that Gerontology is not a discipline is to sweep the growing older population under the rug. It basically leaves them as an “other”, set to figure out things for themselves or not at all. Research in Gerontology relies on theoretical input from a range of academic disciplines like biology, sociology, and psychology. Figuring out what advances we must make with the aging population fits the “recognition of need”.

Evidence:
While taking one of my electives, GRO,651 Theoretical Issues of Aging. I was teamed with four other members to create Graphic Organizers on different theories including biology, psychology, sociology, and transdisciplinary. The transdisciplinary theory is important to highlight how different professions must work together in gerontology, including public health officials. Transdisciplinarity involves individuals from different disciplines constructing an overarching model that includes but transcends their individual disciplines. Transdisciplinarity supersedes multidisciplinarity, in which researchers from separate disciplines work on the same problem independently with the intention of later combining their findings. Transdiciplinarity is also a step further than interdisciplinarity, in which scholars from different disciplines contribute their distinct perspectives to shared work on a common problem. Transdisciplinary efforts thus require a “true integration of disciplines at the level of concepts, assumptions, theories, methods, and interpretation” (Duncan, 2012, p. 7) and is necessary in order to find adequate solutions for pressing gerontology issues.

Gerontology does not have many purely Gerontologic theories of their own and some argue “that gerontologists must identify their own intellectual purpose beyond the work of the disciplines in which the majority of scholars were trained, and that gerontological theories and research must make a unique contribution beyond those from the source disciplines.” (Alkema, MSW, LCSW, Alley 2006) I believe that using other disciplines and interdisciplinary approaches as well as transdisciplinary approaches is the best way to go about research and theories because it allows for more perspective on matters. You are able to see things from a psychological perspective and then the same idea from a biological perspective and that allows more ideas to flow.

As a student of Public health, I can relate to the discrediting that Gerontology has received. Many people do not know what public health is or think that I’m just an advocate for being healthy and that’s it. Public health is not as new as Gerontology, but it has had some of the hardships that Gerontology faces as well. Public health relies heavily on interdisciplinary work and then has established its own work as well, but the interdiscipline has helped officials find spaces in many types of workplaces. Public health and Gerontology can be interwoven together in many aspects. For example, In Gerontology there is the ecological theories in aging (Lawton &Nahemow, 1973) which offer an interdisciplinary perspective incorporating social and environmental characteristics with individual age-associated change. This can be related back to the social determinants of health for Public health which are the conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. To discredit Gerontology would be to discredit Public health as well, since both rely on other disciplines to enhance their own. I say enhance because the other disciplines do not create them, they simply help to make them better.

Methods:

I have also been able to use Gerontology to incorporate the dimensions of health and wellness into my assessment of people and communities. In GRO-621: Health and Aging, we spend each unit discussing a specific dimension of aging and write a 3-4 page assessment of Carl Frederickson’s wellness from the movie UP. We then compare his wellness to other characters in UP using terms and concepts presented in the unit’s lectures, videos, and readings. This has been incredibly helpful in recognizing how wellness impacts health.

For decades, the perfect definition for health has been elusive. Over the years, many definitions have been suggested and then picked apart. The two most commonly used definitions include “the absence of disease” or the World Health Organization’s (WHO) definition, “Complete physical, psychological, and social wellbeing.” However, it has been argued that health is not a “state of complete physical, mental, and social well-being.” Nor is it “merely the absence of disease or infirmity.” A search of Medline—with the terms “World Health Organization,” “health,” and “definition” (or “defined”)—yields 2,081 results. Of these, only a handful focused specifically on the definition of health. There is a lack of operational value and the problem created by use of the word “complete", as we learned in HEA609, Principles of Community Health education. The WHO’s definition was supposed to provide a transformative vision of “health for all,” one that went beyond the prevailing negative conception of health based on an “absence” of pathology. Others declare the definition, which has not been modified since 1948, “simply a bad one.” More recently, Richard Smith suggested that it is “a ludicrous definition that would leave most of us unhealthy most of the time.”

None of the historic definitions will do in an era marked by new understandings of disease at molecular, individual, and societal levels. Moreover, when we think of health, we often think of doctors and the medical field. However, doctors are interested in disease, not health. Mary Tinetti and Terri Fried have argued in the American Journal of Medicine that thinking in terms of disease has become counterproductive. “The time has come,” they write, “to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and non-biological factors, the aging population, and the inter-individual variability in health priorities render medical care that is centered on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to undertreatment, overtreatment, or mistreatment.”

In the end, we might conclude that any attempt to define health is futile; that health, like beauty, is in the eye of the beholder; and that a definition cannot capture its complexity. French physician, Georges Canguilhem, rejected the idea that there were normal or abnormal states of health. He saw health not as something defined statistically. Rather, he saw health as the ability to adapt to one’s environment. Health is not a fixed entity. It varies for every individual, depending on their circumstances. Health is defined not by the doctor, but by the person, according to his or her functional needs. The role of the doctor (and other health professionals) is to help the individual adapt to their unique prevailing conditions. We might need to accept that all we can do is to frame the concept of health through the services that society can offer, and modulate our hopes and expectations with the limited resources available on a case-by-case basis.

Wellness is multidimensional. The dimensions overlap and coordinate to provide rich environments for living. Several frameworks for wellness have been suggested that include anywhere from 5 to 12 different dimensions, but 7 dimensions is the most commonly used framework. The dimensions are:

Emotional/Mental. Feelings are the lens through which people view the world, and the ability to be aware of and direct one’s feelings helps to create balance in life. Coping with challenges and behaving in trustworthy and respectful ways signal emotional wellness, attributes that can be encouraged through peer counseling, stress management, humor/laughter, and personal histories.
Intellectual/Cognitive. Engaging in creative pursuits and intellectually stimulating activities throughout life is a proven approach to keeping minds alert and interested. There are many ways to stay intellectually active, including taking college courses, journaling, painting, or joining a theater company, and challenging oneself with games and puzzles.
Physical. The goal of living independently is one shared by many people, and physical wellness is necessary to achieve this. Lifestyle choices that can maintain or improve health and functional ability include engaging in physical activity, choosing healthy foods with adequate nutrition, getting adequate sleep, limiting alcohol intake, not smoking, making appointments for check-ups, and following medical recommendations.
Occupational/Vocational. Work that utilizes a person’s skills while providing personal satisfaction is valuable for society as well as the individual. Participating in the paid and unpaid workforce means maintaining or improving skills and helping others. Older adults contribute to society as experienced professionals, caregiver, mentors, teachers, and volunteers. Leisure-time vocations in the arts and through hobbies maintain vocational skills.
Social. Social interactions with family, friends, neighbors, and chosen peer groups can be valuable for maintaining health. Personal contact by joining clubs, traveling, visiting friends and family, and engaging in intergenerational experiences like making quilts with elementary school children is beneficial for everyone who participates.
Spiritual. Living with a meaning and purpose in life, guided by personal values, is key to feelings of well-being and connection to the larger world. Group and individual faith-based activities, personal meditation, mindful exercise (yoga, tai chi), and experiencing nature can open up and create the opportunity for spiritual growth.
Environmental. Surrounded by natural and man-made environments, good stewardship means respecting resources by choosing “green” processes that re-use and recycle goods. It also means looking at ways to bring people into the natural environment and encourage active living through urban and property designs emphasizing walking paths, meditation, and vegetable gardens and similar options.
In understanding the difference between health and wellness, in short, health is a state of being whereas wellness is the state of living a healthy lifestyle. Health refers to physical, mental, and social well-being; wellness aims to enhance well-being.

In gerontology, the debate to focus on wellness rather than health is ongoing. Considering the definition of wellness includes the idea of helping people towards a “more successful existence,” wellness may be a more appropriate goal. The seven dimensions of wellness can be integrated with Rowe and Kahn’s model of successful aging. Each of the seven dimensions acts and interacts in a way that contributes to a person’s overall ability to age and age well. They also each play a role in the three dimensions of Rowe and Kahn’s model—avoiding disease and disability, engagement with life, and high cognitive and physical function.

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