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CHAPTER – I
INTRODUCTION
“Old age” or the “elderly” are the terms, which are frequently used, both in
popular usage and in academic environment to refer to those who are above 60 years.
Despite the frequency with which the terms are used, the definitions vary depending
upon the background of the user. While everyone agrees that ageing is a normal,
inevitable and universal phenomenon for biologists and medical scientists, ageing
refers to and is measured as deterioration in physical capabilities; psychologists
measure it as a decline in various adaptive capabilities.
DEFINITION OF OLD AGE
Later adulthood is the last major segment of the life span. Sixty-five has usually
been cited as the dividing line between middle age and old age (Hareven, 1976). There
is nothing magical or particularly scientific about age 65. Wrinkles do not suddenly
appear on the 65th birthday, nor does the hair suddenly turn gray or fall out.
Gerontologists have attempted to deal with these age-related differences among
the elderly by dividing later adulthood into two groups: the young-old, from age 65 to
74 years, and the old-old, from 75 years and above (Hall, 1980).
Our society tends to define old age mainly in terms of chronological age. In
primitive societies, old age is generally determined by physical and mental conditions
rather than by chronological age. Such a definition is more accurate than ours.
Everyone is not in the same mental and physical condition at age 65. Ageing is an
individual process that occurs at different rates in different people, and psychosocial
factors may retard or accelerate the physiological changes. It is said that the statuses
and roles of older persons, their culture patterns, social organization and collective
behaviour are affected by social change.
DEFINING AGEING
Ageing is, no doubt, a physiological phenomenon, which is accompanied by
some complex progressive changes in an organism. According to Phelps and
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Henderson (1952), “Old age is a natural and normal condition. Its pathologies are the
same as those that occur at any other age period, but they are intensified by illness,
family disorganization, unemployability, reduced income and dependency.”
Various scientists have attempted defining ageing from time to time. Few are
given below:
Handler (1960) defined as “the deterioration of a mature organism resulting
from the dependent essential irreversible changes, intrinsic to all members of a species,
such that with the passage of time they become increasing the probability of death.”
Birrren and Renner (1977), well known psychologists refer to ageing as “the
sum of regular changes that occur in mature genetically representative organisms living
under representative environmental conditions as they advance in chronological age.”
Davidson (1984) opines that ageing comprises of those fundamental changes
not due to disease occurring in individuals after maturity which are more or less
common to all members of the species and which increase the probability of death.
Ageing is thus the increasing inability to resist death.
Gorman (2000) says, the ageing process is, of course, a biological reality which
has its own dynamics, largely beyond human control. However, it is also subject to the
constructions by which each society makes sense of old age. In the developed world,
chronological time plays a paramount role. The age of 60 or 65, roughly equivalent to
retirement ages in most developed countries is said to be the beginning of old age. In
many parts of the developing world, chronological time has little or no importance in
the meaning of old age.
Other socially constructed meanings of age are more significant such as the
roles assigned to older people; in some cases it is the loss of roles accompanying
physical decline, which is significant in defining old age. Thus, in contrast to the
chronological milestones, which mark life stages in the developed world, old age in
many developing countries is seen to begin at the point when active contribution is no
longer possible.
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GERIATRICS
“Geriatrics” is a combination of two Greek words namely “Geron” meaning old
man and “iatrikos” meaning medical treatment. The term “Geriatrics” was coined by
American Physician, Ignatz Nascher in the year 1909. It deals with that area of medical
practice, which is concerned with the physiological and disease problems of the aged.
THE
PROCESS
OF
AGEING:
BIOLOGICAL,
SOCIAL
AND
PSYCHOLOGICAL
The term “ageing” is a broad one and can be studied under three broad
categories: biological, psychological and socio-cultural.
Biological ageing refers to the bodily changes that occur in the later part of the
life of an individual. Biological ageing starts quite early in the life period, the body
loses the functional capacity at the rate of 0.8% per year after age of 30. The
cumulative impact at later stages is considerable. These are internal and external visible
changes. Slowly the body clock winds down and ultimately stops. The mid-phase of
body growth is a period when there is an essential balance between the phases of
growth and decay.
So ageing involves two continuous processes that proceed simultaneously in
the life-time of an individual and those processes are contradictory to each other. On
one hand, there is the process of breaking down or shrinkage that includes graying of
hair, loss of teeth and the diminishing of sight and audibility and general slowing down
of all systems of the body. Biologically, the aged is an estimate of the individual’s
present position with respect to his potential life span. With this one can predict,
accordingly, whether the person is older or younger than other persons of same
chronological age.
Psychological ageing is studied in terms of changes in the nervous system and it
consists of general decline in the mental abilities that accompany old age. It also
includes the attitude and behavior of others towards the old. Cultural ageing also
defines what behavioral changes mean to the individual and the way she or he makes
internal and external adjustment to them. Psychologically, ageing refers to person’s
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adaptive capacities, i.e., how well he/she adapts to changing environmental conditions
with the average of his group; how well she or he can cope up with the society and how
best the person can lead herself or himself to higher thinking and behavioral patterns.
Psychologically speaking, ageing is associated with progressive declines in aerobic
power, muscle strength, thermoregulation, reaction speed and acuity of special senses,
in most environments.
Socio-cultural ageing refers to the changes in an individual’s changing
circumstances as a member of family, community and society. The changes include
completion of parental roles, retirement from work, reduced income, onset of diseases
and disability, and need for support. Socially, ageing also refers to the roles or
obligation and social habits of an individual with respect to other members of society,
whether he behaves younger or older than what is expected of him by society, or
whether he behaves in a manner suitable (in the eyes of society) to his age (Birren and
Renner, 1971).
In late adulthood, persons come to the realization that they can no longer
occupy the center stage of their world. They are called upon, and increasingly call upon
themselves, to reduce middle adulthood’s heavy responsibilities and to live in a change
relationship with society and themselves. Moving out of centre stage can be a traumatic
affair since people receive less recognition and have less power and authority. Their
generation is no longer the dominant one. As part of the “grandparent” generation
within the family, individuals still can be helpful to their grown offspring and serve as a
source of wisdom, guidance, and support. However, a major shift has taken place. As
Levinson points out, it is time for a person’s offspring, as they approach and enter
middle adulthood, to assimilate the major responsibility and authority in the family. If
authority is not relinquished, again the offspring may become tyrannical rulersdespotic, unwise, unloved, and unloving-and their adult offspring may become puerile
adults unable to love their parents or themselves.
DEMOGRAPHIC TRENDS IN INDIA
In India the reduction in fertility level, reinforced by steady increase in the life
expectancy has produced fundamental changes in the age structure of the population,
which in turn leads to the ageing population. The analysis of historical patterns of
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mortality and fertility decline in India indicates that the process of population ageing
intensified only in the 1990's. The older population of India, which was 56.7 million in
1991, is 72 million in 2001 and is expected to grow to 137 million by 2021. Today
India is home to one out of every ten senior citizens of the world. Both the absolute and
relative size of the population of the elderly in India will gain in strength in future.
Among the total elderly population, those who live in rural areas constitute 78 percent.
Sex ratio in elderly population, which was 928 as compared to 927 in total population
in the year 1996, is projected to become 1031 by the year 2016 as compared to 935 in
the total population. The data on old age dependency ratio is slowly increasing in both
rural and urban areas. Both for men and women, this figure is quite higher in rural areas
when compared with that of urban areas. More than half of the elderly populations were
married and among those who were widowed, 64 percent were women as compared to
19 percent of men. Among the old-old (70 years and above), 80 percent were widows
compared to 27 percent widowers. Men compared to women are found to be
economically more active. In 1991, 60 percent of the males were main workers whereas
only 11 percent of the females were main workers. Out of the main workers in the 60
plus age group, 78 percent of the males and 84 percent of the females were in the
agricultural sector. Since women's economic position depends largely on marital status,
women who are widowed and living alone are found to be the worst among the poor
and vulnerable.
PROBLEMS OF OLDER PERSONS IN INDIA
Given the trend of population ageing in the country, the older population faces a
number of problems and adjusts to them in varying degrees. These problems range
from absence of ensured and sufficient income to support themselves and their
dependents during ill health, absence of social security, loss of social role and
recognition, to the non-availability of opportunities for creative use of free time. The
needs and problems of the elderly vary significantly according to their age, socioeconomic status, health, living status and other such background characteristics. As
people live longer and into much advanced age (say 75 years and over), they need more
intensive and long term care, which in turn may increase financial stress in the family.
Among the several problems of the elderly in our society, economic problems occupy
an important position.
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Mass poverty is the Indian reality and the vast majority of the families have
income far below the level, which would ensure a reasonable standard of living. The
Ministry of Social Justice and Empowerment, Government of India (1999) in its
document on the National Policy for Older Persons, has relied on the figure of 33
percent of the general population below poverty line and has concluded that one-third
of the population in 60 plus age group is also below that level. Though this figure may
be understated from the older person’s point of view, still accepting this figure, the
number of poor older persons comes to about 23 millions. As people live longer and
into much advanced age (say 75 years and over), they need more intensive and long
term care, which in turn may increase financial stress in the family. Inadequate income
is a major problem of elderly in India (Raju, 2002). The most vulnerable are those who
do not own productive assets, have little or no savings or income from investments
made earlier, have no pension or retirement benefits, and are not taken care of by their
children; or they live in families that have low and uncertain incomes and a large
number of dependents.
Nearly half of the elderly are fully dependent on others, while another 20
percent are partially so (NSSO, 1998). For elders living with their families - still the
dominant living arrangement - their economic security and well being are largely
contingent on the economic capacity of the family unit. Particularly in rural areas,
families suffer from economic crisis, as their occupations do not produce income
throughout the year.
The unorganized sectors employ nearly 90 percent of the total workforce and
people retire from their gainful employment without any financial security like pension
and other post retirement benefits. The organized sector workforce which includes the
employees of the Central and State governments, of local government bodies, and of
major enterprises in basic industries (e.g. manufacturing, mining etc.) constitute
approximately 30 million workers and nearly one in every 10 members of the total
Indian workforce of 314 million (Vijay Kumar, 2003). The work participation rate
among the elderly in unorganized sector was around 40 percent. More elderly men
participate in the economic activities compared to women. The participation is high in
rural areas compared to urban areas. Majority of workers in 60 plus age were engaged
in agriculture. Nearly half of the elderly are fully dependent on others, while another
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20% are partially so (NSSO, 1998). Women are more likely to be dependent on others,
given lower literacy and higher incidence of widowhood among them. The most
vulnerable are those who do not own productive assets, have little or no savings or
income from investments made earlier, have no pension or retirement benefits, and are
not taken care of by their children; or they live in families that have low and uncertain
incomes and a large number of dependents (Bose, 1996). Vulnerable groups like the
disabled, fragile older persons, and those who work outside the organized sector of
employment like landless agricultural workers, small and marginal farmers, artisans in
the informal sector, unskilled labourers on daily, casual or contract basis, migrant
labourers, informal self-employed or wage workers in the urban sector, and domestic
workers deserve mention here.
THEORIES OF SOCIALIZATION IN OLD AGE
DISENGAGEMENT THEORY
Cumming and Henry (1961) coined the term disengagement to refer to a process
whereby people respond to ageing by gradually withdrawing from the various roles and
social relationships they occupied in middle age. Such disengagement is claimed to be
functional for the elderly as they are thought to be gradually losing the energy and
vitality to sustain all the roles and social relationships held in younger years.
Disengagement theory refers not only to the elderly withdrawing from society
but also to society withdrawing from the elderly or societal disengagement (Atchley,
1983). It is claimed it is functional for our society (which values competition,
efficiency, and individual achievement) to disengage from the elderly, who have the
least physical stamina and the highest death rate. Societal disengagement occurs in a
variety of ways: employers may seek to force the elderly to retire, the elderly may not
be sought out for leadership positions in organizations, their children may involve them
less in making family decisions, and the government may be less responsive in meeting
their needs as compared to people who are younger. Societal disengagement is often
unintended and unrecognized by employers, younger relatives, and other younger
members of society. Disengagement theory also asserts that the elderly welcome this
withdrawal and contribute to it.
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Disengagement theory has generated much research over the years. There is
controversy regarding whether disengagement is functional for the elderly and for our
society. Research has found that some people undeniably do voluntarily disengage as
they grow older. However, critics assert that disengagement is related less to old age
itself than to the factors associated with ageing, such as retirement, poor health, death
of spouse and of close friends, and impoverishment. For example, when people are
forced to retire they tend to disengage from co-worker friendships, union activities,
professional friendships, and reading in their field. Once retired, they also have less
money to spend on entertainment, so disengagement from some activities is forced.
Disengagement is neither universal nor inevitable. Contrary to the Ory’s
predictions, older persons maintain extensive associations with friends, and active
involvement in voluntary organizations (such as church groups and fraternal
organizations). Also, some of the elderly, after retiring, develop new interests, expand
their circle of friends, join clubs, and do volunteer work. Others rebel against society’s
stereotypes and refuse to be treated as if they had little to offer to society.
Disengagement theory at times advocates the exact opposite of activity theory.
Activity theory asserts it is beneficial for the elderly to be physically and mentally
active, while disengagement theory asserts it is beneficial to withdraw from a variety of
activities (many of which provide physical and mental stimulation). A severe criticism
of disengagement theory is that the theory may be used to justify society’s failure to
help the elderly maintain meaningful roles. It may also be used to justify ageism.
Disengagement theory, may, at best, be merely a description of the age/youth
relationships (and reactions to them) which we should combat as we try to combat
ageism.
The disengagement theory was the result of a five-year investigation of a
sample of 275 elderly persons aged between 50 and 90 years. The researchers noted
that disengagement was generally initiated by the individuals themselves or by the
social system. Retirement, for example, is an event that release older people from
specific social roles and enables them to become disengaged to some extent. Loss of a
spouse serves as another example. In time, when disengagement is complete, the
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balance that existed between the person and society in the middle years has shifted to
an equilibrium characterized by greater psychological distance, altered types of
relationships, and decreased social interaction (Cumming, 1963; Cumming and Henry,
1961)
Finally, it is argued that many of the societal conditions that have forced the
elderly into restricted environments are likely to change in the future (e.g., people are
retiring earlier; improved health care will enable more older people to remain more
physically active; higher social security benefits may increase the economic security of
the retired and enable them to engage in more active lifestyles).
ACTIVITY THEORY
The activity theory of successful ageing suggests that retired individuals prefer
to remain productive and active. In contrast to the theory of disengagement, this view
point suggests that the aged prefer to resist preoccupation with the self and
psychological distance from society.
The activity theory of ageing sees ageing in many ways of middle age
(Havighurst et al., 1968).This theory maintains that the best way to approach ageing is
the way one approached the rest of adult life: a full life will find the individual engaged
in many different statuses, roles, and activities. A status that is lost through retirement,
such as being a worker, will be replaced by things such as being a volunteer. The best
way to be happy in later life, in other words, is to be active and attempt to retain desired
roles and statuses from earlier parts of life. Allowing that physical limitations and
circumstances make giving up some things a necessity, the activity theory expresses the
concept that age-appropriate replacements should be found and that the happy older
person is an active older person.
This makes a certain amount of sense, of course; it is the opposite of a “rocking
chair” approach to retirement. People who give up trying or who become hermits tend
to be unhappy in later life. Older people thus have essentially the same needs as
middle-aged people; both resist the shrinkage of their social world. Neither wishes to
rust out; most would prefer to wear out. Any decline in social interaction results from a
withdrawal by society from the ageing person rather than voluntary withdrawal from
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society. The activity theory stresses that older people seek to maintain their status in
later life. This view reflects the worth-through-work norm of the society into which the
theorists have been socialized; people should be busy accumulating things such as
wealth and property and using their time productively. Losing any of these is evidence
of decline. Voluntarily giving those up would be seen as a contradiction of activity
theory.
Happiness and satisfaction originate from involvement and the older person’s
ability to adjust to changing life events (Maddox, 1968). The fact that not all activities
provide sustenance for one’s self-concept has long been recognized, but little attention
has yet been given to the differences among kinds of activities or the person’s ability to
exert any significant control over either the roles themselves or the performance of
those roles. Consequently, the activity theory has received limited empirical support
and has been criticized as an over simplification of the questions involved. It may
hardly be appropriate to substitute pastimes, geared to what is believed to be older
persons’ interests and abilities, for those roles they had relinquished as they moved
beyond middle age. Occupying one self with enterprises that are meaningless in terms
of dominant cultural values, presumably still subscribed to the older people may not in
itself contribute to adjustment.
The first real test of the activity and disengagement theories came with the
Kansas City Studies of Adult Life, involving repeated interview with 159 women and
men aged 50-90 during the years 1956-1962. Because of attrition (people dying,
moving, or preferring to leave the study for other reasons), just 88 subjects remained in
the group by the end of the study. The researchers concluded that neither the activity
theory nor the disengagement theory was adequate to explain the study’s findings. It
was apparent that high levels of life satisfaction were found among both the active and
the disengaged elders. It was suggested that dimensions of personality might better
explain satisfactory adjustment in later life (Neugarten et al. 1961).
The theories do not allow the heterogeneous nature of aged people: they become
less like one another as they age, rather than more alike. This has been a common
stumbling block with many studies of the aged; a tendency to lump all old people into
one group and not to allow for individual differences. Obviously, some people are
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happy with an active later life, and some are perfectly pleased with being disengaged.
Longitudinal research has suggested that these may be characteristics of younger adults
that persist into late life: people who were active when they were young continue to
strive to be active, and people who would have preferred to be less engaged in younger
adulthood now have the opportunity to be less active. Finding substitute activities for
those roles that have terminated is a key feature of this kind of adjustment. It is
believed that old age offers numerous “role exits”
ROLE THEORY
Role is mainly behavioural concept. Roles and statuses are interlinked as roles
are associated with given social positions. Social role refers to the behaviour of statusoccupants that is oriented toward the patterned expectations of others (who accord the
rights and obligation). Each person in society inevitably occupies multiple statuses and
that, for each of these statuses, there is an associated role. The system is changing, and
it is likely to change even further. Politicians are aware that the elderly are more likely
to register and vote than the young, are listening when senior citizens speak. So are
younger people. The new interest is encourageing. Americans have for too long turned
their backs on their old people. Now many are seeing them for the first time,
recognizing their plight and moving to help them. The interest and action are both
humane and pragmatic. Today, millions of Americans are wondering what to do about
them. That can prove to be psychologically devastating if no substitute activities are
found. Thus, the greater the number of role resources with which individuals enter old
age, the better off they will be adjusting to the demoralizing effects of role exits (Blau,
1973).
There are four main role changes that must be dealt with by the elderly. Each
requires realignment of some kind. First, the work role that may have been the major
object of activity and attention throughout the course of one’s life is lost. The loss of
gainful employment affects both marital partners, who usually must adapt to a changed
domestic situation (Streib, 1977).
The second related loss to the elderly is the loss of income. The elderly may not
be able to afford some kinds of activities. Thus, not having a sufficient income and
having to make sacrifices not previously made may affect overall life satisfaction.
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Third, retirement coincides with declining health for many people, although many are
automatically retired while they are still in good health. Either way, the elderly discover
that as they age, their physical condition deteriorates, and they may have to give up
some activities and moderate others. Finally, changes in the family often require role
realignment. As children leave the home, the role behavior and expectations of both
parents change. By the retirement years, help and assistance patterns have shifted,
sometimes with assistance flowing from child to parent instead of the reverse. Severe
illness or death of a spouse also calls for significant adjustment in the partner’s role.
The reduction in role activity as worker and as parent, combined with declining
health and usually reduced income, constitute the realistic framework within which
older persons enact their many roles in later life. Many persons-old, young, persons of
influence and the man in the street-must be aware of the role losses and the necessary
role realignments which are an integral part of later life. There must be a clear
recognition that old age can be a period of new role opportunities. Public and private
organizations can aid in reaching broad goals of spending the new leisure time of later
life constructively, and achieving positive and well-integrated roles within the family,
the community and in a broad spectrum of groups and organizations.
ROLE TRANSITIONS
Rosow (1974) writes that ageing, is characterized by a loss of social status,
roles, and norms. Lacking status and roles in later life, older people can thus be seen to
be in a “role less role.” By contrast, they then note that Hochschild (1973), in her
research among a group of elderly widows living in an apartment complex, found that
the women did not face this bleak picture of old age at all. Not only were they not
“roles,” they appeared to take on many new and satisfying roles as they formed a
community within their environment: “these women live busy, purposeful lives within
their group. That is, this group of people in a transitional context did not have to grope
for new statuses or roles- they developed them. Being without appropriate roles or
statuses was not a problem.
Findings of the author may force us to view ageing within a social context as
more complex than any one theory encompasses. We might look at ageing as a series of
transitions. Roles and statuses may be discarded as people leave one period of life and
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enter another. The giving up of a treasured status such as “worker” is often traumatic.
In the practical context of retirement, if people actually had problems when they faced
the role transition of retirement and it was found that retirement indeed was a period of
adjustment as well as some decline in income. But retirement could not be found to
explain any health differences, to have any major effects on social activity, or to have
much influence on life satisfaction of happiness.
To return to role theory, we might think of later life not so much as a period of
role loss but as a period of role transition. Particularly with an issue like ageing, we
have time to get ready to shed old roles and statuses or to assume new ones. Those who
are facing later life have simple opportunity to prepare psychologically. They have
received warning signs of physical deterioration throughout middle age. They have
seen examples of others older than themselves and how they have coped with the
transitions that come with the ageing process. Many ageing people are masters of
adaptation; they have seen many changes in their lives, and the gradual changes
associated with ageing are taken pretty much in stride.
CONTINUITY THEORY
The continuity theory of ageing holds that people’s personalities remain pretty
much the same throughout adult life (Neugarten, Havighurst and Tobin, 1968). Thus,
their likes and dislikes will also remain pretty much the same. Those who prefer to
remain active will do so, given certain physical limitations; those who desire a lower
level of interaction may finally achieve it in later life, just when society places fewer
demands upon them. This theory, of course, has some face validity; it seems to be
reasonable. Unfortunately, it is also very difficult to test. Most longitudinal studies of
ageing have focused upon measures of performance rather than personality or social
interaction. Few have set out directly to test the continuity theory itself.
Essentially, the ideal of research in the social sciences is deductive: the scientist
has a hunch and then does research that either proves or disproves the theory. Most
social science research, however, winds up being inductive: something is found in a
study or a series of studies, and then the researcher tries to come up with an explanation
of why, to form an explanatory hypothesis. As evidence accumulates, one feels more
comfortable supporting one theory or another.
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Critics might charge that gerontology has done little deductive research and has
been observational or descriptive; with hypotheses advanced later to help explain what
has been observed. The concept of continuity theory itself, of course, rests on the
notion that older people are too diverse to be explained by one theory or another; it
merely says that they remain pretty much like themselves as they age. Perhaps this
simple explanation is adequate, but it leaves those in search of practical implications
somewhat frustrated.
Blau (1981) argues that assigning older people the role of “senior citizen’ in
effect takes them out of the perceived useful population and puts them into a separate
category: people who no longer really matter. She notes that the persuasive body of
evidence actually is going the other way. People are living longer, are more involved in
their communities, are accomplishing useful roles, have functions beyond those that
were expected of the aged only a few years ago, and are leading increasingly complex
lives. No longer does one have a simple, assigned status such as “worker” or “mother.”
People have greater freedom to explore their own potentials, to grow, to return to
school, to being new careers, or to pursue other new directions. Simply setting old
people on the shelf as those who have lived their lives does them a great disservice.
Blau (1981) adds that the old are not a subculture (people who interact mainly
with one another) but have important relationships and roles to accomplish that are
intergenerational. The evidence of the past few decades is that people go in different
directions as they develop and that there is no reason to expect the aged to be any
different. Only when illness or frailty dictates should the lives of older adults be
expected to become somewhat constricted. Most of the people move into and out of a
succession of different statuses and roles as they age. This age stratification, however,
need not be a predictor of how people will approach old age so much as an explanation
of the diversity of roles in which people engages as they develop through life. Many
will continue to blossom until shortly before they wither.
EXCHANGE THEORY
The concept of quantifying the exchange of interpersonal relationships was
proposed by two psychologists, Thibaut and Kelley (1959). They saw that interaction
could be expressed as a system of investments in others relative to an expected payoff.
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A person’s investment in another would tend to continue if the “investor” got
something back. Ideally, the payoff would be at or higher than the level of investment.
So if a woman invests in a relationship with a man at the rate of 90 and she only gets
benefits at a level of 60, she will have a tendency not to make this a long-term
relationship. She will be putting too much in for what she is getting back. On the other
hand, if she puts in at a level of 80 and gets back at 95, she will seek to maintain the
relationship. In other words, we have a tendency to seek to maximize payoff (but not
necessarily a corresponding tendency to minimize investment).
This is an expression exchange theory, which works as a sort of mental
calculation of costs and benefits of social interaction (Blau, 1964). People engage in
relationships that they find to be rewarding, and they withdraw from those relationships
that they see as too costly. Exchange theory could be applied at any age. However,
Dowd (1975) thought to apply it to later life in an attempt to explain why old people
sometimes withdraw from social relationships, especially with younger people and he
writes that old people have few resources to bring to such relationships and, as a result,
decrease their participation in interactions with younger people
and this is not a true
expression of exchange theory, which would hold that young people might disassociate
themselves from older people who had less to give in a relationship.
It was reported that Dowd’s analysis overlooks an emotional component, love,
that makes analysis of relationships in strictly economic terms less apt. The relationship
of parents with their children, for example, is hardly ever on equal terms. Nor are the
changing relationships of older people with their adult children. Most adult children
acknowledge a sense of filial obligation, a feeling that they ought to care for their
parents out a sense of both duty and love. Thus, the strictly objective principles of
exchange theory are not always applicable. However, it has been observed that many
older people, in fact, pay a price for relationships with younger adults that might
otherwise seem to be unequal. Roberto and Scott (1986) have shown that the principle
of exchange theory is applicable only among older adults and their friends.
MODERNIZATION THEORY
Cowgill and Holmes (1972) postulate that as societies become more complex
and technically sophisticated, the status of the elderly declines. The modernization
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theory notes that, in traditional societies the aged tend to retain their status and serve in
important roles as elders of the tribe. As societies become more modern, elders’ roles
are less important. This view is modified with the realization that in historical terms
relatively few people actually lived into old age and that there are many more aged
people in contemporary society. High status tended to be, according to this theory,
associated with agricultural societies where older survivors not only knew the traditions
but also owned the land. Now, older people in urban societies tend to have
comparatively less status and fewer important roles.
Palmore and Manton (1974) reviewed data from thirty-one different countries
and found only slight evidence that supported modernization theory; moreover, in her
research in Samoa. It is also found that little support for the idea of elders losing status
in a modernizing society. Cultural values may have a greater influence on respect for
and status of the elderly than does social change. That is, a tradition of reverence for the
aged may be more important than modernization. Further, research by Abel (1992)
indicates that rural elders in the nineteenth-century United States did not necessarily
enjoy high status. This erodes part of the assumption upon which modernization theory
is based.
Respect for people in many societies, such as our own, might also be said to be
largely a function of economics: we gauge status for the most part by relative income.
Poor people get little respect; rich people get a lot of it, almost regardless of their
personal qualities. If this is so, we might see the relative status of the aged as having
improved in recent decades as their relative economic position has improved.
SOCIAL RECONSTRUCTION SYNDROME THEORY
This theory was developed from the social breakdown syndrome which was
conceptualized by Zusman (1966). He indicated that social breakdown occurs for the
elderly because of the effects of labeling. The process occurs as follows: society has
unrealistic standards or expectations that all adults should work and be productive;
other people label the elderly as being incompetent or lacking in some ways; the elderly
accept the label and view themselves in terms of the label; they then learn behavior
consistent with the label and downplay their previous skills. As a result, they become
more dependent, incompetent, and feel inadequate.
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Kuypers and Bengston (1973) assert that this negative interaction between the
older persons environment and self-concept explains many of the problems of ageing in
our society. To break the vicious cycle of this labeling process, they recommend the
social reconstruction syndrome, which has three major recommendations. First, our
society should liberate the elderly from unrealistic standards and expectations. The
belief that self-worth depends on a person’s productivity has adverse consequences for
the elderly who are retired. They recommend that society be reeducated to change
these unrealistic standards. Fischer (1977,) specifies the direction such reeducation
should take:
The values of our society rest upon a work ethic-an ethic of doing-that gives
highest value to people in the prime of their productive years. We should encourage
plurality of ethics in its place-not merely an ethic of doing, but also an ethic of feeling,
an ethic of sharing, an ethic of knowing, and an ethic of enduring and even an ethic of
surviving.
The second recommendation of Kuypers and Bengston (1973) is to provide the
elderly with the social services they need. Such services include transportation, medical
care, housing, help with housekeeping, and programs that provide physical and mental
activity.
The third recommendation is to find creative ways to give the elderly more
control over their lives. He recommends that at nursing homes the decision-making
bodies should be “exclusively comprised of the elderly themselves. While the nursing
and social service staff, for example might be younger people, they are servants of the
elderly board of directors, the elderly committee structure and the elderly
administrators.”
INDICATORS OF QUALITY OF LIFE
Overall quality of life is a composite assessment of the quality of the social,
economic and physical environments. Eleven domains(or aspects of life) have been
used to assess the external conditions of overall quality of life. The eleven domains
were categorized into the three environments of overall quality of life. The quality of
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each domain was assessed by several indicators, which were then combined to create a
quality of life index. Eleven domains and their respective indicators are used to assess
the important aspects of quality of life.
1.
Housing

Percentage of population living in housing requiring major repairs(inverse)

Average number of persons per room(inverse)

Percentage of household incomes with owners major payments(or gross rent)
for shelter being greater than or equal to 30 percent of household
income(inverse)
2.
Accessibility to Services

3.
4.
Distance from centre of census subdivision to nearest other services(inverse)
Environmental Quality

Density of dwelling requiring major repairs(inverse)

Air quality; measured as total population particulate emissions(inverse)
Household Finance

Average owner’s major payments(inverse)

Percentage of income from government transfer payments(inverse)

Ratio of percentage of households in lowest income category to that of
households in highest income category(inverse)

5.
Percentage incidence of low income families(inverse)
Employment/Paid Work

Unemployment rate(inverse)

Ratio of individuals working part time to individuals working full year, full
time(inverse)

6.
Average employment income(direct)
Social Opportunity and Mobility

Ratio of female median income to male median income (direct)
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7.

Male participation rate in workforce (direct)

Female participation rate in workforce(direct)
Participation in Democratic Processes

8.
Percentage of the population that participated in the 1997 elections(direct)
Social Stability

Ratio of percentage of population living in owned housing to percentage of
population living in rental housing(direct)

Percentage of population living at the same address they lived at five years
earlier(direct)

Percentage of population at a different address than the one they lived at
five years earlier(inverse)
9.
Education

Ratio of percentage pf population with trade/college or university education
to percentage of population with less than Grade 9 education(direct)
10.
11.
Access to Health Resources

Number of physician specialists per thousand people(direct)

Number of family physicians per thousand people(direct)
Leisure and Recreation

Number of leisure-related commercial activities per thousand people

Number of libraries per thousand people (ENVIS centre on human
settlement-Department of Environmental Planning, SPA, New Delhi, 2009).
ACTIVITY AND AGEING
It has been well-established that the ageing process can be associated with
increased susceptibility to chronic conditions, disability, and co morbidity, which often
results in reductions in Quality Of Life (QOL). Physical activity has been consistently
associated with enhanced QOL; however, few efforts have been made to determine
whether this relationship is direct or whether it potentially operates through other
psychosocial factors. The traditional approach in the activity literature has been to
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conceptualize QOL as representing physical, mental, and social indicators of health
status. Stewart and King has adopted this approach to explain the relationship between
physical activity and QOL in older adults by conceptualizing QOL as an overarching
term with other factors, such as function and well-being, influencing the effect of
activity on QOL.
McAuley and colleagues have tested several alternative models of the physical
activity and QOL relationship in a sample of older women. In these models, they
adopted Diener and colleagues' position that QOL is a global construct reflecting a
cognitive judgment of an individual's life. This contrasts with more traditional
approaches to QOL which view physical and mental health status as QOL outcomes. It
has been said that HRQL represents a more proximal QOL indicator than global QOL.
In the context of older adults, a number of physical and psychosocial factors might
represent mental and physical health status outcomes. From a physical health status
perspective, the likelihood of developing some type of disability increases
exponentially as we age, and there is evidence to suggest that disability is an important
outcome of physical inactivity. Additionally, physical activity has been suggested to
offer a protective effect against functional limitations, a precursor to disability.
Prohaska et al have made the important observation that many theoretical approaches to
understanding physical activity and its consequences in older adults rarely take into
consideration the role played by the demographic characteristics of participants.
This may be an important issue to consider given that the lowest levels of
physical activity participation are reported by adults of poorer socioeconomic status
(SES) and that fewer exercise facilities are found in low SES neighborhoods.
Moreover, age is inversely related to physical activity with only few per cent of
individuals aged 65–74 years, and very little percent of those aged 85 years and over,
meeting public health recommendations. It is therefore important to determine whether
the proposed relationships among activity, self-efficacy, and indicators of QOL hold
well when controlling the demographic influences. Research on life satisfaction also
suggest that levels of life satisfaction typically remain very stable, even in the face of
substantial change in its documented predictors, despite evidence that life satisfaction is
strongly related to objective life conditions. Significant social losses, especially
widowhood and the onset of disability are associated with decreases in life satisfaction.
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However, there is considerable evidence that older adults are satisfied with life
conditions that are objectively worse than those needed to produce perception of
equivalent life quality among middle aged and younger adults (Campbell, et al., 1976).
Older persons often express satisfaction with levels of income that are substantially
below those required for minimally adequate food, shelter, and medical care.
QUALITY OF LIFE AND AGEING
The concept of quality of life developed in the social sciences, was first applied
in medical practice to determine the quality of life of patients getting treatment for
cancer. This concept was later applied to compare several antihypertensive medications
in terms of functioning, well-being and life satisfaction.
Quality of life refers to complex aspects of life that cannot be expressed by
using only quantifiable indicators; it describes an ultimately subjective evaluation in
general. It comprises not only the subjective well-being but also other indicators such
as health status and external life situations. There are numerous definitions of the term
and an analysis of one or two definitions will help to conceptualize it better.
WHO QOL Group (1994) defined Quality of Life as “an individual’s perception
of his/her position in life in the context of the culture and value systems in which he/she
lives, and in relation to his/her goals, expectations, standards and concerns. It is a
broad-ranging concept, incorporating in a complex way the person’s physical health,
psychological state, level of independence, social relationships, and their relationship to
salient features of their environment”. This definition reflects the view that quality of
life refers to a subjective evaluation that is embedded in a cultural, social and
environmental context.
The definition and measurement of quality of life has been comprehensively
developed by Cummins (1961). According to him “Quality of life is both objective and
subjective, each axis being the aggregate of seven domains; material well-being, health,
productivity, intimacy, safety, community and emotional well-being. Subjective
domains comprise domain satisfaction weighed by their importance to the individual”.
This definition stands apart from other definitions in terms of the subjective-objective
experience and the influence of seven domains on each experience.
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Saxena et. al. (1998) defined Quality of life as a dynamic interaction between
the external conditions of an individual’s life and the internal perception and this is
becoming an important component of overall assessment in health care setting. It
provides a measurement of function and well-being, and hence is more comprehensive
and compatible with World Health Organization’s concept of health. This definition
also emphasizes the view that, Quality of life is a subjective experience and gives a
comprehensive measure of individual’s function and well-being.
When one investigates the quality of life of the elderly, it is always advisable to
have an understanding of the variables that influence the quality of life in the elderly
population, especially because of the complexities of the old age. Research on quality
of life has identified some major antecedents of life satisfaction. Regardless of age, for
all adults, the major determinants of quality of life are health status, attachment to
social structures such as education, occupation and marital status, personal resources
including health and income, involvement in and support from primary groups, family
and friends and participation in meaningful social and leisure activities.
The determinants of QOL in the elderly could be divided into physical,
psychological and social factors. Good physical health when compared with
psychological resources and adequate social support provides the basis for a continuing
life satisfaction and well- being among elderly and it was found that psychological
factors like, lack of confidence and self- esteem, deterioration in the cognitive functions
and a range of judgmental coping skills that develops over the life course influence the
quality of life of elderly. Many elderly persons continue to develop their social and
coping capacities and others suffer decrements due to negative social and community
attitudes.
SUBJECTIVE WELL-BEING AND AGEING
Subjective well-being is a ‘real’ and universal concept. A simple linguistic
review shows that an enquiry into subjective well-being is a part of a friendly greeting
in many languages.
Traditionally, quality of life measures tend to be ‘objective’
measures of income, education, availability of social and health services and the like.
People’s feelings were considered ‘subjective’ and therefore irrelevant or unreliable.
Certainly, there is now enough evidence of a growing incidence of low levels of wellbeing among the aged in Asia, particularly in India for which enough data is currently
available. People tend to develop most in areas where they reliably meet success. By
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middle age, most have identified preferences and competencies that predictably lead to
satisfying results and have incorporated them into their identities. It is not difficult to
maintain motivation toward inner continuity in the presence of proven patterns for
producing a sense of inner well-being. Participation in social, household and religious
activities is essential for the well-being of the aged connecting with family members,
friends, neighbours, work colleagues and community groups brings happiness to all
An individual's evaluation of his or her life is the definition have assigned to the
term SWB. Subjective well-being includes both affective and cognitive components.
The "affective" component of SWB center’s around the broad definition given above
for happiness; positive over negative affect, pleasant versus unpleasant affect. The
"cognitive" component is identified by an individual's overall life satisfaction and add
that happiness is “a global assessment of a person's quality of life according to his own
chosen criteria" and include a measure of personal control - that it is "a conscious
cognitive judgment of one's life in which the criteria for judgment are up to the person"
that shapes SWB. Specifically, because many individuals are living longer lives and are
becoming increasingly aware of their well-being, age has become a major contributor
to the level of SWB. In spite of increase in the likelihood of chronic illnesses, health
declines, loss of spouses and social supports, research suggests that older persons do
not report being unhappier than their younger peers.
LIFE SATISFACTION AND AGEING
The “relationship between ageing and successful adaptation (variously ‘morale’
or life satisfaction’ or ‘well-being’) is perhaps the oldest most persistently investigated
issue in the social scientific study of ageing” (Maddox and Wiley, 1976). According to
George (1986) life satisfaction is variously viewed as a prime indicator of overall life
quality, a testimony to the importance of social structures and location in personal wellbeing, and one component of positive mental health. It is most frequently defined as “a
global assessment of life quality, derived from comparison of one’s aspiration to the
actual conditions of life” (Campbell, Converse and Rodgers, 1976; George, 1981).
Neugarten, Havighurst and Tobin (1961) have operationally defined life satisfaction as
1) Zest vs. Apathy which relates enthusiasm of response and degree of involvement; 2)
Resolution and Fortitude which refers to the acceptance of responsibility for own life as
opposed to feeling of resignation and passively accepting things; 3) Congruence
between desired and achieved goals, 4) Positive self-concept and 5) Mood Tone (moodtone reflects spontaneous, happy, optimistic attitude of one who enjoys life). Social
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production function theory assumes that people produce their own well-being by trying
to optimize achievement of universal needs within constrains they are facing. In
accordance with economic and psychological theory, human beings are seen as active
agents who choose cost-effective ways to produce well-being.
Cost does refer to all sort of scarce resources that one can give up, such as
money, time, and one more aspect is life satisfaction and is becoming little clearer that
what is considered of high importance for one’s sense of subjective well-being at one
developmental stage may be less relevant at another stage. Elwell and Maltbie-Crannell
(1981) found income to be having a strong, direct effect on life satisfaction for older
men, but weaker and indirect effects for older women. Similarly, George, Okun and
Linderman (1985) found that “a) marital status is less important for a sense of wellbeing among young adults than among middle-aged and adults; b) income is most
important for middle-aged adults, least important for young adults, and intermediate for
older adults; c) health is much important for older adults than young and middle-aged
adults; and d) social relationship are more important for younger and older adults than
the middle aged” effort, including the time and effort, including the time and effort
required to develop new skills.
As people age they have to deal with biological, psychological and social
challenges. Further reaching old age successfully and unscathed will be influenced by
the various experiences, activity, environmental stresses, social contacts and social
support etc. In the last twenty years research on elderly has been given attention due to
the increase in the number of elderly worldwide and due to the socio-economic and
technological developments, the prevalence of well being among the older persons has
risen phenomenally, which has caused to dwell into this period for years together. In
the present circumstances, the study of older persons become essential to preserve, cure
and improve the quality of life of those older persons who are dwelling in community.
Thus the present study attempts at describing the extent of activity on quality of life,
life satisfaction and related variables on the older persons in Salem District, Tamil
Nadu.
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