MAR DEL PLATA, Argentina — In the "active aging" vision promoted by the World Health Organization (WHO), older adults stay physically active, independent, and involved. This concept, though well-intentioned, is not very realistic and could easily be discouraging to individuals suffering from the psychological or physical limitations of old age. It also does not account for diversity among individuals and across cultures. These conclusions were presented by the Geriatric Psychiatry Chapter of the Argentine Psychiatric Association at its XXXVI Argentine Congress of Psychiatry.
"The WHO's proposal of active aging is a prescriptive, standardized ideology that seems to suggest that being active is the only healthy way to age. However, that's only part of the picture, and a biased part at that. It doesn't account for the broad spectrum of aging processes that come in many shades," said Mariana Pedace, psychologist with the Adult Intensive Care department at the Italian Hospital in Buenos Aires and head of the Older Adults section of the civic association Project: Unite.
"The question is whether the idea of active aging is just one more way to create mandates or rules for older adults, which make up such a heterogenous and diverse generation," said Ana Laura Vega, MD, psychiatrist with the Mental Health Department at the Italian Hospital of Buenos Aires.
Might it be better to speak of aging "as expected" or "aging well"? Speakers at the conference did not reach a consensus on which word would be the best to replace the adjective "active."
"I don't really see why there has to be an additional term when, at other stages of life, we only talk about 'infancy,' 'adolescence,' or 'middle age,'" said Vega.
A Thorny Issue
Since the late 1990s, the WHO has defined active aging as "the process of optimizing opportunities for health, participation, and security to enhance quality of life as people age." This concept allows older adults to "realize their potential for physical, social, and mental well-being throughout the life course and to participate in society according to their needs, desires, and capacities, while providing them with adequate protection, security, and care when they require assistance."
The organization clarifies that the word "active" refers to continuing participation in social, economic, cultural, spiritual, and civic affairs, not just the ability to be physically active or to participate in the labor force. "However, in practice, active aging programs invariably promote physical activity and exercise as having health and social benefits," says sociologist Elizabeth Pike, PhD, head of the Research Unit in Sport, Physical Activity, and Aging at the University of Hertfordshire in the United Kingdom.
"The concept of active aging, as presented, is a thorny issue and can potentially be problematic," said Pedace. Along with laying out a single prescriptive way to age healthily, which by default makes passive aging "abnormal," it also ignores demographic, ethnographic, and cultural differences.
"Each culture has different values. The suggestion of aging well in terms of activity, autonomy, and a happy-go-lucky mindset clearly reflects Western capitalistic values. In Eastern cultures, elderly people occupy a position reflecting their experience and wisdom, while also maintaining a contemplative mindset, which is something that is held in high regard. They are at the heart of the family, and their role is to guide and counsel the younger generations," said Pedace.
The specialist added that there are programs inspired by active aging that prioritize outward, dynamic, and observable activities to the detriment of activities that take place behind the scenes such as reflection, analysis, and contemplation. "Following this mindset, an older individual who spends their time in contemplation would be somewhat wasting their sunset years. This raises a problem, because as the years go by and death approaches, spiritual life begins to gain far more significance. And that's not an activity that is valued or recommended in the terms of this program," she said.
Pedace went on to say that another concern with the active-aging program is that it seems to minimize certain characteristics that are unique to old age. Resulting physical, cognitive, and emotional changes can lead to reduced activity but are merely idiosyncrasies of this stage in life and are not pathologic.
Cecilia Guerstein, psychiatrist with the Older Adults Division of Project: United in Buenos Aires, cited Julieta Oddone, PhD, a sociologist on aging who believes that the theory of activity informs the underlying supposition of most programs for older adults: that social activity in itself is beneficial and results in greater fulfilment in life. And that all older people need and desire to stay active and engaged. "The idea is that the more active they are, the happier they will be," said Guerstein.
"But 'doing things' isn't necessarily appreciated by every elderly person, nor does it automatically lead to their well-being. The fact that some find a sense of well-being from it doesn't mean we have to always do the same activities across different contexts. There are ethnographic studies that show that there isn't necessarily a relationship between activity and well-being, or true social integration," said Pedace.
Not a Burden
Practically speaking, few would question whether physical activity has health benefits and believe that it's never too late to start moving. Among his more than 45 tips on how to live to a ripe old age and "ripen" slowly and nicely, George D. Lundberg, MD, who is 90 years old, gives six recommendations for exercise. These include walking at least two miles every day, trying to swim every day, learning and practicing the techniques of yoga, deliberately lifting heavy objects (resistance training), and working on balance.
"A key for healthcare professionals encouraging exercise among older adults is knowing what to listen for and how to identify situations that motivate the person to exercise. For example, it could be walking their granddaughter down to the ice cream parlor," explained Carolina Díaz, MD, to Medscape Spanish Edition. Díaz is a geriatrics physician and the medical director of the Hirsch nursing and rehab center for older people in San Miguel, Argentina, which is home to 180 residents with an average age of 82 years.
"Exercise shouldn't be a burden. If someone has never gone on walks before, I wouldn't make them walk just because they ought to. Maybe they discover well-being in meeting up with their grandchildren or reading with someone. We believe that well-being is related to mobility, but for someone to move, they need the motivation. And until they have that, there won't be any change," said Díaz.
She added that a physician-patient relationship must be forged and an intervention plan drafted that revolves around the person and focuses on his or her current problems like loneliness, difficulty walking, or pain. "Based on those problems, we can draw up a plan in which physical activity may play a part; other times, it may not."
Osvaldo Bodni, psychiatrist and psychoanalyst, former director of the Department for Older Adults within the Argentine Psychoanalytic Association and author of the book La delegación del poder en el envejecimiento humano: Teoría del legado y de la investidura del sucesor (Delegating Power in Human Aging: The Theory of Legacy and Passing the Baton) told Medscape Medical News: "Aging isn't a disease, though it does increase vulnerability. The proposal of physical activity is not the only 'antidote.' In my opinion, serenity during aging provides even better protection against life's storms."
The physician went on to say, "Active aging programs promote physical activity because it's easier to go on a walk with someone than it is to have a literature debate with them. However, the goal is to create a feeling of being part of a group. This isn't bad, but it's a replacement for family. Being part of a group has come to fill the place that was once filled by one's children, grandchildren, and students.
"When the flood of change in modern society rushes in so quickly, there is a 'programmed phase-out' of knowledge, and the demand for experience drops off. It becomes less valuable, such that older adults often get more comfort from finding someone who is willing to show an interest in their stories. The best therapist is the one who listens; not necessarily the one who invites them on a walk or a bike ride," concluded Bodni.
Vega, Guerstein, Díaz, Bodni, and Pedace have disclosed no relevant financial relationships.
This article was translated from the Medscape Spanish Edition .
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Cite this: Is the WHO's 'Active Aging' the Only Healthy Alternative? - Medscape - Jun 09, 2023.