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Subjective aging: factors influencing individuals’ perspectives

Commentary on “The paradox of subjective age: age(ing) in the self-presentation of older adults” by Okun et al.

Published online by Cambridge University Press:  06 December 2022

Angela Kydd*
Affiliation:
School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
Margaret Rees
Affiliation:
Editor in Chief Case Reports in Women’s Health; Emeritus Editor in Chief Maturitas; Executive Director EMAS: European Menopause and Andropause Society; Reader Emeritus in Reproductive Medicine, and Supernumerary Fellow, St Hilda’s College, University of Oxford Visiting Professor, Faculty of Medicine, University of Glasgow and Adjunct Associate Professor Rutgers Robert Wood Johnson Medical School; 2020 Women’s Health Institute’s Woman of Distinction Award Rutgers Robert Wood Johnson Medical School, UK
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Abstract

Type
Commentary
Copyright
© International Psychogeriatric Association 2022

The subjective experiences of old age or any event or experience occurring in an individual’s life can be researched through both qualitative and quantitative methodologies. Asking participants how they maintain self-presentation of themselves as they age provides useful insights, not generalizations, into the field of inquiry. Okun and Ayalon (Reference Okun and Ayalon2022) undertook an online survey in 2020 of 818 Israeli adults (342 women and 350 men) aged 65–90 to address this question. This article focuses on two main questions from the survey: ‘How do you define yourself?’ and choosing and ranking by participants of the old age terms they preferred from a list that included the eight most common terms in the Hebrew language. The majority of the sample were aged 65–75 years, were married, were academic (education for more than 12 years), were retired, and had no economic problems. The authors' found that participants employed three strategies for self-presentation: absence of old age, camouflaged aging, or multiplicity of old age terms.

The findings are interesting and beg further questions. For example, one study on subjective old age by Kornadt et al. (Reference Kornadt2022) added the variable of psychological and physiological stress, which may serve to address some of the disparate challenges that individuals have to cope with which would affect their subjective experience of aging. A further illuminating and well-referenced text on self-reported health and older aboriginals is a commentary by Smith and Flicker (Reference Smith and Flicker2022) who call for culturally diverse studies in order to understand an individual’s subjective experience of aging. They cite Aboriginal doctor Tamara Mackean (p1269) who said it was essential to “deliver an optimal health service that facilitates physical repair, psychological buffering, social nurturing, cultural reclamation and spiritual maintenance.” The commentary centered on an Aboriginal study that found the importance of healing, balance, connection, and inner spirit, which Smith and Flicker suggest are important concepts that researchers in aging could learn from.

However, Okun and Ayalon (Reference Okun and Ayalon2022) give no data linking the three strategies identified to the demographics of their participants and their experience across the life course. These would include adverse childhood experience, health status, disability, and socioeconomic factors such as previous low-paid and precarious employment considering those identifying as LGBTQI+. Further research would benefit from a wider base sample as has occurred in other fields to increase understanding of the diversity of the aging experience (Riach and Rees, Reference Riach and Rees2022).

Furthermore, not seeing the full survey, perhaps one would question why people aged 65–90 were asked in the second reported question to choose to use one of eight terms, even if they did not class themselves as such. One might also question the etiology of the terms, who coined them and why. One possible explanation is that societies need to provide for different generational needs, such as the number of nurseries, schools, and nursing homes for their particular populations. This would be the case in Israel because the authors Okun and Ayalon make reference to the fact that the aging population of Israel has grown quite quickly and so maybe these classifications fill that requirement. It could also be that many western cultures have been brought up to view people over 60 as old. This was the age of retirement and a time when mainstream services referred clients over 60 to ‘older people’s services’ and so the concept of having the young and old in society was seen more as a classification than a derogatory statement. Notwithstanding, old age has also been viewed in a negative light, a time when an individual becomes needy, frail, or burdensome (Gilleard and Higgs, Reference Gilleard and Higgs2015). This stereotyping may result in age bias with healthcare professionals having, for example, a reduced likelihood to recommend surgery for breast cancer in older women (Neal et al., Reference Neal, Morgan, Kenny, Ormerod and Reed2022).

This does not however mean that people over the age of 60 views themselves as old and several texts have supported the concept that becoming ‘old’ has not been the feared time of life one has grown up to believe it would be. It could be that past societal ingrained negative images of being old, cultivated from youth, have been realized or have come as a pleasant surprise. Indeed Okun and Ayalon’s study findings from a word cloud showed very positive responses to how their participants presented themselves.

The experience of aging and of becoming an older person (in the eyes of others) has been documented in seminal works by many authors such as De Beauvoir (Reference De Beauvoir1970), Kauffman (Reference Kauffman1986), Neugarten (Reference Neugarten1974), Tornstam (Reference Tornstam1989), Tobin (Reference Tobin, Johnson and Barer1997), Johnson and Barer (Reference Tobin, Johnson and Barer1997), and Baars (Reference Baars, Dannefer and Phillipson2010).

To expand on the works of the authors above, whilst all authors do acknowledge the heterogeneity of populations classed as ‘old’, differences in cultural, racial, mental and physical health, past life traumas, abuse, socioeconomic circumstances, and age are rarely extrapolated in the findings of such works. How old age is interpreted by the individual has been reported in many studies. In her book Old Age, De Beauvoir states that the concept of death from old age is as remote to a 75-year-old as it is to a younger person. However, some authors argue that age is an important distinction because aging is deleterious and universal, with work by Neugarten (Reference Neugarten1974) suggesting that people aged 60–74 are more akin to those classed as ‘middle aged’ and put forward a classification of the young old and old old (those over 75). The rationale being that people over 75 are more likely to experience the deleterious effects of aging. However, Kauffman (Reference Kauffman1986) argues that ‘old age’ has no intrinsic meaning for the participants in her study. They did not view themselves as old. Kauffman suggests that people in advancing years have a sense of self that is ageless and that they experience continuity of identity, despite the physical and social changes associated with old age. However, the participants (n = 60) were urban dwelling white middle class Californians, over the age of 70 and the positivity was reported in a group that lacked diversity. Such positivity is also seen in the work of Tornstam (Reference Tornstam1989) who put forward the theory of ‘gerotranscendence’, built from reviewing qualitative and quantitative studies on aging experiences, in which people continue to feel positively as they grow older, regardless of the challenges an older age brings. However, Rajani and Jawaid (Reference Rajani and Jawaid2015) criticise this theory as focusing on the experiences of people facing retirement in later life and not exploring it at a macro level to encompass sociodemographic factors. The theory purports that in later life, an individual loses interest in material concerns and shows less concern for challenges they face as they transcend into old age. Tobin (Reference Tobin, Johnson and Barer1997), a gerontologist and writing in her sixties, speaks of the limitations experienced and accepted by one of her participants in her late 80s. She reflects that at her time of life she would not cope because this would be premature for her and she makes reference to her mentor Neugarten, who introduced the concept of young old and old old. Research by Johnson and Barer (Reference Tobin, Johnson and Barer1997) showed greater detail in age groups and characteristics. Their work involved people categorized as the ‘young old’ aged 75–84 (n = 100) and those categorized as the oldest old (n = 150). However, due to recruitment challenges, the participants were all white urban-dwelling residents of San Francisco, although the authors did target city precincts with differing socioeconomic status. The data tabled in their research included economic and health status, physical ability, mood, formal, and informal support. Yet the overall findings remained positive, with participants accepting limitations and feelings of powerlessness. This fortitude Johnson and Barer called the ‘aura of survivorship’.

Rajani and Jawaid (Reference Rajani and Jawaid2015) call for more attention to be paid to the diversity of older people’s lives and encompass their mental health status. A point made earlier by Woods (Reference Woods1996:4) who states that “The older person cannot be studied in isolation from their context: they are enmeshed in a presumptive world order, rich in accumulated expectancies.”

Baars (Reference Baars, Dannefer and Phillipson2010) gives a more encompassing view of aging and suggests three dimensions of aging: (1) natural (physical and biological), (2) sociocultural, and (3) personal. He states that “all human aging takes place in specific contexts which co-constitute its outcomes” (ibid:10).

Thus, research has to include factors that affect the diversity of experience of aging from childhood onwards. The paper by Okun and Ayalon, while offering an interesting insight into the paradox of aging, only examines a limited socioeconomic sample and gives a wide age band of the ‘old’ participants which span 65–90 years. Twenty-five years is a long time in which many changes can occur and echoes what Tobin reported earlier in their paper. Kydd et al. (Reference Kydd, Fleming, Paoletti and Hvalič Touzery2020) suggest dispensing with the term ‘old’ and call for a universal agreement on defining people aged 60 and over into cohorts (such as septuagenarians, octogenarians etc.) to provide a common understanding of who is being researched, in their historical context, thus giving a dependent variable to aging research. They add that aging research needs to include culture, race, education, physical and mental health status, and socioeconomic conditions that dictate how a person ages. Okun and Ayalon have provided an interesting study and do acknowledge the limitation that their participants are most likely to be educated. To fully appreciate why an individual does or does not acknowledge whether they are ‘old’ or feel ‘old’, surely it is necessary to dig a little deeper as detailed previously (Riach and Rees, Reference Riach and Rees2022). Okun and Ayalon cite many references to show that self-ageism equates to negative aging experiences – but what if it is the other way around? That negative experiences lead to self-ageism.

In order to hypothesise that negative outcomes lead to self-ageism, it is important to explore the diversities within age bands. Resilience for example has been found to impact on the aging process (Janssen et al., Reference Janssen, Abma and Van Regenmortel2012; Zimmerman and Grebe, Reference Zimmermann and Grebe2014), yet factors that make people resilient will include culture, education, income, and social supports. A further consideration is the effect of austerity in the current global economic crisis. A recent UK report by YouGov (November 2022) found that approximately half of care workers (n = 1,009) reported that their older clients had no other form of social support, and many were living in abject poverty. Lack of any significant human contact coupled with hardship has been well documented to lead to negative outcomes. In the early 19th Century, the social psychologist and symbolic interactionist William James stated that a man has as many selves as there are people who recognise him in that self, for example father, son, teacher, boss, friend etc. (Meltzer et al., Reference Meltzer, Petras and Reynolds1975). Without such recognition where would one find feelings of worth? This is perhaps a different matter from that of self-perceptions, but the acknowledged self, plus living conditions affects a person’s outlook on themselves and their lives.

In conclusion, the concept of self-perception is surely grounded in symbolic interactionism. Redmond (Reference Redmond2015) cites the work of Cooley, who coined the term “looking-glass self”. This consists of three elements: imagining how one presents to other people, imagining other people’s judgment of that presentation, and a self-feeling in response to that imagined judgment. The latter is the subject matter of Okun and Ayalon’s paper and although not without the limitations we have discussed, is a worthy and interesting addition to the topic of self-ageism. Positive reports on aging are still few and the paper has a very optimistic outlook. In celebrating age, we finish with the story of John Goodenough who received the Nobel prize in Chemistry at age 97 is now 100 and still running a research group (Cheetham et al., Reference Cheetham, Grey and Rao2022).

Conflict of interest

None.

Description of authors’ roles

Angela Kydd and Margaret Rees contributed equally to drafting, editing, and revision of the manuscript. Both authors approved the final submitted version.

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