UNIT 4 CONCEPT AND ATTITUDE

TOWARDS SUCCESSFUL AGEING,

DEATH AND DYING
Structure
4.0 Introduction
4.1 Objectives
4.2 Ageing
4.2.1 Types of Ageing
4.2.2 Characteristics Associated with Successful Ageing

4.3 Domains of Successful Ageing

4.3.1 Successful Biological Ageing: Born to Live Long
4.3.2 Successful Cognitive Ageing: The Power of Comparisons
4.3.3 Successful Psychological Ageing: The Power of Well Being

4.4 Theories of Successful Ageing

4.5 Death and Dying
4.5.1 Definitions of Death and Dying
4.5.2 Attitudes Towards Death and Dying
4.5.3 Different Viewpoints of Death

4.6 Kubler-Ross Model

4.7 Let Us Sum Up
4.8 Unit End Questions
4.9 Suggested Readings

4.0 INTRODUCTION
Despite the varying perspectives of biology, psychology and sociology of ageing,
it is evident that both public and professional attention to old age has increased
dramatically over the latter half of the twentieth century.

4.1 OBJECTIVES
After reading this unit, you will be able to:
 define aging;
 explain characteristics associated with successful ageing;
 explain theories of successful aging;
 identify attitudes towards dying and death;
 describe Kübler-Ross model; and
 explain physiological, philosophical and spiritual viewpoints of death.

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Development During
Adulthood, Middle Age and 4.2 AGEING
Old Age
Ageing is a natural process that begins at birth, or to be more precise, at
conception, a process that progresses throughout one’s life and ends at death. It
is a constant, predictable process that involves growth and development of living
organisms. It can’t be avoided, but how fast we age varies from one person to
another. How we age depends upon our genes, environmental influences, and life
style.
Ageing can also be defined as a state of mind, which does not always keep pace
with our chronological age. Attitude and how well we face the normal changes,
challenges and opportunities of later life may best define our age.

4.2.1 Types of Ageing

There are four types of ageing as listed below:
1) Ageing: It is due to natural changes and the result of disease. Also known
as Primary ageing, it refers to the changes in human functional capacity due
to changes in cells and tissues, causing deterioration of the biological system
and its subsystems and susceptibility to disease and mortality. It is the pre-
programmed coding that our bodies follow and the gradual and inevitable
process of body deterioration that takes place throughout life.
2) Psychological Ageing: It refers to continuous growth and change in cognition
and personality. This change in cognition affects person’s ability to process
the information and their susceptibility to persuasion.
3) Social Ageing: It refers to changes in social relationships that define social
status within a society, power relationships within social groups and various
roles people are expected to play at various stages of life.
4) Secondary Ageing: It results from negative environmental influences, poor
diet and disease, lack of physical activity, poor nutrition, environmental
pollution, stress and unhealthy activities like smoking and drinking, and
exposure to hazardous materials.

4.2.2 Characteristics Associated with Successful Ageing

Developmental Psychologists have highlighted the importance of several
characteristics associated with of successful ageing.
1) Selective Optimization and Compensation: Successful ageing is associated
with the ability to optimize one’s time and use available resources to
compensate for short comings in physical energy, memory and fluid intelligence.
Older people may optimize their time by focusing on things that are more
meaningful and important, such as visiting with family and friends more often
and taking up activities that help them to fulfill their emotional goals. They
may compensate for declining functioning by writing something to improve or
activate their memories. They may giving themselves more time to learn.
They may use mechanical devices such as hearing aid, etc. to compensate
for any loss of sensory or motor ability.
2) Optimism: Optimism refers to the ability to preserve high level of performance
by continued effort and added experience. Maintaining an optimistic frame
of mind is associated with higher levels of life satisfaction and lower levels
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of depressive symptoms in later life.
3) Self Challenge: Seeking new challenges is a primary feature of successful Concept and Attitude
towards Successful Ageing,
adjustment at any age. The key challenge for older people is not to do less Death and Dying
but to do more of the things that matter most to them.
Self Assessment Questions
1) Explain ageing.
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2) What are three types of ageing?
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3) What are the characteristics of successful ageing?
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4.3 DOMAINS OF SUCCESSFUL AGEING

The concept of successful ageing can be traced back to the 1950s, and popularised
in the 1980s. Successful ageing may be viewed as an interdisciplinary concept,
spanning both psychology and sociology, where it is seen as the transaction
between society and individuals across the life span with specific focus on the
later years of life. The terms “healthy ageing” and “optimal ageing” have been
proposed as alternatives to successful ageing.
Various definitions of successful ageing from different scientific domains are as
follows.

4.3.1 Successful Biological Ageing: Born to Live Long

Models of successful biological ageing consider that successful ageing is represented
by two main factors: compression of morbidity and longevity. To understand the
importance of these factors for the definition of biological successful ageing, it is
important to distinguish between ‘maximum life span’ and ‘average life span’ or
‘life expectancy’. The maximum life span represents the longest-lived member(s)
of the population or species.
The average life span has been shown to depend on various environmental factors
such as socio-economic status and nutritional status (Cutler1990). It is mainly a
result of a significant improvement in sanitary conditions over the past century that
the average life expectancy at birth is now high at present. 39
Development During a) Compression of morbidity
Adulthood, Middle Age and
Old Age Although the average life expectancy at birth has increased in the past century,
there are still many diseases that can decrease life expectancy. The age-associated
diseases are cardiovascular disease, cancer, stroke, diabetes and dementia.
Although most of these age associated diseases do not occur exclusively in older
people and/or in all older people, it is interesting to note that the high prevalence
of these diseases in the elderly has created the impression that disease is a
necessary part of ageing.
b) The role of genetic factors
In contrast to average life span, which is sensitive to major diseases and
environmental challenges, it has been shown that maximum life span, which
represents the longest-lived member(s) of the population or species is species
specific and very stable. This stability suggests that genetic factors might make a
major contribution to the maximum life span of an individual.
c) Selective pressure on genes
If longevity is genetically determined, then it implies that selective pressure on
specific genes has been applied through out evolution. Here, it is interesting to
note that species with a short life span have generally a higher fertility rate
(Williams1966).This trade-off between life expectation consists of three major
premises. (i) The first is that in natural populations (with the exception of humans),
most deaths generally occur accidentally. This means that the probability of reaching
maximum life expectancy is low. (ii) The second premise is that the long-term
survival of an individual depends on the maintenance of the organism, a process
that is energetically costly. (iii) The third premise is that it is not advantageous for
an individual to invest a large fraction of metabolic resources in long term survival
if only a small fraction of these resources necessary to survive in reasonably good
condition.

4.3.2 Successful Cognitive Ageing: The Power of

Comparisons
The measurement of individual differences is of central importance for the models
of successful cognitive ageing. In this approach, the characteristics of individuals
that are deviant from the normal are contrasted with those of persons ageing
more in accordance with the normative expectations.
The entire approach of models of successful cognitive ageing stands on three
types of comparison of an aged individual to other groups. (i) In the first
approach, the cognitive performance of an older person is compared with normative
data obtained in individuals of the same chronological age (the normative approach).
Here, a successful agarng will be defined as someone being above normative
values when controlling for age, education level and socio-economic status.
(ii) In the second approach, the cognitive performance of the individual is
compared with the mean performance of a group of individuals within the same
chronological age range (the age-related approach). Here, a successful agar is
defined as someone showing a higher performance (by two or three standard
deviations) than the mean of the group. (iii) In the third approach, the cognitive
performance of the individual is compared with that of a group of young individuals.
In this case a successful agar is defined as someone having a cognitive performance
as good as that of young individuals (the age-difference approach).
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4.3.3 Successful Psychological Ageing: The Power of Well- Concept and Attitude
towards Successful Ageing,
being Death and Dying

The models of successful psychosocial ageing emphasise social interaction, life

satisfaction and well being as major determinants of successful ageing.
a) The importance of social support: Social support is a key determinant of
successful ageing. Social integration and support are linked to protection
against physical and mental health conditions such as cardiovascular diseases,
hypertension and depression, which is each of related to cognitive decline.
b) Subjective well –being: Successful ageing and life satisfaction have shown
that although the two concepts are different, they both contributed to subjective
well- being in the aged population.
c) The importance of personality traits: Self-concept and attitudes, in addition
to other factors, contribute to stability and change in personality, which in
turn influence the prospect of successful ageing.
Self Assessment Questions
1) What is compression of morbidity?
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2) Briefly explain the approaches on which the power of comparison is based.
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3) Find the difference between biological and psychological ageing.
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4.4 THEORIES OF SUCCESSFUL AGEING

There are various theories which define successful ageing, and these include
(a) the disengagement theory (b) the activity theory (c) the selective theory and
(d) continuity theory. These are described below:
1) The disengagement theory, first proposed by Cumming and Henry (1961),
states that as people age, their withdrawal from society is normal and desirable
as it relieves them of responsibilities and roles that have become difficult. As
older adults slow down they gradually withdraw from society. Older adults
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Development During develop an increasing self- preoccupation, lessen emotional ties with others
Adulthood, Middle Age and
Old Age
and show a decreasing interest in society’s affairs.
2) The activity theory contends that activity is necessary to maintain a “life of
quality,” that is, one must “use it or lose it,” no matter what one’s age. People
who remain active in all respects—physically, mentally, and socially—adjust
better to the aging process. Proponents of this theory believe that activities
of earlier years should be maintained as long as possible. The more active
and involved older people are, the less likely they will age and the more
likely they will be satisfied with their life. This theory suggests that individuals
should continue their middle adulthood roles if roles are taken away from
them.They should find substitute roles that keep them active and involved in
the society.
3) The Selectivity theory mediates between Activity and Disengagement Theory,
which suggests that it may benefit older people to become more active in
some aspects of their lives, more disengaged in others.
4) The Continuity theory is proposed by Havighurst and co-workers in reaction
to the disengagement theory. This theory assumes that basic personality,
attitudes, and behaviours remain constant throughout the life span”. Ageing
people are inclined to maintain, as much as they can, the same habits,
personalities, and styles of life that they have developed in earlier years.
Individuals, in later life, make adaptations to enable them to gain a sense of
continuity between the past and the present, and the theory implies that this
sense of continuity helps to contribute to well-being in later life.
Although there are losses and declines with age, many people respond to them
adaptively and adjust well to the changes associated with ageing, and report high
levels of enjoyment of life in their later years.
Successful aging occurs when elders have developed many ways to minimize
losses and maximize gains. Social contexts can foster successful aging. These are
such things as well-funded social security plans, good health care, safe housing
that adjusts to changes in elders’ needs, social services and opportunities for
lifelong learning. Better in-home help, adapted housing and sensitive nursing home
care could make a difference in aging, too.
Self Assessment Questions
1) Define the role of activity theory in successful ageing.
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2) Explain continuity theory.
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 Concept and Attitude
4.5 DEATH AND DYING towards Successful Ageing,
Death and Dying
Understanding death as a part of normal life is a fundamental concept. It is part
of life, and an extension of birth. Everything that has a life on earth will perish
one day. The later years however are associated with thoughts of looming death
and the realisation of death affects different people differently. Some individuals
face the reality calmly and with careful preparation whereas others resist any
thoughts about dying and struggle to ignore what fate has foreordained. Still
others succumb to thoughts of death and go into depression. Although people can
imagine others of dying, they often have trouble imagining their own death.
Death is one of the most profound emotional experiences one encounters. Since
time immemorial, death has captured the imagination of poets, philosophers, artists,
scientists, and lay persons alike, who have used the concept of death to understand
and explain the meaning of life.
Each person has his or her own view of death and attitude towards it. However,
the society as the main influencer has a huge impact on people’s perception of
death. The attitudes of the society towards death have been changing over time.
Each person’s attitude toward death will affect nearly every activity of his or her
life. The attitudinal disposition is marked by
a) fear of death to such an extent, that one becomes slave to one’s emotions;
b) suppression or ignoring of the thought of death by becoming engrossed in
living, and;
c) accepting death as a reality and preparing for it physically, emotionally, and
spiritually.

4.5.1 Definitions of Death and Dying

The literature defines death and dying from a number of perspectives, many of
which depend upon people’s belief system. The commonly used definitions are as
follows:
Fischer (1998) defined death as the final moment of life, the end of life as we
know it.
Kubler and Ross (1975) defined death is the final stage of growth in this life.
There is no total death. Only the body dies. The self or spirit, or whatever you
may be wish to label it, is eternal. You may interpret this in any way that makes
you comfortable.
Fischer (1998) Dying is a journey a person must take in the last phase of life. It
is the process leading to the end. It can sometimes be a long journey of progressive
suffering on many levels. Old persons often fear weakness, pain, physical
dependence, and mental deterioration more than the cessation of life.
Keble and Ross (1975) defined dying as the stage in our life which can be
experienced as the most profound growth event of our total life’s experience
(Keble- Ross, 1975).

4.5.2 Attitude towards Death and Dying

As death transcends old age, most elderly persons recognize that their own death
is close at this time in their lives. Older people think of death more than any age
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Development During group. A number of attitudes towards death and dying are prevalent, but the most
Adulthood, Middle Age and
Old Age
often depicted in the elderly are:
1) Attitude: Fear of death and dying
Fear of death is anxiety experienced in anticipation of the event. Such fearful
anticipation is basically the result of a failure to observe the death process in
others. There are three direct determinants of death anxiety: past- related regret,
future related regret, and meaningfulness of death. Past related regret refers to the
perception of not having fulfilled basic aspirations. Future related regret refers to
the perceived inability to fulfill basic goals in the future. Meaningfulness of death
refers to the individual’s conceptualisation of death as a positive or negative, as
making sense or being senseless.
2) Attitude: Hope
It is well known that most of the time people do hope to live as long as possible.
This is a human trait. All humans face growing old, but are unable to concretely
imagine their own dying process. They are also unable to see themselves truly old
because for most people the change is frightening.
3) Attitude: Dignity or Integrity
Human integrity can be maintained if one has an attitude of doing things for others
and being helpful and contributing positively to the society. Also in order to
preserve their dignity and integrity, the elderly needs to know that others support
them and there is someone to fall back in times of need. The supportive task is
to make the person realise the basic truth of life. This acceptance often leads to
humility. Helping others will strengthen and complete the lives of those who care.
Positive attitude has a direct impact on a person’s life.
4) Attitude: Forgiveness
Many people nurse grouse against certain people as it is perceived that they have
harmed them to forgive and forget and to think positively go a long way in making
a person peaceful. Forgiveness means ceasing to feel any claim to recompense.
A person forgives in order to bring peace into one’s own life. It stimulates new
spiritual and emotional growth in a person. By letting go off the hatred and blame,
one releases energy that is trapped in the unproductive service of holding a
grudge.
5) Attitude: Love
Affection and love are the two key positive emotions that sustain a person’s life
and make life worth living. Love opens mysteries of human life. Social scientists
today are exploring several aspects of love in later life, especially the three major
areas: love and sex after sixty, the importance of friendship in the later years, and
the call to compassion and universal love.

4.5.3 Different Viewpoints of Death

Death has been viewed at from varied points of view these include death according
to physiological, philosophical and spiritual viewpoints.
Physiological views of death
 When brain and heart stop functioning.
44  No breathing.
 When nervous system does not respond Concept and Attitude
towards Successful Ageing,
 When slowly your body is getting damaged and you can observe that Death and Dying

everything is going numb.

 When a person slips into a coma.
Philosophical views of death
 It is a stage of life when there is no hope for the future, nothing to look
forward to.
 It is one’s inability to look beyond or wish for as it is the final stage of life.
 Death forces you to leave everything behind; it takes everything away from
you.
 Death is perceived as an inevitable, unwanted fact of life, as a “grey area”,
an unknown dark area, which no one has previously experienced. It is
perhaps this perception that evokes fear in people.
Spiritual views of death
 Death is akin to moving away from this materialistic world and your soul is
meeting with God, the supreme authority. It is moving to a higher level. It is
a beginning of new life. It is only the end of physical entity of our physical
being, when the soul leaves the body’.
 ‘Death’ to some means the end of merely the physical existence and the
beginning of a new life. It is part of a continuous process.
 ‘Death’ is also perceived as a great leveler that ‘visits everyone without
discrimination of caste class, or gender’.
 ‘Every moment since we took birth on this earth, we are inching towards
death’.
Self Assessment Questions
1) What is the philosophical view of death?
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2) What is death anxiety?
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3) Differentiate dying and death.
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Development During
Adulthood, Middle Age and
Old Age
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4) What are the various views of death? Elucidate
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4.6 KUBLER-ROSS MODEL

Although there are many theories about the emotional transitions encountered by
dying people, the best known is Kubler-Ross. She studied extensively death and
dying and suggested that terminally ill patients display the following five basic
reactions.
1) Denial – Behavioural response - Refuses to believe that loss is happening.
“I feel fine.”; “This can’t be happening, not to me.” Denial is usually only a
temporary defense for the individual. He regards initial denial as a healthy
way of coping with the painful and uncomfortable news. During this stage the
person may generate a temporary protective denial system and isolate himself
or herself. This feeling is generally replaced with heightened awareness of
situations and individuals that will be left behind after death.
2) Anger – The second stage is characterised by “Why me? Pattern. People
in this stage can not continue the myth of denial, so they may exhibit hostility,
rage, envy and resentment in addition to anger. It’s not fair!”; “How can this
happen to me?”; “Who is to blame?” Because of anger, the person is very
difficult to care for due to misplaced feelings of rage and envy. Any individual
that symbolises life or energy is subject to projected resentment and jealousy.
3) Bargaining – During the third stage, people generally bargain with God or
doctors for an extension of life, one more chance, or time to do one more
thing. This is another period of self- delusion, hoping to be rewarded for
promises of good behaviour and good deeds. “Just let me live to see my
children graduate.”; “I’ll do anything for a few more years”. This stage
involves the hope that the individual can somehow postpone or delay death.
Usually, the negotiation for an extended life is made with a higher power in
exchange for a reformed lifestyle. Psychologically, the individual is saying, “I
understand I will die, but if I could just have more time...”
4) Depression – “I’m so sad, why bother with anything?”; “I’m going to die...
What’s the point?”; “I miss my loved ones, why go on?”
During the fourth stage, the dying person begins to understand the certainty
of death. In this stage, the individual may become silent, refuse visitors and
spend much of the time crying and grieving. This process allows the dying
person to disconnect oneself from things of love and affection. It is normal
for depression to set in. Ross identifies two types of depression in terminally
ill patients: 1) Reactive depression, 2) Preparatory depression. The first is a
reaction to the irrevocable loss; the second is an inner emotional preparation
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 to give up everything. It is not recommended to attempt to cheer up an Concept and Attitude
towards Successful Ageing,
individual who is in this stage. It is an important time for grieving that must Death and Dying
be processed.
5) Acceptance – In this stage, people reconcile the loss and accept the fate.
“It’s going to be okay.”; “I can’t fight it, I may as well prepare for it.” In this
last stage, the individual begins to come to terms with their mortality or that
of their loved one.

4.7 LET US SUM UP

In the early twenty-first century, while substantial numbers of people die early,
death occurs mostly in old age in developed countries. Nevertheless, both one’s
own death and the death of a person close to him or her, even when expected,
can seriously affect his or her system of beliefs and sense of meaning. Acceptance
of death requires the active construction of meaning throughout the life span. To
fully live our lives we should live our lives as if we knew we only had days to live.
Thomas Aquinas describes people’s fear of death by making the statement, “Man
(woman) shuns death not only when he (she) feels its presence, but also he (she)
thinks of it,”

4.8 UNIT END QUESTIONS

1) Describe theories of successful aging.
2) What are the dimensions of successful aging?
3) Explain Kubler- Ross model.
4) Define aging and its components.
5) Briefly discuss death as a life event.
6) Discuss spiritual and philosophical view of death

4.9 SUGGESTED READINGS

Harry R. Moody (2006): Aging: Concepts and Controversies. Pine Forge
Press, An imprint of Sage Publication.
Clifton D. Rryant (2003): Handbook of Death and Dying. Sage Publication,
Inc.
Death Attitudes and older Adults (2000): Theories, Concept and Application.
Publisher: Brunner Routledge.
Elizabeth B. Hurlock (1980): Developmental Psychology: A Life-Span Approach.
Publisher: Tata McGraw-Hill.
William C. Crain (2005): Theories of Development: Concepts and Applications
Publisher: Pearson/Prentice Hall.

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