Myths and Lessons about Aging

Myth: All older people are the same. This couldn't be further from the truth; in the words of many gerontologists, if "you meet one older person, you've met one older person." Older people, just like younger people, are a very diverse group. As people age, their experiences, needs, resources, and abilities vary according to such factors as gender, race, ethnicity, and economic status. ¹ For many, the later years are very healthy and active. Professionals working with these older people will strive to maintain health and vitality for as long as possible. On the other hand, some older persons are frail and much less active, particularly those in nursing facilities, and will have needs, preferences, and desires very different from those of other seniors; maintaining function, however, is critically important for all segments of the geriatric population. Additionally, chronological age is not a good predictor of an individual's aging process.

Myth: Baby boomers are the fastest-growing segment of the population. Although baby boomers represent the largest population group, they are not the fastest-growing age group. Today there are more than 3 million Americans over the age of 85. That number is expected to quadruple by the year 2040, when there will be more than 12 million people in that age group. Thus, those over 85-the "oldest old"-are the fastest-growing segment of the population. For professionals working with seniors, it is important to recognize that the different age cohorts of the senior population have different needs, and that the oldest old most frequently require the greatest level of health care and social services-needs that will greatly increase in the future.

Myth: Most older people live alone. Living arrangements among older persons range from living with a spouse to living in an institutionalized setting to living alone. Eighty percent of men and 60% of women live in family settings, although the proportion living with family does decrease with age.3 Seventy-two percent of men and 40% of women live with a spouse; obviously the percentage of women is lower because most women outlive men. A common fear and myth of aging is that to grow older is to be alone. On the contrary, families tend to live close to their older relatives, allowing for social, emotional, and physical support for older relatives. Many family members who live close by serve as caregivers and are very involved in all aspects of their elderly loved one's life.

Another common misperception is that a high percentage of older persons live in nursing facilities: In fact, only 5% of the older population reside in an institution. The other 95% of seniors live in their own homes in communities across the country. "Aging in place" is a goal for most older persons because seniors' own homes are the most comfortable; it's the place they know best, and it's typically where they want to stay. The needs of seniors living in the community, particularly the oldest old, may be very similar to those of seniors residing in institutions, including the needs associated with medication management. Opportunities for pharmacists to work with seniors in community-based settings are numerous. Gerontologists can serve as links to seniors in the community.

Myth: All older people become confused. Confusion and forgetfulness in old age may be caused by a number of conditions, many of them reversible. Poor nutrition and adverse medication reactions are only a few of the many examples. Dementia is not an inevitable part of growing older. Today research, writing, academics, public policy, and entertainment are only a few of the many fields in which older people continue to make amazing contributions. This myth of confusion and dementia does not exist across cultures; in many countries, older individuals are respected and remain active in family decisions into their later years.

Myth: You can be too old to exercise. Exercise benefits all. At any age, exercise can help strengthen the heart and lungs and lower blood pressure. Exercise has been shown to improve muscle strength even among the "oldest old" and, if carefully chosen, to lessen aging-related bone loss. Exercise should be encouraged at any age.

Myth: Most older people are depressed. Most older people are not depressed. Depression is not an inevitable part of growing older. When depression does occur, it should be determined whether the depression is caused by medication, physical illness, stress, major life change or other factors. The condition can be successfully managed using a number of pharmacologic and nonpharmacologic approaches that have been shown to be effective in older persons.

Myth: Older people might as well accept urinary incontinence as a fact of life. Senior care pharmacists recognize that urinary incontinence is actually a symptom, not a disease. Usually it is caused by specific changes in body function that can result from infection, diseases, or the use of certain medications. A variety of treatment options are available depending on the cause.

Myth: Declines in all of the five senses normally occur as one ages. Actually, this statement is true. Decreased ability to taste and smell, which causes many seniors to lose interest in food, is common and can frequently lead to nutritional problems. Most sensory decline in old age occurs in vision and hearing, although some hearing problems may be caused by cumulative damage from exposure to loud noises over many years. It is estimated that by age 79, 50% of people have hearing problems. Vision and hearing impairments can cause an array of problems ranging from increased risk for falling to poor understanding and adherence to medication regimens. Pharmacists must be sensitive to these sensory changes when communicating with seniors.

Myth: As your body changes with age, so does your personality. Research has found that, except for the changes that can result from Alzheimer's disease and other forms of dementia, personality is one of the few constants in life.

Myth: People begin to lose interest in sex around age 65. Many believe that people begin to lose interest in sex as they age and have no desire for sexual relations. Sexual activity does tend to decrease as individuals age; however, there are tremendous individual differences in this aspect of life. Differences are determined in part by cultural norms, health and illness conditions, and the availability of sexual or romantic partners. Research on sexuality and late life has shown that the large majority of older persons continue sexual activities throughout their lives and into their 80s and 90s.

Gerontology Programs

The history of education in gerontology reveals a dramatic increase in the number of institutions of higher education offering gerontology courses. In 1957, only 57 campuses offered gerontology programs. A 1992 survey estimated that 1,639 campuses offered 920 formal programs of instruction in gerontology, geriatrics, or aging studies. ⁴

Another type of gerontology program-probably the most practical for practicing pharmacists-is a graduate certificate in gerontology. Certificate programs appeal to persons who have already established a career but want to enhance themselves because they recognize the importance of gerontology in their profession. In 1992, 211 masters- and doctoral-level programs offered a certificate in gerontology. The graduate certificate in gerontology provides documentation that students have completed a program of instruction and educational experiences in the field of gerontology at the graduate level.

Completion of the certificate program enables graduates to integrate knowledge of gerontology into their own disciplines, thereby bringing their specific training to the provision of services for an older target population. The need for such a certificate arises because most issues and problems of aging require at least a minimum understanding of the several multidisciplinary areas of study within the field of gerontology.

According to the Association for Gerontology in Higher Education (AGHE), a formal graduate certificate program should consist of a minimum of 21 credit hours and involve at least six different courses of formal instruction plus three to nine credit hours of supervised practicum or research activities related to aging. Required courses for the certificate frequently include social gerontology, psychology of aging, biology of aging, basic research, gerontological electives, and supervised research, for a total of 21-27 credits. ⁴ Students in a certificate program can be currently enrolled in a graduate program in another discipline or have already completed an advanced degree in a profession or scientific discipline.

Other types of gerontology programs result in an associate's or bachelor's degree, minors in gerontology, bachelor's degree continuing education in gerontology, master's degree program, and doctoral degrees. These programs are very similar to the certificate program's course work but vary in the quantity of hours needed to complete the degree. For example, bachelor's degrees require about 45 credits for completion, whereas doctoral degrees require approximately 64 credits.

Gerontology and Senior Care Pharmacists

Sandra Brownstein, PharmD, a consultant pharmacist from Tucson, Arizona, is currently enrolled in a certificate program in gerontology. She notes that "obtaining a certificate in gerontology is helpful because the field of gerontology looks at several aspects of aging. Consultant pharmacists tend to focus on the frail elderly-a very small percentage of the entire geriatric population. The certificate program looks at all aspects of this population.

"As pharmacists, we are venturing out from the long-term care setting and working with the senior population regardless of their living arrangements. It is important to understand a range of other aging issues, such as the economics and the psychosocial aspects of aging," Brownstein notes. "A certificate program in gerontology also helps to develop networks with the other disciplines that are involved in providing services across the entire senior care continuum."

By expanding their horizons and taking a broader, more holistic approach to senior care, pharmacists stand to gain increased clinical competence, greater sensitivity to the challenges elderly patients face, and an enhanced ability to be an integral player in a growing array of senior care practice settings. The ultimate beneficiaries will be the seniors in their care.

Editor's note: For more information about the field of gerontology, contact the Gerontological Society of America at www.geron.org. To learn about educational opportunities in gerontology, check out the Association for Gerontology in Higher Education at www.aghe.org. A directory of gerontology programs-National Directory of Educational Programs in gerontology and Geriatrics, Sixth Edition-can be obtained from the Association for Gerontology in Higher Education at 202-429-9277.

References

1. Association for Gerontology in Higher Education. Careers in Aging (http://www.aghe.org). Accessed Oct 1999.
2. National Institute on Aging. What's your aging I.Q.? (survey). Washington, DC: U.S. Government Printing Office; 1991.
3. American Association of Retired Persons, Administration on Aging. A profile of older persons: 1998. Washington, D.C.: AARP Resource Services Group; 1999.
4. Association for Gerontology in Higher Education. Standards and guidelines for gerontology programs. 3rd edition. Washington, DC: AGHE; 1997.