Terapia Ocupacional Terapia Ocupacional



We are living in an aging world. Never before in Spain, in Germany, in Europe, in the whole world so many people could reach such an advanced age. There is an enormous extension of the lifespan in all European countries, but also in all countries of the world. This is due to the improvement of the socio-economic living conditions and the progress of modern medicine, - and it is also influenced by the life style.

But it is not only important to add years to life, but also to add life to years. Many years ago HANS SCHAEFER, a wellknown expert of social medicine and professor of the University of Heidelberg has stated: „Our life expectancy is dependent from our life style. Life expectancy does not only mean length of life, but also quality of life. It does not only count how old one will be, but how one will get old."(SCHAEFER,1975). 

Aging in Europe takes place differently in each country or region. Even within each country, aging has many different faces. Aging itself is not only a biological process, but it is a process determined by a number of biological, social and ecological factors. There is a difference between people of the same chronological age within the same country – a difference which is sometimes more prominent than the difference 60 to 70 years olds and 70 to 80 years old.

Aging today, at the beginning of the new century, is completely different from what is used to be of the beginning of the last century. Far more people reach the age of 60, 80 or even 100 years. The life style has changed; everyday life is easier in many aspects. For instance the legendary „wash day", house keeping and food organization in times without refrigerators had been more difficult in former times. But at the same time every day life has become more difficult, e.g. the family situation, the traffic situation - although older people also profit considerably from it. Trips to far away countries remain no longer wishful thinking for many of the elderly; they can become reality. A better education, more knowledge of foreign languages and a better status of health and very often a better financial situation is typical for the old of today in comparison to the old of yesterday in many European countries.

But aging has many faces: There is the competent and wise senior, who is able to manage his own life, who is integrated into the society, who lives on a relatively high standard on the one hand and there is the ill, helpless and dependent senior who needs help and support on the other hand.

Scientists of all disciplines and faculties have to discuss the question of longevity combined with a state of psycho-physical wellbeing. What can be done to assure a healthy aging? What can be done to assure the quality of life in old age? What can be done to prevent illness, diseases and dependency in old age?

These questions will be discussed in the second part of my lecture. In the first part I shall refer to the demographic change and its consequences for the individual and the society. The demographic change is caused by an increase of the life expectancy and an decrease of the birth rates,

I. The demographic change

Europe is turning grey. I will discuss the demographic trends in population change and its consequences under 5 aspects:

1: The rise of the individual life expectancy

The life expectancy of newborns in Europe is among the highest in the world: 74 years for males and 80 years for females. These are exactly the numbers of Germany. - In Spain in 1995 the life expectancy of a newborn boy was 73.2 years, of a newborn girl 81.2 years.

The worldwide average is 61 and 64 years. There are, however, great differences between the different countries. in Africa it is 52 years, and in Japan it is for males and females 80 years

In most of the European countries a 60 years old person can expect 20 to 24 more years. That means: after retirement a person will live about 20-25 more years – one fourth of his /her life! Most of the persons today are not prepared for such a long period in a postoccupational – and a postparental (!) – stage

2: The aging population, the graying society

One hundred years ago the percentage of persons 60 years and older in Germany was 5%; to-day it is 22%. In the year 2030 it will be 35-38% - and here in Spain it is very similar: About 20% of the population in the European States is older than 60 years. Predictions show that this portion will increase strongly until the year 2020. Italy predicts 29,9%, Belgium 28,8%, Finland 28,2% Germany 27.7%.and Spain 27.2%. The lowest portion is predicted for Ireland with only 21.8%, followed by Denmark (24,3%) and the Netherlands (24,8%) (WALKER et al., 1997) 15,5% of Europe`s population in 1995/1996 was older than 65; Sweden with 17,5%, Italy with 16,8% and Belgium with 16% took top places. In Germany 15.4% and in Spain 15.5% of the population was 65 years and older. The lowest portion had Finland with only 10.3%, Iceland with 11.3% and Ireland with 11,5%. These countries have higher birth-rates. In all our countries there is a development of the population structure from a pyramide to a mushroom..

If you compare the figures of population development from 1995 to 2025 in Europe, Latin America and Asia you can see, there is relatively little change in Europe, but an enormous change in Latin America and Asia. That means, the increase of the elderly population in the next future will be very,very high in the developing countries

We also got an increase in the group of the 80, 90 and 100 year-old-persons. 30 years ago we have had only 385 centenarians in our country, in 1994 we have had more than 5000 – and now the estimated number of persons, which were born 189x is about 10.000. - You in Spain have also an remarkable increase of the oldest population;.

Now there are worldwide studies on centenarians – and we can summarize the findings and state: One third of them are very competent and able to manage their daily life; another third needs some help, but is able to go out of the house. Only the last third is bedridden and needs help and care.

Scientists of all disciplines and faculties, administrators and practioners, and politicians, too, have to discuss the question of longevity combined with a state of psychophysical wellbeing.

As it was mentioned, the demographic change has two important reasons: the increase of the life expectancy on the one hand and the decrease of the birth rate on the other hand, which you can find in all the European countries. The average number of birth in the countries of the European Union is 1.43; Ireland has the highest fertility rate with 1,87, Italy and Spain the lowest with 1.18 resp.1.17, followed by Germany with 1.24 .- We do not expect that the fertility rate will increase in the European countries during the next years.

Relationships between sociopolitical measures on the one hand and fertility on the other hand can not be demonstrated in a significant way. The rise of the children`s bonus or the introduction of maternal or parental leaves and their extension to three years in Germany did not enhance the birth rate even if the leave is granted with a guarantee to return to the former job. From a psychological point of view the motivation for having children is of main interest. Actually it is a bundle of motives which becomes effective here

- the better possibility of family planing and birth control;

- the „instrumental" motivation for a child became increasingly ineffective. Due to the pension-system the function of children as a financial support for the own age is no longer vaild. Also the child as man-power, especially among farmers, is no needed. The function of the sons as „Stammhalter" no longer is an important motive especially as daughters do-day can continue to keep their former family name after marriage.

- In the political discussion about fertility children are perceived increasingly as a burden and costs while the pleasure and enrichment from children is not emphasized in a sufficient way.

- the theory of the continuos presence of the mother influenced many women with a good academic and professional training to stay in their job instead of having a child.

- unfavorable economic, ecological and housing conditions

- Today most women undergo a long period of occupational training; marriage no longer is a condition for living together; therefore marriage is delayed into middle adulthood which lowers the biological chances for having more than one child.

- Another psychological factor influencing fertility is related to the social role of women. Formerly they lived in their own nuclear family until they married. An adjustment to the own family was necessary. The women, very well trained in adjustement to other family members, were used to delay the satisfaction of their own needs. Today women leave their parental home with 20 years or earlier and stay independent. Through this life style they develop individuality, personality and the desire for self-realization. After ten years of this way of living very often it is difficult to adjust the own behavior and wishes to that of a partner (which may be one of the reasons for the high rates of divorce in our country). Even more it is difficult for the women to adjust to the needs of one or more children. – As this extended independent young life style can not be reversed, the chances for a rise of the birth rate in Germany and similar European countries are rather poor.

And so political measures influencing fertility rates are very limited.

3: The proportion between the different age groups.

One hundred years ago, the proportion of persons beyond and below 75 years of age in our country was 1:79; 1925 the ratio was 1:67; 1936 it was 1:45, 1950 1:35, 1970 1:25, 1994 1:14,8 and in the year 2000 it will be 1:6,2.

There is an important change in the structure of the households, too. We have a trend from the three-generation-household over the two-generation-household to the one-generation-household – and from here to the one-person-household. In our country only 1.1% of all the 34 million households are three-generation-households. From all the people 65 years and older, nearly 40% are living in one-person-households, and in the age group 75 plus 68% of the women and 26% of the men are living in one-person-households. In Spain only 12% of the persons 60 years and older and 18.8% of the persons 80 years and older, in Portugal 16,2% of the persons 60 years and older and 25.2% of the over eighties are living in a one-person-household. And these numbers will increase. In Greece 18,6% of the elderly are living in one-persons-households. But also in this countries living-arrangements of the elderly together with their children will be reduced in the future. This will have consequences for the potential care-givers, if they are needed. More ambulant services for the aged will be needed.-

It should be remembered, however, that according to many studies conducted in many countries of Europe this change in household-structure should not be identified with loneliness or isolation of the elderly, as frequent intergenerational contacts are reported independently from the household-structure. It is very interesting, that in European countries, in which the elderly have the highest score of contacts with family members – like Greece, Portugal and Italy – WALKER and MALTBY found the highest percentage of loneliness (36% in Greece, more than 20% in Portugal and 15-19% in Italy), whereas in Denmark, where most of the elderly are not living together with their family, less than 5% had the feeling of loneliness. (in Germany, the Netherlands and United Kingdom these are 5-9%, in Belgique, France. Ireland, Luxembourg and Spain these are 10-14%). 

The family integration of the elderly is quite different in each European country. While most of the elderly prefer „intimate relations by distance" („innere Nähe bei äußerer Distanz") as the ideal situation – in particular in Denmark, in the Netherlands and in England, where less than 20% stated to have daily contact – the daily contact within the family structure in Italy, Greece, Portugal and Spain with 60-70% is much stronger.

There is also a trend from the three-generation-family to the four or five-generation-family - not living in the same household. In former times a newborn child had very seldom the opportunity of knowing his/her four grandparents. Today a child very frequently has teh chance to know all of his/her 4 grandparents and very often 2 great-grandparents, too. Persons in their sixties and older with great-grandchildren are quite common – and also persons, 60 years and older, who are caring for their own parents. In our Interdisciplinary Longitudinal Study of Adulthood and Aging (ILSE) 36% of the mid-sixties (born 1930-1932) have living parents or parents in law. The grandparent-generation of today is the „sandwhich-generation", helping children and grandchildren and also helping and caring their own parents.

4: From the three-generation-contract to the five-generation-contract:

The three-generation-contract in Germany was introduced by BISMARCK, who created the pension-system more than 110 years ago. The idea of the three-generation-contract is, that persons in the labor force have to provide (via insurance contributions and taxes) for those who are not yet working and those who have finished working, who are retired. Around the turn from the 19. to the 20. century, the 15-70 years old were in the labor market and provided for the under 15s and the over 70s in this way. But at this time just 2% of the population was 70 years and older. Today young people are beginning their occupational life at an average age of 25 years and – due to the situation at the labor force, due to the high unemployment rate – people are finishing their occupational life when they are 58-59 years of age (there were many special laws for an early retirement). So the group of employed persons between 25-58 years has to provide for those who are not yet working (and in some cases these are two generations of them, because some 30-years old students have their own children in the kindergarden) and for those who have already finished their occupational work – and these are 26% of the population, often two generations. This has consequences for the pension-system. –

To-day about 3 persons in the labour force have to pay for one retired person; in 2040 the relation will be one to one. 

Today the economic situation of the elderly in our country is still fine. Only 1,5-2% of the elderly are living under the poverty line (mostly women 75 years and older) and need social welfare support. In our country it is quite unusual, that grown-up children are giving financial and material support to their parents. Very often parents and grandparents are supporting their children and grandchildren from their pension.

5: Aging does not necessarely means getting frail and dependent.

Most of the elderly people, also of the 80 plus, are competent and able to manage their daily life. A representative study of INFRATEST (1992) on dependency in old age in Germany, in which more than 26.ooo housholds were included, shows, that aging is in no way identical with getting dependent. In the age group of 60-74 years only 3-4% are dependent and need help. In the age group 75-85 years only 10% are dependent – indicating that 90% of this group are fully competent to master the daily challenges. Only in the group 85 years and older 21% of all men and 28% of all women were disabled and dependent. With other words: 79% of the men and 72% of the women 85 years of age and older are competent and able to manage their daily life. That means: aging does not necessarely mean getting frail and dependent. 

But the number of people over the age of 80 will rise – in all the European countries. And so the number of people needing help and care could increase. But it is to expect that dependency and helplessness will start at an later age. According to research findings of SVANBORG,Göteborg, of MANTON from the Duke University in USA and from the Gerontological Center of Geneve/ Switzerland the aged of today are in a much better health status that the aged 15, 20 years ago. The estimated number of persons needing care in the future could be lower if the increase of life expectancy is caused by longer lasting health, fostered by a more healthy life style, by prevention and rehabilitation. Longevity is a challenge for all of us, for every individual and the society!

Today in 80% of the cases family members are the caregivers for the frail aged persons. But this will change in the near future; family care has its limitations

Summarizing the research findings on family care, we have to state:

1. Family care very often leads to conflicts in the own family; sometimes to the separation of the adolescent children from their caring parents and to conflicts in the relationship between husband and wife;

2. Family care is daughter care, but the daughter is very often a grandmother herself. This can lead to adverse effects on these women`s personality develoment and to negative geroprophylaxis. They have more difficulties to prepare themselves for their own aging. Very often the daughter has to take over the care of her parents at an age at which her last chance offers to re-enter labor force or to take over extrafamilial roles in social or political organizations, churches, communities etc.

3. According to the demographic change in many European countries there is a growing number of single elderly persons who do not have children

4. The decrease in the number of children, which means that the care for dependent old parents cannot be provided by the cooperation of several siblings.

5. More and more women are in the labor force, which does not allow an intensive care for a dependent family member.

6. There are some indications also that many elderly people are not too enthusiastic about living in a three-generation-household

7. Very often the one or two children are living far away from their parents – a necessity in industrial societies and in a globalized labor market.

8. There is an increasing divorce rate in many of the European countries (and women will not take care for their ex-mother-in-law)

9. In some cases it is better for the dependent elderly to live in a nursing home where he/she can get adequate medical treatment

10. The rising age of getting frail and dependent – and so the rising age of the potential care-taker

Any policy for the aged should keep in mind the demographic trends, mentionned before, which question the feasibility of considering family care as the only solution for depending frail elderly. In the European survey WALKER & MALTBY (1997) found, that 70% of the population aged 60 and over in Europe agreed to the statement: „Families are less willing to care for older relatives than they used to be" (in Spain and Portugal this were 84 and 83%, in Ireland only 55%)

While it is true that families caring for an aged person and keeping him/her out of nursing homes should be supported by society, it is problematic to rely on family care as the only and best solution. As valuable and helpful caring for a dependent and frail parent or grandparent may be for all family members, and as much as this may contribute to an increase of intergenerational understanding and to an increase of enrichment to the younger generation, it cannot be doubted, that the same situation may lead also to many problems within the family, especially for the women. That means: we need a very differentiated support-system, which has to be adapted to the specific demographic, regional and ecological situation from time to time. In the future we need more high qualified professional help and ambulatory services.

II. Longevity – a challenge for healthy aging

We know that life expectancy and quality of life is not dependent only on physical or biological conditions. Social, psychological and environmental factors are also important. Not only the state of curative medicine affects life expectancy but also – and to a much greater degree – knowledge and compliance with preventive measures. Therefore much more attention should be paid to prevention and rehabilitation. As people are living longer, in fact, it is the task for everyone, but also for the society, to do everything possible to prolong the period of active, healthy life rather than simply to delay the time of death.

Healthy aging is a challenge for every individual, too. Measures of preventioin for maintaining and increasing competence for an indepeneent life are necessary. What can be done to secure a high quality of life in old age? The importance of physical and mental activity must be made clear from childhood on. It is also necessary to maintain a high degree of physical, social and mental activity in men and women during the years of adulthood. 

There are many studies which demonstrate, that physical activity is a prerequisit for successful aging. Age-determined physical changes – such as functional impairments of the organs, changes in the motor system and muscular system as well as changes in the respiratory organs (which of course, depending on the individual, can appear at any age) are similar to the effects of lack of exercise. The young physical inactive individual seems old, just as the old but active individual seems young. Physical activity has also effects on psychological wellbeing by promoting mental abilities, subjective wellbeing, social skills and self-concept.

Mental activity is a prerequisit of successful aging, too. Many studies have found, that mentally more active people, individuals with a higher range of interests, a farther reaching future time perspective and a greater number of social contacts reach old age with greater feelings of psycho-physical wellbeing. It has been established that cognitive activity is essential for healthy aging. An older person must be given mental tasks; she/he must be feeded with (new) informations and be challenged to mental activity. Reduction in mental activity can speed up the process of aging. This can also work in reverse: mental challenge can result in older people acting spontaneously such as one would only expect from younger people.

Motivation for mental, for physical and social activity has to be increased. Numerous possibilities must be offered in order to make this goal attractive to each individual – And many barriers, which are given in our societies (like societys image of older people, ecological conditions) must be reduced or done away completely. 

III. Findings from psychological and gerontological basic research for rehabilitation resp. intervention:

Analyzing many studies we can summarize the results under the following 8 topics:

1. Revising the deficit-model of aging is needed

The last forty years of psychogerontological research provided evidence for the secondary role of the age factor in determining consistency and change in cognitive and social functioning. Socioeconomic factors, personality, health and environment contribute to the stability or instability of the functional status of the aged to a greater extent than the number of years, the chronological age. Aside from this experimental research on the effects of intervention strategies has demonstrated a high degree of plasticity (BALTES, 1984, KRUSE 1992, s.LEHR 2000). From this point of view rehabilitation measures for the aged are urgently suggested by the state of the art in psychogerontology.

Consequences: effects of disease, deficits in cognitive and psychological functions, which formerly were regarded as irreversible can be reduced by adaequate measures of intervention.

2. Distancing oneself from wear-and tear-theories is highly recommended-

Activity is one of the most important conditions for the preservation and restoration of cognitive, psychomotor and social functioning in old age. Wear-and tear-theories suggesting rest and inactivity for the prevention and treatment are rejected by many findings.

Consequences: Prevention and rehabilitation therefore should be focussing on the activation of physical, mental and social abilities.

3. Attention to patterns of aging rather than to age-norms is necessary

Research on aging provided evidence for the existence of a variety of patterns of aging. These patterns may have some biological sources, but more important are personality and social, economic and cohort-specific conditions. The multidimensionality and multidirectionality of aging propcesses have to be taken into regard.

Consequences: Rehabilitation therefore should take into consideration aside from medical points of view also psychological and social aspects.

4. The individuality of processes of aging has to be taken into account.

Aging is a highly individual process. It is a highly specific process, not only for each individual, but also for different organ systems within the same individual (SHOCK et al., 1983, p.207) From a psychosocial point of view the biography of an individual must be taken into account when planning a rehabilitation programme. Historical events are important in this context, especially the age, in which an individual faced these events (like war, inflation, currency reform, displacement etc.). Many attitudes and behaviors which seems age-bound according to frequently prevalence (like religious beliefs, attitude toward sex or political behavior) actually are cohort-specific variables and may change in future cohorts.

Consequences: Measures of rehabilitation should be individually designed and takereagrd of the biography of the patient.

5. Social network has an important role.

The decisive role of the social network for coping with physical handicaps and mental problems was demonstrated in many studies. „Significant others" can be helpful in some situations. But they also can contribute to an reinforcement of dependency (KRUSE & KRUSE.1990; GÖRRES 1992).

Consequences: The family, partners and other persons of the social network should be integrated into the rehabilitation process. These persons should be given informationand –if home care is needed – qualification for these tasks (BRUDER et al.,1981, KRUSE, 1988). Members of the family should be given help, too, in order to prevent negative effects on their own health.

 6.Ecological aspects are important also in gerontology.

The role of ecology in the shaping of human behavior and experiences was demonstrated already 30 years ago. LAWTON (1979) formulated the „docility hypothesis", according to which the variance in independent life style explained by ecological factors decreases with increasing competence of the person. This means. however, also with increasingly poor health and low wellbeing ecological factors gain increasingly more influence. Very often ecological variables as defined by the housing situation, equipment of the home or appartment, rural or urban environments, transportation etc. will determine the degree of dependency of a person. Favorable ecological conditions extend the range of the activity of the person and elicit more activity, social contacts and provide more stimulation. Unfavorable ecological variables may result in a restriction of the life space and a loss of abilities and skills (WAHL,1992).

Consequences: Rehabilitation plans must take into consideration also ecological factors. Often an adaptation of the home to the specific needs of an individual will contribute to more independence of a handicapped elderly person. General guidelines for the construction of appartments for the elderly will be of limited help in this context.

 7. Cognitive representations of situation are the main determinants of behavior. The role of the cognitive representation of situations for the shaping of human behavior has been demonstrated in many studies (THOMAE, 1970, LEHR 1972, 2000, LEHR, SCHMITZ-SCHERZER, THOMAE, 1974, THOMAE1974, KRUSE 1989). The individual behaves according the situation as perceived rather than to the objective equality of the situation. This is true for his behavior toward the family, regarding the housing situation, and regarding the own health resp.illness. This should be taken into account also in the interaction of the doctor with the patient which is most important for the subjective health of the patient.

In the Bonn Longitudinal study of aging (BOLSA) and the ILSE, the interdisciplinary longitudinal study of adulthood and aging and ion the BASE it was shown, that subjective health was more associated with wellbeing and longevity than objective health. Subjective health also predicted more mortality in the New Haven Health Survey in a highly significant way. 

Consequences: All members of the rehabilitation team should be informed about the role of subjective awareness of the situation, especially the own health status. Too much or too less information can have detrimental effects for the well-being of the patient. These effects will cause a retardation in the rehabilitytion process. Doctors and their team should know that behavior is dependent on the perceived situation rather than on the objective situation.

8.Coping with health problems can be promoted by many new insights.

The role of patterns of coping with poor health was demonstrated in studies on patients suffering from stroke, cardiovascular diseases, cancer, etc. MEIER-BAUMGARTNER (1992) emphasized: „The success of the rehabilitation process is dependent on equal degree of effective emotional and cognitive coping with illness on the one hand and of the improvement of the functional (ADL) status" (1992.p.100)

Favorable coping strategies were „accepting" the disease or the handicap (but „make the best of it"), which were followed by „achievement related behavior" or „using chances", „hope" and „adjustment to the situation". Unfavorable response patterns were „evasive reaction", „depressive reactions", non-compliance and „agressive behavior" The unfavorable coping-styles were found more frequently in patients who believed in the unchangeability of their situation and in low own or society`s control of this situation.

Consequences: The patient should be informed about the ways how to deal with his/her situation. It is important to show the patioent aside from the limitations of his functional status also the chances for a change in this situation. He must be guided to accept the handicap but also stimulated to make the best of it, to use all chances availiable and to cope psychologically with it.

The main goal of all kind of intervention measures is to reach a long life with psychophysical wellbeing. – But there is a variety of determinants, which is influencing longevity and wellbeing in old age

IV. The multidimensional determinants of longevity

From results of many studies we can conclude that no single one variable can independently explain longevity. As influential as genetic, biological and physical factors may be, they are not sufficient in explaining longevity.

The results of international longevity research point to a numer of interesting relationships. And yet, considering the present state of research, it still seems premature to derive theories or even lawful relationships which may be related toi long life expectancy. Especially it should be stressed, that a series of factors that can possible influence increased life expectancy interact with each other. This interaction points apparently to a complicated reciprocal causal network.

A possible model of these interacting influences upon longevity you can see in this figure :

Genetic, physical and biological factors can be regarded as having a direct influence upon longevity (1) and also upon the personality development (2) of an individual (personality, intelligence, activity, moral, adaptation, self-esteem, coping styles etc.) Personality, moreover, is determined by socialization processes, child-rearing methods, the teachers, significant others, and the social environment in general; historical factors also play a role in this socialization process (3) In addition, ecological determinants such as physical environment, living in urban or rural areas with their specific stimulations, and climatic conditions have an impact on personality development (4). A number of studies have determined direct connections between personality (especially activity) and longevity (5). Correlations between ecological factors and longevity (6) are frequently referred, too, in studies of centenarians. Personality variables, on the other hand, have an impact on education and occupational training, on occupational activities, and so on socioeconomic status (7). Correlations between social status and longevity (8) have been derived primarily from vital statistics and demographic analyses and also by follow-up and longitudinal studies finding increased life expectancy for persons with high socioeconomic status. Social status (9) and personality (10) as well as ecological factors (11) influence nutritional habits. Moreover, a direct correlation between nutrition and longevity (12) is claimed to exist. The role of nutrition for diabetes in relation to age and nutritional aspects of atherosclerosis and stroke have to be mentioned here. Smoking and use of alcohol must be mentionned, too. – Genetic and biological factors (13), personality (14), ecological variables (15) and socioeconomic status (16) have been found to influence physical activities and sports, and also preventiove medical care and hygiene. Correlation of all these variables with longevity (17) have also been demonstrated,

Our model by no means includes all variables that may possibly influence longevity. It is merely meant to stimulate further empirical studies and to provide encouragement for future modification, elaboration and differentiation.

V. A policy for healthy aging - a challenge of our time!

Today a policy for the elderly has to be more than a policy for pensions systems and a policy for care and has to include also other aspects than financial ones. In order to cope with the challenges of a graying world three issues should be stressed. 

1. The first issue is maintaining and increasing the competence of the elderly in order to prevent dependency , to secure a healthy aging with a high degree of quality of life.

2. The second one is the extension and the improvement of rehabilitation measures in order to re-enable the elderly for an independent life. It is quite necessary to promote rehabilitation programmes for the aged and to qualify the medical doctors and nurses in geriatric medicine and gerontology:

3. The third issue asks for the solution of the problem of the dependent and frail elderly, and the problems of caring.

A policy for the aged is a policy for healthy aging, combined with a state of psycho-physical wellbeing. We know, aging is affected by biological heredity as well as by individual behavior and a wide range of social, environmental, cultural and political factors. Healthy aging is the result of a life long process. So it is necessary to optimize the development of the individual. We know that a variety of influences in early childhood, adolescence, during early and middle adulthood, but also the present life situation of the aged are determining the process of aging and well-being in old age. Interdisciplinary cooperation is needed, to which biology of aging, geriatrics, behavioral as well as social sciences should contribute. Healthy aging is a challenge for all gerontologists and geriatricians, a challenge for scientists of many disciplines – a challenge for politicians and a challenge for all practitioners, for all persons, working with the aged.

In 1985 Robert BUTLER asserted firmly that „the participation of older people enriches societies, economically, culturally and spiritually". Health and productivity are closely connected. The loss of one may entail the loss of the other and so lead to dependency, decline of mental, psychological and physical abilities, and incompetence – whereas productivity, participation, responsibility and the feeling of being needed have a favourable effect on health. And BUTLER stated: „Much discussion of health...is really a discussion of medicine. The medical model is a very restricted one. Only relatively recently has attention been drawn to the elements of health promotion and disease prevention, a movement toward a broader social definition of health" (p.7), and: We have to „recognize that health and productivity are interacting conditions. The unproductive human is at higher risk of illness and economic dependency; and the sick person is limited in productivity and is, therefore, at higher risk of dependency" (BUTLER, 1985, p.12).

Concluding remarks:

The demographic change, the aging Europe and the aging world, is a challenge for all of us. A policy for the aged, however, should not be determined only by the question: „What can we do for the aged?"; it also should be asked: „What can the aged do for the society ?". For this we need to revise the negative image of the aged, which can be found in some European countries – like in Germany. Most of the elderly are competent and wish to engage themselves for other people, for the society. Societies, communities, churches, clubs etc. should promote this readiness for voluntary public engagement and be prepared to provide the framework and to utilize the potential and services elderly people have to offer.

From some political and economic discussions in our country one could get the impression, that the extension of life span is the worst thing which could happen for the human race because of the rising costs for pensions and for the health care system. Listening to some of the messages of politicians one could feell that it is very unlucky that so many people survive into very high ages and get their pension for which the younger generation has to pay. One should not forget, however, that mankind took many efforts since many centuries to enable people to survive into old age. The history of medicine is also one of continuos efforts for the prolongation of human life. It would be strange to consider the great progress made in clinical medicine, in biology, in pharmacology as bad luck for women and men. Since many years the WHO is promoting programmes for a healthy aging. science and politics are striving together to create new medical and economic conditions for this aim – and to educate people for a healthier life style.

The increasing life expectancy shows that they were successful. We should be happy thereabout! It would be ungreatful not to appreciate the progress made so far in attaining a remarkable decrease in morbidity and mortality and focussing only on the high costs associated with longevity.

Old age, longevity, should not be seen as a problem but as a chance and challenge – a challenge for everyone: for the aging individual, for his family and for our society. We should not only ask for the problems and defizits of aging and old age. We have to ask for – and we have to open our eyes for- the new potentials of the aged, also for the competences and new potentials of the very old persons. We have to see the aged as human capital.


See: Ursula LEHR : Psychologie des Alterns, 9.Edition, völlig überarbeitet von Hans 

THOMAE & Ursula LEHR, Quelle & Meyer, Wiesbaden-Heidelberg, 2000