Aging Beyond Frailty: The Future of Old Age

Critical reflections on the blind sides of frailty in later life

Since the 1970's, frailty emerged as a major theme and has become one of the most researched topics in aging studies. However, throughout the years, the concept 'frailty' became susceptible to different interpretations and has been approached by different synonyms, which resulted in a confusing picture. Based on a narrative literature review, this theoretical paper not only attempts to describe these different views on frailty, but by criticizing the dominance of some of these views, it also aspires to move the research and policy agenda on frailty forward. This paper is part of the D-SCOPE project in Belgium, and critically reflects on the blind sides of the biomedical domination of frailty and discusses three main themes: 1) frailty as a multidimensional and multilevel concept; 2) positive perspectives on frailty in later life; and 3) the suggestion of moving from a merely deficit-based frailty approach towards the concept of frailty-balance. At the theoretical level, conceptualizing frailty is not simply an exercise in semantics, but altering the theoretical definition of frailty can have wide-ranging implications, not only for the way frailty prevalence is measured and handled, but also for public or personal opinions on frailty in older people, for care and support practices, and for the scope of legislation. Therefore, the final section of the paper presents three building blocks for future research and policy-making: 1) adopting a multidimensional, multilevel, dynamic and positive view on frailty; 2) moving from dependency to interdependency; and 3) giving voice to (the resilience of) frail older people.

The practice of dealing with existential questions in long-term elderly care

Purpose: Existential questions concerning life and death or meaning in life are very salient for many older people receiving long-term care. However, little is known about how long-term care organizations deal with existential issues. This study describes the practice in two long-term care organizations that took part in a Dutch pilot programme on existential questions and formulates recommendations for building a professional quality framework. Method: Starting from theoretical notions on ultimate concerns, life events and meaning in life, organization policy and care practices were explored. Existing documents, in-depth interviews and participatory observations were used as data sources. Results: The outcomes indicate that the long-term care organizations had little active policy on dealing with existential questions; also, personnel had few specific tools except listening closely. Central requirements for dealing with existential questions appeared to involve organizational framework conditions like the availability of spiritual counsellors, having facilities in the building, and clear roles for various actors. Moreover, social-communicative competence building for care personnel was found to be an important demand as well as an organization-wide attitude that puts residents at centre stage. Conclusions: A professional quality framework requires a “tiered system” that differentiates organizational roles in dealing with existential questions.

Cognitive enhancement for the ageing world: opportunities and challenges

Population ageing and the global burden of dementia pose a major challenge for human societies and a priority for public health. Cognitive enhancement,i.e.the targeted amplification of core cognitive abilities, is raising increasing attention among researchers as an effective strategy to complement traditional therapeutic and assistive approaches, and reduce the impact of age-related cognitive disability. In this paper, we discuss the possible applicability of cognitive enhancement for public health purposes to mitigate the burden of population ageing and dementia. After discussing the promises and challenges associated with enhancing ageing citizens and people with cognitive disabilities, we argue that global societies have a moral obligation to consider the careful use of cognitive enhancement technologies as a possible strategy to improve individual and public health. In addition, we address a few primary normative issues and possible objections that could arise from the implementation of public health-oriented cognitive enhancement technologies.

'Holding on to life': An ethnographic study of living well at home in old age

In recent years, much attention has been paid to how older people living at home can remain independent and manage their illness themselves, while less attention has been given to those who have become frail and need assistance with challenges of everyday life. In this article, I drew on Latimer's formulation of care for frail older people as relational and world-making and on Foucault's work related to the care of the self in developing an understanding of how frail older persons manage to live well at home in the final years of their lives. I use data from an ethnographic study of home care nursing in the homes of 15 frail older people to develop an understanding of how their care at home can be developed. The participants were holding on to life, which reflected their vitality and vulnerability as well as agency in continuing to explore ways to preserve and build their world at home. With declining ability and stamina relations with material things, relatives and official care workers become of central importance in holding on to life. Home care services can be thought of as part of life, as world-forming, where workers contribute to daily activities that support living well at home.