Increased life expectancy has led to policy interest in adding quality to years of life and in related concepts such as attitudes to ageing. Improving attitudes to ageing is regarded as one means of improving the participation and contribution of older people within society. In considering age- related attitudes in the dynamic nature of social identity, age is not just one social category that may or may not constitute a part of one’s identity. Other identities such as gender may be more salient in attitudes to ageing. The purpose of this study was to explore Norwegian gender differences in attitudes to ageing among 282 females and 200 males living in the community. Attitudes to ageing were measured using the Attitudes to Ageing Questionnaire (AAQ; Laidlaw, Power, Schmidt, & the WHOQOL-OLD Group, 2007). Both genders in this study had positive attitudes toward their ageing, in spite of acknowledging loss with problems of exclusion, making friends and talking about difficult feelings. Compared to men, women perceived ageing as a time of greater loss, however, they felt more strongly that ageing brought wisdom and that their life had made a difference. On the other hand, men felt more strongly that physical problems did not hold them back from doing what they wanted to do and believed more strongly that they passed on their experiences to others. Both genders felt that their identity was not defined by age, they didn’t feel old, aging was a privilege, and appraised the importance of exercising. Attitudes to ageing are becoming increasingly important in ageing societies. Such positive attitudes should be regarded with importance to health professionals, leaders and policy makers in planning interventions to buffer the detrimental aspects of ageing.
Populations worldwide are ageing with women living longer than men. Women make up two-thirds of the global population over 80 and as life expectancy rises, this proportion will increase. On average, women also live 2 - 8 years longer than men, and make up a larger proportion of the “old-old” group. They have a greater chance of being widowed, experience reduced nutrition, lower education, and limited access to services in earlier life resulting in poor health in old age. Men, on the other hand, tend to suffer from the loss of a declining capacity to meet their traditional role as breadwinners in old age, which can leave them vulnerable. Men also have higher mortality rates, shorter life spans, and exhibit more risk taking behaviour from a global perspective. Many policy makers proclaim that this situation will result in higher expenditures on health and social services for this age group [
Norway is also ageing. Those aged 65 and over account for 13% of the population with an expected increase to 21% in 2050 [
Increased life expectancy has led to policy interest in adding quality to years of life and in related concepts such as attitudes to ageing and successful ageing. Ageing attitudes have powerful influences not only upon older adults’ perception of health, quality of life and utilization of health and social care services, but should also influence the provision of health services for this age group. Improving attitudes to ageing is regarded as one means of improving the participation and contribution of older people within society [
Researchers have been criticized for perpetuating a narrow view of aging by concentrating on the central tendencies within a group and ignoring the substantial differences [
Erik Erikson proposed a psychosocial theory of development which is perhaps one of the best known stage theories of adult personality [
Erikson described the last stage of life development as “wisdom: ego integrity versus despair” covering the ages from 65 to death. Successful resolution of this stage results in being able to look back on one’s life, finding meaning and developing a sense of wisdom before death. Alternatively, meaningless and despair can ensue if life review results in primarily negative outcomes. If the stage is managed poorly, the person will emerge with a sense of inadequacy and not develop the essential skills needed for a strong sense of identity and self. In other words, feelings of ego integrity versus despair, are focused on retrospection where people look back on their lives and accomplishments and confront the existential question of “is it okay to have been me in this life?” People develop feelings of wisdom, contentment and integrity if they believe that they have led a happy, productive and successful life. However, if they regard their lives as unproductive, experience guilt, or feel that they did not accomplish their goals, they become dissatisfied with life and develop despair, often leading to depression and hopelessness.
The data used in this paper is part of a larger study of quality of life among older adults funded by the European Commission, in collaboration with the World Health Organization [
Of the 802 older adults who were sent invitations to participate, 401 consented and were sent questionnaires by mail. Another randomized sample of 89 older adults receiving formalized health care services (home care) was drawn from Statistics Norway to increase participation of frailer older people more likely to have morbidities, primarily with a view to capturing varied levels of quality of life. These frailer older people were also personally interviewed to minimize respondent burden. A total of 282 females and 200 males participated in the study. For the sample participating in the postal survey the response rate was 53%. Unfortunately, no record was kept regarding those participants were asked yet refused to take part by personal interviews. Inclusion criteria were: 60 or more years of age, Norwegian speaking, resident of Norway, no illness likely to cause death within the next six months, and no significant cognitive impairment. Questionnaire packets included study information, informed consent forms, sociodemographic questions, an attitude toward aging scale, and questions assessing quality of life, psychological distress and health. This paper is focused on the attitudes to ageing questionnaire data.
Attitude to Ageing Questionnaire (ATA)
The ATA consists of 24 items comprising a three-facet model based on psychosocial loss, physical change and psychological growth [
Total subscale scores were calculated as the sum of item values in the separate domains. Descriptive statistics were used to examine the frequency distributions and means of the variables. To analyze internal consistency of the ATA, Cronbach alpha was applied. A Cronbach alpha coefficient above 0.70 indicates good reliability [
The study was approved by the Norwegian Data Inspectorate and the Regional Ethical Committee. For those participating in the postal survey, informed consent was sent and returned with the battery of instruments sent to the participants. For those participating in the personal interviews, written consent was obtained prior to the interviewing.
The total sample was composed of 58% women and 41% men. Both women and men had a mean age of 76 years. Most adults were married or partnered, 88% women and 87% men. Eleven percent of the women and 13% of the men were non-married, widowed or divorced. Educational status among women showed that 41% had completed primary education, 36% high school, and 23% post-secondary education. Among the men, 28% had completed primary education, 26%, high school, and 55% post-secondary. Both 83% of the women and men appraised themselves to be healthy. In spite of this fact, 28% of both women and men had at least one disease, with 16% of the women and 8% of the men stating they had two diseases. Further, eleven percent of the women and 6% of the men reported three diseases or more.
The results in
The psychosocial loss subscale showed that for women that attitudes were significantly more negative in appraising old age as a time of loss as compared to men ( women 4.13 (SD 0.97), men 3.90 (SD 1.02), p = 0.05). For both men and women, the highest mean score for psychosocial loss was feeling excluded from activities due to age (women 4.42 (SD 0.95), men 4.26 (SD 0.80). For men, the next highest mean score regarding psychosocial loss was feeling that old age is a time of loss (3.90 (SD 1.02), followed by perceiving it difficult to make friends (3.68 (SD 1.13) and difficult to talk about feelings (3.66 (SD 104). For women, the next highest mean score was perceiving it difficult to make friends (377 (SD 1.22) and difficulties with talking about feelings (3.77 (SD 1.22). Regarding psychosocial losses, the lowest means scores for both men and women was affirming that old age is a time of loneliness (women 3.11 (SD 1.16), men 3.11 (SD 1.01).
Regarding “physical change” men’s attitudes were significantly more positive to feeling that physical problems did not hold them back from doing what they wanted to do ( men 3.08 (SD 1.22), women 2.9 ( SD 1.28), p = 0.05). For both men and women the highest mean scores regarding physical change was the importance of exercising at any age (men 4.64 (SD 5.28), women 4.58 (SD 0.73). The next highest mean scores for men was feeling their identity was not defined by age (3.42 (SD 1.26), followed by the importance of keeping fit by exercising (3.25 (SD 1.25). For women, the next highest mean score was not feeling old (3.41 (SD 1.33), followed by one’s identity not defined by age (3.35 (SD 1.36) growing older is easier than thought (3.41 (SD 1.33). Further, for both men and women the lowest mean scores were related to feeling that they did not have more energy than they had expected (men 2.83 (SD 1.18), women 2.75 (SD 1.3).
Domains and Items | Females Mean (SD) | Males Mean (SD) | Mean Difference (95%CI) |
---|---|---|---|
Psychosocial Loss | 29.02(4.94) | 28.34 (4.72) | 0.679 (−0.203 - 1.56)a |
Old age is a time of loneliness Old age is depressing Difficult to talk about feelings Old age is a time of loss Lose physical independence Difficult to make new friends Don’t feel involved in society Feel excluded due to my age | 3.11 (1.16) 3.62 (1.04) 3.76 (1.13) 4.13 (.96) 3.51 (1.13) 3.77 (1.22) 3.44 (1.21) 4.42 (0.95) | 3.11 (1.01) 3.52 (1.05) 3.66 (1.04) 3.90 (1.02) 3.46 (1.06) 3.68 (1.13) 3.54 (1.15) 4.26 (0.80) | 0.003 (−0.192 - 0.199)a 0.120 (−0.069 - 0.310)a 0.103 (−0.095 - 0.301)a 0.221 (0.041 - 0.399)* 0.052 (−0.148 - 0.253)a 0.086 (−0.128 - 0.301)a −0.093 (−0.309 - 0.122)a 0.156 (−0.005 - 0.317)a |
Physical Change | 26.11 (6.23) | 26.76 (5.28) | −0.654 (-1.69 - 0.379)a |
Important to exercise at any age Growing older is easier than I thought I don’t feel old My identity is not defined by my age I have more energy than expected Physical problems don’t hold me back Health is better than expected Keep fit by exercising | 4.58 (0.73) 3.21 (1.19) 3.41 (1.33) 3.35 (1.36) 2.75 (1.3) 2.84(1.34) 2.93 (1.3) 3.11 (1.4) | 4.64 (0.59) 3.13 (0.99) 3.36 (1.21) 3.42 (1.26) 2.83 (1.18) 3.05 (1.28) 3.08 (1.2) 3.25 (1.25) | −0.060 (−0.179 - 0.059)a 0.071 (−0.125 - 0.268)a 0.050 (−0.180 - 0.280)a −0.066 (−0.306 - 0.173)a −0.078 (−0.304 - 0.149)a −0.245 (−0.484 - 0.006)* −0.183 (−0.415 - 0.049)a −0.145 (−0.388 - 0.098)a |
Psychosocial Growth | 28.88 (4.86) | 28.06 (4.70) | 0.821 (−0.050 - 1.69)a |
Better able to cope Growing old is a privilege Wisdom comes with age Pleasant things about growing older More accepting of self Pass on benefits of experience My life has made a difference Want to give a good example | 3.28F (0.99) 3.62 (1.04) 3.69 (.94) 3.83 (.91) 3.31 (1.21) 3.63 (1.15) 3.94 (1.01) 3.68 (1.01) | 3.12 (0.88) 3.61 (1.05) 3.43 (0.95) 3.79 (0.80) 3.23 (0.98) 3.84 (0.98) 3.57 (1.09) 3.49 (1.03) | 0.104 (−0.065 - 0.273)a 0.004 (−0.186 - 0.193)a 0.251 (0.080 - 0.422)** 0.046 (−0.112 - 0.203)a 0.084 (−0.106 - 0.273)a -0.216 (−0.409 - 0.023)* 0.364 (0.168 - 0.560)*** 0.185 (−0.009 - 0.380)a |
Note: CI = confidence interval: nsa, p < 0.05*, p < 0.01**, p < 0.001***; Note: 8 participants with missing answers.
Regarding psychosocial growth, more significant differences were found between the genders. Women’s atti- tudes towards gaining wisdom was significantly more positive than men (women 3.69 (SD 0.94), men 3.43 (SD 0.95), p = 0.01). Men, on other hand, had more positive attitudes towards feeling that they passed on benefits of experience to younger generations than women (men 3.84 (SD 0.98), women 3.63 (SD 1.15), p = 0.05). Significant differences were also found between men and women’s attitudes toward believing their life had made a difference, where women were significantly more positive (women 3.94, (SD 1.01, men 3.47 (SD 1.09), p = 0.001). For men, the next highest mean score regarding psychosocial growth, was feeling that there were many pleasant things about being older (3.79 (SD 0.80), followed by feeling that growing old was a privilege (2.61 (SD 1.05). For women, the next highest mean score regarding growth, was feeling there are many pleasant things about growing older (3.83 (SD 0.91), followed by feeling wisdom comes with age (3.79 (SD 0.80) and growing old was a privilege (3.62 (SD 1.04). For all three subscales, most items had scores slightly above average mean scores suggesting positive trends towards attitudes to ageing.
Although aging occurs at varying rates, women have been found to find ageing more negative than men [
Women’s feeling of loss may be related to appraising more issues as important to their quality of life. This may also be connected to the fact that they have more multiple past-present identities than men. In an earlier study with the same Norwegian sample, comparison across genders revealed that a fourth of the items on a quality of life scale were more important to women [
Women have a different relationship to their bodies than men which may have impacted their attitudes. Body image and appearance have been found to be more important to older women than men [
Feeling of loss among older women could also be due to the fact that they compare themselves to younger and middle aged women. Since the Second World War, women’s increased educational opportunities, widening occupational and public roles, greater capacity for self?realization and their increased capacity to control their fertility are opportunities few older women have experienced. Older women were largely engaged in childcare and domestic support for their husbands. Feeling of loss in women may therefore reflect a culmination of lifetime experiences within social structures influenced by gender disparity.
Women’s feeling of loss may also be related to a sense of diminished sense of control over their lives. Importantly, a sense of control has been shown to be an important resource for avoiding loneliness in later life among Norwegians, especially for people with impairment [
Both men and women experienced difficulty in talking about feelings. This finding has also been reported by a large Norwegian survey (2012) showing that 12% of those 67 years or older have little contact with friends, 9% are without a close friend and 9% have little contact with good friends by phone, email, internet, etc. [
From a life developmental perspective, the concept of “life review” has been described as being related to developmental task of later age [
Both men and women felt excluded from activities due to their age. In another study, which applied the Attitudes to Ageing Questionnaire among older adults, feeling excluded from activities was also a major finding [
Regarding physical changes, positive attitudes toward activity and exercising played an important role for both genders. Activity limitation is one of the most frequent geriatric clinical syndromes with both individual and societal effects. Importantly, the concept of activity is central to the International Classification of Functioning, Disability and Health (ICF) and is considered vital to successful ageing [
Both genders had positive attitudes toward feeling their identity was not defined by age. Queniart and Charpentier [
Notably, both genders felt there were many positive things about growing in spite of the fact they acknowledged existing losses and physical changes. Positive attitudes to ageing have been found in other national and international research, but unfortunately, become less visible against existing negative stereotypes of ageing. For example, Bryant et al. [
It is recommended that future studies explore subjective meanings and importance issues given to sources of psychological growth, physical changes and psychological growth in both qualitative and quantitative studies. It would also be interesting to investigate such changes from a developmental theoretical perspective in clarifying gender differences in what constitutes gains and losses in later life and the relationships between them. Because men and women have different relationship to bodily changes, it would be interesting to investigate similarities and differences in body concerns, and what coping strategies are used to manage these changes, together with considering how societal stereotypes and traditional sex-role stereotypes may contribute to gendered perceptions. Because both genders felt excluded from activities due to their age, qualitative data on exploring what potential meaningful activities men and women regard important to their sense of self should be explored, and how such participation might enhance the sharing of difficult feelings. This theme could also be explored in relation to how sensory abilities and civil status impact these aspects. Lastly, because both men and women felt that their identity was not defined by age and there were many positive things about ageing, it would be interesting to explore how old or young older men and women actually feel in regards to their chronological age and how this perceived age is related to other factors such as health, psychological and social characteristics. Here, both qualitative and quantitative studies with longitudinal perspectives would also enhance understanding of the similarities and differences between genders.
According to recruitment procedures, the strength of this study rests in the representative sampling techniques which were employed. The older people in the sample consisted of a randomized heterogeneous group of older people living in the community with a wide variety of diseases, representing many geographical areas in Norway. In spite of this strength, several limitations to this study should be noted. There is a lack of representation of older ethnic groups in our sample. Non respondents were not recorded and only a few nursing home residents participated who may represent those most frail. Cognitive problems were not measured with the use of validated scales. Although personal interviews are described as the least burdensome method for collecting data among older adults, they have been shown to be more conducive to more positive and socially desirable responses as compared to survey methods [
Older adults are faced with numerous physical, psychological and social changes that challenge their sense of self. Consequently, old age is often characterized as a period of declining quality of life impacted by negative attitudes. Notably, both genders in this study had positive attitudes toward their ageing, in spite of acknowledging loss with problems of exclusion, making friends and talking about difficult feelings. Identity issues such as identity not being defined by age, not feeling old, aging as a privilege and making a difference, growing in wisdom and passing on benefits to the next generation, as well as the importance of physical activity should be explored in relation to how these issues help counter balance negativity and lead to resiliency and ego strength. Attitudes to ageing are becoming increasingly important in ageing societies. Such positive attitudes should be regarded with importance to health professionals, leaders and policy makers in planning interventions to buffer the detrimental aspects of ageing.
The author is grateful to Diakonova University College in Oslo for financial support in carrying out this study. Special appreciation is given to Dr. Liv Halvorsrud who helped collect primary data for this study, Dr. Gail Low who helped with the statistical analyses and Jenny Owe, Head Librarian, who helped with the references. The author also expresses appreciation to the anonymous reviewers.
Mary Kalfoss, (2016) Gender Differences in Attitudes to Ageing among Norwegian Older Adults. Open Journal of Nursing,06,255-266. doi: 10.4236/ojn.2016.63026