four - Is it possible to ‘age successfully’ with extensive physical impairments?

Summary

Introduction

The question in the title of this chapter is the point of departure for the discussion here: is it possible to age actively and ‘successfully’ with extensive impairments?

Recent decades have witnessed the emergence of a perspective on ageing that has provided a sharp contrast to the negative loss and decline perspective that has dominated gerontology for many years (Minkler and Fadem, 2002). A common trait among scholars promoting this positive and active view is to present avoidance or absence of disease and impairment as prerequisites for enabling later life to become a period of engagement and self-fulfilment. For example, Laslett (1989) argues that even if the preconditions for self-realisation and pursuit of leisure activities, characteristic of the so-called ‘third age’, are often greatest when one has passed retirement age, retirement as such does not ensure active and positive ageing. What Laslett describes as crucial, on the other hand, is a person's health and functional state. Similarly, characterisations of active, ‘successful’ ageing have been closely related to the maintenance of high physical and cognitive functions (Minkler and Fadem, 2002). Laying out their model of successful ageing, Rowe and Kahn (1987, 1997, 1998) highlight three hierarchically ordered features as necessary preconditions for successful ageing: avoiding disease and disability, maintaining mental and physical functions and continuing engagement with life. Even the critical voices raised against the notion of ‘successful ageing’ seem to assume that impairments naturally and inevitably exclude older people from adopting an active lifestyle. This assumed exclusion is, in fact, the basis for their criticism. For example, Blaikie (1999), Öberg and Tornstam (2001) and Minkler and Holstein (2005) have, among others, argued that the ideal of the active pensioner is likely to reinforce the stigma surrounding diseases and impairments in older age and to contribute to the marginalisation of a large group of sick and disabled old-age pensioners. According to Cohen (2005), comparisons between seniors with impairments and ‘successful agers’ should, for this reason, be avoided altogether: ‘Those and others who have been precluded from the formulas to successful aging by illness, trauma, or other cause of impairment, should not be contrasted to the successful agers, and even by implication characterised as failures’ (Cohen, 2005, p 111; original emphasis).