The Fourth Age: Quality of Life

 

Aztec Ruins in Aztec, New Mexico. April 2013. Credit: Mzuriana. 

Remember that the Fourth Age is the time when our bodies, and perhaps our cognitive functioning, have begun the process of shutting down shop.

I have questions about the Fourth Age

Who decides if a 4th-ager is enjoying a rich quality of life? 

What does a rich quality of life look like when one is in the Fourth Age? Is the definition equivalent to that of someone under age 60 who:

• Is in hospice? 
• Has physical, mental, or cognitive disability that requires accommodations of some sort? 

Or do we segregate 4th-agers into a special category that allows us to lower the quality-of-life standards that younger people enjoy, thus contributing to:

• Infantilization
• Denial of rights to self-determination (including the right to make mistakes and stupid decisions sometimes), and 
• Learned helplessness? (Or perhaps, more accurately put: taught helplessness)

Must the definition of a rich quality of life for 4th-agers be relative and not absolute? In other words, does it require the qualifier "for her age,"  as in: Life kinda sucks, but it sucks less than the lives of most people her age.

Again I must circle back to: What is the definition of the Fourth Age?

From the 2018 article Self-perception during the Transition to the Fourth Age in the Czech Republic are these thoughts (which I've chunked for easier readability): 

"A definition proposed by Gilleard and Higgs describes the fourth age as the period:

1. When individuals are seen as no longer being able to manage their everyday life, 
2. 'When they become third persons in others’ age-based discourse, within others’ rules' [Gilleard and Higgs, 2010: 122], 
3. Which in turn results in a process of 'othering'—i.e., of becoming the other, who is discursively associated with alienation, vulnerability (associated with frailty), and a state of abjection [Higgs and Gilleard, 2014]. 

Othering simultaneously becomes part of a person’s identity:

1. Not only in terms of self-perception, 
2. But also as a dynamic relationship between self-perception and how one is seen by others, 
3. As well as the approach of institutions and practices that are anchored within wider cultural frames. 

The sense of identity of fourth-agers is described as being continually renegotiated ....  leading to a radical form of othering that increasingly separates the older adults and infirm from the rest of humanity [van Dyk, 2016]." 

Studies about quality of life of people over age 85

This study was a meta-survey study of other research that asked "older people" how they define quality of life. 

The researchers used these QoL (quality of life) domains (categories): 

1. Attitude and adaptation
2. autonomy 
3. Emotional comfort
4. Financial security
5. Health perception
6. Home and neighborhood
7. Relationships
8. Role and activity
9. Spirituality

Table 1 shows the ages of the subjects. Unfortunately, the ages of the subjects in some of the included studies begin at 60. Furthermore, all of the subjects lived at home.

 On the bright side, I like Table 2 for showing the criteria the researchers used to measure each of the domains. 

Another wrinkle. So to speak. 

From the article, The Impact of Quality of Life on the Health of Older People from a Multidimensional Perspective [Emphases and chunking added]:

"As we have already mentioned, quality of life and life satisfaction are different concepts, but at the same time, they are complementary.

Life satisfaction represents an indicator of quality of life ....  focuses on moral, cognitive, and affective aspects, on the tasks carried out independently, and on satisfaction with social support received and, in general, is related to life expectancy.

On the contrary, quality of life is ... linked to ... the ability to be independent in their daily activities. .... improving self-esteem, satisfaction with functioning, a sense of independence in daily life tasks, and a sense of participation, which are important components of the whole structure that makes up the standards of quality of life of the elderly.

Alas, this was another study with an age threshold of 65. And, yes, a person age 65 can be in the Fourth Age, depending on their health status, but generally speaking, age 65 is toward the beginning of the Third Age. 

Can my 4th-age quality of life measurement be absolute or must it be relative? 

By this I mean, do I use different QoL scales depending on my residence:

• In my own home (alone? with a mate? with a roommate? with a caregiver?)
• In an assisted living situation (with communal dining? with my own kitchen?)
• In a nursing home
• With a family member (in the same home? in a casita on the same property?)
• In a shared-housing residence (a la Golden Girls)
• In hospice (at  home? in a hospice facility?)

Do I use different QoL scales depending on the nature of my disabilities (if, by definition, a person has at least one disability in the Fourth Age):

• Cognitive impairment?
• Memory impairment?
• Nature and extent of mobility impairment?
• Pain management?
• Complexity of health management, such as for diabetes, cancer treatment (or palliative care)
• Vision impairment
• Hearing impairment

I don't have answers, clearly. 

At a certain point, however, I'll need to define my personal measures for quality of life. Doing this will help me:

1. Fashion a Plan A, Plan B, and Plan C for my 4th age, dependent on various typical scenarios
2. Have SWOT conversations with my descendants about the Strengths - Weaknesses and  Opportunities - Threats to my (our) plans for my 4th age. 

In the meantime, I continue to watch and learn from both positive and negative role models in their aging process.