The Glossary has been prepared based on principles from many sources, including the creation of the Oxford English Dictionary.
The importance of language in reaching agreement It is very important to agree the meanings of the terms we use, terms such as ageing or growing older. Often disagreements and misunderstandings occur because the people trying to reach agreement are using the same term but with different meanings. This is one reason for producing the Live Longer Better glossary, but there is another important reason.
The importance of language in changing culture To change culture, we have to change language. It is now generally agreed that the culture of an organisation is the most important determinant of success. It is also accepted that a key factor distinguishing leadership from management is that leadership is responsible for shaping the culture whilst management works within that culture.
“When we examine culture and leadership closely, we see that they are two sides of the same coin; neither can really be understood by itself. If one wishes to distinguish leadership from management or administration, one can argue that leadership creates and changes cultures, while management and administration act within a culture.” Source: Schein, E.H. (2004) Organizational Culture and Leadership. John Wiley & Sons Inc. (pp.10-11).
To change culture, the leadership needs to do many things. One of them is to create the right language, for example introducing the word enablement and stopping using the word care. But language can play an even more revolutionary role. It can even create a new reality.
The importance of language in creating reality
The traditional view of language was that it described reality. This is undoubtedly true for physical objects such as “a table” or “chair” however a number of philosophers, anthropologists and sociologists have written how language does not simply describe social reality; it creates it. So, the adoption of a new set of terms changes reality and creates a new reality.
The clearest description of the relationship between language and reality comes from anthropologists, notably Benjamin Lee Whorf who worked as a loss adjuster for The Hartford Fire Insurance Company and studied the language of the Hopi Indians. He created the theory of linguistic relativity, which proposes that language creates social realities such as “the future” or “the quality of evidence” – or, indeed, “evidence-based healthcare”. Through the use and evolution of language comes social change and social reality. Sociologists have further developed the work of anthropologists such as Whorf and Edward Sapir, whose Whorf Sapir hypothesis of linguistic relativity is the best articulation of this concept, in the statement that “the fact of the matter is that the ‘real world’ is to a large extent unconsciously built up on the language habits of the group”. The most accessible sociological text is The Social Construction of Reality by Berger and Luckman.
Words have meanings but the meanings create and change reality as well as expressing it. They change the circuits in the brain , a process sometimes called rewiring. To bring about a paradigm shift, leadership needs to tell people that new circuits are needed and can be created due to the neuroplasticity of the brain.
In changing culture and creating a new reality in which people are positive about the potential for living longer better we need to recognise the important part that language plays in expressing and sustaining the negative, ageist attitudes, that prevail as shown by this extract from the Centre for Ageing Better resources;
Doddery but dear?: Examining age-related stereotype Our report summarising what existing research tells us about the role and impact of language and stereotypes in framing old age and ageing in the UK. Download report
An old age problem? How society shapes and reinforces negative attitudes to ageing Our report looking at the language used by government, the media and social media, advertising and ageing-focused charities in relation to the topics of age, ageing and demographic change. Download report
Age-positive images: our free to use image library We've launched a free library showing ‘positive and realistic’ images of older people in a bid to challenge negative and stereotypical views of later life. The images show a more realistic depiction of ageing and old age – to provide alternatives to the commonly used pictures of ‘wrinkly hands’ or walking sticks. The library, which contains over 400 images and will be regularly updated, offers organisations a wide selection of images that avoid stereotypes associated with older people. View Image library
Lnguage creates reality. This is very well described in an excellent podcast by Michael Rosen and Lucy Pollock author of a number of books including the Book about Getting Older
We need to create a new positive culture and a new reality, moving from one in which population ageing is seen as a tidal wave of need, to a reality in which it is accepted that many of the problems assumed to be caused by the ageing process can be delayed, prevented or reversed, not only by effective NHS clinical care but also by what older people can do for themselves and for other people of all generations. That is the reality of Living Longer Better
Terms About The Process of Living Longer Better
Most people, including many clinicians, have a muddled concept which they may refer to as ‘ageing’ or ‘growing older, terms they may use as synonyms and which refer to a singular process they perceive as inevitable. A core message of our work is to help people see there are actually four interrelated processes because the science is clear there are four processes that affect us as we live longer, but the language used to describe this is not yet universally used. These key four key processes are described below:
Ageing A normal biological process, sometimes called senescence, which has two characteristics, a decrease in maximum level of performance, for example maximal pulse rate, and by what is termed resilience, namely the ability to respond to a challenge such as a stumble, or a change in temperature or a period of inactivity. It has now been agreed that it is unhelpful to classify ageing as a disease (1,2) which is a separate process. Until recently ageing has been assumed to be a process that cannot be influenced, although large amounts of finance and research-time is being invested in the search for chemicals which could ‘slow’ the ageing process. However the study of people classified as ‘super-agers’(3), and a better understanding of the fact that our genes and chromosomes do not control our development to the degree that was once assumed (4,5), show that our environment, social and physical, is a much more important determinant of our capacity as we live longer. Asa consequence the term exposome has been introduced as distinct from the influence of our Chromosomes.
Disease An abnormal process such as Parkinson’s disease or a condition defined as being a disease because the person is in a subgroup of the population defined by the level of a variable which has been designated by expert opinion as requiring intervention, for example sarcopenia, pre-diabetes and high blood pressure. However recent work initiated by the WHO has proposed that it is more important to focus on a person’s intrinsic capacity when assessing their ability and prospects than simply to focus on ‘multi morbidity’. Intrinsic capacity has 5 dimensions - ‘locomotor, cognitive, psychological and sensory capacities, and vitality’ with vitality being the WHO term for what others term ‘resilience’ or ‘reserve’ (6). It is also very important to clarify the distinction between Alzheimer’s Disease and dementia, and to agree on whether the terms MCI, Mild Cognitive Impairment, and pre-dementia are useful or not.
Fitness Best measured by the maximum level of performance and by what is termed resilience, the ability to respond to a challenge and these are the same characteristics as those of ageing which is why the two have been confused until recently. It has also been recognised recently that many of the effects attributed to disease are the result of accelerated loss of fitness due not so much to the disease process as to the treatment process, notably hospitalisation, an effect called deconditioning (7); increasingly fitness is used in relation to both physical and cognitive ability.
Social factors Such as poverty, deprivation, racism and ageism. We know that 80% of health outcomes are determined by factors that lie beyond health services.
The Exposome These four factors are inter-related as the diagram shows and there is now a new term, the Exposome, which is defined as being how external exposures (spanning social, psychological, behavioral and geo-physical factors) and their interaction with internal factors (such as genetics, epigenetics and physiology), encapsulated by the term ‘exposome’, affect health trajectories and overall resilience, including chronic disease, geriatric syndromes and disability as people age. (4)
Other key terms include:
Frailty A distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves. It is also important to recognise prefrailty. If frailty is “the presence of three or more out of five indicators: weakness (reduced grip strength), slowness (gait speed), weight loss, low physical activity, and exhaustion”, people with one or two indicators are classified as pre-frail.
Another way of defining frailty is by The use of pictures, such as in the Rockwood Scale, and before this is dismissed as being too childish, it is important to remember that Wittgenstein argued that pictures were very useful ways of expressing complex ideas. Thefirst five levels of Frailty are shown below.
Dementia A condition defined by severe impairment of cognitive ability, Alzheimer’s Disease is one of the two most common causes of dementia, the other being caused by disorders of the blood flow to the brain, vascular dementia.
Wellbeing A termincreasingly used rather than healthy to describe the outcome that people aspire to. Although a very broad term, it has meanings and criteria in the literature for example
“…being well psychologically, physically, and socioeconomically, and, we should add, culturally: it is all these things working together.” (8)
It also has agreed criteria for measurement, for example produced by the Office of National Statistics. Age UK have also produced a useful review of the determinants of wellbeing and indicate the need to think in terms of five dimensions Personal, e.g., housing, Social e.g., relationships, Health, Resources, e.g., income, and Local e.g., satisfaction with services.
This is how they measure wellbeing:
Deconditioning and Reconditioning This term has been in use for some time, mostly to refer to younger people and sports people losing fitness if they reduce activity levels but in an important BMJ contribution Dr Arora, a geriatrician, described how even a week in hospital could have a severe ‘deconditioning’ effect on older people. Anyone who stops being physically active will decondition to some extent and will experience loss of muscle mass, stiffening of joints, loss of bone density (musculoskeletal deconditioning) and decreases in aerobic fitness (cardiovascular deconditioning). Musculoskeletal deconditioning among adults in mid and later life is a particular problem due to its association with risk of falls, frailty and loss of functional ability. The term Reconditioning is now also in use as an activity designed to help people recover the ability lost as a result of deconditioning, as distinct from Rehabilitation which is a clinical service designed to help people regain the abilities and skills lost as a result of disease or injury.
Activity This is a more effective term than ‘exercise, but it may be preferable always to talk about ‘activity, physical, cognitive and emotional’ rather than just ‘physical activity'.
Inter–relationship of Ageing with the three other factors
The four processes described above are interrelated in the following ways:
With Fitness The ageing process reduces the capacity to be resilient in the face of challenges, therefore fitness is more easily lost, but it can be regained at any age. Also, the effects of both ageing and loss of fitness are very similar – loss of maximal ability and loss of resilience or reserve:
With Disease The ageing process increases the risk of some diseases but most diseases which cause premature mortality are preventable.
With Growing Older The ageing process and the process of getting older are limited by the beliefs and assumptions of people of all ages, many of which are wrong. The original WHO Classification described ageing by itself as causing relatively little problem till the age of ninety.
Inter–relationship of Loss of Fitness with the three other factors
With Ageing Fitness becomes more important as the ageing process takes places because the best possible performance becomes closer to some crucial levels below which independence is compromised. It is therefore important that the fitness gap is minimised.
With Disease Fitness loss is accelerated when disease develops because of both the direct effects of the disease and the indirect effects, for example the belief that rest is best for older people with long term conditions.
With Growing Older Fitness is often associated with youth in the minds of both older and younger people.
Inter–relationship of Disease with the three other factors
With Ageing Disease is sometimes the result of cellular changes due to ageing but at least as often is caused by lifestyle or environmental factors.
With Fitness Disease often accelerates the loss of fitness and it is always important to prescribe physical activity as well as medication.
inter relationship with the environment, particulalry the ageist social environment The effects of disease may be incorrectly attributed to ageing as a result of ageism.
Inter–relationship of the Ageist culture with the three other factors
With Ageing Beliefs about the effects of aging are overly pessimistic and this leads to unduly negative attitudes towards, and of, older people.
With Disease Beliefs about disease and ageing too often result in the assumption that disease is inevitable whereas many diseases can be prevented, postponed or managed effectively.
With Fitness Wrong beliefs about the benefits of physical, mental and social activity lead to inactivity and preventable decline due to loss of fitness. With the right beliefs and attitudes ability can be increased at any age.
Inter-related actions to Live longer Better Because the causes of decline are inter-related so too are the solutions.
Unhelpful language about living longer
We have provided definitions about the four process that are taking place as we live longer and emphasised how important it is to use these accurately and often and some examples from the important work of the Centre for Ageing Better countering ageism. There are in addition some terms that should be used with caution not because the meaning is not clear but because they perpetuate the negative image and pessimism about living longer.
These terms include:
Care This is a term that can be used as a verb or a noun and it is appropriate to care about someone or something, like the planet and climate change but care as a noun, for example ‘she needs care’ or ‘we will have to provide care’ usually means doing something for someone. Of course, some people do need some things to be done for them, but the initial assumption should always be that the person could do something for himself, with support, that being one or more of physiotherapy, encouragement and advice, or the provision of some aid or adaptation. The simplest term to use is ‘support‘, as in ‘needs support to be able to get dressed‘. We first attacked the term ‘care’ in an article in the Lancet in 1980. Gray J.A.M. (1980) Do we care too much for our elders? Lancet 2; 1289-1291 A term and concept now being used is Social Pedagogy which started as a cultural approach to education and social services for children in 19th century Germany, for example the Montessori schools, but whcih is now across the whole of Europe including the UK. the philosophy is not to do things to or for children but to do things with them and this is obviously equally relevant to services for older people. In addition the Social Pedagogy style of service for older people is based on the assumption that the person, the patient or client, has learned a great deal through life and can make a contribution to the wellbeing of others, of all ages
Retirement This has connotations of retreating from society. Other terms being used are renaissance or simply the term phase, as advocated in the book The Hundred Year Life by Andrew Scott and Lynda Gratton.
The Elderly This term is very loosely used and as we wrote in the Guardian in 2015 it is a figure of speech that reflects and perpetuates: "Prejudices about all people with a single characteristic. It is sometimes useful to generalise about people of a certain age group, to determine the music of their teenage years for example, or to tell them that there are prejudices about people in their 70s or 80s, for example the prejudice that fitness is a concept irrelevant to people in these age groups and that they should be ignored." Problems result from any attempt to describe the ageing population as a single entity because of the huge age range, from 65 to 105. No one would attempt to generalise from birth to forty, or forty to eighty, so why generalise about ‘the elderly’?
In the book Healthy to 100 Ken Stern advises all older people to "Remodel your own language" and one way to do this is to use the term elders rather than old people as recommended in the Michael Rosen podcast
