The fourth age, frailty and transitions

Abstract

One of the implications of an ageing population is the growing number of people aged 85 years and over. This cohort is increasingly described as belonging to the fourth age: a life stage that ‘demarcates experiences that occur at the intersection of advanced age and impairment’. The fourth age intersects with frailty: a biomedical status characterised by multiple impairment, decline and dependency.26 per cent of those aged 85 years and over are considered to be frail. The losses and challenges that accompany the fourth age, including becoming frail, can be conceptualised as transitions. Physical, psychological and experiential transitions tend to multiply in the fourth age and to co-occur. The fourth age, frailty and transitions intersect in a complex and mutually reinforcing way posing a profound challenge to mental health and psychological wellbeing. Autonomy, agency, dignity, independence, identity, choice and control are all threatened. Older people’s accounts draw attention to a need to accommodate both change and continuity and to preserving selfhood. A discourse dominated by a focus on ill health and frailty tends to obscure the influence of the lifecourse, including inequalities, on health outcomes. A policy and practice focus on ‘managing frailty’ is a key example.