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Mental Health in Later LifeTaking a Life Course Approach$
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Alisoun Milne

Print publication date: 2020

Print ISBN-13: 9781447305729

Published to Policy Press Scholarship Online: September 2020

DOI: 10.1332/policypress/9781447305729.001.0001

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PRINTED FROM POLICY PRESS SCHOLARSHIP ONLINE (www.policypress.universitypressscholarship.com). (c) Copyright Policy Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in PPSO for personal use.date: 19 September 2021

The fourth age, frailty and transitions

The fourth age, frailty and transitions

(p.129) 7 The fourth age, frailty and transitions
Mental Health in Later Life

Alisoun Milne

Policy Press

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.

Keywords:   Fourth age and frailty, Physical, psychological and experiential transitions, Lived experience of frailty and transitions, Frailty dominated discourse

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