End-Of-Life : Old age In Contemporary Society , Self-Perception Of Aging And ‘ An ’ Islamic Perspective

Population aging is a global phenomenon which has important and far-reaching implications for many facets of human life. Although it is an achievement of public health policies and socioeconomic development; it is generally greeted with alarm as it is assumed that elderly will be ill and dependant due to age-related chronic diseases which will require long term care. Despite the fact that many older adults continue to work and contribute to the society, they are seen as a burden and a drain on resources, rather than as a resource in themselves. Ageism and discrimination towards elderly is prevalent at individual and institutional levels that affect their physical and mental health, putting them at risk of depression and social isolation. According to the World Health Organization’s (WHO) combatting ageism has great potential for achieving healthy ageing for all people as they age. Individual health and longevity is influenced by biological, environmental, and psychosocial factors, however modifiable risk factors are especially relevant as they are amenable to intervention. There is enough evidence that religiosity and spirituality (R/S) are among such factors which allow older adults to age in a more positive way. Further R/S activities are prevalent globally and elderly tend to have high rates of involvement in religious activities. Health benefits that may stem from R/S involvement could be important for the future of global health which suggests that they could be incorporated into the idea of positive ageing. Islamic perspective on old age is deeply rooted in the very texts of revelation and as such is divinely based. This review article intends to create awareness of the elderly on the ageing process, their status in the contemporary society and how by adopting positive attitude toward ageing they can enjoy better functional health, self-esteem and satisfaction in life.


Introduction:
The phenomenon of population ageing is a global phenomenon, which is unprecedented in human history, as the proportion of the elderly is increasing relative to the younger generation. 1 It is projected that by the year 2020, there will be one billion elderly people (65+ years) in the world and 71% of whom will live in low-income countries. 2Malaysia is expected to reach ageing population status by the year 2035, when 15% of its total population will be 60 years and above. 3Although population ageing is an achievement of public health, policies and advances in medical technology, rather than evoking celebration it is generally greeted with alarm, fear and anguish by individuals and policymakers.It is assumed that longer the people will live, the longer they will be ill and dependant due to age-related chronic diseases which will International Journal of Human and Health Sciences Vol. 03 No. 02 April '19 Page : 64-73  DOI: http://dx.doi.org/10.31344/ijhhs.v3i2.79  require long term care. 4The old age and ageing has become the subject of research and debate all over world; being discussed by politicians, economists, policymakers and to ordinary people.6][7] Public is consciously and subconsciously primed to follow the negative ageing story.This age related negative perceptions have been particularly restrictive for women who sought to engage in various forms of physical activity.A recent analysis carried out by the World Health Organization (WHO) using world values survey data of 83 034 adults from 57 countries found low respect for older adults. 8he lowest levels of respect were reported in high income countries.Even the medical profession is not immune to this prejudice. 9Elderly receive less screening, less preventive care and poorer management and treatment. 10Labelling them as 'geriatric' can be used as an excuse to provide inferior medical care.They are not encouraged to be physically active.Many common, functional problems such as reduced vision and hearing are overlooked or accepted as a normal part of ageing.The World report on ageing and health highlights great diversity in health and functioning in older age and marked health inequities in this group. 11his prevalent age-related bias towards old people can have detrimental effects to their health and wellbeing in the long-term.They often internalize the negative stereotyping and adopt "ageing myths" and see decline as inevitable. 12They perceive and accept that it is socially desirable for them to slow down and become less active with advancing age.4][15][16][17] Society can benefit from ageing population if they age more healthily.For example, in the United States of America (1940-1990) population ageing contributed to around 2% of the increase in health expenditures, compared to 51% related to technology innovation in medical practice. 18Japan is currently the only country in the world with 30% of its population aged 60 or over.However, there is a very limited effect of population ageing on their economic growth. 19 It provides answer to the purpose of life and up to a certain extent regulates their life.][24] Each religion has its own ideals and values towards elderly.In Islam elderly have a special status, which is deeply rooted in the very texts of revelation and as such is divinely based.Older adults who attend religious gatherings develop social contacts, which promote their health, social support and self-esteem.They feel less lonely.R/S is not regularly attended in clinical practice, while it is among the nursing care priorities.Therefore health care personnel should give value to R/S in professional practice, which will make practice of medicine more holistic, ethical and compassionate.This review article intends to create awareness of the aged on the healthy ageing process, their status in the contemporary society and how by adopting positive attitude towards ageing they can enjoy self-esteem and satisfaction in life.

Definition of old age
Ageing is a normal, inevitable and universal phenomenon that starts from the day we are born and begin our journey back towards our creator.It is an inescapable reality of ones life and a biological reality which has its own dynamic, largely beyond human control.It is highly individualized and occurs at different rates in different people determined by genetic, socioeconomic, regional, dietary, and disease factors. 25,26 espite slow progression, it almost always catches people with a decline in strength, immunity and body resources. 27here is no consensus on a universal definition of old age.Opinions vary according to the economic situation and cultural level, and even among scholars there is no unanimity.According to the World Health Organization (WHO), old age is fixed at 60 years for developing and the third world countries, and at 65 for developed countries, a classification based on economic and social situation in the country. 28The Psychological age refers to a person's adaptive capacities to the ageing process and his/her mental functioning and personality.For example, an 80-year-old who participates in daily activities, plans and looks forward to future events is considered psychologically young.Social age is related to social roles and ones habits relative to society's expectations, one's relationships with relatives and friends and in formal organizations where one has worked.It has been observed that people with strong social networks report greater emotional well-being in day-to-day life.Many sociologists believe that old age is socially constructed and is the result of the interaction between the individual and the society where he/she exists and what is the concept of old age in that society. 30,31 rontology (field of medicine and social science that seeks to understand the process of aging) defines old age as the process of a system's deterioration through time. 32It classifies old age into three periods: The period from age sixty-five to seventy-five sometimes called the 'young old' which denotes relatively healthy and financially independent elders; the period from age seventyfive to eighty-five are called the 'old'; and the period post age eighty-five, is referred to as the 'old old' when activities are limited due to functional disabilities.7 This stage is generally defined as the period in the life course that occurs after retirement but prior to the onset of disability, revealing a period in which individuals have the capacity to remain actively engaged; and today would roughly fall between the ages of 65 and 80+.At the individual level, this period can last a few years or even two decades or more.For many elderly these are the "golden years" when typically they have fewer responsibilities. 38A survey of 2,500 seniors in a Los Angeles community revealed that, they continued to grow, create, and engage in activities related to education and travel.Some of them become active in their families or proactive in their communities, or enter the political arena.
A sizeable proportion of the elderly in Malaysia (professionals, scientists, scholars) still maintain a high level of mental acuteness and hence, are able to contribute to society. 39The modern prosperous multi-cultural society of Malaysia is the result of diligence and sacrifice of previous generations, some members of which are still living and contributing to the country like the current Prime Minister, Tun Dr Mahathir bin Mohamad.A World Health Organization (WHO) study and the Malaysian component of an ASEAN study revealed that the aged, particularly in rural areas, continue to work until 75 years of age or older. 39,40he contribution made by active older people goes well beyond monetary influence.They have much to offer to younger generations through their rich experience, knowledge and skills.Grandmothers now provide half of all informal work-related child care, with more than a third of employed women having a grandmother look after their children when at work.Therefore it is important that society does not belittle the importance of elderly nor does consider them as burdensome and redundant.In accordance with the practice of Islam, we must accord them special status and position, maintain their rights and respect, and look after their daily needs.Ageing Process: Old age is the sunset of life, characterized by various processes which involve all the systems of the body and ultimately lead to death within the course of time.The most obvious changes are wrinkles on the face; the greying of hair, decline in strength, hearing impairment, weakening vision, and the increasing susceptibility to infection, hypertension, heart disease, diabetes, and osteoporosis followed by restriction of movement, but these changes are very variable.
Elderly are susceptible to degenerative joint diseases such as arthritis causing aches and pains.Osteoporosis and bone resorption affects their strength and functional performances.They develop fractures often with trivial trauma.The knee is the most frequently affected synovial joint followed by the hip and facet joints of the cervical and lumbar spine causing a significant reduction in mobility.This in turn causes difficulty in living alone, and caring for personal needs (bathing, dressing, etc.).Similarly the gastro-intestinal tract (GIT) function is affected leading to reduction of gastric acid, intrinsic factor and pepsin secretion, which then reduce the absorption of vitamin B6, B12, folate, iron and calcium.Other GIT problems include gastritis and gastrointestinal cancers which reduce nutritional status. 41In addition to the "anorexia of ageing" physical, social, cultural, environmental and financial reasons can lead to inadequate diet. 42The All religions strive to raise individuals above themselves, to help them achieve a life better than they would lead if left to their own impulses.Religion functions as a stabilizing force at a time when one's own strengths are dwindling as happens in old age.Many old people face important existential challenges, mainly due to chronicdegenerative diseases, widowhood, death of close friends and relatives, loss of social roles, isolation, financial difficulties and the heightened awareness of the reality of death.Human beings choose a variety of threads to cope with these concerns especially when their physical, mental, and cognitive abilities are declining. 52Many of them turn to R/S, perhaps for the first time as a source of comfort that helps them to surpass suffering and the knowledge of sure death. 535][56] There are a number of empirical and theoretical reviews on the topic that indicate valuable benefits arising from R/S involvement across a number of health domains and the findings apply across regions with differing ideologies, practices and religions.24, 57-59 R/S beliefs and practices are associated with healthy behaviours, stronger immune function, better cardiovascular function, and a longer life 57 A study of Mexican Americans aged 65 to 80 found that those who frequently attended religious activities had higher life satisfaction and lower levels of depression than those who did not. 58rom an Islamic perspective, old age provides the individual with the opportunity for selfpurification and reform while also emphasizing their social role in the community.The holy Qur'an speaks that life in this world is but a brief stopover; the final destination will be determined by Allah (SWT) on the basis of one's deeds in this world.''…the life of this world as compared with the Hereafter is but a brief passing enjoyment'' 60 The purpose of life is made clear in these three verses of the Qur'an: ''Say: '  66 This mind set leads them to prayers and supplications to seek the pleasure of Allah SWT, and hoping for the highest abode in Heaven.Muslim spiritual practices should not be seen as mere mystical or ritualistic exercises, but interpreted in terms of positive intellectual, emotional and behavioural outputs.Remembrance of death is thus perceived as an opportunity to draw closer to Allah swt to earn His pleasure during this life, in preparation for the hereafter -the 'Eternal Home' -to which all human beings ultimately go.Every person will be rewarded [or punished] according to their attitude, appreciation and efforts during their stay on earth.Thus, a Muslim would experience both hope and fear in his or her relationship with Allah SWT.We should always remember Allah SWT, asking forgiveness to expiate past sins and earn His pleasure, readying to meet Him and hoping for the highest abode in Heaven.

Discussion
Old age is an unavoidable problem-ridden phase of life, but there is much evidence that personnel attitude and belief about aging has a noticeable impact on overall health and quality of life. 15,17,67,68lderly need to accept the changes inherent to the aging process but take up new interests and continue to learn and experience new situations.Healthy Ageing is the focus of WHO on ageing; between 2015 -2030, which replaces the previous Active ageing policy developed in 2002.It emphasizes the need for actions across multiple sectors to enable older people remain a resource to their families, communities and economies.This process involves invoking personal choices and assuming responsibility for personal wellbeing.Despite the fact that certain physical and cognitive declines are a normal part of aging, staying intellectually tuned in and socially engaged appears to contribute to successful aging. 69There is promising evidence that older adults can benefit from brain plasticity/ neuroplasticity to reduce age-related cognitive decline. 70,71 hese benefits can be achieved by challenging aging brains through cognitive training, leisure activities, intellectual engagements, and learning new skills. 72Maintaining a healthy brain is a critical factor for their quality of life and the preservation of their independence.
Medical researches on preventing or reversing aging; should focus on modifiable risk factors, especially those that are amenable to intervention; and can improve the quality of life until the fixed moment of death what Allah SWT has ordained.They should develop preventative strategies and therapies that can delay or prevent the onset of age-related diseases.
cognitive impairment is linked to Vitamin B 12 deficiency, however it is highly variable from one person to another, and it does not typically interfere with activities of daily living.It typically leads to difficulty in learning new languages and increased forgetfulness.Holy Qur'an appraises us and specifically mentions about the changing nature of humans in old age, characterized by certain reduction in energy, fragility and vulnerability.
46It also makes special mention of an age termed ardhal al-'umur, "It is Allah Who creates you and takes your souls at death; and of you there are some who are sent back to a feeble age, so that they know nothing after having known (much); for Allah is All-Knowing, All-Powerful"44ardhal al-'umur as is one's lowest point of inability, whereby one becomes similar to an immature child (la 'aqla lahu).45In the final stages of life, elderly often regress to a state of childish dependency both physically and mentally what is interpreted in medicine as the Second Childhood. Hu life starts out as dependent and through aging ends-up as dependent which Holy Qur'an informs us very articulately in the following verses.''And he whom We grant long life, We reverse him in creation (weakness after strength).Will they not then understand?''46Reverse him in creation," means that in old age Allah swt turns him back to the state of childhood.then We bring you out as babes, then (foster you) that you may reach your age of full strength; and some of you are called to die, and some are sent back to the feeblest old age, so that they know nothing after having known (much), and (further), of you and he says, 'O Lord, if only you would give me a little more time so that I can give sadaqa and be one of the righteous.'Allah will not give anyone more time, once their time has come.Allah is aware of everything you do." 65; 'Did you think that We had created you in play (without any purpose), and that you would not be brought back to Us?'61; 'And I (Allah) created not the jinns and humans except they should worship Me (Alone)'62This explains the significance of spiritual and moral refinement of character as outlined in the following tradition of Prophet Muhammad saw, "None of you should wish for death or pray for it before it comes to him, for when one of you dies, his good deeds come65and Allah swt says, "O you who believe! Donot let your wealth or children divert you from the remembrance of Allah.Whoever does that is lost.Give from what We have provided for you before death comes to one 81,79, eat of all fruits, and follow the ways of your Lord made easy for you"75and "It is He who produced gardens… and date palms, and crops of different shape and taste and olives, and pomegranates, similar in kind and different in taste.Eat of the fruits when they ripen."76ProphetMuhammadSAWhassaid,""Thebest of you are those who live the longest and do the best deeds."Theonewho is physically stronger is better before Allah swt because they are more active and energetic in the performance of worship and taking care of the needs of others.Elderly should continue to exercise even in moderation as it reduces morbidity, lessens body pain, and helps maintain bone strength.Exercise can also have profound effect on the brain, helping prevent memory loss, cognitive decline, and dementia.Walking is one of the best ways to stay fit.Other choices include swimming, biking, gardening, etc. Yoga and Tai Chi are the perfect exercises as they are both low-impact, slow-motion exercises, plus have some other incredible benefits.Whle the problems of old age cannot be averted entirely, healthy ageing is a positive and constructive view of growing older which accepts aging as the continuous and normal development of human life78,79.Old age does not mean your life is without a purpose.You are much wiser and need to contribute to the society/ world by your experiences and social participation.Evidence has shown that exercising, quitting smoking, participating in cultural events and social activities can help to prevent the loss of functional capacity, thus maintaining sense of joy and improving quality of life.Isam emphasises positive thinking and sustaining a healthy mind.Further to counter ageism we need to raise awareness among younger generations and give realistic portrayals about elderly through education, religious sermons and the media to prevent the culture of indifference.Islam consistently holds elderly in high regard and respect, and grooms its youth to show respect, honour and dignity towards them.In Malaysia, the elderly care is provided both by private, NGOs and governmental bodies.Currently, the elderly care centres have more percentages of non-Muslim patrons.The concept of retirement home/ facilities/ villages does not exist since it is the obligation for all Muslims in looking after their parents.At present Muslim retirees choose the Pondok system (Islamic teaching system descended from 'Ulama and guided by religious teachers) to spend their time after retirement which deepens their understanding in Islam.It enhances their knowledge and practice and also keeps them intellectually stimulated.In Islam, serving one's parents is a duty second to prayer, and it is their right to expect it.The holy Qur'an clearly states, "Your Lord has commanded that you worship none but Him, and that you be kind to your parents.If one of them reaches old age with you, do not say to the word of disrespect, or scold them, but say a generous word to them.An act humbly to them in mercy, and say, "My lord, have mercy on them, since they cared for me when I was small."80Furtherprophetsawhas said: "Let him be humbled into dust; let him be humbled into dust" On further enquiry, He said: "He who sees either of his parents during their old age or he sees both of them, but he does not enter Paradise (neglecting his / her duties towards them)"81This understanding of Islamic values towards elderly would perhaps contribute towards the effective development of culturally sensitive approaches on elderly issues from different faith groups; including Muslims.This will create a better society for people of all ages.
74at and drink, yet not in excess, for the Lord loves not those who commit excess.74Italso discusses a healthy diet as there are eighteen verses specific to this topic.It focuses on fruit consumption with a progressive focus on plant based dietary patterns,