Education for physical, psychological and social health as an element of preventive gerontology based on the example of Universities of the Third Age

The changes that take place in the modern world make it difficult, especially for elderly persons, to adapt to the constantly transforming environment. One of the most effective ways to prevent the marginalization of senior persons and enable their active inclusion in the structures of the society of the 21st century is using the lifelong learning opportunities available to "a person of the third age". Lifelong learning is offered by Universities of the Third Age (U3A). In Poland, the first U3A was founded, at the initiative of Professor Halina Szwarc in 1975 at the Centre of Post-Graduate Medical Education (CPGME) in Warsaw, one of its main goals being to include elderly persons in the lifelong learning system. This unit and other universities of the third age that followed, offer space for personal development and socializing and create appropriate conditions for elderly persons to participate in the social life on a regular basis. For more than 40 years, the U3As in Poland have offered programmes that meet the various needs of senior persons, with activities dedicated to broadening their knowledge, education, personal development, developing skills and interests, spending their free time actively and promoting a healthy lifestyle, thus contributing to preventive gerontology and health in the holistic meaning of the term. One of the factors that could affect the structure and implementation of U3A programmes is the evident feminisation of their students. Because of this, educational programmes and other activities offered to U3A students may be selected mainly to suit female interests, reducing the engagement of men to a minimum. Another possible challenge is ensuring the right team of lecturers.


Foreword
Nowadays, we live now in a time of struggle for the human being, for what the human being will be like and consequently what the society will be like. Will the society be ignorant and susceptible to manipulation, concerned only about the economic aspects of life, or, to the contrary, will it be able to define what is good and what is bad and sensitive to the needs of other people, and will the educated members of the society use their knowledge and skills to the benefit of other people and the entire state? (1).
This question is particularly relevant now, when, as a result of ongoing changes, elderly people find it difficult to adapt to a world that worships and promotes the youth, and where the old age is being excluded (2). One of the most effective ways to prevent the marginalization of the elderly and enable their active inclusion in the structures of the society of the 21st century is using the lifelong learning opportunities available to all ages, and in particular to "a person of the third age". An elderly person who takes the effort of self-development in educational institutions based on various forms of own activity, associated with the individual educational needs, has a chance to gain new knowledge, enrich or develop attitudes, develop interests and learn skills that are useful for the health and in social life (3). Such needs are satisfied by Universities of the Third Age (U3As), which offer educational solutions that enable learning activity of individuals in their advanced stages of life. U3As make it possible to implement numerous projects that ensure a high standard of life for the elderly. Preventive gerontology projects are of particular importance. They focus both on health promotion and disease prevention in order to maintain or improve the functional fitness, in the broad meaning of the term, which U3A students achieve through education, engagement and healthy lifestyle promotion. It is worth noting here that the importance of preventive gerontology was discussed in Poland back in the 1980s, for example in the research concerning optimization of gerontological nursing in urban environments conducted at CPGME (4).

Universities of the Third Age
The idea of permanent education is implemented, among other things, by the education of seniors in the Universities of the Third Age (U3A), founded by Pierre Vellas in 1973 in Toulouse (5). The idea of the founder was that the U3As would cooperate with academic centres in order to improve the comfort of life of persons in post-working age by offering continued intellectual, cultural and social development in an academic environment and by taking care of their physical condition. Soon, lifelong learning institutions for the elderly based on the French model were founded across Europe and later also in other parts of the world.
The first U3A in Poland was founded on the initiative of Professor Halina Szwarc  in 1975 at the CP-GME in Warsaw. Krystyna Bielowska accounts that Professor Halina Szwarc went on 2 April 1975 to Milan for a symposium on social welfare, where she met Pierre Vellas, founder of the U3A in France (the first in the world). He gave her the idea of creating such institution in Poland and promised his organizational and methodological assistance. A College of the Third Age, with the kind support and assistance of the CPGME, opened in the autumn of the same year -on 12 November. Then, at a conference organized by the College of the Third Age on 4 June 1980, it was decided that all the institutions that meet the basic goals (i.e. improving the quality of life of elderly persons by including them in the lifelong learning system and intellectual and physical engagement) would take the name of the U3A.
When establishing the first U3A, professor Halina Szwarz defined the following tasks of the institution: y to include elderly persons in the lifelong learning system, y to promote intellectual, psychological and physical activity of the students, y to engage them in observations and research, y to develop methods for continued education of the elderly. As a result of great effort, years of hard work, knocking on the doors of official sponsors, convincing the colleagues and, most importantly, attracting senior students and patiently persuading them that the new institution makes sense in our reality, a number of U3As were founded across Poland. Professor Halina Szwarc visited practically every new U3A, she gave advice and spoke during opening ceremonies, and she made sure that the ambitions of the founders and participants and the level of courses were not compromised. She believed, according to the French prototypes, that this was only possible if the U3As had the strong support of "traditional" universities (6). It should be noted that the U3As were supposed not only to provide a senior with education but also to familiarize students with preventive gerontology (7).

Activities of the U3As
The U3As, as institutions that belong to the lifelong learning system, implement the main goal of providing education, in the broad meaning of the term, and a number of specific goals, such as developing students' personality, disseminating various disciplines of knowledge and increasing physical, psychological and social fitness and activity in order to help the elderly live a dignified and interesting life and improve their quality of life (8).
The latter model is mainly founded on self-help and self-education of senior persons, without any evident links with universities (9). Currently, the two main models characteristic of the first U3As become intermingled and new types of institutions for seniors develop combining different aspects of elderly education. This means that the U3As may take many different forms and engage in different cultural and educational activities.
Considering the formal and legal principles of the operation of the U3As in Poland, three basic types of their operation are usually identified (10). The first are institutions established within public or non-public university structures. U3As operating within university structures are established by university authorities and managed by a representative of the university president. The university determines the terms of operation of the U3A and provides support in organizing the U3A and delivering its educational courses. Such institutions have an Academic Council consisting of representatives of its host University, selected representatives of the U3A authorities, representatives of local authorities, and other individuals. The second type are U3As that operate as non-government organizations, i.e. U3A associations or foundations. They are governed by the Associations Law, the Foundations Act and the Act on Non-Profit Organizations and Charities. They all have legal personality. They are independent and they organize their educational activities and logistics by their own means. Their governing bodies are elected in accordance with their statutes. They often cooperate with universities, under their academic auspices and using their teaching personnel, as well as with local authorities and other NGOs. The third type are organizations that operate within the structure of institutions managed by local authorities, such as cultural centres, lifelong learning centres, libraries or social services. U3As operating within local authority structures are founded by local authorities and managed by their delegated employees. Local authorities determine the terms of their operation and provide support in delivering educational courses.
The operation of U3As depends on their organizational structure, status, method of financing and location. The number of active students per U3A usually ranges between 50 and 1,500 and they are financed from student contributions, subsidies from the local authorities, by sponsors or from funds donated by public universities (11).
According to Aleksander Kobylarek, in Polish reality, the U3As promote a mixed model that combines education, charity work, assistance, dissemination of gerontological knowledge, leisure activities for the elderly and developing their interests (12). Regardless of the dominant type of their organizational activity, the U3As help satisfy the need of seniors to be in a group and to be important in that group by performing certain roles, to socialize, to express themselves and to have a sense of achievement (13).
According to the "Zoom on U3A" survey conducted by the Towarzystwo Inicjatyw Twórczych "ę" (Association of Creative Initiatives), in April 2012, there were 372 U3As in Poland, and by the end of 2012, there were already 400 of them. In the 2013/14 academic year, there were more than 420 U3As in Poland with appr. 100,000 students, and 11% of them operated in rural areas (14). In 2018, there were already 640 such universities in Poland, with the total of 113,200 students, of which 95,400 were women.
According to a country-wide survey conducted by the Central Statistical Office in November 2015, the most numerous (87,7%) among the students of the 464 U3As was the group of persons aged 60 to 75 years. The oldest students, aged 76 years or more, represented 12,3% of the total number of students (15). In 2018, the majority of senior students (71,9%) were aged between 61 and 75 years. Persons aged 76 years represented 16,4% of all students, and persons younger than 60 years -11,7 %. It should be noted here that in 2018, only 363 U3As had the minimum age requirement of 60 years for enrolment, while the other universities did not impose such restriction, which explains the large number of students below 60 years of age (which is considered to be the old-age threshold) using this form of education (16).

Lifelong learning as the educational aspect of the operation of U3As
It should be noted that the first Polish U3As undertook not only to stimulate intellectual, psychological and physical activity of their students, conduct observations and research and promote preventive gerontology but also to include elderly persons in the lifelong learning system.
Lifelong learning is not only a part of education policy but also a lifestyle consciously chosen by a growing number of persons. Lifelong learning (also referred to as permanent education, continuous education, lifelong education, learning throughout life) is an education model that arises from the need of individuals to constantly adapt to rapid technological changes that pose new life challenges to people in the contemporary world. The concept of lifelong learning changes the traditional division of human life into the period of preparation, and the period of mature social and professional activity, when one utilizes what he/she has learned before. However, according to the lifelong learning concept, the time spent in various educational institutions, from primary education to universities, incorporating, apart from general curricula, many specialist courses and technical and vocational education institutions would only be the first link in the education process, preparing an individual for subsequent educational activity throughout life.
One of the international institutions that has strongly supported the idea of permanent education is UNESCO, which proposed in Montreal in 1960 the slogan: "From continuing education to continuous education". Also, subsequent Global Conferences on Adult Education organized by UNESCO (including the 6th International Conference on Adult Education in Brazil, called "Harnessing the power and potential of adult learning and education for a viable future") discussed, among other things, the problem of continuous education, assuming that lifelong learning is both the result of and condition for full participation in social life (18). Among the scholarly papers associated with UNESCO's activity, devoted to lifelong learning, it is worth noting Edgar Fauer's report "Learning the be" (19) and the report of Jacques Delors' commission "Revisiting learning: The treasure within" (20). It was based on the papers published in 1996 by 15 members of the Delors committee appointed by UNESCO. The report (which identifies the directions and recommendations for the development of education in the 21st century) emphasizes the importance of lifelong learning. According to the report, education in the 21st century should be founded on the following four pillars: y learning to know (to understand the world around us), y learning to do (to affect one's environment), y learning to live together (to be able to successfully collaborate with others), y learning to be (learn for one's own development).
According to Delor's report, universities should change their image from educational institutions that give theoretical foundations and necessary knowledge and skills for a profession to a meeting place of adults who learn throughout their life, meaning that one of the tasks of universities is to introduce permanent education (21).
There are many concepts and theoretical ideas concerning lifelong learning. The co-author of one of them, Paul Lengrand claimed that the basic principle of lifelong learning is to maintain the continuity and regularity of the learning process. The continuity is supposed to guarantee continuous development and constant updating of the knowledge one already has (22). He was the chair of an international team of nine members, who published the paper: "Areas of learning basic to lifelong education" (23), which presents nine areas of learning important for lifelong education: communication, educating the corporal person, time, space, art, citizen, morality, technology and science. Lengrand believed that lifelong learning required establishing links between the goals of education and the above nine areas of learning. Lifelong learning should first of all ensure the continuity of the learning process to enable further development of an individual. Rivindra H. Dave emphasized the fact that lifelong learning is a process extending throughout the entire life and he identified its three basic dimensions: life, education and continuity. The above concepts -both in terms of their scope and content -comprise continuous education, which is a mutual relationship between the entire life and education in a continuous perspective. In such perspective, the goal of continuous education would be to maintain and improve the quality of life by development and integration in order to better perform one's professional and social roles (24).
One of the Polish scholars who explored the issue of lifelong learning was Professor Bogdan Suchodolski. He presented his ideas of lifelong learning in his book entitled "Edukacja permanentna -rozdroża i nadzieje" (Permanent education -crossroads and hopes). He believed that lifelong learning was closely linked with integrated education covering the life of a human being constantly functioning in different social groups. Permanent education is a lifelong process that should be implemented through the idea of an educating society. To become a human being is the deepest sense of permanent education (25). Meanwhile, Professor Józef Półturzycki described lifelong learning as a process that continues throughout the life of a person and serves the purpose of the person's development. The main goal of lifelong learning, in this perspective, is to educate a person to have a creative and active attitude to life and culture, to educate a person capable of self-improvement and of changing and improving the living conditions for the benefit of the society (26).
The above goals of lifelong learning coincide with the goals of the U3As, and in particular the goal of encouraging openness to the world and the interdisciplinary teaching content delivered through various forms of educational activities (lectures, classes, seminars, conservatories, workshops, foreign language courses and leisure activities), helping preserve the multidimensional fitness and acquire new skills that are important from the social perspective (e.g. soft skills, like interpersonal communication). Another important goal is to raise the level of self-esteem among "the generation of the third dimension" and promote its social reintegration, and to build a sense of being the elite as members of university community, as well as to overcome the reluctance of elderly persons to use new technologies through computer courses or teaching how to use the knowledge available in the Internet (27).

Activity of the Universities of the Third Age
Surveys conducted for the purpose of the "Zoom on U3A" report show that the Universities, using many different models, engage in activities that are typical of: y universities, y non-government organizations, y informal social groups, y local authority institutions. This means that being in the first place universities and serving the purpose of senior education, they offer space for personal development and socializing, and create appropriate conditions for elderly persons who want and are able to do that, to participate in the social life on a regular basis. According to the abovementioned report, the most important to U3A students were activities that broadened their knowledge and education (85% of respondents), stimulated their personal development and the development of their interests and skills (65% of respondents), enabled them to spend their free time actively (65% of respondents) and promoted healthy lifestyle (41% of respondents) (28). The most frequent topics of lectures given at the Universities of the Third Age were medicine and health, history, tourism and geography, literature, culture and religion, psychology/ psychological education, tradition, local history and culture, economics and history of art (29). The above results correspond to the analysis of lectures given by the U3A at the CPGME in Warsaw. According to the assessment of the abovementioned U3A, the most common topics of lectures were medicine and health (20,1% of all lectures) and history (20%). They were followed by lectures in psychology/ psychological education (11,7%), history and art (11,5%), literature (10%), local tradition, history and culture (8,2%), tourism and geography, and culture and religion (7% each) and economics (1,6%). Other topics represented 2,9% of all the lectures.
Considering the fact that both U3As operating at universities and U3As operating as non-government organizations or established on the basis of the Associations Law, the Foundations Act of the Act on Non-Profit Organizations have different kinds of representative bodies of their students, it may be assumed that the topics of lectures correspond to the needs and interests of U3A students. The American gerontologist, Clark Tibbitts proposed a very relevant classification of those needs: y need to render some socially useful services; y need to be considered a part of the community, the society or the group and to play a specific role in them; y need to occupy their increased leisure time in satisfying ways; y need to enjoy standard companionships; y need for recognition as an individual; y need for opportunity for self-expression and a sense of achievement; y need for suitable mental stimulation; y need for health protection and care; y need for suitable living arrangements; y need for family relationships; y need for spiritual satisfaction (30). It could be claimed that the U3As, offering a multidirectional programme that responds to the health-related, cognitive, social, cultural and interpersonal needs, satisfies most of the above needs by engaging elderly persons in various activities. At the same time, they prepare senior persons to live in new, rapidly changing conditions and enable them to live creative and active lives.
It should also be noted that old age is often associated with chronic diseases and an increased level of disability. Because of this, with age, people become increasingly interested in topics related to health and health protection as well as factors that accelerate the ageing process and cause physical and mental infirmity. At the same time their demand for medical services grows. The U3As also respond to this particular need by engaging in a broad range of activities in the field of preventive gerontology, a discipline that encompasses the biology of ageing, medicine, sociology, psychology and rehabilitation. These activities include, among other things, lectures discussing medical, health-related, psychological and psychological education issues, which justifies the claim that the U3As are an important element of health education among the elderly.

Conclusions
For more than 40 years, the U3As in Poland have enjoyed undiminished popularity among the elderly, by offering various forms of lifelong education and -which is equally important -by satisfying their need for contacts with others. These universities offer programmes that respond to various needs of the elderly and they integrate and engage their students, develop and satisfy their interests and promote preventive gerontology and holistic health among them.
U3A students not only benefit from their social, inclusive, socializing and normalizing opportunities, but can also learn to understand the world better, have their need to be useful satisfied and are empowered to take control of one's own life (education focused on self-reliance) (31). The idea of the U3As is to stimulate the development of the elderly by engaging them in various activities (including self-education) and by teaching them to be responsible and to solve everyday problems in the contemporary world, e.g. by familiarizing them with modern technologies. (32).
One of the factors affecting the structure and implementation of U3A programmes is the evident feminisation of their students, which is mainly due to the demographics of Poland. Another reason for the high level of female engagement in the U3As could be the fact that their need for self-fulfillment was not satisfied earlier in their lives. According to the surveys conducted for the "Zoom on U3A" report, on average, male students represented 15% of all U3A students. The data of the Central Statistical Office are similar: in 2018, there were 113,200 students in total of all the 640 Polish U3As, of which 84,3% were women and only 15,7% were men. Because of this, educational programmes and other activities offered to U3A students are selected mainly to suit female interests, which could lead to growing exclusion of men who may find the "female-oriented" programme not sufficiently attractive.
It is worth noting that U3As, especially those that do not have sufficiently strong links with higher education institutions may find it difficult to ensure competent teaching personnel, because some potential U3A lecturers may represent opinions or therapies that are not founded on scientific evidence or may want to use lectures to advertise, in a more or less disguised way, certain products or services.