The Social Context of Ageing

A Textbook of Gerontology

Christina Victor

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781134598182
• Edition: 1
• Topic: Social Sciences
• Subtopic: Gerontology
• Index: Social Sciences

This comprehensive text focuses on the social contexts of ageing, looking at the diversity of ageing and older people, and at different factors that are important to experiences of old age and ageing. It includes key chapters on:

• theoretical and methodological bases for the study of ageing
• demographic context of the 'ageing' population
• health and illness
• family and social networks
• formal and informal care and other services for older people.

Providing an invaluable introduction to the major issues involved in the study of ageing, this book is essential reading for students of sociology, gerontology, social policy, health and social care, and professionals working with older people.

1
The social perspective on ageing

Gerontology is the science concerned with the study of ageing. Also encompassed within the term is a more expansive definition of the study of ageing to include the study of later life, old age and older people. As such it is a comparatively `young' science: the term 'gerontology' was first used by a Russian biologist Metchnikoff in his book The Prolongation of Life published in 1908. However, the recency of the identification of the science of gerontology masks an interest in old age and older people that has existed for thousands of years. Distinguished scientists such as Francis Bacon, Benjamin Franklin and Francis Galton all wrote about ageing. There have always been 'older' people present within societies. The oldest reported lifespan is that of Methuselah, who is supposed to have lived for 969 years. The longest verifiable lifespan was that of Jeanne Calment, who died in 1997, aged 126. Individuals living to advanced age is not a feature unique to contemporary society: Thomas Parr was presented to Charles I as being 152 years old, but such claims were largely unverifiable because individuals were not always certain as to their exact date of birth. As a society we have always been interested in what it is about certain individuals that means that they can survive to very advanced old age while others do not. Writers from the times of Aristotle onwards have been interested in the attributes required for living to old age and the first question many are asked upon achieving their centenary is what do they ascribe their long life to.

Perspectives upon ageing

Given the breadth of the topic under study it is, perhaps, not surprising that there are a number of different perspectives upon the study of ageing. These are usually defined as the biological, the psychological and the social. Thus gerontology is a multidisciplinary field of investigation in which each of these perspectives has a valuable contribution to make. One of the many challenges confronting the gerontologist is to be able to integrate these differing approaches to enhance and develop our understanding of ageing and later life. The bio-social- psycho model initially advanced by Engel (1977) is one way of developing a more integrationalist framework towards the study of old age. He argues that in order to understand ageing and the experience of old age, and to develop interventions to compensate for the vicissitudes of old age, we need to be able to integrate these differing perspectives. This model for understanding ageing was developed in response to the dominance of the biomedical model of ageing. This later model is imbued with notions of decline and deterioration, is focused upon disease and is highly reductionist in its thinking about later life. In contrast the bio-psycho-social model focuses upon health, integrates notions of both mental and physical health, and emphasises the influence of contextual factors upon the experience of old age.

The biological perspective

The biological approach to ageing is concerned with how the passage of time affects physiological systems (see Kirkwood, 1999). We are all aware of how older people illustrate specific physical changes such as wrinkles or grey hair. The key question is whether such changes are a result of 'ageing' or growing older or whether they represent potentially modifiable changes resultant from social and environmental factors. For example the presence of wrinkles is seen by many as arising from growing older. However, we know that, in part, wrinkles reflect lifestyle and environmental factors such as sun exposure and smoking. Physiological changes attributed to ageing may, in part, be attributable to social and environmental influences or mediated by them. In theory, at least, this offers the potential to develop interventions to ameliorate such factors, if not eradicate them entirely.

Biologists are interested in longevity and the varying life spans of different species. Longevity refers to the maximum lifespan that a species could attain under 'optimal' conditions. Lifespan refers to the period between birth and death and the maximum verified to date for a human is 126 years. Life expectancy refers to the 'average' number of years remaining to a person of a specific age. This is an actuarial calculation often calculated at birth but can also be calculated from any given age. Biologists refer to ageing as 'senescence'. This describes decreases in the efficient functioning of an organism with age as a result of natural processes rather than abnormal processes which bring about pathology and disease (Ebrahim and Kalache, 1996). There have been various attempts to define the biological changes and characteristics which accompany growing older in all forms of life. Strehler (1962) defines ageing as the changes which occur in the post-reproductive phase of life that result from a decrease in the ability of the body to maintain homeostasis, that is to regulate the functions of the body within the very precise limits required for efficient functioning and survival. Consequently the body becomes less able to adapt to physiological stress and less resistant to disease and pathology. Ageing is viewed as an involuntary phase in the development of the organism which brings about a decrease in adaptive capacities and, ultimately, death. Although there is still considerable debate about the precise biological definition of ageing, Strehler (1962) again suggests that four criteria distinguish ageing from other biological processes and which can also be used to distinguish 'ageing' from 'disease'. For a physiological change to be considered part of 'ageing' and not some other process, Strehler (1962) suggests that it should demonstrate the following attributes: universality (it must happen to every member of a population), internality (it must result from internal processes and not reflect lifestyle or environmental factors), progressiveness (it is progressive, rather than acute, with cumulative effects) and harmfulness (it should demonstrate a deleterious, rather than benign, effect upon the organism and its ability to cope with its environment). Using these criteria, Box 1.1 illustrates that dementia is clearly a disease rather than an ageing effect as it fails to fulfil most of the Strehler (1962) criteria.

There are at least twelve different theories advanced to account for why we age and it is neither appropriate nor practical to examine all of these here. We shall illustrate the range of theories in this area by using examples from the two major approaches to theories of ageing: 'error theories' and 'programming theories'. Error-based theories of ageing develop the proposition that ageing results from the development and replication of errors within the physiological system. Perhaps the oldest manifestation of this approach to theorising biological and physiological ageing is the 'wear and tear' theory which can be traced back to the ideas of Aristotle. This perspective likens the human body to a machine, which eventually wears out, with this process being expedited by 'overuse'. A popularist development of this theory is that all individuals have a fixed amount of time 'allocated' to them and that vigorous exercise or lifestyle will use up this energy, leading to premature death. The second set of theories relate to the notions of 'programmed' age ing which hypothesises that ageing and the maximal life span are programmed into the genes of the particular organism and derives from the work of Hayflick (1996). Ageing and death are 'pre-programmed' events with an inherent biological clock, which keeps track of time and initiates the ageing process when certain limits are met.

BOX 1.1 AGEING AND DISEASE

Ageing is

• universal
• internal
• progressive
• harmful (death)

Disease is

• random
• intrinsic and extrinsic
• acute and chronic
• may be halted

Dementia (impaired cognitive function) is not part of the ageing process because it is

• selective not universal (prevalence of about 5 per cent—but depends upon threshold)
• intrinsic (variety of causes—vascular)
• progressive (slow onset, drugs may reverse)
• harmful (causes disability or dependence not necessarily death)

Ageing is a 'normal' process; distinguishing this normal process from pathology and disease remains a key challenge. Much work in gerontology has tended to conflate these two distinct notions so that we have not always clearly distinguished between them. Disease and age-related change have been linked together and have contributed to many of our negative views of ageing by a concentration upon decline and dysfunction. Increasingly we are aware that the physical changes we have attributed to 'ageing' are age related but not causally. Such changes may be linked to the social and environmental context and that they may be modified.

The psychological perspective

The psychological approach concentrates upon examining personality, mental function and notions of self and identity. The psychologist is interested in both differences in behaviour between individuals and changes within individuals with the passage of time. Hence this perspective is distinguished from the cellular/organ systems approach of the biologist and the structural/social factors approach of the sociologist. This is a diverse area of research which embraces topics such as cognitive function, health psychology (health beliefs and behaviour), mental illness and personality and adjustment. The biomedical model has influenced this area of work in that there has often been a very negative, decline and loss orientated approach to the subject. The focus has been upon adjustment to loss rather than more positive notions of self-development in later life. This topic is dealt with in more depth in Chapter 6.

The social gerontological perspective

The sociology of ageing is concerned with using sociological perspectives to understand ageing. Social gerontology is a wider discipline in that it is concerned with approaching ageing from a variety of social science perspectives in order to achieve a better understanding of ageing and old age rather than for developing sociological theory and insights. As such social gerontology incorporates three distinct perspectives—individual, social and societal—at two levels of analysis, the microscale and macroscale which illustrates the complexity of the subject area. The microscale approach is concerned with understanding and explaining ageing as an individual experience by investigating such topics as changes in perceived age identity as the individual progresses through the lifecourse. Here we are trying to elucidate what it is like to be an older person within contemporary society.

However, few individuals grow older in isolation from the rest of society. Rather, ageing occurs within a social context ranging from the microscale of the family to the macroscale of the whole society or culture or increasingly of a globalised world (Estes et al., 2004). Hence the second approach to the study of ageing examines the social context which defines ageing and seeks to understand the position of and experience of older people within society and how this is shaped by major structural factors such as class, gender and ethnicity. The meaning and impact of the constraints operating upon the older adult are highly dependent upon the social environment in which the individual encounters them. It is now evident that ageing is not a homogeneous experience which affects every individual within the same society in a monolithic fashion. All 'old people' are not alike and pre-old-age characteristics such as class and gender continue to exert a strong influence across the lifecourse. To conceptualise old age as an undifferentiated experience is both naive and unhelpful. We all bring to the experience of old age access to various resources—material, health and social —and these are strongly influenced by our experiences prior to 'old age'. Indeed, with the development of the ideas of the 'successful ageing' (Rowe and Kahn, 1999) the importance of the social context for the shaping of the experience of old age has assumed greater prominence. These authors argue that successful ageing is defined by both longevity and quality of life and that these are promoted by the interaction of three sets of factors: social engagement and participation, reduction of disease, and promotion of high levels of physical and mental functioning.

The third facet of social gerontology is concerned with 'societal ageing'. This is concerned with the demographic, structural, cultural and economic transformation resultant from the increase in the number and proportion of 'older' people within society. How do social institutions respond to the changes in the nature and composition of our population? How will society respond to the increased number and visibility of older people? In this chapter we consider the different approaches which have been adopted towards the definition of old age and we examine the characteristics of these competing perspectives. The chapter then provides a summary of some of the dominant values that characterise society, which are of importance for understanding the experience of ageing and the position of the older people in contemporary society.

What is old age?

Both professionals and the lay public, when describing people in the later phases of life, often use terms such as 'the elderly' or 'older people'. These are terms which are common currency in both popular usage and more academic environments. Despite the frequency with which they are used, the definition of exactly what constitutes 'old age' and when it starts remains problematic. These terms are a shorthand way of identifying the group of interest and little more. We cannot presume that the identified group is homogeneous as it may encompass an age range of 40 years or more from, for example, 65 to 105 years. It is totally unrealistic to expect such a group to be homogeneous in either character or attitudes.

There are a number of different ways, in theory at least, to determine when old age starts and to identify our group of interest. There is no readily agreed biological definition of ageing or of the onset of old age. The physiological manifestations of biological ageing occur at different rates in different people with the result that the older age groups are very varied in terms of senescence. Hence the potential for using biological markers or some notion of functional age remains problematic for theoretical, conceptual and technical reasons.

Perhaps the easiest measure of old age is 'chronological' or calendar age. Of itself chronological age simply conveys the number of birthdays that an individual has accumulated. Clearly for this measure to be used it requires a society to be sufficiently well organised that its members know their chronological age. Although this is frequently used to define the onset of old age it is, at best, only a very rough guide to the ageing of the individual in biological terms because of the variability across individuals in terms of senescence. In addition chronological age of itself has no innate 'meaning' but is derived from the social and historical context within which it operates. Hence the interpretation and meaning of specific chronological ages vary both historically and culturally. Because of the ease with which information is presented, chronological age is by far the most accessible definition of old age, but we need to remain alert as to the limitations which this approach poses.

Another approach to the definition of old age is via the concept of the lifecycle or life stage. This is usually conceived as an orderly progression from infancy to old age with biological and socio-cultural factors interacting to govern the sequence of progression. Old or middle age are broad social categories that encompass changes of role (from child to adult), physical changes and other forms of social transition (becoming a grandparent). Although these life stages are often perceived as a simple universal progression from one well-defined set of social roles to another, it is in reality a highly complex concept. Within the broad term lifecycle it is possible to distinguish between a variety of sub-lifecycles related to different aspects of life such the family or work. The family dimension of the lifecycle involves numerous transitions including courtship, newly married, new parents, parents of teenagers, 'empty nesters' and widowhood. Not everyone will experience all these phases of the family cycle; there may also be enormous variations in the age at which individuals experience these transitions. For example, some people marry at 18 and have three children by the age of 25; others may not marry until well into their thirties, while others have their children in their forties at an age when others are becoming grandparents. Furthermore this trajectory is based upon notions of monogamy across the life course. Neugarten (1974) describes how the lifecycle has become increasingly differentiated into smaller segments with the emergence of the subgroups of 'adolescence', 'pre-school' and 'middle age' as distinct phases. It was not until industrialisation in the seventeenth and eighteenth centuries that childhood emerged as a spe...