Ch13 Aging and the Elderly

• Gerontology is a field of science that seeks to understand the process of aging and the challenges encountered as seniors grow older. Gerontologists investigate age, aging, and the aged.

• Social gerontology refers to a specialized field of gerontology that examines the social (and sociological) aspects of aging. Researchers focus on developing a broad understanding of the experiences of people at specific ages, such as mental and physical wellbeing, plus age-specific concerns such as the process of dying.

• Scholars in these disciplines have learned that “aging” reflects not only the physiological process of growing older but also our attitudes and beliefs about the aging process.

• Some older adults even succumb to stereotyping their own age group

• Attitudes toward the elderly have also been affected by large societal changes that have happened over the past 100 years.

• Researchers believe industrialization and modernization have contributed greatly to lowering the power, influence, and prestige the elderly once held. On the other hand, the sheer numbers of elderly people in certain societies can have other effects, such as older people's influence on policies and politics based on their voting influence.

• The elderly have both benefited and suffered from these rapid social changes. In modern societies, a strong economy created new levels of prosperity for many people.

• Healthcare has become more widely accessible, and medicine has advanced, which allows the elderly to live longer. However, older people are not as essential to the economic survival of their families and communities as they were in the past.

Studying Aging Populations

• Since its creation in 1790, the U.S. Census Bureau has been tracking age in the population. Age is an important factor to analyze with accompanying demographic figures, such as income and health. The population chart below shows projected age distribution patterns for the next several decades.

• A cohort is a group of people who share a statistical or demographic trait. People belonging to the same age cohort were born in the same time frame.

Phases of Aging: The Young-Old, Middle-Old, and Old-Old

• In the United States, all people over eighteen years old are considered adults, but there is a large difference between a person who is twenty-one years old and a person who is forty-five years old.

• groupings are helpful in understanding the elderly. The elderly are often lumped together to include everyone over the age of sixty-five.

• The United States’ older adult population can be divided into three life-stage subgroups: the young-old (approximately sixty-five to seventy-four years old), the middle-old (ages seventy-five to eighty-four years old), and the old-old (over age eighty-five).

• Today’s young-old age group is generally happier, healthier, and financially better off than the young-old of previous generations. In the United States, people are better able to prepare for aging because resources are more widely available.

The Graying of the United States

• There is an element of social construction, both local and global, in the way individuals and nations define who is elderly; that is, the shared meaning of the concept of elderly is created through interactions among people in society.

• Members of the Baby Boom generation indicate that a person is officially "old" when they turn 73 years old. Millennials, a much younger group, felt that people became old when they turned 59.

• There are several reasons why the United States is graying so rapidly. One of these is life expectancy: the average number of years a person born today may expect to live.

• It is interesting to note that not all people in the United States age equally.

• In 2010, there were ninety sixty-five-year-old men per one hundred sixty-five-year-old women. However, there were only eighty seventy-five-year-old men per one hundred seventy-five-year-old women, and only sixty eighty-five-year-old men per one hundred eighty-five-year-old women.

Baby Boomers

• Of particular interest to gerontologists today is the population of Baby Boomers, the cohort born between 1946 and 1964 and now reaching their 60s and 70s.

• People in the Boomer generation do not want to grow old the way their grandparents did; the result is a wide range of products designed to ward off the effects—or the signs—of aging.

• According to the U.S. Department of Health and Human Services, healthcare spending is projected to grow by 5.5 percent each year from now until 2027.

• Certainly, as Boomers age, they will put increasing burdens on the entire U.S. healthcare system.

• Unlike the elderly of previous generations, Boomers do not expect that turning sixty-five means their active lives are over. They are not willing to abandon work or leisure activities, but they may need more medical support to keep living vigorous lives.

• The economic impact of aging Boomers is also an area of concern for many observers. Although the baby boom generation earned more than previous generations and enjoyed a higher standard of living, they did not adequately prepare for retirement.

• According to most retirement and investment experts, in order to maintain their accustomed lifestyle, people need to save ten times their annual income before retiring.

• Higher education costs increased significantly while many Baby Boomers were sending their children to college. No matter what the cause, many retirees report a great deal of stress about running out of money.

• Social Security is a government-run retirement program funded primarily through payroll taxes. With enough people paying into the program, there should be enough money for retirees to take out.

• But with the aging Boomer cohort starting to receive Social Security benefits and fewer workers paying into the Social Security trust fund, economists warn that the system will collapse by the year 2037.

Aging around the World

• The United States is certainly not alone regarding its aging population; in fact, it doesn’t even have the fastest-growing group of elderly people. In 2019, the world had 703 million people aged 65 years or over. By 2050, that number is projected to double to 1.5 billion. One in six people in the world will be 65 or over

• This percentage is expected to increase and will have a huge impact on the dependency ratio: the number of citizens not in the labor force (young, disabled, or elderly) to citizens in the labor force (Bartram and Roe 2005). One country that will soon face a serious aging crisis is China, which is on the cusp of an “aging boom”— a period when its elderly population will dramatically increase.

• As healthcare improves and life expectancy increases across the world, elder care will be an emerging issue. Wienclaw (2009) suggests that with fewer working-age citizens available to provide home care and long-term assisted care to the elderly, the costs of elder care will increase.

• In the United States, decisions to care for an elderly relative are often conditionally based on the promise of future returns, such as inheritance or, in some cases, the amount of support the elderly provided to the caregiver in the past (Hashimoto 1996).

• These differences are based on cultural attitudes toward aging. In China, several studies have noted the attitude of filial piety (deference and respect to one’s parents and ancestors in all things) as defining all other virtues.

• In the United States, by contrast, many people view caring for the elderly as a burden. Even when there is a family member able and willing to provide for an elderly family member, 60 percent of family caregivers are employed outside the home and are unable to provide the needed support.

• Poverty among elders is a concern, especially among elderly women. The feminization of the aging poor, evident in peripheral nations, is directly due to the number of elderly women in those countries who are single, illiterate, and not a part of the labor force.

• In 2002, the Second World Assembly on Aging was held in Madrid, Spain, resulting in the Madrid Plan, an internationally coordinated effort to create comprehensive social policies to address the needs of the worldwide aging population.

• The plan identifies three themes to guide international policy on aging: 1) publicly acknowledging the global challenges caused by, and the global opportunities created by, a rising global population; 2) empowering the elderly; and 3) linking international policies on aging to international policies on development.

• The Madrid Plan has not yet been successful in achieving all its aims. However, it has increased awareness of the various issues associated with a global aging population

Biological Changes

• Biological factors, such as molecular and cellular changes, are called primary aging, while aging that occurs due to controllable factors, such as lack of physical exercise and poor diet, is called secondary aging.

• Most people begin to see signs of aging after fifty years old, when they notice the physical markers of age. Skin becomes thinner, drier, and less elastic. Wrinkles form. Hair begins to thin and gray. Men prone to balding start losing hair.

• The effects of aging can feel daunting, and sometimes the fear of physical changes is more challenging to deal with than the changes themselves. The way people perceive physical aging is largely dependent on how they were socialized.

• If people can accept the changes in their bodies as a natural process of aging, the changes will not seem as frightening.

• Some impacts of aging are gender-specific. Some of the disadvantages aging women face arise from long-standing social gender roles.

• For example, Social Security favors men over women, inasmuch as women do not earn Social Security benefits for the unpaid labor they perform (usually at home) as an extension of their gender roles.

• In the healthcare field, elderly female patients are more likely than elderly men to see their healthcare concerns trivialized and are more likely to have their health issues labeled psychosomatic.

• Another female-specific aspect of aging is that mass-media outlets often depict elderly females in terms of negative stereotypes and as less successful than older men

• For men, the process of aging—and society’s response to and support of the experience—may be quite different. The gradual decrease in male sexual performance that occurs as a result of primary aging is medicalized and constructed as needing treatment (Marshall and Katz 2002) so that a man may maintain a sense of youthful masculinity.

Social and Psychological Changes*

Male or female, growing older means confronting the psychological issues that come with entering the last phase of life. Young people moving into adulthood take on new roles and responsibilities as their lives expand, but an opposite arc can be observed in old age. What are the hallmarks of social and psychological change?

Retirement—the withdrawal from paid work at a certain age—is a relatively recent idea. Up until the late nineteenth century, people worked about sixty hours a week until they were physically incapable of continuing. Following the American Civil War, veterans receiving pensions were able to withdraw from the workforce, and the number of working older men began declining. A second large decline in the number of working men began in the post-World War II era, probably due to the availability of Social Security, and a third large decline in the 1960s and 1970s was probably due to the social support offered by Medicare and the increase in Social Security benefits (Munnell 2011).

In the twenty-first century, most people hope that at some point they will be able to stop working and enjoy the fruits of their labor. But do we look forward to this time or fear it? When people retire from familiar work routines, some easily seek new hobbies, interests, and forms of recreation. Many find new groups and explore new activities, but others may find it more difficult to adapt to new routines and loss of social roles, losing their sense of self-worth in the process.

Each phase of life has challenges that come with the potential for fear. Erik H. Erikson (1902–1994), in his view of socialization, broke the typical lifespan into eight phases. Each phase presents a particular challenge that must be overcome. In the final stage, old age, the challenge is to embrace integrity over despair. Some people are unable to successfully overcome the challenge. They may have to confront regrets, such as being disappointed in their children’s lives or perhaps their own. They may have to accept that they will never reach certain career goals. Or they must come to terms with what their career success has cost them, such as time with their family or declining personal health. Others, however, are able to achieve a strong sense of integrity and are able to embrace the new phase in life. When that happens, there is tremendous potential for creativity. They can learn new skills, practice new activities, and peacefully prepare for the end of life.

For some, overcoming despair might entail remarriage after the death of a spouse. A study conducted by Kate Davidson (2002) reviewed demographic data that asserted men were more likely to remarry after the death of a spouse and suggested that widows (the surviving female spouse of a deceased male partner) and widowers (the surviving male spouse of a deceased female partner) experience their postmarital lives differently. Many surviving women enjoyed a new sense of freedom, since they were living alone for the first time. On the other hand, for surviving men, there was a greater sense of having lost something, because they were now deprived of a constant source of care as well as the focus of their emotional life.

Aging and Sexuality

Figure 13.11 In Harold and Maude, a 1971 cult classic movie, a twenty-something young man falls in love with a seventy-nine-year-old woman. The world disapproves. (Credit: luckyjackson/flickr)

Although it is sometimes difficult to have an open, public national dialogue about aging and sexuality, the reality is that our sexual selves do not disappear after age sixty-five. People continue to enjoy sex—and not always safe sex—well into their later years. In fact, some research suggests that as many as one in five new cases of AIDS occurs in adults over sixty-five years old (Hillman 2011).

In some ways, old age may be a time to enjoy sex more, not less. For women, the elder years can bring a sense of relief as the fear of an unwanted pregnancy is removed and the children are grown and taking care of themselves. However, while we have expanded the number of psycho-pharmaceuticals to address sexual dysfunction in men, it was not until recently that the medical field acknowledged the existence of female sexual dysfunctions (Bryant 2004). Additional treatments have been developed or applied to address sexual desire or dysfunction, which sometimes leads members of both sexes to believe that problems are easily resolved. But emotional and social factors play an important role, and medications on their own cannot resolve all issues (Nonacs 2018).

Aging and sexuality also concerns relationships between people of different ages, referred to as age-gap relationships by researchers. These types of relationships are certainly not confined to the elderly, but people often make assumptions about elderly people in romantic relationships with younger people (and vice versa). Research into age-gap relationships indicates that social pressure can have impacts on relationship commitment or lead to break ups. The life stages of the people can also have impacts, especially if one of them is elderly and the other is not (Karantzas 2018). A relationship between a 30-year-old and a 45-year-old most likely involves fewer discussions about serious health issues and retirement decisions than one between a 55-year-old and a 70-year-old. Both have 15-year age gaps, but the circumstances are quite different.

Death and Dying

Figure 13.13 A young man sits at the grave of his great-grandmother. (Credit: Sara Goldsmith/flickr)

For most of human history, the standard of living was significantly lower than it is now. Humans struggled to survive with few amenities and very limited medical technology. The risk of death due to disease or accident was high in any life stage, and life expectancy was low. As people began to live longer, death became associated with old age.

For many teenagers and young adults, losing a grandparent or another older relative can be the first loss of a loved one they experience. It may be their first encounter with grief, a psychological, emotional, and social response to the feelings of loss that accompanies death or a similar event.

People tend to perceive death, their own and that of others, based on the values of their culture. While some may look upon death as the natural conclusion to a long, fruitful life, others may find the prospect of dying frightening to contemplate. People tend to have strong resistance to the idea of their own death, and strong emotional reactions of loss to the death of loved ones. Viewing death as a loss, as opposed to a natural or tranquil transition, is often considered normal in the United States.

What may be surprising is how few studies were conducted on death and dying prior to the 1960s. Death and dying were fields that had received little attention until a psychologist named Elisabeth Kübler-Ross began observing people who were in the process of dying. As Kübler-Ross witnessed people’s transition toward death, she found some common threads in their experiences. She observed that the process had five distinct stages: denial, anger, bargaining, depression, and acceptance. She published her findings in a 1969 book called On Death and Dying. The book remains a classic on the topic today.

Kübler-Ross found that a person’s first reaction to the prospect of dying is denial: this is characterized by the person's not wanting to believe he or she is dying, with common thoughts such as “I feel fine” or “This is not really happening to me.” The second stage is anger, when loss of life is seen as unfair and unjust. A person then resorts to the third stage, bargaining: trying to negotiate with a higher power to postpone the inevitable by reforming or changing the way he or she lives. The fourth stage, psychological depression, allows for resignation as the situation begins to seem hopeless. In the final stage, a person adjusts to the idea of death and reaches acceptance. At this point, the person can face death honestly, by regarding it as a natural and inevitable part of life and can make the most of their remaining time.

The work of Kübler-Ross was eye-opening when it was introduced. It broke new ground and opened the doors for sociologists, social workers, health practitioners, and therapists to study death and help those who were facing death. Kübler-Ross’s work is generally considered a major contribution to thanatology: the systematic study of death and dying.

Of special interests to thanatologists is the concept of “dying with dignity.” Modern medicine includes advanced medical technology that may prolong life without a parallel improvement to the quality of life one may have. In some cases, people may not want to continue living when they are in constant pain and no longer enjoying life. Should patients have the right to choose to die with dignity? Dr. Jack Kevorkian was a staunch advocate for physician-assisted suicide: the voluntary or physician-assisted use of lethal medication provided by a medical doctor to end one’s life. This right to have a doctor help a patient die with dignity is controversial. In the United States, Oregon was the first state to pass a law allowing physician-assisted suicides. In 1997, Oregon instituted the Death with Dignity Act, which required the presence of two physicians for a legal assisted suicide. This law was successfully challenged by U.S. Attorney General John Ashcroft in 2001, but the appeals process ultimately upheld the Oregon law. As of 2019, seven states and the District of Columbia have passed similar laws allowing physician assisted suicide.

The controversy surrounding death with dignity laws is emblematic of the way our society tries to separate itself from death. Health institutions have built facilities to comfortably house those who are terminally ill. This is seen as a compassionate act, helping relieve the surviving family members of the burden of caring for the dying relative. But studies almost universally show that people prefer to die in their own homes (Lloyd, White, and Sutton 2011). Is it our social responsibility to care for elderly relatives up until their death? How do we balance the responsibility for caring for an elderly relative with our other responsibilities and obligations? As our society grows older, and as new medical technology can prolong life even further, the answers to these questions will develop and change.

The changing concept of hospice is an indicator of our society’s changing view of death. Hospice is a type of healthcare that treats terminally ill people when “cure-oriented treatments” are no longer an option (Hospice Foundation of America 2012b). Hospice doctors, nurses, and therapists receive special training in the care of the dying. The focus is not on getting better or curing the illness, but on passing out of this life in comfort and peace. Hospice centers exist as a place where people can go to die in comfort, and increasingly, hospice services encourage at-home care so that someone has the comfort of dying in a familiar environment, surrounded by family (Hospice Foundation of America 2012a). While many of us would probably prefer to avoid thinking of the end of our lives, it may be possible to take comfort in the idea that when we do approach death in a hospice setting, it is in a familiar, relatively controlled place.

Poverty

Figure 13.14 While elderly poverty rates showed an improvement trend for decades, the 2008 recession has changed some older people’s financial futures. Some who had planned a leisurely retirement have found themselves at risk of late-age destitution. (Credit: (a) Michael Cohen/flickr; Photo (b) Alex Proimos/flickr)

For many people in the United States, growing older once meant living with less income. In 1960, almost 35 percent of the elderly existed on poverty-level incomes. A generation ago, the nation’s oldest populations had the highest risk of living in poverty.

At the start of the twenty-first century, the older population was putting an end to that trend. Among people over sixty-five years old, the poverty rate fell from 30 percent in 1967 to 9.7 percent in 2008, well below the national average of 13.2 percent (U.S. Census Bureau 2009). However, given the subsequent recession, which severely reduced the retirement savings of many while taxing public support systems, how are the elderly affected? According to the Kaiser Commission on Medicaid and the Uninsured, the national poverty rate among the elderly had risen to 14 percent by 2010 (Urban Institute and Kaiser Commission 2010).

Before the recession hit, what had changed to cause a reduction in poverty among the elderly? What social patterns contributed to the shift? For several decades, a greater number of women joined the workforce. More married couples earned double incomes during their working years and saved more money for their retirement. Private employers and governments began offering better retirement programs. By 1990, senior citizens reported earning 36 percent more income on average than they did in 1980; that was five times the rate of increase for people under age thirty-five (U.S. Census Bureau 2009).

In addition, many people were gaining access to better healthcare. New trends encouraged people to live more healthful lifestyles by placing an emphasis on exercise and nutrition. There was also greater access to information about the health risks of behaviors such as cigarette smoking, alcohol consumption, and drug use. Because they were healthier, many older people continue to work past the typical retirement age and provide more opportunity to save for retirement. Will these patterns return once the recession ends? Sociologists will be watching to see. In the meantime, they are realizing the immediate impact of the recession on elderly poverty.

During the recession, older people lost some of the financial advantages that they’d gained in the 1980s and 1990s. From October 2007 to October 2009 the values of retirement accounts for people over age fifty lost 18 percent of their value. The sharp decline in the stock market also forced many to delay their retirement (Administration on Aging 2009).

Ageism

Figure 13.15 Are these street signs humorous or offensive? What shared assumptions make them humorous? Or is memory loss too serious to be made fun of? (Credit: Tumbleweed/flickr)

Driving to the grocery store, Peter, twenty-three years old, got stuck behind a car on a four-lane main artery through his city’s business district. The speed limit was thirty-five miles per hour, and while most drivers sped along at forty to forty-five mph, the driver in front of him was going the minimum speed. Peter tapped on his horn. He tailgated the driver. Finally, Peter had a chance to pass the car. He glanced over. Sure enough, Peter thought, a gray-haired old man guilty of “DWE,” driving while elderly.

At the grocery store, Peter waited in the checkout line behind an older woman. She paid for her groceries, lifted her bags of food into her cart, and toddled toward the exit. Peter, guessing her to be about eighty years old, was reminded of his grandmother. He paid for his groceries and caught up with her.

“Can I help you with your cart?” he asked.

“No, thank you. I can get it myself,” she said and marched off toward her car.

Peter’s responses to both older people, the driver and the shopper, were prejudiced. In both cases, he made unfair assumptions. He assumed the driver drove cautiously simply because the man was a senior citizen, and he assumed the shopper needed help carrying her groceries just because she was an older woman.

Responses like Peter’s toward older people are fairly common. He didn’t intend to treat people differently based on personal or cultural biases, but he did. Ageism is discrimination (when someone acts on a prejudice) based on age. Dr. Robert Butler coined the term in 1968, noting that ageism exists in all cultures (Brownell). Ageist attitudes and biases based on stereotypes reduce elderly people to inferior or limited positions.

Ageism can vary in severity. Peter’s attitudes are probably seen as fairly mild, but relating to the elderly in ways that are patronizing can be offensive. When ageism is reflected in the workplace, in healthcare, and in assisted-living facilities, the effects of discrimination can be more severe. Ageism can make older people fear losing a job, feel dismissed by a doctor, or feel a lack of power and control in their daily living situations.

In early societies, the elderly were respected and revered. Many preindustrial societies observed gerontocracy, a type of social structure wherein the power is held by a society’s oldest members. In some countries today, the elderly still have influence and power and their vast knowledge is respected. Reverence for the elderly is still a part of some cultures, but it has changed in many places because of social factors.

In many modern nations, however, industrialization contributed to the diminished social standing of the elderly. Today wealth, power, and prestige are also held by those in younger age brackets. The average age of corporate executives was fifty-nine years old in 1980. In 2008, the average age had lowered to fifty-four years old (Stuart 2008). Some older members of the workforce felt threatened by this trend and grew concerned that younger employees in higher level positions would push them out of the job market. Rapid advancements in technology and media have required new skill sets that older members of the workforce are less likely to have.

Changes happened not only in the workplace but also at home. In agrarian societies, a married couple cared for their aging parents. The oldest members of the family contributed to the household by doing chores, cooking, and helping with child care. As economies shifted from agrarian to industrial, younger generations moved to cities to work in factories. The elderly began to be seen as an expensive burden. They did not have the strength and stamina to work outside the home. What began during industrialization, a trend toward older people living apart from their grown children, has become commonplace. As you saw in the opening, children of older people can also feel guilt, sadness, and sometimes anger at both taking care of aging parents and with accepting that their parents are losing their abilities. Living apart, especially if an older person is moved to a nursing home or other facility, can often exacerbate these issues.

Mistreatment and Abuse

Mistreatment and abuse of the elderly is a major social problem. As expected, with the biology of aging, the elderly sometimes become physically frail. This frailty renders them dependent on others for care—sometimes for small needs like household tasks, and sometimes for assistance with basic functions like eating and toileting. Unlike a child, who also is dependent on another for care, an elder is an adult with a lifetime of experience, knowledge, and opinions—a more fully developed person. This makes the care-providing situation more complex.

Elder abuse occurs when a caretaker intentionally deprives an older person of care or harms the person in his or her charge. Caregivers may be family members, relatives, friends, health professionals, or employees of senior housing or nursing care. The elderly may be subject to many different types of abuse.

In a 2009 study on the topic led by Dr. Ron Acierno, the team of researchers identified five major categories of elder abuse: 1) physical abuse, such as hitting or shaking, 2) sexual abuse, including rape and coerced nudity, 3) psychological or emotional abuse, such as verbal harassment or humiliation, 4) neglect or failure to provide adequate care, and 5) financial abuse or exploitation (Acierno 2010).

The National Center on Elder Abuse (NCEA), a division of the U.S. Administration on Aging, also identifies abandonment and self-neglect as types of abuse. Table 13.2 shows some of the signs and symptoms that the NCEA encourages people to notice.

Table 13.2 Signs of Elder Abuse The National Center on Elder Abuse encourages people to watch for these signs of mistreatment. (Credit: National Center on Elder Abuse)

How prevalent is elder abuse? Two recent U.S. studies found that roughly one in ten elderly people surveyed had suffered at least one form of elder abuse. Some social researchers believe elder abuse is underreported and that the number may be higher. The risk of abuse also increases in people with health issues such as dementia (Kohn and Verhoek-Oftedahl 2011). Older women were found to be victims of verbal abuse more often than their male counterparts.

In Acierno’s study, which included a sample of 5,777 respondents aged sixty and older, 5.2 percent of respondents reported financial abuse, 5.1 percent said they’d been neglected, and 4.6 endured emotional abuse (Acierno 2010). The prevalence of physical and sexual abuse was lower at 1.6 and 0.6 percent, respectively (Acierno 2010).

Other studies have focused on the caregivers to the elderly in an attempt to discover the causes of elder abuse. Researchers identified factors that increased the likelihood of caregivers perpetrating abuse against those in their care. Those factors include inexperience, having other demands such as jobs (for those who weren’t professionally employed as caregivers), caring for children, living full-time with the dependent elder, and experiencing high stress, isolation, and lack of support (Kohn and Verhoek-Oftedahl 2011).

A history of depression in the caregiver was also found to increase the likelihood of elder abuse. Neglect was more likely when care was provided by paid caregivers. Many of the caregivers who physically abused elders were themselves abused—in many cases, when they were children. Family members with some sort of dependency on the elder in their care were more likely to physically abuse that elder. For example, an adult child caring for an elderly parent while at the same time depending on some form of income from that parent, is considered more likely to perpetrate physical abuse (Kohn and Verhoek-Oftedahl 2011).

A survey in Florida found that 60.1 percent of caregivers reported verbal aggression as a style of conflict resolution. Paid caregivers in nursing homes were at a high risk of becoming abusive if they had low job satisfaction, treated the elderly like children, or felt burnt out (Kohn and Verhoek-Oftedahl 2011). Caregivers who tended to be verbally abusive were found to have had less training, lower education, and higher likelihood of depression or other psychiatric disorders. Based on the results of these studies, many housing facilities for seniors have increased their screening procedures for caregiver applicants.

Big Picture

World War II Veterans

Figure 13.16 World War II (1941–1945) veterans and members of an Honor Flight from Milwaukee, Wisconsin, visit the National World War II Memorial in Washington, DC. Most of these men and women were in their late teens or twenties when they served. (Credit: Sean Hackbarth/flickr)

World War II was a defining event in recent human history, and set the stage for America to become an economic and military superpower. Over 16 million Americans served in the war—an enormous amount on any scale, but especially significant considering that the U.S. had almost 200 million fewer people than it does today. That sizable and significant group is aging. Many are in their eighties and nineties, and many others have already passed on. Of the 16 million, less than 300,000 are alive. Data suggest that by 2036, there will be no living veterans of WWII (U.S. Department of Veteran Affairs).

When these veterans came home from the war and ended their service, little was known about posttraumatic stress disorder (PTSD). These heroes did not receive the mental and physical healthcare that could have helped them. As a result, many of them, now in old age, are dealing with the effects of PTSD. Research suggests a high percentage of World War II veterans are plagued by flashback memories and isolation, and that many “self-medicate” with alcohol.

Research has found that veterans of any conflict are more than twice as likely as nonveterans to commit suicide, with rates highest among the oldest veterans. Reports show that WWII-era veterans are four times as likely to take their own lives as people of the same age with no military service (Glantz 2010).

In May 2004, the National World War II Memorial in Washington, DC, was completed and dedicated to honor those who served during the conflict. Dr. Earl Morse, a physician and retired Air Force captain, treated many WWII veterans. He encouraged them to visit the memorial, knowing it could help them heal. Many WWII veterans expressed interest in seeing the memorial. Unfortunately, many were in their eighties and were neither physically nor financially able to travel on their own. Dr. Morse arranged to personally escort some of the veterans and enlisted volunteer pilots who would pay for the flights themselves. He also raised money, insisting the veterans pay nothing. By the end of 2005, 137 veterans, many using wheelchairs, had made the trip. The Honor Flight Network was up and running.

As of 2017, the Honor Flight Network had flown more than 200,000 U.S. veterans of World War II, the Korean War, and the Vietnam War to Washington. The round-trip flights leave for day-long trips from over 140 airports in thirty states, staffed by volunteers who care for the needs of the elderly travelers (Honor Flight Network 2021).

Functionalism

Functionalists analyze how the parts of society work together. Functionalists gauge how society’s parts are working together to keep society running smoothly. How does this perspective address aging? The elderly, as a group, are one of society’s vital parts.

Functionalists find that people with better resources who stay active in other roles adjust better to old age (Crosnoe and Elder 2002). Three social theories within the functional perspective were developed to explain how older people might deal with later-life experiences.

The earliest gerontological theory in the functionalist perspective is disengagement theory, which suggests that withdrawing from society and social relationships is a natural part of growing old. There are several main points to the theory. First, because everyone expects to die one day, and because we experience physical and mental decline as we approach death, it is natural to withdraw from individuals and society. Second, as the elderly withdraw, they receive less reinforcement to conform to social norms. Therefore, this withdrawal allows a greater freedom from the pressure to conform. Finally, social withdrawal is gendered, meaning it is experienced differently by men and women. Because men focus on work and women focus on marriage and family, when they withdraw they will be unhappy and directionless until they adopt a role to replace their accustomed role that is compatible with the disengaged state (Cummings and Henry 1961).

The suggestion that old age was a distinct state in the life course, characterized by a distinct change in roles and activities, was groundbreaking when it was first introduced. However, the theory is no longer accepted in its classic form. Criticisms typically focus on the application of the idea that seniors universally naturally withdraw from society as they age, and that it does not allow for a wide variation in the way people experience aging (Hothschild 1975).

The social withdrawal that Cummings and Henry recognized (1961), and its notion that elderly people need to find replacement roles for those they’ve lost, is addressed anew in activity theory. According to this theory, activity levels and social involvement are key to this process, and key to happiness (Havinghurst 1961; Neugarten 1964; Havinghurst, Neugarten, and Tobin 1968). According to this theory, the more active and involved an elderly person is, the happier he or she will be. Critics of this theory point out that access to social opportunities and activity are not equally available to all. Moreover, not everyone finds fulfillment in the presence of others or participation in activities. Reformulations of this theory suggest that participation in informal activities, such as hobbies, are what most affect later life satisfaction (Lemon, Bengtson, and Petersen 1972).

According to continuity theory, the elderly make specific choices to maintain consistency in internal (personality structure, beliefs) and external structures (relationships), remaining active and involved throughout their elder years. This is an attempt to maintain social equilibrium and stability by making future decisions on the basis of already developed social roles (Atchley 1971; Atchley 1989). One criticism of this theory is its emphasis on so-called “normal” aging, which marginalizes those with chronic diseases such as Alzheimer’s.

Conflict Perspective

• Theorists working the conflict perspective view society as inherently unstable, an institution that privileges the powerful wealthy few while marginalizing everyone else.

• According to the guiding principle of conflict theory, social groups compete with other groups for power and scarce resources.

• Modernization theory (Cowgill and Holmes 1972) suggests that the primary cause of the elderly losing power and influence in society are the parallel forces of industrialization and modernization.

• The central reasoning of modernization theory is that as long as the extended family is the standard family, as in preindustrial economies, elders will have a place in society and a clearly defined role.

• As societies modernize, the elderly, unable to work outside of the home, have less to offer economically and are seen as a burden.

• Another theory in the conflict perspective is age stratification theory (Riley, Johnson, and Foner 1972). Though it may seem obvious now, with our awareness of ageism, age stratification theorists were the first to suggest that members of society might be stratified by age, just as they are stratified by race, class, and gender.

• Age stratification theory has been criticized for its broadness and its inattention to other sources of stratification and how these might intersect with age.

• exchange theory (Dowd 1975), a rational choice approach, suggests we experience an increased dependence as we age and must increasingly submit to the will of others because we have fewer ways of compelling others to submit to us. Indeed, inasmuch as relationships are based on mutual exchanges, as the elderly become less able to exchange resources, they will see their social circles diminish.

Symbolic Interactionism

• Generally, theories within the symbolic interactionist perspective focus on how society is created through the day-to-day interaction of individuals, as well as the way people perceive themselves and others based on cultural symbols.

• A woman whose main interactions with society make her feel old and unattractive may lose her sense of self. But a woman whose interactions make her feel valued and important will have a stronger sense of self and a happier life.

• Symbolic interactionists stress that the changes associated with old age, in and of themselves, have no inherent meaning. Nothing in the nature of aging creates any particular, defined set of attitudes. Rather, attitudes toward the elderly are rooted in society.

• Rose’s subculture of aging theory, which focuses on the shared community created by the elderly when they are excluded (due to age), voluntarily or involuntarily, from participating in other groups. This theory suggests that elders will disengage from society and develop new patterns of interaction with peers who share common backgrounds and interests.

• Another theory within the symbolic interaction perspective is selective optimization with compensation theory. Baltes and Baltes (1990) based their theory on the idea that successful personal development throughout the life course and subsequent mastery of the challenges associated with everyday life are based on the components of selection, optimization, and compensation.

• In this theory, the physical decline postulated by disengagement theory may result in more dependence, but that is not necessarily negative, as it allows aging individuals to save their energy for the most meaningful activities.

• Swedish sociologist Lars Tornstam developed a symbolic interactionist theory called gerotranscendence: the idea that as people age, they transcend the limited views of life they held in earlier times.

• Tornstam believes that throughout the aging process, the elderly become less self-centered and feel more peaceful and connected to the natural world.