Ageing

Christopher Phillipson

• Publisher: Polity
• Year: 2013
• ISBN:
  9780745669540
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Ageing populations represent a key global challenge for the twenty-first century. Few areas of life will remain untouched by the accompanying changes to cultural, economic and social life. This book interrogates various understandings of ageing, and provides a critical assessment of attitudes and responses to the development of ageing societies, placing these in the context of a variety of historical and sociological debates. Written in a highly accessible style, this book examines a range of topics, including demographic change across high- and low-income countries, theories of social ageing, changing definitions of 'age', retirement trends, family and intergenerational relations, poverty and inequality, and health and social care in later life. The book also considers the key steps necessary in preparing for the social transformation which population ageing will bring. Ageing provides a fresh and original approach to a topic of central concern to students and scholars working in sociology, social policy and wider social science disciplines and the humanities.

1

Introduction: Understanding Ageing

Ageing populations now exert a major influence on all aspects of social and economic life. Concerns about the best way of resourcing such populations, their impact on standards of living, and relations between age groups and generations feature prominently in public debate and discussion. The twenty-first century will without question be a time when all societies take stock of the long-term impact of demographic change and the implications for managing and organizing a major area of social and economic activity. Thus far, discussions have been tentative at best, discriminatory at worst, focusing on the apparent ‘cost’ and ‘burden’ associated with population change. Doubts about the value and purpose of ageing seem, if anything, to have become more not less strident in the present century.

The reasons behind the continued anxieties about ageing are at least fourfold. First, demography is of course important. Demographic projections (reviewed in Chapter 2) indicate that many societies across the globe can anticipate having up to one-third or more of their populations aged 60 and over by 2050. And the numbers are substantial – China, for example, is likely to reach a total of some 480 million people aged 60 and over by the middle of the twenty-first century. Second, the ‘intensification’ of ageing – resulting from continuing falls in fertility and continuing gains in longevity – has coincided with a crisis in confidence affecting institutions arising from the financial crash of 2008 and subsequent economic recession. Suddenly, population ageing – often viewed as a ‘mixed blessing’ by western governments – has assumed even more negative connotations. Demographic change could not be said to have ‘caused’ the economic crisis, but – it is argued – finding solutions will become ever more difficult given the rising tide of elderly people and the health and social problems which they bring (Liedtke and Schanz, 2012). Increasingly, governments fall upon the spectre of population ageing as a way of explaining why resolving economic problems will be difficult and why the pain incurred in searching for solutions will create challenges for all age groups. Third, the potency of fears about the consequences of an ageing population has been reinforced because these are no longer viewed simply through the lens of the nation-state. As will be argued throughout this book, the role of global organizations in interpreting population change has become of major significance. Global actors take concerns about ageing to a new and often dystopian level – linking it to other vulnerabilities which seem to beset what is presented as a ‘runaway world’ (Beck, 2000). Finally, ageing seems to be a problem because the moral framework which once gave it security (family and community in particular) is now seen as fractured and detached, seemingly cutting individuals adrift at a time when their need for help and support is increasing.

In responding to the above arguments, this book has set itself three main aims. First, it tries to make sense of the wider context influencing discussions about ageing, whether in terms of the characteristics of demographic change, trends in relation to work and retirement, the complexities of pension provision or issues affecting the provision of health and social care. The second aim is to undertake a critical inquiry about what is meant by terms such as ‘age’, ‘old’ or ‘elderly people’. Indeed, one of the major points developed in this study is that misunderstandings about the nature of ‘age’, false assumptions about behaviours associated with particular ‘ages’, and the conflating of ‘individual ageing’ with ‘population ageing’ still influence many debates – lay as well as scientific. A third aim of the book is to provide a sense of the possibilities and potential inherent in ageing populations. Again, there is much work being undertaken in this area, to which reference will be made at appropriate points. But linking these discussions with a systematic overview of the nature and development of ageing populations, along with examination of the way in which ageing is socially constructed, provide a major focus of the present study.

Origins and arguments

This book builds upon my Reconstructing Old Age, published in 1998. That study pursued a particular argument: namely, that two key institutions supporting older people – mandatory retirement and the welfare state – appeared to be in decline, but with no obvious signs of replacement in respect of social and economic support. This book provides an opportunity to assess developments over the intervening period and to consider trends that might take place in the future. The changes affecting older people since the 1990s have been substantial. The institution of retirement has undergone further disintegration, with the policy of extending working lives now seemingly embedded in the discourse surrounding older workers. The welfare state has undergone similar transformation, with changes affecting a broad spectrum of activities from pensions to health and social care.

This study provides an opportunity to assess the implications of these developments. The argument put forward is that both sets of changes have created a sense of crisis for ageing populations. Mandatory retirement and the welfare state – for all their limitations (these are highlighted at different points of this book) – started to provide a framework around which ageing could be built. The uncertainty (to put the most neutral gloss possible on what have been seismic changes) affecting both institutions substantially deepened over the course of the 1990s and 2000s. Older people were enjoined to work even though the possibilities for employment appeared increasingly limited; they were tasked with creating their own sources of income over and above that provided by the state even while personal pensions declined in value; they were faced with organizing their own social care, under the guise of ‘personalization’, even though standards and quality of support were placed increasingly in doubt.

The above dilemmas and contradictions have been sharpened by two aspects which were less prominent when Reconstructing Old Age was written in the mid-1990s. First, although generational discord was highlighted in that book, it seems to have become a more prominent theme in UK and European debates since that time. True, there are prominent campaigns within the European Union and other bodies aimed at highlighting ‘intergenerational solidarity’. But the entry of the ‘baby boom’ generation into their 60s has given rise to new predictions of generational conflict, notably over meeting the welfare entitlements of what is increasingly presented as an over-privileged group (Howker and Malik, 2010; Mandelbaum, 2010). Second, the terms of the debate appear even sharper than in the 1990s as a result of the anxieties arising from long-term changes affecting work and social life. The late Tony Judt (with Snyder, 2012: 385) captured this point when he argued:

Gone is the sense that the skills with which you enter a profession or job would be the relevant skills for your working lifetime. Gone is the certainty that you could reasonably expect a comfortable retirement to follow from a successful working career. All these demographically, economically, statistically legitimate inferences from present to future – which characterised European life in the post-war decades – have been swept away.

The above quotation gets to the heart of worries about ageing – namely, that the institutions which might support this phase in life have been eroded to the point where insecurities and fears seem to have the upper hand. But the argument given in this book is that other possibilities also present themselves. ‘Ageing’ is viewed as a ‘problem’ because it seems to work against the grain of what is needed for a ‘growing’ and ‘productive society’. Yet the reverse point can also be made: ageing and continued gains in longevity raise the possibility for renewing and re-engaging with activities and institutions that were abandoned in the period of dysfunctional economic expansion which characterized the 1980s through to the early 2000s (Tett, 2010). Ageing populations may not restore balance to what is a chronic crisis affecting the economic system; but, as is argued in this book, they do provide new ways of thinking about social life, offering in the process radical solutions to supporting hard-pressed social institutions.

On this last point, it is important to point out that the arguments presented here are written from the standpoint of a sociologist trying to think about ageing, using the tools of social science, especially as applied to the field of social gerontology (the study of social aspects of ageing). The book does not assume extensive knowledge of sociology, let alone of gerontology. Rather, the aim has been to take the literature within and outside these areas and see how they can illuminate some of the issues and challenges raised by ageing populations. The sociological dimensions are also part of an underlying argument about alternative ways of viewing demographic change. The problem with conventional perspectives on ageing populations is precisely that they are primarily looked at from a public accounting perspective. But the concern here is to ask questions about how a group known as ‘older people’ engages with and changes social institutions (and vice versa). Crucially, the book puts to one side certain assumptions about ‘age’ and looks instead at the way these are built up through practices and activities which arrive at particular definitions and conventions for treating ‘old’ or ‘elderly’ people.

Structure of the book

The book is divided into three main sections. Part I sets out the context for understanding ageing populations, drawing on demographic, sociological and historical approaches. Part II extends the discussion by reviewing various examples of changes affecting ageing populations, including pensions, families and generations, and experiences in later life. Part III examines proposals for change in a number of key areas, including work, education and social relationships.

Part I starts off with a review of the development of population ageing, defining in the process what is meant by the term ‘ageing societies’ (Chapter 2). The chapter contrasts population ageing across the global south and north and examines gender and social class variations in life expectancy, and the rise of what is termed the ‘very elderly population’ (including the increasing number of centenarians). The chapter also examines population change within a sociological context, exploring various influences on beliefs and attitudes about ageing.

Chapter 3 examines the ranges of theories developed to understand social aspects of ageing. The chapter considers the context for the emergence of social theory applied to ageing, focusing in particular on the expansion of sociology in the US in the 1940s and 1950s. The initial influence of functionalist theory applied to ageing is highlighted, as is the emphasis upon individual adjustment to transitions associated with retirement and widowhood. The chapter then considers the shift in theoretical perspectives from the 1970s and 1980s, with the development of theories of the life course and the application of approaches drawn from phenomenology, Marxism and feminism. The rise of critical gerontology is assessed, with an emphasis on the social construction of ageing and the link between social ageing and social inequality. The chapter goes on to review further developments in theoretical perspectives on ageing, notably those focused around the rise of the so-called ‘third age’ and the importance of consumption in shaping the lives of older people. The concluding section reviews the future of theory in the field of ageing, highlighting the importance of theoretical perspectives for understanding the challenges facing older people and the societies in which they live.

Chapters 4 and 5 explore a series of arguments and illustrations about the way in which ‘age’ as a social category is defined and constructed. Chapter 4 provides a historical overview of the way in which ideas about ‘age’ and ‘ageing’ developed, drawing together various changes from the early modern period to the twentieth century. These trace the emergence of old age as a distinct part of life, albeit one which carried different meanings according to gender and social class. Chapter 5 extends the discussion by highlighting the way in which retirement and the welfare state formed the framework through which ageing was built, underpinned by the idea of a life course constructed around education, work and retirement. However, the chapter goes on to demonstrate the ‘destablization’ of retirement in the twenty-first century and the emergence of new forms of risk and insecurity associated with growing old.

Part II explores some of the above themes with a more detailed review of particular areas. Chapter 6 develops a critical analysis of the field of pensions, highlighting the impact of neo-liberal policies which emerged in the period from the 1970s onwards. The chapter examines problems affecting the provision of pensions and assesses their more general influence on expectations and attitudes about ageing. Chapter 7 then looks at the role of family and intergenerational relationships in the construction of ageing, asking questions such as: Do families still form a major part of people’s lives? Do generations work for or against each other? What are the implications of the changes accompanying globalization? In Chapter 8 we turn to what is referred to as ‘late’ old age and issues affecting people in their 80s and beyond. The chapter considers issues associated with the distinction between the ‘third’ and ‘fourth’ age, the impact of the ‘bio-medicalization’ of ageing and the crisis in the provision of care for people in institutions. The concluding section of the chapter explores the emergence of new fears and anxieties about ageing and how they link to the uncertainties surrounding the ending of life.

Part III of the book then considers some examples about how we might think in a different way about the potentials and possibilities of an ageing society. Chapter 9 sets out ideas for preparing for ageing populations, examining three main areas: new approaches to age integration, supporting older workers and lifelong learning. Chapter 10 continues the argument by identifying distinctive ‘pathways’ for later life, constructed through new forms of solidarity which can work across different generations and support a range of social groups and institutions. The areas identified are: mutual solidarities, family and friendship solidarities, caring solidarities and global solidarities.

This book was written at a time of intense debate about the costs and benefits of ageing populations. The entry of the baby boom generation into retirement contributed to soul searching about whether a ‘selfish’ generation was about to replace one that had been more ‘deserving’ of the benefits provided by the welfare state.¹ At the other end of the age spectrum numerous reports appeared to suggest a breakdown in the care received by people towards the end of their life.² More people started to write about their own ageing experiences or about caring for people with particular conditions associated with ageing.³ And the thing that is called ‘ageing’ itself became elusive as people came to redefine later life in a variety of ways, challenging many of the conventional labels. This book is, then, about the concept of ‘ageing’: where it comes from, what it means and where it might it take us in the years ahead. In short, it asks: What do we understand by the concept of ‘ageing’?

Notes

1 The literature on and by the boomer generation expanded at a rapid rate through the 2000s. Some examples include: Diski (2009) with a biographical account; Buckley (2007) and Grant (2010) with fictional accounts; Willetts (2010) a critical review of potential tensions between generations; Phillipson et al. (2008) an overview of the construction of boomers as a ‘problem’ generation; Bonvalet and Ogg (2011) on the housing and consumption experiences of boomers.

2 These reports will be discussed in Chapter 8 of this book.

3 Athill (2008) provides a powerful account of her own ageing; Davidson (1997) the challenge of caring for someone with dementia.

Part I

Demographic and Social Dimensions of Ageing

2

Ageing Societies in a Global Perspective

Introduction

The twenty-first century has witnessed the emergence of population ageing as a global economic and social trend. Most countries in the world – even those with long-established older populations – are still in the process of adjusting to the implications of the changes involved. These are likely to be substantial, reaching into all aspects of cultural, economic and social life. Yet it is important to provide a balanced assessment of the type of challenges that demographic change will bring. Issues concerned with maintaining health and social care will doubtless occupy a prominent place in debates and will be discussed at different points in this book. But ageing populations will be transformative for society in various other ways, bringing innovative lifestyles, creating different types of communities and relationships, expanding the range of leisure and cultural activities and developing new institutions.

As will be argued, there are in fact many different paths likely to be followed by ageing populations. These will reflect factors such as social and cultural variations across different societies, contrasting levels of resources within and between countries, differences in the speed of demographic change and contrasting attitudes towards older people and the idea of ageing. The purpose of this chapter is to review the key demographic drivers behind population ageing, setting these within the broader global context which forms the organizational framework for this book. The chapter first reviews the development of population ageing, defining in the process what is meant by the term ‘ageing societies’. It goes on to survey contrasts between different societies – both within high-income countries and in comparison with low-income countries of the global south. We will also consider gender and social class variations in life expectancy, and the rise of the very elderly population (including the increasing number of centenarians). The discussion then places population change within a sociological context, examining questions about the link between the development of ageing and individual beliefs and attitudes. Finally, the chapter considers a theme which will be returned to at various stages throughout the book: Why are ageing populations often presented as a ‘problem’? What is the historical context for this? What alternative arguments might be developed in response to such views?

Population ageing in the twenty-first century

The ageing of populations was one of the most important developments of the twentieth century and will raise major challenges for life in the twenty-first. The proportion of the global population aged 65 and over in 1900 was 1 per cent (UK 5 per cent); in 2000 it was 7 per cent (UK 16 per cent) and by 2050 it is estimated that it will be 20 per cent, a figure that the UK is likely to reach in 2020. Population ageing refers to both the increase in the average (median) age of the population and the increase in the number and proportion of older people in the population. This change arises during the move from a demographic regime of high fertility and high mortality to one of low fertility and relatively low mortality. The former is associated with fast-growing young populations; the latter with more stable populations including a larger proportion of people in the older age groups. This process is described in the demographic transition model, derived from observations of the experiences of West European countries over the course of the nineteenth and twentieth centuries. Two clear phases are identified in this model. In the first, mortality rates decrease as a result of economic growth, improved material well-being and advances in public health. Fertility rates stay high, however, leading to a rapid increase in the size of the population, reinforced by higher survival rates through chil...