Healthy Aging in Sociocultural Context

Andrew E. Scharlach, Kazumi Hoshino, Andrew E. Scharlach, Kazumi Hoshino

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136198977
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Gérontologie

Healthy Aging in Sociocultural Context examines two emerging trends facing countries throughout the world: population aging and population diversity. It makes a unique contribution to our understanding of these timely issues by examining their implications for healthy aging, a topic of increasing importance to policy-makers, planners, researchers, families, and individuals of all ages.

The book focuses on three countries that provide important examples of these emerging global trends - Japan, Sweden, and the United States. Japan and Sweden are at the forefront in terms of healthy life expectancies, while the United States represents a country with considerable diversity. Examining these three countries together provides a unique opportunity to address questions such as the following: How can we understand differences in healthy life expectancy among different countries? What role might diversity play? And how might these effects change as geographic mobility increases diversity, even among societies that historically have been relatively homogeneous?

Part I
Healthy Aging and Policy Implications in the U.S.

1
Healthy Aging in Community Context

Andrew E. Scharlach

Population Aging in the U.S.

Approximately 39 million Americans, representing 12.8% of the total U.S. population, were age 65 or older in 2008 (Vincent & Velkoff, 2010). This number will increase dramatically in the coming years, partly because of temporarily larger birth cohorts associated with the postwar “Baby Boom” years of 1946 through 1965 (Frey, 2007), and partly because of increased longevity. Indeed, Americans reaching the age of 65 today can expect to live an average of 19 more years, compared to about 12 more years for those reaching age 65 one hundred years ago (Federal Interagency Forum on Aging-Related Statistics, 2011). The combined effect of the 78 million members of the Baby Boom cohort and increased longevity will result in an elderly population of more than 88 million individuals, or 20% of the U.S. population, by the middle of this century (U.S. Census Bureau, 2008). Although this represents a substantial change in the age composition of the U.S., it must be noted that the resulting impact is considerably less dramatic than for most other industrialized societies, including Japan and Sweden.

Although many of tomorrow’s elderly will be in relatively good health, there is growing evidence that some cohorts of aging Americans may actually have an increased likelihood of health problems and disability. Baby boomers currently approaching retirement report more chronic illness, pain, alcoholism, mental health issues, and difficulty with physical functioning, than did those retiring ten years previously (Soldo, Mitchell, Tfaily, & McCabe, 2006). Younger baby boomers also appear to be in poorer health than the current cohort of older adults. In the mid-1990s, as disability rates decreased among older adults, they increased by 40% among those in their 40s (Lakdawalla, Bhattacharya, & Goldman, 2004). As just one example of the combined effect of health and aging, the number of new cases of Alzheimer’s disease in the U.S. is expected to more than double between 1995 and 2050, from 377,000 to 959,000 per year, in large part because of the growth of the population ages 85 and older, who represent about 60% of these new cases (Hebert, Beckett, Scherr, & Evans, 2001).

Structural Lag and Healthy Aging

America’s communities are largely unprepared for the challenges that these demographic changes are likely to produce. As captured by Matilda White Riley’s concept of “structural lag,” existing policies, norms, and social institutions are predicated on a much younger society than the one that awaits. As a result, the current community context is woefully inadequate to meet the needs of a growing elderly population (Riley, Kahn, Foner, & Mack, 1994).

As one example, the majority of American elders reside in single-family suburban homes, where they have limited access to services and social interaction, and are nearly entirely dependent upon automobiles to get anywhere. To a large extent, the problems associated with suburban aging are a result of land use and transportation policies originally designed to address societal concerns and priorities of another era. Zoning ordinances that separate residential and commercial areas, for example, were originally designed to improve safety and prevent the spread of infectious diseases that were prevalent in urban centers in the U.S. 100 years ago (Schilling & Linton, 2005). The American love affair with the automobile and the associated growth of suburban communities also is a result of subsidized fuel prices, government investments in a national highway system, and failure to adequately account for the secondary environmental costs of automobile use (Dagger, 2003; Frank, 2000). In the context of an individualistic society in which geographic mobility often is the price paid for economic security, elders are less likely to reside in the same community as family members, and less able to participate in reciprocal social and community activities such as providing and receiving assistance, visiting with friends, or participating in communal organizations (Putnam, 1995).

Ecological Approach to Healthy Aging

There can be no doubt that the physical and social contexts within which a person lives are critical to her or his ability to experience healthy aging. As proposed in Lawton and Nahemow’s “Ecological Theory of Aging,” human beings and their environments form an interdependent and interactive system, which affects health and adaptation (Lawton & Nahemow, 1973). Person-environment fit is determined by a number of interrelated factors, including the following: relative interpersonal homogeneity; ability of environmental resources to respond to individual needs; ability of individual capacity to respond to environmental demands; and congruence between personal preferences and environmental features (Shinn & Rapkin, 2000). When environmental characteristics (“environmental press”) exceed personal characteristics (“personal competence”), individuals may not be able to adapt successfully to environmental demands, resulting in physical or psychological distress, maladaptive behavior, and unmet needs (Nahemow, 2000). Physical and social community characteristics, moreover, are affected by community programs, housing policies, and zoning laws, which in turn are affected by societal norms, economic and political factors, and historical events (Bronfenbrenner, 1979). However, most examinations of health outcomes minimize or ignore entirely the impact of enduring neighborhood and community contexts on well-being and behavior (Shinn & Toohey, 2003). Indeed, modernization itself may be implicated in the tendency to “disembed” individuals from the social worlds that provide meaning and connection (Gilleard & Higgs, 2005).

Social patterns and contextual norms give priority to the needs and concerns of younger persons at the expense of older adults, reflecting the ageist assumption that pre-elderly social and behavioral patterns are normal and ideal (Moos & Lemke, 1996). As hypothesized in the “environmental docility hypothesis” (Lawton & Simon, 1968), individuals whose personal competence is more compromised (e.g., older individuals) tend to be more vulnerable to environmental influences, and less able to alter or avoid resulting impacts. This is one reason why physical and social contexts become more important with age. However, able-bodied individuals may not realize the disabling influence of environmental characteristics whose impact primarily affects persons with functional limitations. For example, although retired men living in suburban settings generally report higher well-being than those living in urban and rural settings, poor health reduces levels of well-being more for suburban men than for their urban counterparts (Reitzes, Mutran, & Pope, 1991).

It should be noted that environments can be enabling, not just a source of “press.” Within an individual’s adaptive range (reflecting environmental demands and personal competence), increased environmental press can be stimulating, potentially contributing to learning and growth, thereby enhancing adaptive capacity. Moreover, an environmental transactional perspective (Golant, 2003) suggests that the potential for healthy aging is associated with not only the “content” of environments (e.g., physical and social structures), but also the ways in which individuals interact with their environments as evidenced by behaviors (e.g., functioning) and cognitions (e.g., self-efficacy). For example, fall prevention is associated with not just the presence of grab bars, but also the meaning attributed to those grab bars and how the grab bars actually are used (e.g., how often, how well, how safely).

From a life-span developmental perspective, person-environment fit sits within a temporal context (Golant, 2003), including factors such as the following: (a) the individual’s actual and perceived change over time (past, present, and anticipated future); (b) the environment’s actual and perceived change over time (e.g., changing neighborhoods, deteriorating physical infrastructure of home and community); and (c) the point in the individual’s life course and in the environment’s history when critical events (e.g., impairment, relocation) occur (Baltes, Nesselroade, & Cornelius, 1978). The manner in which individuals adapt to environments over time (development of scripts, automaticity, reduced physical/cognitive/psychological load) affects the benefits of environmental stability (e.g., familiar environments) on healthy aging as personal competence declines.

Impact of the Physical Environment on Healthy Aging

The physical environments within which older persons live have both direct and indirect effects on opportunities for healthy aging. The manner in which communities are designed allows or even calls forth certain types of human behavior and social interaction, while making other types of behavior and interaction difficult or unlikely, resulting in community “scripts” (Barker, 1968) that shape individual and social behavior associated with healthy aging. Of course, those physical designs themselves reflect personal, social, and societal goals and meanings, which in the U.S. rest on sociocultural norms of individuality, non-dependence, and commercialism. For example, communities frequently widen roads to accommodate more automobiles, in an effort to help residents get to work more quickly, reflecting personal and societal priorities focused on economic gain. However, wider roads and faster traffic can make it difficult or even impossible for slow-moving elders to get across the street, virtually isolating them from friends, neighbors, stores, and services on the other side of the street. Such community changes reflect efforts to maximize economic gains (e.g., transit and road improvements designed to get people to work faster, “big box” stores that are more economical than neighborhood shops, transit villages designed for commuters), often at the expense of older adults, who may be perceived as having little economic value in an ageist society.

Macintyre, Ellaway, and Cummins (2002) propose five environmental characteristics that have potential health implications for older persons:

1. General physical features of the environment that affect all members of the community, such as the quality of air and water;
2. Salutary or deleterious environmental characteristics in the particular settings where elders spend most of their time (e.g., in or around the home);
3. Types, amount, and adequacy of services that are available, including transportation, street maintenance, policing, and health and social services;
4. Sociocultural characteristics, such as the political, economic, ethnic, and religious history of a community, its norms and values, the degree of community integration, levels of crime, direct and indirect threats to personal safety, and networks of community support;
5. The ways in which neighborhoods are perceived—by residents, by service planners and providers, and by family members and friends.

As just one case in point, consider evidence regarding the multiple impacts of physical environments on the development of dementia, Parkinson’s disease, and other aging-related diseases (Stein, Schettler, Rohrer, & Valenti, 2009). Environmental lead exposure can increase the risk of cognitive impairment later in life, including Alzheimer’s disease and Parkinson’s disease. Air pollution can affect the lungs, heart, nose, and blood vessels, and also is harmful to the brain, contributing to inflammation and cellular damage associated with both early Alzheimer’s and Parkinson’s diseases. Exposure to a variety of pesticides is associated with increased risks for Parkinson’s disease, Alzheimer’s disease, and impaired memory, as well as diabetes, prediabetes, and metabolic syndrome.

The Need for “Aging-Friendly” Communities

Given the many ways in which contextual conditions shape the potential for healthy aging, recent years have seen increased attention to how communities can become healthier environments for their increasing numbers of older residents—that is, more “aging-friendly.” An “aging-friendly” community, therefore, might well be defined as one in which the physical infrastructure and social systems support healthy aging, or at a minimum do not create unnecessary barriers to doing so. In particular, “aging-friendly” communities foster five developmental tasks for healthy aging: continuity, compensation, connection, contribution, and challenge.

Continuity refers to the ability of individuals to maintain lifelong interests and activities even as they experience normal aging. Maintaining meaningful and fulfilling roles and activities has repeatedly been identified as a sign of healthy aging (e.g., Atchley, 1989), and as a component of successful aging (Rowe & Kahn, 1997). From this perspective, an aging-friendly community is one that removes age-based barriers that might otherwise make it difficult for older individuals to continue personally and societally meaningful life patterns as they age. Maintenance activities that preserve one’s sense of personal identity and continuity of self-construct may become more important in later life, in the face of a variety of forces that threaten to undermine one’s sense of self and disconnect a person from much that previously has given his or her life meaning, including the following: an ageist society that sees older adults as less valuable; social interactions that focus on physical attributes (e.g., appearance and functional ability) rather than enduring non-observable characteristics; and personal physical and social changes that make it difficult to continue activities and relationships that previously reinforced self-concept and self-worth.

Compensation refers to the availability of adequate supports and accommodations to assure that the basic health and social needs of individuals with age-related disabilities are met. Simply removing potential barriers may not be sufficient, especially when environments themselves may contribute to disablement by undermining the coping abilities of persons with potentially disabling conditions.

Connection refers to the increasing salience of interpersonal relationships as we age. Socioemotional selectivity theory (Carstensen, Fung, & Charles, 2003) suggests that age-related increases in the importance of existing relationships and contexts may be due in part to a recognition that there is limited time left to live, rather than to aging or disability per se. For example, ...

Table of contents

• Cover Page
• Half Title page
• Series page
• Title Page
• Copyright Page
• Contents
• Figures
• Tables
• Preface
• Acknowledgments
• Part I Healthy Aging and Policy Implications in the U.S.
• Part II Healthy Aging and Policy Implications in Sweden
• Part III Healthy Aging and Policy Implications in Japan
• Part IV Future Directions
• List of Contributors
• Index