Introduction

Social gerontology, as the term suggests, is concerned with the study of the social aspects of aging and old age. These include a large range of topics, disciplines, and methods requiring a good understanding of the clinical and economic dimensions of aging. This chapter includes the following discussions: individual experiences of aging (e.g., age identities, social networks and supports, life events, coping, and resilience); the social institutions that provide health and social care services to older adults; how old age is socially constructed and the age-related inequalities that flow from this; the factors that drive social and health inequalities in older age, such as class, gender, ethnicity, and race; and the broad social impact of our aging populations. Central to these studies, however, has been a concern to understand the factors that promote or undermine the well-being, or quality of life, of older adults.

Conclusions from research on older adults’ quality of life and their clinical implications were well summarized in Hepburn’s chapter in a previous edition of this volume, which focused on factors that contribute to social functioning—social status, social connections, occupations, activities, personal resources, and life events.¹ Here we take a broader view of the social context of aging, describing the development of approaches in social gerontology that seek to theorize and understand the aging experience. We illustrate how these ideas have developed in ways that reflect changes in the experience of aging and show how the drivers of these changes relate to social inequalities at older ages. We begin by describing the tendency in social gerontology to problematize the circumstances of later life through accounts of adjustment, disengagement, dependency, and poverty and through a conceptualization of increasing life expectancy in terms of the potential difficulties that are brought about as populations age. We argue that as later life becomes more of a potentially positive experience for greater numbers of people, such an approach is not the most useful way to view old age. We suggest that we are seeing dramatic changes in the experience of aging that need to be understood in terms of changes to the health and wealth of older adults and in terms of the cultural context of cohorts, such as the baby boomer generation, now entering retirement. These “new” older people challenge much of the thinking about old age and how it relates to gerontology, as well as the reordering of later life into what can be referred to as the third and fourth ages. We conclude by returning to the theme of inequality by exploring the heterogeneity of aging experiences and how these relate to class, gender, ethnicity, and race.

The “Problem” of Old Age

As Cole, Achenbaum and Katz have observed, current academic concerns with aging have tended to focus on the problem of old age.^2–4 The perception of older adults as a social problem has a long history in social and health research, and this preoccupation with the problems of senescence characterizes the development of gerontology, including social gerontology. Katz⁴ has quoted the first article in the first issue of the newly established Journal of Gerontology in 1946, which stated that “Gerontology reflects the recognition of a new kind of problem that will increasingly command the interest and devotion of a variety of scientists, scholars, and professional workers.”⁵ How this influenced the development of specifically social approaches to later life can be seen with the establishment of a Committee on Social Adjustment in Old Age by the U.S. Social Science Research Council in 1944 and a Research Unit into the Problems of Aging by the Nuffield Foundation (England) in 1946. In this immediate postwar period, Sauvy suggested that Britain’s economic difficulties were largely the result of an aging population. Furthermore, he claimed that “The danger of a collapse of western civilization owing to a lack of replacement of its human stock cannot be questioned. Perhaps we ought to regard this organic disease, this lack of vitality of the cells, as a symptom of senility of the body politic itself and thus compare social biology with animal biology.”⁶

This sense of foreboding had been a strong theme driving earlier developments in social policy. The introduction of old age pensions in Britain in 1908 was not only intended to eliminate extreme poverty in old age, but also to lower “poor law” expenditure on older people.⁷ By the mid-1920s, the effects of economic turbulence had moved the terms of debate in the direction of the capacity of retirement to alleviate unemployment. In this formulation, removal from active participation in the workforce was the main motivation for retirement, which in time led to a lowering of the retirement age to 65 years.

In the United States, there were similar concerns to take older workers out of the workforce, with the economic depression of the 1930s creating an impetus for change. However, several factors complicated matters, including the fact that most older people in the United States were still employed. In addition, legislators had to deal with the federal structure of the government, the confusing pattern of Civil War pension entitlements for which many were eligible, and the wide array of pension schemes operating across companies and occupations.^8,9 In this context, the Townsendite movement of the 1930s, named after Dr. Francis E. Townsend, argued for a tax-funded state pension rather than one based on a contributory principle. Furthermore, in advocating the reflationary potential of creating a large number of state-funded consumers, the movement reconceptualized retirement with the slogan “Youth for work, age for leisure.”⁹ However, the New Deal and its Social Security pension, when it was established in 1935, was much more conventional in its conception, acting as a poverty alleviation program and as a way of dealing with unemployment by using retirement to release jobs to younger workers.

The identification of the old as a problem that needed to be resolved continued along these lines for much of the second half of the twentieth century, although with different national emphases. In Britain, the tradition that included Rowntree’s studies of poverty^10,11 continued in the work of Townsend¹² and has been a continuing theme of social gerontologists into the twenty-first century.¹³ Conversely, in the United States, the successful selling of retirement after World War II led to research initiatives and programs on successful and productive aging, concerned with investigating adaption to the circumstances of retirement. Whatever the national differences, the collection of data to answer questions posed as the problem of aging has continued to the present day, although more recently within the context of population aging and the economic consequences that accompany it. Paradoxically, this has meant that research is now directed at the problems posed by “a rapidly growing population of rather healthy and self-sufficient persons whose collective dependence is now straining the economies of western nations.”⁴ We will return to this theme shortly but first will describe the early theoretical perspectives that have underpinned social gerontology.

Theoretical Approaches: From Functionalism to Structured Dependency

Much of the reason for social gerontology’s focus on the problems associated with later life lies in the emergence of retirement, in the 1940s in the United States⁹ and the 1960s in Britain,¹⁴ as a distinct part of the life course. This led sociologists working within the functionalist tradition such as Parsons and Burgess^15,16 (an approach concerned with how elements of society operate in complementary ways) to worry about the “roleless role” of the retired person, a population defined by its permanent exit from the labor market rather than indigence. Obviously, this referred mainly to men, for whom their social role and employment were seen as largely interchangeable, whereas a consistent domesticated role was assumed for women. Criticism of this view, and the corresponding assumption that retirement was therefore relatively nonproblematic for women, came from Beeson,¹⁷ who noted that it was not based on any empirical evidence and ignored the existence of working women.

Some approached this roleless state through the prism of disengagement theory,¹⁸ focusing on the social and psychological adjustment of the older person to after work and after married life. Theorizing the wider processes that accompanied retirement, this theory hypothesized that older adults in industrial societies disengaged themselves from the roles they occupied so that younger generations would have opportunities to develop and take on their socially necessary roles. Consequently, disengagement was assumed not only to occur in relation to work roles, but also in relation to families, when retired generations became much less central to the lives of their children. Focusing on a psychological approach, disengagement theory saw itself as influenced by the work of Erikson and the notions of life review.¹⁹ A considerable amount of research was undertaken in the United States during the 1960s to provide evidence for this theory. A longitudinal study in Kansas City showed that older adults did indeed disengage, although women were observed to start this process at widowhood and men began on retirement.²⁰ This approach, which for a long time was one of the dominant paradigms in social gerontology, saw the way in which old age occurred in modern societies as an inevitable and natural process. Questions about whether older adults wanted to disengage, or were forced to do so by society, were not asked. The emphasis on psychological adjustment also avoided looking at the very real social processes that structured old age.

Although disengagement theory centered on the perspective of the individual older person, the analysis put forward by the predominantly British structured dependency approach stressed the importance of social policy.²¹ For writers in this school and those who described themselves as adopting the political economy approach to aging, the problem of old age was not one of individual social and psychological adjustment but of a dependency structured by the circumstances of retirement, something that was set by government social policy.^22–24 Townsend noted that retirement not only marks a withdrawal from the formal labor market, but also indicates a shift from making a living through earning a wage to being dependent on a replacement income.²¹ The fact that this income was often funded by the state demonstrated the role of social policy in structuring the dependency that many older people experienced after retirement. In Britain, for example, the relatively low levels at which the state pension was paid out indicated the low priority that older adults had in decisions about state welfare. As Walker²² and others have noted, the continuing impact of social class into later life was also indicated in the relative imbalance among the levels of state retirement pensions that funded most working class retirees’ old age and the amounts paid out by the better funded occupational pensions enjoyed by the middle class. Those reliant on state retirement pensions, consequently, were seen as a residual category of the population drawing resources from public funds, a problem that led to considerable interest in researching poverty in later life.

It is also argued that structured dependency is not just limited to the economic sphere, but pervades social processes more generally. Townsend suggested that the association of age with infirmity and dependency not only represents the position of older adults, but also justifies the inferior status of older adults and their exclusion from various forms of social participation.²⁵ Ageism also emerges out of the cultural valorization of youthfulness, which not only defines aging in negative terms, but also clears the way to make it acceptable to discriminate against older people. This can manifest itself in policies seeking to limit medical or health care resources to older people, in discriminatory employment practices, and in the treatment of physically frail or mentally confused older adults.²⁵ For writers such as Townsend and Walker, with a focus on well-being and social inequality, the disengaged position of later life is not only a social construct, but also something that should be challenged by campaigns for the restoration of full citizenship rights to older adults.²⁶

Increasing Life Expectancy and Compression of Morbidity: a Golden Age

As described elsewhere in this text, there are many who argue that the human life span is malleable, with mortality only occurring as a result of an accumulation of damage in cells and tissues and limitations in investments in somatic maintenance.²⁷ And, more controversially, writers such as de Grey have argued that longevity can be extended upward once the basic biologic processes have been understood.²⁸ Although these views have been heavily criticized, there is now recognition at a population level that life expectancy is increasing rapidly, perhaps at an accelerating rate. For example, Rau and colleagues²⁹ have shown that for men aged 80 to 89 years, mortality rates dropped by 0.81% in the 1950s and 1960s but by 1.88% in the 1980s and 1990s, whereas for women of the same age group the figures were 0.91% and 2.45%, respectively. The rate of acceleration in decline in mortality rates is greatest for older adults. Given a focus on the problem of age, it is not surprising that concerns have been expressed that increased longevity might lead to higher rates of morbidity and/or disability, a failure of success in which industrial societies have passed through an epidemiologic transition that has shifted the burden of disease onto chronic conditions in later life.³⁰ However, this conclusion has been challenged by evidence that suggests that increased life expectancy does not come at the cost of an expansion of morbidity.³¹ Researchers such as Fries have proposed a thesis built around a compression of morbidity, in which even under the conditions of increased life expectancy, the proportion of life spent in ill health is concentrated into an ever-shorter period prior to death.^32,33

Although this view challenged many of the assumptions made about the connection between aging and chronic illness, there has been considerable support for the claim that chronologic age in itself is not a factor in increasing levels of disability and chronic illness.³⁴ Although analyses based on subjective measures of health have suggested an increasing disease burden in later life,³⁵ more objective indicators of disability suggest a more positive view of healthy life expectancy.^36,37 Analyses of disability rates in the United States have suggested that not only are disability rates falling, they are falling at an accelerating rate, much in the same way as mortality rates are falling at an accelerating rate. For example, in 1982 to 1984, rates were falling at a rate of 0.6%/year, a figure that increased to almost four times that level (2.2%) by 1999 to 2004-2005, and rates decreased most rapidly for the oldest people.³⁸

However, to this must be added the emergence of an obesity epidemic, which may reverse the decline in mortality and disability and may lead to new patterns of chronic illness. Olshansky and associates have argued that current U.S. trends in obesity may result in a decline in life expectancy for future cohorts.³⁹ Based on current rates of death associated with obesity, they have predicted that life expectancy will be reduced by between one third and three quarters of a year. Therefore, the trends are complex. In Canada, a study of health lifestyles among baby boomers identified a number of contradictory changes. A substantial fall in smoking rates, increases in levels of excessive drinking, and reductions in levels of exercise over the last quarter of the twentieth century was accompanied by a sharp increase in rates of obesity and diabetes.⁴⁰ Manton uses the notion of dynamic equilibrium to suggest that mortality in later life is affected by the rate of natural aging and the distribution of risk factors for specific diseases in the population.⁴¹ Interventions aimed at risk factors will bring improvements in mortality and reduce the severity of associated disabilities. Schoeni and coworkers have noted how changes in smoking behavior, greater educational attainment, and declines in poverty have affected the U.S. decline in disability levels in.³⁶ This, however, raises the issue of whether the achievement of a successful postretirement later life is the province of the disciplined individual, rather than the expectation of the ordinary person. Again, this raises questions about the roles and contributions of healthy, retired, older adults.

Opportunity Age: Successful Aging and the Third Age

The implicit concerns regarding the status of older people has also been a theme of what has come to be known as the productive aging approach.⁴² This position has antecedents in Rowe and Kahn’s notion of successful aging,^43,44 which sought to separate this positive state, characterized by good health and social engagement, from what was termed usual aging. Productive aging adopts a broader approach than that of successful aging. It is concerned about making it possible for the increasing numbers of people who are living longer and healthier lives, under changes in the circumstances of retirement and the nature of work, to make significant social or economic contributions, rather than simply retiring to a state of leisure. Again, the focus is on social engagement, with productive aging going beyond conventional meanings of economic productivity to include volunteering and civic participation.^45,46 Older adults acting in this way would therefore demonstrate that they are not just consumers of resources, but also making a valuable contribution to the societies in which they live. The benefits of engaging in productive aging for the individual and society are argued to be considerable because they not only engage individuals in society, but also use otherwise wasted capabilities.

Many of the criticisms of the productive aging approach have focused on the possibility that such laudable intentions could be easily interpreted as a simple invocation of the need to be productive in conventional economic terms.⁴⁷ Estes and Mahakian have gone further in their criticism by linking successful and productive aging approaches with an extension of market principles into the process of aging itself, arguing that this acts to benefit what they call the “bio-medically orientated medical-industrial complex” and ignores the social and economic disadvantages operating in society and social policy.⁴⁸ As a result, although the advocates of the productive aging approach have moved the debate on aging away from a simple equation of age and dependency, a tendency to identify aspects of later life that mesh with normative assumptions about desirable social and economic worth remains in this approach. Thus, the problematizing of old age has occurred not only around perceived role deficits and social exclusion, it has also focused on the responsibilities that older adults should take on.

This is also reflected in discussions of the potential for older adults to enjoy a fulfilling third age of relative good health and affluence. The idea of the third age is most associated with the work of Laslett, who argued that later life can no longer be viewed in a pessimistic fashion.⁴⁹ Not only is the portion of most people’s lives spent in retirement increasing, the idea of a fixed retirement age has been challenged by the many individuals who have chosen to take retirement at ages other than those set by eligibility for the state retirement pension, as well as the changes to those entitlement ages. For many, Laslett argued, retirement offers possibilities for undertaking the self-enriching activities denied earlier in life when the tasks of earning a living, bringing up children, or both got in the way.

The life phase in which there is no longer employment and child raising to commandeer time, and before morbidity enters to limit activity and mortality brings everything to a close, has been called the Third Age. Those in this phase have passed through a first age of youth, when they are prepared for the activities of maturity, and a second age of maturity, when their lives were given to those activities, and have reached a third age in which they can, within fairly wide limits, live their lives as they please, before being overtaken by a fourth age of decline.⁴⁹

In discussing a long positive third age underpinned by relatively good health and a short, but ultimately terminal, fourth age, Laslett demonstrated opening up of the period of retirement, away from a simple conflation with old age. However, in this focus on the third age, Laslett was wary that later life should not become self-indulgent. To this end, Laslett warned of the dangers of indolence and the importance of accepting the responsibilities of the third age. In particular, education is identified as one of the key areas necessary for a successful third age, and to this end was a proponent of the “University of the Third Age.” The duties of the third age were regarded as going much further than just using time well and explicitly called for older adults to act as cultural trustees for society.⁴⁹ The challenge, as Laslett saw it, was to get those in the third age to accept their responsibilities rather than simply enjoy a leisure retirement.

However, this moral reading of the third age has become more difficult to maintain as the conflation between the third age and the baby boomer generation has become widely accepted, particularly in the United States.^50,51 For the baby boomer generation, there is the real potential for retirement to be transformed into an arena of lifestyle and consumption, rather than education and responsibility. A blurring of the distinction between middle age and old age has been fostered by the increasing influence of lifestyle consumerism on significant numbers of older adults, rather than just the younger age groups typically associated with these developments.⁵² Here, the third age can be seen as a space in which old age can be avoided and an ill-defined middle age can be extended further and further up the life course.⁵³ For example, the blurring of clear age-appropriate divisions in dress, along with the greater acceptability of leisure clothing, has meant that jeans and T-shirts can be worn by people of very different ages without social sanction.⁵⁴ The signs of old age become seen as a mask detracting from the person beneath.⁵² This relates to the individualization, or destandardization, of the life course, for which the idea of a linear life course, with clearly defined stages, has become less applicable.^55,56

Gilleard and Higgs have argued that to grasp the contemporary experiences of aging better, there is a need for understanding the implications of this increasing cultural engagement with lifestyle and consumerism by successive cohorts of retirees.⁵⁷ Such an approach suggests that we are witnessing the aging of generations whose adult life has been organized through the prism of a youth-orientated consumer culture. The postwar baby boomer cohorts who grew up in circumstances of expanding consumer choice and economic prosperity created a generational schism between themselves and those older than them, who had grown up in less prosperous times. This schism manifested itself in attitudes, music, and clothes, but most significantly in lifestyles, where there have been cumulative changes to the nature of families, relationships, and sexuality. This has not been discarded, however, because the teenagers of the 1960s became the retirees of the twenty-first century.^51,58 It is this generationally located set of attitudes and behaviors that may lie behind many of the features of contemporary aging.

The identification of retirement in terms of its opportunities for leisure, rather than simply being a roleless role or a moment for life review, can be seen among those older workers who do not wait until the state retirement pension age, or forced redundancy, to retire. Retirement as choice is valorized by a consumer culture, whereas those who face redundancy or conventional retirement patters are seen as less agentic and less able to deal with the new circumstances of later life. Contemporary retirement and later life are structured more by these contemporary cultural pressures than by concerns for the social worth of older generations; this can be seen in the concerns of governments and social commentators as they seek to reflect and adapt this image of later life to their more pressing objectives of deregulation and commodification of social policy. It is the emphasis on leisure retirement over civic participation, rather than inequality, that is most reflected in the writings of Laslett on the third age and those advocating productive aging. Whether the so-called greedy geezers will take the resources without reciprocating is a question that motivates much of the research agenda.⁵⁹ Also, the opportunities of current retirees cannot be assumed to continue indefinitely because some of the unique factors associated with the baby boomer generation may disappear, and the proretired stance of many welfare regimes may become the focus for reform.

Following from an interest in the idea of the third age, there has been a renewed interest in what has been termed the fourth age. This was initially envisaged by Laslett⁴⁹ as a description of the point when physical dependency and chronic or terminal illnesses make it impractical for individuals to participate in the third age. Laslett, drawing on the idea of the compression of morbidity, saw this stage of life as being relatively short and leading to a terminal drop and death.

More recently, the fourth age has been used by Gilleard and Higgs⁶⁰ to describe what they term a social imaginary of deep old age where, in contradistinction to the third age, aging is now experienced without agency. Within contemporary health and social care, they have described how older adults are being increasingly scrutinized for risk in terms of their physical functioning and cognitive capacity. Identification of frailty or dementia can mean that older adults find that their first-person narratives are replaced by those of other third persons, whether they are family, professionals or caregivers. This process is at its most obvious in the provision of long-term institutional care, where residents display some of the highest rates of physical and mental dependency. Unlike Laslett’s formulation of the fourth age, Gilleard and Higgs’⁶⁰ idea was not of a short terminal drop, but rather a “densification” of many of the greatest fears about old age. Not only is this a complete inversion of the third age, it also acts as a social and cultural image of what could be called unsuccessful aging. The impact of this social imaginary is as much about how the rest of society deals with old age as about marking individual experiences in hospitals and nursing homes. The fear of the fourth age sets boundaries for societal and retired people’s engagement with topics such as dementia and high levels of physical dependency. It also provides the rationale for social exclusion, which can have cultural as well as economic dimensions. A key factor in the operationalizing of the boundary between the the third and fourth ages is the presence or diagnosis of frailty. This term has become important in health care and social policy because its presence in older individuals represents not only a cue for intervention, but also acts as a marker for higher levels of dependency. Not only does frailty represent a much more vulnerable situation for older adults, but it can also be the precursor of decisions being gradually taken out of their hands, a form of aging without agency.⁶⁰