Old Age Psychiatrist (2014) 59
Ageing and Ageism
A brief introduction to the Social theory of Ageing and Ageism
Dr Noel Collins, Consultant Psychiatrist
There are many theories of ageing. Although most of us have been trained in the
positivist medical tradition, the process of getting older can be viewed from
other perspectives. Although ageing is a biological process, it does not occur in
a social vacuum, so it can also be understood as a social experience and in
sociological terms.
Social theories of ageing have evolved since the 1950s. Burgess initially
suggested a 'role-less role for the aged' in which there was tacit acceptance that
as we enter old age (when ever that may be) we relinquish roles previously
accumulated in adult-hood. This idea was extended in ‘disengagement theory’,
proposed by Cumming and Henry, which theorised that as people entered the
‘third age’, there was a contract with society whereby it was expected that
elders would disengage from certain roles (employment being a prime example)
in exchange for exemptions from certain responsibilities and societal
obligations (Henry and Cumming, 1959). It was thought that this process was a
mutually satisfying preparation for the final disengagement of death. In their
original study, the significant number of older people who maintained their
occupational and other roles were deemed as 'unsuccessful disengagers'. Rowe
and Kahn's 'activity theory', by comparison, viewed the maintenance of activity,
health and social engagement as characteristic of successful ageing (Rowe and
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Kahn, 1987). Although the theory emphasized the value of agency and
individualism, the categorizing of older people as successful or unsuccessful
agers was criticised as ignoring the socioeconomic context of individuals. Not
everyone had access to resources to ensure 'successful ageing’.
A life course perspective then began to emerge to conceptualise ageing. This
paradigm emphasised that being older was not a discrete stage of one's life, but
rather a phase that reflected the accumulation of life's experience and
circumstance. Bernice Neugarten proposed the idea of ‘age norms’ which act as
societal accelerators and decelerations on an individual’s behaviour (Neugarten,
1970). The life course perspective highlights the dynamic tension between an
individual’s determinism and the structural constraints of society. The approach
is particularly helpful when explaining health inequities between different
socioeconomic groups in late life, as these widen in response to processes such
as cumulative advantage and ‘stress proliferation’ over the lifespan (Pearlin et
al., 2005). A life course approach also emphasises the linked nature of our lives
and how we age as part of a generational cohort rather than in social isolation.
This leads on to some very interesting theory on intergenerational conflict and
solidarity.
Critical gerontology theories began to emerge in the 1980s, particularly the
'political economy of ageing'. This theory aimed to understand how an
individual's social, cultural and economic context influenced their experience of
ageing. It considers how political and economic structures challenge and
support an individual's agency over their lifespan. Robert Butler won the 1976
Pulitzer Prize for his book ‘Why Survive? Being Old In America’ which
explored malign political and economic influences on the experience of aging
(Butler, 1975). This included the influence of neo-liberalism. Neo-liberalism
argues that market forces are the best allocators of resources, be it houses or
healthcare. But, within this system, the poor and other disadvantaged groups are
less able to compete for resources. Neo-liberalists view individual merit in
terms of economic activity, meaning the older adult who is retired or receiving a
pension is viewed as an economic persona non grata. In this way, ageing can be
constructed as a social problem. Weekly headlines regarding the ‘pension time
bomb’ reinforce negative stereotypes of the elderly as one way consumers of
precious resources. However, this neo-liberal rhetoric ignores the many ways in
which older adults are vital socio-economically, for example, in their roles as
informal carers (for their grandchildren or spouses). Older carers make up a
sizeable proportion of informal carers nationally, saving social care £120 billion
annually, more than the entire NHS budget (Brindle, 2010).
Ageism, like ageing, can be defined in both narrow and broad terms. It can be
conceptualised as simply discrimination on the basis of single demographic
characteristic akin to sexism or racism, or as more complex construct that
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affects individuals over the entire lifespan through age-related societal norms
and expectations of behaviour. Both the young and elderly can be positively and
negatively affected by this. However, ageism can legitimise the use of
chronological age to deny resources and opportunity. We know this occurs in
many areas of health care from stroke care (Young, 2006) to referral for
cognitive behavioural psychotherapy (NHS, 2013; RCPsych, 2013). And on the
day that I write this, The Telegraph headlines with ‘Too many needless deaths
because elderly cancer sufferers are ‘written off’’. This was prompted by
concerns from Macmillan Cancer Support that older patients are denied
treatment solely on the basis of their age without assessment of the likelihood
that they could benefit from treatment (Donnelly, 2014). However, the reasons
for this apparent age based rationing of health care relate not just to policy and
practitioner factors but also to patient expectation and subsequent health seeking
behaviour (Meisner and Baker, 2013).
Next time we will explore health inequalities in later life in more detail and the
sociological explanations to account for these.
References
BRINDLE, D. 2011. Carers save the country £119bn a year. Guardian. 12 May 2011
BUTLER, R. 1975. Why survive? Being old in America, New York, Harper & Row.
DONNELLY, L. 2014. Too many needless deaths because elderly cancer sufferers are
'written off'. The Telegraph, 24 Jan 2014.
HENRY, W. E. & CUMMING, E. 1959. Personality development in adulthood and old age. J
Proj Tech, 23, 383-90.
MEISNER, B. A. & BAKER, J. 2013. An exploratory analysis of aging expectations and
health care behavior among aging adults. Psychol Aging, 28, 99-104.
NEUGARTEN, B. L. 1970. Dynamics of transition of middle age to old age. adaptation and
the life cycle. J Geriatr Psychiatry, 4, 71-100.
NHS, 2013. IAPT Equalities Older People. http://www.iapt.nhs.uk/equalities/older-people/.
PEARLIN, L. I., SCHIEMAN, S., FAZIO, E. M. & MEERSMAN, S. C. 2005. Stress, health,
and the life course: some conceptual perspectives. J Health Soc Behav, 46, 205-19.
RCPSYCH 2013. Report of the Second Round of the National Audit of Psychological
Therapies (NAPT) London: Healthcare Quality ImprovementPartnership.
ROWE, J. & KAHN, R. 1987. Human aging: usual and successful. Science, 237, 143-9.
YOUNG, J. 2006. Ageism in services for transient ischaemic attack and stroke. BMJ, 333,
508-9.
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