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International Handbook of Population Aging

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Abstract

The International Handbook of Population Aging is the first comprehensive volume to examine research on a wide array of the profound implications of population aging. Global population aging is one of the most important issues facing human societies in the early twenty-first century. Population projections show that the proportion of the world’s population over age 60 will double between 2000 and 2050, and that about one-third of the people living in developed countries will be over age 60 in 2050. Already there are countries in Europe and Asia where the number of people over age 60 exceed the number of children, and by 2050 some of these countries will have twice as many old people as children. As noted by the 2002 UN World Assembly on Ageing Report, this global trend in population aging is unprecedented in human history, is pervasive across societies, is enduring (there is no going back to younger populations), and has profound implications for human beings. "An essential reference work." Glen H. Elder, Jr., Research Professor, Carolina Population Center, University of North Carolina, Chapel Hill "An absolutely essential reading. The rich fare this volume offers has no match or even close competitor in the professional literature." Paul Demeny, Distinguished Scholar, Population Council Editor, Population and Development Review "Exemplary in regard to the range of countries it covers and in focusing on many questions." Karl Ulrich Mayer, Stanley B. Resor Professor of Sociology, Yale University "An impressive volume, showing the ageing populations around the globe through the lens of some of the best demographic observers." Martin Kohli, Professor of Sociology, Department of Social and Political Sciences, European University Institute This is the first handbook to appear in the International Handbooks of Population series, edited by Dudley Poston Jr., Texas A&M University, College Station, TX, USA. Future handbooks in this series will focus on Mortality, Poverty Populations, Migration, Race and Ethnic Demography and more.

Chapters (30)

In this chapter, I explain how changes in birth, death and migration act to change the age structure of populations. We will see how population aging is an inevitable part of the transition to lower rates of population growth that follow the demographic transition from high fertility and high mortality to low fertility and low mortality.
The demographic study of aging in comparative context covers wide intellectual and disciplinary ground. Aging involves social, behavioral and biological processes; thus, scholars studying aging investigate issues ranging from genetic contributions to chronic disease susceptibility (Olshansky et al. 2005) to the effects of economic growth on elders’ living arrangements (McGarry and Schoeni 2000). Aging involves many multifaceted processes that have implications at the microlevel for the analysis of individual lives and at the macrolevel for the analysis of population and historical change.
Population aging has a relatively brief history but one that clearly foreshadows a future in which aging will transform the social structure of many societies. In 1950, no country had more than 11 per cent of its population aged 65 and over; in 2000 the highest figure was 18 per cent but by 2050 it could reach 38 per cent. In most developed countries population aging began to cumulate slowly during the late nineteenth century as their fertility rates entered a phase of sustained decline. The aging of the world’s population emerged much later and the proportion over age 65 passed 6 per cent only during the last quarter of the 20 th century, by which time fertility decline was becoming a global phenomenon. In contrast, the history of old age – referring to the experiences of older individuals and groups – has been a subject of record since ancient times (see Achenbaum 2005). Cicero’s (44 BC) essay De Senectute (“On Old Age”), for example, provides a window into past experiences, attitudes and beliefs about old age. His work foreshadows ideas about how individuals might preserve their health and vitality that became highly influential 2000 years later in research on “healthy aging” and “successful aging” (e.g., Rowe and Kahn 1998).
International research on population ageing up to the 1970s focused mainly on selected countries in Western and Northern Europe. One of the main reasons behind the limited interest in Southern Europe was the low number and proportion of aged people in the area. In 1951 the proportion of people aged 65 and over was around 12 per cent in the UK and 10 per cent in Sweden compared with only 8 per cent in Italy, Portugal and Spain and 7 per cent in Greece. However, the demographic trends behind population ageing have been so rapid and so remarkable in Southern Europe that nowadays, this region together with Japan is among the “oldest” areas of the world. The rapid and intense decline in fertility jointly with impressive achievements in extending survival, especially at older ages, have contributed to making Italy and Spain (and to a lesser extent Greece and Portugal) the countries with the highest proportion of older people, highest median age of population and highest ageing index. The challenges of this rapid population ageing are therefore unique in Southern Europe and they require a detailed analysis of the demographic and socio-economic structures, together with the understanding of the cultural context of the countries belonging to this area.
The Nordic countries, Denmark, Finland, Iceland, Norway and Sweden, have a long history of population aging. They were among the first countries to experience rapid population aging and this aging resulted in government commissions on pensions being formed in the 1800s. Concerns over population aging led to the formation of other commissions on how to foster higher fertility and how to provide public old-age care a few decades later.
Population aging is a global phenomenon and countries of Eastern European are also experiencing a rapid increase in the proportion of older people. The proportion of elderly people in Eastern Europe is currently lower than in the European region as a whole. However population aging in this region is expected to continue over the next few decades, eventually leading to the convergence in the proportion of older people in the countries of Eastern and Western Europe.
Primarily because the fertility transition in a number of Asian countries, particularly in East and Southeast Asia, has been considerably shorter than in the developed countries, the speed of population aging in Asia has been and will be substantially faster than that observed among the industrialized nations in Europe. In the post-World War II period, Japan’s fertility decline was the earliest to occur not only in Asia but also in the world. In addition, it was also the greatest in magnitude among all the industrialized nations.
The proximate determinants of population aging in China are fundamentally the same as those in any other country. It is an inevitable consequence of the process known as the “demographic transition” in which declining fertility together with a rise in life expectancy leads to a shift towards an older age structure of the population. Yet, the story of population aging in China is unmistakably unique, shaped by its distinct historical, cultural, economic and political contexts. The pace of its aging trend is by itself unparalleled, with the proportion of older adults projected to grow from 6.8 per cent to 23.6 per cent over the first half of the twenty-first century (United Nations 2005). As the most populous country in the world, this increase in the population of elderly translates to an astounding growth of 242 million people, which would qualify it for the fourth largest population in the world today.
Auguste Comte, the French mathematician, philosopher and the founder of sociology, is believed to be the first person to write that, “Demography is destiny”. Although Comte focused mainly on the effects on the society of increases and decreases in fertility, the general phrase means that population numbers and the changing composition of their members have important and lasting impacts. Demography is destiny precisely because once the demographic shifts and changes have occurred, the future is set. Based on the demographic events that have occurred, astute observers are able to figure out what will happen in the future, or at least what might happen in the future, before the events of the future actually occur.
Population aging is a global phenomenon. The populations of developed nations have aged quickly over the last fifty years, shifting from a median age of 29.0 in 1950 to a median age of 38.6 in 2005 (United Nations 2007). Although the populations of developing nations are younger, with a median age of 25.5, these populations are expected to age rapidly in the future (United Nations 2007). As described in Chapter 1 of this handbook, the aging of the human population is principally the result of worldwide fertility decline, although reductions in old age mortality also play a role. This set of changes is part of the demographic transition, the process by which societies move from high fertility and mortality to low fertility and mortality (Kirk 1996). In turn, these demographic changes are intertwined with social and economic change such that the demographic transition is typically considered a component of modernization.
Latin America and the Caribbean (LAC) is one of the fastest aging geographic regions in the developing world. The growth in the percentage of elderly (the number of those aged 65 and older divided by the total population) between 2000 and 2025 is projected to be 17 per cent for Sub-Saharan Africa, 47 per cent for the Near East, 79 per cent for Asia (excluding Near East) and 82 per cent for LAC (U.S. Bureau of the Census 2000). Rapid mortality and fertility decline in the last half of the twentieth century started the process of aging in the LAC region, a process that should accelerate starting around 2030. Thus, the period for investment in infrastructure to assist LAC societies is imminent, in particular because infrastructures such as financial markets, human resources to provide health care and investments in the young are deemed to translate into well-being of the future elderly of the region but these systems take two or three decades to formulate or reach maturity. The geographic location of this region, just south of the United States and Canada, also represents peculiar challenges and opportunities for the aging of the LAC populations. Overall, the current and future aging of the countries in this region convey a mixed picture of privileges and disadvantages.
West Africa is one of the four sub-regions of Sub-Saharan Africa (SSA). It comprises 15 major countries: Benin, Burkina Faso, Cote D’Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone and Togo. The dynamics and implications of population ageing in these nations are best examined in the context of a debate on ageing in SSA as a whole. The first part of this chapter, therefore, charts the origins of this debate and critically examines its scope and the key concerns and perspectives at its heart. In light of this, the second part critically reviews what we presently know about the demography of population ageing and the demographics of the older population in West Africa and what key knowledge gaps remain. The review draws mainly on existing literature from the Anglophone countries of West Africa. Given language limitations, it is unable to capture the body of publications from the region’s francophone and lusophone nations. Indeed, it is important to note the significant impediment that language barriers pose to the flourishing of scientific discourse on ageing in Africa as a whole. A second note of caution due at the outset concerns the importance of recognizing the diversity that exists in the cultural, social and environmental contexts in which the ageing of populations and individuals unfolds in West Africa. Nigeria alone, for instance, comprises over 350 ethnolinguistic groups, spread over geographically disparate areas (Nugent 2004; DFID 2004). Sub-regional overviews, as offered in this chapter, are thus inevitably general, able to capture only broad, cross-cutting themes. An in-depth understanding requires country specific research and analyses.
Relative to other regions around the world, research on older adults in Arab countries has been sparse. This gap is surprising, given that adults aged 60 years and older in 2000–2005 represented about 6.5 per cent of Arab populations in Northern Africa and about 6.6 per cent in Western Asia (United Nations 2006). By 2050, these percentages should reach 19.4 and 17.8, respectively (United Nations 2006). Despite these trends, no longitudinal, comparative studies of older adults have been undertaken in the region. One of the first major efforts to characterize the health and socio-economic conditions of older adults in several Arab countries was the World Health Organization Collaborative Study on the Social and Health Aspects of Aging, which was a cross-sectional comparative study of adults aged 60 years and older that was conducted around 1990 in several sub-regions of Bahrain, Egypt, Jordan and Tunisia (Andrews 1998). A wide array of self-reported social, economic, demographic and health-related data were collected in this study but no objective measures of health were gathered and no follow-up was undertaken. Thus, estimates of the health status of the populations represented by these samples are based entirely on self- and/or proxy-reported data and their validity and reliability remain unknown.
Because the popular press has had a long-term interest in the phenomenon of retirement migration, the small proportion of older persons who make long-distance moves has gotten a great deal of public attention. This state of affairs is unfortunate because mobility is richer and much more varied than the popular notion of it suggests and the explanations of mobility that have motivated research on this topic are complex and interesting.
This chapter reviews a recent, still unusual but rapidly growing manifestation of affluence and the freer movement of capital and people around the world, international retirement migration (IRM). The phenomenon engages both theoretical and applied gerontological concerns. The migrants include some of the most “culturally innovative” members of the latest cohort of young elderly people, whose approach to old age is positive and developmental and may indicate more widely shared changes in attitudes and aspirations. Among the concerns, the welfare outcomes for the participants are none too clear, particularly the medium- to long-term implications for their access to informal and formal care and support. IRM also interests actuaries, demographers and human-services planners, because the flows have the potential to change a country’s age distribution and the international distribution of government spending on old-age income support, health-services and long-term care.
Immigration is remaking populations not merely in nations like the U.S. that have long welcomed newcomers but also in societies that have not traditionally received immigrants. Although the U.S., with its policy emphasis on family re-unification, admits increasing numbers of aging immigrants, immigrants are usually young. With the passage of time, they grow older and may make up a significant share of the aged population in places where there have been high and sustained levels of immigration. An important question is whether the well-being of this older immigrant population approaches that of native-born seniors or is characterized by significant disadvantage. The answer to this question depends on immigrant selection and incorporation processes, that is, on the characteristics of those who come to stay as well as on the extent to which they are integrated economically and socially into the society.
There is an almost four-decades old literature focused on the substitution effects of migration for the demographic processes of fertility and mortality. On the simplest level, the question came down to whether international migration could be used to alter purportedly unacceptable population size or composition due to fertility and mortality rates. Policy concerns have not only been about absolute population size as achieved or reasonably projected but also about composition, especially age composition because age structure can affect growth from future fertility, the size of the labor force and dependency ratios. Migration, like differential fertility in an ethnically, racially or religiously mixed population, can also affect the composition of social characteristics in a population that impact political or social events and opportunities.
During the summer of 1932, Franklin D. Roosevelt, then Governor of New York, was nominated to be the presidential candidate for the Democratic Party. In his speech to accept the nomination, Roosevelt discussed the Depression era hardships and told the American people “I pledge you, I pledge myself, to a new deal for the American people.”
In the mid-1990s, in response to the spreading problem of financing public pay as you go (PAYGO) pension systems across industrialized countries experiencing population aging and economic globalization, the World Bank called for a three pillar model of pension policy to avert the old age crisis (World Bank 1994). The first pillar was to consist of minimal public sector defined benefit pensions bas ed mainly on PAYGO financing; the objectives were redistribution and poverty reduction. The second was to consist of earningsrelated or occupational pensions that could have public (government subsidized) or private financing arrangements; the objective was to promote or enforce saving. The third was to consist of private individual savings, with the objective to encourage individual, voluntary saving. Diverse mixes of these three policy alternatives already existed across advanced societies but the decade following the report has been characterized by more and more policy shifts across countries with different welfare state legacies towards more private and voluntary schemes. Meanwhile, the United States pension system was already based on a three pillar structure in 1994 and has tilted towards the third pillar vigorously.
Work gives structure and meaning to daily life. People work because it provides them with something to do, the opportunity to make a contribution, a ready social network and, of course, earnings. For most Americans, access to health insurance requires an employer.
Demographic interest in occupational retirement has two bases. One is retirement’s role in the renewal and repopulation of groups and social institutions. Retirement, while occasioned by aging, is not a necessary societal practice and it only became commonly available to workers during the 20th century. Yet it has proven useful in arranging and managing orderly succession within firms, organizations and labor markets, thus contributing to their continuity as the young replace the old. In addition to managing turnover, retirement is also of demographic interest because it segments the life course. In contemporary practice, withdrawal from work typically occurs at ages far in advance of disability and death. For example, life expectancy exceeds the average age of retirement in European nations by about 15–20 years (Table 21.1), which is also comparable to the experience in Japan and the United States. As a consequence, this pattern opens up a new stage of the life course between employment and death, making a population segment available for age-specific migration, economic behavior, political activity and lifestyles that are potentially discontinuous with the major adult roles of work and family.
Inequality is one aspect of diversity. Differences among individuals, groups, organizations, or nations can be constitutive of a rich variety in talents, interests, expertise, or culture. But, when people face differences in opportunities, resources, rights, political access, life expectancy, or standard of living, for example, we speak in terms of inequality rather than diversity. This distinction in terminology signals the special meaning we assign to the distribution of hierarchically valued goods. However, this sorting process – the distinctions made between what we value and what we respond to with indifference – depends on context. Being able to read sets one apart from those who cannot read and being able to read well – better than many of those who can read – can be an asset when one lives in a world where the skill of reading provides access to people, positions and opportunities favorably located relative to the processes of production and distribution. Similarly, countries with high literacy rates are often viewed as more “developed” than countries with low literacy rates. But these rankings correspond to a global environment that values reading as an essential skill, one which commands higher levels of compensation and rewards a highly literate population with a relatively high standard-of-living made possible by a highly productive national economy. Whereas, the term diversity suggests a non-uniform distribution of something, inequality suggests a non-uniform distribution of something that matters either in a positive way, where access to or amount of that something provides advantage, or in a negative way, where exposure to or accumulation provides a disadvantage.
The thorough description and more complete understanding of older adult mortality patterns have become central and exciting areas in both demography and aging research in recent decades. Increasing numbers of people around the world, particularly in the most economically developed countries, are experiencing overall healthier and longer lives. Indeed, given its impact in nearly all countries, the general increase in life expectancy was arguably one of the most important trends of the 20th century. Increases in life expectancy – initially predominantly caused by decreasing infant and childhood mortality but now largely based on decreasing older adult mortality in high income countries – have also helped to produce greater numbers of people living into older adulthood. The growing size of the older adult population is a relatively new phenomenon in human history and has, in turn, created tremendous interest in the growth, health and mortality prospects of this rapidly growing segment of the population. More recently, elderly populations have experienced lower mortality and substantial gains in life expectancy. For example, in 2004, U.S. life expectancy at age 65 reached 20.0 years for women and 17.1 years for men (Miniño et al. 2007). These figures have improved considerably from the 65-year-old life expectancy figures of 15.0 years for women and 12.7 years for men in 1950 (Arias 2006).
Over the last century, life expectancy in the United States has steadily increased. Though much of this was due to falling infant mortality rates, older Americans have also experienced large increases in life expectancy. In 1950, those who survived to age 65 could expect to live to age 79; today, those who survive to age 65 can expect to live to age 84 (National Center for Health Statistics 2004). Moreover, though there was significant concern that rising life expectancy, particularly among the elderly, would simply mean that people were living many more years in worse health, current evidence belies this (Freedman et al. 2004; Fries 1980). In fact, age-specific disability rates have been falling among the elderly for the past 15 years (Freedman et al. 2004).
The impact of the widespread aging of populations around the world has become of central interest to both researchers and policymakers who wish to understand the broad social implications of these demographic changes. One of the areas of greatest interest has been the potential impact of aging populations on the provision of informal care to older persons by friends and family. These concerns have focused on changes in fertility and mortality that affect the availability of family members to provide emotional, financial and instrumental support, as well as sweeping changes in women’s roles and family relationships that have transformed the responsibilities and obligations among family members (Finch 1989; Safilios-Rothschild 1989).
This chapter presents trends in childlessness over the course of the twentieth century. It also provides a review of the antecedents and consequences of childlessness among older adults. Childlessness has only recently started to figure prominently on the research agenda of the social sciences. Previously, it was studied tangentially, or not at all.
Social scientists have known at least since Durkheim that social relationships are intimately tied to health and well-being. Those with many close personal ties do better, on average, than those with few, with social isolates particularly disadvantaged, as Durkheim pointed out in Suicide. Marriage tends to form the centerpiece of social networks in most societies and plays a key role in the production and distribution of social support, which is one of the reasons that married people tend to live longer, healthier lives than those who are not married.
Widowhood is widely regarded as a women’s issue. In all developed and nearly all developing nations, women are more likely than men to survive the death of their spouse, reflecting men’s higher rates of mortality and the tendency of women to marry men slightly older than themselves. Women also are more likely than men to remain unmarried after their spouse dies, due both to a highly skewed sex ratio among older adults and men’s greater desire to remarry after losing a spouse. Moreover, widowhood has increasingly become an older women’s issue; as life expectancy has increased steadily over the past century in virtually every nation, spousal loss overwhelmingly befalls older adults. As such, widowhood has important consequences for the living arrangements and physical, economic and psychological well-being of older adults. The distinctive ways that older men and women experience widowhood are shaped by demographic factors, including the timing of their spouse’s death; the number and gender distribution of their children; the living arrangements, employment patterns and migration patterns of their children; one’s own physical health and functioning in later life; cultural context; and gender-typed socialization processes that occur over the life course.
The modern rise in life expectancy is one of humanity’s crowning achievements. After more than 200,000 years of slow but steady increases in life expectancy for anatomically modern people like us (McNeill 1976), a new chapter in the book of human longevity began in the middle of the 19 th century when a quantum leap in duration of life began (Omran 1971). The external forces of mortality (e.g., infectious diseases, predation and accidents) that precluded survival beyond the first few years of life for most people were significantly relaxed as modern humans learned how to insulate themselves from the major hazards of the outside world. As a result, the biological consequences of aging are now a common occurrence for the first time in the history of our species. This longevity benefit, however, was accompanied by a trade-off involving a rise in such fatal diseases as cancer, heart disease, stroke and Alzheimer’s disease, as well as such chronic conditions as sensory impairments, arthritis and dementia.
By definition the work of demographers entails not only analytical detachment but also the existential reductionism of personally momentous events to single datapoints. It may seem paradoxical that the assemblage of such discrete and singular bits of information for a society’s population can reveal patterns that provide key insights into the character of both intimate and complex aspects of individual experience and of cultural ideals. Indeed, it is not possible to understand social change in either the domains of the cultural (the collective symbolization of ideas and values) or the personal (the meaning-making processes and struggles within individuals’ everyday lives) without understanding demographic patterns and their role in shaping the domains of culture, value and individual opportunity. Nowhere can the impact of demographic patterns on ideas, values and meaning be more clearly seen than in the matter of human age.
... For descriptive analysis, qualitative variables were presented as absolute frequencies with percentages. Questionnaire results were analysed using a Principal Components Analysis (PCA), which was performed based on questions 1,7,8,10,14,19,34,36 as active variables, while socio-demographic variables and questions 1, 3,7,8,10,11,14,19,21,24,25,33,34,35,36,37,38 were used as illustrative variables. Clusters of residents were identified with Hierarchical Cluster Analysis using Ward's distance. ...
... Despite difficult living conditions, they preferred to remain at home rather than to live in a NH. This is consistent with cultural expectations in Southern Countries, where social support from the family is the norm (25,26). The second profile comprised essentially isolated individuals with few social contacts. ...
... Our study also reveals geographical specificities, which may be at least partially explained by different policies regarding care of older adults in society between countries in the North versus the South of Europe. In southern European countries such as Italy, the fate of incapacitated older persons depends on the family rather than on institutional solidarity (25), in contrast with northern countries like Germany or Belgium. These findings can be interpreted as evidence that culture and socio-economic factors can influence older adults' attitude towards their place of residence (29,30). ...
Article
Background: Entering a NH can represent considerable mental trauma in addition to an increased financial strain. An improved understanding of the psychological issues at play could help professionals to adopt a more empathic attitude. Objectives: the main objective of our study was to identify distinctive profiles of adults aged over 65 in four European countries in order to understand the difficulties associated with the transition to a nursing home. Design: Cross-sectional study and Hierarchical Cluster Analysis. Participants: Retired people from Germany, Belgium, France, and Italy aged 65 or older selected by quota sampling and contacted via an online survey, the Ipsos Poll Institute Access Panel. Methods: Cross-sectional survey. A Principal Components Analysis was performed on the answers to the questionnaire, and clusters were identified by Hierarchical Cluster Analysis using Ward’s method. Measurements: The data was collected using an Internet questionnaire. Results: A total of 4160 subjects aged 65 years or older were selected. Principal component analysis identified six well-defined groups: wealthy homeowners, flexible single people, wealthy Germans, low-income introverts, socially isolated women, Italian homebirds. Conclusions: Understanding the profiles of older Europeans could help healthcare professionals decide how to orient them towards acceptance of their new life in the nursing home.
... Many countries will face further aging of their societies in the coming decades. This is caused by the demographically large generation of Baby boomers, living to an older age than the generations before them [1]. An increased life expectancy, however, is associated with increased multimorbidity and frailty, which in turn is expected to affect the number of older persons with health and social care needs [2]. ...
... This implies, however, increased pressure on older people's informal networks. Yet, due to a further changing age structure, it is expected that there will be fewer available informal caregivers for older adults in the future [1]. ...
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A growing number of informal caregivers of older adults combine caregiving with a paid job, raising the question of whether they will be able to meet the increasing demand for informal care. The aims of our study are twofold: first, to describe the development of a model providing insight into the factors that play a role in the availability and provision of informal care by working caregivers of older adults, and second, to investigate which societal developments will impact the factors in the model, and thus the future availability of informal care by workers. A mixed-methods approach was applied to integrate evidence from academic and grey literature, with insights from experts through a Group Model Building exercise and a Delphi study. The resulting Working Informal Caregiver (WIC) model presents a range of individual, social and environmental factors that are related to working caregivers’ ability and their willingness to engage in informal care. Experts foresee that future informal care will be impacted most by the increasing participation of women in the workforce, while changing household structures may diminish opportunities to share care tasks within their households or families. The WIC model can be used to gain better insight into the availability of informal care by workers, now and in the future.
... It is suggested that social engagement in grandparental caregiving could increase intergenerational exchanges between grandparents and grandchildren (Bengtson, 2001;Uhlenberg, 2009), which could reduce dissatisfaction caused by loneliness to a larger extent. In China, grandparental caregiving is also a way to enjoy family support and maintain emotional closeness with family members, which, in turn, could lower the level of loneliness for grandparents (Goh, 2009). ...
... However, there is one question that remains open in previous studies, i.e., the underlying mechanism behind the gains caused by grandparental caregiving. Our results provided some preliminary insights, suggesting that reduced lonely dissatisfaction associated with grandparental caregiving (Bengtson, 2001;Uhlenberg, 2009) might be one of the reasons. Much of the existing research has demonstrated that loneliness and life dissatisfaction could have dramatic negative effect on older adults' physical and mental health (Coyle and Dugan, 2012;Guven and Saloumidis, 2014;Marum et al., 2014;Hülür et al., 2017). ...
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Objective: The purpose of the present study is twofold: (1) to investigate the differences in terms of physical and mental health between those who provide grandparental care and those who do not and (2) to explore the mechanism that connects grandparental caregiving and health-related outcomes. Methods: Two studies (a cross-sectional and a short-term longitudinal follow-up) were conducted. The cross-sectional study (Study 1) examined 148 older adults who provided grandparental care and another 150 older adults who did not. A small longitudinal follow-up study (Study 2) was conducted among 102 older adults randomly selected from Study 1, of which 52 were older adults who provided grandparental care, and another 50 older adults were those who did not. Health status (measured by SF-36), lonely dissatisfaction (measured by Lonely Dissatisfaction Subscale of PGC-MS), and cognitive functions (measured by subscales of WAIS) as well as demographics were measured in both studies. Results: Results of both the cross-sectional and longitudinal studies showed that, compared with older adults who did not provide grandparental care, those providing grandparental care had significantly better physical and mental health as well as reduced lonely dissatisfaction. Further path analysis showed that lonely dissatisfaction mediated the association between providing grandparental care and enhancement in functions such that providing grandparental care could reduce lonely dissatisfaction, which, in turn, could improve their physical and mental health even after controlling for their cognitive functions. Discussion: These results suggest that providing grandparental care can improve older adults' physical and mental health through reduced lonely dissatisfaction.
... [4][5][6] New concepts have emerged such as "Age Quake" and the "New International Population Order" to characterize the astonishing growth of the elderly population around the world. 7,8 The Universal Declaration of Human Rights, Article (25) emphasized the importance of older adults' right to adequate standards of living that include physical, psychological, social and even spiritual services. 9 As the increased percentage of older adults becomes more visible, the developing countries started to pay more attention and provide various forms of care and services for the elderly to meet their rights and needs. ...
... 32 Furthermore, the historical changes in women's role as prime carers of older adults, the increased life expectancy of older adults and the geographical dispersion of families are considered substantial factors that have contributed to the negligence of the needs of the elderly. 14 The changes and the conflicts in the family members' roles have driven the demand for more adult day care centres in Western culture; centres that recognize the numerous needs of older adults in a more safe and supportive environment compared to 8 I.M. Hweidi et al. that of long-term care settings. 30 In Jordan, the equation for elderly care does not appear to be any different from that of Western culture with regard to the need for day care services. ...
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This paper aims to discuss Jordan’s desperate need to establish adult day care services.More specifically it aims to address the benefits and social transformation that necessitate the establishment of adult day care services. In terms of background, the unprecedented social transformation and the deficient prioritization of social care services for older Jordanian adults have deleteriously impacted on the care provided for them. Despite versatile citations in multiple religious sources, the family support system for older adults in Jordan is inadequate and the duty of providing for their needs is left to governmental institutions. Regarding design, this is a discussion paper to clarify the importance of establishing adult day care services in Jordan. The implications mean that health care professionals are in a prime position to improve awareness about the importance and the benefits of adult day care services. Health care professionals are required to clarify their perspectives on social care issues and to be involved in prospective policies and legislations regarding planning, establishing and managing adult day care services. In conclusion, establishing adult day care services in Jordan needs an interdisciplinary collaborative approach among governmental and non-governmental organizations. These organizations need to contribute significantly in terms of offering the support needed to ensure quality of care for this vulnerable age group.
... Chinese landless peasants are mainly employed by private small and medium enterprises, small and micro enterprises, and individual economies. The private sector contributes more than 90% of the increment in society-wide employment [13]. Therefore, new initiatives and ideas related to encouraging and promoting the self-employment of landless peasants serve as practical solutions to ensure the future subsistence and development of landless peasants. ...
... Schildt et al. [18] reveal that the past entrepreneurship experience of entrepreneurs has a positive influence on EI. Some studies have found that the previous experience, including previous entrepreneurial experience, industry experience, management experience, specific R & D work experience and other functional work experience, affects EI [13,[19][20][21]. Other studies have studied the impact of human capital factors such as education, training experience, and skills on entrepreneurship [22,23]. ...
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Landless peasants have been a great concern for both the government and academics in China. Entrepreneurship is promoted as one of the most important approaches to achieving civilization and urbanization. However, few studies have systematically examined the influencing factors of landless peasants’ entrepreneurial intention (EI). This research gap presents barriers for making effective policies to promote entrepreneurship among landless peasants. This study aims to examine the critical factors influencing the EI of landless peasants and their interrelationships. The critical factors of landless peasants’ EI are identified using logistic regression analysis. The logical and structural relationships among critical factors are mined by interpretative structural modeling. A chain of factors with an interrelated and clear hierarchy is built to clarify the explanatory structure of landless peasants’ EI. The results show that the EI of landless peasants is significantly influenced by five factors: gender, achievement motivation, innovation orientation, land expropriation scenario, and entrepreneurial experience. Entrepreneurial experience is a direct surface factor; innovation orientation is an indirect intermediate layer factor; and gender, achievement motivation, and land expropriation scenario are deeply rooted factors. The results provide a good reference for formulating effective entrepreneurship policies to address landless peasants’ employment and sustainable livelihoods.
... The world is aging much more rapidly than decades ago given the increased life expectancies and decreased fertility rate in many countries. While the aging of the population has created quite a few issues that affect the long-term plan of governments, more attention has been paid to the fulfillment of demand from the aged people (Uhlenberg, 2009). Compared to the general population, older adults not only have equal demand for accessing socioeconomic opportunities such as leisure and shopping, but also show probably more interests in health care, friend visiting, and exercising (Horner et al., 2015). ...
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The steady trend of aging has caused great concern on how cities should better accommodate the social needs of aged population. Older people in general have more leisure time than younger adults but are found highly constrained in daily travel. To examine the imbalance between travel demand and transport supply among older adults, this paper decomposes their daily travel into two categories (visits to non-ubiquitous and ubiquitous facilities) according to major characteristics of travel behaviors using Nanjing Household Travel Survey data. Multinominal logit (MNL) models are applied to exploit the effects of household and personal characteristics, trip characteristics, local supplies, and public transport services on travel mode choices. Results show that (i) travel demand and transport supply are highly unbalanced for most non-ubiquitous facilities, (ii) relative to younger adults, older adults travel further and highly rely on public transport to access non-ubiquitous facilities, (iii) providing more public transit services nearby non-ubiquitous facilities are more reliable to increase the accessibility of older adults than increasing the number of facilities. These results would help policy-makers better understand travel behaviors of older adults and develop strategies to accommodate their travel demand, especially from the perspective of facility network reorganization.
... According to the World Health Organization, more than one billion people live with disabilities worldwide 1 . With the ageing population, disability will become an even greater concern, particularly in Western countries (Uhlenberg, 2009). To catch up with this societal challenge, the United Nations proposed the Convention on the Rights of Persons with Disabilities (CRPD), ratified by 181 countries 2 . ...
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Article
Worldwide, more than one billion people live with disabilities. People with disabilities (PWD) have needs in terms of autonomy, social participation and inclusion. Mobility is one condition for them to be included in society and participate in social life. Autonomous vehicles (AVs) can be part of the concept of Mobility as a Service (MaaS) that enables us to rethink the policy of mobility. However, the way these new autonomous mobility services are designed could exclude PWD. To prevent that, universal design principles and inclusive design could help policymakers and public transport companies design new means of transport that are accessible to all. However, perceptions of PWD regarding MaaS in general and AVs are not well documented. This article presents qualitative research about these perceptions. Eight semi-directive interviews were thus carried out on the subject. Based on these findings, we developed an integrative model to accompany and orchestrate such AV design developments. This integrative model will help policymakers and public transport companies rethink mobility concepts while incorporating AVs and make them accessible to ensure the social inclusion of PWD.
... Older humans have lower cognitive ability, 6 respiratory capacity, 7 immune function, 8 and muscle mass 9 than younger humans, and together, such factors contribute to the increasing morbidity and mortality observed in the elder members of society worldwide. 10,11 Yet despite often being associated with old age, declines in some physiological functions often begin much earlier in the life span than others 12 (see also Hayward et al. 13 for example in a non-human population) and are not necessarily synonymous with debility. For example, some aspects of cognitive decline already begin in healthy, educated adults as early as their mid-to-late twenties, 14 whereas the most pronounced declines in muscle wasting (sarcopenia) do not begin until individuals are over 50 years of age. ...
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Article
Data from elite professional sports players provide a valuable source of information on human performance and ageing. Functional declines in performance have been investigated across a wide range of sporting disciplines that vary in their need for physical strength, endurance, cognitive ability and motor skills, but researchers do not always consider other sources of heterogeneity that can exist between individuals. Using information on all male bowlers to have played Test match cricket since the early 1970s, this study separated age-dependent variation in bowling performance at the population-level into within-individual and between-individual (age-class) changes. There was little evidence for senescence in bowling performance as measured via economy rate or wicket-taking ability, irrespective of the style of the bowler (fast or slow). Instead, analyses detected strong between-individual contributions to bowling performance as higher quality bowlers were able to compete at the elite level for longer, and were therefore over-represented in older age classes: how they accomplish this alongside the physical demands of Test cricket remains unresolved. Bowlers also experienced a deterioration in the last year of their Test careers. Lastly, multivariate models identified a negative correlation between slow bowlers in their economy rate and their wicket-taking ability, suggesting that in general, the most economical slow bowlers in the modern era of Test match cricket have also taken wickets at the fastest rate. The same is not true for fast bowlers, which is perhaps partly because bowling at high speed compromises accuracy and thus increases scoring opportunities for batters.
... As a result, we have a huge number of widowed women elderlies. Deborah Carr and Suasan Bodnar-Deren in the their chapter 'Gender, Aging and Widowhood' in International Handbook of population aging P. Uhlenberg (ed.), said that the sex ratio in developed countries tend to be lower than developing countries, yet approximately in every nation women outnumber men [19,20]. In the year 2000, the global sex ratio for the older population above the age 60 years and older was 81 males per 100 females. ...
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Article
Introduction: The transition of culture, values and life style has shown degradation in morality, sense of responsibility, love and care towards the older family members. In the absence of recognition and acceptance of abuse, support network, preventive measures to control abuse the cases of abuse are often remain underreported. Henceforth, reinforce silently the incidences of abuse.
... Age has profound effects on the pattern of uveitis. The world's population is aging, and the proportion of the elderly population is predicted to increase in the future [12]. However, few reports have focused on the characteristics of uveitis in the elderly population in Asian countries, including in Japan. ...
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Article
PurposeTo clarify the clinical features of uveitis in elderly patients in central Tokyo.Methods We retrospectively identified 1424 patients with uveitis who visited the Uveitis Clinic of the University of Tokyo Hospital between January 2013 and December 2018. The patients were categorized into two groups based on their ages at the time of disease onset: patients aged 65 years or older were included in Group A, whereas those younger than 65 years were included in Group B. The etiological classification of uveitis and its causes were investigated for each group.ResultsGroup A presented significantly higher rates of infectious uveitis (35.5% vs. 17.8%, p < 0.0001) and masquerade syndromes (17.9% vs. 5.0%, p < 0.0001) than Group B. Furthermore, Group A had significantly higher rates of sarcoidosis (23.1% vs. 9.3%, p < 0.0001), intraocular lymphoma (16.6% vs. 4.6%, p < 0.0001), cytomegalovirus iritis (11.0% vs. 5.6%, p = 0.0043), and cytomegalovirus retinitis (5.2% vs. 1.5%, p = 0.0020) than Group B. Conclusion Our results demonstrate a clear difference in the causative diseases of uveitis between elderly and non-elderly patients. These findings may support ophthalmologists in their diagnostic process for elderly patients with uveitis.
... Women of all ages are also more likely than men to be involved in subsistence farming, linked to their role of providing food for the family (OECD, 1997). At the same time, older people are more likely to be concentrated in subsistence farming than younger people (Uhlenberg, 2009). But the literature on older women's subsistence farming is limited. ...
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Technical Report
Older women across the world engage in significant amounts of paid and unpaid work. Paid work is often a necessity for older women, especially for those living in poverty or who have experienced shocks, widowhood, HIV/AIDS in the family or migration of family members. Paid and unpaid work, and particularly having to juggle both, can negatively affect older women’s physical and mental health. But some older women also report positive impacts of their work. Family members often benefit greatly from older women’s paid and unpaid work. Few policy frameworks have focused on older women. Interventions to support older women and their work include social protection, public services and infrastructure, workplace policies, capacity building, education and training, and building social support networks.
... For instance, the proportion of elderly people in the population has continuously increased in the last three decades, from 5.6% in 1990 to 11.9% in 2018, according to 2019 China Statistical Yearbook. It is predicted that this figure will reach 23.6% in 2050 [1]. The rapid aging process has increasingly attracted attention from the government and urged policy makers to reconsider the fundamental needs of this specific group of people in society. ...
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Article
The rapid aging of the population has posed significant challenges to society and raised new demand for transportation services. Understanding travel needs of the elderly is crucial to making effective strategies for accommodating their demand in many newly motorized cities in developing countries such as China. Using a Markov-chain-based mixture model, we identify two main activity patterns of the elderly: recreation-shopping-oriented (RS-oriented) pattern and schooling-drop-off/pick-up-oriented (SDP-oriented) pattern. Elderly people in the RS-oriented pattern enjoy a cozy life with much time spent on recreation and shopping activities, while those in the SDP-oriented pattern take responsibility of sending grandchildren to school and taking them back home. The RS-oriented elderly people are faced with spatial constraints to access the sparsely distributed recreational sights; however, the SDP-oriented group is subject to temporal constraints when making daily trips. These results would encourage policy makers to reconsider the role of transportation in aged people’s lives and better accommodate their demand through designing safer walking and cycling environment and improving the quality of transit services.
... The challenges arising from aging societies have been intensively discussed in the scientific community from various points of view (e.g., [39]). One is the economic facet of this phenomenon: In this context, it is not only the fiscal burden connected to rising numbers of older society members, being associated with costs arising from the growing public pension system [40]. ...
Chapter
Populations of many countries in the world are facing new challenges caused by the current demographic shifts, resulting in a strong increase of the part of society aged 65 years and older. Alongside with economic consequences connected to this phenomenon, societies have to provide improved health care standards, accordingly to the higher needs and requirements of seniors. Assistive technologies (e.g., lifelogging technologies) in the health-related context are capable to support some of the challenges arising from a higher life expectancy and offer more autonomous lifestyle of seniors. However, to be successfully adapted such technologies must be well accepted among diverse potential users. This study examines in an online-survey with N = 585 participants current attitudes towards aging and quality of life in old age, as well as indicators of acceptance for health-supporting technologies, which are meant to support seniors and/or persons with chronic disease(s) in their private environments. In addition, this study examines whether user factors like age, gender, and health status significantly affect these opinions. The findings provide valuable insights into these research aims, supporting the understanding of currently changing aging concepts and indicators which contribute to a long-term adoption of medical assistive technology in modern societies.
... Most developed countries and a number of developing countries, such as China, are now facing the problem of aging populations [1][2][3]. Increasing numbers of elderly people mean a relative reduction in the number of available assistants. Health and security are the top concerns of developed countries with rapidly aging populations. ...
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Article
A number of developed countries are rapidly turning into super-aged societies. Consequently, the demand for reduced surgical invasiveness and enhanced efficiency in the medical field has increased due to the need to reduce the physical burden on older patients and shorten their recovery period. Intelligent surgical robot systems offer high precision, high safety, and reduced invasiveness. This paper presents a review of current intelligent surgical robot systems. The history of robots and three types of intelligent surgical robots are discussed. The problems with current surgical robot systems are then analyzed. Several aspects that should be considered in designing new surgical systems are discussed in detail. The paper ends with a summary of the work and a discussion of future prospects for surgical robot development.
... The same is not true for fast bowlers, which is perhaps partly 29 because bowling at high speed compromises accuracy and thus increases scoring (Masoro and Austad, 2010), and the 37 physiological deterioration that comes with old age (senescence or ageing) is perhaps better 38 understood in humans than in any other species. Older humans have lower cognitive ability 39 (Murman, 2015), respiratory capacity (Sharma and Goodwin, 2006), immune function (Pawelec,40 2012), and muscle mass (Doherty, 2003) than younger humans, and together, such factors 41 contribute to the increasing morbidity and mortality observed in the elder members of society 42 worldwide (Uhlenberg, 2009;Vaupel, 2010). Yet despite often being associated with old age, 43 declines in some physiological functions often begin much earlier in the life span than others 44 (Walker and Herndon, 2010; see also Hayward et al., 2015 for example in a non-human 45 population; Gaillard and Lemaître, 2017) and are not necessarily synonymous with debility. ...
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Preprint
Data from elite professional sports players provide a valuable source of information on human performance and ageing. Functional declines in performance have been investigated across a wide range of sporting disciplines that vary in their need for physical strength, endurance, cognitive ability and motor skills, but rarely have researchers considered other sources of heterogeneity that can exist among individuals. Using information on all male bowlers to have played Test match cricket since the early 1970s, I separated age-dependent variation in bowling performance at the population-level into within-individual and between- individual (cohort) changes. I found no evidence for senescence in bowling performance as measured via economy rate or wicket-taking ability, irrespective of the style of the bowler (fast or slow). Instead, analyses detected strong between-individual contributions to bowling performance as higher quality bowlers were able to compete at the elite level for longer, and were therefore over-represented in older age classes. Bowlers also experienced a deterioration in the last year of their Test careers. These results highlight that the very best Test match bowlers have been able to maintain and often improve their skill level well into their thirties, but how they accomplish this alongside the physical demands of Test cricket remains unresolved. Further multivariate models also identified a negative relationship among slow bowlers between their economy rate and their wicket-taking ability, suggesting that in general, the most economical slow bowlers in the modern era of Test match cricket have also taken wickets at the fastest rate. The same is not true for fast bowlers, which is perhaps partly because bowling at high speed compromises accuracy and thus increases scoring opportunities for batsman.
... Therefore, since the first cigarette, older smokers had been granted more time and opportunity to reinforce their belief and identity as a smoker. In addition, Increasing Persistence Hypothesis suggested that people became gradually more resistant to change throughout their lives [16]. There was also Impressionable Years Hypothesis which suggested that people were highly susceptible to behavioral change during late adolescence and early adulthood [17]. ...
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Article
Positive smoker identity (PSI) is a construct that evaluates the degree of smokers’ positive thoughts, images and feeling about smoking behavior and culture. PSI encompasses the indicators related to tobacco denormalization strategy, which is one of the four WHO tobacco endgame strategies. PSmoQi is a newly validated instrument which could reliably assess PSI. This study’s objectives were to determine the prevalence of positive smoker identity and its associated factors using PSmoQi. A sample of 253 smokers from government agencies in Kota Bharu City, Malaysia were recruited using invitation letters sent to their head of agencies. Data collection was done in a briefing session voluntary attended by the smokers. Factors associated with PSI were analyzed using Multiple Logistic Regression. The prevalence of smokers with positive smoker identity was 72.3%. Factors associated with positive smoker identity were older age (Adjusted Odds ratio; AOR: 1.042; 95% confident interval; CI: 1.004, 1.081); p = 0.028), higher smoking self-concept scale Malay version (SSCS-M) score (AOR: 1.216; 95% CI: 1.112, 1.329; p < 0.001), higher heaviness index (AOR: 1.002; 95% CI: 1.001, 1.004; p = 0.011) and lower educational attainment (AOR: 0.458; 95% CI: 0.233, 0.900; p = 0.024). This study shows a high prevalence of PSI among smokers from government agencies in Kota Bharu City. Factors such as age, SSCS-M score, heaviness index and educational attainment influenced the level of positive smoker identity in a smoker. The finding would contribute an evidentiary guideline in screening smokers for smoking cessation clinic enrollment to achieve the best interventional outcome, as well as it would provide an objective indicator for tobacco denormalization status in a population.
... Furthermore, when sociologists, economists, or policy makers discuss the downsides of low fertility rates, they should let go of the idea that growing up without siblings leads to increased narcissism. There might of course be economic or societal costs associated with low birth rates (Uhlenberg, 2009), but increasing narcissism in the upcoming generation does not seem to be a factor that is relevant to the discussion. ...
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Article
The current research dealt with the stereotype that only children are more narcissistic than people with siblings. We first investigated the prevalence of this stereotype. In an online study (Study 1, N = 556), laypeople rated a typical only child and a typical person with siblings on narcissistic admiration and narcissistic rivalry, the two subdimensions of the Narcissistic Admiration and Rivalry Questionnaire. They ascribed both higher admiration and higher rivalry to the only child. We then tested the accuracy of this stereotype by analyzing data from a large and representative panel study (Study 2, N = 1,810). The scores of only children on the two narcissism dimensions did not exceed those of people with siblings, and this result held when major potentially confounding covariates were controlled for. Taken together, the results indicate that the stereotype that only children are narcissistic is prevalent but inaccurate.
... Population aging is a demographic reality across the advanced industrial world (Uhlenberg, 2009). Yet, there are different ways in which this reality can be framed within and outside policy debates. ...
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Article
Deborah Stone’s Policy Paradox stresses the role of narrative stories in the construction of policy problems. This article takes a critical look at the Policy Paradox and at the claim that paying close attention to narratives is essential to the analysis of policy change. Drawing on recent scholarship on the role of ideas in public policy, the article shows that the analysis of narratives is part of a broader intellectual project associated with the ideational turn in policy analysis. The article explains how the analysis of narrative stories should take institutional factors into account, which can shape policy decisions. To illustrate these theoretical claims, the article analyzes the debate over public pension reform in the United States and Canada during the last 25 years. More specifically, the article compares the reform of the Canada Pension Plan during the mid-1990s and the failed push to privatize US Social Security during the Bill Clinton and the George W. Bush presidencies. The analysis stresses that, while narrative stories shape problem definition, institutional legacies influence policy adoption.
... The long-term challenge of a relentlessly aging population is a well-known phenomenon and is intensively discussed in scientific circles from various points of view (e.g., Uhlenberg, 2009). The fiscal burden connected to this phenomenon is, thereby, not only associated with economic issues due to costs arising from the growing public pension system (Bloom et al., 2011), but there are also huge costs accounting for provision of healthcare to the seniors, as with age the need for medical care increases sharply (Bosworth and Burtless, 1998). ...
Conference Paper
Shifts in demographic developments have led to changed needs and requirements in healthcare. Rising life expectancy and improved medical healthcare enable a more independent and healthier lifestyle of (older) persons , but also changes expectations and perceptions of aging, and health-supporting technologies. Knowledge about attitudes towards aging, medical assistive technologies, and impacting user factors (especially age and health status) is limited with regard to a broad sample of participants. In the present study (N=585), we therefore examined in an online-survey current attitudes towards aging and quality of life in older age, as well as perceptions and acceptance of health-supporting technologies, taking age and health status as user factors into account. Results revealed significant effects of age and health condition on the perception of life quality in older age. In addition, positive perceptions of aging, technology acceptance, as well as benefits and barriers were significantly influenced by the respondents' age. In contrast, health status significantly affected the negative perceptions of aging. Under impacts of age and health condition as user factors, results of the study allow a deeper understanding of changing patterns of perceived aging and prevailing opinions regarding acceptance of medical technology.
... Several other reasons combine to exacerbate the aging population in China. Following the foundation of the Chinese Republic in 1949, people were encouraged to have large families (Uhlenberg, 2009). The group born in 1950s and 1960s are now retirees or are entering retirement. ...
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Chapter
The chapter explores the role of smart phones and mobile apps in the process of third age formation in Zhengzhou, a second-tier city in China located in central Henan province. The term ‘third age' refers to a transition period from active work to retirement. Compared with the previous generation, the demographic approaching retirement in China today is more digitally literate, although this varies accordingly in Zhengzhou, a second-tier city. The use of digital technology offers people a different kind of retirement. This study shows that an increasing number of people around retirement age (55-65) in Zhengzhou are using smart phones and apps to reimagine the possibilities of post-work lifestyles. The research asks if the use of mobile apps is changing peoples' perspectives on traditional responsibilities and peoples' expectations of retirement.
... Several other reasons combine to exacerbate the aging population in China. Following the foundation of the Chinese Republic in 1949, people were encouraged to have large families (Uhlenberg, 2009). The group born in 1950s and 1960s are now retirees or are entering retirement. ...
... The paper discusses the problem of demographic aging of the Polish population. Aging processes are defined as changes in the age structure of population where the percentage of older population compared to the total population number is increasing (Rosset, 1959;Frątczak, 1984;Uhlenberg, 2009). They are accompanied by social, cultural and economic factors; among other things, intentional delaying of procreation time and changing life priorities, leading more and more towards a healthy life style, progress in medicine and wider access to medical services, etc. ...
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Article
One of the major problems involved in estimating information about economic activity across small domains is too small sample size and incompleteness of data sources. For instance, the distribution of enterprises by target variables tends to be considerably right-skewed, with high variation, high kurtosis and outliers. Therefore, it is not obvious that the implementation of traditional estimation methods meets the desired requirements, such as being free from bias or having competitive variance. Furthermore, the pressure to produce accurate estimates at a low level of aggregation or needs to substantially reduce sample size have increased the importance of exploring the possibilities of applying new, more sophisticated methods of estimation. The aim of the study was to test the usefulness of winsorization methods to estimate economic statistics from the DG1 survey.
... Workforce participation, including health workforce participation, among persons aged over 65 years has risen dramatically with the trend expected to continue. 1,2 Older practitioners often possess a depth of experience that may benefit patients 3 ; however, declining practitioner health and out-of-date practices can potentially harm patients. The emerging body of evidence about the risks associated with practitioner ageing has prompted vigorous debate about workforce planning, education, retention, revalidation and patient safety. ...
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Article
Objectives To determine whether ‘older doctors’ (aged over 65) are at higher risk of notifications to the medical regulator than ‘younger doctors’ (aged 36–60 years) regarding their health, performance and/or conduct. Design Retrospective cohort study. Setting National dataset of 12,878 notifications lodged with medical regulators in Australia between 1 January 2011 and 31 December 2014. Participants All registered doctors in Australia aged 36–60 and >65 years during the study period. Main outcome measures Incidence rates of notifications and incidence rate ratios of notifications (older versus younger doctors). Results Older doctors had higher notification rates (90.9 compared with 66.6 per 1000 practitioner years, p < 0.001). Sex-adjusted incidence rate ratios showed that older doctors had a higher risk of notifications relating to physical illness or cognitive decline (incidence rate ratio = 15.54), inadequate record keeping (incidence rate ratio = 1.98), unlawful use or supply of medications (incidence rate ratio = 2.26), substandard certificates/reports (incidence rate ratio = 2.02), inappropriate prescribing (incidence rate ratio = 1.99), disruptive behaviours (incidence rate ratio = 1.37) and substandard treatment (incidence rate ratio = 1.24). Older doctors had lower notification rates relating to mental illness and substance misuse (incidence rate ratio = 0.58) and for performance issues relating to problems with procedures (incidence rate ratio = 0.61). Conclusions Older doctors were at higher risk for notifications relating to physical or cognitive impairment, records and reports, prescribing or supply of medicines, disruptive behaviour and treatment. They were at lower risk for notifications about mental illness or substance misuse. Incorporating knowledge of these patterns into regulatory practices, workplace adjustments and continuing education/assessment could enhance patient care.
... Older adults comprise an increasing portion of the users of health systems and services (including SLP, American Speech-Language-Hearing Association, 1988) in developed nations (Uhlenberg, 2009). Thus, an adaptation of clinical tools to meet the needs and abilities of older adults is called for. ...
Article
Assessments of oral-diadochokinetic rates are commonly performed to evaluate oral-motor skills. However, the appropriate administration protocol is not defined, and varies across therapists, clinics and laboratories. In three experiments and an auxiliary one, this study analyzes the effects of brief (motor) practice and visual feedback on the performance of 98 younger (20–40 years old) and 78 older adults (over 65) with the sequential motion rate (SMR) version. Overall rates were significantly faster for younger over older adults. Irrespective of age-group, averaged performance was significantly better on the second round, but the third round was found to be superfluous, across experiments and age-groups. Visual feedback (using a mirror) was found to be detrimental for younger adults, eliminating the advantage reaped from a practice round. For older adults, visual feedback did not alter the effect of a practice round. Sensory (visual) degradation is presented as a possible source for this age-related difference. We discuss these findings and suggest an administration protocol for younger and older adults with the SMR version, including a total of two rounds and no visual feedback.
... Of course, countries with a long history of below-replacement fertility will, in absence of international immigration, end up with a high proportion of persons aged 65 and more. In a population with replacement fertility, population ageing will be more modest and the proportion of 65-year-olds will not exceed 30% in the next century (Commission, 2014;Uhlenberg, 2009). ...
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Article
La démographie a toujours influencé la pensée politique. La décision récente d'aug-menter l'âge à la pension dans beaucoup de pays développés est inspirée par l'évo-lution importante de la composition par âge de la population. Mais il y a en réalité peu d'arguments pour augmenter l'âge à la retraite si l'on tient compte de l'ensem-ble des données démographiques et économiques. Une interprétation souvent trop simpliste et même parfois erronée d'indicateurs démographiques contribue à cette démarche. L'utilisation systématique d'indicateurs démographiques dans la discussion sur la viabilité du système des pensions et de la sécurité sociale est selon nous souvent inspirée par la théorie de l'économie de l'offre. Un aspect crucial est le fait que la croissance de la productivité est ignorée ou minimisée. À cet égard, la discussion actuelle présente une profonde similitude avec l'approche Malthusienne de la population. Mots clés Vieillissement de la population, espérance de vie, paradigme Malthusien, taux de dépendance. Abstract Demography always influenced political thinking. The recent decision to increase the age of retirement in many high-income countries is driven by a dramatic change in the age composition of the population. We argue that there is in fact no need to increase the age of retirement and that many aspects of the current evolution both in demography and in economy are overlooked. Moreover, some demographic indicators such as life expectancy or the dependency ratio are often interpreted in a simplistic and erroneous way. The systematic use of demographic indicators to discuss the sustainability of the pension system and of the social security system is in our view often inspired by the supply-side way of economic thinking. A crucial aspect is that productivity increase is ignored or minimalized in the discussion. In this regard the discussion has many similarities with the Malthusian approach of the population question.
... Over the past 40 years, China has experienced the demographic transition to an "aging society" that typically took more than 100 years in such developed countries as the United Kingdom, the United States, and the Nordic countries (Uhlenberg 2009). Similarly, most of these developed countries had rural pension systems in place long before populations started to age (see box 1.1). ...
... Over the past 40 years, China has experienced the demographic transition to an "aging society" that typically took more than 100 years in such developed countries as the United Kingdom, the United States, and the Nordic countries (Uhlenberg 2009). Similarly, most of these developed countries had rural pension systems in place long before populations started to age (see box 1.1). ...
... What is often not as clearly understood is that there is a significant relationship between ageing and rates of disability (Uhlenberg, 2009). For example, the Australian data shows a person is 14 times more likely to have a disability at age 65 than they are as a four-year-old (Australian Bureau of Statistics, 2004). ...
... The world population is aging and will continue to grow older over the coming decades (United Nations, 2012). Global population aging – an increase in the relative size of the older population as a share of total population around the world – will clearly be a major social force that impacts the lives of individuals in all age groups, the wellbeing of older people in particular, throughout the 21st century (Powell and Khan, 2013; Uhlenberg, 2009; World Health Organization [WHO], 2012). Increasingly, over roughly the past decade, the subject of global population aging has been receiving serious attention in the literature of sociology, gerontology, and social policy (Harper, 2006; Phillipson, 2005; Rowland, 2009). ...
... Since, on the one hand side, cultural heritage sites are one of the most favoured tourism attractions worldwide (Pegg and Stumbo, 2012, p. 385) and, on the other hand side, the group of disabled people is expected to grow significantly (Uhlenberg, 2009, p. 3), the author mentions that it may be essential for heritage locations to aim for an access for all design. Along the lines of the argument of the English Heritage organisation, Bonet (2013, p. 395) describes, with reference to the tourism-area life cycle, the importance of reorientation and rejuvenation in cultural heritage locations. ...
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Thesis
This thesis reports the findings of a qualitative study, which investigated the cultural heritage experience of visually impaired people. The study explored the juxtaposing and coinciding nature of heritage and accessible tourism in pursuance of ensuring “tourism for all” in cultural heritage sites. The grounded theory method was applied, which analysed virtual documents, open interviews and participant observation. The findings indicate that accessible information, the implementation of experience enhancers, the knowledge and attitude of employees, and the simplicity of orientation and navigation influence the quality of the cultural heritage experience of visually impaired people. In furtherance of guaranteeing the execution of these implications heritage managers are required to enforce inter-organisational collaborations with the tourism industry and blind associations alike. The thesis concludes that curators ought to employ both awareness training as well as disability etiquette and should apply a multisensory experiential design if quality cultural heritage experiences are to be available for visually impaired tourists. Keywords: visual impairment, tourist experience, cultural heritage tourism, accessible tourism, tourism for all, sensory
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Article
Marital disruption defined as widowhood, divorce, or separation, has adverse consequences for women’s health and wellbeing. Extant evidence, however, is primarily available for older women or in developed country settings. Consequences of marital disruption for younger women in the developing countries is relatively less visited. The aim of this cross-sectional study is to assess whether maritally disrupted women of reproductive age (18–49 years) had differential risk of tobacco-use compared to their married counterparts. Using nationally representative data from India, we estimated multivariable logistic regressions to obtain the odds in favor of tobacco-use for maritally disrupted women. We found that compared to women remained in marriage, maritally disrupted women were 1.5 times (95% CI: 1.4–1.6) more likely to consume tobacco. The higher risk of tobacco-use of maritally disrupted women was evident in both younger (age 18–34) and older (age 35–49) cohorts. The results were robust across urban and rural areas, high- and low- education groups, and poor- and non-poor households. The higher odds of tobacco-use among maritally disrupted women persisted even after accounting for household fixed effects. The study findings thus, have implications for strengthening targeted tobacco control policies and health promotion among maritally disrupted women in low-and-middle income countries.
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Article
This paper aims to present an overview of the main demographic characteristics of Europe’s inhabitants entering into first marriages in the 21st c. and the typology of male and female first marriage patterns in European countries in 2010 and 2018. Additionally, a special index is constructed to compare them for nuptiality as an element of the Second Demographic Transition (STD) in 2018. Also calculated are correlations between the types of first marriage patterns and selected demographic and economic indicators. In order to analyse European countries’ populations in terms of first marriages there were used such research methods as descriptive statistics, a cluster analysis, special STD index, and correlation coefficients. The basis of the analysis is data sourced from the Eurostat database. It appeared that the analysis of the males’ and female’s age-specific first marriage rates in the 31 European countries in 2010 and 2018 produced 22 types of first marriage patterns (which can be grouped into seven main categories). In the majority of European countries, the mean age at first marriage was older in 2018 than in 2010. Countries in Central and Eastern Europe are very different from the rest of the continent regarding the types of first marriage patterns. In 2018, the youngest types occurred in post-communist countries (especially in Belarus and Macedonia) and the oldest ones in Spain, Ireland, Denmark, Italy, and Sweden. Older types of first marriage patterns are characteristic of countries that are stronger economically and/or where the second demographic transition takes place at a faster pace.
Chapter
The aim of this chapter is to present the population changes during the demographic transition, which accompanied the social and economic transformations taking place in Poland since the 1990s. This chapter characterises the Polish demography in terms of changes in size of the population, natural movement and migration as well as the structure of the population. Furthermore, the spatial diversification of population growth and the changes in demographic age across 2477 Polish municipalities (it can be also translated as communes or gminas (Polish gmina) are identified. The situation facing Poland with regard to selected demographic indicators is compared with the other member states of the European Union. This chapter identifies a few demographic challenges across Poland such as a high concentration of the population in the most developed agglomerations accompanied with suburbanisation, depopulation of peripheral regions, population ageing in many rural areas as well as the biggest cities and the changes in the family model and life style resulting in a very low birth rate. Furthermore, Poland has a very low fertility rate compared to the other EU countries. Therefore, Poland follows negative natural increase, despite having a relatively low population decline and a demographically young population.KeywordsDemographic changesDepopulationPopulation structureNatural movementMigrationPopulation ageing
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The chapter explores the role of smart phones and mobile apps in the process of third age formation in Zhengzhou, a second-tier city in China located in central Henan province. The term ‘third age' refers to a transition period from active work to retirement. Compared with the previous generation, the demographic approaching retirement in China today is more digitally literate, although this varies accordingly in Zhengzhou, a second-tier city. The use of digital technology offers people a different kind of retirement. This study shows that an increasing number of people around retirement age (55-65) in Zhengzhou are using smart phones and apps to reimagine the possibilities of post-work lifestyles. The research asks if the use of mobile apps is changing peoples' perspectives on traditional responsibilities and peoples' expectations of retirement.
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The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban–rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017–18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural–urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural–urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.
Japan is the oldest society in the world. It has the highest proportion of the population aged 65 and over, a demographic indicator that has been used by demographers for more than a century. One of the main objectives of this study is to apply a new indicator—the cognition-adjusted dependency ratio (CADR)—to remeasure the level of population aging from an innovative point of view. To compute this new index, we apply the mean age-group-specific immediate recall scores for Japan and four other Asian countries, and we compare the results with those derived from the United States and various developed nations in Europe. Our analysis shows that Japan’s pattern and level of age-related decline in cognitive functioning are highly comparable to those of many other developed nations, particularly in Continental Europe. Among the other Asian countries, Malaysia shows a pattern of change similar to countries in Southern Europe, although Malaysia has slightly lower scores than Southern Europe in all age groups. More importantly, these comparative results based on CADR are astonishingly different from the corresponding results obtained from conventional old-age dependency ratios. The Japanese case is the most salient example.
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The aim of this paper is to present the types of fertility patterns that characterise European countries and their NUTS-1 units in the early 21st c. and in the near future. The types of fertility patterns were defined by ordering six five-year age groups of women aged from 15 to 44 years, according to the groups’ fertility rates (from the highest to the lowest). The analysis resulted in the creation of 14 different types of fertility patterns. Countries located in the same European region tend to have the same or similar type of fertility pattern. In most European countries, the postponement transition can be observed, and it will probably continue in the future. Differences between the fertility rates of the age groups were assessed within countries and between countries with the same type of fertility pattern by calculating the so-called fertility rate ratios. The paper also provides an overview of the main theories and concepts explaining the course of family formation processes in Europe and indicates factors that shape fertility patterns in European countries today. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- The article is available at: https://czasopisma.bg.ug.edu.pl/index.php/JGPS/article/view/5925
Book
Internet Dating deals primarily with the experiences of UK and Australian daters, examining their online accounts to see what kinds of narratives, norms, emotions and 'chemistry' shape their dating. Has the emergence and growth of internet dating changed the dating landscape for the better? Most commentators, popular and academic, ask whether online dating is more efficient for individuals than offline dating. We prefer a socio-political perspective. In particular, the book illustrates the extent to which internet dating can advance gender and sexual equality. Drawing on the voices of internet daters themselves, we show that internet dating reveals how social change often arises in the unassuming, everyday and familiar. We also pay attention to often ignored older daters and include consideration of daters in Africa, Scandinavia, South America, Asia and the Middle East. Throughout, we explore the pitfalls and pleasures of men and women daters navigating unconventional directions towards more equitable social relations.
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Objectives: We examine whether socioeconomic inequalities in home-care use among disabled older adults are related to the contextual characteristics of long-term care (LTC) systems. Specifically, we investigate how wealth and income gradients in the use of informal, formal, and mixed home-care vary according to the degree to which LTC systems offer alternatives to families as the main providers of care ("de-familization"). Method: We use survey data from SHARE on disabled older adults from 136 administrative regions in 12 European countries and link them to a regional indicator of de-familization in LTC, measured by the number of available LTC beds in care homes. We use multinomial multilevel models, with and without country fixed-effects, to study home-care use as a function of individual-level and regional-level LTC characteristics. We interact financial wealth and income with the number of LTC beds to assess whether socioeconomic gradients in home-care use differ across regions according to the degree of de-familization in LTC. Results: We find robust evidence that socioeconomic status inequalities in the use of mixed-care are lower in more de-familized LTC systems. Poorer people are more likely than the wealthier to combine informal and formal home-care use in regions with more LTC beds. SES inequalities in the exclusive use of informal or formal care do not differ by the level of de-familization. Discussion: The results suggest that de-familization in LTC favors the combination of formal and informal home-care among the more socioeconomically disadvantaged, potentially mitigating health inequalities in later life.
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This study investigated the differences between Japanese and Korean college students’ images of the elderly. Japan is the most aged society worldwide, while South Korea has the highest rate of aging. Japan has a more advanced elderly welfare system than Korea. The datasets included responses from 320 Japanese students (collected in 2009) and 384 Korean students (collected in 2011). A semantic difference scale of 50 pairs of items was adopted. The chi-square test and logistic regression analyses were utilized. The five most prevalent images among Korean students were generally negative, whereas the most common images among Japanese participants were mostly neutral or positive. A greater degree of talking/good memories, activities with older adults, and experience of gerontological education showed positive relationships to favorable images, whereas living with grandparents and visiting facilities for the elderly did not yield the same results. It seems that greater interaction with grandparents and other senior citizens, as well as more extensive gerontology education, improved the images of the elderly in both countries, whereas merely visiting facilities for older adults seemed insufficient. The results also suggest that living with grandparents can lead to rather negative images of older adults.
Article
Background and objectives: The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation focuses on individual instead of family experience. Guided by Berry's acculturation theory and Intergenerational Solidarity Theory, this study examined continuity and changes in parent-adult child relations of older Chinese immigrants over a 2-year period, and their implications for older adults' depression and quality of life (QoL). Research design and methods: Participants included 2,605 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago (PINE). Latent Transition Analysis (LTA) was used to identify transitions in multidimensional parent-child relations over time. Negative binomial and logistic regressions were used to examine the influence of family transitions on depression and QoL, respectively. Results: LTA revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over 40% of the respondents shifted to a different relation type, with more families classified as modified traditional or independent over time. Transitioning into modified traditional relations or out of detached relations was associated with fewer depressive symptoms and better QoL at the follow-up. Transitioning into independent relation was associated with more depressive symptoms over time. Discussion and implications: Parent-child relations among Chinese older immigrants demonstrate significant complexity, including both heterogeneity and fluidity. Better well-being of these older adults seems to stem from the optimal combination of retaining the supportive heritage culture and embracing the host society's instrumental cultural elements. Services to this population need to include the family context in assessment and interventions.
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Aim To examine factors that influence the health of older widows and widowers. The review question was: What is the evidence of the relationship between widowhood and health in older adults? Design Systematic review. Data sources Academic Search Elite, CINAHL, Medline (Ovid) and PubMed were searched for articles published between January 2013–December 2017. Review methods A systematic review of quantitative research with a qualitative thematic analysis. Results The selection process resulted in 12 studies. One of the themes that emerged was: emotional challenges related to experiences of bereavement, depression and anxiety, which was based on the sub‐theme social support as the main strategy for coping with emotional pain and suffering. The second theme was: struggling with poor physical health. The findings indicate that healthcare professionals need knowledge and skills to deal with the health consequences of widowhood in old age. Building community teams can prevent emotional and physical health problems, as well as reduce mortality.
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This study sought to establish the expectations of people with disabilities when they visit national parks. The study has been motivated by the gap between the increasing numbers of people with disabilities worldwide who travel and the adequacy of tourism facilities, especially nature-based tourism facilities for people with disabilities. It was further stimulated by the fact that most of the accessibility standards in existence today have been formulated by policymakers without any consultations with the affected persons. The aim of the study was to develop research-based guidelines to help park management in product development. The study adopted a mixed method approach of both qualitative and quantitative data collections. It also took a cross-dimensional approach by including different dimensions of disabilities in order to get a more balanced view of the expectations of people with disabilities in national parks. The findings of this study revealed that people with disabilities, regardless of their type of disabilities regard employee attitudes highly. They are more worried about the way people treat them than the physical access. It was established that steps and staircases are highly discouraged by people of all embodiments. A set of recommendations was given to inform policy on universal accessibility.
Article
Social exclusion is an important determinant of health. However, little is known about the relationship between social exclusion and health in older adults. To address this gap, this study examined the characteristics of social exclusion and relationships to the health status among 419 Chinese adults aged 60 and older from three communities in Shanghai, China. Logistic regression analyses revealed that the relationship between social exclusion and health status varied according to the type of exclusion (material, social, civic, service and neighbourhood) and health variables. Multiple exclusion was significantly associated with chronic illness, depression and low-life satisfaction. © 2016 Department of Social Work, National University of Singapore, Singapore
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And so we postulate that the call to reinstate the themes of “fate and mutability, mortality and finitude, suffering and wisdom” (see Cole 1992, p. 243) are certainly noble ideals; nevertheless, they have been swept aside by the rising tide of a postmodern culture that has not only embraced the ever-expanding sphere of the “ageing industry” (Estes 1979, 1993) but has taken the scientific management of ageing and morphed it into many macro-level extensions of a “scientific-industrial” complex emerging out of the 1950s.There may be a “new ageing enterprise” (Moody 2004/2005, 2008) on the rise, but we argue that there has not been any relinquishment of the hegemony found with the “positive” pole of the duality (i.e., the striving toward an optimal ageing) and instead, ironically, there is the emerging value-laden zeitgeist in gerontology that seems to embrace only the way forward—exponentially—without much regard for premodern, modern or postmodern values of ageing at all.
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Records from archeology indicate that the average lifespan of ancient mankind was about 20 years, with few people surviving to age 50. In contrast, people in wealthy nations now can expect to live 85 years or perhaps even 100 if they were born since the year 2000 (Christensen, Doblhammer, Rau, & Vaupel, The Lancet, 374(9696), 1196–1208, 2009). Expansion of the lifespan has introduced a new stage of development that is accompanied by unfamiliar challenges for policy makers, health care providers, employers, educators, religious institutions, and families. A common opportunity is that the longer the duration, the more individuals can anticipate being a grandparent. This additional time can allow them to provide continuity of affection, care, and guidance to grandchildren from infancy until early adulthood. More than 90 % of retirees in the United States are grandparents; half of them will live to see their great grandchildren (Uhlenberg, International handbook of population aging, Springer, New York, 2009). This presentation explains how innovative education can equip grandparents to become a greater source of favorable influence in the family.
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Book
We organize much of our social lives based on age, with access to opportunities and relationships among individuals constrained by the formal and informal rules of age stratification systems. This reality, which we share as part of our culture, comes to be a system by which society organizes itself and through which individuals develop their lives. Just because it is socially constructed does not mean it isn’t a powerful force. When someone encourages an individual to “act their age”—regardless of whether that age is 6 or 66—you are witnessing the power of age as a social construct in operation. It is not simply for individuals that age is significant. Social life would be chaotic if we lacked some rules and orderliness of events and relationships imposed by the social construct of age. We rely on the rules of the system and build it into our social planning in complex ways. It is unlikely that a completely “age irrelevant” society is on the horizon. Nonetheless, many of the distinctions we make today, between someone who is 16 and 18 or between 63 and 66, for example, are subject to serious question. We recognize the power of aging as a concept. Individual and large-scale planning, as we face an aging society, must include flexibility. Social scientists do not have a very good track record of predicting trends far into the future, and the aging of society is one of the most potent trends we face today. Even if age is a socially constructed phenomenon, and thought by some people therefore to be “unreal,” we must recall that such phenomena are real in their consequences. We have constructed as part of our social world a complex understanding of aging and what it means that extends far beyond the physical parameters and changes experienced by individuals. So, the process of aging is not just an individual phenomenon, but also a societal force, developing within a political/historical/economic context that both shapes individuals and their cohorts and, in turn, is shaped and altered by the passage of those age cohorts through the society. The study of aging is an attempt to capture an everchanging process that affects us all as we move through our individual lives, through the domains of family, work, and politics. Our aging is not like that of our parents and grandparents. The dynamic interplay between social change and the aging of cohorts, including my cohort, guarantees that aging in the future will be different socially, economically, and (to some degree) physically. Predicting the forms that those differences will take, however, is a difficult task. The physical environment and conditions of life affect the way at which individuals and populations age. These are, of course, profoundly affected by social factors (e.g., social class, behaviors, and networks) and require social institutions to address them. But in developing and highly developed societies alike, it is within the context of families that the care of needy family members is negotiated, and it is here that commitments to providing care, especially at home, will be sorely tested in the coming years. The challenges of family life and care in the later years raises difficult but important questions about the expectations and responsibilities of siblings, children, grandchildren, and other relationships in a “post-traditional” society. The concept of a post-traditional society refers to a new social order, one in which rapid social change and modernization have left people with more choices and fewer constraints on their lives – but also with more risks, as the choices they make are perceived to be of their own making and there are fewer safety nets to protect them. Unlike traditional societies, in which values, practices, and social institutions more strongly structure opportunities and decisions, post-traditional societies lack well-established social norms and rules for expectations and obligations and, consequently, place greater emphasis on individual action and choices. The freedoms of a post-traditional society have in part created the extraordinary breadth in family forms that exists today. Now we know little about what the strengths and vulnerabilities of these family forms means for the aging of their members, or what normative expectations and obligations their members have for giving and receiving care. Traditional definitions of family, especially the two-parent nuclear family, have become outdated in the face of a wide variety of family or family-like forms and relationships. This variety is driven by many factors, including multiple divorces and remarriages across generations, multi-partner fertility and nonmarital fertility, nontraditional partnerships, the co-survival of multiple generations over many decades, and the presence of four and even five generations at any single moment in family life. The growing physical distance from immediate family members also creates role ambiguities about filial obligations and consequently strains support systems. Together, these and other changes might lead us to envision societies that are relatively kinless, for lack of a better phrase, characterized by fragmented or superficial family ties and limited or uncertain support to family members in the face of poor health, economic distress, and other needs. Of course, we might equally envision that the kin and kin-like relationships that are actively chosen and voluntarily nurtured within these very same conditions might be stronger and more meaningful than those in more traditional societies. Either way, it is unclear how these new or complex configurations of relationships are supposed to function or feel, and who is responsible to whom and for what. Such role ambiguity, for example, may carry significant consequences for the quality of relationships as family members grow old. Who should provide care, or is expected to provide care, when family relationships are tenuous or fragile – and even when they are not? Curiously, we lack rigorous multi-method studies about how adult children and aging parents make decisions regarding health care, living arrangements, and financial management. Many factors clearly come into play in these decisions, including the number and gender of siblings, their history of relationships with one another and with their parents, work-related issues, other family demands, and so on. Systems theories are but one example of the sort of heuristic device that can help us understand decision-making processes in families. For these reasons, it will become necessary to determine how informal mechanisms of support might be augmented (and in an extreme scenario, replaced) by formal sources designed to ease the potential dependency burden of care and to improve the quality of life for everyone involved. Sociologists of aging are well positioned to inform policymaking in an aging society, particularly in determining how inequalities in income and wealth are connected to age and cohort, gender, and race and ethnicity and in anticipating the consequences of alternative policy options on various groups. Consider, for example, the raising of the age-of-eligibility for retirement pensions and social security. What are the various possibilities for strengthening economies to support aging societies? Who will be protected, weak, or fall through the racks? How do retirement policies perpetuate privilege or further disadvantage women and members of other minority groups whose work lives cannot or will not match policy criteria? What conditions are necessary for generating broad public support for social security reform? We also have much to learn about how social institutions can be designed so that, older people will be best prepared to handle expected (and nonexpected) changes. How will the current economic crisis affect the magnitude of public transfers, such as social security, or private transfers within families, for future generations? In addressing issues like these, sociologists can begin to uncover the lifelong effects of economic decline and growth on an aging population and society and provide information to help determine how available resources can be allocated in a socially productive and responsible way. We have much to learn also about the moral dimensions of end-of-life care – for example, who should help and be helped in the end of life, how they should be helped, and who should pay. There is a need for studies to assess barriers to health care service use, especially those that stem directly from policies. An aging society simultaneously brings an increased need for hospital and home health care services, but also to find innovative ways to contain the growth in expenditures for the care of older people and maximize the use of less expensive community supports. These innovations must take into account a range of cultural differences, social trends, and moral issues, as well as changing economic realities. In addition, research needs to examine the ethical considerations of competing costs for families and societies. When should one cease heroic life supports, and who makes that decision? Is it based on cost or on quality of life? The practical issues of curbing rising health care costs raises a serious moral dilemma related to the rationing of expensive life-saving interventions. How much should be spent on older people, Who will win and lose in the game of support? What are the tradeoffs of supporting the old versus the young as the ratio of old-to-young increases? The ethical and moral dimensions of caregiving have been in large part glossed over, leaving a window of new opportunities wide open for fresh ideas to address the support systems of an aging society for generations to come. These are some of the topics we discuss in this book. One of the main things we learn for future research of aging social dimensions is that we should keep social forces and factors front and center in our inquiries. It is especially important to keep in focus the implications of our aging society – and the demographic parameters that produce it (mortality, morbidity, and fertility) – for our society, families, and individuals. As we try to go further into social spaces and attempt to take them into account, our research becomes more difficult. Yet the tendency in individual-based disciplines, such as psychology or biology, to dismiss external forces as being too unwieldy to measure or as already represented in lower-order measures, means that we must, as sociologists, make them visible, which will also require advances in our measures and methods.
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