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11.2: Age and Disability

  • Page ID
    3444
  • Objectives

    • Analyze the effects the aging of the population is having on the American society?
    • Explain how the aging of the population is affecting the life opportunities of older people in the United States.

    Universal Generalizations

    • Different societies place different values on age.
    • In preindustrial societies, age has a significant role in the social standing of an individual.
    • The world’s population is aging.
    • In American society, the media reinforces ageism.

    Guiding Questions

    • How does ageism influence attitudes in American society?
    • How do stereotypes about older Americans contribute to ageism?
    • How do governmental policies towards the aging affect the elderly in the United States?
    • How is the “graying of America” affecting our society?
    • What issues do Americans with disabilities face?
    • Have laws eliminated discrimination against people with disabilities?

    Age and Ageism

    Five sets of road signs, the top one green and the bottom one red in each set, are shown along the right-hand side of a road in a desert setting. The green signs all read “Senior Center” and feature an arrow pointing left. The blue signs, from front to back, read “Don’t Forget,” “Remember to [u]Turn![/u]”, “Wake Up!”, “Lunch Only $4,” and “Turn Now.”
    Figure \(\PageIndex{1}\): Are these street signs humorous or offensive? What shared assumptions make them humorous? Or is memory loss too serious to be made fun of? (Photo courtesy of Tumbleweed/flickr)

    Changes that have been occurring in this nation are also affecting its older citizens. For example, the numbers of older Americans are growing rapidly, with important repercussions for economic and social life. Somewhat like the San, we appreciate our elderly but also consider them something of a burden. We also hold some unfortunate stereotypes of them and seemingly view old age as something to be shunned. Television commercials and other advertisements extol the virtues of staying young by “washing away the gray” and by removing all facial wrinkles. In our youth-obsessed culture, older people seem to be second-class citizens.

    Why study the elderly and the process of growing old? As just noted, understanding the elderly and the experience of aging will help us understand a society. An additional reason might be even more convincing: you will be old someday. At least you will be old if you do not die prematurely from an accident, cancer, a heart attack, some other medical problem, murder, or suicide. Although we do not often think about aging when we are in our late teens and early 20s, one of our major goals in life is to become old. That is partly why many people wear seat belts, watch their diets, and exercise. By studying age and aging and becoming familiar with some of the problems facing the elderly now and in the future, we are really studying something about ourselves and a stage in the life course we all hope to reach.

    Figure \(\PageIndex{2}\): Because we all want to live into old age, the study of age and aging helps us understand something about ourselves and a stage in the life course we all hope to reach.

    The study of aging is so important and popular that it has its own name,gerontology. Social gerontology is the study of the social aspects of aging (Hooyman & Kiyak, 2011).Hooyman, N. R., & Kiyak, H. A. (2011). Social gerontology: A multidisciplinary perspective (9th ed.). Upper Saddle River, NJ: Pearson.The scholars who study aging are called gerontologists. The people they study go by several names, most commonly “older people,” “elders,” and “the elderly.” The latter term is usually reserved for those 65 or older, while “older people” and “elders” (as the headline of the opening news story illustrates) often include people in their 50s as well as those 60 or older.

    Gerontologists say that age and aging have at least four dimensions. The dimension most of us think of is chronological age, defined as the number of years since someone was born. A second dimension isbiological aging, which refers to the physical changes that “slow us down” as we get into our middle and older years. For example, our arteries might clog up, or problems with our lungs might make it more difficult for us to breathe. A third dimension,psychological aging, refers to the psychological changes, including those involving mental functioning and personality, that occur as we age. Gerontologists emphasize that chronological age is not always the same thing as biological or psychological age. Some people who are 65, for example, can look and act much younger than some who are 50.

    The fourth dimension of aging is social. Social aging refers to changes in a person’s roles and relationships, both within their networks of relatives and friends and in formal organizations such as the workplace and houses of worship. Although social aging can differ from one individual to another, it is also profoundly influenced by the perception of aging that is part of a society’s culture. If a society views aging positively, the social aging experienced by individuals in that society will be more positive and enjoyable than in a society that views aging negatively. Let’s look at the perception of aging in more detail.

    Aging in Society

    Think of American movies and television shows you have watched recently. Did any of them feature older actors and actresses? What roles did they play? How were these older actors portrayed? Were they cast as main characters in a love story? Grouchy old people?

    Many media portrayals of the elderly reflect negative cultural attitudes toward aging. In the United States, society tends to glorify youth, associating it with beauty and sexuality. In comedies, the elderly are often associated with grumpiness or hostility. Rarely do the roles of older people convey the fullness of life experienced by seniors—as employees, lovers, or the myriad roles they have in real life. What values does this reflect?

    One hindrance to society’s fuller understanding of aging is that people rarely understand the process of aging until they reach old age themselves. (As opposed to childhood, for instance, which we can all look back on.) Therefore, myths and assumptions about the elderly and aging are common. Many stereotypes exist surrounding the realities of being an older adult. While individuals often encounter stereotypes associated with race and gender and are thus more likely to think critically about them, many people accept age stereotypes without question (Levy 2002). Each culture has a certain set of expectations and assumptions about aging, all of which are part of our socialization.

    While the landmarks of maturing into adulthood are a source of pride, signs of natural aging can be cause for shame or embarrassment. Some people try to fight off the appearance of aging with cosmetic surgery. Although many seniors report that their lives are more satisfying than ever, and their self-esteem is stronger than when they were young, they are still subject to cultural attitudes that make them feel invisible and devalued.

    Gerontology is a field of science that seeks to understand the process of aging and the challenges encountered as seniors grow older. Gerontologists investigate age, aging, and the aged. Gerontologists study what it is like to be an older adult in a society and the ways that aging affects members of a society. As a multidisciplinary field, gerontology includes the work of medical and biological scientists, social scientists, and even financial and economic scholars.

    Social gerontology refers to a specialized field of gerontology that examines the social (and sociological) aspects of aging. Researchers focus on developing a broad understanding of the experiences of people at specific ages, such as mental and physical wellbeing, plus age-specific concerns such as the process of dying. Social gerontologists work as social researchers, counselors, community organizers, and service providers for older adults. Because of their specialization, social gerontologists are in a strong position to advocate for older adults.

    Scholars in these disciplines have learned that “aging” reflects not just the physiological process of growing older, but also our attitudes and beliefs about the aging process. You’ve likely seen online calculators that promise to determine your “real age” as opposed to your chronological age. These ads target the notion that people may “feel” a different age than their actual years. Some 60-year-olds feel frail and elderly, while some 80-year-olds feel sprightly.

    Equally revealing is that as people grow older they define “old age” in terms of greater years than their current age (Logan 1992). Many people want to postpone old age, regarding it as a phase that will never arrive. Some older adults even succumb to stereotyping their own age group (Rothbaum 1983).

    In the United States, the experience of being elderly has changed greatly over the past century. In the late 1800s and early 1900s, many U.S. households were home to multigenerational families, and the experiences and wisdom of elders was respected. They offered wisdom and support to their children and often helped raise their grandchildren (Sweetser 1984).

    But in today’s society, with most households confined to the nuclear family, attitudes toward the elderly have changed. In 2000, the U.S. Census Bureau reported that, of the 105.5 million households in the country, only about 4 million of them (3.7 percent) were multigenerational (U.S. Census Bureau 2001). It is no longer typical for older relatives to live with their children and grandchildren.

    Attitudes toward the elderly have also been affected by large societal changes that have happened over the past 100 years. Researchers believe industrialization and modernization have contributed greatly to lowering the power, influence, and prestige the elderly once held.

    The elderly have both benefitted and suffered from these rapid social changes. In modern societies, a strong economy created new levels of prosperity for many people. Health care has become more widely accessible and medicine has advanced, allowing the elderly to live longer. However, older people are not as essential to the economic survival of their families and communities as they were in the past.

    Studying Aging Populations

    An older woman with white hair and glasses is shown looking out a window, across a body of water.
    Figure \(\PageIndex{3}\): How old is this woman? In modern American society, appearance is not a reliable indicator of age. In addition to genetic differences, health habits, hair dyes, Botox, and the like make traditional signs of aging increasingly unreliable. (Photo courtesy of the Sean and Lauren Spectacular/flickr)

    Since its creation in 1790, the U.S. Census Bureau has been tracking age in the population. Age is an important factor to analyze with accompanying demographic figures, such as income and health. The population pyramid below shows projected age distribution patterns for the next several decades.

    A population pyramid depicting the U.S. age distribution of 2010, and projecting the age distribution o f the U.S. in the years 2030 and 2050.
    Figure \(\PageIndex{4}\): This population pyramid shows the age distribution pattern for 2010 and projected patterns for 2030 and 2050 (Graph courtesy of the U.S. Census Bureau)

    Statisticians use data to calculate the median age of a population, that is, the number that marks the halfway point in a group’s age range. In the United States, the median age is about 40 (U.S. Census Bureau 2010). That means that about half of Americans are under 40 and about half are over 40. This median age has been increasing, indicating the population as a whole is growing older.

    A cohort is a group of people who share a statistical or demographic trait. People belonging to the same age cohort were born in the same time frame. Understanding a population’s age composition can point to certain social and cultural factors and help governments and societies plan for future social and economic challenges. The cohort below compares the age distribution of the United States as a whole to the indigenous population.

    Sociological studies on aging might help explain the difference between Native American age cohorts and the general population. While Native American societies have a strong tradition of revering their elders, they also have a lower life expectancy because of lack of access to health care and high levels of mercury in fish, a traditional part of their diet.

    Phases of Aging: The Young-Old, Middle-Old, and Old-Old

    In the United States, all people over age 18 are considered adults, but there is a large difference between a person aged 21 and a person who is 45. More specific breakdowns, such as “young adult” and “middle-aged adult,” are helpful. In the same way, groupings are helpful in understanding the elderly. The elderly are often lumped together, grouping everyone over the age of 65. But a 65-year-old’s experience of life is much different than a 90-year-old’s.

    The United States’ older adult population can be divided into three life-stage subgroups: the young-old (approximately 65–74), the middle-old (ages 75–84), and the old-old (over age 85). Today’s young-old age group is generally happier, healthier, and financially better off than the young-old of previous generations. In the United States, people are better able to prepare for aging because resources are more widely available.

    Also, many people are making proactive quality-of-life decisions about their old age while they are still young. In the past, family members made care decisions when an elderly person reached a health crisis, often leaving the elderly person with little choice about what would happen. The elderly are now able to choose housing, for example, that allows them some independence while still providing care when it is needed. Living wills, retirement planning, and medical power of attorney are other concerns that are increasingly handled in advance.

    The Graying of the United States

    A tall man with white hair and moustache and glasses in casual business attire is shown flanked by two elderly women on his right and two elderly men on his left. The elderly people are all wearing blue T-shirts reading “Keep Social Security Strong: A A R P.” A banner in the background can also be seen, reading “Social Security Benefits America.”
    Figure \(\PageIndex{5}\): As senior citizens make up a larger percentage of the United States, the organizations supporting them grow stronger. (Photo courtesy of Congressman George Miller/flickr)

    What does it mean to be elderly? Some define it as an issue of physical health, while others simply define it by chronological age. The U.S. government, for example, typically classifies people aged 65 years old as elderly, at which point citizens are eligible for federal benefits such as Social Security and Medicare. The World Health Organization has no standard, other than noting that 65 years old is the commonly accepted definition in most core nations, but it suggests a cut-off somewhere between 50 and 55 years old for semi-peripheral nations, such as those in Africa (World Health Organization 2012). AARP (formerly the American Association of Retired Persons) cites 50 as the eligible age of membership. It is interesting to note AARP’s name change; by taking the word “retired” out of its name, the organization can broaden its base to any older Americans, not just retirees. This is especially important now that many people are working to age 70 and beyond.

    There is an element of social construction, both local and global, in the way individuals and nations define who is elderly; that is, the shared meaning of the concept of elderly is created through interactions among people in society. This is exemplified by the truism that you are only as old as you feel.

    Demographically, the U.S. population over age 65 increased from 3 million in 1900 to 33 million in 1994 (Hobbs 1994) and to 36.8 million in 2010 (U.S. Census Bureau 2011c). This is a greater than tenfold increase in the elderly population, compared to a mere tripling of both the total population and of the population under 65 (Hobbs 1994). This increase has been called “the graying of America,” a term that describes the phenomenon of a larger and larger percentage of the population getting older and older. There are several reasons why America is graying so rapidly. One of these is life expectancy: the average number of years a person born today may expect to live. When reviewing Census Bureau statistics grouping the elderly by age, it is clear that in the United States, at least, we are living longer. Between 2000 and 2012, the number of elderly citizens between 90 and 94 increased by more than 30 percent, and the number of elderly citizens 95 to 99 increased by almost 30 percent. Finally, the number of centenarians (those 100 years or older) increased by 2,910: a mere 5.8 percent, but impressive nonetheless (Werner 2011).

    It is interesting to note that not all Americans age equally. Most glaring is the difference between men and women; as the graph below shows, women have longer life expectancies than men. In 2010, there were ninety 65-year-old men per one hundred 65-year-old women. However, there were only eighty 75-year-old men per one hundred 75-year-old women, and only sixty 85-year-old men per one hundred 85-year-old women. Nevertheless, as the graph shows, the sex ratio actually increased over time, indicating that men are closing the gap between their life spans and those of women (U.S. Census Bureau 2010).

    A line graph depicting the narrowing percentage by which women outlive men, years 1990, 2000, and 2010.
    Figure \(\PageIndex{6}\): This U.S. Census graph shows that women live significantly longer than men. However, over the past two decades, men have narrowed the percentage by which women outlive them. (Graph courtesy of the U.S. Census Bureau)

    Baby Boomers

    Of particular interest to gerontologists right now is the population of baby boomers, the cohort born between 1946 and 1964 and just now reaching age 65. Coming of age in the 1960s and early 1970s, the baby boom generation was the first group of children and teenagers with their own spending power and therefore their own marketing power (Macunovich 2000). As this group has aged, it has redefined what it means to be young, middle aged, and, now, old. People in the boomer generation do not want to grow old the way their grandparents did; the result is a wide range of products designed to ward off the effects—or the signs—of aging. Previous generations of people over 65 were “old.” Baby boomers are in “later life” or “the third age” (Gilleard and Higgs 2007).

    The baby boom generation is the cohort driving much of the dramatic increase in the over-65 population. The figure below shows a comparison of the U.S. population by age and gender between 2000 and 2010. The biggest bulge in the pyramid (representing the largest population group) moves up the pyramid over the course of the decade; in 2000, the largest population group was age 35 to 55. In 2010, that group was age 45 to 65, meaning the oldest baby boomers are just reaching the age at which the U.S. Census considers them elderly. In 2020, we can predict, the baby boom bulge will continue to rise up the pyramid, making the largest U.S. population group between 65 and 85 years old.

    A population pyramid depicting the U.S. population by age and sex, years 2000 and 2010.
    Figure \(\PageIndex{7}\): In this U.S. Census pyramid chart, the baby boom bulge was aged 35 to 55 in 2000. In 2010, they were aged 45 to 65. (Graph courtesy of the U.S. Census Bureau)

    This aging of the baby boom cohort has serious implications for our society. Health care is one of the areas most impacted by this trend. For years, hand-wringing has abounded about the additional burden the boomer cohort will place on Medicare, a government-funded program that provides health care services to people over 65. And indeed, the Congressional Budget Office’s 2008 long-term outlook report shows that Medicare spending is expected to increase from 3 percent of gross domestic product (GDP) in 2009 to 8 percent of GDP in 2030, and to 15 percent in 2080 (Congressional Budget Office 2008).

    Certainly, as boomers age, they will put increasing burdens on the entire U.S. health care system. A study from 2008 indicates that medical schools are not producing enough medical professionals who specialize in treating geriatric patients (Gerontological Society of America 2008). However, other studies indicate that aging boomers will bring economic growth to the health care industries, particularly in areas like pharmaceutical manufacturing and home health care services (Bierman 2011). Further, some argue that many of our medical advances of the past few decades are a result of boomers’ health requirements. Unlike the elderly of previous generations, boomers do not expect that turning 65 means their active lives are over. They are not willing to abandon work or leisure activities, but they may need more medical support to keep living vigorous lives. This desire of a large group of over-65-year-olds wanting to continue with a high activity level is driving innovation in the medical industry (Shaw).

    The economic impact of aging boomers is also an area of concern for many observers. Although the baby boom generation earned more than previous generations and enjoyed a higher standard of living, they also spent their money lavishly and did not adequately prepare for retirement. According to a 2008 report from the McKinsey Global Institute, approximately two-thirds of early boomer households have not accumulated enough savings to maintain their lifestyles. This will have a ripple effect on the economy as boomers work and spend less (Farrel et al. 2008).

    Just as some observers are concerned about the possibility of Medicare being overburdened, Social Security is considered to be at risk. Social Security is a government-run retirement program funded primarily through payroll taxes. With enough people paying into the program, there should be enough money for retirees to take out. But with the aging boomer cohort starting to receive Social Security benefits, and with fewer workers paying into the Social Security trust fund, economists warn that the system will collapse by the year 2037. A similar warning came in the 1980s; in response to recommendations from the Greenspan Commission, the retirement age (the age at which people could start receiving Social Security benefits) was raised from 62 to 67 and the payroll tax was increased. A similar hike in retirement age, perhaps to 70, is a possible solution to the current threat to Social Security (Reuteman 2010).

    Mistreatment and Abuse

    Mistreatment and abuse of the elderly is a major social problem. As expected, with the biology of aging, the elderly sometimes become physically frail. This frailty renders them dependent on others for care—sometimes for small needs like household tasks, and sometimes for assistance with basic functions like eating and toileting. Unlike a child, who also is dependent on another for care, an elder is an adult with a lifetime of experience, knowledge, and opinions—a more fully developed person. This makes the care providing situation more complex.

    Elder abuse describes when a caretaker intentionally deprives an older person of care or harms the person in their charge. Caregivers may be family members, relatives, friends, health professionals, or employees of senior housing or nursing care. The elderly may be subject to many different types of abuse.

    In a 2009 study on the topic led by Dr. Ron Acierno, the team of researchers identified five major categories of elder abuse: 1) physical abuse, such as hitting or shaking, 2) sexual abuse including rape and coerced nudity, 3) psychological or emotional abuse, such as verbal harassment or humiliation, 4) neglect or failure to provide adequate care, and 5) financial abuse or exploitation (Acierno 2010).

    The National Center on Elder Abuse (NCEA), a division of the U.S. Administration on Aging, also identifies abandonment and self-neglect as types of abuse.

    What is elder abuse?

    Elder abuse includes physical abuse, emotional abuse, sexual abuse, exploitation, neglect, and abandonment. Perpetrators include children, other family members, and spouses—as well as staff at nursing homes, assisted living, and other facilities.

    • Physical abuse means inflicting physical pain or injury upon an older adult.
    • Sexual abuse means touching, fondling, intercourse, or any other sexual activity with an older adult, when the older adult is unable to understand, unwilling to consent, threatened, or physically forced.
    • Emotional abuse means verbal assaults, threats of abuse, harassment, or intimidation.
    • Confinement means restraining or isolating an older adult, other than for medical reasons.
    • Passive neglect is a caregiver’s failure to provide an older adult with life’s necessities, including, but not limited to, food, clothing, shelter, or medical care.
    • Willful deprivation means denying an older adult medication, medical care, shelter, food, a therapeutic device, or other physical assistance, and exposing that person to the risk of physical, mental, or emotional harm—except when the older, competent adult has expressed a desire to go without such care.
    • Financial exploitation means the misuse or withholding of an older adult’s resources by another. https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/

    How prevalent is elder abuse? Two recent U.S. studies found that roughly 1 in 10 elderly people surveyed had suffered at least one form of elder abuse. Some social researchers believe elder abuse is underreported and that the number may be higher. The risk of abuse also increases in people with health issues such as dementia (Kohn and Verhoek-Oftedahl 2011). Older women were found to be victims of verbal abuse more often than their male counterparts.

    In Acierno’s study, which included a sample of 5,777 respondents age 60 and older, 5.2 percent of respondents reported financial abuse, 5.1 percent said they’d been neglected, and 4.6 endured emotional abuse (Acierno 2010). The prevalence of physical and sexual abuse was lower at 1.6 and 0.6 percent, respectively (Acierno 2010).

    Other studies have focused on the caregivers to the elderly in an attempt to discover the causes of elder abuse. Researchers identified factors that increased the likelihood of caregivers perpetrating abuse against those in their care. Those factors include inexperience, having other demands such as jobs (for those who weren’t professionally employed as caregivers), caring for children, living full time with the dependent elder, and experiencing high stress, isolation, and lack of support (Kohn and Verhoek-Oftedahl 2011).

    A history of depression in the caregiver was also found to increase the likelihood of elder abuse. Neglect was more likely when care was provided by paid caregivers. Many of the caregivers who physically abused elders were themselves abused—in many cases, when they were children. Family members with some sort of dependency on the elder in their care were more likely to physically abuse that elder. For example, an adult child caring for an elderly parent while, at the same time, depending on some form of income from that parent, would be considered more likely to perpetrate physical abuse (Kohn and Verhoek-Oftedahl 2011).

    World War II Veterans

    A group of elderly men, many in wheelchairs, all dressed in blue shirts and baseball caps, are shown standing and sitting in a memorial setting, with a fountain and pillars behind them.
    Figure \(\PageIndex{8}\): World War II (1941–1945) veterans and members of an Honor Flight from Milwaukee, Wisconsin, visit the National World War II Memorial in Washington, D.C. Most of these men and women were in their late teens or 20s when they served. (Photo courtesy of Sean Hackbarth/flickr)

    World War II veterans are aging. Many are in their 80s and 90s. They are dying at an estimated rate of about 740 per day, according to the U.S. Veterans Administration (National Center for Veterans Analysis and Statistics 2011). Data suggest that by 2036, there will be no living veterans of WWII (U.S. Department of Veteran Affairs).

    When these veterans came home from the war and ended their service, little was known about posttraumatic stress disorder (PTSD). These heroes did not receive the mental and physical health care that could have helped them. As a result, many of them, now in old age, are dealing with the effects of PTSD. Research suggests a high percentage of World War II veterans are plagued by flashback memories and isolation, and that many “self-medicate” with alcohol.

    Research has found that veterans of any conflict are more than twice as likely as non-veterans to commit suicide, with rates highest among the oldest veterans. Reports show that WWII-era veterans are four times as likely to take their own lives as people of the same age with no military service (Glantz 2010).

    In May 2004, the National World War II Memorial in Washington, D.C., was completed and dedicated to honor those who served during the conflict. Dr. Earl Morse, a physician and retired Air Force captain, treated many WWII veterans. He encouraged them to visit the memorial, knowing it could help them heal. Many WWII veterans expressed interest in seeing the memorial. Unfortunately, many were in their 80s and were neither physically nor financially able to travel on their own. Dr. Morse arranged to personally escort some of the veterans and enlisted volunteer pilots who would pay for the flights themselves. He also raised money, insisting the veterans pay nothing. By the end of 2005, 137 veterans, many in wheelchairs, had made the trip. The Honor Flight Network was up and running.

    As of 2010, the Honor Flight Network had flown more than 120,000 U.S. veterans of World War II, and some veterans of the Korean War, to Washington. The round-trip flights leave for day-long trips from airports in 30 states, staffed by volunteers who care for the needs of the elderly travelers (Honor Flight Network 2011).

    Aging Around the World

    A shirtless elderly man is shown manipulating a large tree branch while standing waist-deep in a river.
    Figure \(\PageIndex{9}\): Cultural values and attitudes can shape people’s experience of aging. (Photo courtesy of Tom Coppen/flickr)

    From 1950 to approximately 2010, the global population of individuals age 65 and older increased by a range of 5–7 percent (Lee 2009). This percentage is expected to increase and will have a huge impact on the dependency ratio: the number of non-productive citizens (young, disabled, elderly) to productive working citizens (Bartram and Roe 2005). One country that will soon face a serious aging crisis is China, which is on the cusp of an “aging boom”: a period when its elderly population will dramatically increase. The number of people above age 60 in China today is about 178 million, which amounts to 13.3 percent of its total population (Xuequan 2011). By 2050, nearly a third of the Chinese population will be age 60 or older, putting a significant burden on the labor force and impacting China’s economic growth (Bannister, Bloom, and Rosenberg 2010).

    As health care improves and life expectancy increases across the world, elder care will be an emerging issue. Wienclaw (2009) suggests that with fewer working-age citizens available to provide home care and long-term assisted care to the elderly, the costs of elder care will increase.

    Worldwide, the expectation governing the amount and type of elder care varies from culture to culture. For example, in Asia the responsibility for elder care lies firmly on the family (Yap, Thang, and Traphagan 2005). This is different from the approach in most Western countries, where the elderly are considered independent and are expected to tend to their own care. It is not uncommon for family members to intervene only if the elderly relative requires assistance, often due to poor health. Even then, caring for the elderly is considered voluntary. In the United States, decisions to care for an elderly relative are often conditionally based on the promise of future returns, such as inheritance or, in some cases, the amount of support the elderly provided to the caregiver in the past (Hashimoto 1996).

    These differences are based on cultural attitudes toward aging. In China, several studies have noted the attitude of filial piety(deference and respect to one’s parents and ancestors in all things)as defining all other virtues (Hsu 1971; Hamilton 1990). Cultural attitudes in Japan prior to approximately 1986 supported the idea that the elderly deserve assistance (Ogawa and Retherford 1993). However, seismic shifts in major social institutions (like family and economy) have created an increased demand for community and government care. For example, the increase in women working outside the home has made it more difficult to provide in-home care to aging parents, leading to an increase in the need for government-supported institutions (Raikhola and Kuroki 2009).

    In the United States, by contrast, many people view caring for the elderly as a burden. Even when there is a family member able and willing to provide for an elderly family member, 60 percent of family caregivers are employed outside the home and are unable to provide the needed support. At the same time, however, many middle-class families are unable to bear the financial burden of “outsourcing” professional health care, resulting in gaps in care (Bookman and Kimbrel 2011). It is important to note that even within the United States not all demographic groups treat aging the same way. While most Americans are reluctant to place their elderly members into out-of-home assisted care, demographically speaking, the groups least likely to do so are Latinos, African Americans, and Asians (Bookman and Kimbrel 2011).

    Globally, the United States and other core nations are fairly well equipped to handle the demands of an exponentially increasing elderly population. However, peripheral and semi-peripheral nations face similar increases without comparable resources. Poverty among elders is a concern, especially among elderly women. The feminization of the aging poor, evident in peripheral nations, is directly due to the number of elderly women in those countries who are single, illiterate, and not a part of the labor force (Mujahid 2006).

    In 2002, the Second World Assembly on Aging was held in Madrid, Spain, resulting in the Madrid Plan, an internationally coordinated effort to create comprehensive social policies to address the needs of the worldwide aging population. The plan identifies three themes to guide international policy on aging: 1) publically acknowledging the global challenges caused by, and the global opportunities created by, a rising global population; 2) empowering the elderly; and 3) linking international policies on aging to international policies on development (Zelenev 2008).

    The Madrid Plan has not yet been successful in achieving all its aims. However, it has increased awareness of the various issues associated with a global aging population, as well as raising the international consciousness to the way that the factors influencing the vulnerability of the elderly (social exclusion, prejudice and discrimination, and a lack of socio-legal protection) overlap with other developmental issues (basic human rights, empowerment, and participation), leading to an increase in legal protections (Zelenev 2008).

    Disability

    A blue handicapped accessible sign is shown here.
    Figure \(\PageIndex{10}\): The handicapped accessible sign indicates that people with disabilities can access the facility. The Americans with Disabilities Act requires that access be provided to everyone. (Photo courtesy of Ltljltlj/Wikimedia Commons)

    Disability refers to a reduction in one’s ability to perform everyday tasks. The World Health Organization makes a distinction between the various terms used to describe handicaps that’s important to the sociological perspective. They use the termimpairment to describe the physical limitations, while reserving the term disability to refer to the social limitation.

    Before the passage of the Americans with Disabilities Act (ADA) in 1990, Americans with disabilities were often excluded from opportunities and social institutions many of us take for granted. This occurred not only through employment and other kinds of discrimination, but through casual acceptance by most Americans of a world designed for the convenience of the able-bodied. Imagine being in a wheelchair and trying to use a sidewalk without the benefit of wheelchair accessible curbs. Imagine as a blind person trying to access information without the widespread availability of Braille. Imagine having limited motor control and being faced with a difficult-to-grasp round door handle. Issues like these are what the ADA tries to address. Ramps on sidewalks, Braille instructions, and more accessible door levers are all accommodations to help people with disabilities.

    People with disabilities can be stigmatized by their illness. Stigmatization means that their identity is spoiled; they are labeled as different, discriminated against, and sometimes even shunned. They are labeled (as an interactionist might point out) and ascribed a master status (as a functionalist might note), becoming “the blind girl” or “the boy in the wheelchair” instead of someone afforded a full identity by society. This can be especially true for people who are disabled due to mental illness or disorders.

    Many mental health disorders can be debilitating, affecting a person’s ability to cope with everyday life. This can affect social status, housing, and especially employment. According to the Bureau of Labor Statistics (2011), people with a disability had a higher rate of unemployment thaN people without a disability in 2010: 14.8 percent to 9.4 percent. This unemployment rate refers only to people actively looking for a job. In fact, eight out of 10 people with a disability are considered “out of the labor force;” that is, they do not have jobs and are not looking for them. The combination of this population and the high unemployment rate leads to an employment-population ratio of 18.6 percent among those with disabilities. The employment-population ratio for people without disabilities was much higher, at 63.5 percent (U.S. Bureau of Labor Statistics 2011).

    Summary

    Despite generally good health in the U.S. compared with less-developed countries, America is still facing challenging issues such as a prevalence of obesity and diabetes. Moreover, Americans of historically disadvantaged racial groups, ethnicities, socioeconomic status, and gender experience lower levels of health care. Mental health and disability are health issues that are significantly impacted by social norms.

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