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soc17 health and aging.docx

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University of Toronto St. George
Robert Brym

Chapter 17 Lecture-Health and Aging CHALLENGING COMMONSENSE BELIEFS ABOUT HEALTH AND AGING We can learn much about health and aging by reading stories of peoples lives. Each story has unique features, but we can find common elements in the social factors that influence then and provide the context within which they play out. There are many complexities we encounter when thinking about aging, health, and health care. When Jean died, people wondered aloud: Why hadnt she taken better care of herself? Why did she let her weight go? Why hadnt she quit smoking before it became such a problem? Why didnt she get more exercise? Why hadnt she sought paid work when her children were grown up? Why had she opted to live in an area far from health services? The assumption was that Jean should have been able to make choices that would have been more beneficial to her health ignores the complex role of social-structural factors such as social class, gender, age, ethnicity, and rural- urban residence in defining the available range of choices and their implications for health and longevity. During and after the Depression and WWII, living and working conditions were often harsh, and services or benefits, such as health care, unemployment insurance, and pensions that might soften the impact of these conditions were often limited or nonexistent. Gender also played an important role. Family fortunes were generally tied to mens occupations and income levels. The fact that Jeans work was largely unpaid and that she assumed the responsibility for the care of other family members, continually placing their needs (including their health) above her own, was typical of the experience of women at this time. When John died, Jean was experiencing the accumulated health affects of her earlier life circumstances. However old age and its associated low status also appear to have played a role, possibly undermining her health further by limiting access to economic resources, affordable housing, and appropriate health care. Sociology offers a lens through which to examine the social factors linked to peoples health and longevity as they age. 2 areas of sociology often considered separately are brought together- the sociology of health and illness (medical sociology) and the sociology of aging. One may easily connect the 2: aging tends to be equated with, and defined in terms of, ill health. Health tends to be a major problem in later life, and older adults account for much of the illness, disability, and health care utilization in any society. INDIVIDUAL AND POPULATION AGING Today most Canadians can expect to live to old age, barring accidents and wars. In 1920, at birth, Canadian men lived to their late 50s, women to around 60. People can now expect to live more than 20 years longer if they had been born in 1920. At 65, they can expect to live even longer. In 2005 a 65 year old could expect to live another 19.5 years (17.9 more if a man; 21.1 more if a woman) or to age 84.5. That is 4.1 years more than could be expected at birth. The fact that almost everyone can expect to live to old age distinguishes our era from earlier historical periods. In the past, some individuals lived as long as people live today, but never before has the vast majority expected to live to old age. Older adults represent an increasing proportion of the Canadian population. In 1921, just over 5% of the population was 65+; this cohort is projected to constitute 20% of the population by 2021. The main reason for the increasing proportion of older adults in the population is not obvious. It reflects decreases in fertility. With declines in the number and proportion of children in the population, the proportion of older persons necessarily increases. Fertility was the major predictor of population aging until the population reached a life expectancy at birth of 70 years of age. At that point, almost all young persons survive. Further declines in mortality are now concentrated at he older ages resulting in relatively larger older age groups and thus contributing more to population aging. Deaths in old age usually result from chronic degenerative diseases. Circulatory diseases, including heart disease and stroke, are the major causes of death, followed by cancer, respiratory diseases, and infectious diseases. We now live much of our lives assuming that an extended future is before us. Forward thinking has become realistic. Most of us now have multigenerational families. Young people today often know their grandparents and even their great grand parents. Increased longevity also means that illnesses and disabilities accompanying old age are more prominent and that different demands are placed on the health-care system than was the case when fewer people lived to old age. Longer life expectancy results in more health-care and service jobs for the younger generation. It affects when people retire and what they do after they retire. Now that mandatory retirement has disappeared from virtually all Canadian provinces, more people will likely continue to be employed into their 70s and 80s. How the lives of elderly people are experienced is influenced by the social construction of old age- how society views elderly people. We are inclined to see elderly people as poor; frail; having no interest in, or capacity for, sexual relations; being socially isolated and lonely; and lacking a full range of abilities in the work place. Researchers have documented ageism in students attitudes toward older people, health-care treatment, literary and dramatic portrayals, humour, and legal processes. It has been called a quiet epidemic that contributed to indifference. However ageism speaks to our treatment of older people as a social category and not necessarily to interpersonal antagonism. Ageism exists for several reasons. Some analysts point to the importance of structural factors, such as the segregation of young and old cohorts in society. However ageist attitudes vary within cohorts. Other researchers attribute ageism to younger peoples fears of their own future. Old age isnt only associated with declining health, both physical and sometimes mental. Old age has been medicalized, so aging tends to be equated with poor health or disease. Because of the legitimacy according to medicine in present-day society, the appropriate response to aging becomes treatment by physicians. This outcome can be devastating. Not all cultures view the type of changed behaviour that tends to accompany dementia in the same manner. DIVERSITY IN AGING Not all people 65+ are the same Differences in class position, gender, race, ethnicity, and rural-urban living environments distinguish them. SOCIOECONOMIC AND CLASS DIFFENCES People who enjoy socioeconomic advantages tend to experience better health and live longer than others do. This fact is especially evident in middle age but it extends into old age, when individuals generally are no longer part of the labour force. Economic disadvantage follows people into old age. Having few economic resources affects ones everyday life in profound ways everything from the : -> type of house and neighbourhood you live in -> schools you attend -> the food you eat -> people you associate with -> leisure activities and food you can afford -> whether you have a car, pension, investment GENDER More elderly women than men and the gender imbalance increases in older age cohorts. Women live longer than men do partly because women are the hardier sex, biologically speaking, but social and economic reasons are also important. Lower among more highly educated and wealthier people because working class men often engage in dangerous jobs. Gender indifference in mortality rates has other important implications. Elderly men are more likely to marry than elderly women because late in life, there are more unmarried women than men who are available as potential partners. If they dont remarry elderly men appear to be at a great risk of social isolation because they are less likely to maintain social support networks than women are. Women are the kin keepers in society, whereas men tend to rely on their wives for social connectedness. ETHNICITY AND RACE Represent fundamental organizing principles of society that are pervasive, socially constructed, and operate throughout the life course. Effects are evident in the lack of social, economic, and political power of some racial and ethnic minorities. Among Canadian seniors, there are more foreign born individuals than there are younger population. Most foreign born seniors immigrated to Canada when they were younger. Thus the ethno cultural composition of our adult population is heavily influenced by the immigration policies that were in effect in the past. Reserves like most other rural locations across the country, see young adults leave for educational and employment opportunities in urban settings; most dont return. APOCALYPTIC DEMOGRAPHY The belief that a demographic trend (population aging), has drastic negative consequences for society is sometimes called apocalyptic demography. Reduces the complex issue of an aging population of elderly adults places tremendous strain on government-financed services, especially medicare, so government debt and deficits rise to dangerous levels. The problem with such apocalyptic thinking
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