Aging as a Social Process: Canadian Perspectives 6th Edition PDF

1 544492_00_prelims.indd 1 13-11-01 12:02 PM  1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of...

1 544492_00_prelims.indd 1 13-11-01 12:02 PM  1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries. Published in Canada by Oxford University Press 8 Sampson Mews, Suite 204, Don Mills, Ontario M3C 0H5 Canada www.oupcanada.com Copyright © Oxford University Press Canada 2014 The moral rights of the authors have been asserted Database right Oxford University Press (maker) Fourth Edition published in 2004 Fifth Edition published in 2008 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Permissions Department at the address above or through the following url: www.oupcanada.com/permission/permission_request.php Every effort has been made to determine and contact copyright holders. In the case of any omissions, the publisher will be pleased to make suitable acknowledgement in future editions. Library and Archives Canada Cataloguing in Publication McPherson, Barry, 1937–, author Aging as a social process : Canadian perspectives / Andrew Wister, Barry McPherson. -- Sixth edition. Includes bibliographical references and index. ISBN 978-0-19-544492-6 (pbk.) 1. Aging—Social aspects. 2. Older people—Social conditions. 3. Aging—Social aspects—Canada. 4. Older peopl—Canada—Social conditions. I. Wister, Andrew V., 1955–, author II. Title. HQ1061.M38 2013 305.26 C2013-904729-8 Cover image: James Baigrie/Food Pix/Getty Images Oxford University Press is committed to our environment. Wherever possible, our books are printed on paper which comes from responsible sources. Printed and bound in the United States 1 2 3 4 — 17 16 15 14 544492_00_prelims.indd 2 13-11-01 12:02 PM  Contents Preface viii Acknowledgments xi Developments in Social Gerontology since 1940 That Have Had a Major Impact on Canadian Research, Policy, and Practice xii PART I | An Introduction to Individual and Population Aging 1 1 Aging as a Social Process 3 Introduction: Challenges of an Aging World 4 Population Aging: Adding Years to Life 6 Individual Aging: Adding Life to Years 11 Interacting Aging Processes 14 Dimensions of Social Aging 18 Images of Aging and Their Influence on Individuals and Society 22 The Field of Gerontology Grows Up 27 Three Conceptual Dimensions to Understand the Study of Aging 29 Critical Issues and Challenges for an Aging Society 30 Summary 36 For Reflection, Debate, or Action 37 Notes 38 2 Historical and Cultural Perspectives on Aging 39 Introduction: Diversity in Aging across Time and Place 40 Aging in Canada’s Multicultural Society 41 The Multiple Meanings of Culture 43 Historical and Comparative Approaches to Understanding Aging Processes 43 The Modernization Hypothesis and the Changing Status of Older People 44 Aging in Pre-industrial Societies 47 Diversity of Aging during Modernization 49 Aging in Subcultures 53 Summary 62 For Reflection, Debate, or Action 64 Notes 64 3 Individual Aging: Physical and Psychological Change across the Life Course 65 Introduction 66 Aging, Physical Structure, and the Physiological Systems 68 Aging and the Motor and Sensory Systems 74 Aging and Cognitive Processes 80 Personality Processes and Aging 87 Summary 90 For Reflection, Debate, or Action 91 Notes 91 4 Population Aging: A Demographic and Geographic Perspective 93 Introduction 94 The Study of Demography 96 Global Demographic and Epidemiological Transitions 97 544492_00_prelims.indd 3 13-11-01 12:02 PM  iv Contents Demographic Variations among Generations and Age Cohorts 98 Demography Is Not Destiny: The Misuse of Demographic Statistics 100 The Demography of Aging 102 An Expanding Older Population 105 The Significance of Demographic Indices 108 Geographic Distribution of the Aging Population 114 Summary 117 For Reflection, Debate, or Action 118 Notes 118 PART II | The Social, Environmental, and Health Contexts of Aging 121 5 Theories and Research in Explaining and Understanding Aging Phenomena 123 Introduction 124 The Goals of Scholarly Research 124 Developing Knowledge: The Use of Perspectives and Theories 127 Research Methods: The Search for Answers 143 Methodological Issues in Aging Research 152 Summary 161 For Reflection, Debate, or Action 161 Notes 162 6 Social Structures, Social Inequality, and the Life Course 164 Introduction 165 Social Structures and Aging 166 Age Structures and the Life Course 174 Age Structures and Social Change 179 Summary 191 For Reflection, Debate, or Action 191 Notes 192 7 Health Status and Health-Care Transitions 193 Introduction: What Is Health? 194 Models of Health and Health Care 195 Is the Older Population Healthier over Time? 197 Is the Mid-Life Population Healthier over Time? 198 Increasing Longevity and Centenarians 201 Dimensions of Health and Illness 202 Mental Health 212 Canada’s Health-Care System and Population Aging 218 Summary 229 For Reflection, Debate, or Action 229 Notes 230 8 The Lived Environment: Community and Housing Alternatives in Later Life 232 Introduction 233 The Multiple Meanings of Community 234 An Ecological Model of Aging: Person–Environment Interaction 238 Coping with the Environment: Challenges and Adaptations 242 Living Arrangements in Later Life 251 Housing Alternatives in Later Life 252 544492_00_prelims.indd 4 13-11-01 12:02 PM  Contents v Changing Places: Local Moves and Migration in Later Life 261 Summary 263 For Reflection, Debate, or Action 263 Notes 264 PART III | Aging, Social Institutions, and Public Policy 267 9 Family Ties, Relationships, and Transitions 269 Introduction 270 The Concept of Family 272 Changing Family and Kinship Structures 274 Factors Influencing Family Relationships 275 Family Ties and Relationships 277 Life Transitions in a Family Context 290 Summary 300 For Reflection, Debate, or Action 300 Notes 301 10 Work, Retirement, and Economic Security 302 Introduction 303 Older Workers in the Pre-retirement Years 304 The Process of Retirement 312 Economic Security in Later Life 318 Summary 333 For Reflection, Debate, or Action 335 Notes 336 11 Social Participation, Social Connectedness, and Leisure in Later Life 338 Introduction 339 Social Networks 342 Loneliness and Social Isolation in Later Life: Myth or Fact? 344 Social Participation in Later Life 345 Asocial Behaviour: Older Criminals 359 Leisure and Aging: Conceptual and Methodological Issues 361 Summary 367 For Reflection, Debate, or Action 367 Notes 368 12 End of the Life Course: Social Support, Dying Well, and Public Policy 370 Introduction 371 Social Support and Caregiving in an Aging Society 374 Informal Social Support 376 Formal Social Support 382 Social Intervention Strategies and Issues 385 End of the Life Course: Dying Well, with Support and Dignity 395 Public Policy for an Aging Population 403 Summary 409 For Reflection, Debate, or Action 410 Notes 410 Appendix: Study Resources 413 Glossary 419 References 427 Index 477 544492_00_prelims.indd 5 13-11-01 12:02 PM  Preface To be able to learn is to be young, and whoever keeps the joy of learning in him or her remains forever young. — J.G. Bennett, 1897–1974 T he objective of this book is to present a synthesis and interpretation of social science research concerning individual and population aging, with a focus on aging in Canada. The emphasis is on identifying, describing, and explaining patterns, processes, and current issues. This approach enables students and practitioners to acquire fundamental knowledge about older people and to develop a broad understanding of aging processes and issues that may be experienced across the life course. Reading the book involves more than accumulating information for a mid-term or final examination. As you read, personalize the information so that you are prepared to move through life, with reflection and understanding, to help family members as they age, to participate in an aging society as an employee or as a volunteer serving older adults, and to function as a concerned and well-informed global citizen who can lobby or vote concerning aging-related issues confronting your community, region, or province—or the world. This is the sixth edition of this textbook. The 1983 edition was the first textbook on aging in Canada and was written at a time when few scholarly resources about aging in Canada were available. The second and third (1990 and 1998) editions reflected the growth of Canadian research about aging, and the fourth edition (2004) included even more “made-in-Canada” knowledge about aging. That is why, for the first time, the book was subtitled Canadian Perspectives. These first four editions were solo-authored by Barry McPherson who, along with Victor Marshall, taught the first courses on aging in Canadian universities. I was invited to co-author the fifth edition (2008) with Barry and gladly accepted, in part because of my long history with both the author and the book. I met Barry McPherson in 1985, at which time I began a post-doctoral fellowship at the University of Waterloo under his direction. The first course that I taught in the area of sociology of aging (starting in 1985–6) was in fact Barry’s course, a course that I have taught in different forms for almost 25 years. Over the years of my academic life course, I reviewed subsequent editions of the book so it was a natural process by which I eventually became a co-author on the fifth edition. We sig- nificantly revised the structure of that edition in response to suggestions from students and faculty who had read previous editions, including adding a new chapter on health and aging, expanded sections about the aging baby boom generation, Internet resources, a glossary, and updated literature on every topic. With Barry in partial retirement mode and busy cycling the highways of North America and Europe, I assumed the role of lead author for the current edition. This edition has been further enhanced with expanded sections addressing poverty, gender, ethnicity, and their intersections; new research and program developments in areas such as longevity, innovative care models, and elder abuse; and an updated timeline of historical developments in the study of aging phenomena, with a focus on Canada (see the next section). 544492_00_prelims.indd 6 13-11-01 12:02 PM  Preface vii The field of social gerontology has grown exponentially, developing into a new interdisci- plinary phase that makes research in, and the study of, all key areas challenging. We have main- tained a Canadian focus without sacrificing developments in the field globally. In addition, where available as of 29 July 2013, all data in the text have been updated based on the 2011 Canadian census, labour force surveys, the Canadian Community Health and General Social Surveys, and international data from the Population Reference Bureaus and US Bureau of the Census. Each chapter opens with “Focal Points and Key Facts,” a preview of some of the major issues, ideas, and facts discussed in the chapter. And to encourage debate and reflection and to develop critical thinking and observational skills, each chapter concludes with a section entitled “For Reflection, Debate, or Action.” Hopefully, these two sections will enable you to become a more critical reader who questions commonly held assumptions, myths, and errone- ous beliefs about aging and older people, both in your family and in your community. In each chapter, references are cited in the text or in a note. These serve a twofold purpose. First, they provide theoretical or research support for the ideas. Second, they are a resource to help you locate and use primary sources in the basic literature if you are required to write a term paper on a specific topic or if you wish to acquire additional information about a particular subject. Before social policies and programs for older Canadians can be initiated, we must identify and verify that a problem or a situation exists. We must understand why and how the prob- lem or issue evolved, clarify the role of complex and interacting elements, and then propose alternative solutions. Guesswork, hunches, or past practices are insufficient. Nor will pro- grams and policies implemented in another community or country or for a particular ethnic, religious or cultural group work in every context. Rather, new information must be produced through research and then applied if efficient and effective policies and programs are to be developed and implemented. Moreover, research can refute prevailing myths or misconcep- tions about older persons, thereby changing or eliminating some of the negative stereotypes that we may hold about aging and about the later stages of life. This book uses a variety of theoretical and methodological orientations to describe and explain aging processes. Although it might be desirable to write a book from a single theor- etical perspective, our ability to do so is limited since the social science literature about aging and later life requires a number of perspectives, from a variety of disciplines, if we are to have a more complete understanding of aging phenomena. However, throughout this edition, the life-course perspective is employed as an overarching integrative framework since events, de- cisions, behaviours, constraints, and opportunities at earlier stages in life often have cumula- tive positive or negative effects at later stages, both for aging individuals (namely, you) and for aging birth cohorts (the baby boomers). Moreover, considerable content is based on know- ledge generated by the interpretive perspective and by qualitative research, which reflects the extensive use of these approaches by the Canadian research community. The material in this book is based on the premise that aging, as a social process, involves multi-level and complex interactions between individuals and various social structures and systems; within changing social, economic, political, policy, and physical environments; and across diverse cultural contexts, all of which vary at specific periods in history, as well as across one’s life course. Thus, aging as a social process is considered from an interacting micro (individual) and macro (societal) perspective. This book has three general objectives: 1. To provide you with basic concepts, theories, and methodologies that can be used to understand social phenomena related to individual and population aging and to 544492_00_prelims.indd 7 13-11-01 12:02 PM  viii Preface develop critical thinking and observational and interpretive skills. Moreover, with this knowledge, you will be better prepared to identify, deconstruct, and help refute common misconceptions about aging and growing older. Where possible, the book presents alternative explanations for aging processes rather than a single description or interpretation of a process or problem. 2. To sensitize you to the fact that aging is not just a biological process but an equally complex social process. In fact, you may be left with the impression that there are more gaps in knowledge than answers. Herein lies a challenge to the curious, innova- tive reader who may wish to pursue a career in this field. 3. To make you aware of the dynamic interplay between your individual life course and the local, national, and global historical and cultural forces that shape your life experiences and opportunities. Aging, as a lifelong process, must be of interest and concern to people of all ages and in all communities, cultures, and countries. In conclusion, there has been an enormous growth in knowledge about aging in Canada; however, the sociology of aging and social gerontology fields of study are still in the early developmental phases. Continued integration and synthesis of ideas from what previously were thought to be separate disciplines with distinct pillars of knowledge have resulted in innovative developments at the crossroads of disciplines. Critical thinking and reflection are essential skills to acquire, since gaps in knowledge, differing opinions and interpretations, and even controversy concerning issues, processes, programs, or policies for aging adults or an aging society are prevalent in contemporary Canadian society. Thus, we encourage you to become a critical reader and thinker, to ask questions about what you read, and to discuss with others the validity and applicability of research findings presented in any single study. One published article on a particular subject does not represent the absolute truth. Indeed, even many research studies on a topic may not provide a complete and valid explanation of a particular process, pattern, or problem. To illustrate, many studies describe only one slice of a particular social setting or community at one point in time. Other relevant social, indi- vidual, cultural, structural, or historical factors may not be considered in the analysis and interpretation of the results. Therefore, we encourage you to search for and debate the merits of alternative explanations and to be cautious in what you accept as fact—including what you read in this book. Finally, the test of how well a book serves as a learning resource is whether students find the material useful, interesting, clearly written, and comprehensive. Please provide feedback about this book to your instructor and to the authors: Andrew V. Wister, PhD, Simon Fraser University, Vancouver, BC ([email protected]) Barry D. McPherson, PhD, Waterloo, ON ([email protected]) July 2013 544492_00_prelims.indd 8 13-11-01 12:02 PM  Preface ix Acknowledgments I assumed senior authorship of the sixth edition of Aging as a Social Process: Canadian Perspectives. Writing this edition required intensive work over a long period that could not have been completed without the support and assistance of family, friends, and colleagues. First and foremost, I would like to thank my wife, colleague, and life partner, Barbara Mitchell- Wister, for providing the inspiration, time, and feedback needed to tackle this project. Her expertise in the sociology of the family, theory, and policy helped to fine-tune sections of the new edition. My daughter, Kayzia Wister, provided the university student audience perspec- tive. Over my career, I have also enjoyed the support of my parents Stephen and Iris Wister. I wish to acknowledge the continuing involvement of Barry McPherson, the originator of the text and my co-author, who provided conceptual and editorial input. Thanks are also due to the many professors, students, and practitioners across Canada who submitted constructive criticisms about the content and structure of previous editions. I received support from two graduate students from the Gerontology Department at Simon Fraser University: Laura Booi, a PhD student, and Maia Hillen, a master’s student. Both assisted in searching Web-based re- sources to uncover new highlights, photographs, and bibliographic material. In addition, Ray Adams, Information Officer at the SFU Gerontology Research Centre, assisted with the up- dating of the Web-based resources shown in the Appendix. On the production side at Oxford University Press, we thank the many staff who contributed to the editing and production of this book. We are also deeply appreciative of the assistance provided by Colleen Ste. Marie, a freelance copyeditor, who significantly improved the manuscript with her creative, construct- ive, and rapid copyediting. 544492_00_prelims.indd 9 13-11-01 12:02 PM  Developments in Social Gerontology since 1940 That Have Had a Major Impact on Canadian Research, Policy, and Practice 1962 The “Aging in the World” series included papers from the Fifth Congress of the International-Association of Gerontology 1948 Founding of the held in 1960. These volumes, which illustrated the increasing global International Association of interest in aging, and the growing interdisciplinarity of the field, Gerontology in Liege, Belgium. included the following: C. Tibbits and W. Donahue (eds.)/Social and Psychological Aspects of Aging; J. Kaplan and G. Aldridge (eds.)/ Social Welfare of the Aging; N. Shock (ed.)/Biological Aspects of Aging; H. Blumenthal (ed.)/Medical and Clinical Aspects of Aging. 1940 Publication of the journal Geriatrics. 1959–60 These handbooks summarized the knowledge about a number of gerontology topics in the late 1950s: J. Birren (ed.)/Handbook of Aging and the Individual: Psychological and Biological; C. Tibbitts, (ed.)/Handbook of Social Gerontology: Societal Aspects of Aging; E. Burgess (ed.)/Aging in Western Societies. 1953 R. Havighurst and R. Albrecht/Older People. 1940 1950 1960 1959 L.D. Cain, Jr. (ed.)/The Sociology of 1945 Establishment of Aging: A Trend Report and Bibliography: the Gerontological Society Special Issue in Current Sociology. (later named GSA “of America”) to hold annual meetings to promote the 1959 Ontario Longitudinal Study on Aging initiated under the leadership of L. scientific study of aging Crawford. Followed 2000 men from 1959 from multi-disciplinary to 1978, with follow-up in 1990. perspectives, and to stimulate communication among scientists, researchers, teachers, and professionals. 1945 The 1961 The Gerontologist: A second journal published by the Gerontological Society to focus on applied first issue of research, model programs, and policy initiatives for the Journal of professionals working with and for the aged. Gerontology. 1961 E. Cumming; W. Henry/Growing Old: The Process 1948 O. Pollock/Social of Disengagement. The first attempt to develop a social Adjustment in Old Age. This gerontological theory to account for landmark report of the US Social satisfaction in the later years. Sciences Research Council shifted focus from problems of aging to the process of aging, and led to several 1961 First USA White House Conference on Aging. These conferences are held every ten years in the United States to theoretical developments in social draw scientists and professional workers together to make gerontology. recommendations for consideration by Congress. 544492_00_prelims.indd 12 13-11-01 12:02 PM  1970 E. Palmore/Normal Aging: Reports from 1974 National Institute on Aging the Duke Longitudinal Studies, 1955–69. The (NIA) established in the United first interdisciplinary longitudinal study. States to promote research on all facets of aging. 1974 D. Cowgill; L. Holmes/ Aging and Modernization. This 1965 D. Schonfield/“Memory Changes with book popularized modernization theory to explain the changing Age.” Article published in Nature by a Canadian status of the elderly in primitive psychologist who mentored many first and developing societies. generation gerontologists in Canada. 1971 Founding of Canadian Association 1969 R. Havighurst et al./Adjustment to on Gerontology. Retirement: A Cross-NationaI Study. 1971 Manitoba Longitudinal Study on Aging initiated. 1968 B. Neugarten (ed.)/ Elderly individuals Middle Age and Aging: A Reader living were in Social Psychology. The first interviewed first in collection of readings on the 1971, and later in 1976 social psychology of aging. and 1983. 1965 1970 1975 1967 E. Youmans/Older 1970–2 First Rural Americans. One of sociology of the few studies to consider aging courses aging in a rural context. taught in Canada by B. Havens (University of Manitoba); B. 1972 M. Riley et al./ Aging and Society, McPherson 1968 M. Riley; A. Foner, (eds.)/Aging (University Volume Three: A and Society. Volume One: An Inventory of Sociology of Age Waterloo); and Research Findings. This landmark volume Stratification. Presents V. Marshall presented and interpreted the empirical a model of aging (McMaster findings of social science research to this date. that stresses the University). interaction between 1968 E. Shanas, et al./Older People in history and the social structure as it affects Three Industrial Societies. A cross-national various age cohorts. comparative study of the social situation of older people in Denmark, Great Britain, and the United States 1972 R. Atchley/The Social Forces in Later Life: An Introduction to Social Gerontology. The first textbook 1969 M. Riley et al. (eds.)/Aging and Society, written exclusively Volume Two: Aging and the Professions. A statement for undergraduates of the concerns and involvement of a number of in social gerontology professions in the care of older adults. courses. 544492_00_prelims.indd 13 13-11-01 12:02 PM  1976–7 These handbooks represented the state of knowledge up to the mid-1970s: R. Binstock and E. Shanas (eds.)/Handbook of Aging and the Social Sciences (1976); J. Birren and K. Schaie (eds.)/Handbook of the Psychology of Aging (1977); C. Finch and L. Hayflick (eds.)/Handbook 1986 N. Chappell; L. of the Biology of Aging (1977). Subsequent editions have Strain; A. Blandford /Aging been published every five to seven years. and Health Care: A Social Perspective. 1986 Butterworths 1976 R. Butler/ Perspectives on Individual and Why Survive? Population Aging published Being Old in under the editorship of B. America. This book 1979 Social Sciences and McPherson. The series, which won a Pulitzer Humanities Research Council of ended in 1992, published Prize, bringing Canada (SSHRC) Strategic Grants a total of 15 monographs aging to the Committee on Population Aging was on major aging topics. The attention of the established to award research and to first monograph was by S. media and the fund Aging Centers across Canada. McDaniel/Canada’s Aging public of all ages.   Population (1986). Selected 1979 Research on Aging: monographs are included in 1976 J. Schulz/ A Quarterly Journal of Social Gerontology first published. this timeline; and a summary of developments on most of The Economics the topics since the series of Aging. 1979 Program in aging established ended appeared in CJA Vol. 30(3), 2011, edited by H. at the University of Toronto. Northcott; M. Rosenberg. 1975 1980 1985 1975 R. Rapaport and R. Rapaport Mid-1980s (eds.)/Leisure and the Family Life Cycle. Undergraduate programs The first examination of leisure within the developed at McMaster family context across the life cycle. University, the University of Waterloo, and St 1975 Association for Gerontology Thomas University. in Higher Education (AGHE) formed to facilitate leadership development for training programs that were being 1984 J. Myles/Old Age in established in universities and colleges. the Welfare State: The Political Economy of Public Pensions. Early development of pension issues and challenges in Canada. 1980 The National Advisory Council on Aging (NACA) of Canada created to assist and advise the federal government on seniors’ issues. 1983 B. McPherson/Aging as a Social Process: An Introduction to Individual 1980 Gerontology Research and Population Aging. First Canadian Council of Ontario established. text, now in the sixth edition (2013). 1980 V. Marshall/Aging in Canada: Social Perspective. This was the first reader presenting 1982/83 Gerontology centres and programs a collection of articles pertaining to aging and the funded by SSHRC established at Guelph, Manitoba, aged in Canada. Second edition published in 1987 Simon Fraser, Toronto, and Moncton universities. with considerably more Canadian content. 1980 P. Lawton/Environment and Aging. 1982 Canadian Journal on Development of person-environment fit theory. Aging first published. 544492_00_prelims.indd 14 13-11-01 12:02 PM  1995 S. Arber; J. Ginn/ 1997 E. Moore; M. Rosenberg; D. Connecting Gender and Aging: A McGuinness/Growing Old in Canada: Sociological Approach. Demographic and Geographic Perspectives. 1987 US Bureau of the 1997 E. Gee; A. Martin-Matthews Census/An Aging World. (Eds.)/Canadian Public Policy/Canadian This is the first of nine Journal on Aging Joint Issue—Bridging publications on global 1991 L. McDonald/ Policy and Research on Aging, Volume aging, the most recent by Elder Abuse in Canada. XXIII (CPP)/Volume 16 (CJA). K. Kinsella; W. He (2009). Butterworths Series. 1991 A. Martin-Matthews/ 1998 J. Giele; G. Elder/ 1987 E. Gee; M. Kimball/ Widowhood in Later Life. Methods of Life Course Women and Aging. Research: Qualitative and Butterworths Series. Quantitative Approaches. Butterworths Series. Connected life course 1987 W. Forbes; J. 1991 M. Minkler; C. Estes/ theory and methods. Critical Perspectives on Jackson; A. Kraus/ Aging: The Political and Moral Institutionalization of the Elderly in Canada. Economy of Growing Old. 1999 Development of a critical R. Friedland; Butterworths Series. perspective in aging. L. Summer/ Demography 1987 N. Chappell; L. Driedger/Aging 1991 Canadian Study of Is Not Destiny. This was the first and Ethnicity: Health and Aging initiated. A book to address Toward an Interface. ten-year study with a focus on apocalyptic Butterworths Series. dementia and its care. demography. 1990 1995 2000 1990s–present 1999–2003 B. Spencer; F. Denton/ Several graduate MA/MSc/ Social and Economic PhD programs in Gerontology Dimensions of an Aging were established in a number Population (SEDAP) I of Canadian universities. & II (2005–11), a multi- disciplinary SSHRC-funded 1990 CARNET: The research program. Canadian Aging Research Supported a network of Network established. researchers from across the country to develop a series of major papers on 1988 L. Plouffe; F. Béland (Eds.)/Canadian this topic. Journal on Aging Special Issue—Francophone Research in Gerontology in Canada, Vol 7 (4). This was an important issue of CJA that attempted to 1996 B. Spencer; F. Denton/ Independence make French-language gerontological research and Economic Security of the Older Population more widely known. (IESOP) Program. Led to SEDAP in 1999. 1988 Research Centre on Aging, Sherbrooke, 1996 D. Foot/Boom Bust and Echo: How Quebec, established, funded by Fonds de to Profit from the Coming Demographic recherché en santé du Québec (FRSQ). Shift. First Canadian book to envisage population aging as the primary driver of 1988 J. Birren; V. Begtson/ social and economic change. Emergent Theories of Aging. 1996 Quebec Network for Research on 1988 M. Novak/Aging and Society. Aging established, funded by FRSQ. 544492_00_prelims.indd 15 13-11-01 12:02 PM  2000 Canadian Institutes of Health 2003 N. Chappell; E. Gee; L. McDonald; M. Research (CIHR) created. The Institute of Stones/Aging in Contemporary Canada. Second Aging (IA) was one of 13 institutes created edition 2008, without E. Gee who died in 2002. by the CIHR to stimulate research on health issues related to aging. 2003 V. Marshall; W. Heinz; A. Verma/ Restructuring Work and the Life Course. 2000 E. Gee; G. Gutman/The Overselling of Population Aging: Apocalyptic 2003 W. Heinz; V. Marshall/Social Dynamics Demography, Intergenerational Challenges, of the Life Course: Transitions, Institutions and and Social Policy. First Canadian book to Interrelations. critique population aging as apocalyptic. 2002 J. McMullin; 2004 J. McMullin/ 2006 B. Mitchell/ V. Marshall/ Understanding Social Boomerang Age: Workforce Aging in Inequality: Intersections Transitions to the New Economy of Class, Age, Gender, Adulthood in Families. (WANE). Project Ethnicity, and Race in A life-course analysis of funded by SSHRC. Canada. Second edition family transitions. One of the largest published in 2010. funded studies by SSHRC in aging. 2000 2005 2001 17th World Congress of the International Association of Gerontology (IAG; now IAGG, Geriatrics added), 2005 National Initiative for the Care of the Elderly Vancouver Canada. This was the first (NICE). National network IAGG conference in Canada. funded by the Networks 2001 A. Martin-Matthews; F. of Centres of Excellence— New Initiative Program. Béland (Eds.)/Canadian Journal on Aging Special Issue— Northern Lights: Reflections 2005 A. Wister/Baby on Canadian Gerontological Boomer Health Dynamics: Research, Vol. 20. How Are We Aging? First Canadian book addressing 2001 I. Connidis/Family Ties health of the baby and Aging. Developed out boomers. of the original Butterworth’s series (1989). A second edition 2005 Public Health published in 2010. Agency of Canada/Report on Seniors Falls in Canada. 2001 G. Kenyon/Narrative Gerontology: Theory, Research and Practice. A first Canadian examination of narrative theory and analyses. 2001 Initial developmental 2007 National Seniors Council of Canada established, meeting of the Canadian replacing NACA. Longitudinal Study on Aging, CLSA, Alymer, Quebec. 544492_00_prelims.indd 16 13-11-01 12:02 PM  2008 N. Keating/Rural Ageing: A Good Place to Grow Old? Developed from an original Butterworth’s book (1991) focusing on rural aging in Canada. 2008 A. Martin-Matthews; J. Phillips/ Aging and Caring at the Intersection of Work and Home Life: Blurring the Boundaries. 2010 Alzheimer Society of Canada/Rising Tide: The Impact of Dementia on Canadian Society. 2010 G. Gutman; C. Spencer/ Aging, Ageism and Abuse: Moving from Awareness to Action. 2010 2015 2011 H. Northcott; 2009 V. Bengtson et al./ M. Rosenberg (eds.)/ Handbook of Theories of Canadian Journal on Aging Aging. Includes chapters Special Issue—Individual on integrative theories in and Population Aging: social gerontology. First Commemorating the edition published in 1999. Butterworths Series and the Founding of the CJA. Many of 2009 Canadian the original topics in the series Longitudinal Study on are revisited. Aging launched. This will be the largest longitudinal study on aging in Canada with 50,000 participants aged 45 and over followed for 20 years. 544492_00_prelims.indd 17 13-11-01 12:02 PM 544492_00_prelims.indd 18 13-11-01 12:02 PM  Part I An Introduction to Individual and Population Aging Age is opportunity no less, Than youth itself, though in another dress, And as the evening twilight fades away, The sky is filled with stars, invisible by day. —Henry Wadsworth Longfellow, Morituri Salutamus F or centuries, humans have sought ways to prolong life and to be healthier in later life. The search for a magic elixir—through healthy lifestyles, drugs, surgery, the fountain of youth—has been primarily from a biological or medical perspective. Increasingly, however, researchers have discovered that social aspects of aging—such as historical, socio-cultural, and environmental factors, as well as biological factors and disease states—influence both individual and population aging in any society or community. Given the rapid pace of population aging in Canada and the world, coupled with an increase in knowledge about the aging process, this is an exciting time to study these phe- nomena. The journey you are about to begin by reading Aging as a Social Process: Canadian Perspectives, 6th edition, like the life course itself, will be different for each person. The subject matter will present unique challenges, varying degrees of interest, and many opportunities for personal reflection. By acquiring knowledge, separating facts from myths, and applying this information, you can enrich your own life, as well as the lives of older adults in your personal family and social networks, and in society at large. Whether you are a student thinking about your future, a concerned citizen, a practitioner working with older adults, a person caring for an aging parent or other relative, a policy-maker, or a researcher, knowledge about individual and population aging is a lifelong pursuit and investment. 544492_01_pt1.indd 1 13-11-01 12:02 PM  2 Part I | An Introduction to Individual and Population Aging Part 1 of this book consists of four chapters that introduce facts, trends, and ways of thinking about aging and about growing older in a global society. Chapter 1 introduces the concept of aging as a social process, distinguishes between individual and population aging, defines four types of aging, and identifies some major issues and challenges, as well as images and myths about aging in Canada. In addition, the chapter introduces arguments as to why it is important to understand aging phenomena throughout the life course from a number of disciplinary and theoretical perspectives (see also Chapter 5). This chapter stresses that we do not age in a vacuum but, rather, in a highly interactive and ever-changing social world as we move through our individual life courses. It also stresses the need to treat older persons ethically and to protect their human and legal rights, especially as their physical and cognitive capacities decline. Chapter 2 illustrates the diversity in the aging process and in the status of older people across time because of cultural differences and historical events. Aging, and being labelled as “old,” “elderly,” or a “senior,” varies across time, both within and across countries. A major change in the status of older people is alleged to have occurred as societies moved from pre- industrial to industrial to postmodern states, especially after the onset of modernization. Within a multicultural society such as Canada, the process of aging varies within indigenous, language, ethnic, rural, and religious subcultures. Chapter 3 briefly describes how the various physical and cognitive systems of the human organism change and adapt across the life course. The focus is on how physical and cognitive changes, which may or may not occur in all aging individuals at the same rate or to the same degree, influence the nature and frequency of social relations throughout the life course but more so in later life. Some of these natural and inevitable changes lead to a loss of independence, a lower quality of life, and a need for informal and formal support from others to complete such activities of daily living as dressing, eating, and bathing. For others, positive adaptations to these changes enable aging individuals to maximize well-being and fulfill their potential as human beings. Chapter 4 presents an overview of demographic processes and indicators that describe the size, composition, and distribution of the population by age. Demographic facts from both developed and developing countries are introduced to place the Canadian situation in a global context. Demographic processes are dynamic, and this chapter discusses the implications of demographic changes over time, especially with respect to fertility, mortality (note that terms in bold throughout the text are defined in the Glossary), and immigration rates. The final section of the chapter examines the geographic distribution of populations by age across provincial and rural–urban boundaries and illustrates how immigration contributes to the diversity of Canada’s older population. Population aging is a universal phenomenon that, at times, has been expressed as a fearful and negative event by some members of the media and government. They argue that “demography is destiny” and that population aging will lead to the bankruptcy of public pension systems and to the destruction of the health-care system through excessive use and costs. This chapter discusses whether this view is myth or fact. 544492_01_pt1.indd 2 13-11-01 12:02 PM  1 Aging as a Social Process A [person’s] age is something impressive, it sums up his life: maturity reached slowly and against many obstacles, illnesses cured, griefs and despairs overcome, and unconscious risks taken; maturity formed through so many desires, hopes, regrets, forgotten things, loves. A [person’s] age represents a fine cargo of experiences and memories. — Antoine de Saint-Exupéry, Wartime Writings, 1939–1944 Translated from the French by Norah Purcell Jupiterimgages/Thinkstock.com 544492_01_pt1.indd 3 13-11-01 12:02 PM  4 Part I | An Introduction to Individual and Population Aging Focal Points and Key Facts W  hy should we study social processes of aging? T  o what extent, and why, does population aging influence life chances, choices, and lifestyles throughout the life course? W  hy and how does age and aging matter in our everyday lives, and do the meanings of age and aging change across the life course? A  re older people a burden to society, an untapped resource, or both? H  ow do media images about being old influence the aging process? H  ow do the culture and social structure of a society influence individual aging? W  hy and how are individual aging and population aging linked? W  hy and how should the human rights of older people be protected? In 2011, almost one in seven Canadians was 65 or older (4.95 million people), representing 14.8 per cent of the total population. T  here were 5825 Canadians 100 years of age or older (i.e., centenarians), according to the 2011 census. In 2011, baby boomers (born between 1946 and 1965), comprising 30 per cent of all Canadians, began to turn 65. As a result, the 60 to 64 age group is growing most rapidly, followed by centenarians. Introduction: Challenges of an Aging World The world is growing older as the number and proportion of older people in each country increases. In developed countries like Canada, this growth has occurred over the past 40 years as fertility rates decreased after the baby boom of 1946–65 while mortality rates have gradually declined. The boomers comprise 30 per cent of the total Canadian population—more than 10 million individuals in 2011 compressed into the narrow age range of 46 to 65. As additional cohorts of the baby boomers turn 65 and beyond, the proportion of persons 65 and over in the population will rise significantly. This growth is expected to level off after 2031 when baby boomers reach advanced age and their numbers begin to shrink. In developing countries, much of the increase in population aging will occur over the next 30 to 40 years as fertility rates decline and sanitation and public health improve. That is, with fewer births, older people begin to comprise a larger proportion of the total population, and with improved sanitation and public health, people will live longer, also increasing the proportion of the population that is older. Population aging in these countries will occur at a faster pace than in developed countries because of more rapid drops in fertility and mortality rates. This global phenomenon, known as population aging, is illustrated by the following facts or projections (Kinsella and He 2009; Population Reference Bureau 2011; US Census Bureau 2012). In 2012, 8 per cent of the world’s population was 65 years of age or older, estimated at 562 million individuals (US Census Bureau 2012). 544492_01_pt1.indd 4 13-11-01 12:02 PM  1 | Aging as a Social Process 5 By 2040, one in seven persons could be 65 and older. In developed or modernized countries, 16.5 per cent of the population is 65 or over (US Census Bureau 2012). In some of these countries, the proportion is projected to reach one in four, one in three, or even one in two during the next 30 years (Kinsella and He 2009). In comparison, only 6.2 per cent of the population in the less developed nations is 65 and over (US Census Bureau 2012). However, this percentage will rise quickly over the next several decades. About 75 per cent of the world’s older population lives in developing countries, given their large populations. In 2011, 5825 Canadians were 100 years of age or older—an increase of 25.7 per cent since 2006—compared to almost 50,000 centenarians in Japan, the country with the highest life expectancy. We live not only in an aging world but in a society in which older citizens are healthier and more active. As individuals and as a society, we cannot ignore the chal- lenges of population aging and the needs of older adults. Understanding and developing a society for all ages is essential—today and in the future when you and members of your family grow older. The effects of population aging permeate all spheres of social life: work, the family, leisure, transportation, politics, public policy, the economy, housing, and health care. Consequently, both challenges and opportunities exist for aging individuals, as well as for family members, politicians, employers and employees, health and social services person- nel, and public policy–makers. Indeed, aging issues are linked to many of the well-known challenges facing societies, including gender inequality, intergenerational family relations, retirement and economic security, universal access to health care, and social assistance in later life, to name but a few. We do not age in a vacuum. Rather, individually and collectively (as a family, community, or society), we live in a social world. In our lifelong journey, we interact with other individuals and age cohorts across time and within a unique culture, social system, and community. Just as individuals change as they grow older, so too do social institutions—such as the family, the health-care system, the labour force, the economy, and the educational system. In short, we do not age alone, nor do we have total freedom in selecting our lifestyle or life course. There is constant interplay among individuals and various social processes and social institutions across the life course (Heinz and Marshall 2003; Mitchell 2003, 2008; Pearlin, 2009; Dannefer and Settersten Jr. 2010). To illustrate, mandatory retirement at age 65, or its elimination, can restrict or increase work opportunities for the individual who attains 65 years of age, and provide eco- nomic advantages for society. Similarly, the state of our health at any stage in life is linked to personal decisions about diet and lifestyle; the cost, quality, and availability of foods; and the quality of care provided by the informal and formal support systems and by the health-care system. It was C. Wright Mills (1959), a well-known sociologist, who first stressed that we must understand and appreciate how and why the “private troubles,” or personal responsibilities, of individuals interact with the “public issues,” or public responsibilities, of a society—at the local, regional, national, and global level. This dialectical private–public debate and process pervades the study of individual and population aging, and it should be on the agenda whenever policies or programs for older adults are being debated. Highlight 1.1 summarizes why the study of aging processes and the social world of older adults is important—to you personally, to your family, and to your community and the larger society. 544492_01_pt1.indd 5 13-11-01 12:02 PM  6 Part I | An Introduction to Individual and Population Aging Highlight 1.1 Why Study Aging and Older Adults? to challenge, refute, and eliminate myths about aging and older people to “know thyself” and others by examining personal journeys across the life course to assist and support older family members as they move through the later stages of life to serve as an informed and effective volunteer in your community while assisting older adults to prepare for a job or career (as a practitioner, policy-maker, or researcher) in which the mandate is to address aging issues or to serve an older population to identify and understand significant changes in patterns of aging and in the age structure to understand intergenerational relations and the status of older adults in a multicultural society to critically evaluate policies and practices for an aging population and to identify where and why the needs of older adults are not being met to understand aging and older people from an interdisciplinary perspective—their potential, their competencies, their history, and the complex interactions of physical, social, and cognitive elements to enhance the quality and quantity of interaction with older people in your personal and professional life to help Canada become a healthy and active older society Population Aging: Adding Years to Life Throughout history, humans have been preoccupied with searching for a fountain of youth, for ways to look younger in later life, and for ways to prolong life (Gruman 2003). However, it was not until the twentieth century that enormous gains in longevity were achieved, as evidenced by an increase in the average and maximum lifespan of humans, in the average life expectancy at birth, and in the number of centenarians—those who reach 100 years of age and beyond. While each centenarian has a different life history, their longevity, in general, can be attributed to some combination of genetics, environmental factors, diet, and lifestyle choices. Lifespan is the fixed, finite maximum limit of survival for a species (about 20 years for dogs, about 85 for elephants, and about 120 for humans). The longest-living human with a verified birth certificate was Madame Jeanne Calment, who was born in 1875 in Arles, France—before films, cars, or airplanes had been invented. She died at the age of 122 in 1997. Today, the oldest living woman and man are about 114 and 113 years of age, respectively, living in France and the US. The maximum lifespan for humans is unlikely to increase to any great extent in the immediate future because there are multiple and complex causes of mortality linked to genetics, lifestyle, and environmental factors that cannot be easily altered. Life expectancy is the average number of years a person is projected to live at birth or at a specific age (such as 65). Average life expectancy has increased in the past 50 years and will 544492_01_pt1.indd 6 13-11-01 12:02 PM  1 | Aging as a Social Process 7 continue to increase, although more in developing nations where life expectancy is still quite low because of high infant mortality rates, AIDS, and poor living conditions. In the early 1800s, average life expectancy in Canada was about 40 years; by the late 1800s, it had reached about 50 to 55; and by the late 1900s, it was 75 to 80. Life expectancy in China and Vietnam was about 40 years in the 1950s versus 70 years in Sweden; today, life expectancy has increased to 70 years in China and Vietnam but only to about 80 in Sweden (Population Reference Bureau 2011). These dramatic increases are part of an evolving “health transition” (Riley 2001; Land and Yang 2006) in which there are fewer deaths at birth and in infancy, and more individuals reaching advanced age. Not surprisingly, these gains in life expectancy have stimulated dreams of even longer lives but without all the physical changes that occur with age. To satisfy these wishes, entrepreneurs market anti-aging products that claim to slow, stop, or reverse the physical pro- cess of aging. However, there is little or no scientific evidence for such claims; indeed, some of the products or treatments (such as drugs or cosmetic surgery) have serious risks associated with their use (Olshansky et al. 2002; Mehlman et al. 2004). Life expectancy varies by gender, culture, geographic region, ethnicity, race, education, personal habits (such as diet, exercise, smoking, and drinking), and birth cohort. Based on 2006 to 2008 data, the average life expectancy at birth for Canadian women was 83 years; and for men, 79 years (Statistics Canada 2011). But among Aboriginal people, life expectancy is lower—about 78 years for women and 73 for men. And because of the diversity of genetic, environmental, and lifestyle factors, some Canadians will die before reaching the average life expectancy for their group, and few will ever approach the theoretical maximum lifespan. Increased life expectancy (i.e., lower mortality) is only part of the reason that the propor- tion of older people in a society increases. The most important factor is a significant decline in the fertility rate, which has the most direct and largest effect in shaping the age structure. For instance, the large baby boom generation was the result of increased fertility rates occurring after World War II. In 2012, Canada’s birth rate was about 11 infants per 1000 population, down from a high of 26.9 per 1000 in 1946 when the baby boom started (Population Reference Bureau 2011) Figure 1.1 shows the actual and projected growth in Canada’s older population from 1921 to 2041. As the baby boomers age, the population of those 65 and older is projected to reach about seven million in 2021 and nine million in 2041 (almost one in four Canadians). Population aging began in Canada after the end of the baby boom period (1946–65) when a “baby bust” period (from about 1966 to 1980) began. During this period, women had fewer than two children on average, and the first pregnancy was often delayed until a woman was in her mid- to late thirties (McDaniel 1986, 96). This “baby bust” period was followed by a small “baby boom echo” from about 1980 until the mid-1990s. However, the number of “echo” births was only about 30 per cent of the number in the original baby boom. Since the mid-1990s, fertility rates have fallen further to about 1.6 children per woman. This low fertil- ity rate is below the “replacement rate” of at least two children per woman that is needed to replenish the population when normal fertility and mortality rates prevail. However, some of this population decrease is offset by immigrants arriving in Canada, which results in modest positive population growth. Some politicians and media personnel claim that this rapid aging of the population will weaken the viability of the Canada Pension Plan, the Canadian economy, and the health-care system; that it will cause an enormous demand for long-term care and social support of older adults; and that it may lead to intergenerational inequities or conflict. Indeed, some consider population aging, and particularly the aging baby boomers, an impending crisis for our society. 544492_01_pt1.indd 7 13-11-01 12:02 PM  8 Part I | An Introduction to Individual and Population Aging 85+ 75–84 65–74 25% 20% Percentage 15% 10% 5% 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011 2021 2031 2041 Year Figure 1.1 Canada’s Aging Population, 1921–2041 Source: Canada’s Aging Population. Public Health Agency of Canada, 2002. Reproduced with the permission of the Minister of Public Works and Government Services Canada, 2013. At the turn of the millennium, Ken Dychtwald, an influential futurist in the US, contended that American baby boomers will face a pandemic of chronic disease and mass dementia, a care- giving crunch, conflict with other generations, and inadequate pensions, among other crises. He stated, “When I look into the future, I see a number of train wrecks about to happen—all of which are preventable, but only if we fully understand the relationship between our current decisions and their future outcomes and only if we initiate corrective action now” (Dychtwald 1997, 11). His views tend to be based on selected demographic and social “facts” and would seem to be exaggerations that instill fear in society. Highlight 1.2 features newspaper headlines and comments showing that these views continue to reappear whenever new statistics indicate an increase in population aging, a rise in public debt, or a perceived crisis in the social welfare or health-care systems. Such fears can interfere with rational policy-making by focusing only on sheer numbers instead of taking into consideration other important social changes (Cheal 2003a). For instance, more careful and detailed analysis has demonstrated that with health promotion and health- care improvements, increased savings and private investments, higher levels of education, and creative and timely policy planning, an older population will not be a drain on societal resour- ces. Indeed, healthier, better-educated, and more active older people are an untapped societal resource who can serve as volunteers, caregivers, or paid workers when the labour force shrinks (Gee 2000; Cheal 2003b; Fast et al. 2006; Gottlieb and Gillespie, 2008; Morrow-Howell, 2010). This labelling of older people as a burden to society has been called “apocalyptic,” “cat- astrophic,” or “voodoo” demography, which results from a process of exaggerating or mis- interpreting population statistics. Gee (2000, 5) describes apocalyptic demography as “an ideology... a set of beliefs that justifies (or rationalizes) action... wherein the beliefs converge on the idea that an aging population has negative implications for societal resources—which get funneled to the sick, the old, and the retired at the expense of the healthy, the young, and 544492_01_pt1.indd 8 13-11-01 12:02 PM  1 | Aging as a Social Process 9 Highlight 1.2 Journalistic Views of Population Aging Raise Seniors’ Taxes* Ottawa should hit older people and their estates with new taxes to pay down the national debt, says a top tax lawyer. Seniors have benefited from a lifetime of economic growth boosted by government spending, and it is now time for them to pay the country back.... The $500-billion federal debt “belongs” to older Canadians, but younger generations are being asked to pay for it. (Toronto Star, 11 November 1994) Painful Decisions Must Be Made to Ensure Future of Social Programs* If you think we are having a hard time affording our social programs today, just wait a few years. What is little understood is how the demographic clock is working against us and how fast it is ticking. (Peter Hadekel, The Gazette, Montreal, 10 December 1994) Pension Plan Pins Prospects on Market* Faced with the daunting demographic challenges of an aging baby-boom... Canadians— younger ones in particular—are skeptical... will the CPP be around for their retirement. And they have every reason to worry. (Shawn McCarthy and Rob Carrick, The Globe and Mail, 11 April 1998) Rising prevalence of dementia will cripple Canadian families, the health- care system and economy A report released by the Alzheimer Society today to mark Alzheimer Awareness Month reveals alarming new statistics about the projected economic and social costs of dementia in Canada. (Alzheimer Society of Canada, The Medical News, News medical.net, 4 January 2010. Retrieved from www. news-medical.net/news/20100104/Rising-prevalence-of-dementia-will-cripple-Canadian-families-the-health-care- system-and-economy.aspx) Canadians ill-prepared for the inevitable The strain this lack of preparedness puts on family members at one end of the patient- care spectrum and medical professionals on the other could become intolerable in Canada. (Editorial, The Gazette, Montreal, 23 July 2010) It is argued that the very old (typically women) who enter hospitals, do so with multiple chronic conditions that can not be cured. This leads to wasted health care dollars on these “bed blockers.” (M. Wente Article, The Globe and Mail, Thursday, 11 November 2010) *Source: Reprinted with permission from Gee and Gutman 2000, 6–7, with additions by authors. 544492_01_pt1.indd 9 13-11-01 12:02 PM  10 Part I | An Introduction to Individual and Population Aging the working.” This way of thinking has been influenced by public policies designed for hypo- thetical average or typical people and by simplistic projections of the number of people who must be supported by public funds in the future. The media and policy-makers, faced with an increasing number of older people, ask such questions as the following: Will there be sufficient funds in the public pension system when future birth cohorts reach 65, or will the C/QPP (Canada/Quebec Pension Plan) become bankrupt while supporting the large baby boom generation that will retire from about 2011 to 2031? Will hospitals disproportionately serve frail older people and make it difficult for those in other age groups to receive hospital treatment? Will the number and proportion of individuals with Alzheimer’s disease due to popula- tion aging create an economic and social crisis? Who will provide home care and social support to the large number of aging people, especially with a decline in fertility, more dual-career families, and an increase in older people experiencing singlehood and divorce? Will conflict emerge between younger and older generations over what are perceived to be intergenerational inequities favouring older people in the receipt of public services? Will an older society become economically stagnant with people aged 65 and over being out of the labour force? Will baby boomers place greater demands than earlier generations on the health-care system? Some of these apocalyptic fears are magnified when there is a global or national economic recession and high government debt. These economic conditions, combined with projections of exponential increases in per capita costs for economic, health, and social support services, encourage governments to propose reducing economic or social support for older people. Governments also employ these arguments as they attempt to download more of these costs to lower levels of government or to individuals and families. To illustrate, in the past decade when governments were faced with an increasing public debt, they built fewer long-term-care facilities and reduced the operating budgets of existing facilities, thereby forcing more families to be involved, at greater personal and financial cost, in the long-term care of aging parents. Seldom were new, alternative, and more economical types of care proposed (see chapters 7 and 12). This issue of public support for older Canadians is a classic example of the debate proposed by Mills (1959) as to whether support in a welfare state should be a “public responsibility” of the state or a “personal responsibility” of the individual and the family. Despite questions about the sustainability of Canada’s universal pension and health-care systems, there is increasing evidence that the significant growth in population aging over the next 30 to 40 years will not bankrup