The Social Context of Ageing PDF

 The Social Context of Ageing Why do some people live to an advanced old age while others do not? And what does old age really mean in modern society? Gerontology is a multi-disciplinary science concerned with the study of ageing, which integrates biological, psychological and...

 The Social Context of Ageing Why do some people live to an advanced old age while others do not? And what does old age really mean in modern society? Gerontology is a multi-disciplinary science concerned with the study of ageing, which integrates biological, psychological and social study. This book focuses on the social contexts of ageing, looking at the diversity of ageing and older people, and at different factors that are important to experiences of old age and ageing. This comprehensive text includes chapters on: · theoretical and methodological bases for the study of ageing · demographic context of the `ageing' population · health and illness · family and social networks · formal and informal care and other services for older people The book provides an invaluable introduction to the major issues involved in the study of ageing and is essential reading for students of sociology, gerontology, social policy, health and social care, and professionals working with older people. Christina R Victor BA MPhil PhD Hon MFPH has worked in social gerontology for over twenty years. She is professor of Gerontology & Health Services Research, and Acting Head, School of Health & Social Care, University of Reading, Reading, UK.  In loving memory of my father Idris Windsor Ronald Victor 12 February 1914 to 24 August 2003 The Social Context of Ageing Christina R. Victor LONDON AND NEW YORK  First published 2005 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Simultaneously published in the USA and Canada by Routledge 270 Madison Ave, New York, NY 10016 Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” © Christina Victor, 2005 All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book has been requested ISBN 0-203-33859-6 Master e-book ISBN ISBN (hardback) 0-415-22139-0 ISBN (paperback) 0-415-22140-4 Composition by Wearset Ltd, Boldon, Tyne and Wear  Contents List of illustrations vi Acknowledgements viii 1 The social perspective on ageing 1 2 Theoretical perspectives on the study of ageing 9 3 Methodological aspects of the study of ageing 38 4 The demographic context 68 5 Health and illness 99 6 Psychological health and well-being 133 7 Family and social networks 161 8 Material resources in later life 196 9 Caring networks 228 10 Services for older people 256 11 The future of old age 279 References 288 Index 302  Illustrations Figures 4.1a Idealised population pyramid for Great Britain in 1990 74 4.1b Idealised population pyramid for Great Britain in 2000 75 4.1c Idealised population pyramid for Great Britain in 2050 75 Boxes 1.1 Ageing and disease 3 3.1 Idealised schema of different types of study design in ageing research 47 3.2 `Most efficient' resea rch design for studying ageing 55 Tables 3.1 Longstanding limiting illness by age, Great Britain, 2001 48 3.2 Trends in health status over time, Great Britain 1972–2001 50 4.1 Growth of the population aged 60+, United Kingdom, 1901–2001 71 4.2 Population aged 60+, and life expectancy at birth for selected 73 countries, 2000 4.3 Fertility data for selected European countries 80 4.4 Deaths by age, England and Wales, 1841 and 2002 84 4.5 Expectation of life, England and Wales, 1841, 1901 and 2001 85 4.6 Sex distribution of population aged 60+, United Kingdom, 2001 89 4.7 Civil status of population aged 65+ living in the community, Great 91 Britain, 2001 4.8 Civil status population aged 65+, Great Britain, 1980 and 2001 92 4.9 Percentage enumerated in `non-private' households, England and 93 Wales, 1921–2001 4.10 Household composition of population aged 65+, Great Britain, 2001 94 4.11 Household composition of population aged 65+, Great Britain, 1980 95 and 2001 5.1 Death rates by age and sex, England and Wales, 2002 112 5.2 Death rates for population aged 65+, England and Wales, 1841–2002 114  vii 5.3 Prevalence of acute illness (restricted activity in the 14 days before 121 interview), Great Britain, 2002 5.4 Longstanding limiting illness by age and sex, Great Britain, 2001 121 5.5 Comparison of chronic illness rates between GHS and 2001 Census, 123 England and Wales 5.6 People reporting varying disabilities, England, 2000 126 5.7 People unable to manage items in the Townsend Disability Index by 126 age and sex, Great Britain, 2001 5.8 People aged 65+ unable to manage specific tasks: a comparison of 127 community and care home populations, England, 2000 5.9 People aged 65+ having difficulty undertaking items in the Townsend 129 Disability Score, Great Britain, 1980–2001 6.1 Health rating in year prior to census, England and Wales, 2001 150 6.2 Trends in health rating of population aged 65+, Great Britain, 1980– 151 2001 7.1 Generational structure of households in which older people live, 167 Great Britain 7.2 Comparison of the living arrangements of older people, Great Britain 168 7.3 People living alone by age, Great Britain, 1973, 1991 and 2001 171 7.4 Marital status of people aged 65+, England and Wales, 2001 177 7.5 Weekly direct contact with relatives or friends, Great Britain, 1980 183 and 2001 8.1 Membership of employer pension scheme, 1983, 1991 and 2001 221 8.2 Source of pensioners' total gross incom es, Great Britain, 1951–2001 221 8.3 Access of people aged 65+ to consumer goods, Great Britain, 1980– 224 2001 8.4 Housing tenure for older people, Great Britain, 1980–2001 225 9.1 Population aged 65+ unable to perform selected activities of daily 230 living, Great Britain 9.2 Prevalence of caring, Great Britain, 1985–2001 242 9.3 Who is being cared for? Great Britain 246 9.4 Type of help given by carers, Great Britain 1985–2000 248 9.5 Provision of care by household type Great Britain 249 9.6 Levels of caring responsibility, Great Britain 1985–2000 250 10.1 Self-reported use of health services in previous year: a comparison of 273 GHS and Health Survey for England 10.2 Trends in health service use in the year before interview, Great 273 Britain, 1982–2002 10.3 Utilisation of community services in previous month, Great Britain, 274 2001 10.4 Utilisation of key services by age, Great Britain 1980–2001 275 10.5 Usual sources of help for those able to undertake tasks only with 275 help, Great Britain, 1998  Acknowledgements This book was started while I was Professor of Social Gerontology in the Department of Community Health Sciences at St George's Hospital Medical School in London and I am grateful to the department for their support for this literary enterprise. Particular thanks are due to Loretta Hall for her help in the preparation of early drafts of the manuscript and to the various groups of students who provided feedback on the material to be included in the book. I also wish to take this opportunity to thank my colleagues in the School of Health and Social Care at the University of Reading for providing the encouragement to complete the writing of this book. Amanda Harvey provided valuable help in preparing the final manuscript, including deciphering the almost illegible alterations written in my unique handwriting style! As always David and Christopher provided moral support, encouragement to finish the task and invaluable technical help.  1 The social perspective on ageing Gerontology is the science concerned with the study of ageing. Also encompassed within the term is a more expansive definition of the study of ageing to include the study of later life, old age and older people. As such it is a comparatively `young' science: the term `gerontology' was first used by a Russian biologist Metchnikoff in his book The Prolongation of Life published in 1908. However, the recency of the identification of the science of gerontology masks an interest in old age and older people that has existed for thousands of years. Distinguished scientists such as Francis Bacon, Benjamin Franklin and Francis Galton all wrote about ageing. There have always been `older' people present within societies. The oldest reported lifespan is that of Methuselah, who is supposed to have lived for 969 years. The longest verifiable lifespan was that of Jeanne Calment, who died in 1997, aged 126. Individuals living to advanced age is not a feature unique to contemporary society: Thomas Parr was presented to Charles I as being 152 years old, but such claims were largely unverifiable because individuals were not always certain as to their exact date of birth. As a society we have always been interested in what it is about certain individuals that means that they can survive to very advanced old age while others do not. Writers from the times of Aristotle onwards have been interested in the attributes required for living to old age and the first question many are asked upon achieving their centenary is what do they ascribe their long life to. Perspectives upon ageing Given the breadth of the topic under study it is, perhaps, not surprising that there are a number of different perspectives upon the study of ageing. These are usually defined as the biological, the psychological and the social. Thus gerontology is a multidisciplinary field of investigation in which each of these perspectives has a valuable contribution to make. One of the many challenges confronting the gerontologist is to be able to integrate these differing approaches to enhance and develop our understanding of ageing and later life. The bio- social-psycho model initially advanced by Engel (1977) is one way of developing a more integrationalist framework towards the study of old age. He argues that in order to understand ageing and the experience of old age, and to 2 THE SOCIAL PERSPECTIVE ON AGEING develop interventions to compensate for the vicissitudes of old age, we need to be able to integrate these differing perspectives. This model for understanding ageing was developed in response to the dominance of the biomedical model of ageing. This later model is imbued with notions of decline and deterioration, is focused upon disease and is highly reductionist in its thinking about later life. In contrast the bio-psycho-social model focuses upon health, integrates notions of both mental and physical health, and emphasises the influence of contextual factors upon the experience of old age. The biological perspective The biological approach to ageing is concerned with how the passage of time affects physiological systems (see Kirkwood, 1999). We are all aware of how older people illustrate specific physical changes such as wrinkles or grey hair. The key question is whether such changes are a result of `ageing' or growing older or whether they represent potentially modifiable changes resultant from social and environmental factors. For example the presence of wrinkles is seen by many as arising from growing older. However, we know that, in part, wrinkles reflect lifestyle and environmental factors such as sun exposure and smoking. Physiological changes attributed to ageing may, in part, be attributable to social and environmental influences or mediated by them. In theory, at least, this offers the potential to develop interventions to ameliorate such factors, if not eradicate them entirely. Biologists are interested in longevity and the varying life spans of different species. Longevity refers to the maximum lifespan that a species could attain under `optimal' conditions. Lifespan refers to the period between birth and death and the maximum verified to date for a human is 126 years. Life expectancy refers to the `average' number of years remaining to a person of a specific age. This is an actuarial calculation often calculated at birth but can also be calculated from any given age. Biologists refer to ageing as `senescence'. This describes decreases in the efficient functioning of an organism with age as a result of natural processes rather than abnormal processes which bring about pathology and disease (Ebrahim and Kalache, 1996). There have been various attempts to define the biological changes and characteristics which accompany growing older in all forms of life. Strehler (1962) defines ageing as the changes which occur in the post-reproductive phase of life that result from a decrease in the ability of the body to maintain homeostasis, that is to regulate the functions of the body within the very precise limits required for efficient functioning and survival. Consequently the body becomes less able to adapt to physiological stress and less resistant to disease and pathology. Ageing is viewed as an involuntary phase in the development of the organism which brings about a decrease in adaptive capacities and, ultimately, death. Although there is still considerable debate about the precise biological definition of ageing, Strehler (1962) again suggests that four criteria distinguish ageing from other biological processes and which can  THE SOCIAL PERSPECTIVE ON AGEING 3 also be used to distinguish `ageing' from `disease'. For a physiological change to be considered part of `ageing' and not some other process, Strehler (1962) suggests that it should demonstrate the following attributes: universality (it must happen to every member of a population), internality (it must result from internal processes and not reflect lifestyle or environmental factors), progressiveness (it is progressive, rather than acute, with cumulative effects) and harmfulness (it should demonstrate a deleterious, rather than benign, effect upon the organism and its ability to cope with its environment). Using these criteria, Box 1.1 illustrates that dementia is clearly a disease rather than an ageing effect as it fails to fulfil most of the Strehler (1962) criteria. There are at least twelve different theories advanced to account for why we age and it is neither appropriate nor practical to examine all of these here. We shall illustrate the range of theories in this area by using examples from the two major approaches to theories of ageing: `error theories' and `programming theories'. Error-based theories of ageing develop the proposition that ageing results from the development and replication of errors within the physiological system. Perhaps the oldest manifestation of this approach to theorising biological and physiological ageing is the `wear and tear' theory which can be traced back to the ideas of Aristotle. This perspective likens the human body to a machine, which eventually wears out, with this process being expedited by `overuse'. A popularist development of this theory is that all individuals have a fixed amount of time `allocated' to them and that vigorous exercise or lifestyle will use up this energy, leading to premature death. The second set of theories relate to the notions of `programmed' age ing which hypothesises that BOX 1.1 AGEING AND DISEASE Ageing is Disease is · universal · random · internal · intrinsic and extrinsic · progressive · acute and chronic · harmful · may be halted (death) Dementia (impaired cognitive function) is not part of the ageing process because it is · selective not universal (prevalence of about 5 per cent—but depends upon threshold) 4 THE SOCIAL PERSPECTIVE ON AGEING · intrinsic (variety of causes—vascular) · progressive (slow onset, drugs may reverse) · harmful (causes disability or dependence not necessarily death) ageing and the maximal life span are programmed into the genes of the particular organism and derives from the work of Hayflick (1996). Ageing and death are `pre-programmed' events with an inherent biological clock, which keeps track of time and initiates the ageing process when certain limits are met. Ageing is a `normal' process; distinguishing this normal process from pathology and disease remains a key challenge. Much work in gerontology has tended to conflate these two distinct notions so that we have not always clearly distinguished between them. Disease and age-related change have been linked together and have contributed to many of our negative views of ageing by a concentration upon decline and dysfunction. Increasingly we are aware that the physical changes we have attributed to `ageing' are age related but not causally. Such changes may be linked to the social and environmental context and that they may be modified. The psychological perspective The psychological approach concentrates upon examining personality, mental function and notions of self and identity. The psychologist is interested in both differences in behaviour between individuals and changes within individuals with the passage of time. Hence this perspective is distinguished from the cellular/organ systems approach of the biologist and the structural/social factors approach of the sociologist. This is a diverse area of research which embraces topics such as cognitive function, health psychology (health beliefs and behaviour), mental illness and personality and adjustment. The biomedical model has influenced this area of work in that there has often been a very negative, decline and loss orientated approach to the subject. The focus has been upon adjustment to loss rather than more positive notions of self-development in later life. This topic is dealt with in more depth in Chapter 6. The social gerontological perspective The sociology of ageing is concerned with using sociological perspectives to understand ageing. Social gerontology is a wider discipline in that it is concerned with approaching ageing from a variety of social science perspectives in order to achieve a better understanding of ageing and old age rather than for developing sociological theory and insights. As such social gerontology incorporates three distinct perspectives—individual, social and societal—at two levels of analysis, the microscale and macroscale which illustrates the complexity of the subject  THE SOCIAL PERSPECTIVE ON AGEING 5 area. The microscale approach is concerned with understanding and explaining ageing as an individual experience by investigating such topics as changes in perceived age identity as the individual progresses through the lifecourse. Here we are trying to elucidate what it is like to be an older person within contemporary society. However, few individuals grow older in isolation from the rest of society. Rather, ageing occurs within a social context ranging from the microscale of the family to the macroscale of the whole society or culture or increasingly of a globalised world (Estes et al., 2004). Hence the second approach to the study of ageing examines the social context which defines ageing and seeks to understand the position of and experience of older people within society and how this is shaped by major structural factors such as class, gender and ethnicity. The meaning and impact of the constraints operating upon the older adult are highly dependent upon the social environment in which the individual encounters them. It is now evident that ageing is not a homogeneous experience which affects every individual within the same society in a monolithic fashion. All `old people' are not alike and pre-old-age characteristics such as class and gender continue to exert a strong influence across the lifecourse. To conceptualise old age as an undifferentiated experience is both naive and unhelpful. We all bring to the experience of old age access to various resources—material, health and social —and these are strongly influenced by our experiences prior to `old age'. Indeed, with the development of the ideas of the `successful ageing' (Rowe and Kahn, 1999) the importance of the social context for the shaping of the experience of old age has assumed greater prominence. These authors argue that successful ageing is defined by both longevity and quality of life and that these are promoted by the interaction of three sets of factors: social engagement and participation, reduction of disease, and promotion of high levels of physical and mental functioning. The third facet of social gerontology is concerned with `societal ageing'. This is concerned with the demographic, structural, cultural and economic transformation resultant from the increase in the number and proportion of `older' people within society. How do social institutions respond to the changes in the nature and composition of our population? How will society respond to the increased number and visibility of older people? In this chapter we consider the different approaches which have been adopted towards the definition of old age and we examine the characteristics of these competing perspectives. The chapter then provides a summary of some of the dominant values that characterise society, which are of importance for understanding the experience of ageing and the position of the older people in contemporary society. What is old age? Both professionals and the lay public, when describing people in the later phases of life, often use terms such as `the elderly' or `older people'. These are terms 6 THE SOCIAL PERSPECTIVE ON AGEING which are common currency in both popular usage and more academic environments. Despite the frequency with which they are used, the definition of exactly what constitutes `old age' and when it starts remains problematic. These terms are a shorthand way of identifying the group of interest and little more. We cannot presume that the identified group is homogeneous as it may encompass an age range of 40 years or more from, for example, 65 to 105 years. It is totally unrealistic to expect such a group to be homogeneous in either character or attitudes. There are a number of different ways, in theory at least, to determine when old age starts and to identify our group of interest. There is no readily agreed biological definition of ageing or of the onset of old age. The physiological manifestations of biological ageing occur at different rates in different people with the result that the older age groups are very varied in terms of senescence. Hence the potential for using biological markers or some notion of functional age remains problematic for theoretical, conceptual and technical reasons. Perhaps the easiest measure of old age is `chronological' or calendar age. Of itself chronological age simply conveys the number of birthdays that an individual has accumulated. Clearly for this measure to be used it requires a society to be sufficiently well organised that its members know their chronological age. Although this is frequently used to define the onset of old age it is, at best, only a very rough guide to the ageing of the individual in biological terms because of the variability across individuals in terms of senescence. In addition chronological age of itself has no innate `meaning' but is derived from the social and historical context within which it operates. Hence the interpretation and meaning of specific chronological ages vary both historically and culturally. Because of the ease with which information is presented, chronological age is by far the most accessible definition of old age, but we need to remain alert as to the limitations which this approach poses. Another approach to the definition of old age is via the concept of the lifecycle or life stage. This is usually conceived as an orderly progression from infancy to old age with biological and socio-cultural factors interacting to govern the sequence of progression. Old or middle age are broad social categories that encompass changes of role (from child to adult), physical changes and other forms of social transition (becoming a grandparent). Although these life stages are often perceived as a simple universal progression from one well-defined set of social roles to another, it is in reality a highly complex concept. Within the broad term lifecycle it is possible to distinguish between a variety of sub- lifecycles related to different aspects of life such the family or work. The family dimension of the lifecycle involves numerous transitions including courtship, newly married, new parents, parents of teenagers, `empty nesters' and widowhood. Not everyone will experience all these phases of the family cycle; there may also be enormous variations in the age at which individuals experience these transitions. For example, some people marry at 18 and have three children by the age of 25; others may not marry until well into their thirties, while others  THE SOCIAL PERSPECTIVE ON AGEING 7 have their children in their forties at an age when others are becoming grandparents. Furthermore this trajectory is based upon notions of monogamy across the life course. Neugarten (1974) describes how the lifecycle has become increasingly differentiated into smaller segments with the emergence of the subgroups of `adolescence', `pre-school' and `middle age' as distinct phases. It was not until industrialisation in the seventeenth and eighteenth centuries that childhood emerged as a specific phase of life with its own special needs and characteristics, while adolescence did not become widely recognised until the early part of the twentieth century. More recently middle age has become recognised as a distinctive phase and, increasingly, there is a trend to differentiate between the `young' elderly (those aged between 65 and 74 years) and the `old' elderly (those aged over 75 years). There is also the distinction between the `third age' (those aged 50–74) and the `fourth age' (Laslett, 1989). From the lifecycle perspective, in describing someone as old (or juvenile) we are locating them within a specific social environment, which expects particular roles and provides opportunities and barriers. While these are interesting ways to conceptualise the lifecourse, such life-stage definitions of old age are of limited practical and policy relevance as they are almost impossible to operationalise. Hence, for all its limitations, we are usually left with using chronological age to define the group of interest. Conclusion Gerontology is concerned with the study of ageing, later life and old age and is an area of both academic and policy interest that has experienced a considerable expansion in the post-war period, largely in response to the perceived `problem' of an ageing population. Within this broad area of study, there are three main perspectives towards the study of ageing: the biological, the psychological and the social. In this book we focus upon the social context within which old age is experienced. However, it is important to recognise that this is just one of the perspectives that may be brought to bear upon the ageing experience. Old age, while it is a term that is very widely used, remains an entity that is difficult to define, operationalise and measure. Biological definitions of the onset of old age are not yet well developed, although many of the theories such as vitalism have been rejected because of their simplistic approach. The biomedical model which conceptualises old age as a time of inevitable decline have had a very important influence upon the development of the subject. Chronological definitions of old age are essentially shorthand terms used as a surrogate measure for biological and functional ageing, reflect social ascriptions and norms or relate to statutory provision such as retirement pensions. These definitions of old age are all culturally and historically specific. There are many assumptions about old age and the use of terms such as `the elderly' ca n imply a false sense of homogeneity within this population. In this book we examine the diversity of the ageing 8 THE SOCIAL PERSPECTIVE ON AGEING experience, and consider how the social context, especially issues of gender and class, influences this.  2 Theoretical perspectives on the study of ageing Social gerontology is a multidisciplinary enterprise that involves the social sciences and arts and humanities in the study of the social context of ageing. It also includes insights gained from research, policy and practice. Given the variety of disciplinary perspectives involved in social gerontology, and its comparative recency as an academic discipline, it is hardly surprising that the development of theory within gerontology remains limited. Indeed social gerontology does not possess an extensive theoretical framework in its own right. The systematic development of theory, and subsequent application and testing, are activities that have been largely absent from many social scientific studies of ageing, especially in the United Kingdom where there is a very strong tradition of `applied' gerontological work. Frequently, researchers have been content simply to describe aspects of behaviour in later life, or the characteristics of various subgroups of the older population, without trying to organise the findings into a coherent theory of social ageing. The focus in much social gerontological investigation has been upon identifying, classifying and describing the experience of later life rather than understanding and theorising. Much of the explanation of this largely atheoretical nature of much gerontological work derives from the essentially applied and/or policy related nature of much gerontological research. This dominance is encapsulated by the still relevant comments of Fisher (1978), who wrote: Social gerontology has not succeeded in creating a body of theory¼. Probably, gerontology will never be a theoretical discipline in its own right, but rather a consumer of theory from other sciences. Its major function seems to be that of an applied social science¼. Its major role, perhaps, has been to destroy the myths which so thickly encrust the study of ageing, to oppose the age prejudice which has grown so strong¼. (Fisher 1978:194–195) More recently Estes et al. (1992:50) commented that we still have `no common thread or tie to a common core of knowledge to unify the field' (of gerontology). Bengston et al. (1999) suggest that this reflects the fact that gerontology has been a bottom-up discipline that groups observations into models rather than theories 10 THEORETICAL PERSPECTIVES ON STUDY OF AGEING and because of the different levels of gerontological research—individuals, populations and processes. However, there is a clear need to enhance the theoretical bedrock of our subject of study. Perhaps some of the reticence about the development and utilisation of theory in gerontology derives from the practical focus of much of the work and our concern with describing the characteristics of older people (Estes, 1979). This is contrasted with the `irrelevance' of the development of theory. Yet theory is important because it is concerned with explaining rather than simply describing, in this instance, the social world of older people. Implicitly or explicitly we all use theory to `explain' the facts of ageing. For example the `fact' that older people report higher levels of physical disability may be explained in terms of either physiological and biological changes in musculoskeletal integrity (biological theories) or as a response to the expectation of increased problems of mobility (sociological theory). Theory is also important because as well as attempting to explain observations it may suggest intervention to ameliorate particular problems. Biological explanations of chronic disease may suggest either no intervention (as physiological change is both inevitable and irreversible) or medical interventions such as drug therapy or surgery. Sociological explanations of the same observations may suggest social interventions such as more positive attitudes towards ageing and older people. This failure to formulate a systematic theory within social gerontology is perhaps not surprising given the complexity of the field, its relatively recent development as a substantive area of academic endeavour and the importance of the policy agenda in the development of research questions. There is a further complication that has made the development of theory in gerontology challenging. Gerontology, like sociology, operates at both macro- and microlevels of investigation, which adds to the complexity of our subject. Gerontology is interested in questions of microlevel individual adaptation to the experience of ageing such as `how do individuals adjust to widowhood?' or decide when to consult their doctor. At the macro-level social gerontologists are concerned with questions such as the implications for the health care system of population ageing or the economic purpose of retirement (Phillipson, 1982), or with how factors such as class and gender influence the experience of ageing (Arber et al., 2003). In attempting to evaluate and understand theoretical perspectives and frameworks upon social ageing we need to establish at which level the theoretical proposition is operating at—micro or macro. In reality, of course, the distinction between these two perspectives is much less clear cut than the dichotomy described here—it reflects a continuum rather than a clear division. It is not that one perspective is superior to the other. They both contribute different, but complementary, approaches to our understanding of the experience of old age and serve to enrich our subject. In establishing the utility of any gerontological theories we need to consider three major factors. How well does the theory explain current events? How well does the theory predict future events? How well does it generate new theoretical  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 11 insights? Bond et al. (1993) give examples of these three different attributes of theory in gerontology. They indicate how theories of loss and adjustment can be used to explain and understand three apparently unrelated events: bereavement, retirement and amputation. This indicates how theory can be used to generalise far beyond the initial area of study. Theoretical propositions should then be able to predict future outcomes or trajectories after these three very different events. Finally, good social theory should lead to future areas for research and scholarship. In considering theoretical propositions in gerontology we need to consider how well our theories match these three criteria. We also need to establish the assumptions and ideologies that underpin the various theoretical positions. In the rest of this chapter we examine the major theories and frameworks which have been used to study ageing and consider the levels at which such theories operate and the assumptions which underpin them. Old age as a social problem While not a specific theory as such, the consideration of old age and later life as a social problem is a framework which has consistently informed social gerontological research, especially that carried out in Britain. This perspective with its focus upon the problematic nature of ageing, both for individuals and societies, has had a profound effect upon the types of questions which have been researched and hence in the generation of knowledge about ageing and old age in Britain. This framework is an approach that operates at both micro-and macrolevels of analysis as it can investigate both the problems of ageing individuals and ageing societies. This type of approach has been applied frequently in social gerontology and relies heavily upon the biological model of ageing with its emphasis upon decline and deterioration in function. Clearly in using this perspective the definition of which aspects of ageing are defined as `problematic' is crucial. At the most obvious level social problems are what people think they are. If conditions are not defined as social problems by the people involved in them, then they are not problems to those people although they may be problems to policy makers or to scientists. Hence there is an issue of power and ownership at the heart of the `social' problem approach to the study of ageing. Problems may be defined as being perceived either by the individual or by society at large. In this tradition, who defines which `problematic' aspects of ageing are worthwhile researching is of key importance. Additionally we must consider why the identified problems, for example loneliness or isolation, are seen to be problematic for older people but not to other segments of the population. The essence of this approach is that it is concerned with the problematic and difficult aspects of ageing and the knowledge so generated is concerned with these areas, thus this approach will yield very little evidence as to the `non-problematic' or `normal' aspects of ageing. Indeed the focus is upon the `deviant' or difficulty aspects of ageing rather than to `non-problematic'. We can draw few inferences from work in this tradition about `normal' ageing, except, 12 THEORETICAL PERSPECTIVES ON STUDY OF AGEING perhaps, by counter-example. A concentration upon this problem-focused research agenda, while undoubtedly for the best of possible motives, has perhaps served to perpetuate the very negative stereotypes of old age and later life which is so pervasive in Britain. At the macrolevel older people in Britain emerged as a specific `problem group' for which specific social policies were required in the late nineteenth century (Thane, 2000; see also MacIntyre, 1977). Prior to this older people were not differentiated from the rest of the pauper classes: old age per se was not seen as a social problem; rather destitution, irrespective of age, was the issue. What prompted the emergence of older people as a specific problem group in the late nineteenth century? Demographic changes are an insufficient explanation because the major period of growth in the absolute and relative number of older people in the population did not occur until the early part of the twentieth century. Thane (2000) demonstrates how the awareness of older people as a particular problem group arose from three interrelated factors: a growing awareness of the complexity of the causes of poverty (of which old age was one), the difficulties of older workers remaining in the labour force, and the concentrations of older people, especially in rural areas, brought about by the outward migration of the young. A variety of interlinking social trends combined to increase the social and physical visibility of older people within society and drew attention to the problems of old age for both the individual and society as a whole. There was not, however, the same impetus to examine the `non- problematic' aspects of the newly visibl e population of elders. Within the British research tradition there are two distinct forms of the `old age as a social problem' perspective—the humanitarian and the organisational— and these two approaches reflect the macroand microlevel approaches towards the study of ageing (Maclntyre, 1977). The humanitarian perspective emphasises an interest in the problems of old age and ageing for the individual while the organisation approach is concerned with the problems for society of an ageing population. Again while for the purpose of discussion and description these two approaches are presented as distinct dichotomies, in reality such sharp divisions are less clear cut and a specific piece of research may be addressing both aspects of this perspective. There is an extensive British academic tradition of work in the humanitarian or microlevel framework and it is an approach with a long and honourable pedigree. At the most general level this type of research tradition has concentrated upon describing the circumstances of the poorest and most disadvantaged sections of the community as a means of changing attitudes towards these groups and to argue for the provision of welfare resources and interventions. The surveys of Mayhew in London, Booth in London and Rowntree in York provide some of the earliest examples of this tradition of academic research. There are many examples of work in this traditional `social arithmetic' tradition in the study of ageing and later life. The classic surveys of Tunstall (1966) into loneliness and isolation and Townsend's work on residential  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 13 homes and the social world of older people (Townsend, 1957, 1964) are of particular note. These publications are exemplars of this tradition and there is much for the modern gerontologist to learn from reading such `classic' studies. Within this tradition, the process of ageing is not defined as the problem. Rather, the focus of attention is upon the individual older person and the problems which old age by implication `inevitably' brings. Old age is implicitly conceptualised as a time of declines in physical, mental and social functioning and not as a time of life characterised by new opportunities or challenges. These functional declines are seen as being universal and inevitable and there are obvious parallels with the `biological' model of ageing with its emphasis upon loss, deficit, decline and decay. Research in this framework has focused upon five main areas: morbidity, quality of life, social relationships, use of services and employment. Where issues other than these have been addressed, the focus has been on describing the differences between older people and other age groups, rather than looking at either continuities between age groups or differences within the older age groups. Old age is segregated or separated from earlier phases in the life course and is not often seen as representing a continuation and development of previous phases of life. Few of the investigations carried out considered the contributions made by older people. Research undertaken from this `social problem' perspective often, by the very nature of the questions they are seeking to answer, portray a very one-sided picture which often focuses upon the negative aspects of ageing and which is of only limited generalisability. While undertaken for the best of reasons, social problem-focused research has contributed, in part at least, to perpetuation of negative attitudes towards old and older people and has not looked at the positive aspects of how older people organise and manage their daily lives. The second manifestation of the `old age as a social problem' perspective is as an organisational problem for society and is a macrolevel approach to the `problems' of ageing. This tradition emphasises the ideology that old age is a `burden' for society, especially for those people who are in employment and who will have to shoulder the `burden' of paying to support the legions of pensioners. Despite the recent interest in the notion of `intergenerational conflict' resultant from the burden which younger people are going to face in supporting future cohorts of elders, this is not a particularly new approach. Good examples of the orientation of this approach are demonstrated by titles such as The Rising Tide, a report concerned with projected numbers of older people with dementia in Britain (Health Advisory Service, 1982). This report was concerned that we would be `swamped' by the health care demands of older people with dementia. Another example, Averting the old age crisis, a report from the World Bank (1994) concerned with the economic problems resultant from having to pay pensions to an increasing number of old people. This concern about the burden of population ageing has been termed `moral panic' by Jefferys (1983) or the `elderly avalanche' by Russell (1990). This is an approach which has been highly 14 THEORETICAL PERSPECTIVES ON STUDY OF AGEING distinctive of many British government reports, especially those produced in the 1940s and the 1980s, and is rooted in concerns about the consequences of the changing nature of the British population, especially the very low birth rates of recent years. Forward projection of these rates suggested that there would insufficient young people entering the workforce to provide for the increasing number of older people (often referred to as the demographic time bomb). Indeed, concern about the ageing nature of the wider European population has prompted a debate as to whether immigration should be encouraged in order to ease the burden of caring or supporting all these `unproductive' elde rs. The approach of Beveridge is an exemplar of the negative way that older people are often conceptualised. His 1942 report upon social security provision saw old age as a one-way drain on resources from other more important areas of social need. He wrote that `It is dangerous to be in any way lavish to old age, until adequate provision has been assured for all other needs such as the prevention of disease and the adequate nutrition of the very young' (Beveridge, 1942:96). These comments indicate that the primary focus of social policy as manifested by the creation of the post-war welfare state was towards the young. The post-war Royal Commission on Population (1948) stressed this point further by observing that the old consumed without producing, thereby reducing the overall standard of living. This report recommended ways of reducing the social costs of old age by getting older people to do more to maintain themselves but there was no recognition of the past contributions that they had made to society, or indeed any awareness of their current contributions, especially in terms of informal care. As such this report is typical of the arguments advanced more recently about the `parasitic' nature of older people which fail to acknowledge the contribution of older people to the social and work-based economy and to society more widely. This emphasis upon older people as a burden which society cannot afford re- emerged in the 1980s and is illustrated by the debate about the ability of the nation to `afford' the various health and welfare benefits provided for them. This has been manifested in the development of the notion of `intergenerational' conflict over the distribution of welfare and other social resources. Demographic and ideological factors largely explain the re-emergence of this perspective. As with the immediate post-war period, there has been considerable worry about the perceived ageing of the population. In particular there have been fears expressed about the growth in numbers of the very old (i.e. those over 85 years of age). Decreasing fertility rates and family size have raised fears about the possible lack of workers in the future to maintain the elderly population (and other dependent groups) and that there will develop `intergenerational conflict' between the young and the old for welfare and other transfers of resources (Johnson et al., 1990; Arber and Attias-Donfut, 2000). Ideas of intergenerational conflict arose first, perhaps, in the 1960s when the youthful `baby boomers' challenged many of the then current social norms and the established social order. In its more recent manifestation, there are concerns over the emergence of `grey power' with  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 15 older people monopolising political activity and securing resources for themselves to the detriment of other groups. At its most basic the notion of intergenerational conflict is reduced to the simple question, `are the aims of young and old sufficiently different to make them political and social adversaries?' This presumes that political groups would develop around the basis of age and that these age-based parties would have different agendas: the young lobby wanting support for education and the older age groups pensions or health care. In a time of limited resources conflict may erupt between age groups for control of scarce resources. However, this requires people to act and vote along simple age lines. Older people present diversity in terms of class, ethnicity and gender. Indeed the diversity of the older age groups is increasing and this probably militates against the development of a simple voting lobby organised upon the basis of age, but older people are more likely to vote than younger people and all parties woo the `grey vote' (Vincent , 1995, 1999). Ideological factors have also influenced this debate. In Britain older people account for about half of the current health and social welfare budget. With the election of a Conservative government in 1979 deeply committed to the reduction of public expenditure, combined with economic recession and high unemployment, the ability of the nation to `afford' the `burden of the elderly' has been questioned. In addition the philosophy of the `new right' is centred upon the responsibility of individuals to provide for their old age. Both the ability of, and the appropriateness of, the state providing for old age have been questioned and the post war consensus between political parties concerning welfare provision has been questioned. Administrations following on from 1979 have all, to a lesser or greater degree, sought to reduce the responsibility of the state in supporting older people and have moved more towards promoting a policy of `self-sufficiency' in old age with the state stepping in only as matter of `last resort' (see Victor, 1997; Means and Smi th, 1998). In the United Kingdom in particular this framework has had a profound influence upon the study of ageing and in generating knowledge about the social context of ageing. The emphasis upon the `problems' of ageing means that our knowledge and understanding of other non-problematic dimensions of ageing remains sparse. This type of framework can also be seen in the priority areas identified for research by bodies such as the Economic and Social Research Council (ESRC) and the Medical Research Council (MRC) who are concerned with the potential `future burden' of health and illness among older people and advances a research agenda that is concerned with such matters. The ESRC Growing Older programme also demonstrated a concern with many of the perceived `problematic' dimensions of growing older and has a heavily social policy focus. There remains little interest from funding bodies or research organisations in the `everyday life' of older people nor in the study of problems identified by older people rather than policy makers (Gubrium and Holstein, 2000; Bytheway, 2003). 16 THEORETICAL PERSPECTIVES ON STUDY OF AGEING Developing theory in social gerontology There are a number of different explicit theoretical frameworks concerned with the study of ageing. Psychological and physiological perspectives upon ageing focus upon the changes which happen to individuals. However, when focusing upon the social context within which ageing occurs, both for groups and individuals, then theories derived from sociological perspectives are most pertinent. As noted earlier, a concern with examining and understanding the social context of ageing involves studies which look at questions concerned with the adaptation of individuals (a microscale approach) and of questions posed at the macroscale (i.e. concerns with the impact of ageing upon social structures and vice versa). Social theories of ageing are characterised both by the level of explanation at which they operate and by the assumptions and ideologies that underpin them. Aroni and Minichiello (1992) developed a typology of theories including both the level of analysis (micro versus macro theories) and nature (interpretist contrasted with normative theories such as role theory). When evaluating the theories summarised below, and when encountering others not covered here, the student of gerontology needs to consider four basic questions: What is the level of explanation at which theory x operates? What does the theory try to explain? What type of questions is this theory trying to answer? What are the assumptions and ideology underpinning the theory? Using this basic framework helps us to clarify the robustness of the results and explanations proposed and expose the degree to which we can have confidence in their generalisability and reveal the assumptions upon which the research is based. Functionalist theories and ageing Functionalist perspectives have been highly influential in the development of theoretical frameworks in social gerontology. Theories such as disengagement, activity theory, continuity theory, the thesis of modernisation and age stratification theories of ageing all developed from the structural-functionalist premises. As such this has been a powerful influence upon gerontological thinking and the key assumptions of this approach are, therefore, summarised before examining the major ageing theories which derive from this perspective. Structural functionalism is a macrolevel theoretical stance that is concerned with analysing elements of society (social institutions and structures) in order to elucidate how society is maintained and developed. The appropriate analogy here is with the body. In order to understand how the body works you need to understand how each organ works, how the organs are interrelated and how they relate to the body as a whole. Functionalists adopt a similar approach to understanding and theorising about society and are concerned with identifying the functions that particular social arrangements fulfil for any given society. This approach views the elements of society as being functionally interdependent, with the individual and society always seeking to maintain a state of equilibrium  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 17 between them. In this perspective society is seen as being analogous to a biological system in that it is conceptualised as a number of identifiable and interrelated constituent parts. Each of the individual parts responds to changes in the other elements of the system. Hence within society different groups are conceptualised as interrelated and respond to changes in other parts of society. Society is seen as an `open' system where different component parts adapt and function to ensure that the overall system remains both unified and (relatively) stable and unchanged. In very broad terms functionalism may be seen as analogous to biological and natural sciences where there is an emphasis upon the creation and maintenance of (social) order. Specific behaviour patterns within a social system can be viewed as either functional or dysfunctional. Functional patterns help to main tain and integrate the social network while dysfunctional patterns lead to breakdown and disintegration. The functional operation of each organ or unit within society (such as older people) has implications for the well- being of society as a whole. It is assumed that there is an agreed and universal set of values within society that determine the goals and norms through which social order is maintained. Hence this is a theory which posits that social order is maintained via consensus rather than conflict. Social order is maintained by the existence of powerful social norms (the expectations given to specific social roles) which are internalised via a system of `socialisation' and social control that suppresses deviance from expected norms via agencies of social control such as the police, schools and other state bodies. Before considering the major gerontological theories that have developed out of functionalism it is necessary to outline the metacritiques which have been made of this approach. The implicit emphasis within functionalism is upon social order, equilibrium and the maintenance of the status quo rather than upon possible change and conflict. Hence the functionalist perspectives, and resulting theories of ageing, are seen as being essentially conservative. In reading functionalist theories, with their stress upon determined nature of many social actions, the power of individuals to influence their social environment is highly limited. Individuals are seen as little more than passive social actors or `cultural dopes' (Aroni and Minchello, 1992). Furthermore society is conceptualised almost as a separate entity, with its own set of needs and desires, and an existence separate from the individual members. However, despite these critiques, functionalism has been important in gerontology given that much of the emphasis in our area has been towards investigating and understanding personal and social adjustment to old age, changes in social roles which often accompany later life and life satisfaction. Given these concerns it is, perhaps, hardly surprising that functionalism has been so important to the development of theory in gerontology. Hence we consider the major functionalist theories which have influenced gerontological thinking and have had a very profound influence upon the types of research questions posed and the development of our knowledge base. 18 THEORETICAL PERSPECTIVES ON STUDY OF AGEING Disengagement theory This is a theory which links both micro and macro approaches to the study of ageing. Disengagement was the first explicit social theory that was concerned with ageing and was originally formulated in Growing Old by Cumming and Henry (1961). This theory posits that, independent of other factors such as poor health or poverty, ageing involves a gradual but inevitable withdrawal or disengagement from interaction between the individual and her/his social context and that this process is mutually beneficial. Thus disengagement would be seen as functional or useful, because it facilitates a smooth transfer of power from the old to the young. From this perspective, retirement is seen as a mechanism by which companies can predetermine levels of employee turnover, gives the individual a `graceful' exit from the pressures of employment and creates employment opportunities for younger workers. Hence disengagement, as illustrated by retirement, is a mechanism for ensuring equilibrium within society and the transition of social power across generations. By disengaging from activity, either employment or social, individuals prepare themselves for death. At the same time, society also prepares the individual for the later phases of life, by withdrawing the pressure to interact and facilitating the entry of younger cohorts into the social world and the disruption caused by the death of the individual is minimised. Disengagement therefore implies a triple loss for the individual: a loss of roles, a restriction of social contacts and relationships and a reduced commitment to social mores and values. Successful ageing, from the viewpoint of disengagement theory, implies a reduction in activity levels and a decrease in involvement, until the individual withdraws from all previous activities and becomes preoccupied with the ultimate withdrawal of death. Central to this theory is the assumption that both the individual and the wider society benefit from the process. Withdrawal for the individual may mean a release from social pressures that stress productivity, competition and continued achievement. For society, the withdrawal of older members permits younger, more energetic individuals to take over the roles that need to be filled. Disengagement therefore is seen as a way of permitting an orderly transfer of power between generations. The mutual withdrawal of the individual and society from each other is presented as a necessary condition for both successful ageing and the orderly continuation of society. This involves a triple loss—of social roles validated by society, restricted social contact and a reduced commitment to social mores. Disengagement theory had a profound influence upon the development of gerontological research partly because it was the first major theory and thereby generated considerable debate and discussion within the gerontological world. It has also been influential because it appeared to indicate the pathway to `successful' ageing. In this latter manifestation it is the first of many apparently prescriptive pathways offering the key to successful ageing. In this case the way to age `successfully' was to reduce social involvement and social interaction.  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 19 Although a negative pathway to the nirvana of successful ageing, it is not conceptually different from other ways to a successful old age such as dietary adaptations (such as eating yoghurt) or religious or physical activity. It was also highly influential at a time when the first stirrings of apocolyptic demography were being heard and it clearly resonated with the negative concerns which were linked with population ageing. Disengagement influenced the direction of research as investigators sought to establish the veracity of this particular theory. The empirical evaluation of disengagement as a theory of ageing must address three core aspects of the theory. First, disengagement is a life-long process; for most individuals, it takes place over a period of time rather than suddenly. Throughout the life course the individual is continually acquiring and dropping particular social roles. Hence it is problematic to design a research study which could easily incorporate this `lifelong' perspective. Second, there is an implicit statement that disengagement is inevitable because death and biological decline are inevitable, although the nature and timing of disengagement will vary between individuals, historically and culturally. Again to establish the inevitability of reduced social engagement poses methodological challenges. How can `inevitable' disengagement be differentiated from reduced levels of social participation resultant from ill health or poverty? Third, disengagement is seen as adaptive for both society and the individual. Reduced social engagement is seen as being beneficial. Further measurement challenges are posed by the requirement to measure disengagement. How does one develop a measure to record disengagement? Against what pre-existing standard does one determine if disengagement is present (is it the individual's previous levels of activity or some population norm?). Given these very problematic methodological issues this may be a theory it is impossible to test empirically, clearly a major flaw with any theory. There is some empirical evidence to support disengagement theory in that older people do experience a loss of roles with ageing, whether through retirement, the death of a spouse or the departure of older children from home. However, older people, like other groups within the population, use strategies of substitution and compensation to offset for losses of role. The widowed may remarry, or older people may replace a widespread and loose-knit pattern of interaction with more intense, locally based networks. While empirical data may demonstrate reduced social activity with increasing age, the inevitability, universality and essentially adaptive nature of these changes remains unproven. Indeed the veracity of disengagement theory is further compromised because of the involuntary nature of many disengagements, such as mandatory retirement and the failure for disengagement to be demonstrated universally (for example there are some societies where social roles increase in later life). However, Daatland (2002) has suggested that disengagement theory was an important stage in the development of gerontology because it identified old age as distinct and important phase of life and because it was an essentially multidisciplinary perspective. 20 THEORETICAL PERSPECTIVES ON STUDY OF AGEING Several commentators argue that disengagement theory has had profound negative impact upon older people because of its influence within social and health policy formulation. Blau (1973) argues that disengagement theory has been used to avoid confronting and dealing with the issue of older people's marginality in American society and to condone indifference towards the problems of older people. Estes et al. (1982) and Estes (2001) consider that the popularity of disengagement theory has had a marked influence upon the formulation of policy for older people in the United States. They argue that this concept of old age prescribes either no policy response to ageing or interventions that achieve the separation of the older person from society. Similar arguments could be constructed for the United Kingdom where many services for older people are often discrete or separate from the mainstream (the argument being that specialist services offer better services by concentrating expertise). Such separations may be spatial as well as conceptual with, for example, health services for older people located off main hospital sites, in former workhouse premises or symbolically in the oldest hospital buildings. Disengagement theory has implicitly formed the justification and intellectual basis for age-segregated policies and the separation of older people from other forms of welfare development. The notion of disengagement has been used to legitimise policies that have sought to exclude older people from social arenas and services and enabled professionals dealing with older people to rationalise their often- negative stereotypes. This theory has further enabled the erection of `barriers' between older people and other social groups and the professionals dealing with them, with the inevitable consequence of poor quality services and inadequate education and training for the staff working within them (Biggs, 1993, 1999). It has also provided the theoretical justification for a culture of indifference for both the problems experienced by older people and the policy formulations developed in response to these. Poor quality services, low pensions and inadequate standards of care can be justified by theorising that old age is a time of disengagement and that older people are no longer to be evaluated against current social mores. Hence it is perfectly acceptable to provide them with marginal or substandard care and concern. The response to disengagement: activity theory The presumed inevitability of the process of disengagement, with its basis in the biomedical and sickness model of ageing, has also been subject to extensive academic criticism. While disengagement theory has been highly influential in the development of social gerontology, empirical testing and debate have exposed its essential frailty. It has, however, had an important impact in stimulating the development of counter-theories of which activity and continuity theories are the most significant. These two theories are concerned with the ageing of individuals although, again, approached from a macrolevel theoretical perspective. However, it still remains within the structural functionalist paradigm  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 21 in that it is concerned with the maintenance of equilibrium within society. The focus is upon adaptation and integration into the social system and, again, it is prescribing a route to successful ageing. Diametrically opposed to the notion of disengagement is activity theory. Developed by Havighurst (1963) this perspective maintains that normal and successful ageing involves preserving, for as long as possible, the attitudes and activities of middle age. Here mid-life is conceptualised as the nirvana of `success' to which we are always looking back and always trying to regain. To compensate for the activities and roles that the individual surrenders with ageing, substitutes must be found. Upon retirement from paid employment the retiree must find other roles, such as voluntary work, to compensate for this loss. It is assumed that any type of activity can be substituted for the lost role. The assumption is made that the meaning and value attached to different activities are the same and that all members of society share these meanings. Both these assumptions may be unfounded. Activity theory is a prescriptive view of ageing which argues that activity and engagement offer the path to successful ageing. This is a socially based manifestation of the `use it or lose it' conceptualisation of successful ageing and is the mirror image of disengagement but is equally judgemental and prescriptive. There are two central assumptions of activity theory. First, that morale and life satisfaction are positively related to social integration and high involvement with social networks: those with high levels of activity and integration are more satisfied. Second, role losses such as widowhood or retirement are inversely correlated with life satisfaction and such losses need to be compensated for by the substitution of compensatory activities. Again the empirical evidence in support of these assumptions has been ambiguous. Activity theory suffers from the problems of measurement and research design noted for disengagement theory. It also is a good example of the difficulty resultant from using cross- sectional research designs to make assertions about causal relationships. Studies may well demonstrate that those who are most active are also the most satisfied with life and we can demonstrate a statistical association between these two variables, but we cannot determine if activity `causes' satisfaction. It may well be the case that activity promotes satisfaction. However, it could equally well be argued that satisfaction with life causes activity or that some other confounding (or intervening variable) such as health or income influences both activity and satisfaction. Furthermore, research has demonstrated that individuals can maintain high levels of satisfaction and quality of life with both declining levels of activity and with low levels of activity. Again, one may question the value judgements inherent in the theory that interaction and activity in old age is a `good thing'. The social policy implications of this perspective are rather more positive than disengagement theory, for at least it argues for the integration of older people as full members of society. 22 THEORETICAL PERSPECTIVES ON STUDY OF AGEING The response to disengagement: continuity theory Continuity theory holds that, in the course of growing older, the individual will attempt to maintain stability in the lifestyle he/she has developed over the years. Continuity theory suggests that in the process of ageing, the person will strive to preserve the habits, preferences and lifestyle acquired over a lifetime; that there will be a process of evolution of activities as the individual grows older (Atchley, 1999). Both disengagement and activity theory suggest that successful ageing is achieved by movement in a single direction. Continuity theory, in contrast, starts from the premise that the individual will try to preserve the favoured lifestyle for as long as possible. It then suggests that adaptation may occur in several directions according to how the individual perceives her/his changing status. The theory is rather less dogmatic in that it does not assert that one must disengage, or become active, in order to cope with the ageing. Rather the decision regarding which roles are to be disregarded and which maintained will be determined by the individual's past and preferred lifestyle and potentially by structural factors such as income and health. Unlike activity theory, this approach does not assume that lost roles need to be replaced. Continuity theory, therefore, has the advantage of offering a variety of patterns of successful ageing from which the individual can choose. The disadvantage is the problem of trying to test this theory empirically. Each individual's pattern of adjustment in old age or retirement becomes a case study in which the researcher attempts to determine how successfully the individual was able to continue in her/his previous lifestyle. Building a generally applicable theory from this basis is, therefore, difficult. From a research and policy perspective, it stresses the need to understand the biography and lifecourse of the individual in attempting to understand her/his experience of later life. As such it is a more person-centred approach and stresses the links between `old age' and earli er phases of life. The importance of social roles in functionalist theory Both disengagement and activity theory embrace the structural-functionalist concept of social roles. Social role theory originated within the interpretist perspective derived from anthropology and the theories noted earlier are concerned, as is much gerontological work, with the meaning, content and organisation of social roles in later life. Disengagement, activity and continuity theory are all, to a lesser or greater degree, concerned with how older people adjust to changes and losses in social roles. However, such concerns are also evident in other phases of the lifecycle—role loss is not exclusive to old age. All three theories offer a profoundly negative view of old age in which all role changes are the result of loss. There is little reference to new positive roles such as becoming (great) grandparents. Social role theory assumes the existence of a set of rules, regulations and roles and that as an individual ages there will be a change (adaptation) in the number of  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 23 social roles an individual has and how these are executed. Here roles are conceptualised in the Parsonian sense and are defined in terms of both expectations of the role and orientation of the role. Roles are part of the normative order of society and are powerful determinants of behaviour as there are sanctions for deviation from `social expectations'. Put at its most straight forward a social role can be conceptualised as a pattern of behaviour expected from an individual who holds a particular social status (defined in terms of social position) —in our examples that of an older person. However, the social world is a complex entity and any individual has a multitude of roles to play simultaneously. An individual could be involved in the roles of spouse, parent, sibling or employee at the same time. All of these roles stress different aspects of the individual's persona. In the broadest sense, competing social roles differ in three main ways. First, roles will emphasise varying qualities. Some roles are defined in terms of the task undertaken, such as the worker role, while others are defined more in terms of emotional content, such as wife or husband. Second, social roles vary in the type of reward offered, such as money, prestige, status, emotional support or satisfaction. Third, roles are evaluated according to the values of the society. For example, in capitalist societies strongly imbued with the Protestant work ethic, the role of the retired person or the mother staying at home looking after small children may be ascribed little value. Similarly, the retired person may be ascribed little status in a society, which places its major emphasis upon economic activity and financial independence. The notion of social roles is complex and a dynamic area of social world which not all theories acknowledge. In attempting to understand later life we clearly need to be able to integrate our understanding of the different roles that older people play and how they make sense of them. Age stratification theory This is another good example of a theory which is concerned with the adaption of groups, rather than of individual older people. Again the concern is with examining social integration but from the basis of age-based groups and it flows out of the consensus approach. Society is often conceptualised as being stratified, or divided, along a number of dimensions such as social class or ethnic status and these factors are used to allocate social roles. Age stratification theory uses chronological age as the defining and role allocation variable (Riley, 1971; Riley et al., 1973; Riley, 1987). Three basic issues dominate age stratification theory: first, the meaning of age and the position of age groups within any particular social context, second, the transitions which individuals experience over the lifecycle because of these social definitions of age, and third, the mechanisms for the allocation of roles between individuals. Riley (1971) argues that each age group (young, mid-life and old) can be analysed in terms of the roles that members of that group play within society and how these are valued. For example within the employment field, workers may be 24 THEORETICAL PERSPECTIVES ON STUDY OF AGEING classified as `older' and `younger' and the latter valued more highly because of their perceived greater productivity, innovation and vitality. The use of chronological age in guiding the allocation of social roles is probably universal to all cultures, but the precise nature of these age norms reflects the culture, history, values and structure of specific societies. For example, over the twentieth century there have been substantial variations in some aspects of the lifecycle. Childbearing and child-rearing are now confined to a much shorter period than previously when women were `reproductively active' for twenty-five to thirty years. This has been matched by the creation and increase in the duration of the `empty nest' phase of the lifecycle. Similarly, within specific societies the size, composition and history of particular cohorts influence both the timing and order of the major life events. The existence of compulsory national service will `delay' the major life transitions such as marriage, going to university or starting a career. These age norms in behaviour may originate in tradition, factual regularity or negotiation. Whatever the origin, they are based upon assumptions, either explicit or implicit, about age-related abilities and limitations. These norms may, however, vary with social class, ethnicity or sex, historically or culturally. For example, members of the working class traditionally marry at an earlier age than members of the professional classes. Similarly, age at first marriage is usually older for males than for females. Because of these variations, age norms have different realities and meanings for varying social groups. Despite this, age is a universal criterion for role allocation. The age grading of roles within an age stratification system creates age differences and inequalities. Each age group is evaluated, both by itself and others in the society, in terms of the dominant social values. This differential evaluation of roles will produce an unequal distribution of power and prestige across the age groups. Thus when societies value the accumulated experience and wisdom of the old, and allow them to undertake roles that capitalise upon this experience, then the aged will be accorded a position of respect. Riley and Riley (1994a) have developed the notion of structural lag as a way of responding to the observation that individual lives, in relation to age-graded roles, change more rapidly than social norms or institutions. They argue that social institutions lag behind major social changes such as the institutionalisation of formal retirement. Now people can anticipate fifteen or twenty years of retirement without the development of social opportunities and clear roles. Similarly a policy of `lifelong learning' does not fit easily with the completion of formal education for most people between 18 and 25 years. This approach can be used to argue for a review of our formalised age norms, such as retirement, which can lead to the loss of the potential contribution of older people across the life course. The value of this approach is that it allows the gerontologist to look at any age group in terms of its demographic characteristics and its relationships with other groups. The system of age stratification in any society is complex and dynamic  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 25 and linked in with other systems of stratification such as class or ethnicity. The task of understanding the effects of age stratification is complicated by these interactions. Furthermore the usefulness of this approach is weakened by the use of chronological age rather than `actual' ageing to define cohort membership; the `meaning' attached to particular ages is both historically and culturally specific. This is very much a macroscale approach to the study of ageing for, while it tells us about the attributes of different cohorts, it is of limited value in explaining individual behaviour. This approach can often be seen as being deterministic and allowing little freedom of action for the individual social actor because of the themes' macrolevel orientation and of being an essentially static theory which neglected political processes (Quadagno and Reid, 1999). Riley et al. (1999) developed the ageing and society paradigm to address the static nature of age stratification. This new paradigm distinguished the notions of changing lives and changing structures as two interrelated sets of processes. However, this remains an essentially functionalist stance which emphasises balance, integration and norms and one in which factors such as class and gender are conspicuously absent. Modernisation theory The position of older people in pre-industrial society is usually described as one of respect and authority. Typically, pre-industrial society is depicted as the `golden age' of ageing and older people, although every stage in history seems to look back to its own `golden age'. This stereotypical view of the past is usually contrasted with their position in modern society where older people are thought to be worse off because they are consigned to meaningless retirement, neglected by their family and ignored by the prevailing youth culture. The basic thesis of modernisation theory is that as society moves from rural to industrial, the position of older people deteriorates as urbanisation and industrialisation combine to undermine the extended family and replace it with the nuclear family as the primary unit of society and isolate older people from both society and the family. Cowgill and Holmes (1972) developed these ideas further. The process of modernisation was defined by four parameters: improvements in medical technology, the application to the economy of science and technology, urbanisation and mass education. Cowgill and Holmes (1972) argued that improvements in health care led to an ageing of the population. The decrease in the potency of death results in an ageing of the working population and a decrease in job opportunities for the young. Thus intergenerational tensions are created by the competition for jobs. Retirement then becomes a social substitute for death and creates job opportunities for the young. However, the dominance of the prevailing work ethic results in a `devaluing' of retirement. Additionally economic and technological developments devalue the employment skills of the old. Urbanisation attracts young people from the rural areas, resulting in a break- 26 THEORETICAL PERSPECTIVES ON STUDY OF AGEING up of the extended family. Finally, the development of mass education reduces the hold that older people have over younger people. Changes in these four factors contributed, it was argued, to a decrease in the status of the older people in modern society. In such developing social settings, youth and progress are extolled while the traditions and experience of the old are developed and seen as irrelevant and their reduced power and prestige places them at a disadvantage. The old become socially and physically abandoned and live a marginal existence on the fringes of society. First, implicit within this theory is the notion that pre- industrial societies are uniform and are characterised by a positive attitude towards older people. Second, it assumes there has been a before-and-after situation within societies with regard to the position of older people and that there has been a smooth, uniform, linear translation from one type of society to another. Third, and perhaps most important, there is now a significant body of empirical research which indicates that the presence of an extended family does not guarantee the status and care of older people (Thane, 2000). Again pre- industrial societies illustrate a degree of diversity in the attributes displayed towards older people and it is unwise to presume a homogeneity that is more fable than fact. Conflict theory and ageing As its name suggests, conflict theorists take a rather different view of the organisation of society than functionalists who stress the values that different social groups have in common. In contrast conflict theory, which derives from neo-Marxist and neo-Weberian views of society, stresses discord and conflict. Social groups are conceptualised as having opposing views and are seen as being in conflict over control and access to social resources. However, this is still a macrolevel group of theories in that the concern is with society overall rather than individuals. Society is conceptualised as being stratified into specific groups and classes and society is seen as the result of the conflict between these different groups. The neo-Marxists explain this conflict as a result of economic inequalities resulting from the concentration of economic power within specific groups (which then seek to retain control of them). Neo-Weberians take a more expansive view of the roots of social conflict, which include not only economic power but also social status and ideology. Gerontological applications of this theoretical perspective are much less common than theories from the functionalist perspective but include the highly influential structured dependency theory and political economy approach to ageing. This perspective upon ageing became very important in the development of the `radical' dimension of British gerontological developments and has key protagonists in the United States (Estes, 2001) and Europe. Such themes were not, however, unique to the field of ageing but demonstrated a wider resonance across the social sciences (see Estes et al., 2001).  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 27 Structured dependency and the political economy approach The approach to old age from a conflict theory perspective emphasises the continuity into later life of the inequalities that characterise the earlier phases of the lifecycle. To oversimplify the case, those who were poor in mid-life will be poor in old age (perhaps even poorer) while those who were rich and powerful remain so. A good example of this was Queen Elizabeth, the Queen Mother. Although she lived to be a centenarian her wealth, power and prestige were not compromised by her experience of ageing. The structured dependency theory was initially proposed by Townsend (1981) and then enthusiastically taken up by others such as Estes (1979), Walker (1980, 1981), Myles (1984) and Pampel (1998). Structured dependency theory has been especially influential in British gerontology during the latter part of the twentieth century while in the United States similar views were described as political economy. Political economy is concerned with the interaction between the state, the economy and various socially defined groups, in this case older people, and in particular with the way `social goods' are distributed between groups and the mechanisms by which they are allocated. Those working in the broad field of political economy were informed by four main areas: conflict theory, critical theory, feminism and cultural theory. What both political economy and structured dependency are concerned with is the proposition that the dependent social position of older people and the problems they experience are socially constructed and derive from conceptions of ageing and health. This approach to the study of old age is essentially structural and macrolevel in nature although Estes (2001) now claims that it can be used to study micro- and meso-level (organisational) aspects of ageing. This perspective offers a sharp contrast to the potentially `victim blaming' and `biomedical' philosophy of old age as a time of loss and decline which was at the heart of some manifestations of structuralist theories. Political economy theorists argued strongly against these assumptions and developed a theoretical framework in which age is conceptualised as a social rather than biological construct and one which is located within the explicit study of capitalism. Social policies, which shape old age, are seen as the product of economic, social political and cultural forces. The political economy approach, as exemplified by Estes (1979), Walker (1981) and Olson (1982), argues that old age is defined neither by chronology nor by biology but by the relationship between older people and the means of production in general and social policy in particular. The organisation of production, social and political institutions, social processes and the social policies pursued explicitly (or implicitly) by society is seen to be, in this approach, the key relationships. It assumes a structural relationship between older people and the rest of society, with society constructing the institutions and rules within which old age is defined and the experienced of ageing contextualised. Estes (2001) argues for the importance of the state in defining and experience of old age because (a) the state is important in the distribution of 28 THEORETICAL PERSPECTIVES ON STUDY OF AGEING power and resources, (b) it intervenes to mediate relationships between different social groups, and (c) it intervenes to ameliorate conditions which threaten the overall stability of society. From this perspective, older people are seen not as a group separate from the wider social context, but as an integral, if marginalised, part of society. Capitalism and the state combine to marginalise and dominate older people (Walker, 1999). However, in this perspective older people cannot be analysed in isolation from the society within which they are located. Central to this perspective is the notion of structured dependency (Townsend, 1981). This approach argues that in order to understand the dependent situation of groups such as older people we need to understand the essentially `socially constructed' nature of this status. Dependency is viewed as a socially constructed entity best understood in terms of relationships between the dependent group, in this case older people, capitalism and the state. Policies for social security, retirement and pensions assume particular importance in this perspective because they determine the duration of the working life and assign dependent status to specific phases such as retirement (or child-rearing) or to groups such as the long- term sick or to handicapped people. This dependency is enhanced and reinforced by the exclusion of older people (or young mothers) from employment, the major means of economic status in advanced capitalist societies. As a result of this socially constructed exclusion from the labour market, and their reliance upon welfare and pensions for their source of income, older people experience wider social exclusion such as poverty, reduced community involvement, institutionalisation and marginalisation. This exclusion of older people from the social mainstream could, therefore, be overcome by changes in social policy, most notably a major increase in the level of the state pension. The political economy and structured dependency approaches have several positive aspects. First, it has offered a powerful set of counter-arguments against the demographic `doom and gloom' analysts who portray the increasing numbers of older people as an inevitable social and economic catastrophe. This perspective has important new questions for research and has done much to overturn the assumption that the experience of old age is homogeneous and that those factors such as class, gender and ethnicity do not matter. This perspective has also been instrumental in raising questions about the nature and quality of services offered to older people. Second, structured dependency has, at its heart, a focus upon the full integration of older people into society and, as such, offers a sharp contrast to the notions of disengagement so characteristic of earlier gerontological studies. It has certainly been one of the most influential gerontological theories and excited a whole generation of scholars. There are drawbacks to this approach which are well summarised by Gilleard and Higgs (2000). Conceptually it is a macrolevel theo retical framework concerned, as it is, with the analysis and explanations of the workings of the social system and its problems. The key concept of structured dependency is rather deterministic and fails to address the issue of the power of individuals to challenge such classification and control mechanisms. By focusing upon  THEORETICAL PERSPECTIVES ON STUDY OF AGEING 29 relationships with the labour market and issues of retirement, which for current generations of elders largely concerns men only, this perspective has failed adequately to deal with issues of gender. Perhaps most importantly this approach has largely ignored questions concerning the meaning and purpose of the experience of ageing. Its focus upon structure has led to the relative neglect of the experiences of older people and the ways that they make sense of old age, although this is now changing. By focusing upon a `mass' solution to the key problem of poverty in old age, structured dependency theorists end up homogenising older people by proposing a simple `one size fits all' policy solution. This has been somewhat undermined by the discovery of significant variations among the current cohort of elders in terms of class and gender. Phillipson (1998) responds to this challenge by developing a dichotomy in the history of old age (Gilleard and Higgs, 2000); up to the 1970s the welfare state and retirement were central to the development of a `secure' old age, while after this period the institutions of the welfare state were radically transformed by recession and the rupture of the consensus on the role of the welfare. This, combined with increasing diversity of the older population, has led Phillipson (1998) to argue for the creation of `critical gerontology', which marries the political economy perspective with its recognition of the importance of class, gender and biography to provide a more rounded perspective upon old age and later life. Estes (2001) has significantly developed this approach by developing a complex multilevel analytical framework that incorporates (a) financial/post- industrial capitalism and globalisation, (b) the state, (c) sex/gender system, (d) citizen/public and (e) the ageing enterprise/ medical industrial complex. These are located within the interlocking systems of oppression—class, race, gender and ideology. Despite the refinements, it remains a theory which is problematic at the microlevel of analysis. Interpretist theory and ageing In contrast to the macrolevel theories of ageing are those developed from the interpretative tradition in social science and which have a microlevel focus where the individual is the key focus of theoretical attention. As noted in the development of Phillipson's (1998) notion of critical gerontology, there are now explicit attempts to link these different theoretical approaches in a more integrated fashion. At the heart of the differing manifestations of the interactionist perspective is the notion that we should understand those we study and that we can do this best by trying to view and understand the world as they do. These approaches, with their emphasis upon individuals, offer a very different way of theorising about social phenomena from the structuralist perspectives. In a structuralist