Medical Sociology and Old Age: Towards a Sociology of Later Life (Critical Studies in Health and Society)

155 Pages·2008·0.99 MB·English

by  Paul Higgs

Medical Sociology and Old Age
As populations throughout the world grow older, the health of older
people becomes more and more important for policy makers and the
publicalike.Thisbookreflectsonhowourunderstandingandexperience
ofhealthatlateragesinteractswithsocialandbio-medicaldevelopments.
The nature of health in later life has conventionally been studied
fromtwo perspectives. Medical sociologists have focused on the fail-
ing body, chronic illness, infirmity and mortality, while social ger-
ontologists on the other hand have focused on the epidemiology of
old age and health and social policy. By examining these perspectives,
Higgs and Jones show how both standpoints have a restricted sense
of contemporary ageing which has prevented an understanding of the
wayinwhichhealthinlaterlifehaschanged.Inthebook,theauthors
pointoutthatthecurrentdebatesonlongevityanddisabilityarebeing
transformed by the emergence of a fitter and healthier older popula-
tion. This third age – where fitness and participation are valorised –
leads to the increasing salience of issues such as bodily control, age-
denialandanti-ageingmedicine.Bydiscussingthekeyissueofoldage
versus ageing,the authors examine the prospectofa newsociology– a
sociology of health in later life.
MedicalSociologyandOldAgeisessentialreadingforallstudentsand
researchers of medical sociology and gerontology and for anyone con-
cernedwiththechallengeofageingpopulationsinthetwenty-firstcentury.
PaulHiggsisProfessoroftheSociologyofAgeingatUniversityCollege
London.
Ian Rees Jones is Professor of Sociology of Health at Bangor University,
Wales.
Critical Studies in Health and Society
Series Editors: Simon J. Williams & Gillian Bendelow
Thismajornewinternationalbookseriestakesacriticallookathealthinarapidly
changingsocialworld.Theseriesincludestheoreticallysophisticatedandempiri-
cally informed contributions on cutting-edge issues from leading figures within
thesociologyofhealthandallieddisciplinesanddomains.Othertitlesintheseries
include:
Contesting Psychiatry
Socialmovements inmental health
NickCrossley
Lifestyle inMedicine
GaryEasthope andEmilyHansen
Medical Sociology andOld Age
Towards asociologyofhealth inlaterlife
PaulHiggsandIanReesJones
Emotional LabourinHealth Care
Theunmanaged heartofnursing
CatherineTheodosius
Globalisation, MarketsandHealthcare Policy
Redrawingthe patientasconsumer
Jonathan Tritter, MeriKoivusaloandEevaOllila
Written in a lively, accessible and engaging style, with many thought-provoking
insights, the series will cater to a truly interdisciplinary audience of researchers,
professionals, practitioners and policy makers with an interest in health and
socialchange.
Those interested in submitting proposals for single or co-authored, edited or
co-editedvolumesshouldcontacttheserieseditors,SimonJ.Williams(s.j.williams
@warwick.ac.uk)andGillianBendelow ([email protected]).
Medical Sociology and
Old Age
Towards a sociology of health in later life
Paul Higgs and Ian Rees Jones
Firstpublished2009
byRoutledge
2ParkSquare,MiltonPark,Abingdon,OxonOX144RN
SimultaneouslypublishedintheUSAandCanada
byRoutledge
270MadisonAvenue,NewYork,NY10016
Routledge is an imprint of the Taylor & Francis Group, an informa business
This edition published in the Taylor & Francis e-Library, 2008.
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©2009PaulHiggsandIanReesJones
Allrightsreserved.Nopartofthisbookmaybereprintedorreproducedor
utilisedinanyformorbyanyelectronic,mechanical,orothermeans,now
knownorhereafterinvented,includingphotocopyingandrecording,orinany
informationstorageorretrievalsystem,withoutpermissioninwritingfrom
thepublishers.
BritishLibraryCataloguinginPublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
LibraryofCongressCataloginginPublicationData
Higgs,Paul.
Medicalsociologyandoldage:towardsasociologyofhealthinlaterlife/
PaulHiggsandIanReesJones.
p.cm.–(Criticalstudiesinhealthandsociety)
Includesbibliographicalreferences.
1.Olderpeople–Healthandhygiene–Socialaspects.2.Socialmedicine.I.
Jones,IanRees.II.Title.III.Series.
[DNLM:1.Aged.2.Geriatrics.3.Sociology,Medical.WT30H637m2008]
RA564.8.H542008
362.198097–dc22 2008018379
ISBN 0-203-88872-3 Master e-book ISBN
ISBN978-0-415-39855-8(hbk)
ISBN978-0-415-39860-2(pbk)
ISBN978-0-203-88872-8(ebk)
Contents
Preface vii
1 Medical sociology and old age 1
Introduction 1
Medical sociology approaching old age 3
Age as a category within medical sociology 7
Later life in the context of a second modernity 11
Conclusion 16
2 Social gerontology and old age 17
Introduction 17
Structured dependency theory 19
The third age 21
Productive ageing 23
Cultures of ageing 25
Social research and the problematisation of later life 27
Bio-gerontological perspectives 29
Conclusion 32
3 The body at later ages 34
Introduction 34
Sociology of the body and embodiment 35
Postmodern critiques and realist responses to the loss of
meaning 42
The reflexive self, the lived experience of disability and the
vicissitudes of ageing bodies 44
Conclusion 47
vi Contents
4 New developments in social gerontology 49
Introduction 49
Globalised society and old age 49
Critical gerontology 55
Feminist gerontology 58
Postmodern gerontology 61
The cultural turn in gerontology 62
Conclusion 64
5 The death of old age, critical approaches as undertakers 66
Introduction 66
Bodily appearance 68
Bodily functioning 71
Bodily control 73
Conclusion 80
6 The birth of a new sociology of health in later life 81
Introduction 81
The somatic society at later ages 82
The ‘arc of acquiescence’ 85
Anti-ageing medicine and technologies 87
Boundaries between the third and fourth ages 90
Death and immortality 95
Conclusion 97
7 Conclusion 99
Second modernity and later life 100
A research programme for later life in second
modernity 104
Conclusion 112
Notes 115
References 117
Index 140
Preface
The idea for this book was in part motivated by the fact that both of
us worked in fields that straddled the subject areas of medical sociology
and social gerontology. While we felt that there were many overlaps
between what we were doing in both fields, it became more and more
clear that we were in fact dealing with two separate worlds, each
with their own literatures and pre-occupations. What was striking
was that with a few notable exceptions such as Margot Jeffreys and
Mike Bury there were few who seemed to be aware of the material
that existed on either side of the ‘divide’. Consequently this book
aroseout ofaneedto try toaddressthis gapasmuch forourselvesas
for others undoubtedly dealing with the same issues.
A further motivation came from the fact that not only was ageing
becoming a larger and larger issue for social policy (Esping-Andersen
2002), but it was also affecting the discussion about the provision of
health services for the population as a whole as can be seen in the
work surrounding the Wanless Report (Wanless 2001). A pleasing
consequence of this rise to prominence of ageing in the wider world
was that our work on older people and later life became more inter-
esting tocolleagueswhohadpreviouslyseenitasabitofanintellectual
and research backwater. The attention, however, also demonstrated
that many of the assumptions that were held about ageing by quite a
few social scientists were limited in their understanding of con-
temporary ageing. We were also aware that many of these assump-
tions had, in part, resulted from much of the work that researchers in
ageing such as us had been responsible for. This was all the more
problematic because we were also aware of how the terrain of ageing
was changing and how it necessitated different conceptual tools and
approaches. Indeed, the changes in the nature of old age, the impact
viii Preface
of consumerism and technology as well as the role of generation all
indicated that an engagement with a more sociologically informed set
of ideas was necessary. Certainly we are not the first to come to this
conclusion. Bryan Turner in his The New Medical Sociology (Turner
2004) points out the importance of ageing when trying to understand
the changing nature of health and illness in the twenty-first century.
He links the ageing body around impairment and disability, and
points out the importance of time and context in understanding the
relationship between age and health. However, in general we have
found that few have as yet got beyond seeing ageing as a residual
category. In both Williams and Bendelow (1998) and Crossley (2001),
volumes on the lived body and the social body respectively, there is
littleornoengagementwiththeissueofageingembodiment(although
Simon Williams rectifies this in a later work, see Williams, 2003) and
it will be interesting to see if revised versions of standard medical
sociology textbooks will devote more space to the issue in the future.
It is also not the case that writers in the mainstream of the discipline
are any more aware of the issues of ageing and later life. Ageing itself
is generally seen to be outside the purview of most general socio-
logical texts on social structure – the omission being generally un-
noticed and not seen as needing rectification. Harriet Bradley (1996)
in her Fractured Identities: Changing Patterns of Inequality explicitly
points this out by calling her chapter ‘Age: The neglected dimension
of stratification’. The fact that this book is over a decade old and
there has been little subsequent engagement suggests that age is still a
neglected dimension within sociology.
Our desire in writing this book was therefore to help rectify this
anomaly especially as the issues of ageing in a somatic society not
only presented many opportunities to develop medical sociology but
also made an engagement with the issues thrown up by later life
essential for the continuing relevance of the sub-discipline. However,
if coming to grips with an ageing society is important for medical
sociology, likewise understanding how it has changed is also crucial
for the continuing development of social gerontology. While there
have been many research initiatives around old age in the UK, social
gerontology has remained a relatively weak and peripheral field of
study. There are no undergraduate programmes in gerontology and no
funding organisations with the powerof the US National Institutes of
Aging organising research priorities on later life. Whereas in the US
researchhas beenfocused on determinants ofsuccessful orproductive
Preface ix
ageing, the focus in Britain has been more around the needs of social
and health policy with an emphasis on the ‘structured dependency’ of
older people. The landmark studies in British social gerontology,
Townsend’s The Last Refuge (Townsend 1962) and Family Life of
Older People (1957) continue to set a framework for studying later
life that centres on marginalisation of older people by state and
public institutions.
In the USA, the emphasis on ‘successful ageing’ reflected the dom-
inance of medical and psychological paradigms on research trajec-
tories. Indeed, much of the work that is published in gerontological
journals continues to adopt either an epidemiological or psychologi-
cal rather than sociological approach to issues of health. However,
this does not mean that there has been no theoretical elaboration of a
sociology of ageing (Riley, Johnson and Foner 1972), but it has been
dominated by various attempts to establish a political economy
approach to ageing (Estes, Linkins and Binney 1996). In both coun-
tries a key aspect of what has now come to be identified as ‘critical
gerontology’ has been a critique of the presentation of old age as an
economic and social burden while at the same time being the source
of profits for managed care and medical insurance companies (Estes
2001). In this there is little discussion of how health and disability
interact, other than by reference to the social policies that situate it.
Whilecriticalgerontologyhasmadeanumberofimportantandtelling
points with regard tothe construction of old ageby, and through, the
needs of corporate medical industrial complexes (Estes 1979), and has
expanded its ambit to discussions of identity, neo-liberalism and glo-
balisation, it still seems unable to abandon its connections to social
policy and 1970s Marxism. Indeed, Green (1993) suggests that social
gerontology is an ‘incoherent domain of theory’ applied to both
individual and cohort ageing. This hampers it in its attempts to
develop explanations for the rapid changes to later life experienced in
recent years. As the geriatrician Raymond Tallis points out, there
appears to be incongruence between the concerns of social gerontol-
ogyandthefactthattherapidincreases inlifeexpectancyandquality
of life at later ages are strongly related to advances in medical science
and preventative techniques:
Why is there such a ‘miserabilist’ response to the increases we’ve
seen in life expectancy in rich countries? The evidence is that the
levels of ill-health and disability in older people at any given age