Handbook of Aging and the Social Sciences

USA

Part I

Theory and Methods

Outline

Chapter 1 Aging and the Social Sciences: Progress and Prospects

Chapter 2 Trajectory Models for Aging Research

Chapter 1

Aging and the Social Sciences

Progress and Prospects

Linda K. George¹ and Kenneth F. Ferraro²,    ¹Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA,    ²Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA

The purpose of this is to highlight recent advances in social science research on aging and identify high priority topics for future research. It is organized into four sections. The first section reviews theoretical and conceptual developments in the field; the second provides an update of advances in data, methods, and statistical techniques that have become central in aging research. The third and longest section reviews three thematic topics that have emerged as cutting-edge issues in social research on aging and the life course. In the concluding section, we briefly comment upon the broader issue of how aging research contributes to major issues and assumptions in the social sciences.

Keywords

Theory; Methods; Longitudinal data; Cohort analysis; Individual and social change; Social disruptions

Outline

Theoretical and Conceptual Developments 4

Cumulative Advantage/Disadvantage Theory 5

Cumulative Inequality Theory 6

Methods and Data 6

Data Developments 6

Statistical Sophistication 8

Emerging Themes in Aging Research 9

Increased Attention to Cohort Analysis 9

The Effects of Social and Economic Disruptions on Aging 10

Gradual, Incremental Cultural Change 12

What Aging Research Contributes to the Social Sciences: The Big Picture 16

References 20

The only constant is change. This quote, heard frequently today, is attributed to Heraclitis of Ephesus, a Greek philosopher who lived from approximately 535 BC to 475 BC. One wonders what it was about life at about 500 years before the birth of Christ that led Heraclitis to that conclusion. Was the pace of social change so rapid that it led to this inference? Was it the rhythms of nature that triggered this observation? Or, perhaps, was it the flow of everyday life that convinced Heraclitis that he was not the same person today that he was yesterday or would be tomorrow? At any rate, it is clear that humans have long been aware that change is ubiquitous.

Scholars of aging arguably devote more of their intellectual activity to studying and understanding change than those in any other field. Aging itself is change – some of it easily observable; some of it occurring at the cellular and molecular levels and requiring years or even decades to be measurable and the fodder for scientific inquiry. Aging individuals are embedded in macro-, meso-, and micro-environments in which change also is omnipresent. And a fundamental assumption of the social sciences is that those constantly changing environments affect the ways in which people age. Thinking seriously about the complexity of change leads to the conclusion that considerable audacity and fortitude are required to study aging and lay claim to understanding or explaining its dynamics. And yet that is precisely what aging researchers do.

Audacity and fortitude also are required in any attempt to summarize the state-of-the-science with regard to social science aging research. Yet, the goal of this chapter is to provide a partial summary of the state-of-the-field. More specifically, the purpose of this chapter is to review, in broad brush, recent theoretical, methodological, and selected substantive developments in aging research in the social sciences. We used the approximate dates of 1996–2015 as the focus of this review. This is an arbitrary window of time, but we believe that it is a reasonable temporal scope for summarizing current significant issues in aging research.

The chapter is organized into four sections. The first section reviews theoretical and conceptual developments in the field; the second provides an update of advances in data, methods, and statistical techniques that have become central in aging research. The third and longest section reviews three thematic topics that have emerged as cutting-edge issues in social research on aging and the life course. In the concluding section, we briefly comment upon the broader issue of how aging research contributes to major issues and assumptions in the social sciences.

Considerable subjectivity was employed in developing this chapter, especially in identifying emerging substantive issues. It is possible to produce a veritable laundry list of recent and emerging themes in aging research. We selected only three, with the unifying theme being big picture influences on aging. Undoubtedly, other scholars would have selected other developments in the field. Other scholars may disagree with our labeling these research topics as recent or new. This is inevitable. Nonetheless, we hope that this chapter captures much of the theoretical, methodological, and substantive action of the past two decades in social science research on aging.

Theoretical and Conceptual Developments

Arguably, the biggest story in aging research for the past several decades has been developments in, advances in, and the greatly increased volume of research that incorporates the life course perspective. The life course perspective is not a theory per se; rather, it is a set of five principles that contextualize individual lives in a number of ways (Elder, Johnson, & Crosnoe, 2003). The principle of life span development states that human development and aging are lifelong processes – that patterns observable over time link distal and proximal events and experiences across the life course. The principle of agency focuses on the ways that individuals construct their own lives by the choices they make within the opportunities and constraints of their environments. The principle of time and place states that human lives develop in historical and geographic contexts that strongly affect the opportunities and constraints available. The principle of timing states that the effects of events and other experiences vary, depending on the individuals’ ages or life stages. Finally, the principle of linked lives focuses on the social networks and relationships that also structure the opportunities and constraints available to individuals. Although temporality, especially biographical and historical time, is widely viewed as the hallmark of the life course perspective, context is its major foundation.

Questions arise at times about the relationships between life course research and gerontological research, especially whether gerontological theory and research will be or have been eclipsed by the life course perspective. In order to document its strengths, life course scholars sometimes critique gerontological research that does not incorporate one or more principles of the life course perspective. Nonetheless, multiple research questions appropriately focus on late life and need not incorporate explicit life course principles (e.g., studies of variability within the older population, studies that examine the effects of interventions or policies on older adults). Virtually all studies of older adults, however, should recognize that research participants are members of cohorts measured at specific historical times – and therefore it cannot be assumed that the findings will generalize to other cohorts and historical contexts.

Because the life course perspective is not a theory, its principles need to be incorporated and tested in conjunction with established theories. This cross-fertilization of life course principles with mainstream social science theories has expanded rapidly. Several examples provide illustrations of this cross-fertilization but do not comprise a comprehensive inventory of relevant topics. Life course principles of life span development, agency, timing, and linked lives have been incorporated in stress process theory. This research has provided important knowledge about the persistent effects of early severe trauma on the mental health and well-being of older adults (e.g., Danese & McEwen, 2012; Shaw & Krause, 2002). Another profitable area of research focuses on the ways in which educational achievements and occupational choices in young adulthood affect financial security in later life (Cahill, Giandrea, & Quinn, 2006). And perhaps no topic has been more thoroughly investigated than the effects of childhood conditions (traumatic events, persistent poverty, and poor health) on morbidity and mortality in middle and late life (for a review, see Chapter 5, this volume).

Cumulative Advantage/Disadvantage Theory

If there has been a bona fide theory based on the life course perspective, specifically the principle of life span development, it is cumulative advantage/disadvantage theory (CA/DT). The major hypothesis of CA/DT was developed by Robert Merton (1968), who called it the Matthew Effect, based on a verse in the Gospel of Matthew (13:12). The Matthew Effect refers to a pattern in which those who begin with advantage accumulate more advantage over time and those who begin with disadvantage become more disadvantaged over time (Dannefer, 1987; O’Rand, 1996). The result is ever-widening differences between the advantaged and disadvantaged. This simple theory has been supported in many domains of life (Rigney, 2010). When applied to trajectories of advantage and disadvantage over long periods of time, CA/DT is obviously compatible with the life course perspective. And research on life course patterns often finds support for CA/DT.

Nonetheless, as Rigney’s review of research (2010) documents, CA/DT does not always apply. A key example is late life health. Individuals who begin adulthood in excellent health do not become healthier over time with physical and mental well-being peaking at the end of life. These early advantaged individuals are likely, on average, to have better health than persons who entered adulthood with poor health or experienced health problems as young adults. But their trajectory of health is not monotonic improvement over the life course. As a consequence, aging researchers often label their theoretical foundation as cumulative disadvantage theory.

There is increasing and appropriate recognition that CA/DT is oversimplified. CA/DT posits two trajectories when, in fact, phenomena of interest are typically characterized by multiple trajectories. Depending on the phenomenon under investigation, two of the trajectories may resemble straightforward cumulative advantage and disadvantage, but there will be other meaningful trajectories as well. Despite its shortcomings as a universally applicable theory, CA/DT has been tremendously useful in emphasizing the importance of early social status and cohort membership on life course trajectories and has generated a large volume of important research.

Cumulative Inequality Theory

To capture more of the contingencies involved in how status and life experience influence the aging process, cumulative inequality theory (CIT) integrates elements from multiple conceptual approaches, most notably but not limited to: life course perspective (Elder, 1998), CA/DT, and stress process theory (Pearlin, Schieman, Fazio, & Meersman, 2005). Formulated in five axioms and 19 propositions, the theory builds upon but is distinctive from prior approaches in several ways (Ferraro, Shippee, & Schafer, 2009).

First, CIT prioritizes perceptions of the aging experience while juxtaposing the systemic generation of inequality with human agency (Schafer, Ferraro, & Mustillo, 2011). Social structures constrain choices, and both influence aging. Second, rather than assume inexorable effects of early disadvantage, CIT specifies that exposures to risks and resources also shape life trajectories. Indeed, the timely activation of resources may nullify or compensate for the effects of negative exposures. Third, the influence of family lineage is emphasized in the theory, noting the roles that genes and environment have on status differentiation. It calls for more attention to the intergenerational transmission of risks and resources. Finally, the theory integrates selection processes into the study of inequality. Given that inequality itself is an engine of mortality and other forms of nonrandom selection, failure to consider selection processes may lead to misrepresenting inequality in later life (i.e., typically underestimating inequality).

Several longitudinal studies testing elements of the theory reveal the importance of intergenerational influences on health outcomes – ranging from adult depression (Goosby, 2013) to myocardial infarction (Morton, Mustillo, & Ferraro, 2014) – but also how those health risks may be amplified or diminished by resources and lifestyle choices. Indeed, in a study of racial disparities in health, Kail and Taylor (2014, p. 805) reported that mobilizing financial resources into insurance coverage is protective against functional limitations. Other studies testing elements of the theory reveal that both psychosocial resources and how one interprets life experiences are consequential to status attainment and health (Wickrama & O’Neal, 2013; Wilkinson, Shippee, & Ferraro, 2012). The emerging picture from empirical tests of the theory is that there are powerful systemic influences on exposure to risk, opportunity, and inequality but that these influences on well-being in later life are often contingent on how the exposures are interpreted and whether resources can be activated to address them.

Methods and Data

Data Developments

One of the greatest boons to aging research has been the proliferation of longitudinal data sets covering long periods of time. The increased availability of high-quality data sets in the past two decades or so has transformed aging research. Space limitations preclude a description of all the valuable longitudinal data sets available. Several major differences in data sources, however, will be reviewed. With few exceptions, we focus on data sets with three or more times of measurement, which is the minimum number of data points for modeling trajectories.

Age Ranges and Times of Measurement. Some studies were designed to focus on the dynamics of late life; others followed samples from young adulthood to late life; and still others recruit age-heterogeneous samples at baseline and follow them for significant periods of time. The Health and Retirement Study (HRS), for example, was originally designed to follow individuals from late middle-age until very old age or death. Additional cohorts have been added during the past two decades, however, resulting in some cohorts entering the study relatively early in adulthood (Institute for Social Research, 2014a). The Wisconsin Longitudinal Study (WLS), in contrast, recruited participants during their senior year of high school in 1957 and continues to collect data. Last surveyed in 2011, study participants were approximately 72 years old (University of Wisconsin, 2014). The Americans Changing Lives (ACL) study began in 1986 and recruited a sample of adults age 25 and older (Institute for Social Research, 2014b).

The intervals between measurements also vary across data sources. The HRS began data collection of its original cohort in 1992 and interviews participants every 2 years. The WLS includes seven times of measurement to date and the intervals between them range from 7 to 17 years. The ACL has four times of measurement at intervals ranging from 8 to 10 years. Some studies also oversample specific subgroups of interest, which can enhance opportunities for analyses based on middle and late life. The ACL, for example, oversampled both African Americans and adults age 60 and older.

Academic versus Government Sponsorship. Virtually all large-scale longitudinal studies are funded by government agencies. The distinction here is between studies that were funded via grants to academic institutions and studies carried out by government agencies. The HRS, WLS, and ACL are examples of studies designed and conducted by universities and funded by federal grants. Examples of government-conducted longitudinal studies include the Second Longitudinal Study of Aging (LSOA-II) (CDC, 2014b) and the Medicare Current Beneficiary Survey (MCBS) (CMS, 2014). Virtually all federally funded longitudinal studies focus on health. The data sets also include, to varying degrees, information about social, economic, and psychological characteristics of study participants. In general, data sources that are funded by grants to academic institutions include richer social science content than those conducted by government agencies.

National versus Regional/Local Samples. All the longitudinal data sources mentioned above were designed to be based on nationally representative samples. Data sets based on regional or local samples also offer important research opportunities. The Established Populations for Epidemiologic Studies of the Elderly (EPESE) is an example of data collected at the local or regional level that has made important contributions to aging research (ICPSR, 2014). The EPESE Program included local/regional data collected from adults age 65 and older at four sites: East Boston, MA, USA; New Haven, CT, USA; Iowa and Washington Counties, IA, USA; and central North Carolina, USA. The research design included four in-person interviews over a 10-year period, with brief telephone interviews administered in the years between the in-person interviews. A common set of survey questions were asked at each site, supplemented with site-specific interview content. A few years later, the Hispanic EPESE was added, with the same basic research design (Sociometrics, 2014). The sample included Hispanic older adults, both native and foreign-born, living in five southwestern states. Hundreds of scientific articles have been published using data from one or more EPESE sites, testifying to the value of non-national samples. Other longitudinal studies based on local/regional samples yielded important findings as well (e.g., Alameda County Study).

Merging Survey and Administrative Data. Another trend during the past two decades has been merging survey data from older adults with federal and, occasionally, state administrative data. Merging data from these sources greatly expand the research questions that can be addressed. The most frequently used administrative data base is the National Death Index (NDI), which includes data from death certificates in all 50 US states. Investigators routinely use the NDI to determine study participants’ mortality status and date of death and can use the NDI Plus for cause-of-death data. Although not every name submitted to the NDI can be definitively matched, the overall accuracy of the NDI is excellent (e.g., Lash & Silliman, 2001). The other major administrative data set often merged with longitudinal survey data is Medicare claims data, which include detailed information about the use and costs of inpatient and outpatient health care (CDC, 2014a). Most major longitudinal studies use the NDI and many (e.g., the HRS and EPESE) also obtain Medicare claims data.

Biomarker, Genetic, and Physical Performance Data. Another important trend in longitudinal studies of aging is the collection of biological and physical performance data. Advances in data collection methods now allow biological data to be easily obtained via non- or minimally invasive methods, including buccal swabs for DNA and urine and saliva samples for selected biomarkers. Highly trained interviewers often collect blood samples; measure height, weight, waist circumference, and blood pressure; and/or administer physical performance tests. To date, the genetic and biomarker data typically have been collected at a single point in time. An exception is the National Social Life, Health, and Aging Project (NSHAP; NORC, 2014). To date, NSHAP has collected two waves of data and biomeasures were collected at both test dates, permitting longitudinal analyses spanning about 5 years. This trend will undoubtedly continue in other longitudinal studies, resulting in multiple waves of biological and genetic data that are linked to rich survey and administrative data.

Non-US Databases. An important and relatively new resource for research on aging is the availability of large-scale longitudinal studies conducted in countries other than the United States. Especially rich data are available from Europe and the Pacific Rim. European examples include the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing, and Retirement in Europe (SHARE). The ELSA began in 2002, conducts interviews biannually, and has completed six waves of data, with a seventh in progress (ELSA, 2014). SHARE also interviews participants biannually; it began in 2004 and five waves are complete. SHARE’s baseline sample included older adults from 11 countries. By Wave 5, 15 countries had participated (SHARE, 2014). Both the ELSA and SHARE are modeled on the HRS in design and content. Two studies from the Pacific Rim are especially rich in times of measurement. The Australian Longitudinal Study of Aging (ALSA) began in 1992 and completed 12 times of measurement (Luszcz et al., 2014). The Chinese Longitudinal Healthy Longevity Study (CLHLS) has conducted six waves to date (1998, 2000, 2002, 2005, 2008–2009, and 2014) and focuses on the oldest-old (Chinese Longitudinal Healthy Longevity Survey, 2014). All four of these data sets include biomarker and physical performance tests at one or more times of measurement.

Statistical Sophistication

The statistical armamentarium for analysis of three or more waves of longitudinal data has grown in volume and sophistication over the past two decades. The concept of trajectory – a distinct temporal pattern observed over multiple times of measurement – has become a staple of aging research. Some studies include multiple times of measurement over a relatively short period of time, permitting estimation of fine-grained trajectories (e.g., patterns of onset, stability, and recovery of disability). Other studies examine long-term trajectories of stability and change, such as those hypothesized in CA/DT theory. A variety of statistical techniques can be used to model trajectories, as reviewed in Chapter 2 of this volume.

Structural equation modeling remains an important analytic tool for analysis of longitudinal data. Its unique characteristics include the option of estimating reciprocal relationships between variables over time, production of distinct measurement and explanatory models, the ability to correct for unreliability of measurement, and estimation of direct and indirect effects of explanatory variables on the outcome of interest.

Multilevel modeling is now frequently used to jointly examine the effects of individual-level and aggregate contextual variables on outcomes of interest. These models have proven especially useful in studies examining the effects of environmental characteristics on outcomes of interest. In many of these studies the research question focuses on whether environmental characteristics are related to outcomes of interest after the effects of individual characteristics are statistically controlled (e.g., is living in a high-poverty neighborhood associated with mortality after individual poverty status is taken into account?). It also is possible to estimate interactions between individual-level and contextual variables. In aging research, most multilevel studies examine the effects of neighborhood characteristics on health and quality of life. Chapter 16 reviews this research.

Emerging Themes in Aging Research

In this section, three topical areas of aging research are briefly reviewed. Although there have been notable advances on dozens of research topics, we focus on emerging themes not covered in detail in one of the chapters in this volume. In addition, we selected three research themes that focus on the effects of macro-level characteristics of social structure that have potentially important implications for aging and/or older adults. Of course, some of the topics are mentioned in the chapters that follow, but we think these emerging themes nonetheless merit additional consideration.

Increased Attention to Cohort Analysis

The term cohort, of course, refers to a set of people who experience the same event at the same time. Although any event can define a cohort, social scientists typically use the term to refer to birth cohorts – to people born at the same or approximately the same time – and that is how the term is used here. Norman Ryder’s classic article (1965) was the first systematic consideration of cohort as a social, rather than simply actuarial, phenomenon. For Ryder, cohort differences are evidence of social change. In his words, cohorts do not cause change; they permit it. If change does occur, it differentiates cohorts from one another, and the comparison of their careers becomes a way to study change (p. 844). Ryder hypothesized that four types of circumstances were most likely to differentiate cohorts. First, cohort size is important – very large and very small cohorts experience different structural opportunities and constraints from each other and from cohorts of more usual sizes. Second, major social and historical events cause significant differences across cohorts. Ryder posited that societal disruptions had the strongest and most lasting effects on cohorts who were adolescents or young adults at the time of the events. Thus, although all cohorts experience the disruptive event, it is the young who are permanently changed by it (a line of reasoning compatible with the life course principle of timing). Third, wide variations in the influx of migrants to a society can change the character of a cohort and differentiate it from those before and after it. A variant of this, with the same result, is widespread migration from rural to urban areas. Fourth, Ryder believed that technological innovation was a primary trigger for cohort differentiation – and argued that technological advances were most targeted at and welcomed by adolescents and young adults.

To support the claim that cohort analysis has become increasingly popular in aging research, we conducted an informal analysis of journal articles published between 1970 and the first half of 2014. We used the Web of Science core collection and narrowed the search to journal articles categorized as falling under at least one of three topics: gerontology, geriatrics, and sociology (aging was not a topic offered). Using these criteria, Web of Science identified 7 635 articles in which the word cohort appeared in the title or abstract. Examining the distribution of these articles by date of publication is illuminating. Less than half a percent of the titles appeared between 1970 and 1979 and slightly more than 1% were published between 1980 and 1989. About 16.5% were published in the 1990s and approximately 39.5% were published between 2000 and 2009. In the interval between 2010 and June 30, 2014, 41.8% of the articles were published. Even we were surprised to find that the largest percentage of articles appeared in the most recent four and a half years. There are obvious limitations to this analysis (e.g., we cannot know whether investigators simply began to use the term cohort more frequently in article titles and abstracts). Nonetheless, if the trend observed in this highly unsophisticated analysis is generally accurate, explicit attention to cohorts is increasingly common in research on aging.

Most studies of cohort differences in later life examine health outcomes. Examples include cohort differences in the relationship between education and health (Lynch, 2006), in depression during late life (Yang, 2007), in the extent to which segregated southern schools partially account for Black–White health disparities in late life (Frisvold & Golberstein, 2013), and in the relationship between women’s labor market participation and health (Pavalko, Gong, & Long, 2007). Cohort analysis is valuable for outcomes other than health as well, such as the discrepancy between chronological and felt age (Choi, DiNitto, & Kim, 2014) and patterns of gradual retirement (Giandrea, Cahill, & Quinn, 2009).

Although there are significant exceptions, few studies either empirically test or even speculate about the specific social changes that trigger cohort differences. As a result, cohort analysis often appears simply descriptive. But the best cohort studies are those that not only describe cohort differences, but also attempt to explain the reasons for them. Frisvold and Golberstein’s (2013) study of how segregated schools and their subsequent demise are associated with cohort differences in race disparities in health is an example of a study that aims to explain cohort differences and not simply describe them. The increased attention to cohort differences is an important contribution to aging and life course research. The contributions of cohort analysis could be even greater if this research routinely addressed potential explanations for cohort differences.

The Effects of Social and Economic Disruptions on Aging

Social and economic disruptions have long been of interest in the social sciences. Major shocks to social structure provide a rare opportunity to not only study the consequences of and responses to significant disruptions, but also to highlight social arrangements before the disruptions that were not fully understood. Large-scale events typically receive substantial attention by both scientists and the general public. Much less attention has been paid to the differential implications of these disruptions for population subgroups, including older adults. Recently, however, the implications of large-scale social and economic changes for older adults have received increased attention.

The Great Recession

Perhaps no social and economic disruption in the past quarter century generated more scholarly and public attention than the Great Recession that began in 2008 and continues to shape the lives of the citizens of many countries, including the United States. No age group has been unaffected by the consequences of this major disruption, but there are reasons to believe that older adults are suffering at least as much as their younger counterparts. As a New York Times headline stated, In Hard Economy for All Ages, Older Isn’t Better…. It’s Brutal (New York Times, 2013). A growing body of research addresses the effects of this cataclysm on older adults. Several topics on the consequences of the Great Recession have received empirical attention. First and of obvious concern is whether the increased rates of unemployment in the population at large affected older adults. There appears to be both good and bad news on that front. On the positive side, older adults (variously defined as those age 55, 60, and 65 and older) have lower rates of unemployment than any age group – indeed, rates of unemployment are strongly and inversely related to age (US Bureau of Labor Statistics, 2013). On the other hand, between 2008 and 2010, the unemployment rate of older adults roughly quadrupled and has declined little since then. In addition, the length of time between job loss and reemployment is significantly longer for older adults than their younger counterparts and many older adults opt out of job seeking after a relatively short period of unemployment. A second important issue is whether the Great Recession altered the plans of those nearing retirement. It is too early to know definitively the extent to which persons at or nearing conventional retirement ages are postponing retirement, but there is strong evidence that these individuals report that they plan to retire later than they had intended prior to the Great Recession (e.g., McFall, 2011). Chapter 14 describes the impact of long-term macroeconomic trends on the labor force participation of older adults and reviews in detail the economic and labor force consequences of the Great Recession.

The consequences of the Great Recession are not limited to purely economic issues. A small base of research on the mental health consequences of the Great Recession is emerging, almost none of which focuses on older adults. Cagney and colleagues, however, report that increases in neighborhood foreclosures are associated with increases in depressive symptoms among older adults in NSHAP, controlling on demographic characteristics, socioeconomic status (SES), and physical functioning (Cagney, Browning, Iveniuk, & English, 2014). The spillover from the Great Recession also may affect the family lives of older adults. Livingston and Parker (2010) report that between 2007 and 2009 the number of older adults with custodial care of grandchildren increased by nearly 20%, although these grandparents are a small proportion of the older population.

Hurricane Katrina and Other Disasters

Natural disasters are another form of disruption and have received increased attention in aging research. According to the Centers for Disease Control and Prevention, In Louisiana during Hurricane Katrina, roughly 71% of the victims were older than 60 and 47% were over the age of 75 (CDC, 2013, p. 1). Given these large percentages, it would be logical to assume that older victims received a significant portion of the publicity, aid, and health monitoring in the aftermath of Katrina. There is little evidence, however, to support that assumption. Public discourse about Katrina gave little attention to age groups other than displaced children. No local or regional disaster plans included procedures for transferring residents out of nursing homes – and residents of those homes fared especially badly (CDC, 2013). Some research examined the effects of Katrina on mental health, the coping strategies used by older victims, and the ways that family support did or did not ease the trauma of older victims (e.g., Cherry et al., 2010; Henderson, Roberto, & Kamo, 2010; Kamo, Henderson, & Roberto, 2011; and for a review of research on the effects of disasters on older adults, see Chapter 18).

The examples above illustrate the increased attention paid to events that threaten preexisting structural arrangements and their consequences for older adults. We applaud this trend and encourage broader attention to major social disruptions – for the United States as a whole, such as the Great Recession, and for specific regions or cities, such as Hurricane Katrina.

Gradual, Incremental Cultural Change

Not all consequential social changes take the form of sudden social disruptions; gradual and/or incremental cultural changes also can have important implications for older adults. In fact, social scientists are probably more likely to miss or understudy the effects of more gradual social change than sudden disruptions. The history of aging research reveals numerous gradual changes, the significance of which was not recognized until a critical mass of older adults was affected. Family care for impaired older adults has occurred at least since the beginning of recorded history. Nonetheless, it was not until the vast majority of adults lived until late life and gradual social changes (e.g., women’s labor force participation, intergenerational geographic mobility) made family caregiving difficult for a significant proportion of older spouses and adult children that the concept of caregiver burden became a topic of scientific interest. Indeed, the term caregiver did not appear in public discourse until the 1980s. Similarly, the transition from defined benefit to defined contribution pension plans was underway for a decade or so before the implications of this transition for the financial security of retired adults became an issue in aging research. A gradual societal change that has received significant recent attention is the health effects of income inequality.

Income Inequality and Health

Income inequality refers to the size of the gap between the richest and poorest members of society – the wider the gap, the greater the inequality. Although there are gaps between the bottom and top of the income ladder in all societies, the size of the gap varies widely across countries and over time. The United States has higher income inequality than any other developed country in the world and the gap between the richest and the poorest has widened substantially over a relatively short period of time in the United States, with no apparent end in sight (The Economist, 2013). The implications of income inequality for economic growth, social cohesion, and health are now hot topics in the social sciences, politics, and public discourse.

Conceptual and Methodological Issues. The outcomes of income inequality for which there has been substantial research include rates of labor force participation, workers’ earnings, economic growth, general trust, civic engagement, life expectancy, and other health indicators. For decades, most economists argued that the net effects of economic inequality (both income and wealth inequality) are beneficial. Mainstream economic theory posited that income inequality motivates workers to increase their job skills and productivity in order to climb the economic ladder. In turn, more productive workers not only increase their own incomes, but also spur economic growth for the society as a whole. In contrast, Marxian theorists and other social scientists argued that because income inequality concentrates capital in their control, the very rich are motivated to cut labor costs as much as possible. As a result, increasing income inequality depresses workers’ wages and increases unemployment. Quite recently, economists have found, using data from the United States, that high levels of income inequality suppress rather than facilitate economic development (Stiglitz, 2012), necessitating that economic theory recognize that there is a threshold beyond which high income inequality has negative effects on nations’ economic growth.

The potential link between income inequality and health is especially important for older adults. Research examining the relationships between income inequality and health is voluminous and inconsistent. Some studies report significant correlations between income inequality and a variety of health outcomes. Other studies, however, report nonsignificant relationships.

Four aspects of research design may account for much of the inconsistency in previous studies of income inequality and health. These methodological issues largely result from theoretical ambiguity about the expected relationships between income inequality and health.

First, is the selection of control variables. In order to isolate the effects of income inequality on health, researchers have controlled on a variety of other structural characteristics. The most important of these is economic growth, typically measured as Gross Domestic Product (GDP). Strong and robust relationships between economic growth and multiple indicators of population health have been observed for decades (e.g., Easterlin, 1974). If income inequality is to continue to receive scientific attention, it must be significantly related to health with GDP taken into account. Research findings demonstrate that relationships between income inequality and multiple outcomes are substantially reduced if GDP is controlled. In most instances, coefficients for income inequality remain statistically significant; in others, they do not. Other frequently used control variables include proportion of GDP spent on social and health programs, political regime, and women’s rights. The general hypothesis underlying inclusion of these characteristics is that income inequality may be compensated for by government policies that redistribute resources from the rich to the poor. In general, the more control variables measuring economic growth and welfare state benefits that are included in analyses, the more that the net effects of income inequality are reduced. Theoretically, it is not clear whether these structural characteristics should be conceptualized as control variables, included to test whether the relationships between income inequality and health are spurious, or as mediators of those relationships.

A second important decision in research on income inequality is whether to model the effects of income inequality on health (or other outcomes) solely at the aggregate level or to use multilevel models that incorporate both individual and aggregate predictors of health. Multilevel models are generally viewed as superior to aggregate-only models because the former allow researchers to determine if income inequality is significantly related to health once individual-level predictors are taken into account. Most attention in multilevel models has focused on whether coefficients for income equality are significant net of individual-level income. Again, research findings have been inconsistent. Another, less recognized advantage of multilevel models is the ability to test whether income inequality interacts with individual-level characteristics to exacerbate or reduce disparities across population subgroups. Although arguments favoring multilevel models are strong, the underlying issue is theoretical. Do we expect high levels of income inequality to harm individual health, population health, or both? It is possible that high levels of income inequality harm population health, but not individual-level health (or vice versa). This could happen if elevated income inequality has small effects on multiple risk factors for mortality and morbidity and it is the cumulative or aggregated strength of these multiple small effects that links high income inequality to poorer population health. Choice of the level of the health outcome should be based on theoretical grounds. If the outcome of interest is an indicator of population health, aggregate-only models are appropriate.

A third decision that investigators face is the choice of a unit of analysis. Most early studies compared the relationships between income inequality and potential outcomes using the nation state as the unit of analysis. An increasing number of studies, however, use units of analysis that are smaller than countries, including states or provinces, metropolitan areas, and neighborhoods. The choice of a unit of analysis is undoubtedly determined in part by data availability (e.g., if county-level data are not available for important variables, another unit of analysis for which data are available must be used). There are countervailing advantages and disadvantages to country versus smaller units of analysis.

The disadvantage of country-level variables is that they include a great deal of unmeasured heterogeneity both within and across countries. Economic conditions and public policies often differ substantially across geographic units within a country, and ignoring that variability may mask relationships that would be observed with smaller units of analysis. Unmeasured heterogeneity is undoubtedly even greater across countries, with cultural preferences and unique aspects of national history ignored. The advantages of country-level analyses are that results presumably apply to the population as a whole and many structural characteristics are, by definition, nationally homogeneous (e.g., GDP, political structure). The advantage of using smaller units of analysis in the same country is that some important structural characteristics are national and, thus, constants that need not be included in predictive models, thus permitting fine-grained analyses of other structural characteristics. This also is the primary disadvantage of small units of analysis – if the effects of income inequality differ primarily across countries but are homogeneous within countries, important information about the effects of income inequality will be missed. Again, theory should provide guidance about the most appropriate unit of analysis, but there is little evidence of that in extant research.

Fourth and finally is the question of whether geographic units are the optimal basis for studying the effects of income inequality on health and other outcomes. Although the vast majority of income equality research is based on comparisons across geographic units, other strategies are available. Zheng and George (2012) argue that the best way to study income inequality is to relate time-based trajectories of inequality to health. Time-based analyses permit investigators to determine whether patterns of increasing (or decreasing, although to our knowledge, decreasing levels of income inequality have never been observed) income inequality are associated with worse health. Using time-based trajectories, the temporal order between changes in income inequality and changes in health and the lag times between changes in income inequality and changes in health can be observed. Lag time is important, but theory to date has not addressed this issue. Cross-sectional studies, while plentiful, are of dubious value. It is highly unlikely that increases in income inequality trigger immediate changes in health. Because the lag times between changes in income inequality and changes in health are unknown, trajectory analyses could shed light on that dynamic.

Income Inequality, Aging, and Health. The vast majority of research in this field focuses on the relationship between income inequality and mortality. Other studies examine self-rated health, physical functioning/disability, and mental health. Because older adults have higher rates of death and disability, and are more likely than their younger counterparts to rate their health as fair or poor, studies based on age-heterogeneous samples are clearly relevant to the older population. Mental disorders are less common in later life than in middle or young adulthood, however, and are not reviewed here. Space limitations preclude an extensive review of the voluminous literature linking income inequality and health.

Mortality is the health outcome most frequently related to income inequality. Most studies report a positive and significant relationship between income inequality and mortality rates at the aggregate level, especially in the United States (e.g., Kaplan, Pamuk, Lynch, Cohen, & Belfour, 1996 – a study of US states; Ross et al., 2000 – a study of US states and Canadian provinces, with a significant relationship observed only in the United States). Some aggregate studies report that income inequality is associated with mortality rates with median income and/or poverty rates also controlled (e.g., Kawachi & Kennedy, 1997 – a study of US states; Wilkinson & Pickett, 2008 – a study of US states). Other studies report no significant relationship between income inequality and mortality at the aggregate level (e.g., Beckfield, 2004 – a study of 115 countries). As noted above, an important issue in multilevel studies is whether this relationship remains robust with individual-level income statistically controlled. Results are inconsistent, with some studies reporting that the income inequality–mortality link remains strong and significant (e.g., Lochner, Pamuk, Maduc, Kennedy, & Kawachi, 2001 – a study of US states; Shi & Starfield, 2001 – a study of US metropolitan areas) and others reporting that the association is rendered nonsignificant (e.g., Fiscella & Franks, 1997 – a study of US communities).

Because fewer studies examine health outcomes other than mortality, it is difficult to summarize the pattern of results. Studies of the relationship between income inequality and self-rated health report inconsistent relationships. This is especially true of multilevel studies that include individual-level as well as aggregate predictors. The single multilevel study of physical functioning reported a significant and positive relationship between increasing income inequality and both physical functioning and activity limitations (Zheng & George, 2012 – a temporal study of the US population between 1984 and 2007).

Few multilevel studies examined interactions between income inequality and individual-level predictors, but this appears to be worth additional effort. Diez-Roux, Link, and Northridge (2000) examined the relationship between income inequality and cardiovascular disease in a multilevel study. The unit of analyses was US states. The direct effect of income inequality was significant and in the expected direction for women, but not men. The interaction between income inequality and individual-level income was strong and significant. As expected, the combination of high income inequality and low personal income predicted cardiovascular disease. In contrast, Sturm and Gresenz (2002), in a multilevel study of income inequality and number of chronic physical illnesses, tested the same interaction and it was not significant. To evaluate whether rising income inequality contributes to status-based health disparities, Zheng and George (2012) examined interactions between income inequality and family income, education, employment, marital status, gender, and race-ethnicity. Coefficients for the first four variables were statistically significant and in the predicted direction. That is, the protective effects of individual income, education, employment, and marriage strengthened as income inequality increased. The interaction between income inequality and gender also was significant, with rising income inequality having stronger negative effects on physical functioning for men than for women. These results suggest that increasing income quality may exacerbate SES- and gender-based health disparities, although there was no evidence of elevated risk for racial and ethnic minorities once SES indicators were taken into account.

Two relatively recent reviews reach similar conclusions to those referenced above. The first is a literature review based on 168 published analyses of the relationships between income inequality and multiple health outcomes (Wilkinson & Pickett, 2006). The authors conclude that 70% of the studies totally or partially support the hypothesis that high income inequality is associated with poorer health. They also found that studies based on larger geographic units of analysis were more likely to support the hypothesis that income inequality is positively related to worse health than those based on small areas. They suggest that studies that sample small areas are too small to reflect the scale of social class differences in a society (p. 1768). The second review reports the results of a meta-analysis based on 28 studies that cumulatively included more than 61 million respondents (Kondo et al., 2009). The health outcomes examined were mortality and self-rated health. The results suggested that income inequality is significantly related to both mortality and self-rated fair/poor health in the expected direction, although the size of the coefficient is modest. Kondo et al. also observed significant relationships between specific study characteristics and the odds of a negative association of income inequality with health. Specifically, results were stronger and larger in studies characterized by higher levels of income inequality, longer duration of follow-up, that used data from 1990 and later, and explicitly modeled time lags. In line with the conclusions of both reviews, other studies have empirically examined the effects of size of the geographic unit of analysis, time lags, and income inequality thresholds (Blakely, Kennedy, Glass, & Kawachi, 2000; Kondo, van Dam, Sembajwe, Kawachi, & Yamagata, 2012), demonstrating that these study characteristics strongly affect the size and significance of relationships between income inequality and health outcomes.

Income inequality is only one example of a wide range of patterns of gradual social change that may affect population health as a whole and the health of older adults in particular. Examples of other gradual social trends that may be worth examining include the increasing age at first marriage in the United States, which has implications for the aging of those cohorts and their parents (US Census Bureau, 2012), the steadily increasing proportion of the population, including the older population, living in near poverty (Heggeness & Hokayem, 2013), and the increasing income residential segregation in the United States (Fry & Taylor, 2012). The effects of these cumulative small social changes are easily overlooked. And yet a core premise of social science research is that the larger environment substantially determines the opportunities and constraints within which societal members live their lives. We suggest that these kinds of structural changes merit closer scrutiny from social scientists.

What Aging Research Contributes to the Social Sciences: The Big Picture

Opportunities for innovative and rigorous aging research have never been better. A proliferation of data sets in which large numbers of individuals are followed over long periods of time became available in the past two decades. The ability to merge survey data and other data sources (including, but not limited to Medicare files, Census data, and the NDI) also has broadened the range of research questions that can be addressed. High-quality data sources are available for a growing number of countries other than the United States. Statistical techniques designed for multiple times of measurement and multiple levels of analysis are now readily available in standard statistical packages. Obviously, advances in these and other components of the infrastructure on which aging research rests will continue in the future. But plenty of exciting research questions can be addressed with the resources available now.

Aging research is important for many reasons, ranging from answering basic questions about relatively regular patterns of human development across adulthood to understanding the importance of age structures for social institutions to providing data that guide the development of social/health interventions and public policy. Recently and across many disciplines, the term big questions has enjoyed considerable popularity. The phrase big questions appears to have originated in philosophy as shorthand for describing the discipline’s content and scope (Solomon & Higgins, 2013). Now, however, multiple disciplines are asking their practitioners what big questions they want to answer and how much progress has been made in answering them (e.g., Keeler, 2010; Sussman, 2010). Like other research fields, it may be worthwhile to ask ourselves whether research on aging can or does address big questions. This is not the venue for a comprehensive list of the big questions that aging research can or does address. We will, however, suggest one big question to which aging research makes significant contributions.

For most social science disciplines, a core question has always been: What mechanisms allow societies to survive? Alternatively, what mechanisms convince societal members to create and sustain societies, even when those mechanisms require members to sacrifice some of their own resources, gains, and autonomy? This is a big question that social scientists have tried to answer for more than a century.

Many of the founding fathers of sociology and anthropology looked for answers to the big question of societal order and stability. Durkheim’s comparison of mechanical and organic solidarity outlined two modes of sustaining societal order and stability (1997). Similarly, Weber’s writings on rationalization and bureaucracy focused on forms of organization that yielded stability and order in increasingly diverse societies (Ritzer & Stepinsky, 2012). In anthropology, Levi-Strauss (1966) posited that although societies vary widely in the structural arrangements that they use to achieve solidarity and stability, all humans share the same underlying patterns of thought. Consequently, no matter how much structural arrangements appear to differ across societies, the functions that they serve are the same.

During the first half of the twentieth century, issues of stability and order were generally studied under the theoretical umbrella of structural functionalism. It is not surprising that structural functionalism focused on the cultural tools and practices that promoted order and stability – that was precisely the purpose of inquiries in that tradition. Nonetheless, structural functionalism was heavily criticized for neglecting conflict, innovation, inequality, and social change. These criticisms led to countervailing theories and research and by the middle of the twentieth century research based on structural functionalist theory had declined substantially.

But social solidarity and order are issues that are too fundamental to lay fallow forever. And no scholar played a larger role in bringing these issues back to the forefront of the social sciences than Pierre Bourdieu and his theory of social reproduction. Bourdieu’s theory and research is far-ranging and discussion here will focus on his contribution to understanding the stability of social systems. More specifically, he studied the reproduction of social stratification or, as he preferred to call them, status hierarchies. Bourdieu acknowledged the importance of economic capital in reproducing status hierarchies, but argued that a focus solely on material resources is incomplete. He argued for the importance of social capital, cultural capital, and even physical/bodily capital in sustaining stratification systems over long periods of time (Bourdieu, 1977). Much of his research focused on the role of education in social reproduction of social classes. Buttressing his belief that much more than financial capital is involved in this process, his research focused on cultural capital, especially the arts, in reproducing social stratification (Bourdieu, 1984).

Literally hundreds of studies using the social reproduction framework have been published in the last several decades. As might be expected, a disproportionate number of them focus on education and the failure of schools to generate as much upward mobility for disadvantaged students as would be desirable (Aschaffenburg & Maas, 1997; Collins, 2009). The scope of social reproduction studies, however, is quite large and ranges from research on the effects of economic growth in developing countries (Boughey, 2007) to the failure of politics to break patterns of social reproduction (Ruckert, 2010) to feminist critiques of the persistence of traditional family roles (Chodorow, 1978).

It is interesting to note that the valence of social scientists’ views of social reproduction changed quite dramatically over time. Durkheim and later scholars who relied on structural functionalism began with the premise that stability and order are problems that societies must resolve to survive. Identifying social processes that promoted stability and social integration was viewed as a testimony to the power of social facts to create order out of potential chaos. In short, structural functionalists generally view social institutions and the social arrangements that sustain them favorably. Scholars using the framework of social reproduction tend to take the opposite view. Many studies purport to demonstrate that schools perpetuate social hierarchies rather than reduce them through upward mobility. The social reproduction of inequality is viewed as problematic. Scholars in this tradition clearly favor social institutions that do not reproduce established social hierarchies.

A case also can be made that social reproduction is at the heart of several major theories of aging. Continuity theory, which emerged as a response to and critique of disengagement theory, is essentially a theory of social reproduction (Atchley, 1999). It posits that as older adults experience age-related transitions such as retirement and widowhood, they sustain as many roles and activities that they valued prior to the transitions as possible – in essence, they reproduce the same parameters of their lives that they had previously. Socio-emotional selectivity theory (SST) is similar, in some ways, to continuity theory. According to SST, as aging adults experience declines in their capacities, they express the highest levels of life satisfaction if they release less important roles, relationships, and activities and invest mainly in those that are most meaningful for them (Lockenhoff & Carstensen, 2004). Again, the emphasis of this theory is on continuity or stability of meaningful engagement. Cumulative advantage/disadvantage theory (C/AD) also focuses on stability across individuals over time and, thus, the social reproduction of social stratification. For economic outcomes, C/AD hypothesizes that the rich literally get richer and the poor get poorer. For health outcomes there is no expectation that health improves throughout adulthood, but those who begin adulthood in better health are expected to maintain better health over time than their less advantaged peers. This is a social reproduction scenario.

The valence of aging and life course scholars who document social reproduction is more mixed than was the case historically. Both the disengagement/continuity theory debate and SST focused on identifying the conditions under which older adults are satisfied with their lives. Research based on continuity theory and SST suggests that forms of social reproduction are associated with subjective perceptions of life quality. Given the research questions asked, there is no reason to view these social reproduction processes as anything but positive. Researchers documenting the cumulative effects of advantage and disadvantage are generally less happy with findings that point to the maintenance and the accumulation of resources and deficits due to stratification. Despite the assumption of objectivity in science, it is clear that social scientists (with the possible exception of economists) dislike inequality and the social arrangements that reproduce or increase it.

Whether one views it as a necessary requirement for societal survival or a means of perpetuating inequality (or both), evidence leaves no doubt that social reproduction exists and operates in many areas of life. We suggest, however, that excessive attention to social reproduction and stability promotes an unrealistic and incomplete view of the dynamics of time and aging. This chapter began with reference to the adage that the only constant is change. At the same time that we are persuaded by rigorous evidence of social reproduction, most of us believe that adage. Everything that we see, hear, and experience tells us that change is a frequent, if not constant, dynamic in the world and in our lives. Thus, science needs to focus on change as well as stability.

We hope to make a case for increased attention to individual and social change. The study of individual change is well established in aging research. There may be a tendency to interpret findings from the perspective of stability rather than change – to focus on the stability of physical, emotional, and cognitive capacities across the life course and to miss the processes that permit stability in outcomes (such as life satisfaction) despite substantial change in objective circumstances. Overall, however, aging research in the social sciences is attentive to individual-level change and, as a result of recent statistical advances, trajectories of change over substantial periods of time.

The study of social change and its relationships with aging is much less explored. Social scientists are cognizant of cohort changes, but are too satisfied with labeling them, rather than explaining them. The three topics that we chose to discuss as recent advances in aging research all focus on social change – in the forms of cohort differences; sudden large-scale changes in the basic infrastructure of society or generated by natural or man-made disasters; and gradual changes that creep up and culminate in changes that no one saw coming. Social scientists should be heavily invested in studying social change, as well as social stability. Aging researchers should examine how age and age structures affect broad social changes and the consequences of social change for aging adults.

The antecedents and consequences of social change are a big question for social scientists. They subsume multiple more specific research questions such as What kinds and degrees of social change trigger meaningful cohort differences? and How and under what conditions does social change alter the well-being of older adults? Aging and life course researchers are arguably in one of the best positions of all social scientists to tackle questions about social change because they already study individual change and know the tools needed to study change at all levels of aggregation. Advancing our understanding of social change also would contribute to the social sciences more broadly because social change has widespread implications for individuals, social institutions, and societies. Most importantly, aging research has the potential to balance the current emphasis on social reproduction with recognition of the prevalence and importance of social change.

Yes, aging and life course research is alive and well. Important contributions to our understanding of aging and the social contexts within which it unfolds have been impressive over the past two decades or so. There are also, however, important research questions yet to be addressed. Opportunities to generate new understandings of aging, older adults, and an aging population are plentiful. We invite fresh attention to research opportunities that have the potential to optimize the aging experience in spite of current inequalities.

References

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