PRESENTER

HAMISH ROBERTSON

UNSW 2013

Critical Thinking about Age and Ageing

Contents

� What are age and ageing?

� Major issue with ageing science

� History of basic ideas in brief

� Demography as a moral and political science

� Knowledge production – constructs and issues

� What is population?

� Gerontology and geriatrics

� Criticality and reflexivity – asking good questions

� Conclusion

Take the bus stop test …

You meet someone waiting for a bus

They ask you what you are doing

You say “I am doing a course on ageing”

They say ‘that’s funny, lately I have been wondering what ageing actually is …”

You say ‘let me explain”

You have three minutes before the bus arrives and they leave …

What are Age and Ageing?

� Simple human chronology – passing years of life?

� Time, history and culture

� Biological processes of various kinds – normal and/or pathological?

� Linking age and ageing to population theory/theories

� Knowledge production – taking a critical view

� Psycho-social perspectives – e.g. ageing well, healthy ageing versus ageing poorly and unwell, positive ageing etc

� Cultural determinants e.g. Margaret Lock on menopause –anthropological perspectives

� Why variations and why historical change e.g. rising life expectancies?

� Growing differentiation in the ageing concept/construct

� Politicisation of age and ageing – attribution of responsibility for old age

� Societal change and ageing – population policy and interventions

Ancient Egypt

Hieroglyph for ‘old age’

Ageing in (Pre)History

� Universal human experience – burial of the dead etc� Sumerian kings’ ages were measured in millennia in

pre-Kish dynasties and in centuries thereafter� Biblical patriarchs mostly lived well into their 100’s e.g.

Adam (930), Methuselah (969), Noah (950) etc� Post-flood much lower LE but still higher than present

– Jewish, Christian and Muslim tradition of long life� Classical Greek and Roman attitudes highly ambivalent

to ageing – mostly negative, 60 years as ‘old’ established by 1st century BC

� Other cultures and historical examples (e.g. Ayurvedictradition, Traditional Chinese Medicine etc)…

� If age is essentially attributional, where and what is the science of ageing?

Theology, Sin, Disease and Death

The Bubonic Plague in European Art

Astronomy, Time and Calendars

� Most time and calendar concepts originate from early Neolithic farming societies – deeply religious, symbolic and practical purposes

� Calendars are therefore essentially cultural constructs e.g. Gregorian calendar still currently in use, names of days and months

� Solar versus lunar calendars and birthdates –convention versus ‘accuracy’

� Cosmology, astronomy and physics suggest time as an absolute construct and measure is highly problematic

From Political Arithmetic to Demography and the Modern State

� Oliver Cromwell, William Petty and Jonathan Swift’s Modest proposal� (some) populations as a problem – Plantation

Ireland and early racialisation (Carroll etc)� Linnaeus, Bllumenbach and taxonomies of human

kinds => races� Thomas Malthus vs Godwin

� the lower orders, poverty, starvation and justice� Adolphe Quetelet - populations and probability

� the average man becomes normative man, social physics to sociology and psychology

� The growth of probability theory and Hacking’s avalanche of numbers

From Political Arithmetic to Demography and the Modern State

� Francis Galton (1822-1911) “nature versus nurture” and eugenics amongst much else and Karl Pearson, advocate of ‘race war’

� Race, class and intelligence linked to moral virtues and vices => social policy for the last 100 years? => Oxford History of Eugenics

� And on into the twentieth century and population policy -e.g. Matthew Connelly, “Fatal Misconception”

� James C. Scott, “Seeing Like a State” and an abhorrence of diversity in both nature and society

� Health status still often presented as a consequence of race, class, gender rather than as social processes acting on social categories

� History, politics, social structure and health outcomes are causally linked

Some Problems of Contemporary Knowledge Production

� Knowledge production looking backwards e.g high Victoriana of our education system, academic specialisations and policy domains

� Moral sciences masquerading as ‘social science’ e.g. economics and economic discourse as dominant and detached from politics etc

� Misleading but prevalent heuristics undermine our capacity to deal with complexity – e.g. Malthus (vs Godwin) and Galton

� Rigid dichotomies are prevalent cultural tropes e.g. nature versus culture, rural versus urban, quantitative versus qualitative, objective versus subjective, micro versus macro, nature versus nurture etc

� Missing dimensions e.g. space and scale poorly configured and often absent entirely, alternative perspectives devalued or ignored

� Utilisation of abstract (but powerful) points of reference as core e.g. Lanoix’s white ,educated middle-class male with full ‘capacity’ in health and disability praxis and Haraway’s ‘view from nowhere’

Hacking’s Processes for Creating New Categories of People

1. Count 2. Quantify3. Create Norms4. Correlate5. Medicalise6. Biologise7. Geneticise8. Normalise 9. Bureaucratise

Source: Ian Hacking, Making Up People, LRB, Vol. 28 No. 16 � 17 August 2006

So What is ‘Population’?

� Medieval-early modern term was ‘populous’ – not an abstract entity but a description of the realm

� Malthus and Godwin (Mary Shelley’s dad) engaged for 30 years in a fairly gentlemanly disagreement n population and justice

� Counting the ‘population’ emerged in the 1830’s – the great avalanche of numbers see Ian Hacking and Charles Dickens (Blue Books)

� Foucault’s biopower – disciplinary power through social statistics and measurement – deviance production, ontology of crime etc

So What is ‘Population’?

� Population isn’t just a counting of what is out there in society –ontological-epistemological distinction, natural kinds, concepts and constructs

� Charles Booth’s social mapping, census technologies (also early information science – Babbage etc)and Weber’s social survey methodology become normalised instruments

� Charity and Victorian social policy – liberal and conservative

� Eugenics and scientific racism – skulls and bodies - bioethics

� Demography, population planning and fertility interventions –Post WW2 interventions and the rise of social policy interventions

� Definition absolutely essential e.g. epidemiological, ecological

Colour Coding the Classes

On (Human) PopulationSource: Krieger Milbank Quarterly 2012

� Explores social epidemiological approach vs ecological, biological, statistical etc

� Largely a ‘fuzzy’ concept and rarely explicitly defined –taken for grantedness is problematic

� Became probabilistic during the 19th century – was mainly political-economy prior to this

� Napier’s Statistical Survey of Scotland based on the German version of ‘state’-istics

� Studies claim population science rigour but often arbitrarily exclude socially constituted groups e.g. racial exclusion in the Framingham study (Pollock, 2012)

Very Old Age is a Majority Female Experience: Where is this Acknowledged?

Social Vulnerabilities and Communication:Differential Levels of Risk

Photo Source: CBC

Clinical Aspects of Ageing and Communication: Examples Only - Add to the List!

� Brains and central nervous systems age too!� Visual impairments including short/long sightedness,

macular degeneration, cataracts and blindness� Hearing impairments including Deafness/deaf/ deaf-

blind/HoH/ tinnitus � Cognitive, memory and behavioural problems

associated with neurodegenerative disorders/ diseases � Dementia spectrum including MCI and AD – 50:50

chance of diagnosis in primary care (Draper et al, 2011)� Movement disorders including tremors, PD and gait

ataxias� TIA/Stroke – aphasia etc

Clinical Aspects of Ageing and Communication: Examples

� Persistent pain – e.g. post-operative and post- acute event, headache, neuralgia, severe/persistent dental infections etc

� Delirium in hospital – e.g. staph infection and consent� Polypharmacy – multiple drugs and their interactions in frail

older people� Disability status, cause and consequences for daily life including

self-identification as ‘disabled’, adaptive behaviour and reasoning

Proposition: The whole issue of ethical communication in healthcare settings is very poorly addressed and will (must) grow in scope and complexity as the population ages.

Critical Gerontology

� Gerontology coined by Mechnikov in 1903 – not the same as geriatrics – focus on physical, mental, and social changes in people as they age plus social and systemic implications

� Critical theory and gerontology meet in reaction to ‘dust-bowl’ empiricism (Jan Baars etc,)

� Critical Gerontology: Perspectives from Political and Moral Economy (1997) Minkler and Estes (eds.)

� Focus on ageing and inequalities – local, national, global

� Production of knowledge about ageing and the aged –whose interests are server and how are issues presented?

Origins of Geriatric Medicine

� The workhouse system – 1605-1948, workhouse infirmaries and the establishment of the NHS

� Modern geriatrics established by Dr Ignatz Leo Nascher in 1909 in the US and by Dr Marjorie Warren in the UK approximately 1935

� ‘The Medical Society for the Care of the Elderly’ in the UK founded in 1948 – became the BGS

� Geriatrics often viewed as lower status medicine – no specific organ specialisation!

� Racism and ageism meant many South Asian doctors went into geriatrics in the NHS (Bornat et al, 2012)

The Workhouse ‘System’

Questioning the Ageing Concept

� Old as 60 or 65+ - deep historical links and 19th century social policy e.g. voting rights, Bismark’s pension funds, health insurance, public education etc (Yukio Mishima’sstory)

� ‘Old’ suffices (just) when there are very few old people – not science, just socially adequate for the observed phenomenon

� Then young old, older old, oldest old – 3 sub-categories of old – still kind of chronological plus some pathology

� Now also decadal definitions (octogenarians etc)

� What’s so profound about a decade or a five-year interval –knowing what we know about time? These are conventions.

Differentiation in the Ageing Concept

� And centenarians and super-centenarians –demographic change forcing conceptual change, frontiers of knowledge being reached?

� And where to next? Is this really the limit? And when will it be explanatory rather than still descriptive?

� Okinawan post-mortems often identified as physiologically ‘younger’ e.g. organ health and endocrine systems – so what is the correlationalvalue/utility? Probabilistic only? Explanatory and if so how?

Centenarians and AgeingSource: Poon and Cheung, 2012

Changing Attitudes towards Elderly Dependence in Postwar Japan

Reiko Yamato

AbstractThere is a stereotypical view that East Asian cultures value familism and filial piety, regarding elderly dependence on children as morally desirable. The present study, examining postwarJapan as a case, shows that the social changes this country has undergone have transformed people’s attitudes such that more and more people are seeing elderly dependence on children as less desirable. It is suggested that in order to understand attitudinal changes towards intergenerational relationships in postwar Japan, two research frameworks are necessary: one that takes public welfare systems into consideration as a context where such relationships are placed, and another that distinguishes financial dependence from dependence for personal care. Examining surveys conducted in the last four decades, it is argued that attitudes towards finance changed far earlier than those towards personal care did, and that these attitudinal changes are closely related to the extent to which public welfare systems have developed.

Source: Current Sociology, March 2006 vol. 54 no. 2 273-291

An elderly Chinese woman looks out her window above a trendy clothing store for young women in Beijing. The proportion of people above 65 in China will surpass that of Japan in 2030, which will make China the world's most aged society, according to the Chinese Academy of Social Sciences. The problem with an increase in China's elderly population is that it will slow GDP per capita growth, investment and capital accumulation, while at the same time increasing public debt.

UPI/Stephen Shaver | License Photo

Conclusion

� Age and ageing are still contentious phenomena in terms of definition and causal processes

� Studies of population and population groups have significant limitations and are often ideologically loaded - even now poverty and crime are often linked as causal

� Ageing research is in its early/formative period as data will grow hugely in coming decades

� Many ideas about age/ageing are deep cultural/historical/social constructs

� Critical analysis is fundamental to policy, practice and scientific investigation

� Age and ageing knowledge is only in the early stages of its development – very few absolutes and many unstable theories and assumptions

� Question everything – Why? How? Who said so? What did they have to gain? What evidence is there? How good is it? Test and re-test.