A critical overview of some of the issues associated with age, ageing theory and aged care policy.Includes some summary historical background and links these to contemporary issues.

1. Critical Thinking about
Age and Ageing
PRESENTER
HAMISH ROBERTSON
UNSW 201 3

2. 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

3. 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 …

4. 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

6. Ancient Egypt
Hieroglyph for ‘old age’

7. 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. Ayurvedic
tradition, Traditional Chinese Medicine etc)…
If age is essentially attributional, where and what is the
science of ageing?

8. Theology, Sin, Disease and Death

9. The Bubonic Plague in European Art

10. 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

11. 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

12. 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

13. 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’

14. Hacking’s Processes for Creating
New Categories of People
1. Count
2. Quantify
3. Create Norms
4. Correlate
5. Medicalise
6. Biologise
7. Geneticise
8. Normalise
9. Bureaucratise
Source: Ian Hacking, Making Up People, LRB, Vol. 28 No. 16 — 17 August 2006

15. 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

16. 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

17. Colour Coding the Classes

18. On (Human) Population
Source: 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)

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

20. Social Vulnerabilities and Communication:
Differential Levels of Risk
Photo Source: CBC

21. 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

22. 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.

23. 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?

24. 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)

25. The Workhouse ‘System’

26. 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’s
story)
‘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.

27. 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 correlational
value/utility? Probabilistic only? Explanatory and
if so how?

28. Centenarians and Ageing
Source: Poon and Cheung, 2012

29. Changing Attitudes towards Elderly
Dependence in Postwar Japan
Reiko Yamato
Abstract
There 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 postwar
Japan 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

30. 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

31. 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.