These essays are a collective assault by mainly American social scientists, mostly anthropologists, upon the ‘successful aging’ movement, which they argue has been powerfully promoted in North America since the 1980s. This movement aims to persuade people they can control the ageing process, escaping the experience and appearance of decline and disability through physical and mental activity, engagement with others, good diet and, especially for women, cosmetics, cosmetic surgery and medication, to retain the appearance of eternal youth. The experience of ageing is presented as a personal choice, promoted by the profit-making US cosmetic surgery and pharmaceutical industries. It is impossible to object to encouraging people to remain fit, active and independent as they face lengthening lives; this is obviously desirable and increasingly promoted internationally. The danger the authors perceive in the American movement is that it makes the ageing process appear wholly dependent on personal decisions, hence any sign of ‘unsuccessful’ ageing—the onset of dementia or deafness, dependence upon others, even too many wrinkles—is seen and felt as personal failure rather than changes beyond personal control. This, they suggest, reinforces the very ageism ‘successful ageing’ aims to resist, denigrating and encouraging anxiety about ageing, suggesting nothing about it to be valued, reinforcing discrimination against those, especially women, bold enough to appear in public with grey hair and wrinkles, or too poor to buy the alternatives, leaving people wholly unprepared for the experiences of decline and death. The essays explore the American experience and alternative models elsewhere. American women who have undergone cosmetic surgery describe the boost to their confidence and esteem in the eyes of others, and disparage women who ‘let themselves go’. Other women are happy to do so, appreciating liberation from the male gaze and conventional expectations of femininity, while remaining fit and active. Some people felt growing older gave them more freedoms, others did not. The ‘successful ageing’ model is evidently not all-powerful even in the USA. Frail older Americans showed they could adjust to dependence on carers and still lead valued lives. A community of nuns live long, active, happy lives without cosmetics or surgery, mutually supportive, serenely accepting the inevitability of illness and death, supported by beliefs other than the neoliberal individualism underlying ‘successful aging’. A study of post-communist Poland describes commonplace disparagement of older people, which some better-off people counteract by keeping mentally active in flourishing branches of the University of the Third Age, while people of all classes keep fit and healthy growing food on allotments. It describes residential institutions supporting Alzheimer’s sufferers and challenges the assertion in some of these essays that north Europeans ‘abandon’ their elders to care homes. There is a similar account of dementia care in Brazil. In Poland, as elsewhere, they generally enter homes only when too frail for their families to cope or if they have no family and families continue to support them in care. The Polish experience illustrates that meaningful old age can take many forms, and should be approached more flexibly than ‘successful aging’ apparently requires. The essays imply that ‘successful aging’ has been influential in Europe, but they provide no evidence that it has been as aggressively and negatively applied as they describe in the USA. Certainly ‘active ageing’ has been encouraged in the UK and elsewhere and has been EU and WHO policy for some time. This urges older people to be physically and mentally active, to care for their health and diet—and younger people too as the obesity epidemic grows. But it is not evident that ‘active ageing’ reinforces all-too-prevalent ageism or creates a sense of failure for becoming involuntarily less active. The only other essay on a European country, on ‘active ageing’ in Denmark, where it is official policy, shows older people resisting intrusive pressure to influence their conduct, willing to be active but also enjoying rest and freedom, recognising that eventual decline generally cannot be avoided and preparing for it. The culture seems to encourage more freedom and flexibility than in the USA. Similarly, in Japan an official policy imposing somewhat inflexible measures to delay the ageing process in the country with the longest life expectancy in the world is disregarded by many older people, who prefer to direct and enjoy their own lives. Encouragement to maximise wellness throughout life through activity and diet featured in ancient Chinese medical and philosophical writing, as it did in Europe although this is not mentioned here. ‘Active ageing’ is not a modern invention. In China it has remained influential, visible in the many groups of older people enjoying exercise or dance in city parks morning and evening. The cost of health care is an incentive but the tradition of activity is older and driven as much by enjoyment and companionship as the desire to resist old age, while in both Japan and China older people are keen to avoid burdening their children with their care, which their cultures expect, valuing their independence while it lasts while staying close to families and friends. This is also true in India, while all three cultures prepare people for inevitable decline and death, although they cannot remove the accompanying apprehensions. This is similarly true of the two African countries sampled, Kenya and Uganda, where most people have no access to the fitness regimes encouraged elsewhere and minimal state support, although in Kenya in particular elite older people, especially men, feel they have lost status and respect in modern times. In all these countries communal and family support for ageing is valued above individualism. The editor comments in her own essay, ‘North America must learn to imagine that frailty, dependency and death are normal, acceptable human experiences’. In searching for more realistic approaches to ageing than the ‘successful ageing’ model, the authors explore facets of the experience of ageing in many cultures. The accounts are brief and selective but suggestive, perhaps offering their compatriots some alternatives. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
Social History of Medicine – Oxford University Press
Published: Feb 1, 2018
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