Table Of ContentANNUAL REVIEW OF
GERONTOLOGY AND GERIATRICS
Volume 8, 1988
Varieties of Aging
Editorial Board
Editor-in-Chief
M. Powell Lawton, Ph.D.
Philadelphia Geriatric Center
Philadelphia, Pennsylvania
Associate Editors
Richard W. Besdine, M.D. John W. Rowe, M.D.
University of Connecticut President and Chief
School of Medicine Executive Officer
Farmington, Connecticut Mount Sinai Medical Center
New York, New York
Vincent Cristofalo, Ph.D. George L. Maddox, Ph.D.
Wistar Institute Duke University
Philadelphia, Pennsylvania Durham, North Carolina
K. Warner Schaie, Ph.D.
The Pennsylvania State University
University Park, Pennsylvania
Managing Editor
Bernard D. Starr, Ph.D.
Brooklyn College
City University of New York
Founding Editor
Carl Eisdorfer, Ph.D., M.D.
University of Miami
School of Medicine
Miami, Florida
ANNUAL REVIEW OF
Gerontology and Geriatrics
Volume 8, 1988
Varieties of Aging
George L. Maddox, Ph.D.
M. Powell Lawton, Ph.D.
SPECIAL VOLUME EDITORS
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Copyright© Springer Scicnce+Bnsiness Media New York
Originally pnblished by 1988 by Springer Publishing Company, Inc. in 1988
Softcover reprint of the hardcover 1st edition 1988
All rights reserved
No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Springer Science+Business Media, LLC
88 89 90 91 92 I 5 4 3 2 I
ISBN 978-3-662-37651-5 ISBN 978-3-662-38443-5 (eBook)
DOl 10.1007/978-3-662-38443-5
Contents
Preface vii
Introduction ix
Contributors
XV
Forthcoming Contents, Volume 9 xvi
Orientations
Chapter 1 Differential Gerontology and the Stratified Life
Course: Conceptual and Methodological Issues 3
DALE DANNEFER
Chapter 2 The Changing and Heterogeneous Nature of
Aging and Longevity: A Social and Biomedical
Perspective 37
LISA F. BERKMAN
The Social Distribution of Societal Resources
Chapter 3 A Different Perspective on Health and Health
Services Utilization 71
FREDRIC D. WOLINSKY AND CONNIE LEA ARNOLD
Chapter 4 The Economic Situation of Older Americans:
Emerging Wealth and Continuing Hardship 102
MARILYN MooN
Chapter 5 Convergence, Institutionalization, and
Bifurcation: Gender and the Pension
Acquisition Process 132
ANGELA M. O'RAND
Chapter 6 Gender and Ethnicity Differences in
Psychological Well-Being 156
NEAL KRAUSE
v
vi CONTENTS
Some Policy Implications of Population Heterogeneity
Chapter 7 Better Options for Work and Retirement: Some
Suggestions for Improving Economic Security
Mechanisms for Old Age · 189
YuNG-PING CHEN
Chapter 8 Planning Long-Term Care for Heterogeneous
Older Populations 217
KENNETH G. MANTON
Chapter 9 Insuring Long-Term Care 256
ALICE M. RIVLIN, JOSHUA M. WIENER
AND DENISE A. SPENCE
Index 283
Contents of Previous Volumes 293
Preface
With the appearance of Volume 8 of the Annual Review of Gerontology and
Geriatrics it is appropriate to acknowledge the tremendously creative work
of founding Editor-In-Chief Carl Eisdorfer. Dr. Eisdorfer's leadership was
evident in every phase of the production of the past seven volumes. The
most notable of all his contributions came in the generative phase of each,
where ideas flowed in bewildering profusion, yet were processed to end up
with a coherent set of chapters and authors to constitute each of the
volumes. His leadership will be missed, but his continuing interest will
remain expressed as he contributes in the role of Founding Editor for the
continuing series.
The Annual Reviews of the future will build on Dr. Eisdorfer's tradition.
In a field that includes so many disciplines, it would be unrealistic to
represent a true cross-section of these disciplines in every volume. The series
will thus continue to produce volumes that sample segments of the totality,
the breadth of each segment varying over the years. The present Volume 8,
for example, while it includes content of interest to health-care professionals
and geriatric practitioners, samples its chapters from the segment defined by
sociology, economics, and social policy. Volume 9 is in process and will
represent a particularly broad segment of all gerontology and geriatrics by
focusing on "clinical gerontology," based on the clinical research from
geriatrics, medicine, psychiatry, exercise physiology, counseling, health ser
vice organization, and self-help. Yet another variation on the theme will
come in a later volume designed to provide a scholarly presentation of the
current status of a number of issues in the biology aimed toward the multi
disciplinary audience for this series. Over the long range, the many faces of
gerontology and geriatrics will be covered, but without slavish adherence to
a formula.
The Associate Editors join me in hoping that suggestions for future
directions will be provided by readers.
M. Powell Lawton
Editor-in-Chief
Vll
Introduction
Demographers, epidemiologists and historians have regularly documented
the very large differences in how people age, how they experience aging, and
when they die among societies and across time. The observed differences
appear to be explained substantially by factors external to the individual,
factors such as the stability of food supply, the provision of clean water, the
adequacy of public sanitation, and the availability of effective immunization
against, or medical treatment for, one or another epidemic or chronic disease.
Intra-societal differences, however, are a more complex matter and a rela
tively less studied one.
This volume of the Annual Review focuses attention precisely on the
neglected documentation and explanation of heterogeneity of how people
grow older within a society. The society of special interest is the United
States in relatively recent decades, although some of the chapters include
instructive comparisons with other societies.
In the opening section, sociologist Dale Dannefer and epidemiologist Lisa
Berkman orient the reader to processes of resource allocation within a
society which produces and maintains a system of socioeconomic stratifica
tion. An individual's social address in a system of stratification is indexed in
part by income and level of formal education achieved. But the correlates of
one's social address in a society are also easily recognizable by status-related
differential life expectancy, patterns of sickness and utilization of health
resources, and perceptions of self as socially effective and socially integrated.
Dannefer notes that gerontologists, possibly as a reflection of the immaturity
of their field, have preferred to pursue broad scientific generalizations about
processes of aging and about older adults; consequently they have not been
sufficiently interested in documenting and explaining heterogeneity in later
life. He makes a strong case for both the theoretical and practical values of
differential gerontology. Gerontologists have tended to be keenly aware of
the relevance and interaction of both intrinsic and extrinsic factors in deter
mining the course of aging processes. Precisely to the extent that external
factors are assumed to condition the expression and experience of aging,
one might expect gerontologists to celebrate observed diversity as evidence
of what happens when intrinsic biological factors are conditioned in their
development and expression by sociocultural and environmental factors.
And, if the present is an expression of the past, then the present anticipates
IX
x INTRODUCTION
the future. Can alternative futures of aging be anticipated and pursued? If
aging processes are modifiable, then the answer is affirmative. Acceptance
of the modifiability of aging processes logically leads to a discussion of public
policy options in terms of the possible beneficial effects on achieving and
maintaining well-being in later life.
Lisa Berkman illustrates the application of the perspective of social and
behavioral epidemiology to the study of human aging. The tradition of
epidemiology is exquisitely multidimensional and multivariate in its focus
on the interaction of a host in a particular environment responding to a
challenge of one sort or another. For the epidemiologist, the adequacy of an
individual's response is reflected in the outcomes we describe as health or
illness. Berkman is particularly interested in illustrating more than the classic
finding of epidemiology that socioeconomic factors are powerful predictors
of health and illness. She also reviews a broad range of new evidence about
the effects of socioenvironmental and behavioral factors on the physiologic
mechanisms as individuals age and the preventive and mediating effects of
social support systems on the health of older adults.
In the second section of the volume, four chapters document and inter
pret the heterogeneity of the ways adults age in the United States. Fredric
Wolinsky and Connie Arnold (Chapter 3) document heterogeneity in health
and health-services utilization among older adults but focus specifically on
the need for a new perspective in the study of this heterogeneity. It is not
enough, they argue, simply to "cut the deck" by new and different ways of
subclassifying older adults. Scientific evidence and explanatory models
must increasingly take into consideration that many of the processes of aging
in which we are interested are best conceptualized as processes and as complex
multivariate interactions. Wolinsky and Arnold clearly illustrate some basic
problems in the mismeasurement of variables and mis-specification of models
intended to explain health and health-services utilization in later life. Age,
they find in their analysis, is a weak explanatory variable. Their analysis
focuses attention rather on the importance of correct assessment of health
needs and the relatedness of institutional and noninstitutional care. These
observations lead then to a recommendation of a "fundamental restructuring
of health care" to assure uniform access to services, particularly primary
care services. They go beyond this general recommendation to argue specifi
cally that a system of national health insurance has particular merits in an
aging society.
Marilyn Moon's theme in Chapter 4 is nicely captured in the subtitle,
"Emerging Wealth and Continuing Hardship." It is neither possible nor
particularly useful, she concludes, to try to capture the economic situations
of heterogeneous older adults with aggregated data describing "the elderly."
The most important conclusion about the economic situation of older adults
in the contemporary United States may be the persistence of a large minority
