Challenges of Aging

Health Problems, Isolation, and Mistreatment

In the United States the elderly suffer from relatively high rates of health problems, abuse, neglect, mistreatment, and social isolation.

Old age presents many problems and challenges. These are experienced by individuals, but the challenges of aging are a social issues as well. Societies take different approaches to responding to the challenges of aging. Many of these challenges are common to people around the world. For example, advanced age brings declining physical and mental health. Conditions such as heart disease and cancer are more common among older people. Vision loss, hearing loss, arthritis, and other non-life-threatening conditions associated with old age can lead to a decline in independence, physical capability, and quality of life. Some serious mental health conditions such as dementia and Alzheimer's disease are also strongly associated with advanced age. Medical issues related to old age are addressed by doctors and researchers specializing in geriatrics, a field of medicine devoted to the treatment of conditions prevalent among the elderly.

In addition to physical and mental health issues, elders often face social problems. One major problem is isolation. French sociologist Émile Durkheim (1858–1917) identified social integration as crucial for societies and individuals. Social integration refers to the feeling individuals have of being connected to a community. Durkheim argued that a lack of social integration causes individuals great psychological distress and puts people at a higher risk of committing suicide. Isolation prevents social integration. Many elders in the United States have little or no contact with wider society. This can lead to depression. It can also pose danger to elderly people who may fall, forget to take medication, or choose not to seek medical attention when they may need it.

Isolation of the elderly has several causes. One cause is absence from the workplace. Retirement or lack of employment can cut elders off from large social networks. Cultural patterns can also contribute to isolation of older people. For middle-class and upper-class Americans, the high value placed on careers and income often leads children to move and raise their families far from their parental homes. Another cause of isolation for women stems from the fact that they tend to live longer than men. In societies and communities where multigenerational households are less common, elderly widows are more likely to live alone. For example, it common for elderly American women to live in isolation following the death of their husbands. Another factor driving isolation is that the peer group of the aged is often less available, either through ill-health, relocation to be closer to or live with family, or through death.

Consequences of social isolation include feelings of loss and loneliness as well as mental health conditions such as depression and anxiety. Health and well-being are also negatively affected when an elder has no one to rely on when needs arise, especially in emergencies. Furthermore, a lack of regular checkups by family and friends can lead to serious health or other problems going undetected. Because of declining health and isolation, some elderly people are subjected to elder abuse, mistreatment of elders that can include physical, sexual, and emotional violence, deception, financial exploitation, and neglect.

Elder abuse is linked to several issues. Some elder abuse occurs in the context of frustration and stress on the part of family members or other caregivers. The lack of other sources of support may leave a family member with the persistent burden of caring for a loved one, which over months or years can become oppressive. Some elderly are simply easy to victimize because declining health, isolation, and embarrassment make it difficult for them to report abuse. Some elders are able to afford assisted living, residential facilities for elders who need assistance with daily life but who do not need nursing care. However, abuse can also be a problem in assisted living communities where financial constraints have led to understaffing and inadequate training.

Aging and Poverty

Challenges of aging include poverty, the decline of multigenerational households, and the problems of growing old in a rural area.

Poverty among elderly Americans has several causes. One issue is a lack of employment opportunities for older people. The United States and other postindustrial societies prize flexibility and mobility among workers, high-tech industries, and new technologies. These factors contribute to poverty and marginalization among the elderly, who are less likely to be willing and able to move in order to take a new job. Some older people are less technologically adept, or perceived to be so, making it harder to find employment. In some societies, social welfare spending—government spending on programs to support vulnerable populations such as children, low-income people, and the elderly—help keep the elderly out of poverty. In the United States, where many people are skeptical of social welfare spending, there is less of a social safety net. Fewer opportunities to earn income, combined with a minimal social safety net, mean that older Americans are at an increased risk of poverty.

Often, poverty among the elderly is a result of having retired from the workforce. Because elderly people generally do not work full-time, they have to rely on savings, pensions, and assistance from family or from public welfare programs. Rates of poverty among the elderly are also strongly affected by changes in workplace demographics, social welfare spending, and economic health. Factors such as an increased presence of women in full-time employment and improved retirement benefits led to a reduction in the U.S. poverty rate among those over 65 from about 35 percent in 1960 to just under 10 percent in 2008. However, the financial crisis of 2007–08 and the ensuing recession negatively affected savings and retirement funds, causing the poverty rate among the elderly to rise once more.

In the United States, Social Security is the major publicly funded program for retired people. It has been calculated that by the mid-21st century, as many as 44 percent of elderly Americans would be in poverty without Social Security. It is important to note, however, that Social Security does not provide financial stability and comfort for all retirees. Social Security payments are based on the wages recipients earned during their working lives. Therefore, individuals who earned low wages as workers receive low Social Security payments. This contributes to poverty among the elderly. Many countries have measures in place to provide a minimum income and standard of living to the elderly. For example, Sweden's system includes a guaranteed pension (a set monthly income) and an occupational pension (additional income based on the wages an individual earned when working). The U.S. system provides some support to the elderly, but much less than most other high-income countries. Older Americans do have Medicare benefits but can still face high medical expenses. Medicare pays very little for mental health services, nursing homes, and other assistance that many older people require.

Across the United States, poverty among elderly people is more common in rural areas. This is a result of scant infrastructure, the concentration of high-paying jobs in cities, distance from family, friends, and other caregivers, and low population density, which prevents the elderly population from reaching a critical mass sufficient to justify spending on certain programs and facilities. Rural living both increases the pressure on elderly people, especially as their health fails, and separates them from many of the facilities, programs, and people who could provide necessary assistance.

Another factor affecting poverty among the elderly is the decline of multigenerational families. The practice of living with or near elderly relatives is less prevalent than in the past. This exacerbates problems of poverty, isolation, and health among the elderly relatives who would otherwise have received care and support from their extended families. This pattern is particularly true for middle-class and upper-class families. Less-wealthy families are more likely to live in multigenerational households, as a financial strategy, to share living costs. There are also significant racial and ethnic differences in the prevalence of multigenerational households. In the United States, Hispanics and Asian Americans are significantly more likely than white Americans to live in multigenerational households. Much of this difference can be attributed to cultural patterns and traditions. Hispanic and Asian cultures emphasize filial piety, a sense of duty, respect, and obligation to care for older family members. The growing Hispanic and Asian populations in the United States have contributed to a slight increase in multigenerational households since the beginning of the 21st century. However, an overall trend in less multigenerational living has occurred since World War II. More elders live alone, with many struggling to afford basic costs.

Percent of Americans Living in Multigenerational Households

Following World War II, a major shift in living patterns occurred for Americans 85 years and older. However, changes in the racial and ethnic composition of the United States have led to an increase in multigenerational households.