Core Concepts in Gerontological Thinking does not, for example, tell us when “old age” begins.
The
What Can Thinking Like a
Gerontologist Bring to Bioethics?
BY K ATE D E ME D E I RO S
“Until the moment it is upon us old age is something that
only affects other people. So it is understandable that society
should manage to prevent us from seeing our own kind, our
fellow-men [sic], when we look at the old.”
—Simone de Beauvoir1
I
am a social gerontologist, broadly defined as a social
scientist who studies how later life is experienced,
structured, and controlled in a society and in social
settings. Although gerontology is often confused with
geriatrics (a medical specialty), gerontologists are typical-
ly not clinicians but may study issues related to old age
and health care such as the societal conditions that shape
how medical care is provided and financed and how early
exposure to education relates to later life health.
In this essay, I argue that thinking like a gerontologist
is important when considering what makes a good life
in late life. To think like a gerontologist is to consider
the cultural and societal values—past and present—that
shape the experience of aging, to recognize people as
complex beings whose individual lives do not follow pre-
dictable patterns or easily identified trajectories, and to
recognize our own habits of regarding older persons as
“other” and the consequences of “othering” for older per-
sons and social systems. After a brief history of gerontol-
ogy, highlighting a few core concepts that gerontologists
share, I propose three important questions to consider
regarding a good life in late life.
Kate de Medeiros, “What Can Thinking Like a Gerontologist Bring to
Bioethics?,” What Makes a Good Life in Late Life? Citizenship and Justice
in Aging Societies, special report, Hastings Center Report 48, no. 5 (2018):
S10-S14. DOI: 10.1002/hast.906
S10
aging societies special report text.indd 10-11
A Brief Overview of Gerontology
G erontology (a field so named by Russian zoolo-
gist Elie Metchnikoff in 1903) emerged in the late
nineteenth century when medicine turned its attention
to finding a cure for old age.2 In the first half of the twen-
tieth century, as public health efforts (such as providing
safe drinking water, improving sanitation, and adminis-
tering vaccinations) increasingly succeeded in reducing
childhood mortality, thereby increasing average life ex-
pectancy at birth, demographers began to take notice of
shifting population structures in the United States and
Europe. In 1947, American biologist Edmund Vincent
Cowdry observed that, “[f ]rom 1860, the decennial cen-
sus year before the Civil War, to 1940 [the percentage
of people age sixty-five and over in the United States]
rose from 2.7 to 6.8 percent. It is still going up, being
estimated at 7.2 percent in 1944. Predictions are that
it will reach 14.4 percent in 1980.”3 Although Cowdry
was close, the actual percentage of people sixty-five and
over in 1980 was 11.3 percent.4 This “age alarmism” of
the 1940s, similar to present-day concerns about “gray-
ing” societies, prompted scholars from biology, psychol-
ogy, and sociology to turn their attention to societal and
individual needs arising from populating aging including
but not limited to housing, work and retirement, oppor-
tunities for social connectedness, and care and support.
More recently, gerontology has expanded to include
more disciplinary perspectives, such as history and an-
thropology, and has developed into an academic dis-
cipline with undergraduate, master’s, and doctoral
programs. The term “gerontologists” therefore includes
scholars trained in a variety of disciplines who focus on
aging as well as those trained specifically in gerontology.
September-October 2018/HASTINGS CENTER REPORT
term “aging” describes the “gradual functional and struc-
T here are a few important concepts that most gerontol- tural decline of an organism, resulting in an increasing risk
ogists agree on and that form the basis for gerontologi- of disease, impairment, and mortality over the life span.”5
cal thinking. Perhaps the most important of these concern Since rates of biological and functional change are not uni-
the limits of using chronological age to understand aging. versal across people but are instead affected by genetics and
While chronological age may provide societies with a ba- by environmental exposures and opportunities—including
sis for inclusion and exclusion rules, such as the eligibility factors sometimes characterized as “social”—age reveals
threshold for a social benefit, it is often a poor predictor; it little about individual people’s lives, health, or needs. Yet,
despite this serious shortcoming, age is
primarily studied with respect to chrono-
Aging: A Social Gerontology Primer logical age, given the ties between social
benefits and chronological age and the
A ge effects, period effects, and cohort effects are important consid-
erations within a life course perspective on aging. Age effects are
changes experienced by a person over time that are associated with bio-
subsequent ease of using this concept of
age when comparing outcomes for people
and groups (for example, people seventy-
logical aging, such as hearing loss, rather than chronological age. Period five to eighty). Gerontologists recognize
effects are societal changes experienced by everyone in a population, that use of chronological age cannot be
such as the implementation of a national health care system in the United avoided, but they are also mindful of its
Kingdom starting in 1948. Cohort effects are those societal changes that limits as a way to understand aging.
apply to a historic or situational group, such as people who experienced
the Second World War as teenagers. A sixty-five-year-old and an eighty-
five-year-old living in the same society at the same time will have had
Alternative terms include “biological
aging,” which describes a person’s rate of
cellular and systematic change, therefore
some shared period effects but different cohort effects and different indi- speaking more directly to health trajecto-
vidual experiences, all of which are relevant in the interpretation of data ries;6 “functional age,” which is similar to
and the description of age-related phenomena. biological age but also includes cognitive
“Generation” refers to a cohort formed at birth whose members change; and the “third age” and “fourth
experience personal and historical events at roughly similar ages. age,” which are both concerned with
“Generational consciousness” denotes the effect of perceiving oneself functional ability. “Third age” denotes
as a member of a generation, such as a Baby Boomer, through the ac- high functional ability and overall health
cumulation, filtering, and arrangement of personal experiences to align in later life; “fourth age” refers to a period
with perceived generational norms—a process known as “stratification of poor health or poor functional ability
of experience.” following the third age.7 Instead of being
The life course perspective holds that individual experience in a so- operationalized for research, the concepts
ciety and in families and other social units is shaped by norms and poli- of third and fourth age are often used
cies concerning social equality or inequality and the timing of life events, theoretically as a way to illustrate differ-
such as the “right” time to buy a home, start a family, retire, or become a ences rather than to provide a clear means
grandparent. The related idea of linked lives explains that because most to differentiate between the two.
people live and age in connection to others, the timing of life events often A second important concept is the life
reflects the needs of others. For example, a person may retire or relocate course perspective, which considers how
to become a family caregiver, a decision shaped in part by expectations the culmination and timing of a person’s
about who is responsible for stepping into this role. experiences and connections with others
“Life expectancy” denotes the average number of years a person of a (referred to as “linked lives”) affect one’s
given age (at birth, for example, or at sixty-five), born in a given period, current situation,8 as well as the roles of
can expect to live. In the United States in 2007, overall life expectancy age, period, and cohort effects in shap-
at birth for both sexes and all races was 77.9 years. Because this overall ing expectations and opportunities. The
figure is an average and takes into account people who died young, a life course perspective can shed light on
clearer measure of life expectancy is that of people age sixty-five, who in older persons and groups by considering
2007 could expect to live an additional 18.6 years (or to the age of 83.6). how their lives were shaped by key histori-
“Life span” refers to the theoretical maximum number of years a spe- cal events or cultural experiences, such as
cies is believed to be capable of living. In humans, life span is currently growing up during the Great Depression
estimated to be 120 years. or the Second World War or being sub-
jected to Jim Crow laws, which mandated
S P E CIAL RE P O RT: Wh at Make s a Go o d Li f e i n Lat e Li f e ? Ci t i ze n s h i p an d J u s t i ce i n Ag i ng Societies S11
10/4/2018 2:34:13 PM

What Can Thinking Like a
Gerontologist Bring to Bioethics?
BY K ATE D E ME D E I RO S
“Until the moment it is upon us old age is something that
only affects other people. So it is understandable that society
should manage to prevent us from seeing our own kind, our
fellow-men [sic], when we look at the old.”
—Simone de Beauvoir1
I
am a social gerontologist, broadly defined as a social
scientist who studies how later life is experienced,
structured, and controlled in a society and in social
settings. Although gerontology is often confused with
geriatrics (a medical specialty), gerontologists are typical-
ly not clinicians but may study issues related to old age
and health care such as the societal conditions that shape
how medical care is provided and financed and how early
exposure to education relates to later life health.
In this essay, I argue that thinking like a gerontologist
is important when considering what makes a good life
in late life. To think like a gerontologist is to consider
the cultural and societal values—past and present—that
shape the experience of aging, to recognize people as
complex beings whose individual lives do not follow pre-
dictable patterns or easily identified trajectories, and to
recognize our own habits of regarding older persons as
“other” and the consequences of “othering” for older per-
sons and social systems. After a brief history of gerontol-
ogy, highlighting a few core concepts that gerontologists
share, I propose three important questions to consider
regarding a good life in late life.
Kate de Medeiros, “What Can Thinking Like a Gerontologist Bring to
Bioethics?,” What Makes a Good Life in Late Life? Citizenship and Justice
in Aging Societies, special report, Hastings Center Report 48, no. 5 (2018):
S10-S14. DOI: 10.1002/hast.906
S10
aging societies special report text.indd 10-11
A Brief Overview of Gerontology
G erontology (a field so named by Russian zoolo-
gist Elie Metchnikoff in 1903) emerged in the late
nineteenth century when medicine turned its attention
to finding a cure for old age.2 In the first half of the twen-
tieth century, as public health efforts (such as providing
safe drinking water, improving sanitation, and adminis-
tering vaccinations) increasingly succeeded in reducing
childhood mortality, thereby increasing average life ex-
pectancy at birth, demographers began to take notice of
shifting population structures in the United States and
Europe. In 1947, American biologist Edmund Vincent
Cowdry observed that, “[f ]rom 1860, the decennial cen-
sus year before the Civil War, to 1940 [the percentage
of people age sixty-five and over in the United States]
rose from 2.7 to 6.8 percent. It is still going up, being
estimated at 7.2 percent in 1944. Predictions are that
it will reach 14.4 percent in 1980.”3 Although Cowdry
was close, the actual percentage of people sixty-five and
over in 1980 was 11.3 percent.4 This “age alarmism” of
the 1940s, similar to present-day concerns about “gray-
ing” societies, prompted scholars from biology, psychol-
ogy, and sociology to turn their attention to societal and
individual needs arising from populating aging including
but not limited to housing, work and retirement, oppor-
tunities for social connectedness, and care and support.
More recently, gerontology has expanded to include
more disciplinary perspectives, such as history and an-
thropology, and has developed into an academic dis-
cipline with undergraduate, master’s, and doctoral
programs. The term “gerontologists” therefore includes
scholars trained in a variety of disciplines who focus on
aging as well as those trained specifically in gerontology.
September-October 2018/HASTINGS CENTER REPORT
Core Concepts in Gerontological Thinking does not, for example, tell us when “old age” begins. The
term “aging” describes the “gradual functional and struc-
T here are a few important concepts that most gerontol- tural decline of an organism, resulting in an increasing risk
ogists agree on and that form the basis for gerontologi- of disease, impairment, and mortality over the life span.”5
cal thinking. Perhaps the most important of these concern Since rates of biological and functional change are not uni-
the limits of using chronological age to understand aging. versal across people but are instead affected by genetics and
While chronological age may provide societies with a ba- by environmental exposures and opportunities—including
sis for inclusion and exclusion rules, such as the eligibility factors sometimes characterized as “social”—age reveals
threshold for a social benefit, it is often a poor predictor; it little about individual people’s lives, health, or needs. Yet,
despite this serious shortcoming, age is
primarily studied with respect to chrono-
Aging: A Social Gerontology Primer logical age, given the ties between social
benefits and chronological age and the
A ge effects, period effects, and cohort effects are important consid-
erations within a life course perspective on aging. Age effects are
changes experienced by a person over time that are associated with bio-
subsequent ease of using this concept of
age when comparing outcomes for people
and groups (for example, people seventy-
logical aging, such as hearing loss, rather than chronological age. Period five to eighty). Gerontologists recognize
effects are societal changes experienced by everyone in a population, that use of chronological age cannot be
such as the implementation of a national health care system in the United avoided, but they are also mindful of its
Kingdom starting in 1948. Cohort effects are those societal changes that limits as a way to understand aging.
apply to a historic or situational group, such as people who experienced
the Second World War as teenagers. A sixty-five-year-old and an eighty-
five-year-old living in the same society at the same time will have had
Alternative terms include “biological
aging,” which describes a person’s rate of
cellular and systematic change, therefore
some shared period effects but different cohort effects and different indi- speaking more directly to health trajecto-
vidual experiences, all of which are relevant in the interpretation of data ries;6 “functional age,” which is similar to
and the description of age-related phenomena. biological age but also includes cognitive
“Generation” refers to a cohort formed at birth whose members change; and the “third age” and “fourth
experience personal and historical events at roughly similar ages. age,” which are both concerned with
“Generational consciousness” denotes the effect of perceiving oneself functional ability. “Third age” denotes
as a member of a generation, such as a Baby Boomer, through the ac- high functional ability and overall health
cumulation, filtering, and arrangement of personal experiences to align in later life; “fourth age” refers to a period
with perceived generational norms—a process known as “stratification of poor health or poor functional ability
of experience.” following the third age.7 Instead of being
The life course perspective holds that individual experience in a so- operationalized for research, the concepts
ciety and in families and other social units is shaped by norms and poli- of third and fourth age are often used
cies concerning social equality or inequality and the timing of life events, theoretically as a way to illustrate differ-
such as the “right” time to buy a home, start a family, retire, or become a ences rather than to provide a clear means
grandparent. The related idea of linked lives explains that because most to differentiate between the two.
people live and age in connection to others, the timing of life events often A second important concept is the life
reflects the needs of others. For example, a person may retire or relocate course perspective, which considers how
to become a family caregiver, a decision shaped in part by expectations the culmination and timing of a person’s
about who is responsible for stepping into this role. experiences and connections with others
“Life expectancy” denotes the average number of years a person of a (referred to as “linked lives”) affect one’s
given age (at birth, for example, or at sixty-five), born in a given period, current situation,8 as well as the roles of
can expect to live. In the United States in 2007, overall life expectancy age, period, and cohort effects in shap-
at birth for both sexes and all races was 77.9 years. Because this overall ing expectations and opportunities. The
figure is an average and takes into account people who died young, a life course perspective can shed light on
clearer measure of life expectancy is that of people age sixty-five, who in older persons and groups by considering
2007 could expect to live an additional 18.6 years (or to the age of 83.6). how their lives were shaped by key histori-
“Life span” refers to the theoretical maximum number of years a spe- cal events or cultural experiences, such as
cies is believed to be capable of living. In humans, life span is currently growing up during the Great Depression
estimated to be 120 years. or the Second World War or being sub-
jected to Jim Crow laws, which mandated
S P E CIAL RE P O RT: Wh at Make s a Go o d Li f e i n Lat e Li f e ? Ci t i ze n s h i p an d J u s t i ce i n Ag i ng Societies S11
10/4/2018 2:34:13 PM

racial segregation, and how the age of a person when such
an event occurred affected them. For example, a gerontolo-
gist studying retirement among African American women
ages seventy-five to eighty-four would likely consider the
extent to which women of that age cohort in their society
had access to paid work and to pension programs, what
options for building wealth (such as home equity) were
available to African American men and women during
their working years, and how access or barriers to educa-
tion earlier in life influenced later life experience, with the
goal of understanding the cumulative effects of gender and
racial equality or inequality in the society in which these
women lived.
A life course perspective also considers the role of
linked lives in the life of an older adult, whether these
reflect cultural expectations (for example, that daughters
or daughters-in-law will provide care to their parents and
their in-laws) or social network composition (the presence
or absence of close friends and confidantes), and how these
connections shape an older adult’s thinking and options
concerning late life. The life course perspective is valuable
for understanding the experiences of older adults in con-
temporary society and for forecasting what will be differ-
ent in the future. For example, as American families grow
smaller and more adults age without children, the cultural
expectation that there will be adult children (specifically,
women) available to step into a caregiving role will have to
give way to different accounts of caregiving.
A third concept familiar to gerontology but often over-
looked in general discussions about later life is that women
are “aged” by society differently than men are. The major-
ity of people sixty-five and over in nearly all countries are
women. Although women overall have longer life expec-
tancies at birth than men, women are at greater risk for
dementia and other age-associated conditions because of
these extra years. Women are labeled as “old” at younger
ages than men. Most people over sixty-five who live alone
in the United States are female. Older women are far more
likely to live in poverty than older men. Women (pre-
dominantly white women) account for approximately 75
percent of nursing home and assisted-living residents. For
women who married, this is often because they have out-
lived a spouse for whom they provided care. Women also
comprise most of the paid and unpaid caregiving work-
force in most countries. Because women and men age and
are socially aged differently and face different expectations
concerning caregiving, these differences have broad impli-
cations for aging societies.
A final concept central to gerontological thinking, and
one that constitutes a professional value, is that language
matters. It is a guiding principle in gerontology work to
challenge ageist language behaviors that can reinforce the
marginalization of later life in how we think about human
S12
aging societies special report text.indd 12-13
life and contribute to the reluctance of people to self-iden-
tify as “old.” Here’s a personal example. During a recent
professional meeting in which later life was the topic, an
attendee (someone in her late sixties) used the term “the
elderly” to refer to people over age sixty-five. When I men-
tioned that this label was offensive because it stereotypes a
large and diverse segment of society as frail, weak, depen-
dent, vulnerable, and “less than,”9 she responded, “Well,
I’m sorry, but that’s what they are. Elderly.” Not only her
use of “elderly” was noteworthy; so was her use of “they.”
Although chronologically, she, too, would correspond to
her own definition of “elderly,” she was clear to separate
herself from “them.” What she likely was referring to when
using “the elderly” was a group of people who were age six-
ty-five and over, living with poor health or poor functional
abilities, and from whom she differed based on health sta-
tus; she may also have been thinking about people who,
unlike her, were no longer able to work. What her choice of
language did, however, was to reinforce the marginalization
of a group based on chronological age alone. This form of
“othering” separates people in late life from the rest of so-
ciety, whether it uses chronological age, functional ability,
or some other way to mark the border between “us” and
“them.” It also obscures the heterogeneity and diversity of
older persons; as the example shows, not every older person
fits the attendee’s own definition. But even aside from this
inconsistency, it should trouble us when professionals who
are in later life take care to separate themselves from others
who are in later life as well.
Sometimes people point to reclaimed and newly em-
powered words such as “queer” to suggest that “elderly” is
acceptable. However, a major difference is that “elderly”
is not a word that older persons are using or have tried
to reclaim. Several studies report that people age sixty-five
and over overwhelmingly reject the terms “elderly” and
“old,” preferring the term “older persons.”10 The American
Medical Association’s Manual of Style and the Journal of the
American Geriatrics Society have taken a strong stand against
ageist and ablest language. Authors are asked to avoid use
of “elderly,” “aged,” “elders,” or “seniors” and instead to use
specific age ranges. Authors should also avoid positioning
people living with conditions such as Alzheimer disease as
“suffering from” dementia or “being demented,” terms that
describe people living with dementia as victims rather than
people. Finally, phrases that describe aging as a crisis (such
as “gray tsunami”) or that use conflict metaphors (“how to
fight aging”) should also be avoided and reconsidered in
light of the broad effects of changing demographics, such
as people living longer and healthier lives than in the past.11
September-October 2018/HASTINGS CENTER REPORT
Women are “aged” by society differently than men are.
The majority of people sixty-five and over in nearly all countries are
women. Women are at greater risk for dementia. And women are
labeled as “old” at younger ages.
Using Gerontological Thinking to Consider What
Makes a Good Life in Late Life
T his brief overview of gerontology and four key con-
cepts familiar to gerontological work today suggest
that gerontological thinking can make a vital contribution
to the discussion of what makes a good life in late life by re-
minding us that both “a good life” and “late life” are social-
ly shaped experiences. Here are three questions that suggest
what a gerontologist would ask a bioethicist or contribute
to bioethics research.
• How is “late life” being defined? Chronological age is
an imprecise marker for aging, particularly in societies
like the United States, where socioeconomic inequality
affects life expectancy and causes age-associated health
problems to occur earlier in some groups than in oth-
ers. If “late life” is intended to encompass a period
of functional decline that is age-related, a functional
definition of age, with attention to gender and to life
course factors affecting groups in a society over time,
will provide a clearer picture of what late life looks like.
• What is meant by “good”? Speaking of the “good”
should always involve asking by whose standards and
for what reasons “good” is defined. Does “good” mean
“good enough,” or does it mean “better than,” or is it
a subjective experience? In the gerontological literature
on dementia, for example, quality-of-life measures
aimed at assessing basic standards of living attempt to
determine whether a person living with dementia has a
“good” quality of life. Depending on the questionnaire
or measure used, a loved one or a paid caregiver might
G erontological thinking takes into account the com-
be asked to report on the frequency of phenomena
such as positive or negative emotions, cleanliness, the
presence or absence of negative “behaviors” or neuro-
psychiatric symptoms (such as “wandering,” “aberrant
vocalization,” “agitation,” “aggression,” or “apathy”),
and the presence or absence of pain. This suggests that
if a person living with dementia has a positive affect,
is clean, is not displaying negative “behaviors,” and
is not obviously in pain, then he or she has a “good”
quality of life. This compliance-oriented definition
S P E CIAL RE P O RT: Wh at Make s a Go o d Li f e i n Lat e Li f e ? Ci t i ze n s h i p an d J u s t i ce i n Ag i ng Societies
would likely be unsatisfactory to most people as a vi-
sion of a good life. It also displays little sense of how a
good life would be experienced from the point of view
of a person with dementia or how those of us who are
not living with dementia can understand this point of
view.
• Whose life is it—mine or some “other” person’s? A
lot is done for the large group of people age sixty-five
and over, but not a lot is done with people in this age
group. Benevolent ageism, or the desire to “take care
of the elderly,” can lead to well-intentioned plans that
lack input from the group they are intended to serve.
In addition, the great diversity in the sixty-five-and-
above age group makes it imperative that factors such
as socioeconomic status; cohort difference; differences
in experiences due to race, gender, sexual orientation,
functional and cognitive ability, geographic location;
and other social and cultural characteristics be con-
sidered in program design to avoid a one-size-fits-all
approach. For example, some groups may consider
family, not friends, to be the most important connec-
tions to reduce loneliness. Programs aimed at reduc-
ing social isolation that only focus on facilitating new
friendships may therefore fall short in meeting people’s
needs or expectations.
Age in Social Context
plexities of thinking about lives through time. These
include problems in defining age, the importance of the
past in shaping present and future experiences, and the
need to recognize benevolent ageism that can undermine
explorations of later life. Because gerontologists study ag-
ing in social context, we are accustomed to reflecting on
and applying concepts from a wide range of disciplines that
look at forces shaping societies and therefore the experience
of aging. We use literatures from public health, epidemi-
ology, and other fields to understand the prevalence of a
condition associated with aging—loneliness or dementia,
for example—within a population. We also question the
S13
10/4/2018 2:34:13 PM

racial segregation, and how the age of a person when such
an event occurred affected them. For example, a gerontolo-
gist studying retirement among African American women
ages seventy-five to eighty-four would likely consider the
extent to which women of that age cohort in their society
had access to paid work and to pension programs, what
options for building wealth (such as home equity) were
available to African American men and women during
their working years, and how access or barriers to educa-
tion earlier in life influenced later life experience, with the
goal of understanding the cumulative effects of gender and
racial equality or inequality in the society in which these
women lived.
A life course perspective also considers the role of
linked lives in the life of an older adult, whether these
reflect cultural expectations (for example, that daughters
or daughters-in-law will provide care to their parents and
their in-laws) or social network composition (the presence
or absence of close friends and confidantes), and how these
connections shape an older adult’s thinking and options
concerning late life. The life course perspective is valuable
for understanding the experiences of older adults in con-
temporary society and for forecasting what will be differ-
ent in the future. For example, as American families grow
smaller and more adults age without children, the cultural
expectation that there will be adult children (specifically,
women) available to step into a caregiving role will have to
give way to different accounts of caregiving.
A third concept familiar to gerontology but often over-
looked in general discussions about later life is that women
are “aged” by society differently than men are. The major-
ity of people sixty-five and over in nearly all countries are
women. Although women overall have longer life expec-
tancies at birth than men, women are at greater risk for
dementia and other age-associated conditions because of
these extra years. Women are labeled as “old” at younger
ages than men. Most people over sixty-five who live alone
in the United States are female. Older women are far more
likely to live in poverty than older men. Women (pre-
dominantly white women) account for approximately 75
percent of nursing home and assisted-living residents. For
women who married, this is often because they have out-
lived a spouse for whom they provided care. Women also
comprise most of the paid and unpaid caregiving work-
force in most countries. Because women and men age and
are socially aged differently and face different expectations
concerning caregiving, these differences have broad impli-
cations for aging societies.
A final concept central to gerontological thinking, and
one that constitutes a professional value, is that language
matters. It is a guiding principle in gerontology work to
challenge ageist language behaviors that can reinforce the
marginalization of later life in how we think about human
S12
aging societies special report text.indd 12-13
life and contribute to the reluctance of people to self-iden-
tify as “old.” Here’s a personal example. During a recent
professional meeting in which later life was the topic, an
attendee (someone in her late sixties) used the term “the
elderly” to refer to people over age sixty-five. When I men-
tioned that this label was offensive because it stereotypes a
large and diverse segment of society as frail, weak, depen-
dent, vulnerable, and “less than,”9 she responded, “Well,
I’m sorry, but that’s what they are. Elderly.” Not only her
use of “elderly” was noteworthy; so was her use of “they.”
Although chronologically, she, too, would correspond to
her own definition of “elderly,” she was clear to separate
herself from “them.” What she likely was referring to when
using “the elderly” was a group of people who were age six-
ty-five and over, living with poor health or poor functional
abilities, and from whom she differed based on health sta-
tus; she may also have been thinking about people who,
unlike her, were no longer able to work. What her choice of
language did, however, was to reinforce the marginalization
of a group based on chronological age alone. This form of
“othering” separates people in late life from the rest of so-
ciety, whether it uses chronological age, functional ability,
or some other way to mark the border between “us” and
“them.” It also obscures the heterogeneity and diversity of
older persons; as the example shows, not every older person
fits the attendee’s own definition. But even aside from this
inconsistency, it should trouble us when professionals who
are in later life take care to separate themselves from others
who are in later life as well.
Sometimes people point to reclaimed and newly em-
powered words such as “queer” to suggest that “elderly” is
acceptable. However, a major difference is that “elderly”
is not a word that older persons are using or have tried
to reclaim. Several studies report that people age sixty-five
and over overwhelmingly reject the terms “elderly” and
“old,” preferring the term “older persons.”10 The American
Medical Association’s Manual of Style and the Journal of the
American Geriatrics Society have taken a strong stand against
ageist and ablest language. Authors are asked to avoid use
of “elderly,” “aged,” “elders,” or “seniors” and instead to use
specific age ranges. Authors should also avoid positioning
people living with conditions such as Alzheimer disease as
“suffering from” dementia or “being demented,” terms that
describe people living with dementia as victims rather than
people. Finally, phrases that describe aging as a crisis (such
as “gray tsunami”) or that use conflict metaphors (“how to
fight aging”) should also be avoided and reconsidered in
light of the broad effects of changing demographics, such
as people living longer and healthier lives than in the past.11
September-October 2018/HASTINGS CENTER REPORT
Women are “aged” by society differently than men are.
The majority of people sixty-five and over in nearly all countries are
women. Women are at greater risk for dementia. And women are
labeled as “old” at younger ages.
Using Gerontological Thinking to Consider What
Makes a Good Life in Late Life
T his brief overview of gerontology and four key con-
cepts familiar to gerontological work today suggest
that gerontological thinking can make a vital contribution
to the discussion of what makes a good life in late life by re-
minding us that both “a good life” and “late life” are social-
ly shaped experiences. Here are three questions that suggest
what a gerontologist would ask a bioethicist or contribute
to bioethics research.
• How is “late life” being defined? Chronological age is
an imprecise marker for aging, particularly in societies
like the United States, where socioeconomic inequality
affects life expectancy and causes age-associated health
problems to occur earlier in some groups than in oth-
ers. If “late life” is intended to encompass a period
of functional decline that is age-related, a functional
definition of age, with attention to gender and to life
course factors affecting groups in a society over time,
will provide a clearer picture of what late life looks like.
• What is meant by “good”? Speaking of the “good”
should always involve asking by whose standards and
for what reasons “good” is defined. Does “good” mean
“good enough,” or does it mean “better than,” or is it
a subjective experience? In the gerontological literature
on dementia, for example, quality-of-life measures
aimed at assessing basic standards of living attempt to
determine whether a person living with dementia has a
“good” quality of life. Depending on the questionnaire
or measure used, a loved one or a paid caregiver might
G erontological thinking takes into account the com-
be asked to report on the frequency of phenomena
such as positive or negative emotions, cleanliness, the
presence or absence of negative “behaviors” or neuro-
psychiatric symptoms (such as “wandering,” “aberrant
vocalization,” “agitation,” “aggression,” or “apathy”),
and the presence or absence of pain. This suggests that
if a person living with dementia has a positive affect,
is clean, is not displaying negative “behaviors,” and
is not obviously in pain, then he or she has a “good”
quality of life. This compliance-oriented definition
S P E CIAL RE P O RT: Wh at Make s a Go o d Li f e i n Lat e Li f e ? Ci t i ze n s h i p an d J u s t i ce i n Ag i ng Societies
would likely be unsatisfactory to most people as a vi-
sion of a good life. It also displays little sense of how a
good life would be experienced from the point of view
of a person with dementia or how those of us who are
not living with dementia can understand this point of
view.
• Whose life is it—mine or some “other” person’s? A
lot is done for the large group of people age sixty-five
and over, but not a lot is done with people in this age
group. Benevolent ageism, or the desire to “take care
of the elderly,” can lead to well-intentioned plans that
lack input from the group they are intended to serve.
In addition, the great diversity in the sixty-five-and-
above age group makes it imperative that factors such
as socioeconomic status; cohort difference; differences
in experiences due to race, gender, sexual orientation,
functional and cognitive ability, geographic location;
and other social and cultural characteristics be con-
sidered in program design to avoid a one-size-fits-all
approach. For example, some groups may consider
family, not friends, to be the most important connec-
tions to reduce loneliness. Programs aimed at reduc-
ing social isolation that only focus on facilitating new
friendships may therefore fall short in meeting people’s
needs or expectations.
Age in Social Context
plexities of thinking about lives through time. These
include problems in defining age, the importance of the
past in shaping present and future experiences, and the
need to recognize benevolent ageism that can undermine
explorations of later life. Because gerontologists study ag-
ing in social context, we are accustomed to reflecting on
and applying concepts from a wide range of disciplines that
look at forces shaping societies and therefore the experience
of aging. We use literatures from public health, epidemi-
ology, and other fields to understand the prevalence of a
condition associated with aging—loneliness or dementia,
for example—within a population. We also question the
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 influencing social forces, the cultural “rules,” the historical
backdrop, the current policies, the role of media in shap-
ing opinions, other factors shaping the experience of the
condition, and the experience of interpretation, alert to
how ageism can distort our sense of what can or should
be done about a public health issue. Learning to think like
and alongside gerontologists in considering the experience
of late life in its full social context may help bioethicists
develop fresh perspectives on familiar questions of care and
justice.
1. S. de Beauvoir, The Coming of Age (New York: Putnam, 1972),
5.
2. S. Katz, Disciplining Old Age: The Formation of Gerontological
Knowledge (Charlottesville, VA: University of Virginia Press, 1996).
3. E. V. Cowdry, “The Broader Implications of Aging,” Journal of
Gerontology 2, no. 4 (1947): 277-82.
4. L. M. Howden, and J. A. Meyer, “Age and Sex Composition:
2010,” U.S. Census Bureau, https://www.census.gov/prod/cen2010/
briefs/c2010br-03.pdf.
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aging societies special report text.indd 14-15
5. M. E. Levine, “Modeling the Rate of Senescence: Can
Estimated Biological Age Predict Mortality More Accurately Than
Chronological Age?,” Journals of Gerontology: Series A 68, no. 6
(2013): 667-74, at 667.
6. Ibid.
7. P. Higgs and C. Gilleard, Rethinking Old Age: Theorising the
Fourth Age (London: Palgrave, 2015).
8. R. A. Settersten, “Handbook of Aging and the Social Sciences,”
in Handbook of Aging and the Social Sciences, ed. R. H. Binstock and
L. K. George (San Diego, CA: Academic Press, 2006), 3-16.
9. M. Falconer and D. O’Neill, “Personal Views: Out with ‘the
Old,’ Elderly and Aged,” BMJ 334, no. 7588 (2007): 316.
10. Ibid.
11. N. E. Lundebjerg et al., “When It Comes to Older Adults,
Language Matters: Journal of the American Geriatrics Society Adopts
Modified American Medical Association Style,” Journal of the
American Geriatrics Society 65, no. 7 (2017): 1386-88.
September-October 2018/HASTINGS CENTER REPORT
Precarious Aging:
Insecurity and Risk in Late Life
BY A M A N DA G R E N I E R A N D CH R I S T OPH E R P H IL L IP SON
P
opulation aging and longevity in the context of de-
clining social commitments raise concerns about
disadvantage, inequality, and the well-being of old-
er people. In this short piece, we use the concept of pre-
carity as a lens to understand new and sustained forms
of insecurity that affect late life, and we illustrate how
these risks, when experienced over time and in relation
to conditions such as austerity, can deepen disadvantage.
Cultural representations in countries such as Canada,
the United States, and the United Kingdom depict older
people as a group that is healthier and more prosperous
than ever, but these depictions also tend to overlook con­
trasting experiences in late life. Positive frameworks and
discourses tend to ignore how particular groups of older
people may carry disadvantage into late life and experi-
ence ill health as a result. This includes how disadvan-
tage may accumulate throughout the life course and how
longevity may differ between population groups and be-
tween particular cities or rural areas. The emphasis on
positive models of aging also tends to overlook warning
signs that gains in longevity have started to stall in coun-
tries such as the United Kingdom and the United States.1
The concern when exploring contemporary experiences
of aging, and particularly the experiences of older people
from disadvantaged groups, is that without proper recog-
nition and intervention, the lives of a growing number
of older people may become characterized by precarity
rather than by health and success.
Amanda Grenier and Christopher Phillipson, “Precarious Aging: Insecurity
and Risk in Late Life,” What Makes a Good Life in Late Life? Citizenship
and Justice in Aging Societies, special report, Hastings Center Report 48, no.
5 (2018): S15-S18. DOI: 10.1002/hast.907
S P E CIAL RE P O RT: Wh at Make s a Go o d Li f e i n Lat e Li f e ? Ci t i ze n s h i p an d J u s t i ce i n Ag i ng Societies
Precarity: Understanding Older People’s Needs
in Context
T he concept of precarity refers to insecurities in
the context of global economic and social change,
including unwanted risks and the costly hazards of
contemporary life that result from globalization, neolib-
eralization, and declining social protection. According to
Louise Waite, precarity denotes “life worlds character-
ized by uncertainty and insecurity,” and it implies “both
a condition and a possible rallying point for resistance.”2
In a similar vein, Kathleen Millar outlines three ways of
thinking about precarity, including as a condition, as a
category, and as an experience that includes the political
action to counter precarity.3 Although precarity has been
widely used in other fields, in particular with regards to
changes in the labor market,4 its application to aging and
late life is relatively new.5
Two key writers who inform our understandings of in-
security and risk in late life are Guy Standing and Judith
Butler. Standing’s approach draws attention to the way
in which structural inequalities are reinforced through
differential options and choices about work, but the
thrust of his critique can be extended to later life more
generally. In a long view of the life course, it is precisely
the cumulative effects of precarity that shape late life,
in particular where social and economic inequalities are
concerned. Further, the contemporary economic condi-
tions and austerity measures that are central to Standing’s
critique do not end at retirement or in later life. This
is particularly the case for groups of older people who
are poorly served by traditional programs like pension
schemes (such as immigrants, casual employees, women,
and people with disabilities) as well as caregivers, who
may themselves be precarious by means of migration,
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