Ageing and Care Anthropology

Anthropology of Aging
and Care∗
Elana D. Buch
Annu. Rev. Anthropol. 2015.44:277-293. Downloaded from www.annualreviews.org
Department of Anthropology, University of Iowa, Iowa City, Iowa 52242-1332;

Access provided by University of Nebraska - Lincoln on 10/28/15. For personal use
email: elana-buch@uiowa.edu
Annu. Rev. Anthropol. 2015. 44:277–93 Keywords

First published online as a Review in Advance on life course, intergenerational relations, reproduction, resources, morality,
August 27, 2015
kinship
The Annual Review of Anthropology is online at
anthro.annualreviews.org Abstract
This article’s doi: In concert with lengthening life spans, emerging forms of care in later life
only.
10.1146/annurev-anthro-102214-014254
reflect complex and diverse social changes. Embracing a polysemic under-
Copyright ◯c 2015 by Annual standing of care as simultaneously resource and relational practice, this re-
Reviews. All rights reserved
view works across scales of social life and theoretical approaches to care to
∗ This article is part of a special theme on highlight connections and fissures between global political-economic trans-
Resources. For a list of other articles in this theme,
see http://www.annualreviews.org/doi/ formations and the most intimate aspects of daily life. Arguing for analyses
full/10.1146/annurev-an-44-themes of care that account for the kinds of projects, stakes, and obstacles that
emerge as people engage in social reproduction in later life, this review
traces the circulation of care across aging bodies, everyday practices,
families, and nations. Care in later life never exclusively impacts the lives
of the old; it is thus a critical site for understanding the diverse ways that
increased longevity is shaping the meanings, experiences, and
consequences of life itself.
277
INTRODUCTION
The scope and rapidity with which the global population is growing older provides anthropologists
with the rare opportunity to study how diverse people, communities, and nations experience and
respond to a fundamentally new human phenomenon. Although processes of aging are central to
the human life course, the experience of having so many people live so long is remarkably new.
As life spans lengthen, the intensity and duration of care that many people require as a result of
debilitating chronic illness and frailty also increases. Both aging and care are ongoing throughout
peoples’ lives, and care at earlier moments may share many qualities with care in later life.
Focusing on care in later life is particularly valuable at this historical moment because of the
diverse and complex social changes wrought in concert with longer life spans.
Extending individual life spans has long been a central preoccupation of biomedicine and
global health. Yet, as new medical treatments and technologies improve survival rates for many
diseases, they also transform once fatal conditions into chronic illnesses such that people require
ongoing and often intensive assistance for years or even decades (Manderson & Smith-Morris
2010). The resulting shifts in both global and national age structures wrought in conjunction with
improved nutrition and sanitation and declining fertility have caught international and national
organizations off guard. As a result, according to the World Health Organization (2012), the
proportion of the global population over the age of 60 is expected to double by 2050, when there
Erratum will be an estimated 2 billion older adults alive in the world. Of course, these W H O figures
consolidate global trends, obscuring the vast unevenness of life spans both within and between
nations—even as some segments of the global population can expect to live well into their eighth
and ninth decades, in many places infant mortality, malnutrition, and infectious disease are urgent
concerns. Moreover, aging is not a uniform process, but rather one profoundly shaped by local
environments, access to resources, and social relations. The experiences of those who survive into
old age are shaped by the social roles available to elders, the depth and breadth of social support
available to them, and their access to economic resources.
Discussions of care and aging sometimes tend toward orientalism and nostalgia for places
and times before modernity, globalization, and capitalism when families cared for their elders.
Yet many of these care arrangements depended on forms of gender socialization and coercion
because, in previous eras as now, women were disproportionately recruited to provide elder care
through their roles as wives, daughters, daughters-in-law, and domestic servants. Even as demand
for care of unprecedented duration and intensity rises, fewer working-age women are able to
provide care to relatives, owing to fertility declines, epidemic disease such as HIV/AIDS, and
women’s increased participation in formal labor markets. A resulting “apocalyptic demography”
of catastrophist public and official discourses raises concern that the growing burdens of caring for
only.
an aging population are likely to devastate both families and polities (Robertson 1990). Although
anthropological studies do not shy away from examining the challenges posed by rising demands
for elder care, they also acknowledge the many ways aging and care generate new social forms
and the ways older adults contribute to social life.
Care both entails substantial social, labor, and material resources and is an often-scarce
resource with the potential to sustain life and sociality. Arrangements of care in later life are
deeply enmeshed in the everyday relations that constitute lived experiences of global
political-economic shifts. Changing care arrangements thus highlight the intersections of
embodied experience, everyday practice, intergenerational relations, and political economy in
what Cole & Durham (2007b, p. 19) have called the “intimate politics of globalization.” At the
same time, people negotiate the social significance of interdependence through daily care
practices, highlighting the interconnectedness of moral and political economies. As rapidly
changing social and political formations engender
278
Buch
new ways of caring, care becomes an increasingly important site for understanding emerging
forms of governance.
Embracing a polysemic understanding of care as simultaneously resource and relational prac-
tice, this review works across scales of social life and theoretical approaches to care. How care
is practiced depends in part on who is drawn to care for whom and on the role institutions and
national policies play in shaping those dynamics. This is illustrated by examining the role of aging
bodies, everyday care practices, and intergenerational and transnational circulations of care. This
multiscalar approach to studying care in later life highlights the connections and fissures between
large-scale social transformations and the most intimate aspects of everyday life. Such work
pushes anthropologists to consider the kinds of projects, stakes, and obstacles that arise as
people engage in social reproduction in later life. In so doing, anthropological analyses of care in
later life account for the ways that access to diverse resources makes care in later life possible
and, thus, how access to resources impacts whether and how different kinds of people are
able to achieve what they consider a good old age. Moreover, because care in later life never
exclusively impacts the lives of the old, examining the ways that care circulates across
generations, nations, and communities is essential for understanding the diverse ways that
increased longevity is shaping the meanings, experiences, and consequences of life itself.
WHAT IS CARE?
In less than a decade, anthropology has generated a veritable explosion of work on care.
Moti- vated in part by a turn from discussions of suffering to consideration of the social
relations that sustain life in both mundane and dire moments ( J. Robbins 2013), emerging
theories of care draw from vastly different theoretical lineages and ethnographic foci. Within
these discussions, care remains a shifting and unstable concept—alternately referring to everyday
practices, engage- ments with biomedicine, biopolitics, affective states, forms of moral
experience and obligation, structures of exploitation, and the relationships between these
various things. Rather than insist on one definition of care, this review treats these approaches as
complementary. At the same time, anthropologies of care in later life will be strengthened by
integrative theoretical approaches to care that attend to its multiple qualities as a form of moral,
intersubjective practice and a circulating and potentially scarce social resource. Simultaneously
considering the ways care is practiced and the paths by which it circulates enables analysis that
neither romanticizes care as separate from political economy nor reduces care to power
altogether.
Like other English-language words that anthropologists employ analytically, care carries with
it complex and particular connotations. “Care” in English-speaking places connotes both affective
only.
concern (caring about) and practical action (caring for); often this duality of meaning contributes
to beliefs that caring actions are best or most naturally motivated by caring feelings (Tronto
1994, Ungerson 1990). Whether this particular moral understanding of the relationship between
feeling and action extends to non-English speakers is an empirical question, and further explicit
comparison between the terms translated as “care” should prove useful in determining whether
care stands as a generative comparative concept or instead carries too much specific cultural
freight to move across contexts.
Drawing from Tronto (1994) and other arguments in feminist care ethics, Kleinman (2008,
2009), Mol (2008, 2010), and others focus on the moral and ethical aspects of daily care practices
to productively critique biomedicine’s ethical focus on autonomous choice. Both Mol and
Kleinman develop their theories of care by engaging directly with the daily care of older
persons. Kleinman (2009, p. 293) argues for greater attention to the ways that care is a
“defining moral practice ... of empathic imagination, responsibility, witnessing and solidarity
with those in great need” that
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makes us “more present and thereby fully human.” Mol focuses on the forms of “tinkering” carers
deploy to nourish fleshy, fragile bodies, attuning their work to the idiosyncratic tastes, habits, and
experiences of their clients. For Mol (2008, p. 46), care is involved in complex negotiations over
competing notions of the “good,” always seeking to craft “more bearable ways of living in—or
with—reality.”
Following Engels (1978), socialist feminist scholars argue that care is another way of talking
about social reproduction and is thus the work involved in reproducing and sustaining both biolog-
ical and social life over time and across generations. Care is persistently undervalued in capitalist
economies, where personhood and citizenship are often deeply tied to participation in
productive labor (Glenn 2010). In these contexts, the unequal distribution of reproductive
labor by gender, race, nationality, and class intensifies social inequalities across both time and
space (Colen 1995, Glenn 1992). Processes of stratified reproduction, in which only certain
people are encouraged to reproduce both biologically and socially, have primarily been
examined in relation to the begin- ning of life (Colen 1995, Ginsburg & Rapp 1995b). However,
unequal abilities to receive adequate and socially meaningful care as an older person crucially
shape the later end of life.
A related discussion focuses on the biopolitical deployment of care in humanitarian and global
health projects (Fassin 2011, Feldman & Ticktin 2010, Ticktin 2011). Ticktin (2011) argues that
the purportedly apolitical efforts of social policies and humanitarian organizations enact “regimes
of care” that seek to respond to individual traumas and dislocations. In this analysis, regimes of
care can have perverse consequences when they harness forms of compassion that imagine apo-
litical suffering subjects as separate from broader sociopolitical circumstances (Fassin 2007). By
individualizing, anonymizing, or medicalizing responses to human suffering, these forms of care
can foreclose structural or collective responses to injustice (Stevenson 2014, Ticktin 2011). Of
note is the way that organizations motivated to relieve human suffering may define or provide
care in ways that differ from those whom they seek to help, potentially undermining that which
makes life worth living (Stevenson 2014). Much work on transnational humanitarianism has
focused on programs for children, women, and victims of war and disaster. Perhaps because
humanitarian relief efforts are more focused on age groups that garner greater attention
among funding communities, relatively little anthropological research focuses on the
particular implications of humanitarian forms of care for older adults. Elders are nevertheless
disproportionately impacted by war and natural disasters, and they constitute an essential
piece of the social safety net for those impacted by migration and epidemic disease (for
exceptions, see Block 2014; Christensen & Castan˜ eda 2014; Livingston 2005, 2007).
Amid neoliberal restructurings of governments that have retracted public health and welfare
programs, a number of scholars describe how local practices of care among kin and neighbors
only.
work to morally and practically recuperate social relations (Garcia 2010, Han 2012). This body
of work examines everyday care as “it takes shape and is experienced through concrete relations
inextricably woven into unequal social relations” (Han 2012, p. 5). In these accounts, the complex
and sometimes desperate workings of moral economies that compel people to care for one
another are laid bare, showing both the power and the limits of peoples’ determination to
sustain social ties amid long histories of dispossession and deprivation. Drugs—both prescribed
and not—play crucial roles in these accounts of care and complicate distinctions between
curative and destructive medication, perhaps offering a model for thinking about the
embeddedness of pharmaceutical use in elder care. Though this body of work does not
explicitly address the role of older persons in care, it provides a productive approach to
integrating concerns about everyday care practices, moral economy, and political economy.
Despite their multiple orientations to the study of care, I read each of these approaches as
concerned in part with different aspects of the ways that care is involved with the social
constitution
280 Buch
of personhood. Following the Maussian tradition (Mauss 1979), personhood here refers to
people’s (human or nonhuman) membership, roles, or status in society that are conferred in
and through social relations. Concerns about personhood are continuously and socially
negotiated, especially at the beginnings and ends of life, when questions about who, how, and
when someone is recognized as included in human communities come to the fore (Kaufman
1994, Kaufman & Morgan 2005, Luborsky 1994, Strathern 1992). Examinations of care
practices and moral economies of care highlight the formative potential of care to generate
and sustain social persons, whereas socialist- feminist analyses and critiques of
humanitarianism show the potential for care to be atomizing, sustaining the personhood of
those in particular social and historical positions while undermining broader social relations.
Both care practices and political economies of care play crucial roles in the constitution of
personhood. Simultaneous attention to both thus clarifies the stakes of diverse forms of care.
AGING BODIES AND THE CALL TO CARE

The aging body figures critically in discussions of care in later life, as increases in debility that
typically accompany advanced age signal older adults’ needs for direct care. Which bodily changes
signify old age is highly variable around the world, and frailty does not necessarily signal a
decline in social status (Lock 1993, Rosenberg 2009). In part, bodily changes are seen as
signs of aging because of the ways such changes impact both personhood and kin relations.
Among Brahmins in the North Indian villages studied by Lamb (1997, 2000), bodily changes
in old age were seen as potentially difficult but desired. These changes were associated with
cooling and drying processes that helped diminish ties to others that could prevent elders
from achieving a good death. In contrast, Japanese law formalizes reciprocal norms in which
older people are due love and respect, and they in turn are expected to maintain mental and
physical health and continue to participate in society. In Japan, some forms of mental and
physical decline are recognized as boke, which indicates an elder’s antisocial unwillingness to
remain active and to avoid burdening others (Traphagan 2000, 2006). In many North
American and European contexts, bodily frailty and disability are associated with
dependence, creating deep threats to personhood both for older adults and those who care for
them (Buch 2013, 2015; Kittay 1996).
Bodily experiences of aging and the ways these experiences call forth care are historically
dynamic, responding to changes in local biologies, economies, and public polices (Lock 1993).
For example, in Mexico, bodily aging, including losses of erectile function, is seen as part of a
wider array of changes in which older men focus on home and care of family, rather than on
infidelity and other “macho” behavior thought normal in youth (Wentzell 2013a,b). In Botswana,
only.
the rising prevalence of chronic illness means that many older adults manifest the physical signs of
senescence long before they are seen as elders, thus limiting their ability to claim care from
younger relatives. At the same time, in Botswana as elsewhere, national pension schemes have
imposed numerical definitions of old age, altering the significance of bodily senescence,
collapsing local gradations of age, and shifting local moral economies that pattern flows of
money, love, and care (Livingston 2003, 2005).
As with other bodily changes, the cognitive and behavioral shifts signaled by terms such as
senility, dementia, and Alzheimer’s disease are made meaningful in relation to both institutional
and social milieu (Lock 2013). Dementia and dementia care have garnered significant amounts of
anthropological attention in part because of how senility challenges fundamental Euro-American
assumptions about the centrality of rationality and conscious subjectivity to human personhood.
Yet anthropologies of senility show that these categories are fundamentally dialogic and relational
in character and that interactions with carers play a crucial role in the ways that such conditions

Care
are brought into being (Cohen 1998, Leibing 2006, Taylor 2008). As with the case of boke in
Japan, cognitive changes are often read not only as signs of aging, but also as threats to
personhood and social relations. As with other bodily signs of aging, the meanings of senility
and the forms of care and concern they engender are historically unstable. For example, in
India, the meanings of senility in old age have changed over time. In the 1990s, elders’ confusion
and distress were read as indicative of the perils of modernity and “bad families” (Cohen 1995,
1998), whereas contemporary middle-class Indians may be more likely to interpret dementia as
a product of medicine, culture, and technology (Brijnath 2014).
In a number of countries, lengthening life spans and concerns about care have led to the
addition of the “Third Age” as a new periodization in the life course. Originating in Europe and
the United States, discussions of the Third Age distinguish between healthy, active and engaged
older persons in this third stage of life and the disabled “oldest old” who are in need of care. Thus,
the period of the Third Age explicitly distinguishes between older persons who do not require
significant care from others and those who do. Policies and programs that celebrate and seek to
extend the Third Age thus formalize fears about abandonment and dependence associated with
the needs of the “oldest old” (Leibing 2005, Robbins-Ruszkowski 2013a). In many contexts, elders
are thus encouraged to adopt techniques of the self intended to help them remain healthy, active,
productive, contributing members of society as long as possible (Foucault 1988). Broad research
and policy agendas promote these conceptions of “successful” and “active aging” that are intended
not only to improve elder well-being, but also to reduce the amount of labor and material
resources expended in their care (Estes & Mahakian 2001, Lamb 2014, Lassen & Moreira
2014, Leibing 2005, Robbins-Ruszkowski 2013b, Zhang 2009).
EVERYDAY CARE PRACTICES

Moving outward from scholarship focused on how diverse and historically dynamic aging
bodies are understood in relation to their need for care, a significant literature examines the
relations of intimate everyday care practices in all their mundane, nitty-gritty glory. The term
“care practices” emphasizes what is done in care (Mol et al. 2010b), which varies depending on
the social context and needs of care participants. This work highlights the particularities of
caring for older persons whose lifetimes of experience and aged bodies render their care
different from care at earlier points in the life course. Current research emphasizes the ways
that daily care practices are both moral and embodied, the diverse forms of attunement and
intersubjectivity crafted through care practices, and the ways that care practices are embedded
within particular social and institutional contexts. As a caveat, ethnographic work focused on
daily care practices is overwhelmingly based in European and North American contexts, and
only.
the themes emerging from this corpus are likely to shift with additional ethnographies of care
practices from other regions.
Mol et al. (2010, p. 13) argue that what sets care practices apart from other activities is that
they entail a “specific modality of handling questions to do with the good” that has less to do
with reasoning from basic principles, but rather “implies a negotiation about how different
goods might coexist in a given, specific, local practice” that is achieved through “practical
tinkering” and “active experimentation.” In this sense, work on care practices examines the
different kinds of tensions and notions of “the good” that arise in various contexts of care. It
further attends to the ways that people actively work to ease suffering and enable one another
to live valued lives.
Drawing on the work of Merleau-Ponty (2002) and Bourdieu (1977, 1984), scholars argue
for the importance of embodied knowledge and experience in shaping what counts as the good
in any given context (Buch 2013, Mazuz 2013a). Food, central to both survival and sociality,
offers ethnographers an important window into the embodied dimensions of care, highlighting
282 Buch
the links between bodily well-being, individual sensory preference, histories of experience, and
the sociality of commensality (Brijanth 2011, Harbers et al. 2002, Hazan & Douglas 2003, Mol
2010, Savishinsky 2003). Among Catholic nuns in the United States, prayer is a care practice that
alters embodied experience and mobilizes social support among generations of younger and
older nuns (Corwin 2012a,b). The importance of embodied histories for shaping subjectivity
is well illustrated in studies of dementia care, which show the limits of cognitive and
memory-centric models of personhood and subjectivity. In cases of dementia care in Western
Europe and North America, ethnographic research shows how care that engages the specific
embodied aspects of elders’ lifetimes of experience promotes greater expression and quality of
life among those with dementia (Hendriks 2012; Kontos 2005, 2006; Taylor 2008).
Work on embodied care practices also attends to the links between care at its most intimate
and broad sociopolitical concerns. As caregivers attune their bodies to those of the older persons
for whom they care, they also embody forms of social difference and hierarchy. For example,
in U S home care of older adults, the embodied empathic knowledge of paid care workers for
their clients’ histories of bodily experience enables these care workers to sustain older adults’
personhood and ways of life, while also intensifying the broader social inequalities that structure
home-care work (Buch 2013, Ibarra 2002). In Thailand, embodied care practices take the form
of ordinary rituals, which not only meet the daily needs of older adults, but also stand as part of
broader practices of care for the “social body” that includes the reproduction of hierarchy (Aulino
2012). The impacts of bodily care on caregivers’ social status are widely variable, depending in
part on cultural understandings of the ways that bodily substances are thought to convey purity
and pollution ( Jervis 2001). For example, in the United Kingdom, Twigg (2000) argues that the
bodily aspects of care such as bathing and toileting are designated polluting “dirty work,” thus
contributing to the hidden character of care work, its gendered association with women, and its
low status. In Indian contexts where concerns about the flow of bodily substance organize daily
life, both family and nonfamily caregivers are likely to be recruited according to hierarchical
understandings of the social world (Lamb 2000, 2009). Taken together, work on everyday care
practices counters discourses of older persons as passive and potentially decrepit objects of care,
showing how personhood and subjectivity are connected to embodied histories and forms of
difference, while drawing attention to the potential for everyday care to intensify broader forms
of hierarchy and inequality.
INTERGENERATIONAL CIRCULATIONS OF CARE

At a broader scale, scholarship examines the ways that intimate care practices are also a
kind of scarce resource that circulates through complex webs of kinship and intergenerational
only.
relations. Ideas of intergenerational reciprocity and gendered kinship obligations play key roles
in shaping these circulations of care in part by influencing national care policy and the
provision of market- based care (Cole & Durham 2007b, Mannheim 1952). Notably, scholarly
and popular emphasis on intergenerational care naturalizes ideas that care is provided to
those at either end of the life span by those in the middle, which has profound impacts on
structures of care and erases the intragenerational and intergenerational forms of care
provided by the young and old (Hunleth 2013; Kittay 1996; A. Seaman, personal
communication). Shifting circulations of care across families and generations are also connected
to broader social transformations. These changes provoke critical questions about how
processes of stratified reproduction change over time, impacting which kinds of people can
participate in care relations that sustain meaningful ways of living in old age.
Circulations of care are widely associated with the constitution of kinship, thus leading
scholars such as Borneman (2001, p. 43) to argue that studies of kinship may be productively
reoriented away

from concerns about marriage, sexuality, and gender toward “a concern for the actual situations in
which people experience the need to care and be cared for and to the political economies of
their distribution.” At the same time, people decipher care obligations entailed by local
figurations of relatedness (Carsten 2000). In many places, ideal or assumed caregivers are
decided through some combination of gender roles, marriage, descent, inheritance, and
birth order. In many Indian contexts, patrilocality has historically meant that wives perform
seva, or respectful service and care, for husbands’ coresident parents as a way of
reciprocating earlier parental forms of care (Brijnath 2014; Cohen 1995; Cohen 1998; Lamb
2000, 2009). In contexts across East Asia, the concept of filial piety, understood as the younger
generation’s support for and obedience to older generations, organizes both intergenerational
obligations and inheritance norms, though it does so in diverse and often contested ways
(Ikels 2004b). In many of these contexts, eldest sons are seen as responsible for supporting
aging parents, while their wives perform the bulk of daily bodily and household care. In the
United States, gendered divisions of labor hold wives and daughters responsible for the bulk
of daily elder care (Abel & Nelson 1990).

Research highlights the ways that people and scholars broadly associate changes in intergener-
ational relations with modernity, as signaled by new medical technologies, economic ideologies,
as well as migration and social policies (Cohen 1998). However, national and local norms for
intergenerational relations never completely describe the diversity of actual practices. For
example, in China, market reforms limit public support for older adults at the same time that
urbanization and the one-child policy have limited the ability of sons and daughters-in-law to
care for aging parents, leading to efforts to promote late-life remarriage and national laws
enforcing norms of filial piety by mandating parental care (Miller 2004; Zhang 2007, 2009).
For older Russians, changing pat- terns of coresidence, emigration, and the transition from
state socialism to neoliberal capitalism have increased the provision of care by nonprofit and
foreign welfare groups rather than families (Caldwell 2007). In Japan, which famously has the
oldest population in the world, new forms of multigenerational housing, intergenerational
care facilities, and national long-term care policies are evolving in the face of urban
migration and women’s increasing resistance to traditional care roles within patrilocal stem
marriages (Brown 2003, Jenike 2003, Thompson et al. 2003, Traphagan 2003). Paradoxically,
these services individuate elders as consumers of care, engender- ing forms of abandonment
that older adults counter through memorial practices (Danely 2014). In Botswana and
Lesotho, complex intersections of colonial and postcolonial reorganizations of work,
HIV/AIDS, medicalization, and international intervention have shifted the kinds of claims to
care that younger and older generations make of one another, simultaneously limiting the care
available to elders while expanding demand for older women’s continued care of younger gener-
only.
ations (Block 2014; Livingston 2003, 2005). In the United States, deinstitutionalizing health care
policies have increased the amount and duration of technologically complex care families provide
to chronically ill and disabled kin; husbands and sons increasingly provide such care (Heinemann
2013, 2015; Russell 2001, 2007). Indeed, an increasing proportion of men provide care to their
spouses or aging parents in multiple parts of the world, often without widespread social support
or recognition for this role (Eriksson et al. 2008, Long & Harris 2000).
For much of the twentieth century in Western Europe, social welfare programs assumed
significant responsibility for the well-being of older citizens. More recently, in several nations,
liberal concerns about ageism, discourses of active aging, and concerns about the expense of aging
populations have eroded support for retirement and long-term care systems built on previous
understandings of national intergenerational solidarity, indicating significant changes in the
ways that welfare states care for populations (Da Roit 2010, Da Roit & de Klerk 2014, Degiuli
2010, Greenberg & Muehlebach 2007). Neoliberal retractions of the welfare state are provoking
284
Buch
new ways of understanding care and sociality. For example, in Italy, volunteers practice forms
of “ethical citizenship” and compassion by visiting nonkin elders, even as such voluntarism is
harnessed by the state to support controversial reforms (Muehlebach 2012).
In many places, historical changes in the intergenerational organization of care have led to
increases in care provided through formal labor markets and related shifts toward providing care
in residential institutions. In many places, domestic servants have long assisted wealthier families
with the day-to-day work of elder care (Abel & Nelson 1990, Glenn 1992, Ray & Qayum 2009).
For those who can afford it or live in places where paid care services are publicly subsidized, paid
care plays a key role in filling care gaps created by lengthening life spans, increasingly medicalized
care, and shifts in gendered divisions of labor that make it difficult for many families to provide
adequate care to their older members. Expansions of paid care raise concerns about the
commodification of intimacy and the ways these jobs drive the gendered and racialized global
care chains discussed
below (Boris & Parren˜ as 2010, Buch 2014, Hochschild 2003, Zelizer 2005).
In European and North American contexts, neoliberal health care policies have increased
support for paid home-care programs, thereby reconfiguring the meanings of home and care as
sustaining personhood against the threats of social death signaled by institutionalization (Angus
et al. 2005, Buch 2015, Gubrium & Sankar 1990). Older adults thus engage with material posses-
sions during transitions between homes and institutions in creative ways that attempt to sustain
social personhood (Luborsky et al. 2011; Marcoux 2001; Perry 2014a,b). At the same time, a va-
riety of technologies meant to support elders at home—ranging from medical devices to telecare
services—transform experiences of both home and care (Lopez et al. 2010, Pols 2010, Willems
2010).
Globally, the prevalence of residential institutions for elder care is uneven; they are
rela-
tively rare in places with hegemonic expectations of familial care. Classically theorized as
“total institutions” by Goffman (1961), nursing homes have frequently been analyzed as places
of radical rupture characterized by their own hierarchies, culture, and norms (Gubrium 1975,
Stafford 2003b, Townsend 1964). Yet nursing home ethnographies also highlight the possible
continuities between life within and beyond care institutions, showing how personal histories,
the incorpo- ration of residents’ families, and the forging of new forms of relatedness
influence the degrees to which nursing homes are experienced as places of rupture to social
relations and personhood (Lamb 2009, Perkinson 2003, J.C. Robbins 2013, Shield 2003). In
some contexts, nursing home residents experiencing dementia seem to find greater comfort
and quality of life in care arrangements that recognize ongoing communicative capacities and
embodied histories without insisting on continuity of other forms (Basting 2009; Chaterjee
only.
2006; McLean 2006, 2007; Taylor 2008). Life in nursing homes is also deeply impacted by
profit-making goals that can lead to methods of organizing care that are inattentive to the
physical well-being and social personhood of residents, while also proving deeply exploitative
to care workers (Diamond 1992, Foner 1994).
Whether in institutional or domestic settings, by kin, volunteers, or paid workers, how care is
provided highlights the diversity among the ways that care reflects and shapes intergenerational
relations. As greater amounts of care are provided by paid workers, national labor and migration
laws enable the exploitation, protection, or organization of care workers (Boris & Parren˜ as
2010, Parren˜ as 2001). For example, in the United States, long legacies of racial and
gendered occu- pational segregation reflected in current exclusions of paid home-care
workers from wage and overtime protections deepen the inequalities experienced by the
women of color and immigrants who disproportionately fill these jobs (Boris & Klein 2012,
Glenn 2010, Poo 2015). These varia- tions highlight the critical importance of attending to
national policy as well as broad sociopolitical and economic change even in studies focused on
www.annualreviews.org • Anthropology of Aging and Care
intimate care practices and relations. 285
TRANSNATIONAL CIRCULATIONS OF CARE
As global economic shifts, migration, and epidemic disease simultaneously expand demand for
elder care and alter intergenerational expectations, the critical roles older persons play in familial
care systems and global care chains become increasingly clear (Sassen 2006; Yeates 2009,
2012). As high-status professions and capital concentrate in urban centers, elite needs for
reproductive labor create complex global care chains in which urban families hire lower
status, poorer, and often migrant women to sustain their lives and ways of living (Ehrenreich
& Hochschild 2002, Sassen 2006). Although early work on global care chains focused on
migrant child-care workers (Colen 1995, Hochschild 2000), migrant women from poor
countries also play a key role in elder care in many wealthy nations (Brijnath 2009, Da Roit
2007, Degiuli 2007, Parren˜ as 2001, van der Geest et al. 2004).
Many countries experiencing rapidly aging populations rely on immigrant care workers, whose
status, working conditions, and ability to organize are highly responsive to national migration and
labor laws. Restrictions on migrants’ legal status may trap them in poorly paid and frequently
exploitative jobs while limiting their participation in communal social life (Parren˜ as 2001,
Qayum & Ray 2010). Thus, across contexts, those performing the bulk of paid elder care are
disproportionately likely to be poor, relatively uneducated, racially and politically
marginalized women (Degiuli 2007, Raijman et al. 2003). Migrant care workers frequently care
for elders with signifi- cantly different bodily and historical experiences, drawing creatively on
their own models of care to articulate cultural and gendered identities and make claims about
their contributions to the nation (Colen 1990; de la Luz Ibarra 2002; Degiuli 2007; Mazuz
2013a,b; Raijman et al. 2003).
Despite their low wages, elder-care positions in wealthy countries nevertheless offer migrant
women the possibility of sending remittances home. Remittances frequently support the caring
labor of even more marginalized women, whether kin or nonkin workers. For example, in India,
where intergenerational joint households have long been the dominant domestic arrangement,
the rise of elder-care homes and surrogate-son services, often paid for by older adults’
nonresident kin, represents significant reformulations of kin relations and new ways of
imagining a good old age (Lamb 2009). Grandmothers often play a crucial role in global care
chains, facilitating the migration of younger female kin through their care of grandchildren. In
Mexico and Nicaragua, grandmother care represents a significant shift in intergenerational
circulations of care as grandmothers continue to provide support and care at a stage in life
in which they might otherwise have expected to receive it, with potentially deleterious
consequences for their health (Scott 2012, Yarris 2014). Grandmother care does not always
represent a radical reordering of family life; for example, in Peru these arrangements mark
only.
extensions of long-standing practices of child fostering into transnational contexts (Leinaweaver

2010, 2013).
Circulations of care are also refashioned by the migration of older persons and by the aging
of those who migrated earlier in life. These experiences are highly variable, depending in part on
the migrant’s resources, whether migration was voluntary, and whether migrants join kin. Many
older persons migrate to continue to participate in intergenerational relations with kin. However,
an increasing number of elders migrate internationally to enjoy retirement in desirable or more
affordable countries, raising questions about their experiences of care abroad and their impact on
care arrangements and social relations in receiving countries (Benson & O’Reilly 2012, Oliver
2007).
As in other contexts where familial care resources and state supports for child rearing are
spread thin, migrant grandmothers often assume critical roles caring for grandchildren (Hayslip
2009, Rodr´ıguez-Galań 2013). Concerns about care are thus particularly salient for older migrant
women living in communities where they are primarily responsible for managing dense familial
286
Buch
networks of reciprocity and obligation—women in these situations appear to be at high risk for
psychosocial distress and depression (Cohler & Lieberman 1980, Sokolovsky 2009b). When older
adults migrate to join younger kin, they often find family life organized very differently. For
example, Indian elders living in the United States are faced with expectations of independence,
changes in familial authority, and limited time and intimacy with kin (Lamb 2002, 2007, 2009).
At the same time, many older persons form new social relations, engaging creatively with local
ways of being and understandings of good old age (Hegland 2009, Lamb 2007). For example,
Chinese and Taiwanese migrant families in the United States transform the meanings and
practice of filial care by recruiting paid workers into familial roles, using the receipt of public
care to reinforce kin bonds (Lan 2002). For older adults who have experienced forced migration
and political exile, diminished economic resources, fractured kinship networks, nostalgia,
and legacies of trauma may shape their aging experiences and impact their care (Hegland
2009, Lewis 2008, Martinez 2009, Myerhoff 1979). Migration in later life is often a significant
disruption, and migrant elders commonly require more assistance than familial networks are
able to provide, though they face social, cultural, and linguistic barriers to receiving such care
(Sokolovsky 2009b). The circulation of elder care across national borders counters depictions
of later life as a time of stasis, drawing attention to the critical intersections between the
intimacies of daily life and global care chains.
CONCLUSION
Moving across the multiple scales through which care circulates, this review works toward an
anthropological approach to care in later life that traces the connections among local
understandings of aging bodies, everyday practices, and generational and transnational
circulations of care. Acknowledging the polysemic, shifting qualities of care both within
anthropological theory and in ethnographic contexts, this review approaches care as both
practice and resource. Care is simultaneously moral, relational, historically specific, and
embedded within forms of governance and global political economic transformation. Debates
about care proliferate in anthropology, with disparate discussions focusing on the ways that
care can be seen as a moral practice with the potential to recuperate fractured relations as well
as the ways it holds the potential to generate hierarchy and difference and forestall collective
action. In later life, older adults both provide significant amounts of care to kin and,
depending on the resources available, find their personhood supported or threatened by care
relations. Comparative work on care in later life thus offers a key site for examining the links
between broad social transformation and intimate, daily life. By considering the different
kinds of projects, stakes, and obstacles that emerge through care, anthropologies of care and
only.
aging examine the resources and practices that enable different kinds of people to realize a
meaningful old age.
Among the limitations of current work on care and aging is its bias toward examining daily,
embodied care in contexts of paid and residential care, mostly in European and North American
contexts. Commensality and bodily intimacy are often taken for granted in discussions of familial
elder care; however, studies from earlier parts of the life course suggest that attention to these
aspects of daily care can generate significant insight into the stakes and projects of personhood. A
related concern is the clustering of studies of aging and care in Indian, Japanese, North American,
and European contexts—each valuable because of its centrality to ethnographic theorization of
kinship, aging, and liberal capitalism, respectively. However, fuller comparative theorization of
care and its circulations requires a more diverse ethnographic corpus (Appadurai 1986). Concerns
about intragenerational relations, including marriage and sexuality, are notably limited in studies
of later life, and may provide important insight into the relations between morality, age, gender,
and care. Most broadly, anthropologies of care in later life will be strengthened by theoretical

approaches to care that consider the ways that moral practices that sustain personhood and
social relations may simultaneously participate in or generate forms of difference and power.
DISCLOSURE STATEMENT
The author is not aware of any affiliations, memberships, funding, or financial holdings that might
be perceived as affecting the objectivity of this review.
ACKNOWLEDGMENTS
I am grateful for the generative comments I received on drafts of this review from Laura
Heinemann, Kristin Yarris, Aaron Seaman, Jessica Robbins-Ruszkowski, and Ken Hill. Any errors
or oversights remain my own.
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www.annualreviews.org • Anthropology of Aging and Care

293
Annual Review of
Anthropology
Volume 44, 2015 Contents
Perspective
Some Things I Hope You Will Find Useful Even if Statistics
Isn’t Your Thing

George L.
Cowgill .............................................................
................. 1
Archaeology
Pleistocene Overkill and North American Mammalian
Extinctions
David J .
Meltzer .............................................................
................ .33
The Archaeology of Ritual
Edward
Swenson .............................................................
................ 329
Recent Developments in High-Density Survey and Measurement
(HDSM) for Archaeology: Implications for Practice and Theory
Rachel Opitz and W. Fred
Limp ........................................................... 347
Biological Anthropology
only.
The Evolution of Difficult Childbirth and Helpless Hominin

Infants
Holly Dunsworth and Leah
Eccleston ........................................................ .55
Health of Indigenous Peoples
Claudia R. Valeggia and J . Josh
Snodgrass ................................................ 117
Energy Expenditure in Humans and Other Primates: A New
Synthesis
Herman
Pontzer .....................................................................
vi ........ 169
An Evolutionary and Life-History Perspective on Osteoporosis
Resource Transfers and Human Life-History Evolution
James Holland Jones ........................................................................ 513
An Evolutionary Anthropological Perspective on Modern
Human Origins
Curtis W.
Marean ........................................................
.................. 533
Anthropology of Language and Communicative
Practices
How Postindustrial Families Talk
Elinor Ochs and Tamar Kremer-
Sadlik .................................................... .87

Chronotopes, Scales, and Complexity in the Study of Language

in Society
Jan
Blommaert ............................................................
.................. 105
Linguistic Relativity from Reference to Agency
N.J.
Enfield .................................................................
................. 207
Politics of Translation
Susan
Gal .....................................................................
............... 225
Breached Initiations: Sociopolitical Resources and Conflicts
in Emergent Adulthood
Norma Mendoza-Denton and Aomar
Boum .............................................. 295
Embodiment in Human Communication
only.
Ju¨ rgen
Streeck ............................................................
................... 419
The Pragmatics of Qualia in Practice
Nicholas
Harkness ..........................................................
................. 573
Sociocultural Anthropology
Virtuality
Bonnie
Nardi .............................................................
.................... .15
Contents vii
Anthropology and Heritage Regimes
Anthropology of Ontologies
Eduardo Kohn ............................................................................... 311
Oil and Anthropology
Douglas Rogers ............................................................................... 365
The Post–Cold War Anthropology of Central America
Jennifer L. Burrell and Ellen Moodie ...................................................... 381
Risks of Citizenship and Fault Lines of Survival
Adriana Petryna and Karolina Follis ....................................................... 401
Siberia
Piers Vitebsky and Anatoly Alekseyev ...................................................... 439
Of What Does Self-Knowing Consist? Perspectives from Bangladesh

and Pakistan
Naveeda
Khan ..........................................................................
..... 457
Addiction in the Making
William Garriott and Eugene
Raikhel ..................................................... 477
Waste and Waste Management
Joshua
Reno ...........................................................................
....... 557
Theme: Resources
Virtuality
Bonnie
Nardi .........................................................................
........ .15
Pleistocene Overkill and North American Mammalian Extinctions
David J .
only.
Meltzer .......................................................................
...... .33
Urban Political Ecology
Anne
Rademacher ..................................................................
......... 137
Environmental Anthropology: Systemic Perspectives
Yancey Orr, J . Stephen Lansing, and Michael R.
Dove ................................... 153
Energy Expenditure in Humans and Other Primates: A New
Synthesis
viii Herman
Contents
Pontzer ........................................................................
..... 169
Recent Developments in High-Density Survey and Measurement
(HDSM) for Archaeology: Implications for Practice and Theory
Rachel Opitz and W. Fred
Limp ........................................................... 347
Oil and Anthropology
Douglas
Rogers ......................................................................
......... 365
Resource Transfers and Human Life-History Evolution
James Holland
Jones ......................................................................
.. 513
Waste and Waste Management

Joshua
Reno .......................................................................
........... 557
Indexes
Cumulative Index of Contributing Authors, Volumes 35–

44 ........................... 591
Cumulative Index of Chapter Titles, Volumes 35–
44 ................................... 595
Errata
An online log of corrections to Annual Review of Anthropology articles may be found at

http://www.annualreviews.org/errata/anthro
only.
Contents ix

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Anthropology of Aging

Department of Anthropology, University of Iowa, Iowa City, Iowa 52242-1332;

Annu. Rev. Anthropol. 2015. 44:277–93 Keywords

www.annualreviews.org • Anthropology of Aging and

AGING BODIES AND THE CALL TO CARE

www.annualreviews.org • Anthropology of Aging and

EVERYDAY CARE PRACTICES

INTERGENERATIONAL CIRCULATIONS OF CARE

www.annualreviews.org • Anthropology of Aging and

of daily elder care (Abel & Nelson 1990).

extensions of long-standing practices of child fostering into transnational contexts (Leinaweaver

www.annualreviews.org • Anthropology of Aging and

S Colen, pp. 89–118. Washington, D C : Am. Ethnol. Soc.

2006, pp. 240–68

www.annualreviews.org • Anthropology of Aging and Care

Volume 44, 2015 Contents

Isn’t Your Thing

The Evolution of Difficult Childbirth and Helpless Hominin

Sadlik .................................................... .87

Chronotopes, Scales, and Complexity in the Study of Language

Of What Does Self-Knowing Consist? Perspectives from Bangladesh

Waste and Waste Management

Cumulative Index of Contributing Authors, Volumes 35–

An online log of corrections to Annual Review of Anthropology articles may be found at

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