Abstract
In Aging in America, Deborah Carr provides a comprehensive and thoughtful examination of the issues that aging individuals and their families confront in the United States. This book guides us through different scholarly approaches to understanding aging and its ramifications at individual, familial, communal, national, and policy levels. Drawing on solid empirical evidence, Carr carefully examines the changing demographic composition of the American population, the driving forces behind these trends across historical contexts, and the challenges stemming from the “graying” of U.S. society. Rather than viewing older generations as burdens or focusing on how to age “successfully," Aging in America debunks common myths about aging and illuminates the diverse needs and aspirations of older individuals and their loved ones. It also offers concrete and much-needed policy solutions to prepare ourselves for the later-life transitions that we all must face individually and collectively.
Aging in America makes several valuable contributions to aging and life course studies, the sociology of family, and public policy. First, this book foregrounds temporal contexts in its analysis of aging individuals. Carr unpacks the biological, behavioral, emotional, and social dimensions of later-life transitions and explains what these changes mean for older individuals’ families and friends. She also provides a historical analysis of how older people and their needs have been perceived and managed over time. For example, in the late nineteenth century, caring for aging parents was considered an honorable decision rather than an unwanted responsibility (p. 24). Yet this cultural understanding of older people's needs has been increasingly replaced by an emphasis on nuclear families, which prioritizes parents’ duties of caring for younger generations. Such evolving public perceptions, as Aging in America elucidates, contribute to the rise of but also restrictions imposed on aging policies in the United States. As Carr astutely captures, the “dual forces of pity and paternalism helped impel the most important and successful policy reforms of the twentieth century: the establishment of Social Security in the 1930s, and the expansion of Social Security and birth of Medicare in the 1960s” (p. 26). This suggests that varying constructions of older people and their needs in different temporal contexts significantly shape our policy responses to the needs and desires of older individuals.
Furthermore, Aging in America demonstrates how social inequalities compromise older adults’ health and quality of life. Race, ethnicity, social class, gender, and citizenship status intersect to influence aging individuals’ welfare. Older adults who confront these structural injustices often lack, or are systematically denied, resources necessary to protect and provide for themselves and their families. The disadvantages, such as racism, class disparities, xenophobia, sexism, and discrimination against sexual minorities, that people encounter from childhood to adulthood tend to accumulate and manifest as they grow older. Yet disadvantaged older people demonstrate remarkable resilience and agency, as Carr explains:
People who survive until age 65 may have protective traits or advantages that make them different from their peers who died before age 65. This is especially the case for men and Blacks; the genetic and socioeconomic advantages that helped them to withstand and survive potential threats during childhood and adulthood also help them to survive until their eighties and beyond. (p. 111)
Structural inequalities not only affect older people's physical and emotional well-being but also profoundly affect their social relations. As older generations live longer, and many of them remain reasonably healthy, they become an important source of support and resources for their children and grandchildren. While advantaged older adults can “help with babysitting, transportation, and recreational activities,” those who are Black and face financial precarity are more likely to “take on more time- and labor-intensive roles, like serving as custodial caregiver when their own children are unable to care for their offspring” (p. 77). Conversely, children and grandchildren can step in and provide much-needed care for older generations who are no longer self-sufficient. The patterns of parental caregiving vary along lines of gender, race, and ethnicity. Daughters spend more time supporting their parents than sons, and men with sisters are less inclined to take an active role in parental care (p. 80). Similarly, Black and Latino children are more likely than their white peers to support their parents financially and socially (p. 81).
Social inequalities also mediate the impact of negative social relations on older people's lives, including those in end-of-life situations. Caregivers may neglect older adults under their care or exploit these older people financially. Caregivers may also abuse aging individuals physically and emotionally. Systems of inequality repeatedly stratify who can better protect themselves from elder neglect and abuse. Older undocumented migrants are, for instance, often reluctant to contact legal authorities when they confront mistreatment or violence. Furthermore, death brings painful endings to relationships that older adults value deeply. Spousal and parental deaths enhance feelings of isolation, and the deaths of siblings painfully alert people to their own mortality. Some older individuals may even outlive their offspring; they thus confront and grieve the death of their child(ren). These challenging and extenuating circumstances often place in sharp relief the varying constellations of resources that older individuals and their families can draw upon to cope.
Furthermore, and most importantly, Aging in America offers concrete policy solutions to the issues that aging individuals and their families confront today. To better protect older adults and their caregivers, Carr identifies three types of aging policies we desperately need: (1) economic policies (e.g., public pensions), (2) health care policies (e.g., publicly funded health insurance), and (3) caregiver policies (e.g., programs to support paid and unpaid caregivers). Using public health care insurance in Taiwan and public pensions in the Netherlands as examples, this book points to necessary and possible policy reforms that can be activated and enforced to make U.S. society more friendly, accommodating, and inclusive to our aging populations.
This book is essential reading for scholars studying aging, care, inequalities, families, and public policy. Beyond its compelling analyses, Aging in America provokes important questions for future research. As Carr notes, American culture evolves over time, and shifting cultural understandings shape policy changes. This raises several questions: What motivates countries emphasizing family responsibility to nonetheless provide public resources for older adults and caregivers? What role does culture play in preventing U.S. policymakers from adopting more progressive aging policies from abroad? How do systems of inequality confronting older adults in the United States vary across national contexts? Are the social inequalities Carr identifies unique to the United Staes, or more pressing in the U.S. than elsewhere? How do other societies conceptualize state and non-state responsibilities for supporting senior citizens?
Finally, as this book indicates, aging policies involve economic safety nets, health care provision, and caregivers for older adults. I want to further point out that aging policies are also migration policies. Many long-term U.S. residents are migrants. What resources do they need to live with dignity? What does the social safety net look like for undocumented immigrants aging without access to public benefits? What happens to migrant workers caring for older adults (Coe 2019; Cranford 2020) as anti-immigrant sentiment is rising and migration policies become increasingly restrictive in many societies? No single book can possibly cover every issue, but Aging in America offers a solid foundation for exploring these urgent questions.