Beyond Successful and Active Ageing: A Theory of Model Ageing 9781447330189

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VIRPI TIMONEN

BEYOND SUCCESSFUL AND ACTIVE AGEING A theory of Model Ageing

POLICY PRESS

RESEARCH

VIRPI TIMONEN

BEYOND SUCCESSFUL AND ACTIVE AGEING A theory of model ageing

POLICY PRESS

RESEARCH

First published in Great Britain in 2016 by Policy Press North America office: University of Bristol Policy Press 1-9 Old Park Hill c/o The University of Chicago Press Bristol 1427 East 60th Street BS2 8BB Chicago, IL 60637, USA UK t: +1 773 702 7700 t: +44 (0)117 9​ 54 5940 f: +1 773 702 9756 [email protected] [email protected] www.policypress.co.uk www.press.uchicago.edu © Policy Press 2016 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested. ISBN 978-1-4473-3017-2 (hardcover) ISBN 978-1-4473-3019-6 (ePub) ISBN 978-1-4473-3020-2 (Mobi) The right of Virpi Timonen to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Policy Press. The statements and opinions contained within this publication are solely those of the author and not of the University of Bristol or Policy Press. The University of Bristol and Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality. Cover design by Policy Press Front cover: image kindly supplied by Printed and bound in Great Britain by CPI Group (UK) Ltd, Croydon, CR0 4YY Policy Press uses environmentally responsible print partners

To those who cannot (or won’t) age particularly successfully or actively

Contents

Preface

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one two three four five

1 13 35 61 87

Paradoxes and puzzles in ageing societies Critique of successful ageing models Critique of active ageing models The problem with modelling ageing Towards a theory of model ageing

References Index

103 115

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What we should avoid … is transforming the old person into the total consumer, making him into a person whom we teach how to pass away the time decently while he waits for his own passing – death. (Fromm, 1984, p 131)

Preface

In 2014 I became preoccupied with the idea of successful ageing and cognate concepts such as positive, productive, active and healthy ageing. It seemed to me that these concepts shared something – a family resemblance, if you like. I found myself wondering: what do these concepts that seek to encapsulate ‘ageing well’ have in common? I had of course come across these concepts before then, many times, but perhaps there was something about another birthday bringing me a little closer to ‘old’ that set off a keener interest in the concepts. I was also aware that yet another ‘Centre for Successful Ageing’ was about to be opened in a local hospital, and I started to marvel at the longevity and prevalence of this concept that had always struck me as bordering on marketing lingo. A Web of Science search, using the key words ‘successful’ and ‘ageing’ (or the US spelling ‘aging’) resulted in staggering 2,743,785 hits, despite the search’s being limited to recent publications. It is evident that in addition to policy makers and salespeople who promote successful and active ageing as a way to achieve their aims (reforming old-age policy, selling stuff to older people), academics and researchers have generated a huge corpus of work around these concepts. There are also many academic works that challenge the concepts of successful and active ageing; yet the literature lacks a comprehensive, theory-oriented critique of these ubiquitous concepts. Perhaps this is not surprising in view of the fact that people who conduct research on ageing are one of the vested interests that drive the use of these concepts.

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There is one book in particular that made me quite determined to marshal a comprehensive critique of successful ageing, active ageing, and related concepts. The book is entitled Winning Strategies for Successful Ageing (Pfeiffer, 2013). I found this book so astonishing that I felt I had no choice but to take to task the concepts that incorporate ‘models’ (noun) of ageing – and those who ‘model’ (verb) ageing in the sense of presenting ideas and ideals of how to age well – hence my term ‘model ageing’. The following are selected highlights from Pfeiffer’s manifold exhortations and advice for older adults who want to age successfully. • ‘Successfully aging persons most often like where they live, they know who they are, and they are not alone’ (p 14). • ‘[Y]ou are now [after retirement] totally portable … you can now live anywhere in the world, unrestricted by job commitments, by college careers, or by where you happen to have been born’ (p 16). • ‘[Y]ou could continue to work at your job or your profession, but in a much reduced fashion … you could do some variation of what you have been doing, such as “consulting” in the field of your expertise’ (p 29). • ‘Now you can go anywhere in the world, for as long as you’d like, by whatever means of travel you choose’ (p 34). • ‘You are now free to spend more time with [your grandchildren], wherever they live’ (p 37). • ‘[N]ow is the time to perfect this [spousal relationship], your most important social relationship’ (p 40). It is abundantly clear that, for Dr Pfeiffer, ageing successfully is a set of choices that anyone can (and should) make – provided, it seems, that they have sufficient income, a successful professional track-record, good health, a happy marriage and no dependants (note that the grandchildren are to be visited for fun, not living with you or in your care). These prerequisites are not openly stated, but remain for the readers to glean as they consider their ability to fulfil the breath-taking list of requirements for successful ageing.

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The book acknowledges that not everybody goes though old age without maladies: ‘You may be faced with an acute or chronic illness at any time, and your responsibility will be to deal with it aggressively … In order to receive great health care, you have to have great health care insurance. You cannot afford not to have good health insurance coverage’ (Pfeiffer, 2013, pp 55–7). Prevention is stressed: ‘You should get a pedometer to measure how many steps you take each day’ (p 76), because ‘exercise will make you a better all-around person’ (p 173). On page 100 there is an aberrant admission that ‘maintaining happiness probably requires relative freedom from deprivation, pain, and threats’. However, the overall tone of the book is of relentless striving towards independence: ‘Any episode of dependency should be regarded as strictly temporary, to be reversed as soon as possible’ (p 174). No area of life is left untouched, as the drive to age successfully extends to all facets and stages of life, including preparation for a good death. But in the meantime, to age successfully is to remain active in areas ranging from careful selection of hobbies to remaining sexually appealing, an important goal that ‘might also include the use of Botox to reduce forehead wrinkles or any variety of plastic surgery and well-toned muscles as a result of regular exercise’ (pp 210–11). Ageing successfully is clearly an all-consuming, expensive project! The book ends with this sentence: ‘We are human, made of the same stuff’ (p 300). Reading these words, I could not but marvel at the thought of how perfectly irrelevant (even offensive) this set of successful ageing advice is, for example, to a grandmother who is the sole guardian of her grandchildren in a run-down inner-city area, or a low-income caregiver of a spouse or partner with extensive disabilities, or indeed for anyone who isn’t already ‘ageing successfully’ along most of the varied dimensions discussed in the book. The ignorance of how the experience of ageing is socially stratified that was demonstrated by this book astounded me. Nonetheless, I am very glad that I read the book. It made me realise that critical sociological approaches to ageing are needed more than ever; popular and scholarly literature contain so many ‘celebrations’ of what are essentially the privileges of healthy, wealthy and socially connected older adults that somebody has to do

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the nasty job of pointing out the downsides of this obsession with success and activity in old age. (Apologies to Dr Pfeiffer for quoting from his book at length, with such a critical intent: his book is not the only one that I could take to task, but it happens to be a recent one, published by a prestigious university press, and widely available. I am sure that as a robust, successful person, Dr Pfeiffer won’t mind the critique, and might well issue a vigorous rebuttal.) Successful ageing literature aimed at a broad readership is just one manifestation of the contemporary ageing enterprise (a term originally coined by Estes, 1979), that is, researchers, business people and policy makers producing and elaborating on a concept that is, for them, a useful reference point and ‘hook’ for research, marketing and policy making. In fact, once I had become attuned to the concepts of active and successful ageing, they kept cropping up everywhere: marketing leaflets for various elder-care services, titles of conference programmes, special issues of journals. Why such ubiquity? Because successful and active ageing are social constructs that help to sell products and ideas to people who are usually already ageing reasonably ‘successfully’, and exclude those who are not fit, or wealthy, or motivated enough to purchase or negotiate for themselves the products, lifestyles and statuses that ostensibly enable successful ageing. The concepts of successful and active ageing can also be used to ‘sell’ policy advice and recommendations, prescriptions, if you like, to entire populations. A perusal of current policy statements produced at national and international level indicates that expectations of active ageing are being extended to concern everyone – despite the differential capacities and inclinations of older adults to buy into the models of ageing that are presented to them. The fact that academics and researchers are also increasingly ‘invested in’ the notions of successful and active ageing concerns me. Those who are supposed to be able to take a more critical stance on successful and active ageing ideation – sociologists of ageing, gerontologists – are often co-opted into this enterprise, not the least because markets and technologies aimed at successful and active ageing are now among the few well-funded areas of research open to social scientists working on

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questions related to ageing. In addition to being a critique of active and successful ageing notions in the business and policy spheres, this book is therefore also hoped to hold up a light for some self-examination among the academic and research communities that are part of the model ageing enterprise. Virpi Timonen 22 December 2015

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ONE

PARADOXES AND PUZZLES IN AGEING SOCIETIES Puzzlement and curiosity underlie all discoveries and advancement of understanding. The discourses and scripts around ageing are replete with paradoxes, puzzles and contradictions that make me wonder about the ageing societies we live in. Paradoxes, puzzles and contradictions can be frustrating in practice, but they are also ripe material for theorising because they make us ask: ‘why do they exist?’ and ‘what do they tell us?’ – and even ‘whose interests do they serve?’ In the course of seeking to understand seemingly irreconcilable and contradictory phenomena, theory in the sense of accounts of what explains the existence of and relationships between (conflicting) concepts emerges. I will begin by drawing out some of the key paradoxes and puzzles in contemporary ageing-related discourses, with a view to identifying sensitising concepts that are important starting points in developing new critical insights and theory. Despite policy documents, marketing and media exhorting older adults to remain active contributors to society and to maintain their independence, older adults are often construed in ambivalent terms in parallel discourses. The paradigms of active and successful ageing (and the centrality of agency and individual responsibility inherent in these) are evident in, for example, the expectation that older people must act as ‘informed consumers’ who make choices and assume responsibilities regarding their own care (Bertelsen and Rostgaard, 2013). Yet older

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adults (especially those with care needs) are often treated as lacking personhood and agency (O’Dwyer and Timonen, 2010). I label this • the paradox of (in)dependence: exhorting independence among a group of people who are simultaneously construed as dependent and vulnerable. What might explain this paradox? I will offer explanations in subsequent chapters, but my opening gambit is that this paradox exists because policy and literature are in fact not referring to the older population in totality but, rather, sending messages about sub-groups that they consider somehow problematic, in contrast to groups that are adhering to ideals of ‘ageing properly’. Policy aspirations pertaining to older populations have a strong gender dimension, both because women form the majority in older populations and because the aspirations have more extensive ramifications for women’s life courses, which have traditionally diverged more than men’s from some of the paths and patterns that are now prescribed (especially with regard to paid work). A central contradiction is the increasingly widespread expectation that older people should both work in paid employment for longer than is currently the case and they engage in unpaid (care) labour. Men are also increasingly expected to provide care, because of evolving gender norms and demographic changes (such as the diminishing difference between women’s and men’s life expectancies). Nonetheless, because the distribution of care labour between women and men remains far from equal, these aspirations ‘load’ more heavily onto women, especially women in lower socioeconomic groups (Conlon et al, 2014). I call this • the puzzle of gender and social class blindness, arising from the implicit assumption that women and men, and rich people and poor people, have similar trajectories in ageing. Furthermore, there is the paradox of high-level policy generation for ‘the older population’, with insufficient sensitivity to diversity in this

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population. In particular, the influence of social class on differentiating opportunities and experiences in later life has received little attention (exceptions to this are Formosa and Higgs, 2013; Timonen et al, 2013). This is surprising in view of the prevalence and persistence of a social gradient in virtually all outcomes of interest in older populations, beginning with something as basic as survival rates to reach old age, where the higher socioeconomic groups maintain a distinct advantage; yet we are all now expected to work longer (in some cases presumably until death). I call this • the paradox of seeking homogeneous outcomes amidst increasingly heterogeneous older populations. There has been a shift from public responsibilities towards increasing emphasis on private (individual/family) responsibilities for welfare, including the assumption that it is the responsibility of older people to optimise their functional abilities, to maintain their incomes through work and savings and to remain active, contributing members of society through unpaid inputs into the care and well-being of kin (especially ageing parents) and even non-kin (for instance, ‘looking out’ for neighbours). Some actors also argue for increase in older people’s involvement in the design and delivery of services, assuming that they are both capable of and interested in co-producing services, including care – assumptions that remain inadequately explored and theorised. I call this • the puzzle of assuming strong agency in welfare production on the part of older adults in the midst of growing structural (welfare state) uncertainty. These reform proposals and exhortations for change are premised on the idea that ‘the problem’ (older people and the resultant ‘burden’) can and must also be ‘the solution’ (older people becoming more active and less dependent). This is the central paradox: • the paradox of turning the problem into the solution.

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This last paradox is the one that fascinates me most, because it is the biggest paradox of all, and one that best encapsulates the current policy agendas in ageing welfare states. ‘Turning the problem into the solution’ is the direction that more and more policy and practice towards older adults is taking as policy makers worry about ageing and turn to the resources of older adults (or, indeed, older adults themselves as a resource) in the hope that this will hold the total, or at least partial, ‘solution’ to the ‘problem’ of ageing. Thus, there are recommendations that older adults’ accumulated wealth should be used to pay for care costs, thereby solving the problem of rising costs of care; older married people are highlighted as a useful ‘care reserve’ as they already live with their dependent spouses; the older volunteers who serve meals to other older people in their community are held up as the model that all older people should emulate. Together, these ‘handy solutions’ amount to a picture of the future of ageing societies that I want to examine more closely and critically in this book.

Questions that arise from the paradoxes and puzzles There is evidence that some social locations and structures are more conducive to the ‘model’ behaviours that policy makers increasingly expect from older adults, although understanding of the mechanisms that bring about desired behaviours remains patchy (Erlinghagen and Hank, 2006). Many of the benefits of the ‘prescribed’ behaviours are already incurring to groups within the older population who are relatively privileged and inclined towards ‘model behaviour’ in the first place – witness, for instance, the virtuous cycle of better-off, healthier older people being more likely to work and to volunteer and hence reaping the rewards of better health and other positive consequences of work/volunteering. In order to achieve the ambitious policy aims, shifts in individual behaviours and attitudes are required; some of these intended micro-level shifts are radical, such as extension of working lives in societies where early retirement has become entrenched. Myriad questions arise around the quest for the ‘model older person’ that policy scripts endorse and seek to cultivate. How might a profusion

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of such ‘model people’ be brought about? Why do some older adults make ‘right’ and others ‘wrong’ choices regarding the prescribed and recommended life courses, roles and behaviours? It is unclear to what extent the stated policy ambitions and assumptions inherent therein are consistent with the expectations of older people themselves. How far do older adults in rich countries expect, and are they prepared to take, responsibility for their own well-being/welfare and the wellbeing of their families and communities? Do they welcome or resist expectations of independence and productivity? Are some groups ‘opting out’ of the prescribed behaviours, either because they cannot fulfil the requirements or because they have other options? These are questions that gerontologists and sociologists have barely broached. The purpose of this book is not to examine which policies are most effective in bringing about desired outcomes, nor to test hypotheses pertaining to the factors that predispose some individuals to be ‘compliant’ and others to ‘deviate’ from the model behaviours. Rather, I believe that we need to assemble some building blocks of a new theory of meso-level dynamics in ageing societies where particular sets of policy and marketing scripts are supposed to shape the lives of older people. The theory that I develop here can be used to examine and illuminate the experiences of older people in diverse gender, class, ethnic and systemic locations, in the process of coming into contact with ‘model ageing’ aspirations (and paradoxes) through the different contexts they live in.

Why a new theory? Ossewaarde (2014) argues that ‘without social theory, aging research runs the risk of serving particular interests, of reinforcing certain powers, and correspondingly of being both blind to hidden dangers and smothering alternatives yet unthought-of ’ (p 163). The foremost of these interests and powers, ‘health experts’ (medico-political power elites), work alongside other ‘experts’ such as neuroscientists and information technology (IT) specialists to generate evidence to support ‘a constant work of self-modulation in relation to politically

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and ideologically desired forms of aging’ (Ossewaarde 2014, p 172). Alongside the actors singled out by Ossewaarde, policy makers across rich aged societies are also among the ‘stakeholders’ who have a strong interest in devising models of ageing and seeking to mould the behaviour of older populations to fit these. Responding to the pervasive and irreversible phenomenon of population ageing is one of the greatest scientific and societal tasks of our time, whether one considers it an objective fact (and perhaps a threat), or whether one believes the ‘ageing challenge’ (demographic time bomb, ageing tsunami) to be socially constructed (Timonen, 2008). Making sense of this phenomenon, and why it is giving rise to so much concern and activity by diverse groups of actors, calls for theory. The macro-level social theories of ageing that are applied in the literature are arguably dated (for a comprehensive review, see Bengtson, Silverstein, Putney and Gans 2009). The revolutionary changes in demography and in society (including the development of ideation around successful and active ageing) give rise to the need for new theories of ageing. The area where the need for new theorising is particularly striking is the interface between policy/business/ research aspirations, on the one hand, and the lives and behaviours of individual older adults, on the other. Empirical investigations often broach this ‘surface’ between the macro (public, policy) and the micro (private) levels, but these investigations are rarely guided by, or give rise to, theory (as opposed to ad hoc description or loose conceptual frameworks). While theory development pertaining to the meso level in ageing societies has been sluggish, ageing and associated phenomena have become subjects of intensive policy making, marketing and research efforts at local, regional, national, supranational and international levels. Policy makers and policy-formulating organisations, researchers and businesses across rich countries have directed their gaze to their ageing populations, perceived problems (or ‘challenges’) in these populations and set themselves targets regarding the modification of behaviours among older adults (Timonen, 2008). The aspirations to bring about changes in the way older adults live are legion. However, the most

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prominent reform drives across welfare states with aged populations cohere into three main foci, encapsulated in the European Commission (2002, p 6) statement that exhorts ‘lifelong learning, working together, retiring later and more gradually, being active after retirement and engaging in capacity enhancing and health sustaining activities’. These aspirations therefore seek to ensure that older adults: A. actively engage in preserving and enhancing their independent living skills, B. stay on in paid employment, and C. remain or become ‘socially productive’, that is, make unpaid contributions to families and society. Through such efforts, it is argued, active ageing becomes a ‘coherent strategy to make ageing well possible in ageing societies’ (European Commission, 2002, p 6). The European Union authorities are not alone – all economically developed countries with large older populations prescribe ‘model’ behaviours for older people, with the aim of alleviating the ‘burden’ of population ageing. Invariably, these prescribed behaviours cohere around the ‘holy trinity’ of living independently, working longer and contributing to families/ communities. A virtuous cycle arises between these components, where each ‘good’ behaviour fosters and enables further ‘good’ behaviours. These aspirations also neatly map onto the wishes of businesses that are primarily seeking to target the healthy, wealthy and active sections of older populations. A new theory is called for because existing theoretical frameworks do not adequately illuminate the interface between the macro level of policy ambitions relating to ageing and the micro level of older people’s experiences of ageing. Not all policy contexts are equally oriented to rewarding and enabling the prescribed behaviours. For instance, while some welfare states provide extensive retraining opportunities for older workers (and therefore are conducive to ‘model’ behaviours), others merely expect them to work longer when pension age is increased (and therefore are here labelled adverse contexts). One of the

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important questions that arises is why some older people are ‘model citizens’ despite an adverse policy context (that does not support model behaviours); and why some older people ‘deviate’ from ‘the model’, despite a conducive welfare-state context (that does foster model behaviours). Context matters, but it is not everything – older adults make choices both in accordance with and contrary to what external actors expect, and little is known about how and why they make these choices. Reflecting on the possible answers to the above questions (as I do in Chapter Four) can bring us closer to a meso-level theory of ageing in contemporary societies where powerful actors from governmental, business and research elites prescribe ‘model’ behaviours for older adults.

Epistemological underpinnings My ontological position is critical realism. According to Bhaskar (1989), one of the foremost scholars of critical realism, ‘social reality’ is a set of arrangements that result from significant but unobservable structures of social relations. Scholars within the critical realist paradigm seek to explain phenomena with reference to these underlying structures. People who operate within social structures attach different meanings to their lives and behaviours, and to those of others. In other words, they socially construct the world around them. Social constructs are not ephemeral but, rather, they have real influence. For instance, while ‘power’ is a social construct, power relations between groups in society are real and consequential, and exist independently of the varying interpretations of such relations. The four central tenets of critical realism are that (1) reality exists independent of our experiences; (2) reality is stratified into different levels; (3) society is an open system; and (4) people are agents in their everyday world. I recognise the importance and explanatory relevance of the meanings that people attach to their lives and behaviours, and believe that our understanding of these meanings is essentially interpretive; hence I combine ontological realism with epistemological constructivism.

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Sociological theorising calls for disciplined use of imagination in seeking to understand social phenomena (Mills, 1959). The discipline arises from systematic collection and analysis of empirical material (data). Empirical material enables the ‘active mobilization and problematization of existing [theoretical] frameworks’ and serves as ‘a source of inspiration and … a partner for critical dialogue [with theory]’ (Alvesson and Kärreman, 2011, p 14). This involves unpacking and criticising the concepts and categories that are conventionally used to describe and make sense of old age. My starting point is a reflexive acknowledgement of the ‘frames’ that I bring into this enquiry: I do not start with a tabula rasa, but I strive to be as open as possible to the unexpected, and in fact seek out novel and poorly understood angles of ideation. I aim to achieve ‘a hermeneutical translation and clarification of the life-world of the particular group of people under study’ (Alvesson and Kärreman, 2011, p 36), in this case older adults who are ‘objects’ of policies on ‘model ageing’. Older adults engage in ‘ordinary’ or ‘everyday’ theorising (Gubrium and Wallace, 1990, p 131); my theorising seeks to tease out how policy and research frame older adults and how older adults themselves might see and explain their behaviours in contexts where radical changes are expected in how they live and what they do. I am particularly attuned to phenomena and behaviours that are surprising or puzzling, because these reactions are most likely to foster theory development. Such puzzling phenomena also call for empirical investigation. In Chapter Four I have selected substantive domains and groups that have the greatest potential to illuminate hitherto poorly understood/novel phenomena that are of importance for understanding the dynamics between the demands of ‘the model’, on the one hand, and the everyday existence and experiences of older adults, on the other hand; I hope that empirical investigations along these lines ensue. Theory building is aided by abduction, a term that refers to ‘a creative inferential process aimed at producing new hypotheses and theories based on surprising research evidence’ (Timmermans and Tavory, 2012, p 167). In reasoning abductively, the researcher engages

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in an iterative process of analysis in tandem with being ‘abducted’ – led away from old insights and towards new ones. Abbott (2004) advocates the exploration of existing theories for their heuristic potential, as aids to discovery and innovation; I use existing conceptual and theoretical frames to assist the explication of literature and policy documentation. Fundamentally, I regard all aspects of ageing societies as data, including casual observations of everyday phenomena – this is in line with the grounded theory proclamation that ‘everything is data’ (Glaser, 1978). I will make liberal use of analytic induction, that is, case-based reasoning where data items are generated and analysed in a constant loop with the formulation of hypotheses (Katz, 2001): the aim is not to use cases to confirm or reject theories but, rather, to use them as resources for conceptual exploration and theory building. I want to emphasise that the theory I put forward in this book is interpretive, and is offered as a set of postulates: it is not theory in the (positivist) sense of tried-and-tested hypotheses cohering into an explanatory account that links variables into outcomes. It is of course possible to draw out testable hypotheses from each of the postulates, and to subject these to empirical testing. All descriptors of adult life stages are fundamentally socially constructed. I do not seek to pre-define in a rigid way what ‘old age’ or ‘being old’ means but, rather, approach this openly, pragmatically and inductively. I have selected studies and documents for review that maximise the potential for illuminating contrasting phenomena of conceptual and theoretical interest. It is not helpful to ‘fix’ the start point of ‘old age’ at 65+ or by some other convention; sometimes the relevant age threshold might be a lot lower (for instance, when studying Roma people who develop care needs), for other groups it might be a lot higher (for instance, middle-class people in Denmark who receive home-based rehabilitation services). The focus of interest is how actors and organisations that concern themselves with ‘the problem of ageing’ construct the older population: what is seen as problematic, and how do they propose to solve those problems?

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Chapter structure This book has a very simple structure. Chapter Two explores how sociologists, epidemiologists and gerontologists have modelled the concept of successful ageing. Chapter Three considers active ageing models in the welfare-state context. Through these two chapters, I hope to demonstrate the considerable similarities and interlinkages between these ‘two worlds’ (one more academic, the other more practical and policy oriented) of modelling ageing. Based on Chapters Two and Three, I will marshal a critique of attempts to model ageing in Chapter Four; and Chapter Five will present a theory of model ageing.

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TWO

CRITIQUE OF SUCCESSFUL AGEING MODELS The ubiquity and longevity of successful ageing If you have had any exposure to gerontology, the study of ageing, the chances are that you have come across the concept of successful ageing. Indeed, if you observe any Western ageing society you will come across the term very quickly: in advertising, policy documents and in the media. However, if asked to define the concept, you would most likely proffer a different definition than the next person (even if you are both gerontologists). This is because successful ageing is a construct that has no single widely accepted and applied definition. Depp and Jeste (2006), in their review of 29 successful ageing studies, identified almost as many (28) definitions of successful ageing. Cosco and colleagues (2014) identified 105 operational definitions of successful ageing. This does not mean that the concept is unimportant, or too vague to have exerted an influence on the study of ageing. On the contrary, the fact that diverse definitions abound demonstrates the ‘appetite’ for a summative concept like successful ageing, in the sense of a desire to spell out what it is, and who is living it – in all cases underpinned by a particular understanding of what constitutes ‘success’. The idea of a ‘recipe’ of successful ageing is old: one of the earliest examples of pointing to a path to a good old age can be found in

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Cicero’s (106–43 BCE) De Senectute (‘on old age’). When his two young friends enquire about the positive and negative aspects of old age, the elder statesman Cato responds that he continues to enjoy intellectual activities; does not miss the physical vigour of his youth; and has adjusted his activities to be manageable. For Cato/Cicero, old age ‘may well be very busy indeed, always in the middle of some activity, or projecting some plan – in continuation, of course, of the interests of earlier years’. However, Cicero was dismissive of advice regarding good old age: ‘Advice in old age is foolish; for what can be more absurd than to increase our provisions for the road the nearer we approach to our journey’s end.’ Notions of successful ageing, therefore, have abounded through history, but few recent writers have taken Cicero’s reluctant stance on sketching out how to age well. Indeed, the present-day gerontological community is more invested than ever in the concept of successful ageing, and has become an important force in promulgating and widening the use of the concept to areas beyond academia (see Chapter Three). The notion of successful ageing (as it features in contemporary scholarship) was initially an attempt to counter negative stereotypes and ageism by demonstrating that ageing well is possible, provided certain conditions are met. The term ‘successful aging’ first featured in the title of Havighurst’s (1961) article where it was defined as ‘the conditions of individual and social life under which the individual person gets a maximum of satisfaction and happiness’ (p 8). Havighurst contrasted activity theory, which construed successful ageing as the ‘maintenance as far and as long as possible of the activities and attitudes of middle age’ with disengagement theory, which defines successful ageing as ‘the acceptance and the desire for a process of disengagement from active life’ (p 8). He went on to advocate a subjectivist definition of successful ageing, with emphasis on well-being. The 1960s and 1970s saw attempts to develop empirical measures of successful ageing such as Palmore’s (1979) criteria of surviving to age 75 in good health, in tandem with a subjective judgement of happiness. However, a turn towards more objectivist understandings of successful ageing took place in the late 1980s, when Rowe and Kahn

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(1987) argued that dichotomising ageing into pathological versus normal states did not capture the range of ageing experiences. They differentiated ‘normal’ ageing into usual aging, in which individuals experience nonpathological age-related changes but are at high risk for disease, and successful ageing, in which nondiseased individuals experience high functioning and are at low risk for disease. This conceptualisation was nonetheless one-dimensional in its focus on objective physical functioning, a deficiency that the authors wanted to address. In 1997, building on their 1987 publication, Rowe and Kahn declared that: Substantial increases in the relative and absolute number of older persons in our society pose a challenge for biology, social and behavioral science, and medicine. Successful aging is multidimensional, encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities. Research has identified factors predictive of success in these critical domains. The stage is set for intervention studies to enhance the proportion of our population aging successfully. Rowe and Kahn’s argument has given rise to widespread discussion of notions of successful ageing. Four aspects of their argument are particularly noteworthy, and continue to characterise the successful ageing paradigm: • First, the idea that we need to understand successful ageing because the increase in older populations is a ‘challenge’ (that is, a problem to be addressed). • Second, the idea that, in order to age successfully, one has to ‘tick’ several ‘boxes’ across selected domains of life: physical, cognitive and social. • Third, the argument that certain characteristics and behaviours bring about successful ageing, and that we know what these are. Rowe and Kahn stress that intrinsic (genetic) factors are influential, but ‘do

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not dominate the determination of risk in advancing age’ because extrinsic (life-style) factors exert a strong influence (1997, p 435). • Fourth, the argument that interventions can and should be developed with the aim of bringing the successful ageing experience to a greater number of older people. These ideas persist in the contemporary literature on ageing. In particular, there is a profusion of research that seeks to better understand the factors that are related to ‘success’ in different domains of ageing. Rowe and Kahn specified a range of independent variables that are associated with successful ageing. In relation to good cognitive function, they outlined research that shows correlations with higher levels of education, pulmonary flow, strenuous exercise and self-efficacy. The ‘social’ domains of successful ageing are firmly linked to ‘healthy ageing’ by Rowe and Kahn, as isolation is deemed ‘a risk factor for health’ and ‘social support, both emotional and instrumental, can have positive health-relevant effects’ (1997, p 438, my emphasis). ‘Productive activity’ is broadly defined as work, unpaid or paid, that can in principle be translated into monetary value, including voluntary work and care provision; Rowe and Kahn marshal evidence that functional capacity, education and self-efficacy predict engagement in productive work. The virtuous cycle of various advantages (education, self-efficacy and so on) fostering successful ageing behaviours is therefore in evidence from the start, and fundamentally integrated into the model. In relation to their exhortation to develop interventions, Rowe and Kahn provide remarkably little by way of evidence or examples: reducing risk and enhancing resilience/recovery for the parts of the older population who are at greatest risk of ageing ‘unsuccessfully’ are evidently the least developed aspects of successful ageing. The stage was thus set for decades of publications on successful ageing that are fundamentally health oriented and that, despite viewing ageing through the pathological-healthy distinction, are strangely ignorant of ways forward in ‘rescuing’ individuals who are on the path to ill health in old age – or indeed unlikely to reach ‘old age’ in the first place. In fact, given how individual-centric the Rowe and Kahn

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model is, it is hard to imagine what room is left for policy. In their 1998 book, Rowe and Kahn argue that we can have a dramatic impact on our own success or failure in aging … Successful aging is in our own hands … To succeed means to have desired it, planned it, worked for it … we regard [successful aging] as largely under the control of the individual … Successful aging is dependent upon individual choices and behaviors [and] can be attained through individual choice and effort’. (Rowe and Kahn, 1998, pp 18, 37; my emphasis) In the Rowe and Kahn framework, these all-important individual choices are fully decontextualised: gender, class, ethnicity, neighbourhood and other social locations are assumed to be unimportant in this model where we are all free agents, choosing or rejecting the life-styles that lead either to successful ageing or away from it. The resemblance to the argumentation in the book by Pfeiffer (2013) – discussed in the Preface of this book – is striking. The advice proffered by Pfeiffer is a consistent and logical elaboration of Rowe and Kahn translated into practice. As the literature on successful ageing has expanded, the problems mentioned above have magnified. I will now go on to outline and discuss the most problematic aspects of the notion of successful ageing under four headings that answer the question ‘What’s wrong with successful ageing?’

Problems with successful ageing 1: there’s no consensus over its meaning Definitions of successful ageing based on  objective criteria define success by the judgement of others, omitting the perceptions of the  ageing adults, and focusing on functioning and health state as measures of success. This puts many older adults in the ‘unsuccessful’ category: indeed, the ‘pure’ biomedical model precludes people with chronic illnesses from ageing successfully. When  definitions rely

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on health being the absence of disease and disability (bio-medical criteria),  there are few successful agers – for instance, 19% in a Strawbridge et al (2002) study, 15% in a study by Jeste and colleagues (2010), and only 5% in a Montross et al (2006) study. McLaughlin et al (2010) discovered that only 12% of older adults aged 65 and over in the United States ‘age successfully’ in the light of the Rowe and Kahn criteria in any one year, and highlighted the importance of structural factors in enabling/hindering successful ageing. Expanding the definition used in McLaughlin et al (2010), McLaughlin et al (2012) found prevalence rates of up to 33.5%, and recommended relaxing the criteria of successful ageing in order to make it relevant for a broader section of older populations. There is a large gap between how individuals and researchers define success: in two studies that asked people to self-rate whether they were ageing successfully, 50% (Strawbridge et al, 2002) and 92% of older adults (Montross et al, 2006) self-rated themselves as ageing successfully. Disparity between self-rated satisfaction with ageing and ‘objective’ criteria therefore is evident, but also varies enormously between studies. As a result, many scientists have argued that the early definitions of successful ageing were overly restrictive and limited successful ageing to an objective judgement made by others, ignoring older adults’ perceptions. Others have pointed out that definitions focusing on physical functioning and freedom from disability are misleading and may lead to the conclusion that a large majority of individuals are getting older unsuccessfully, given the high incidence and prevalence of diseases that are common in later life. In contrast, ‘lay’ definitions tend to open up successful ageing to a much broader group: ‘satisfaction and happiness’ was identified as a frequent response in a study by Tate and colleagues (2003) that asked older Canadian men ‘What is your definition of Successful Ageing?’ Once the door to incorporating subjectivist aspects was opened, further conceptualisations of successful ageing started mushrooming. Phelan et al (2004) aspired to compare older adults’ perceptions of ageing successfully with attributes of successful ageing presented in the literature. The older adults indicated that 13 out of the 20 attributes

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extracted from the literature were consequential to ageing successfully. The authors characterise the participants’ selection of important attributes as ‘multidimensional’, comprising physical, functional, psychological and social health, and argue that no previous research had taken all four domains into account. Among the study’s limitations, Phelan et al (2004) specify that ‘the perspective of other populations, such as nonrespondents, or populations with higher or lower prevalence of depression, might also be expected to differ’ (p 215). Moreover, the study sample were highly educated and focused on health and prevention, characteristics that predisposed them to particular notions of ageing well, and indeed the authors acknowledge that ‘given that older adults are a heterogeneous group, responses might differ’ in other population groups (Phelan et al, 2004, p 215). Reichstadt and colleagues (2010) set out to understand ‘lay perceptions’ of successful ageing. They argue that, as only one-third of older adults meet disease-based criteria for successful ageing (absence of disease/disability), it is important to know what constitutes ageing successfully from the point of view of older adults themselves. Again, they hope that understanding successful ageing, this time from the ground up, ‘may help guide … the development of models of care, interventions, and policy reform’. Reichstadt et al (2010) argue that older adults view successful ageing as a balance between self-acceptance and self-contentedness, on the one hand, and engagement with life and self-growth, on the other. This can also be characterised as a balance between stability/consistency and experimentation/growth. The older adults in their study emphasised psychosocial and behavioural adaptations to life changes and disabilities, rather than freedom from or avoidance of disabilities. Bowling and Dieppe (2005) noted that a definition of successful ageing based on lay perspectives was more predictive of quality of life than were criteria based on physical functioning. However, there is an interesting similarity in the lay definition that they unearthed and the ‘medical model’ of successful ageing, as the most frequent lay reference was to ‘having good health and functioning’ (Bowling and Dieppe, 2005, p 1549). Additional lay definitions included ‘accomplishments’,

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‘enjoyment of diet’, ‘physical appearance’, ‘sense of humour’, ‘sense of purpose’ and ‘spirituality’, among others, an eclectic collection indicative of the impossibility of a single, reductionist definition of successful ageing. Bowling and Dieppe conclude that the vast majority of older adults cannot achieve the ‘full set’ of successful ageing markers; that successful ageing should be seen as a ‘continuum of achievement’; and that adopting a broader perspective on successful ageing ‘will have relevance for elderly people themselves’ (p 1550). Neugarten (1972) emphasised psychological attributes and resources (such as coping style and adaptability) as key in shaping the chances of ageing successfully. Other studies have shown that older adults report optimism, socialisation, successful coping techniques and community involvement as more significant than the objective (physical and mental) health criteria. Subjective quality of life has been strongly correlated with resilience, confidence, emotional and mental strength and similar psychosocial traits (Depp et al, 2007; Lamond et al, 2008; Reichstadt et al, 2010). This further supports the paradigm shift in separating predictors of successful ageing and good life quality from objective health states. Pruchno and colleagues (2010), noting the existence of both subjective and objective dimensions/definitions of successful ageing, proposed that the term be treated as essentially multidimensional. Their model incorporates having few chronic health problems, maintaining functional ability and experiencing little pain (objective criteria), and subjective rating of how well one has aged and is ageing, and how one would rate life overall (subjective criteria). Despite these efforts, there are no signs of the scholarly communities electing to favour any particular definition of successful ageing over the multitude of others; rather, successful ageing literature has become an engine that perpetuates the production of an ever-increasing diversity of definitions of success.

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Problems with successful ageing 2: it’s been conceptually stretched to the point of meaninglessness Many researchers have sought to ‘democratise’ successful ageing through incorporation of ‘lay perspectives’. While well intentioned, this has led to conceptual stretching of the notion of successful ageing to the point where it does not amount to a coherent concept. To add to the diverse understandings of successful ageing, it has been (correctly) pointed out that its components differ across cultures. Fry et al (2007) outlined some of the cultural differences they had identified between ‘Eastern’ cultures and the United States, where the former placed emphasis on harmonious family relations and the latter on activity as keys to successful ageing (see also Hung et al, 2010). In a study of low-income South Korean elders, Soondool and Soo-Jung (2008) report on the importance of adult children’s success for assessments regarding successful ageing. ‘Harmonious ageing’, with an emphasis on ‘the integrity of body and mind, and the interdependent nature of human being’, is advocated as an alternative to successful ageing by Liang and Luo (2012). Death, suffering, dying and other aspects of the ‘Fourth Age’ are usually neatly excluded from the realm of successful ageing. Higgs and Gilleard (2015) characterise the Fourth Age as the life stage where all the ‘undesirable elements of later life cluster together to create a symbolic other on the margins of everyday life’ (2015, p viii). In response to such critique, the notion of successful ageing has been adapted to reach ever-expanding audiences and populations. A body of research focuses on older adults who might at first sight appear to be straightforwardly ‘unsuccessful’ in that they have extensive disabilities, do not live independently or have characteristics that are widely considered marginalising. These studies tend to allow the research participants to define what successful ageing means for them, and then to self-assess whether they are able to adhere to this definition. Following such methodological approaches, older residents in assistedliving facilities have been shown to age, for the most part, successfully (Jang et al, 2013), as have people with disabilities (Romo et al, 2013).

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Hutchinson and Nimrod (2012) interrogated the ways in which older adults with chronic health conditions managed to enjoy leisure and to age successfully despite their disabilities. Successful ageing has also been observed among people with dementia: following interviews involving 224 people with Alzheimer’s disease over a period of 18 months, ageing successfully was directly predicted by mental health and social relationships, rather than general health or severity of cognitive decline (Depp and Jeste, 2006). A  transcendent perspective may help to account for lay persons’ perceived successful ageing while most researchers’ definitions continue to uphold physical and cognitive health as necessary criteria. To ‘transcend’ means to rise above or move beyond personal boundaries and limitations; transcendence changes older adults’ perspective on themselves, relationships with others, the nature of life and conceptions of afterlife.  In Tornstam’s (2005) developmental theory of ageing, gerotranscendence, successful ageing combats projection of mid-life aims, values and expectations onto old age. For Tornstam, old age has a different meaning and character than earlier life stages, echoing Erikson’s (1950) stages of the life span, of which the 7th and 8th entail generativity (concern with younger and future generations) and integrity (overall satisfaction with one’s life as a whole). These criteria of successful ageing are subjective and phenomenological. Successful ageing is usually defined in terms of outcomes, but some models emphasise processes, which in turn makes it easier to ‘democratise’ successful ageing. Arguably the most influential ‘process’ model is the goal-based Selective Optimisation with Compensation (SOC) model by Baltes and Baltes (1990), which grounded successful ageing in the interaction of three processes. Selection involves redirecting efforts and resources to certain goals and tasks while disengaging from other goals. This in turn allows individuals to optimise and strengthen the resources necessary for achieving selected goals. Ageing individuals can also compensate for declining abilities and skills by establishing new resources and strategies for maintaining desired outcomes. The assumption is that these self-regulatory processes become crucial with age and greater longevity. In their outline of successful ageing, Baltes

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and Baltes (1990) advocated the incorporation of multiple objective and subjective criteria, and recognition of individual and cultural differences. Socioemotional selectivity theory bears broad resemblance to SOC, as it postulates that older adults become more selective in their relationships, focusing on positive ones and seeking to optimise positive emotional experiences (Carstensen et al, 2003). These more processoriented studies have shown that mental and psychosocial functioning often improve with age, even if physical health and some elements of memory decline. Physicians, psychologists and gerontologists argue that age-related wisdom might serve to compensate for the biological losses in old age, thereby enabling older adults to better utilise their remaining resources and age successfully. Studies that incorporated the perspectives of older adults into the model of successful ageing have found that optimism, effective coping styles and social and community involvement are more important to ageing successfully than traditional measures of health and wellness. There has been a progression from rejecting emphasis on ‘objective’ health status and toward focusing on subjective views, psychosocial well-being and even transcendence; in other words, ever closer movement to a conceptualisation of successful ageing that encompasses everyone. This can be characterised as a collective exercise in ‘democratising’ successful ageing. From here, it is a short leap to policy discourses that prescribe similar behaviours for everyone, in the name of promising to enable everyone to ‘age successfully’. However, as Chapter Four elaborates, this is a misguided and deeply uncritical jump that is more likely to exacerbate existing inequalities among older populations than to remedy them.

Problems with successful ageing 3: it assumes a high degree of individual control All definitions of success are open to the critique that they are driven by particular interests and epistemologies. Critical gerontologists have argued that the notion of successful ageing is rooted in the preferences, characteristics and experiences of privileged groups, to

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the neglect of inequality in outcomes and experiences by social and cultural location (most importantly socioeconomic position, gender and ethnicity). The objectivist understandings of successful ageing have been critiqued for imposing standards or expectations that are undesirable and/or unattainable for many, especially marginalised individuals and groups. This is further accentuated by the fact that successful ageing often implies great responsibility and even moral imperative on individuals to strive to achieve age successfully, regardless of their resources. In media representations, too, the individual older adults are consistently identified as the key agent in bringing about successful ageing (Rozanova, 2010). The most fundamental critique of the ‘individual control’ assumption pertains to the influence of biological and genetic factors on outcomes that are associated with successful ageing. There are genetic influences on successful ageing – beyond those that influence longevity alone. From the perspective of genetics, successful ageing is a multifactorial phenomenon influenced by numerous genes and environmental factors, each making a small contribution to the phenotype. The genes contributing to successful ageing can be grouped into genes involved in the maintenance of cholesterol, lipid or lipoprotein levels (with a strong connection to cardiovascular health); genes related to cytokines, which affect inflammation and immune responses and in turn influence successful ageing by regulating cellular senescence, determining susceptibility to age-related cancers; and genes that are related to age-associated pathological processes such as Alzheimer’s disease. The pace of ageing (the rate at which we age biologically) has been shown to vary very significantly between individuals. In a study by Belsky et al (2015), biomarkers (such as body mass index and cholesterol) from over 1,000 individuals at age 26, 32 and 38 were obtained to develop an algorithm to calculate each individual’s personal pace of ageing. Although the individuals all had the same chronological age (all were born in 1972 or 1973), their biological ages were starkly different, with some ageing much more rapidly than others. Individuals with an older biological age exhibited distinct characteristics when

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compared to their biologically younger counterparts. Despite being the same chronological age as their counterparts, individuals with an older biological age exhibited cognitive decline, deteriorated balance and motor skills and characteristics consistent with higher risks for stroke and dementia. In addition, individuals with an older calculated biological age were weaker in grip tests and said to look older by an outside panel. The algorithm may be later used to determine genetic, environmental and social factors that accelerate age. The authors conclude that ‘antiaging interventions are needed to reduce the burden of disease and protect population productivity. Young people are the most attractive targets for therapies to extend healthspan (because it is still possible to prevent disease in the young)…. The science of healthspan extension may be focused on the wrong end of the lifespan; rather than only studying old humans, geroscience should also study the young’ (Belsky et al, 2015). In an early critique of the notion of successful ageing, Masoro (2001) drew on his research into caloric restriction where he had discovered that although decreased food intake slows the ageing processes in rats and results in animals that live longer, they suffer senescent deterioration for as long as do the shorter-lived rats on the higher caloric intake on the life span. He spells out the implications for human populations as follows: I have heard people involved in public policy say that an appropriate lifestyle with an emphasis on diet, weight control, and exercise can enable those reaching advanced ages to avoid the disabilities that are so costly in terms of societal resources. Concepts like that of ‘Successful aging’ have probably led to this belief, and they certainly serve to sustain it. It is important that those involved in public policy decisions recognize that at this time, we do not know if such a lifestyle will reduce or increase the extent and/or duration of senescent disability. Indeed, a strong case can be made for the latter. In fact, if the lifestyle responsible for ‘Successful aging’ also underlies achieving long life (e.g., becoming a centenarian), there is strong reason to

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believe such a lifestyle will increase the extent and duration of senescent disability. (Masoro, 2001, p 418) Against this backdrop of mounting evidence of the impact of our genetic makeup and biology, and uncertainty surrounding the possibility of compressing morbidity, the comprehensive critique of Rowe and Kahn’s model of successful ageing marshalled by Rubinstein and de Medeiros (2014) is particularly apposite. It is perhaps surprising that nearly two decades passed before such a comprehensive critique appeared in one of the most prominent gerontological journals in the US (The Gerontologist). Rubinstein and de Medeiros argue that the successful ageing framework of Rowe and Kahn is consonant with and shaped by the core tenets of neoliberalism, in particular its emphasis on individual effort, and ignorance of social patterning of (dis)advantage, with no room for consideration of how gender, family background, social status, ethnicity or any other ‘group’ characteristics might influence ageing. They argue that the paradigm does not engage in any explicit, causal explanation of why some older adults become/ are ‘successful agers’ while others are excluded from successful ageing; the only explications pertain to individual choices to age successfully (or not). For this reason, the Rowe and Kahn framework also fails to yield any suggestions pertaining to social, political and cultural change that would be needed to ensure that more older adults ‘age successfully’. In contrast, Rubinstein and de Medeiros (2014) suggest that ‘the changes required are in fact massive and go beyond the level of individual action’. In similar vein, Dillaway and Byrnes (2009, p 708) argue that the successful ageing paradigm implies that ‘society does not have to provide support for those who fail at aging’. Rubinstein and de Medeiros (2014) point out the paradox inherent in the intent to dispel the image of older people as dependent, and the neglect of ‘those older adults truly in need’. The successful ageing paradigm implies that ageing successfully is possible for only those individuals who bring with them sufficient resources, and exert sufficient agency, to reach the criteria of successful ageing. They deem the Rowe and Kahn (1998) book ‘essentially a self-help book,

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unsupported by any explicit theory about human behaviour but with an implicit theory about the action of individuals’ (Rubinstein and de Medeiros, 2014). The lifecourse is barely perceptible: it is assumed that neither ‘baggage’ nor resources are brought by individuals into their old age but, rather, that they can choose from the present moment onwards to age well. This approach is to blame for the paucity of literature on ‘“unsuccessful agers”, those denizens of a Third-Age underclass or the Fourth Age’ (Rubinstein and de Medeiros, 2014, p 36). The successful ageing construct of Rowe and Kahn is not conducive to ‘the improvement of life quality for older adults’ because it does not take into account ‘the problems, losses and negative events that many older adults experience’ (p 40).

Problems with successful ageing 4: it’s a commodity for sale As the successful ageing paradigm suggests that ageing successfully is more dependent on behaviour, attitude and environment than hereditary traits, researchers and clinicians are developing strategies to enhance ageing well. Current strategies include restricting intake of calories, exercising, cognitive stimulation, cultivating social networks, quitting smoking and substance use, obtaining appropriate healthcare and eating healthily; in these areas, products that are aimed specifically at older adults are ubiquitous and readily identifiable in advertising in all rich, aged societies. We are told that seeking help for both physical and mental illnesses is critical, as these conditions interfere with nearly all determinants of successful ageing. Additionally, it is considered important to develop cognitive and psychological strategies such as positive attitude, resilience and reducing stress. Cognitive and emotional adaptation to chronic illnesses that often impact on older adults is also an important aspect. Cognitive training programmes are widely marketed as methods of enhancing one’s ‘cognitive reserve’ and targeted mostly to older adults. Social strategies, such as seeking and giving social support through volunteering, working in a group, learning a new skill or mentoring younger individuals, are also advocated as ‘tools’ to promote successful ageing.

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Although many dietary supplements are on the market and advertised as having anti-aging effects, there is a general lack of evidence regarding their impact on ageing, and some researchers even point to several possible health risks. There are multi-billion-dollar industries dedicated to developing and selling cosmetics and cosmetic surgery, ‘non-invasive’ anti-wrinkle treatments and ‘rejuvenating’ products. In the realm of sexuality, too, performance-restoring and enhancing products such as Viagra and Cialis are aimed at older people (mostly men). Collectively, these strategies, remedies and devices amount to ‘the anti-ageing’ industry. This industry is constantly expanding and diversifying into new areas. Among the spheres of life where older adults are increasingly expected and exhorted to make an effort is the maintenance of cognitive function – to give just one example of this trend, see the Hello Brain website and app (www.hellobrain.eu/en/), an excellent illustration of what Williams, Higgs and Katz (2012) call ‘neuroculture’. According to a half-page review, Hello Brain ‘is a European health awareness webbased campaign … funded by the European Commission that provides easy-to-understand information and short films about the brain and brain health. It addresses a general audience with the intention to support people who wish to learn about brain health, mainly through promotion of healthy habits and healthy lifestyle. The initiative is available as a free App for smartphones (iPhone and Android), a web version for PC, and a hardcopy version … the app comprises short recommendations of mainly pleasant things to do during the day (strolling, reading, chatting, playing cards, etc), to establish good habits for brain health’ (Pardal Bermejo, 2015). This description of the app is flagged on the Hello Brain website as an ‘endorsement by one of the world’s oldest and best known general medical journals’: an example of how ‘innovations’ that older people ‘should’ adopt get perpetuated and sold as ‘beneficial’ in the absence of any scientific measurement of their impact at general population level. Gerontologists tend to view anti-ageing practitioners as mercenaries focused on increasing their profits and market share. However, Flatt and colleagues (2013, p 951) argue that the ‘scientific’ language of

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successful ageing has been appropriated by anti-aging practitioners, a development that reveals how the successful ageing paradigm has spread to other domains: ‘The prominence of common components of the Successful aging model in the goals of anti-aging practitioners would seem to signal the widespread infusion of mainstream models of Successful aging into contemporary medicine and culture.’ Flatt et al argue that the tension between gerontologists and anti-ageing practitioners is largely rhetorical because the goals of anti-ageing medicine (preventing and curing disease, encouraging maintenance of functioning into old age) are essentially shared by gerontologists. Gerontologists’ dislike of the terms ‘old person’, ‘old people’, and ‘old age’, Flatt and colleagues argue, is indicative of a different kind of ageism, ‘in which old age is viewed as something that can be transcended, resulting in a stance that amounts to an only slightly different version of “anti-aging”’ (p 952). Academic models of successful ageing have therefore unintentionally promoted the consumption of anti-ageing products to respond to (and generate) consumer demand that has arisen around successful ageing: ‘markets that are founded on the belief that it is possible, acceptable, and even necessary to intervene into the aging process in order to optimize aging experiences’. In similar vein, Dillaway and Byrnes (2009) argue that the successful ageing paradigm emerged from political and business networks imbued in neoliberalism and was tailored to suit medical business interests. Business interests are not the only actors who sell successful ageing; it serves as an intellectual commodity, too. Pruchno (2015, p 3) concludes her editorial comment on a special issue of The Gerontologist by advocating the adherence to and future development of the successful ageing construct: The popular press has become fascinated with the topic of successful aging, and tips for achieving successful aging are abundant in magazines and on the Internet. It would be irresponsible for gerontologists to abandon the concept of successful aging. Nearly three decades after Rowe and Kahn’s

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initial article was published, it is incumbent on gerontologists to use the conceptual and empirical knowledge base that now exists to develop consensus about what successful aging is and how it should be measured. We should approach this goal knowing that our measures will not be perfect, but at least our findings will be comparable. Advancing this work will help us learn how individuals can experience successful aging regardless of their social or health conditions. It is hard to understand why the attachment of the popular press to successful ageing means that researchers must continue to cultivate it (the popular press is awash with notions that scholars do not take seriously). However, it is easy to see how successful ageing has currency in both popular and scholarly spheres. Despite such currency, comparability of measures, let alone consensus over successful ageing concepts, is hardly on the cards, in the light of the profusion of objectivist and subjectivist definitions and understandings outlined in this chapter. The notion that everyone, regardless of social and health conditions, can experience successful ageing is deeply unfair towards populations that struggle to live as long as the majority and are faced with other entrenched inequalities in health, well-being and social outcomes that cannot be glibly subsumed into the notion of successful ageing. In the same special issue of The Gerontologist on successful ageing, a diametrically opposed view is put forward by Martinson and Berridge (2015, p 66), who argue that taking successful ageing critique seriously involves shifting our attention from productivity, independence, avoidance of disability, and individual responsibility, and instead placing value, for example, on unproductiveness, interdependency, disability, and social responsibility. Further, they posit that

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identifying ideal models of individual aging is not only impossible but it is also destructive. Such ideals serve to devalue the vast diversity that inevitably sits outside of their constructed parameters. It is time to move away from successful aging and the broader paradigm of ideal models in which it exists, and focus our work on creating the conditions in which people can thrive, on their own terms, as they age. (p 66) The appetite for successful ageing does not appear to be waning; on the contrary it is being fed by new products and vehicles, including special issues of several prominent gerontological journals. In the foreword and invitation to contribute articles to the most recent (forthcoming in 2017) special issue on successful ageing in the Journals of Gerontology (Psychological Sciences and Social Sciences), Rowe and Kahn, the originators of the concept, encourage scholars to keep fleshing out the concept through greater attention, among other things, to the relationship between the life course as a whole, and successful ageing. They lament that Currently, our youth is spent in education, our mid-life too often dedicated completely to work, and our later life to ‘leisure’, which too often is a roleless role, lacking in meaningful engagement. (Rowe and Kahn, 2015, p 595) It is immediately obvious for anyone who occupies a position other than that of a Westerner who in his youth had access to (higher) education, had the benefit of a stable, full-time employment and could rely on the assistance of a spouse (at least to the extent that such employment was possible in parallel with family life), that the above depiction is not a widely shared (let alone a future) scenario but, rather, a social position that is deeply rooted in a particular type of social-structural circumstances that is accessible to a privileged minority among future older cohorts. (To draw an even more pointed contrast: ask an unemployed Black man in the US or a Mediterranean woman who is a part-time worker and struggles with childcare how

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‘current’ the above scenario seems to them.) The opportunity to age successfully in the light of objectivist criteria is a minority privilege, and increasingly convoluted definitions of what exactly this privilege entails are not going to bring us closer to addressing the issues that do require our urgent attention (for instance, combating pensioner poverty; decreasing differences in mortality between socioeconomic groups). Parallel to this call for further elaboration of the concept, Rowe and Kahn engage in less-rigorous sketching-out of the idealised picture of old age that appears to keep the door open to everybody: Older people have much to offer, including their accrued knowledge, stability, their heightened capacity for problem solving, their increased ability to manage conflicts, and their ability to take the perspectives of other age groups into account. (Rowe and Kahn, 2015, p 595) Here, we are again seeing the ‘democratisation’ of successful ageing that even the originators of the concept are drawn to, lest the ideal-typical successfully ageing person appear overly elitist. However, while perhaps everyone who has become ‘old’ has some claim to ‘accrued knowledge’ and perhaps even some understanding of the perspectives of different age groups, not everyone can claim stability, enhanced problem-solving and conflict-management skills: once again, successful ageing leads us to the elite preserve of strong, stable, capable people – the ones that we don’t really need to worry about when developing policy. The unfortunate ramification of this is that policy is increasingly shaped by this focus on the ‘successful agers’ – to the extent that everyone is increasingly expected to adhere to the model of ageing successfully that is propagated through policies targeted at ageing populations; the next chapter explains why and how.

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Conclusion Rowe and Kahn’s (1987, 1997) model of successful ageing became popular because it presented a re-orientation away from loss and pathology and towards growth, adjustment and adherence to patterns adopted in mid-life. It is frequently argued that the main merit of the successful ageing paradigm is that it challenges the ‘deficit’ model of ageing. However, the outcome of this challenge has been either to deny all deficits by declaring that all older adults are (in their own way) ageing successfully, or to create new divisions through increasingly elaborate, diverse and pained definitions of who exactly is deemed to be ageing successfully. As a result, on the one hand, successful ageing now belongs to everybody who wants to claim it: ‘I think I am ageing pretty successfully, ergo I am ageing successfully’. On the other hand, successful ageing – as a result of the efforts of those who are in the academic business of slicing it thinner and thinner – is becoming a marker of high, exceptional achievement, even an elite preserve of those who are luckiest in their genes and most persevering in their efforts to stay youthful (or, ideally, both). In short, successful ageing has become a deeply confused, self-contradictory, schizophrenic concept. Despite its evident limitations, many gerontologists are reluctant to criticise or abandon the concept: this is not surprising, and indicates that they have become stakeholders in the new ageing enterprise of modelling ageing. The next chapter discusses the cognate concept of active ageing and examines both overlaps and tensions between the successful and active ageing constructs.

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THREE

CRITIQUE OF ACTIVE AGEING MODELS The previous chapter outlined the argument that the successful ageing paradigm seamlessly ‘translated’ or ‘migrated’ into the anti-ageing industry (Flatt et al, 2013). In this chapter, I argue that successful ageing ideas have also made their mark on policy, feeding into the notion of active ageing. Active ageing is ‘primarily a policy concept’ (Juul Lassen and Moreira, 2014, p 33). Gerontologists have contributed to the translation of successful ageing ideation into the policy sphere, where the ideas take on a more practice-oriented form; this is a manifestation of what I call modelling ageing. The meaning of active ageing remains somewhat vague, largely because the actors who employ the concept use it ‘as a convenient term for a wide range of policy discourses and responses concerning demographic change’ (Walker and Foster, 2013, p 28). Despite this blanket application, Foster and Walker (2015) argue that active ageing has emerged in Europe as ‘the foremost policy response to the challenges of population aging’ and that it ‘presents a more holistic, lifecourse-oriented approach than successful aging’ (p 83). Immediately following this statement, however, Foster and Walker qualify that the active ageing perspective ‘has been dominated by a narrow economic or productivist perspective that prioritizes the extension of working life’ and ‘has also been gender blind’ (p 83). Foster and Walker argue that the active ageing paradigm is split into two contrasting branches,

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one focused on productivity and employment, the other more ‘social’ and all-encompassing; a ‘comprehensive, non-coercive and inclusive approach’ in keeping with the latter type of active ageing is endorsed by Foster and Walker (2015, p 84). Their view of the concept is deeply bifurcated into ‘the good’ meaning of active ageing (understood as attempts to help everyone to age well, in accordance with their resources and with the help of supportive policies) and the ‘bad’ meaning of active ageing (understood as agendas for driving productivity and growth without regard to structural barriers that many older adults face). The parallels to the confusion over the meaning of the concept, and the objectivist and subjectivist understandings of successful ageing (outlined in Chapter Two) are striking. In the gerontological literature, successful ageing is lauded for its ‘optimistic’ emphasis on scope for change and individual determination in bringing about better outcomes in old age. Active ageing is similarly imbued with notions of mutability and progress. Active ageing has been characterised as ‘a policy tool that dominates the way the ageing society has been constituted during the last decade’ – it seeks to unmake old age by focusing on the malleability of the ageing process, and amounts to a ‘new ideal of the “good late life”’ (Juul Lassen and Moreira, 2014, p 33). In similar vein, Stenner, McFarquhar and Bowling (2011) argue that active ageing is ‘designed to change our views, perspectives, understandings, stereotypes and prejudices about ageing in order to reconstruct the practical societal reality of the ageing process in an “ageing society”’ (p 468). In other words, the social construct of active ageing is ‘put to work’ to achieve the aims of the actors who cultivate the term.

How active ageing is socially constructed in the policy sphere Explicit orientation to active ageing is relatively recent in most polities. However, policy scripts and rhetoric that call for active ageing are generated and feature prominently across all welfare state contexts with aged populations. In order to examine active ageing ideation in a set of rich countries that share well-articulated policy scripts and evince

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diversity, I have decided to draw on examples from international and supranational policy-making organisations: the United Nations (UN), the World Health Organisation (WHO) and the European Union (EU). I will begin by reviewing the active ageing pronouncements that have emanated from the UN and the WHO, as these were the first international organisations to spell out and proclaim the principles of active ageing. The policy overview that follows could give the (wrong) impression that active ageing ideation is confined to and arises from policy documents. It is important to note at the outset that this is not the case. Readers who are interested in getting a good illustration of the diverse ways and locations where active ageing messages crop up might like to look up, for instance, the European Innovation Partnership (EIP) on Active and Healthy Ageing (these types of initiatives are constantly being developed, implemented and then wound down – a quick internet search will indicate the current active ageing projects). The EIP, in the words of the European Commissioner for Research, innovation and Science ‘seeks to translate innovative ideas into tangible products and services that really respond to the needs of older Europeans and thus boost the EU’s competitiveness, growth and potential for job creation through generating new opportunities for our businesses’ (quoted in European Commission, 2014, p 5). The video clip that is used to invite people to the ‘marketplace’ for ‘innovative ideas’ for active ageing (https://www.youtube. com/watch?v=R0ip9ZLRdZU) depicts at first a young man, who intermittently turns into his older self (‘Antoine, age 72’). The clip illustrates some ways in which technology and good urban design are helpful for people of all ages, suggesting that there is little or no difference in what design and IT features people of different ages need and benefit from: the ‘old Antoine’ handles the tablet computer with a connection to a healthcare professional just as deftly as his younger self does. The depiction amounts to an obliteration of age-related disability and illness. The various ‘challenges’ that might arise with old age are simply morphed into handy solutions in a way that appears to generate cost-free, easy, win-win scenarios for both the young and

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the old. This is just one example of the multitude of projects and initiatives at national and international levels that in various ways extol the benefits of active ageing; what now follows is a short outline of some of the policy documentation that has been generated over time to underpin and justify such initiatives.

Active ageing according to the United Nations and the World Health Organisation The first example of international organisations’ engagement with population ageing as a major policy issue is usually dated to the first UN World Assembly on Ageing in 1982, and the resultant Vienna International Plan of Action on Ageing, which included 62 recommendations for action in areas spanning research, health, housing, protection of consumers, social welfare, income security and education. It is clear that, from the start, ageing has been an expansive policy area. In 1991, the UN General Assembly adopted the UN Principles for Older Persons, comprising independence, participation, care, self-fulfilment and dignity. The cover page of the WHO (1996) ‘Heidelberg Guidelines’ for promoting physical activity among older people specifies the ‘TARGET’(sic) as ‘Older Persons’. The aim of the guidelines is to facilitate ‘the development of strategies and policies in both population and community-based interventions aimed at maintaining and/or increasing the level of physical activity for all older adults’. With slogans such as ‘appropriate physical activity can be fun and is good for you!’, the aim of this document is to encourage more older adults to move from ‘the physically unfit frail’ (otherwise labelled as ‘unhealthy dependent’) to ‘the physically unfit’ (or ‘unhealthy independent’) category, and on to the ‘physically fit’ (healthy) group (the ‘Health Fitness Gradient’ in WHO, 1996). In 1999, the UN’s ‘International Year of Older Persons’, the WHO officially established active ageing as one of its key policy foci by launching a publication entitled Ageing – Exploding the Myths (WHO, 1999). Throughout the publication, the tension between the

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expectations regarding the ageing individual and the influence of the surrounding social context is evident. In the foreword, Gro Harlem Bundtland, then Secretary General of the WHO, declares that ‘[t]here is much the individual can do to remain active and healthy in later life’, but also acknowledges that ‘[p]olicies that reduce social inequalities and poverty are essential to complement individual efforts towards Active Ageing’. The document contains allusions to the traditional way of depicting the ‘arc’ of the human life span from infancy to an apex in early mid-life to inevitable decline in old age: ‘The capacity of our biological systems (e.g. muscular strength, cardiac capacity) increases during the first years of life, reaches its peak in early adulthood and declines thereafter.’ On the other hand, it states that the rate of this decline ‘is largely determined by external factors’. Interestingly, when listing these ‘external factors’ the WHO mixes behaviours that are, in principle, within individual control, and social locations that are less amenable to such control: ‘smoking, alcohol consumption, diet, and social class’ (WHO, 1999, p 14; my emphasis). Ageing – Exploding the Myths therefore reflects considerable tension between expectations regarding the ageing individual and the surrounding social context – tension that continues to plague notions of active ageing. In specifying ‘Action towards Active Age’ (WHO, 1999, p 21), the document carefully spells out ‘Individual action’ next to ‘Policy action’ with regard to each of the ten ‘Factors’ that contribute towards active ageing (foetal environment; childhood environment; smoking; alcohol; physical activity; diet; adult diseases; social integration; gender; income security). However, in many cases the ‘actions’ within the ‘policy’ sphere are very limited; for instance, under ‘alcohol’, the sole policy recommendation is to ‘ban sale of alcohol to children’. Overall, similar to successful ageing notions, the emphasis remains on individual action and decisions to achieve active ageing. The WHO’s 2002 Active Ageing Policy Framework is exemplary in its scope and interrogation of ageing as a policy issue. ‘Active ageing’, the document argues, holds the key to success: ‘countries can afford to get old if governments, international organizations and civil society

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enact “active ageing” policies and programmes that enhance the health, participation and security of older citizens’ (WHO, 2002, p 6). It goes on to argue that active ageing policies should be based on the ‘rights, needs, preferences and capacities of older people’ (p 6). The definition of active ageing is all-encompassing, covering both productivity and dependency: Active ageing … allows people to realize their potential for physical, social, and mental wellbeing throughout the life course and to participate in society according to their needs, desires and capacities, while providing them with adequate protection, security and care when they require assistance. (WHO, 2002, p 12) The life-course perspective is emphasised throughout: good old age is the result of a good childhood and youth. Preventative approaches, health promotion and equitable access to primary healthcare are strongly recommended. However, following these remarks, the report hones in on demographics, citing the vast numbers of older people that will be alive within a couple of decades, the shift from population pyramids to ‘a cylinder-like structure’, and old-age dependency ratios. The emphasis therefore shifts to ‘breaking’ the second (downward) half of the ‘arc’ of the human life span and lifting it up towards the ‘healthy mid-life’ point through maintaining independence and preventing disability, and recourse to rehabilitation where necessary (WHO, 2002, p 14). By reducing the range of functional ability in older individuals, through ‘pushing’ more people towards the competent, functional end of the spectrum, more older adults, it is hoped, will stay above the dreaded ‘disability threshold’. Throughout WHO (2002), a sound understanding of the social determinants of health and cumulative (dis)advantage is evident from statements such as ‘socio-economic status and health are intimately related’; ‘old age often exacerbates other pre-existing inequalities’; and ‘older people with low incomes are one-third as likely to have high levels of functioning as those with high incomes’. In developing active

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ageing policies, the WHO (2002, p 17) also recognises the need to balance individual responsibility and structural supports: Active ageing policies and programmes recognize the need to encourage and balance personal responsibility (self-care), age-friendly environments and intergenerational solidarity. Individuals and families need to plan and prepare for older age, and make personal efforts to adopt positive personal health practices at all stages of life. At the same time supportive environments are required to ‘make the healthy choices the easy choices’. Over time, the WHO portrayal of the conditions necessary for active ageing has become more balanced towards structural determinants and preconditions. The diagram on active ageing in WHO (2002, p 19) lists four factors that are structural (economic determinants, social determinants, health and social services, physical environment) and only two that are more actor centred (personal determinants and behavioural determinants). Two overarching factors, culture and gender, further emphasise the structuralist approach evident in more recent WHO documents, and in the approach of the organisation as a whole. Finally, the three pillars of a policy framework for active ageing are specified as ‘Participation’, ‘Health’ and ‘Security’ (WHO, 2002, p 45). Indeed, the 2015 WHO World Report on ageing and health is a model of awareness of structural factors in shaping outcomes in old age. However, this awareness stands in marked contrast to the more individual-centred approaches adopted by organisations and governments that have spending power – and hence the ability (and perceived need) to control spending on their ageing populations. As it is not practicable to review the policies of individual countries here, I will now turn to examining active ageing policies at the European level; these are a good illustration of the general policy direction in rich, aged welfare states.

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How the European Union construes active ageing The notion of active ageing was first floated in the EU (then called the European Community, EC) in the early 1990s, when the EC established an ‘observatory’ to focus on ageing. The first European year of older people was marked in 1993. In 1999 a document entitled ‘Towards a Europe of all ages’ highlighted the decline in the workers-per-pensioner ratio, rising pension expenditure, growth in care needs and diversity of risks and resources among older adults. Given this focus, it is unsurprising that the central aim at the EU level has become the extension of working lives; closure of or limits on early-exit schemes, increase in retirement age and closer connection between contributions and pensions are portrayed as the key policy tools to overcome the ‘ageing challenge’ in Europe. However, the tenyear headline target (set in Lisbon in 2000) of increasing labour-market participation among 55- to 64-year-olds to 50% was not reached by any EU country. In 2011 the European Commission declared that We need to enable older people to make their contribution to society, to rely more on themselves and to depend less on others and for this we need to create conditions that allow people to stay active as they grow older. Active ageing promises to be such an approach because it seeks to help older people to: remain longer in the labour market; contribute to society as volunteers and carers; remain as autonomous as possible for longer. (European Commission, 2011, p 14; my emphasis) In one of many articulations of this ‘holy trinity’ of active ageing, the European Council in 2010 defined it as: creating opportunities for staying in the labour market longer, for contributing to society through unpaid work in the community as volunteers or passing on their skills to younger people, and in their extended families, and for living autonomously and

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in dignity for as much and for as long as possible. (European Council, 2010, p 5) The productive potential of the older population remains firmly in focus in the recent outlines of the implications of population ageing in Europe (European Commission, 2014). To the forefront are concerns about the shrinking labour force and resultant threat to economic growth. The agenda for new skills and jobs, the flagship initiative of Europe 2020, is cited as the overarching ambition of ensuring that three out of four 20- to 64-year-old Europeans are working; which in turn is seen as the main method of rescuing European economies in the face of population ageing. With regard to long-term care, ‘one of the most important issues is how to restore sound public finance and assure the sustainability of social protection schemes without excessively burdening younger generations in the future’ (European Commission, 2014, p 8). The ‘older adults as burden’ discourse therefore remains firmly embedded in and motivates many of the policy prescriptions arising from the EU. The European Year of Active Ageing and Solidarity between Generations in 2012 gave rise to high-profile articulations of active ageing (Council of the European Union, 2012a and 2012b). The 2012 Council pronouncements on active ageing arise from a long list of policy documents, declarations and reports produced over the previous decade (Council of the European Union, 2012b, p C 396/8). Perhaps most foundationally, Article 3 of the Treaty on European Union (Lisbon Treaty) attests the EU’s commitment to promoting social justice and protection, equality between women and men – and solidarity between generations. Council of the European Union (2012a, p 3) notes that Solidarity between generations in an ageing society notably requires creating conditions which permit older people to achieve more independence that will allow them to take better charge of their own lives and to contribute to society, enabling them to live in dignity as full members of society … Action

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is needed to enable both women and men to remain active as workers, consumers, carers, volunteers, and citizens and to preserve the solidarity between generations. The European Council’s Guiding Principles on Active Ageing and Solidarity between Generations (Council of the European Union, 2012a) centre on three foci, namely Employment, Participation in Society and Independent Living. I will now discuss each of these ‘pillars’ in more detail, in order to demonstrate some of the important implications and ramifications of active ageing ideation.

Active ageing modelling of ‘independent living’ In the broad area of physical functioning, active ageing prescriptions tend to take as their starting point the acknowledgement of physical frailty, its growing prevalence and the need to control/combat this through policy. For instance, the European Commission (2013) declares that ‘the ageing of the population will lead to a significant increase in the number of frail older people with functional limitations and disabilities’ (p 7). Active ageing in principle incorporates strategies and behaviours that delay the onset of diseases and disabilities, but because the focus of welfare state measures tends to be curative (rather than preventative), the bulk of active ageing rhetoric in the area of health and functioning pertains to older adults who have become ‘problematic’ because they have developed needs that incur costs. In the Guiding Principles for Active Ageing and Solidarity between Generations (Council of the European Union, 2012a), the following are singled out as central elements of ‘independent living’ and associated policy actions: • Health promotion and disease prevention: take measures to maximise healthy life years for women and men and reduce the risk of dependency through the implementation of health promotion and disease prevention.

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• Adapted housing and services: allow older people with health impairments to live with the highest possible degree of autonomy. • Accessible and affordable transport: adapt transport systems to make them accessible, affordable, safe and secure for older people, allowing them to stay autonomous and participate actively in society. • Age-friendly environments and goods and services: adapt local environments as well as goods and services so that they are suitable for people of all ages (design-for-all approach), in particular by making use of new technologies, including eHealth. • Maximising autonomy in long-term care: for people in need of help/care, ensure that their autonomy and participation are augmented, preserved or restored to the greatest possible extent. All of these measures are intended to maximise self-care and autonomy, and to push the ‘heavy lifting’ of care from the public/policy sphere towards the private sphere. These measures do not engage with disease and disability; rather, they seem to be based on the hope that disease and disability will not arise, or not arise to the same extent as feared/predicted, and not become major drains on the public purse. The emphasis is on the older adults as independent actors who are consumers accessing goods and services; and the role of policy is confined to preventing age discrimination in the process of accessing goods and services. Even in the final sphere of ‘maximising autonomy in long-term care’ the thinking clearly pertains to older adults as active, participating actors who are making choices. ‘New technologies’ feature prominently as the ‘great white hope’ of dealing with health and social care needs. Policy, it seems, is simply not engaging with the Fourth Age (that is, those with extensive care needs). Where dependency begins, policy ends. The active ageing approach enables policy makers to refocus attention away from ‘problematic’ and costly older adults in the Fourth Age and towards the ‘lighter’, longer-term task of improving population health by limiting the focus to ‘younger old’ population groups. Council of the European Union (2012b) promulgates the lifecourse approach to healthy ageing, but frames this as something that

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is limited to health promotion and disease prevention: ‘healthy ageing is closely related to the implementation of effective health promotion and disease prevention programmes, starting from the early years of life and continuing throughout the life cycle’ (p C 396/9). There is no room, it appears, for actual, heavy-duty, hands-on care that would meet bodily and household care needs. Where the reality of long-term care needs is confronted, care is framed as a ‘circle’ that must be ‘squared’. The European Commission (2013) argues that the inexorable growth in the ‘oldest-old’ (people aged 80 and over) and the decline in the care capacity of families have opened up a ‘care gap’ that can realistically be closed only through improvements in care labour productivity and controls on the sum total of care that is needed from sources that carry a cost, whether indirect (as in the case of family care) or direct (formal care). The scenario that is painted is bleak and threatening: Over the next five decades, the shrinking of the population of working age will tend to limit economic growth and make it more difficult to recruit formal carers. Changes in living and family arrangements, a rise in female labour force participation rates and higher retirement ages will reduce the reservoir of informal carers. At the same time, the threefold increase in the number of those in the age groups most likely to need long-term care is likely to lead to very substantial growth in demand for such care. In short, the challenge is to find ways to contain the growth in demand for long-term care while improving the capacity to provide more, better care with fewer human resources and less funding. (European Commission, 2013, p 16; my emphasis) Here, the orientation to greater independence in old age, even among older adults with care needs, begins to emerge as the putative solution to the problem. The social investment approach to long-term care promises a new direction where preventing, postponing or mitigating care needs becomes more and more important vis-à-vis traditional ‘passive’ care provision. (The social investment approach has evolved as

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an alternative to both Keynesian and neoliberal approaches to boosting productivity and well-being (Morel et al, 2012). Later life was at first largely ignored within this approach as it was considered a period of dependency and/or unproductivity, and hence not worth ‘investing’ in.) Reduced disability and improved capacity on the part of older adults, and higher productivity on the part of care service providers, are expected to help in squaring the circle of growing numbers of older adults with the diminishing capacity of the younger population to finance/provide care. In practical terms, the document states that this amounts to enabling elderly people to manage without care, or with far less care than today, despite functional limitations. (European Commission, 2013, p 16; my emphasis) Alongside an acknowledgement that long-term care policies in Europe vary considerably, the Council argues optimistically that ‘Europe could potentially add significant value by pooling the cost of research and development and by facilitating knowledge transfer and mutual learning on better ways of mitigating dependency and delivering LTC [long-term care] services’ (European Commission, 2013, p 4). The tone of the European Commission’s working document on long-term care as social investment shifts from the empiricist to social constructionism with the statement that ‘the extent to which physical and mental impairment means people becoming dependent is influenced by a person’s perception of their ability to manage despite functional limitations’. Consequently, ‘it matters a lot whether people are encouraged and enabled to cope’ (European Commission, 2013, p 7). This suggestion (that care needs will reduce or disappear if older adults with care needs think differently about them) is not just optimistic: it borders on the absurd. Under the heading ‘assistive aids and modern ICT’, the examples that are offered are ‘automated toilets, walking and lifting aids, power utensils, monitoring and communication tools’, that is, devices that have been available for a long time. Somewhat comically, the only

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specific device that is singled out has been in wide use in developed countries since the 1980s: ‘the widespread use of micro-wave ovens has been a great help to frail older people, enabling them to prepare their own hot meals’ (European Commission, 2013, p 8). There is a perfunctory mention of ‘technological devices … becoming available at affordable prices’ and how ‘public procurement policies can support such developments’, but no reference to any evidence that this is happening. Again, the importance of prevention is stressed, especially through physical and mental activity and fitness that build a reserve that is useful for both decreasing the likelihood of adverse health events and speeding up recovery: Active and healthy ageing and a determined emphasis on prevention and rehabilitation can reduce the incidence of frailty, postpone its onset and reverse or mitigate the course of frailty, functional limitations and disability. People who are fit when they become old and seek to remain physically and mentally active not only have a better chance of avoiding or postponing frailties, they are often also better at managing functional decline when it occurs. (European Commission, 2013, p 16; emphasis in the original) Alongside ‘general prevention and health promotion schemes for all ages’, policy makers are encouraged to develop ‘special awareness programmes for people in their 50s to very old people hampered by functional limitations’ (European Commission, 2013, p 17). Public health policy should strive to prevent ‘premature erosion of physical and mental fitness’, ‘mal-medication’, ‘accidents such as falls’, promote ‘early detection of emerging limitations and frailties’ and encourage ‘senior citizens to participate in physically and mentally stimulating activities in various settings, such as universities, language schools, sport centres, volunteering organisations and day care centres’ (European Commission, 2013, p 17). The document cites Rohwedder and Willis (2010) to back up the assertion that these ‘stimulating activities’ can ‘halt the course of decline and help maintain and sharpen faculties’

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(European Commission, 2013, p 17). However, on reading Rohwedder and Willis (2010), it becomes clear that their article marshals no such arguments, but is rather sceptical about the ‘mental exercise’ hypothesis, citing a review of the literature on this topic which states that the mental-exercise hypothesis is ‘more an optimistic hope than an empirical reality’. The following optimistic scenario is offered by the European Commission: Physical and mental restrictions in older people need not be perceived as ill health and a threat to their ability to lead independent lives as long as sufficient resources are available to compensate for the deficits. It will be crucial to make the necessary social investments in age-friendly adaptations of older people’s private homes and in new assistive devices, including those that allow for self-monitoring, self-care and self-management. This is about empowering and enabling older people with functional limitations to manage a higher degree of self-sufficiency. ICT can facilitate social interaction with family and friends and allow for emotional support, even when people are largely bound to their homes and relatives do not live nearby. Public procurement can be used to secure assistive devices at affordable prices. (European Commission, 2013, p 17; emphasis in the original) As a corollary of such ‘empowerment’ and ‘enablement’, the document advocates reduction of formal long-term care service provision and greater reliance on individual and family resources: Public policies can also encourage older people and their relatives to pay out-of-pocket for assistive devices to help older people look after themselves day-to-day. The aim would be to enable and empower older people with functional limitations to get by with much less long-term care than today, so that they can retain autonomy with choice and dignity despite the physical and mental effects of ageing. (European Commission, 2013, p 17; my emphasis)

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To justify such chilling policy recommendations, European policy documents tend to use a simple mathematical formula to emphasise the urgency of ageing-related challenges. In the area of care services, the repeated, alarmist formula is the ‘tripling’ in the number of people at-risk-of-needing-care (‘the oldest old’). In the area of pensions, the formulaic refrain is the ‘halving’ of the working-age population in relation to the retired population. This, in turn, is argued to necessitate a dramatic increase in the labour market contributions of older adults and tighter control over pensions expenditure, a policy area that I turn to next.

Active ageing modelling of ‘economic contributions’ The 2012 EU White Paper proposed a two-pronged approach to this challenge, firstly ‘encouraging people to stay in work longer and save more for their retirement’, and secondly, ‘enhancing the safety and cost-effectiveness of such savings’ (European Commission, 2012, no page numbers). Pensions are described as an important EU policy matter because of their centrality to the ‘economic and social success’ of the Union. The issues of adequacy and security do not feature among the justifications for EU action in the area of pensions in the ‘Citizens’ summary’ document (European Commission, 2012, no page numbers). In relation to the question ‘what exactly will change’, the document professes that the EU will support ‘national pension and retirement reforms that encourage and enable people to earn adequate, sustainable and safe pension entitlements by working longer and increasing their complementary retirement savings in a cost-effective manner’. In relation to employment, the European Council’s Guiding Principles (Council of the European Union, 2012a) advocate: • Continuing vocational education and training: Offer women and men of all ages access to, and participation in, education, training and skills development allowing them (re-)entry into and to fully participate in the labour market in quality jobs.

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• Healthy working conditions: Promote working conditions and work environments that maintain workers’ health and well-being, thereby ensuring workers’ life-long employability. • Age management strategies: Adapt careers and working conditions to the changing needs of workers as they age, thereby avoiding early retirement. • Employment services for older workers: Provide counselling, placement, reintegration support to older workers who wish to remain on the labour market. • Prevent age discrimination: Ensure equal rights for older workers in the labour market, refraining from using age as a decisive criterion for assessing whether a worker is fit for a certain job or not; prevent negative age-related stereotypes and discriminatory attitudes towards older workers at the work place; highlight the contribution older workers make. • Employment-friendly tax/benefit systems: Review tax and benefit systems to ensure that work pays for older workers, while ensuring an adequate level of benefits. • Transfer of experience: Capitalise on older workers’ knowledge and skills through mentoring and age-diverse teams. • Reconciliation of work and care: Adapt working conditions and offer leave arrangements suitable for women and men, allowing them as informal carers to remain in employment or return to the labour market. It is assumed, correctly, that older workers are most attracted to remaining in work if they are working in healthy and safe environments, have sufficient monetary incentives to work, receive services such as counselling, are viewed as valuable colleagues and can take time off to care. Indeed, these policies appear to cover all bases in that they tap into a range of considerations that cause early exit from work. However, there is no sense of inequalities in the capacity to continue working: all workers are assumed to have similar capacity and to respond in similar ways to the suggested policies. An additional problem with active ageing notions in this context is that they have

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not been thought through in an integrative way, taking into account not just older populations but the younger populations and political debates. For instance, in a country with mass youth unemployment, most politicians and many older workers (rightly or wrongly) will not be favourably disposed towards the idea of lengthening their careers. Many European scripts pertaining to active ageing are pure rhetoric. To give just one example relating to longer working lives: a press release on 13 January 2012, on the launch of survey findings pertaining to older workers, quotes Lázló Andor, Commissioner for Employment, Social Affairs and Inclusion, who presented the survey saying: ‘Today’s Eurobarometer survey shows that people are ready to remain active as they grow older.’ Astonishingly, this statement is presented below the survey finding that one-third of the respondents would like to work beyond retirement age. The ‘business’ of policy generation is intertwined with the ‘business’ of knowledge creation in ways that are hoped by the advocates of the policy reforms to be mutually reinforcing.

Active ageing modelling of ‘societal contributions’ Looking at the third pillar of active ageing, the first observation is the relative ‘thinness’ of EU-level documentation pertaining to this area vis-à-vis independent living and productive ageing; it is clear that much less European-level policy recommendation and activity is generated in this sphere. This might be because the area is too diverse, and also very informal, as it comprises a variety of contributions ranging from organised volunteering to everyday domestic and personal care inputs by unpaid family and social network members. In many ways, this is the residual category where rhetoric pertaining to ‘the social’ aspects of older adults’ lives is generated, such as exhortations to • Social inclusion: Fight social exclusion and isolation of older people by offering them equal opportunities to participate in society through cultural, political and social activities.

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• Senior volunteering: Create a better environment for volunteer activities of older people and remove existing obstacles so that older people can contribute to society by making use of their competences, skills and experience. • Life-long learning: Provide older people with learning opportunities, notably in areas such as infor mation and communication technologies (ICT), self-care and personal finance, empowering them to participate actively in society and to take charge of their own life. • Participation in decision making: Keep older women and men involved in decision making, particularly in the areas that directly affect them. • Support for informal carers: Make professional support and training available to informal carers; ensure respite care and adequate social protection to prevent social exclusion of carers. This is the least cohesive of the three active ageing clusters, as it comprises volunteering, participation in decision making and informal care – areas of life that are tenuously connected. In fact, one gets the impression that this last category has received all the ‘left-over’ bits of ‘dated’ thinking on older adults constructed in their more dependent (pensions recipient) and traditional (caregiver, unpaid volunteer) roles. However, here, too, the emphasis is productivist: older people must be made to contribute to society through their skills and experience; they must ‘take charge of their own life’. The active ageing aspirations of the EU are justified on the grounds of demographic developments (shifting ratio of older to younger people) and the attendant consequences for social protection systems that are essentially based on solidarity between generations, which in turn is argued to necessitate a ‘balanced distribution of resources between age groups’ (Council of the European Union, 2012a, p 7). Socio-demographic development has a further dimension that is used to justify drawing on older persons’ resources to a greater degree than previously, namely hypothetical improvements in the health status of successive cohorts of older people (although evidence of this is patchy

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at best). Lastly, ‘Active ageing also allows for greater solidarity among older people themselves. As more older people take care of their own needs through active ageing, society can channel more support to those older people in greatest need’ (Council of the European Union, 2012a, p 8). In the light of these EU policy pronouncements, present-day ‘model older people’ are women and men who are committed to maintaining or restoring their independent living skills; who are in paid employment until retirement age, or preferably beyond; and who make unpaid inputs into the care of (older) relatives, but also of younger ones, especially grandchildren, and into their communities through volunteering. All three strands are of course inter-linked, because healthier older people can work longer and have a better chance of remaining socially productive, and because work and socially productive activities can have a protective effect on health. The three strands resonate with the Western notion of successful ageing, with its emphasis on independence and self-maintenance in old age (Rowe and Kahn, 1997; Lamb, 2014).

Attempts to measure and explain the extent of active ageing Arising from the European Year of Active Ageing (2012), the European Commission and the UN Economic Commission for Europe (UNECE) have sought to measure the extent of active ageing in Europe, with the help of a new instrument called the Active Ageing Index. This Index is motivated by the ‘paradigm of healthy and active ageing [that] makes the most of the potential of older people and makes them less dependent on family and state’ (UNECE and European Commission, 2015, p 4). The index is described as ‘a flexible tool to assess untapped potentials of older people’; it is argued to incorporate ‘most aspects of the lives of older people’ (UNECE and European Commission, 2015, pp 4, 5). The analysis of change over the period 2010–14 attributes the very small increase in the global index (for all 28 EU countries), for the most part, to an increase in grandparents’ looking after grandchildren. The authors of the report express surprise

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at this increase – ‘despite the financial and economic crisis and fiscal austerity measures during this period’ – but don’t allude to the (fairly obvious) connection between economic struggles among the younger generations and the turning to the resources of the older generation (in the form of, for instance, grandchild care). The increase in grandparental childcare is here viewed as an unmitigated ‘win’ for active ageing, an outcome that could have only positive consequences, as it reinforces active ageing. The possibility that intensive grandparenting might be highly unequally distributed, and might have negative impacts on those who contribute most (often despite health problems and against their own preferences) does not feature here. The Active Ageing Index report contains repeated exhortations to emulate the ‘successful’ countries, with the goal of ‘encouraging the search for better ways to develop [older people’s] full potential … to contribute towards improving the future sustainability of public welfare systems’ (UNECE and European Commission, 2015, p 9). On the positive side, the Index incorporates the ‘capacity and enabling environments’ for active ageing – and it is not surprising that the Nordic countries, with their more extensive and more egalitarian welfare states do well in the index. Hank (2011) has shown considerably higher levels of successful ageing in Northern European countries such as Denmark (21%) than in Southern (3.1% in Spain) or Eastern Europe (1.6% in Poland) – differences that are largely attributed to differential rates of inequality and variability in welfare state provisions. Public policies, through their impact on inequality, influence the propensity to ‘age successfully’ at a societal level. Of course, this also means that active ageing should be acknowledged as an uphill struggle, relatively speaking, for the ageing populations of many Eastern and Southern European populations. In a similar vein, it would be helpful if the developers of the Index were to highlight more prominently that the welfare state is not the only structural context that shapes the opportunities to ‘age actively’ – within societies, many barriers confront, for instance, older adults from ethnic minorities and lowincome groups.

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At the macro level, some welfare states offer insufficient or even perverse incentives for older individuals to modify their behaviours in accordance with active ageing policy aspirations. We have some understanding of how such macro-level incentivising varies between welfare states (for instance, Gruber and Wise (2004) on the impact of pension systems on retirement ages). In contrast, we have very little insight into how individuals view the kind of behaviours that policy makers consider desirable or undesirable – ‘there are virtually no studies investigating how individuals deal with demands of active ageing and what predicts engagement with or disengagement from these demands’ (Tomasik and Silbereisen 2014, p 8). In a German sample of 55- to 75-year-old men and women, Tomasik and Silbereisen (2014) found a ‘strong preference for engagement with [active ageing] demands and a low preference for disengagement’. A higher load of demands for active ageing was associated with greater engagement with active ageing; older adults were ‘responding’ to the demands, especially where they had ‘higher internal control beliefs’ concerning the demands of active ageing, that is believed that they could control them. In contrast, a perception of everyday surroundings as unfavourable increased disengagement with demands for active ageing. Tomasik and Silbereisen state that they ‘are tempted to conclude that the way older people negotiate the demands of active ageing is only marginally associated with their social standing in terms of age, gender, occupational and marital status, and the region where they live’. However, ‘occupational status’ in this study merely refers to ‘working’ or ‘not working’. This is an important omission in the light of what we know about the relationship between socioeconomic status and a wide range of characteristics and outcomes in older populations. Apart from the possible role of the pressures emanating from the surrounding environment and the (obvious) role of internal control beliefs, we have little insight into the factors that make some people more likely than others to ‘respond’ to active ageing expectations. Despite this, much of scholarship and policy making proceed on the basis of the assumption that we know all the relevant ‘factors’ that determine behaviours in old age. Generating a better understanding of

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why older adults make choices in accordance with or counter to policy aspirations is particularly important because many attempts to change social policies pertaining to older populations have failed or been reversed, due to resistance, protest and refusal to comply (Timonen, 2003), and because growing numbers of older voters can in some cases exert a powerful influence on what is politically feasible by, for instance, staging protests and withdrawing their vote from parties they disapprove of (Doyle and Timonen, 2013). If older voters find future policy proposals unpalatable, they are likely to protest in various ways (including through their voting behaviour), and may not respond to any new policies that they view as undesirable. Critique of active ageing has not been as intensive and widespread as critical views of successful ageing. However, many commentators are aware of the potential of active ageing to adversely affect population groups that are not able to live up to the expectations of active ageing scripts. In their vision for active ageing, Foster and Walker (2015) advocate that the concept of ‘activity’ should include ‘all meaningful pursuits that contribute to individual wellbeing’ (p 87). This leaves the door wide open to individual choices, many of which will run counter to public policy aims. For instance, eating and drinking in excess of the recommended healthy limits clearly contributes to many people’s well-being (if we are prepared to acknowledge that wellbeing is first and foremost a subjective experience, not a paternalistic notion of ‘what is good for you’). In contrast (and contradiction) to such a liberal approach, Foster and Walker go on to suggest that ‘rights to social protection, lifelong education, and training should be accompanied by obligations to take advantage of education and training opportunities and, wherever possible, to remain active in other ways’ (p 87). These suggestions bear a similarity to the attempts (outlined in Chapter Three) to extend the scope of successful ageing to cover everybody. But the concepts become fundamentally meaningless through the process of over-stretching them; all they actually amount to is modelling ageing – attempts to socially construct desirable ways of behaving and thinking in old age. I am sympathetic to Foster and Walker’s (2015) call for recognising that ‘tackling … inequalities is

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an important part of a comprehensive active aging strategy that aims to provide normatively fair solutions’ (2015, p 87). However, taking this emphasis on evening out inequalities within the context of the lifecourse theory leads to the logical conclusion that the problem (and solution) lies in long-term patterns of (dis)advantage. The solution is therefore not to focus on active ageing but, rather, to address inequalities across the lifecourse, and these are two different things, not the same as Foster and Walker argue.

Conclusion Ageing has become a policy challenge – through processes whereby manifold practices and disputed arguments cohere into ‘a matter of concern’ (Latour, 2004). The ‘equivalents’ of successful ageing in the policy sphere are active ageing ideas, recommendations and policies. Just as the successful ageing literature paints a picture of a successfully ageing individual and seeks to understand what constitutes such a person, active ageing language in the realm of policy construes the ‘model older citizen’ who behaves in ways that policy prescriptions want him or her to behave. This construction is in many ways driven, in the words of Higgs and Gilleard (2015, p ix), by the sense in modern aged societies that ‘they are heading to exhaustion and indebtedness as a result of ever greater agedness, ever increasing ill health and ever more expensive forms of dependency’. There is both a connection and a disjuncture between scholarly conceptions of successful ageing and active ageing in the policy sphere: there is a connection because the requirements of active ageing rely upon assumptions and behaviours of successful ageing being widespread in the older population, and becoming more widespread over time. For instance, the assumption that older adults work longer assumes in principle either that older adults as a group are maintaining their health or that health is improving between cohorts so that today’s 60-somethings are in better health than 60-somethings in the past. Assumptions of unpaid contributions assume social connectedness, one of the elements of successful ageing.

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The disjuncture between successful ageing and active ageing arises from the fact that policy operates in the absence of any deeper understanding of health, social and economic outcome patterns in the population. We know that successful ageing is more widespread among some groups than others, first and foremost the higher socioeconomic status groups, who tend to live longer, have better health, better social connectivity and higher levels of volunteering (WHO, 2015). Yet the policy prescriptions for dealing with ‘the ageing challenge’ are issued in a blanket manner, concerning all older adults regardless of how long they can expect to live, or what their level of health, social and material capital is. I argue that the term ‘model ageing’ encapsulates the drive towards reorienting and reconceptualising old age that is increasingly evident in the international, supranational and national policy texts and rhetoric discussed in this chapter, but also in the academic literature discussed in Chapter Two. Model ageing encapsulates (and explains) both successful ageing and active ageing. In the next chapter, I interrogate the assumptions underlying model ageing, and contest the premise that all older adults have equal access to and capacity for the model ageing behaviours. As a result, model ageing is becoming another engine of exacerbating, rather than ameliorating, inequality.

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FOUR

THE PROBLEM WITH MODELLING AGEING ‘Model ageing’ vs anti-model Chapters Two and Three have provided ample evidence of the productivity of policy makers and academics in developing and ‘selling’ the concepts of active and successful ageing. I have already alluded to my aim to examine these two concepts, as well as other related concepts such as productive, positive and healthy ageing, under the umbrella term of model ageing. This chapter elaborates on the case for viewing the notions of active and successful ageing, as well as other ‘prescriptions’ for ageing appropriately, through the prism of model ageing – an integrative concept that throws light on the reasons for, and the consequences of, thinking about ageing populations within models of ‘how to age well/properly’. In order to examine the interface of these models and individual experience, I will employ the heuristic devices of ‘model’ and ‘antimodel’ older person – ‘model’ being aligned with active/successful ageing, and ‘anti-model’ deviating from the model behaviours and outcomes. We can begin to understand some of the parameters of being a ‘model older person’, as well as obstacles to becoming a ‘model older person’, by reflecting on who might fit the model, and on those who do not conform to it. The ‘model’ ageing citizen is a

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social construction and a policy aim; but it is also manifest (embodied) in people who (intentionally or unwittingly) adhere to (elements of) the model. We can surmise that some of the ‘model agers’ are privileged (for instance a professor who continues to work in her 70s – because she can, and wants to); others are socially disadvantaged (for instance an older low-income worker who derives no enjoyment from his menial and exhausting work but needs the income). Some enjoy fitting the ‘model’; others resent it. However, it is important to acknowledge that we know little about the lived experience of being an ageing ‘model citizen’, or the ‘antithesis’ of the model. Investigating the lived experience of ‘model citizens’ is important for scholarly and policy reasons, because this helps to elucidate the drivers of and obstacles to ‘model’ behaviour. But we cannot fully understand the dynamics of the model unless we also study people who do not adhere to the model, and stand in stark contrast to it. These should be core elements of future research agendas in ageing societies where various actors advocate model ageing. I argue that we can best develop a useful sociological theory of ageing in 21st-century rich countries by studying individuals and phenomena that are as close to the model as possible, and those who are as far removed from it as possible. It will be particularly illuminating to study these ‘models’ and ‘antitheses’ within different welfare state contexts because some welfare states are more conducive to producing the ‘model’ than others. However, even the welfare states that appear to be trained on ‘the model’ and are relatively successful in cultivating ‘model citizens’ contain many individuals who are closer to the antithesis than the model. Conversely, some welfare states are not particularly conducive to cultivating ‘model citizens’, but nonetheless contain ‘model older people’ who remain independent, continue to work past retirement age and make great unpaid contributions, all in the absence of any enabling policies. The context clearly matters, but it is far from determining; there are differential paths to the ‘desired’ outcome.

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The ‘model older adults’ living in welfare states that are not conducive to producing model citizens can best illustrate the characteristics and behaviours of the kinds of people that model ageing scripts endorse; and the individuals who do not conform to the model, even when they live in a welfare state that has put in place policies and frameworks to encourage and reward the model, can best illustrate the ‘resistance’ to the model. Therefore, this chapter will reflect on cases of being a ‘model citizen’ despite an adverse context; and ‘deviating from the model’ despite a conducive context. In setting out to build theory, I pose two central questions: • What might be the reasons why some older adults adhere to ‘the model’ despite a context that does not support and reward model behaviour? • Why might some older adults deviate from ‘the model’ despite a context that fosters model behaviour? This chapter takes some steps towards a meso-level theory that will be useful for understanding the contradictions between model ageing aspirations and the ‘reality’ of people’s everyday lives in welfare states with aged populations. It can be used by scholars from multiple disciplines to illuminate the challenges that policies and interventions face, and to investigate possible new causal pathways across a variety of ageing-related phenomena, ranging from health and economic behaviours to micro-sociological investigations. First and foremost, the interrogation of notions of model ageing is theory building that engages with both structure and agency, an endeavour that is rare in present-day sociological work on ageing populations. I reflect on how and why older adults negotiate independence and dependence; engage with the notion of working longer; and respond to the idea of social productivity. Building upon these three areas, the objective is to generate a middle-range theory of how and why older adults relate to the model ageing expectations that policy and society direct at them. Following the groundwork in this chapter, the core postulates of the theory will be spelled out in Chapter Five.

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Interrogating the dimensions of model ageing The three key dimensions of model ageing are outlined below, in each case in association with one illustrative context that is particularly strongly geared towards ‘cultivating’ the model and one context that is currently particularly adverse to the model. While some countries are better at illustrating, at the macro level, how the model works and can be brought about, these countries of course also contain older people who ‘deviate’ from the model (for instance, some older people in Finland retire early, despite a policy context that encourages later retirement). Conversely, some older people ‘go against the grain’ of the surrounding macro-context by, for instance, being highly socially productive, despite the external disincentives and barriers. The cases that I outline below are not empirical, because no empirical research has yet been done that would apply the concept of model ageing to any ‘actual’ older populations. Rather, the cases are used to illustrate the features that model ageing presumes older adults to have; to interrogate the contexts and social locations where those characteristics occur, or do not occur; and to draw inferences from these enablers and obstacles to model ageing. Note that I do not imply that individual older adults are somehow ‘antithetical’ in themselves. On the contrary, I anticipate that many older individuals who do not adhere to ‘the model’ will nonetheless evince behaviours and attitudes that embody qualities that befit ‘the model’; and that what appears ‘antithetical’ at first sight may have completely different meanings on closer inspection. Conversely, examination of ‘model behaviours’ might throw light on aspects of adhering to the model that have been hitherto ignored; my enquiry is open to such discoveries, and indeed premised on the assumption that we currently know little about what motivates behaviours among older people. I will develop a theoretical understanding of the older people who adhere to the model ‘against the odds’, and others who ‘deviate’ from the model despite a welfare state structure that is pushing them towards it. Each pairing is intended to illuminate the model that policy

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scripts seek to achieve, and some of the challenges and opportunities in bringing about the behaviours that are prescribed by the model. The aim is to generate a theory of why older adults’ experiences and views reflect or deviate from what the policy ambitions portray as the contemporary (Western) ideal of ageing. I reiterate that the purpose of this book is not to test hypotheses; the purpose is to theorise, which involves conceptualisation of individual experiences and formulation of ideas concerning how these experiences might relate to the (policy) context.

Interrogating model dimension 1: the imperative to ‘live independently’ As Chapter Three demonstrated, collective responsibilities for support during old age are being challenged by a paradigm shift emphasising individual responsibilities for maintaining health and well-being. Other conceptual shifts emphasise co-production – the active engagement of users in the production of services – both to enhance effectiveness and as a reflection of contemporary citizenship responsibilities (Leadbeater, 2004). Public and policy perceptions of older people are shifting from a ‘dependency model’ to seeing them as active agents in their own lives (Tulle, 2004). The capabilities and social investment approaches, focusing on opportunities to achieve outcomes that individuals and society/economy value, have to date centred on children, young people and working-age adults (Morel et al, 2012). However, older adults with disabilities and care needs are also increasingly framed as a group whose capabilities and productive capacities are valued, can be maintained or can even be enhanced; a recent example is the European Commission’s call for a ‘longer-term strategy of social investment’, including measures that ‘raise the capacity of frail older people to manage self-care and independent living’ (European Commission, 2013, p 4). Overarching imperatives in the direction of self-care are argued to stem from economic pressures to reduce social expenditures. In the realm of independent living, cultivating the ‘model older citizen’ involves attempts to push the limits of independence in old age. Older adults with care needs are increasingly framed as a group

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whose capabilities can be maintained, or even enhanced. The social investment approach constitutes a promise of escaping welfare state inertia, as it incorporates new types of ‘solutions’ to ageing. One of the key hoped-for solutions to the ‘care crisis’ is the re-ablement approach. Re-ablement can be defined as a set of services for people with poor physical or mental health to help them accommodate their illness by learning or relearning the skills necessary for daily living. By casting older adults within the social investment frame, reablement amounts to a reconceptualisation of older people with care needs as not ‘just’ a drain on resources, but involved in ‘producing’ their own care and well-being. Re-ablement adopts a view of old age and disability that is very different from ‘traditional’ care approaches depicting older persons as passive recipients of services. Re-ablement views the older person’s abilities and trajectories as mutable and multi-directional – improvement and recovery of abilities are possible. Re-ablement overlaps to some extent with rehabilitation, but is more encompassing. Rehabilitation focuses on restoring specific functional abilities (such as walking) after an adverse health event (for instance a broken hip as a result of a fall). Re-ablement is about empowering and enabling older people with functional limitations to manage a higher degree of self-sufficiency, through supporting and actively encouraging them to regain confidence and (re-)learn everyday living skills and selfcare. The approach may also include the supply of assistive equipment and environmental adaptations to the home. The term ‘restorative’ care services is used in some countries (for example, Australia). Danish policy on older people in need of care has incorporated notions of self-care and rehabilitation for a couple of decades, but in recent policy statements this orientation has become particularly prominent and taken the form of a strong drive towards re-ablement. The 2013 Danish Home Help Commission report contains an exhortation to extend rehabilitation even to some frail segments of the older population: ‘the target group for rehabilitation includes … people with very complex needs’ (Hjemmehjælpskommissionen, 2013, Recommendation 7). Indeed, since 2015, Danish municipalities have been obliged to offer re-ablement services as the first alternative when

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an older person with care needs seeks help. Research conducted to date on re-ablement has focused primarily on outcomes such as cost savings and reductions in need for ongoing support (Lewin et al, 2013), and has not yet addressed the compatibility of re-ablement with older people’s own attitudes and wider concepts of ageing and agency. Research on re-ablement has focused on short-/medium-term outcomes, including the economic returns (cost savings) achieved by restoring independence instead of providing (more intensive/expensive/ longer-term) services (Ryburn et al, 2009; Glendinning et al, 2010). As re-ablement approaches emphasise restoring independence and reducing expenditure in the long-term, advocates hope that they may be conducive to enhancing the legitimacy of public expenditure on support for older adults. Re-ablement is one manifestation of the shift away from public/ welfare state responsibilities and towards increasing emphasis on private (individual/family) responsibilities for welfare/well-being, including the assumption that it is the responsibility of older people to optimise their functional abilities/well-being. Some actors also argue for more user involvement in the design and delivery of services, assuming that all service users are both capable of and interested in ‘co-producing’ services, including care – assumptions that need to be empirically explored. However, emphasising individualised responsibilities risks creating new inequalities. Older people undertaking re-ablement bring with them significant material inequalities resulting from lifelong patterns of (dis)advantage. They also bring inequalities in social capital, particularly the (un)availability of relatives who can provide support during/after re-ablement. Referral and eligibility criteria, assessment protocols and interventions embody assumptions about which older people are considered able or unable to optimise independence through re-ablement. Those who do not meet the selection and eligibility criteria may experience disadvantage and exclusion from the ideal of the active, responsible citizen. The implications of the re-ablement approach for family carers are also important, if they lead to greater pressure to support the older person at home. To date, re-ablement services have been introduced without considering the possible

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patterning of outcomes and experiences by socioeconomic status/ family status/extent of frailty/gender/ethnicity. Indeed, a systematic review of studies of the effectiveness of re-ablement has revealed that its benefits are unproven, an astonishing finding in view of the very considerable investment that many developed welfare states have made in introducing re-ablement services (Legg et al, 2015). The fact that policy makers have been so (blindly) attracted by the notion of reablement is symptomatic of their search for ‘handy solutions’ to the ‘problem’ of growing care needs. Some older adults indicate either immediately or within a short period of receiving re-ablement services that they are not interested/ have not benefited from the intervention; why they do they not believe the re-ablement approach to be desirable or workable? How do the paradigms of agency and independence fit with paradigms of costefficiency: are we witnessing a new ‘social investment’ approach to care, or a legitimisation of cost-cutting and withdrawing of collective responsibility? What are the wider potential, and limits, of re-ablement approaches, including the implications for social solidarity and equity? What do the aims, outcomes and experiences of re-ablement services tell us about evolving attitudes towards individual versus collective responsibility for meeting care needs in old age? One of the reasons why re-ablement has remained such an ill-defined and under-researched topic lies in the absence of answers to these fundamental questions, forgotten in the rush to implement ‘solutions’ to the ‘care gap’. We need new insights into how older people’s agency and desire for independence can be maximised, while being alert to dangers such as imposing re-ablement on those who are not able or prepared to ‘self-care’; creating new inequalities; or using re-ablement as a legitimation of cutting and limiting services. Questions about the appropriate parameters for re-ablement remain unanswered – first and foremost, how to maximise its potential to transform demand for, and the organisation and experiences of, long-term care, without risking inadequate or inappropriate care for people with support needs. In the meantime, we of course have cases of older adults everywhere around us who do de facto adhere to what the re-ablement approach

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advocates all older adults should be like: some of them are in various ways motivated and resourced to restore and learn skills; some are enabled to continue living independently with the help of family, friends and neighbours; others simply have to live independently because there is no other alternative. Re-ablement is just one example of a lens through which older people’s attitudes and expectations of agency and co-production of care can be interrogated. Studying socially excluded older adults is also instructive in this regard. The Romani people are undoubtedly one of the most disadvantaged groups in Europe in terms of high mortality and morbidity at older ages, and very limited access to formal care services; they are likely to belong to the ‘no alternative but to get by’ group. Older Roma develop morbidities relatively ‘young’ (in mainstream European conception) and tend to experience extreme difficulties in accessing formal services. The population structure is characterised by high fertility and low life expectancy. In addition to the difficulties that arise from their low socio-economic status and widespread discrimination, the Romani in most European countries have poor access to health and social care services (Cemlyn et al, 2009). What are the behaviours and strategies that help older adults in such deeply inimical circumstances to live independently in the community? The study of older Romani people who manage to live independently despite extreme difficulties in accessing services would constitute an ideal example for illuminating the dynamics of (self-)care that are as far removed as possible from the circumstances where older adults are structurally supported to age well. However, studies of such marginalised older adults are few, and properly designed intervention studies with marginalised older people are fewer still. The Aboriginals in Australia are another manifestly socially disadvantaged group. One stark reminder of this is the fact they have been included in the Census only since 1967, having until then been ‘regarded as part of the flora and fauna’ (Ranzijn, 2010, p 719). Only 2% of the Aboriginal population make it into ‘old age’ (that is, are aged 65 and over), and their average life expectancy is 17 years lower than that of the Australian population as a whole. Ranzijn (2010) points out

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that ‘the lack of resources, or at best minimal resources, provided for the [Aboriginal] Elders reflect the marginalization and exclusion they have experienced throughout their lives’ (p 719). In other words, the barriers to ‘ageing well’ that the Aboriginal elders face did not spring up in their old age: they have been hampering their progress and wellbeing from birth. The underpinnings of active ageing – which Ranzijn identifies as independence, autonomy and self-reliance – contrast with ‘Aboriginal worldviews, which are characterized by interdependence, mutual reliance, reciprocity and an intricate kinship system by which all Aboriginal people in Australia are related to all others’ (p 720). Ranzijn (2010) argues that active ageing conceptions further marginalise socially disadvantaged populations such as the Aboriginals. He proposes that ‘ageing well’ or ‘authentic ageing’ are concepts that might better encompass groups who are not able to fully ‘subscribe’ to active ageing understood as physical fitness, hence promoting social inclusion and cultural diversity in older populations. Ranzijn lists the manifold resources that are required in order to ‘age actively’: good health (or at least the ability and motivation to restore good health through exercise and other ‘healthy choices’); access to good healthcare; social ties (in particular a spouse or partner); money; and infrastructure that facilitates active pursuits and social interaction (for example, transport); motivation; psychological well-being and absence of anxiety (Ranzijn, 2010, pp 717–18). From this list arises the sober realisation that in order to age actively/independently/successfully, one needs to be ageing actively/ independently/successfully: a classic tautology. Chapter Five will draw out the logic and implications of this tautology that is evident in many different ‘prescriptions’ for ageing that are produced by researchers, policy makers and business interests.

Interrogating model dimension 2: the imperative to ‘work longer’ Older adults who ‘give up’ on paid employment ‘too early’ and thereby relinquish their role as economically productive citizens represent failure in a welfare state context that is designed to lengthen working

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lives. In the 2005 pension reform, retirement age in Finland was set flexibly between the ages of 63 and 68, and the minimum retirement age is now rising to 65. Various early retirement routes were closed off, so that early old-age pension is obtainable only from the age of 62. There is a reasonable amount of up-to-date scientific evidence on why some older adults are staying on in the labour market up to and beyond the earliest allowable retirement age (typically female white-collar employees) and why others retire earlier (typically male blue-collar employees) (Nivalainen, 2014). However, there is no upto-date research on the motives and experiences of individuals who have retired ‘too early’ on other than ill-health/disability grounds, and for this reason we lack a comprehensive picture of the factors that feed into the early retirement decision. However, we can surmise that preferences (for leisure, for activities other than work, for retiring at the same time as spouse) do play a role in these decisions, especially where they are facilitated through access to a ‘good enough’ pension income. In other words, the early retirement decision is a manifestation of choice and agency for some groups who want to and can retire early. The popularity of books with titles such as ‘The Joy of Not Working’ and ‘How to Retire Happy, Wild and Free’ is indicative of a counter-movement of individuals away from long-term, sustained engagement in paid work until old age. While these books advocate early retirement for everyone, including even those with little savings and capital, de facto the early retirees by choice tend to be those who have sufficient economic resources either through assets and savings or by virtue of being married/partnered with people who have a sufficiently high income. After all, nobody wants to retire early in order to be ‘unhappy, poor and constrained’, as a parody of a retirement guide title might read. As a context that is conducive to ‘model ageing’, Finland has also invested heavily into health promotion across population groups, yet here, too, some groups have been reluctant to act on the healthy life-styles advice. Karisto (2006) identifies a group of older people in Finland who are resistant to public health messages, and hypothesises that the choice to eat unhealthy food despite awareness of what is

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healthy may be one of the few remaining areas of autonomy for the predominantly lower-educated, socially disadvantaged groups that make these unhealthy choices. In other words, not being a model older person might not be due to structural constraints alone: it might also be a manifestation of agency – a choice, but this time contrary to ‘the model’. It is also important to understand the motives of older adults who retire at or after official retirement age in a contrasting pension policy and labour market context – such as for instance Poland – where multiple factors militate against longer working lives. Why do these older adults keep working ‘against the odds’? In contrast to Finland, Poland constitutes a welfare state context that has been less successful at fostering longer working lives (Ruzik-Sierdzińska et al, 2013). Despite a gradual increase in official retirement age to 65, early retirement is still widespread, and has been exacerbated by the failure to introduce measures that would improve the quality of work for older workers (Trawinska, 2013). It would be important to gain a better understanding of what motivates older workers in contexts where it is not easy to stay on in employment, especially in sectors where there are strong pressures on older people to withdraw from the workforce to ‘make room’ for younger workers (such as heavy manual work); and where constant updating and learning of new skills is required (such as IT industries). The motives and strategies that keep older adults in the labour force even in highly pressured and unfavourable contexts are indicative of the kinds of qualities that welfare states with aged populations exhort, yet do not always manage to inculcate.

Interrogating model dimension 3: the imperative to ‘be socially productive’ Alongside care of (younger and older) family members, the form of social productivity that is most frequently encouraged in older populations is volunteering. Hank and Erlinghagen (2010) draw on the Survey of Health, Ageing and Retirement in Europe (SHARE) data to explore the limits of exhorting older adults to volunteer. They

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note that the drive to encourage volunteering among older citizens is much longer established in the United States than in Europe, dating back to the Older Americans Act (1960s). (It is interesting to note that the European ‘older volunteers’ projects that they provide internet references to have not had staying power, as the websites are no longer in use.) Hank and Erlinghagen (2010) point out that engagement in unpaid productive activities requires specific resources, and that volunteering behaviours and opportunities are therefore not equally distributed across older populations. Regarding the impact of social class (measured by level of education), they summarise existing research that indicates that participation rates increase by about 5 percentage points when comparing the lowest-educated with the middle-educated groups, and by a further 8 percentage points when looking at the highest-educated group (that is, range from 5% to 19% of the older population). Other factors that are positively related to volunteering include good health, steady partnership and engagement in other activities: in other words, engagement fuels further engagement, constituting a classic ‘virtuous cycle’. At the cross-national comparative level, a country’s civic culture and welfare system matter, as the degree of civil liberties and social spending are positively associated with volunteering – and the crossnational variation in percentage of older adults volunteering is great, from around 20% in the Nordic countries and the Netherlands to only about 5% in the Mediterranean countries. Educational and training opportunities, public transport, tangible rewards in the form of tax credits and a degree of flexibility in voluntary work are some of the policy measures that might help to attract more, and especially more ‘non-traditional’ volunteers; but most welfare states have no or minimal examples of using such devices. Fundamentally, however, the only way of ‘correcting’ disparities in the opportunity structure of volunteering in old age calls for longterm investments in education and health, starting with children (Tang, 2008). Hank and Erlinghagen sound the cautionary note that ‘promoting voluntary participation also bears in it the potential of increasing polarization among older persons, if the selection of people

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into social activities is biased by the individual’s endowment with health or socioeconomic resources’ (p 13). Reciprocity is important in volunteering, even to the extent that volunteering might be beneficial for well-being only if the volunteer thinks that his or her efforts are rewarded and reciprocated (Siegrist et al, 2004). Hank and Erlinghagen express doubt that volunteering would exceed 35–40%, and caution that undirected initiatives are likely to reach those who would volunteer anyway, or who are already socially connected and relatively healthy. They also argue that ‘unproductive’ behaviours among older adults are not necessarily ‘bad’; in fact they state that condemning ‘unproductive’ behaviours is dangerous for social cohesion because it is stigmatising (2010, p 15). In the domain of social productivity, the ‘antithesis’ is harder to pin down than in the health and labour market domains, because so many dimensions of social productivity are hidden and poorly understood. The ‘antithesis’ of social productivity is, in principle, older adults who do not engage in care labour or volunteering but, rather, opt for ‘selfish’ pursuits of leisure and other forms of self-actualisation, in spite of a context that encourages and facilitates volunteering and informal care (such as in Germany). While volunteering is a central form of ‘social productivity’, the majority of older people everywhere are not active volunteers. There is plentiful research on older volunteers, but virtually nothing on the reasons for not volunteering. The few sources of research on why many older people do not volunteer suggest that ‘potential older volunteers are stopped by poor health, work commitments or lack of time, in other words a fairly superficial analysis lacking in-depth understanding’ (Warburton, 2014). Germany is a particularly fruitful context for theorising on nonvolunteering older adults because some older Germans engage in highly innovative and novel forms of voluntary work such as acting as ‘elective grandparents’ (Wahlgroßeltern). The ‘inactivity’ of others in such a context might be seen as particularly ‘deviant’ from the kind of behaviour that a ‘model older citizen’ is expected to evince. In Germany, considerable policy energies have gone into developing the Federal Volunteer Service (Bundesfreiwilligendienst) for older adults

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and establishing centres (Mehrgenerationenhäuser) that are explicitly inviting older adults to make and receive voluntary inputs to/from younger members of their communities. What are the reasons for not volunteering and reactions to the expectation that older adults should be overtly ‘socially productive’? Some answers might lie in the reflections by Martha Holstein on the expectation of civic engagement in old age: [I]n most ways, I would seem to be the ideal person, a possible icon, of what these goals for an aging society represent. Instead, I am a critic. I dream of retirement in ways that had hardly entered my thinking even three years ago. My head is filled with writing projects, books to read, classes to take without ever having to take notes, a less disciplined and scheduled life, and as many visits to my children and granddaughter as possible. I would add travel to this list, but I suspect my resources won’t allow very much of that. These dreams come, I think, because of a profound sense of time limited. At this age, it seems to me, there is a visceral sense of a time before and a time after. This sense was recently reinforced when a good friend was diagnosed with Alzheimer’s disease, the first of my generation.When my time after comes, as I know it must, I want to have as few regrets as possible. I’ve been a responsible parent and worker. Now I would like the luxury of relative freedom, of fewer expectations and responsibilities.To even harbor this wish is to recognize that I speak from a place of relative privilege, even though my freedom is constrained by financial needs. I ask myself – can’t I just be tired of being responsible, of being busy, of having one more deadline? (…) We have so much yet to think about in regard to late life, both socially and individually, that assertions about what it should be about seem premature and exclusionary. (Minkler and Holstein, 2008, p 199) Holstein paints a picture of retirement as (ideally) a time of choices and fulfilment, unconstrained by the heavy demands of work and family

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that have dominated life until then; and acknowledges that this vista is not open for all. It is quite likely that for many older adults in developed countries, not being ‘socially productive’ is a deliberate choice, one that they have made without regrets or guilt – but (astonishingly) the fact that some old people want to, can and will ‘opt out’ of more onerous forms of social productivity is a consideration that does not seem to have entered the minds of policy makers who advocate active ageing for all. Of course, intense social productivity can occur despite a context that does not formally reward or encourage such intensive inputs, and where gendered norms regarding care labour remain strong. For instance, active grandfathering is practised in contexts where the gendered ordering of care labour remains strong (for example, Ireland, Italy). What motivates older men to make intensive unpaid contributions in a context where (older) men as caregivers run counter to a norm? The welfare state shapes grandparenting roles, and a North–South gradient exists in Europe whereby grandparents provide less support in aggregate in the South, but when they do so, in a more intensive manner than in the North. Across welfare states, understanding of the evolving role of grandfathers remains very limited (Timonen and Arber, 2012). Recent research carried out in Italy indicated that parents of children up to 12 years old view their own parents as a crucial resource for balancing work and family (Naldini et al, 2013); however, the grandparents’ experience of this role calls for further investigation. Grandfathering in particular is very poorly understood currently. I am especially intrigued by grandfathers who are breaking out of the ‘traditional’ model and becoming heavily involved, not just as occasional assistants to the grandmothers: they are adhering to ‘the model’ of social productivity, against the odds, and it would be important to elicit a fuller picture of why they do so (and not merely refer to the lack of alternative childcare options for many parents in Mediterranean countries).

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Social determinants of successful/active ageing The above examples were intended to illustrate the ‘blindness’ of active and successful ageing frameworks to some key structural constraints and incentives that older adults face in their everyday lives, not to mention the choices that they wish to make regarding their use of time and resources. The influence of structural constraints and circumstances throughout the lifecourse is extensively documented, and the studies referenced here represent examples of hundreds of published pieces of research that testify to the social gradient that shapes lives from the cradle to the grave. Brandt et al (2012) established a relationship between advantageous childhood circumstances (higher parental socioeconomic status, better maths and reading skills, self-reported good health) and ‘ageing well’ (using criteria similar to Rowe and Kahn’s successful ageing). Schafer and Ferraro (2012) showed that childhood experiences (such as parental abuse) and adult factors (such as smoking) were of comparable strength in predicting ‘disease free’ status in old age. These and other similar findings, Stowe and Cooney (2015) argue, ‘challenge the reversibility of broad SA [successful ageing] classifications like that of Rowe and Kahn. Although personal agency and behavioral change may alter single health indicators, the extent to which they can reverse one’s overall SA classification in the Rowe and Kahn model is unknown.’ In addition to early-life circumstances, mid-life social position also strongly predicts successful ageing (Britton et al, 2008). As Katz and Calasanti (2015) point out, ‘If different groups enter their later years with varying financial resources, then these deeply affect how they govern their ability to engage in the activities related to successful aging’ (2015, p 30). Furthermore, ‘to the extent that power relations themselves are not dismantled, the inequalities that constrain individual choice will persist, and the call to age successfully will continue to demarcate winners and losers and will itself serve as another marker of group-based differences’ (Katz and Calasanti, 2015, p 30).

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These are just a few examples of a huge literature on the social gradient that is evident in outcomes in childhood, youth, mid-life and in old age: in other words, across the entire lifecourse. However, policy targeted at older adults is almost always blind to such stratification within the ageing population. The fact that policy is blind to these factors does not mean that is has a random effect on individuals. On the contrary, this means that policy impacts assume certain patterns. For instance, if it is decided that volunteering should be encouraged, in the absence of carefully thought-out strategies, the benefits of the initiative are likely to further advantage those who are already benefiting from the effects of volunteering, that is, predominantly the higher socioeconomic groups. Policy thereby becomes an exercise in reinforcing virtuous circles while vicious circles are left to selfperpetuate.

Agency and advantage: attributes of ‘model agers’ Model ageing texts and talk assume that all, or almost all, older adults have strong, self-directive agency, in the sense of making decisions and changes in their lives that are oriented to specific socially, politically and economically desirable goals. Older adults are assumed to be highly goal oriented in the sphere of physical functioning (‘I will restore my independence because I want to cope by myself ’) and labour market participation (‘I will work longer because it makes sense economically, socially, societally’). In the area of social productivity, they are supposed to be other-oriented, yet also agentic: keen to take up social roles and responsibilities in their families and communities. This amounts to a very specific, normatively driven social construct of ‘ageing well and appropriately’. It is also a very new construct. As Gilleard and Higgs (2000, p 3) point out, ‘only in the late 20th century has the idea emerged that human agency can be exercised over how ageing will be expressed and experienced’. Model ageing is a logical development of this trend and is the result of attributing more and more agency to all older adults.

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Successful and active ageing do not leave room for individuals whose preference is for ‘passive’ receipt of care and services; for ‘selfish’ leisure; or for economic ‘dependence’. In fact, model ageing notions systematically advantage older adults with specific qualities (such as good health, driven personality, extensive social networks), in specific circumstances (for example, in good-quality housing and safe neighbourhoods); in other words, individuals who are already, thanks to these characteristics and circumstances, likely to enjoy social, health and economic advantages as they age. Figure 4.1 depicts the virtuous cycle that arises and self-perpetuates as older adults who are healthy and physically active are likelier than their less independent peers to stay on in paid employment, and better able to remain socially productive. Conversely, model ageing notions systematically disadvantage ageing adults who are not well resourced in terms of health, wealth, social networks and the surrounding environment. Model ageing also leaves Figure 4.1: The virtuous cycle of active ageing

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‘off the hook’ those older adults who have been able to make provision for themselves through purely private means; for instance, the spouse of a high earner can retire early, hire paid home help and donate to good causes to generate the sense that they are independent and contributing. In contrast, the low-wage earner has little choice but to keep working, even when motivation is lacking and health is waning, and is not in a position to ‘contract out’ any family care expectations that might arise: they have to pay the real price of being a ‘model older person’ who works, cares and lives independently, even when these ‘contributions’ become a struggle. Psychological resources are also important for understanding the implications of successful and active ageing (Sargent-Cox et al, 2015). Among the psychological resources that are conducive to and bring about successful ageing are ‘a positive outlook and self-worth, selfefficacy or sense of control over life, autonomy and independence, and effective coping and adaptive strategies in the face of changing circumstances’ (Bowling and Dieppe, 2005, p 1549). Bowling and Iliffe (2011) go even further when they argue that ‘Successful ageing is not only about the maintenance of health, but about maximising one’s psychological resources, namely self-efficacy and resilience’ (p 1). Health and longevity are improved through the use of preventive care, better medical management of morbidity, and changing life-styles – but these may not lead to improvements in quality of life. Hence, ‘adding years to life and life to years may require two distinct and different approaches, one physical and the other psychological’ (Bowling and Iliffe, 2011, p 1). Another psychological resource that is useful in seeking to age ‘successfully’ and ‘actively’ is sense of coherence. Sense of coherence refers to the extent to which a person perceives reality as controllable, manageable and meaningful, and wants to take on the challenges of life. Older adults with higher levels of education, a work history in senior responsible roles, and living with a partner, tend to score higher on measures of sense of coherence than their lower-educated counterparts living alone, or with less responsible job roles in the past (Ciairano et al, 2008). The meaningfulness component of sense of coherence

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declines with age, although here, too, the older adults with a spouse or partner are at an advantage in that they have a stronger motivation to persist in facing life’s challenges, including the expectations that arise from model ageing ideals. The concept of locus of control is derived from Rotter’s social learning theory and refers to the extent to which an individual believes they can influence outcomes. Locus of control has been linked to several health outcomes (Berkman and Kawachi, 2000), and hence individuals who score highly on this characteristic have an ‘inbuilt’ advance in the race to age successfully. Attributes such as a strong sense of coherence and locus of control are helpful in responding to the ever-expanding realm over which the ageing individual is supposed to exercise agency.

Agency meets structure Not only are model ageing scripts and advocates weakly attuned to the surrounding contexts (environment/society/welfare state/culture) and the obstacles that these might pose to achieving model ageing behaviours. Model ageing scripts also tend to ignore social structures, in particular socioeconomic status, and the impact of families and social networks on the opportunities to age well. It is assumed that once the incentives are right at the macro structural level (for instance, retirement income is boosted in return for working longer), model ageing behaviour will follow. Consequently, model ageing prescriptions have the effect of marginalising groups that have the lowest resources to age successfully/actively. Model ageing ideation also amounts to ‘cancelling’ or obliterating ‘the Fourth Age’. Model ageing is about morphing various ‘challenges’ that arise from ageing into ‘solutions’ in a way that appears to generate free-of-cost, win-win scenarios when, for instance, older adults start to practise more sport, stay in better health, and use fewer healthcare resources. Older adults come across manifestations of model ageing in the course of their everyday lives. From these encounters, new dynamics evolve. Some older adults respond to model ageing exhortations and opportunities to practise model ageing in ways that policy makers have

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envisaged. Others ‘subvert’ these expectations in various ways. Social networks and environment play a very important role in influencing the extent to which ‘model’ behaviours are adopted and adhered to. Christakis and Fowler (2009) have demonstrated the significant connections between social networks and health-related behaviours such as smoking and diet, and health outcomes. They argue that some network effects on health extend up to three degrees, that is, to friends of friends of friends. In contrast, in model ageing ideation, individuals are free, independent agents who pick up on the ‘handy’ advice on ‘ageing well’ and transform their behaviours irrespective of environmental or social network influences. Businesses that are interested in ‘turning silver into gold’ can be forgiven for neglecting the groups that are not able to purchase the goods and services that are construed by advertising as necessary for successful and active ageing; profit is, after all, the chief raison d’être of business. However, it is alarming that large sections of the ageing enterprise within academia and policy making appear not to be cognisant of the counterproductive nature of ‘selling’ successful and active ageing in the form of mounting literature on successful ageing and policy advice on active ageing. Academic and policy actors ought to be aware of the limits and implications of constructing conceptual models and policies on the ‘best performers’ in the older age groups. As Bowling and Dieppe (2005) put it, ‘If high social functioning … is accepted as part of ageing successfully, the implication is that people need encouragement to build up their social activities and networks from a young age, and the provision of enabling community facilities is needed’ (p 1550). Furthermore, ‘interventions need to target potentially vulnerable groups early on, as several longitudinal datasets have shown that variables measured in middle age predict outcomes in old age … adaptation to old age is related to experiences of stressful events, and is also associated with social class’ (p 1550). In other words, the current focus on exhorting older adults to change their behaviours is misplaced as a ‘solution’ to the ‘problem’ of growing older populations: the efforts to transform capabilities and behaviours should be predominantly directed at younger age groups.

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The very length of life is highly dependent on social class, including the social class one is born into. There is enormous room for improvement before all groups are equivalent to the best-off groups with regard to longevity. Education has an impact on mortality and other key outcomes through its function as human capital. This refers to the argument that education lowers mortality risk by increasing cognitive function, sense of control, access to information, social ties and problem-solving skills – all of which are conducive to better health (and thereby, as argued above, to successful ageing). The education as credentialism explanation argues that a university degree opens up the pathways to a better job, more income, better insurance and the opportunity to purchase better-quality housing in safer neighbourhoods than would be possible with no degree or a lower-level degree. In contemporary societies, education is increasingly tied to information about, access to and support for healthy life-styles such as smoking avoidance and cessation (for example, workplace-based programmes to quit smoking), exercise (for example, the social network effect of knowing people who exercise and invite you to join them), diet and health technologies. Public health campaigns that typically focus on individual-level behaviours have not been able to offset the growing influence of education in social and economic arenas. Extensive research demonstrates that disparities in adult mortality by educational attainment have increased in many developed countries (Crimmins et al, 2011). Moreover, both absolute and relative disparities by educational attainment are widening, playing into the hands of those who are in a position to acquire higher levels of education (Meara et al, 2008). In such a context, public health campaigns have to evolve if they are to be effective; they need to focus on the mechanisms linking education and cause-specific mortality, that is, to tap into the pathways that differentiate the experiences and behaviours of the higher-educated and the lower-educated. For instance, in view of the close link between education and smoking, it is necessary to focus intensively on smoking among lower-educated men and women. Income differences are very important in accounting for the education

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gap in mortality (explaining 30–40% of it) – hence, reducing income inequality across education levels would help to address the education gap in mortality. This, however, is a remote prospect in the face of the mega-trend of rising inequality (Dorling, 2015). It is hard to isolate the effect of policy on outcomes, as several factors impact on, for instance, the average age of retirement. However, model ageing exhortations have been around for several decades, and have been embedded so systematically into several strands of policy that even in the presence of contrary developments we ought to observe some movement towards the desired outcomes, such as later average age of retirement. However, the evidence does not point to the unequivocal march of polities towards model ageing outcomes. For instance, workers in the United States still retire on average (at 64) earlier than they did half a century ago, despite the declining generosity of Social Security and occupational pensions and rising medical expenses (Ellis et al, 2014). Due to increases in longevity, the average period spent in retirement has risen from 13 years (in the 1960s) to 20 years at present. This leaves open three scenarios: working longer; saving more while working; or retired people living on less. The third option is perhaps least appealing in a consumerist society where the prices of, for instance, medicine and health technology are rising. The first and second options are model ageing behaviours, but it is increasingly evident that such behaviours are not easy to inculcate in societies where the importance of leisure is increasing, where occupational healthcare is not available to all older workers and where a large segment of the older workforce is faced with the prospect of fatiguing, often monotonous work in the ‘food and fun’ or low-paid consumer and social services sectors. Policy tools have been brought to bear on the growing gap between entitlements and pensions financing, so that formal retirement age for instance in the US is rising to 67, and early retirement is increasingly carrying the penalty of a lower pension. The rising Medicare premiums are deducted directly from Social Security, meaning that an individual’s higher medical expenses are immediately reflected in their pension payment. As a result, it is anticipated that the replacement ratio of

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Social Security (the pension as a proportion of pre-retirement earnings) will fall from about 40% (for the average worker) in the 1980s/1990s to about 31% by 2030. Workers can combat this by working longer; staying in employment until the age of 70 increases the pension by 76% as compared to the pension obtainable at 62. This will favour individuals who are able and inclined to work longer. In the realm of private/occupational pensions in the US, so-called 401k-defined contribution schemes have come to replace more generous finalsalary pension schemes. Contributions to these are around 9% of a worker’s annual salary on average. Furthermore, these pensions are of course subject to investment risk: poor investments and poor (or even negative) yield on those investments equals inadequate pension income. Over one-third of US workers have no savings for retirement. Ellis et al (2014) calculate that workers who start saving at age 25 will need to save 12% of their income in order to retire at 65; waiting to start saving until the age of 45 raises this proportion to 35%, an amount that is very hard or impossible to set aside for most workers at a time when they are meeting the costs of raising children and loan commitments such as a mortgage. Policy has developed in a similar direction in most other Western welfare states; the implications for those with precarious jobs, interrupted careers and low incomes are discouraging.

Conclusion Gilleard and Higgs (2000, p 1) have argued that ‘ageing has become … complex, differentiated and ill defined, experienced from a variety of perspectives and expressed in a variety of ways … there is a gradual and irreversible fragmentation of ageing as a socialized attribute’. This is a valid and useful observation, but such fragmentation is increasingly countered by model ageing conceptions; there are more and more attempts, by powerful actors such as businesses, governments and academics, to spell out how older adults should live out their lives. By now, my concern about people who are not able to follow the model ageing exhortations should be quite clear. However, this group of anti-model agers has not been entirely neglected in contemporary

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policy making. Indeed, those who fail to model age have also come under the gaze of the ageing policy enterprise. The better-off among them are also of some interest to the commercial sector (although most people who fail to model age are not very lucrative or enthusiastic consumers, so they would need the support of welfare states in securing services and products). The future sustainability of the measures that are targeted at those who ‘fail’ to adhere to the goals of living independently and being economically and socially productive is extensively questioned in policy documents. This creates the clear impression that ‘old’ policies such as ‘passive’ provision of long-term care are under threat, and that the ‘traditional’ collective provisions are going to be thinned out gradually as the older populations grow. In the area of care services provision, these trends are already evident, for instance in the form of targeting services to those with the highest levels of disability and least financial resources (Rostgaard et al, 2012). Childhood events and socio-structural circumstances are largely beyond the control of even the most agentic individuals, and continue to shape outcomes throughout the lifecourse; yet policy directed at older adults is based on the assumption that simply deciding to change one’s life-style is sufficient for achieving major changes at individual and population levels. Berkman and colleagues (2011) argue that ‘most of our interventions to improve the health of older populations come too late in the evolution of disease and disabling processes’ (p 338). Policy makers have, effectively, given up on bringing about deep, meaningful change for the marginalised older populations, and are increasingly resorting to the notions of successful and active ageing to justify the shift in responsibility towards older adults and their families. The antecedents and consequences of this trend are spelled out in Chapter Five, which puts forward the theory of model ageing.

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FIVE

TOWARDS A THEORY OF MODEL AGEING In this chapter, I take the first steps towards the model ageing theory. I employ the term ‘model’ in two different but closely related ways. First, I use it to describe what various actors do with and to ageing, and what then ensues: they model (verb) old age and the people who are defined as old. As a result of this modelling, different models (noun) of what are good, appropriate, proper ways to age have come into existence. Use of the terms successful ageing, active ageing, positive, healthy, productive ageing and so on is ubiquitous and variable. However, all these concepts attempt to model ageing as a phenomenon and stage of life that is perceived to be in need of direction, reshaping and control. For instance, gerontologists model (verb) successful ageing by generating data on how people within the older population fare (how long they live, how healthy they are, to what extent they take part in paid and unpaid work) and then assigning labels that signal how different categories of old people are performing (‘normal ageing’, ‘pathological ageing’, ‘successful ageing’ and so on). In addition to gerontologists, policy makers are very interested in older adults, and so they have also sought to model (verb) old age policy and older adults’ incentive structures in a particular way, for instance in a direction that would be encouraging of longer working lives. Businesses and entrepreneurs are another group interested in old people, in their case

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as consumers of goods and services, and so they also model (verb) their target group in a particular way: typically as dynamic and attractive, provided they become consumers of various goods and services. As a result of the efforts of these actors who model ageing, models (noun) of ageing have come into existence. For instance, the model (noun) of old age that suggests that older adults should continue working until retirement – and preferably longer – is now firmly a part of the definition of how to age appropriately in most developed welfare states. Another widespread model (noun) of ageing pertains to the idea that older adults should consume goods and services, that is, that they should promote both their own well-being and the good of the economy as a whole through their consumer power and choices. I also apply the term model (noun) to academic definitions and explications of successful ageing – researchers are, after all, one of the three main communities that generate products and income from the ‘new’ ageing enterprise of modelling ageing, the other two groups being policy makers/bureaucrats and business interests (for the original definition of the ageing enterprise that emphasised the latter two groups, see Estes, 1979). Second, I have formulated the first iteration of a theory of model ageing that offers an explanatory account of the origins, mechanics and consequences of this ubiquitous activity of modelling ageing. This is an interpretive theory that seeks to make sense of how later life is construed and moulded in contemporary aged societies. Interpretive theorists give ‘abstract understanding greater priority than explanation’ and ‘view theoretical understanding as gained through the theorist’s interpretation of the studied phenomenon’; the aim is to ‘understand meanings and actions and how people construct them’ (Charmaz, 2014, p 230). I have asked ‘What do people assume is real? How do they construct and act on their views of reality?’ (Charmaz, 2014, p 231) with specific reference to policy agendas and aspirations pertaining to ageing populations. I have formulated this theory because I believe that we need a new theoretical lens for viewing and making sense of what I have described above: the wide range of actors modelling ageing and

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generating models of how to age well/appropriately/productively/ actively/successfully. I argue that this (often frenetic) activity by these actors (academics, business people, policy makers) arises from their attempts to make sense of and control a phenomenon that is new, largely uncontrollable, perhaps frightening, but also fascinating and potentially profitable: the mega-trend of ageing. I use the term model ageing to encapsulate systems of ideation pertaining to the question of ‘how to age in contemporary Western society’ because these systems amount to a distinctive and coherent social construction of what it is to live like a model older person in 21st-century welfare states. Model ageing comprises policy ideals, commercial depictions and academic conceptualisations of what model old adults are or ought to be like (keen and able to work, to consume, to contribute); as I have argued in the previous chapters, it is striking how consonant the notions of successful ageing and active ageing, and other articulations of ‘how to age’ are; the theory proposed here seeks to make sense of these similarities. Accordingly, postulate number one of the model ageing theory is that 1. A wide range of actors have an interest in controlling or capitalising on population ageing. These actors construct classifications, categorisations, recommendations and aspirations pertaining to old age. These constructions of ‘how to age well’ arise from a deep concern about and with ageing: the specification of ‘solutions’ is preceded by the identification of ‘problems’ such as: (some) older people are not working/consuming/exercising enough. In other words, the language and practice of model ageing are not merely about pointing to problems (or challenges, the preferred expression in most texts about population ageing), they are also about identifying putative solutions: ‘if only (more) older people were like this, we would not have a problem with ageing’. Postulate number two therefore states that

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2. These constructs are attempts to ‘model’ ageing in the sense of pinpointing the problematic aspects of ageing, and specifying putative solutions to these problems. The endeavour to model ageing arises from both a concern about the costs and an interest in the benefits of ageing populations. The ideal scenario for actors in this field is the prospect of ‘turning silver into gold’, that is, turning the costs and other problematic aspects of ageing into benefits. Most evidently, this is the modus operandi of the businesses that seek to invest in, produce and sell products and services that claim to turn wrinkles into smooth skin, boredom into activity and fun, and so on. However, more subtle forms of the attempt to ‘turn silver into gold’ can also be detected. For instance, policy makers are increasingly active in generating win-win (or even win-win-win) scenarios concerning the older population. In the area of care services, the idea that home care is cheaper and more desirable for old people (the first ‘win’) might be combined with the conviction that more immigrant women should be brought into the care work sector as they have a ‘natural inclination’ to care, rooted in their cultural background (the second putative ‘win’), and this in turn might be linked to the third ‘win’ argument that immigrant labour remittances into the ‘country of origin’ are a form of ‘development aid’ (this ideation is common, if implicit, in Western countries – see Olakivi and Niska, 2016). Postulate number three posits that 3. Attempts to model ageing are rooted in concern about and interest in the costs of ageing populations, and aim at controlling the costs, or turning them into benefits/profit. A significant strand within the attempts to ‘turn silver into gold’ (controlling costs/maximising profit) is the trend of turning toward older adults themselves as a ‘solution’ to ‘the problems’ that they have allegedly caused or are about to cause; I call this pattern ‘turning the problem into the solution’. Again, the activities and ideas that illustrate

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this are diverse, and are driven by the three key groups of academics, policy makers and businesses. For instance, researcher communities are currently busy generating more evidence to back up the wider implementation of so-called re-ablement approaches to care, where (in a nutshell) the intention is to ‘turn’ a dependent (or potentially dependent) old person into someone who can look after herself (see Chapter Four). Another example of this trend is the exhortation that old people are ideally suited to looking after other old people: spouses should care for each other; fitter older people should get active in preparing meals for disabled older adults within their communities. In the realm of commercial interests, a good example of this trend is the recommendation that old people should tap into the equity in their homes to finance their own care. Postulate number four encapsulates the pattern that 4. The ‘solutions’ to population ageing are being increasingly drawn from ‘the problem’ by singling out ways in which older adults are malleable and can be made to absorb the costs of population ageing themselves (or made into sources of profit). Within academic research, the emphasis has been on defining and identifying ‘successful agers’. This tendency has seeped into the policy sphere, where most of the ideation arises from the image of ‘successful agers’ who strive to remain healthy and fit, stay in work and make unpaid work inputs into their community and family. For this reason, notions of model ageing tend to prove unrealistic when interrogated against the ‘reality’ of ageing populations. The diversity of older populations means that they are not amenable to simplifications. Most importantly, older populations are contoured by the same (or even more extreme) socio-structural factors as the younger population: and socioeconomic position (‘the social gradient’) has been shown, over and over, to shape how long we live, how healthy we are, and how much we are able to contribute in an unpaid capacity to voluntary work (if you are rich, usually quite a lot) and how much we have to sacrifice in the name of family care duties (if you are poor, usually a lot).

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On this basis, postulate number five states that 5. The proposed ‘solutions’ to the ‘problem’ of population ageing are progressively less collectivist, and increasingly individualistic, making extensive and unrealistic assumptions about the ability and willingness of all older people to respond to them. What happens when people who have little or no capacity are asked to contribute a lot? An older adult who bears the ‘baggage’ of disadvantage from a lifecourse characterised by childhood maltreatment, lack of educational opportunities and patchy work history is already labouring under multiple challenges; he or she is not on the same starting line as the advantaged members of the older population. Where both the older adult who has multiple advantages accumulated through the lifecourse and the disadvantaged person are supposed to accomplish the same goals, the exhortation to successful and active ageing is not fair or equitable. Therefore, postulate number six contends that 6. Model ageing has inequitable consequences because it has not been calibrated to the differential capacities of population groups to respond to it. Consequently, model ageing expectations load most heavily onto those who are least capable of meeting them. For instance, with regard to exercise, the sections of the older population who would most benefit from changing their life-style are also those where the practice of not exercising is most ingrained, and where the environment offers few supports for taking up or increasing exercise. To date, products, programmes and studies that probe into the benefits of increased exercise have not managed to reach these sections of the older population; and expecting them to transform their life-styles, with little or no external assistance (posters on the walls of health centres do not count), borders on the nonsensical. Of course, this is not to argue that older adults from poor communities have no agency to change

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their life-styles; but it must be recognised that exhorting older adults with weak material and physical resources to transform their life-style, often after a lifetime of living in social and physical environments that are inimical to good health, is not a reasonable or realistic expectation in the absence of huge public supports, which have so far not been forthcoming in any welfare state. In view of the minimal public investment in helping those who face the greatest challenges in achieving successful and active ageing, postulate number seven states that 7. Model ageing expects those with least resources to change and adapt the most. As Chapter Four argued, many older adults with extremely weak capacity and resources are already adhering to model ageing expectations, in the absence of any alternatives (for instance, they have to work to supplement meagre pensions). In contrast, those who have the requisite material, social and psychological resources can circumvent the requirements of model ageing. For instance, they can save for their retirement, retire early and avoid having to work longer. Or, they can replace active inputs into the care of their family members by hiring (or contributing towards the costs of hiring) paid help, for grandchild care or spousal care. Even in the area of community social contribution, they will be regarded as having done their duty if they make a donation of money for a good cause instead of baking, or selling raffle tickets, or other forms of volunteering. But in any case, such individuals are more likely to volunteer in the first place; they are ‘naturally inclined’ towards model ageing, and well resourced to comply with its expectations. Postulate number eight therefore states that 8. Older adults with good resources can elect to remain outside the prescriptions of model ageing. Wealthy, healthy and socially connected older adults have no problem ageing successfully, or actively. Look around any wealthy

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neighbourhood in the Western world and you will witness fit and relaxed older adults walking or driving around with their (mostly) equally fit and healthy spouses and friends – an idyllic snapshot that is substantiated by mountains of data that show ageing to be a very different set of circumstances and outcomes for disadvantaged groups. If all else fails, the older adults from higher socioeconomic groups can always purchase elements of independent living such as home-care services; such capacity to cover the costs of one’s own ageing is of course an indication of the kind of independence that welfare states are increasingly encouraging. For the same reason, virtually all antiageing and active ageing products that are on the market are targeted at wealthy older consumers, either explicitly (the products and services are expensive) or implicitly (for instance, older adults with poor diets don’t tend to have access or inclination to use ‘healthy eating’ websites). Postulate number nine is therefore in line with the Matthew principle of ‘to those who already have, more shall be given’: 9. Most older adults with good resources are already adhering to model ageing without any need for additional incentives because model ageing is in accordance with their life-style, preferences, capacities and choices: some of them stand to gain from model ageing. A good theory aspires to predict, and serves as a guide to future developments. There are no signs that the drive towards modelling ageing is abating; on the contrary, there are grounds to argue that, at least in the medium term, the tendency towards prescribing and exhorting particular behaviours will increase, for reasons outlined in postulates two and three. The final postulate, number ten, therefore predicts that 10. Model ageing tendencies will keep growing, with increasing exhortations on older adults to adapt and change their behaviours. This will have negative consequences for the disadvantaged older populations, exacerbated by the mega-trend of growing inequality.

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Box 5.1 draws together the postulates of the model ageing theory. I emphasise that this is the first iteration of the theory, the first attempt to map the territory by staking out initial propositions; relationships between key concepts remain to be teased out; hypotheses can be spelled out for the benefit of those who are inclined to test the theory; the postulates are open to falsification and modification. Box 5.1: Postulates of model ageing theory

1. A wide range of actors have an interest in controlling or capitalising on population ageing. These actors construct classifications, categorisations, recommendations and aspirations pertaining to old age. 2. These constructs are attempts to ‘model’ ageing in the sense of pinpointing the problematic aspects of ageing and specifying putative solutions to these problems. 3. Attempts to model ageing are rooted in concern about and interest in the costs of ageing populations, and aim at controlling the costs, or turning them into benefits/profit. 4. The ‘solutions’ to population ageing are being increasingly drawn from ‘the problem’ by singling out ways in which older adults are malleable and can be made to absorb the costs of population ageing themselves (or be made into sources of profit). 5. The proposed ‘solutions’ to the ‘problem’ of population ageing are progressively less collectivist, and increasingly individualistic, making extensive and unrealistic assumptions about the ability and willingness of all older people to respond to them. 6. Model ageing has deleterious consequences because it has not been calibrated to the differential capacities of population groups to respond to it. 7. Model ageing expects those with the least resources to change and adapt the most.

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8. Those with good resources can elect to remain outside the prescriptions of model ageing. 9. Most older adults with good resources are already adhering to model ageing without any need for additional incentives because model ageing is in accordance with their life-style, preferences, capacities and choices: some of them stand to gain from model ageing. 10. Model ageing tendencies will keep growing, with increasing exhortations on older adults to adapt and change their behaviours. This will have negative consequences for the disadvantaged older populations, exacerbated by the mega-trend of growing inequality.

Beyond successful and active ageing I hope that this book has demonstrated the power and danger of the successful ageing and active ageing paradigms. Academics, business people and policy makers are the actors who have set the model ageing paradigms and discourses in motion and perpetuated them. They all benefit from notions of successful, active, positive and productive ageing in various ways. For researchers, the idea of successful ageing has given a useful anchor, both intellectually and politically. Who could argue against the noble enterprise of teasing out the factors that enable the identification of the ‘secrets’ of successful ageing and the spreading of this knowledge to diverse audiences? But, as I have argued in Chapters Two and Four, the problem is that the bulk of the scholarship has focused on older adults who are already ‘successful agers’ (in the light of the multitude of different definitions), portraying them as the agents of their own success. Access to a good old age is highly dependent on the resources at one’s disposal; successful and active ageing are currently, and are set to remain, in the absence of massive transformations in public policy, the preserve of the privileged (Holstein et al, 2011). When ‘successful agers’ are asked to talk about their ‘successful ageing’, this exercise has a tautological feel – they are happy, contented older adults, talking about their lives: they are effectively describing

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their own contentment, not explaining ‘the secret’ of successful ageing for those who might actually need it (the currently ‘unsuccessful’ agers). The fallacy lies in drawing from their lives the conclusion that what they think and do equals successful ageing, a finding that is of no or very little relevance to the older adults who are not ageing successfully. What such advice and findings amount to is simply a description of the kinds of advantages that bring about further benefits over the lifecourse: education and parental wealth tend to help children succeed in the sense of getting a higher level of education, jobs, income and attendant ‘goods’ in the form of access to social ‘luxury goods’ such as stable marriage and social networks that can in turn be used to procure advantages for one’s children; and so on and so forth, until a relatively ‘successful’ old age is arrived at. In this light, successful ageing is nothing new under the sun: simply another virtuous cycle, and another manifestation of inequality. In many ways, going after the successfully and actively aged is futile: it’s nice to characterise and celebrate their ‘achievements’, but what good is that to the people who don’t get to age successfully and actively? There are groups within all ageing populations who are in some sense ‘the opposite’ of the current ideals of successful and active ageing in that they are, for instance, sick, poor, socially excluded and/or lonely (Scharf and Keating, 2012). Yet the literature that engages with how to help older adults who are currently excluded from successful ageing is pathetically sparse. Can someone impoverished, in pain and socially excluded be reasonably expected to focus on ‘acceptance of self ’ and the ‘present moment’, the key components of successful ageing as recounted by the ‘successful agers’ interviewed for a study by Reichstadt and colleagues (2010)? Few studies that probe into the ‘successful’ and ‘active’ ageing experience have been conducted with people who do not feel affinity with the term, or indeed with populations who would be prepared to state that they are not ageing successfully. This is not surprising, as disadvantaged, unhealthy and unhappy people are not very likely to come forward as participants in a study about successful/positive/active ageing.

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Nonetheless, such is the grip of the idea of successful ageing that some studies have sought to ‘democratise’ the concept by teasing out more and more meanings that older adults attach to the term, including older adults in very marginalised positions in society. I argue that this has contributed to hollowing out the term in an insidious way, suggesting that successful ageing is now within everyone’s reach – a dangerous argument at a time when more and more is expected from older adults in policy discourses that espouse active ageing for everybody. If everybody is argued to be successful and active ageing material, then we don’t appear to have a problem with blanket increases in retirement age – regardless of the fact that the differences in life expectancy between socioeconomic groups are growing in many countries (Crimmins et al, 2011). There is no doubt that some groups live longer, healthier, wealthier and less stressful lives than others, and that by and large these fortunate groups are ageing productively, optimally, actively, successfully – you name it, they are doing well. My argument is that the disadvantaged groups’ exclusion from outcomes that really matter in ageing (such as maintenance of good health in old age) is a real and serious issue, and that the focus on successful and active ageing has by and large failed to bring us closer to helping them age successfully because it has been focused on the ‘successful agers’, rather than on how to help the ‘unsuccessful agers’ reach better outcomes. At the level of policy, successful ageing has translated into notions of active ageing – informed by the research on ‘successful agers’, and policy is calibrated according to their abilities, needs and preferences. Thus we arrive at the dangerous situation of modelling policy for ‘older people’ as a single, homogeneous group on the basis of the abilities and preferences of the more privileged and ‘higher performing’ sections of the ageing populations. The attempt to prescribe ‘model’ behaviours and to put in place policies that ostensibly enable all older adults to turn into ‘active’ and ‘successful’ agers is a dangerous and blinkered way of looking at ageing and older adults. It demands too much from those who have the fewest resources, while leaving off the hook those who can devise their own strategies for ageing well.

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The policy alternatives that would be more in line with what we know about unequal outcomes in old age are not considered seriously anywhere. For instance, in the light of the differential (healthy) life expectancies and disability statuses of higher-educated versus lowereducated workers (as close to a universal pattern as it gets in empirical social science), it is not fair and equitable to push uniform increases in retirement age. Rather, there should be attempts to calibrate retirement age and the latter stages of working life to education, occupational status and health – some groups should be allowed to retire earlier, not later, than they currently do, while others should be expected to work a lot longer than most. Yet this fully evidence-based solution to the ‘pensions crisis’ does not appear to be on the table anywhere. Model ageing is an integrative concept that encapsulates the social constructs that various actors who are invested in ageing populations are peddling to their own advantage (whether that is to sell research, antiageing products or policy ideas). There are better or worse outcomes for us all as we age: living longer versus dying; being healthy versus sick; having social contacts versus feeling lonely. In the eagerness to develop conceptions of model ageing, we have forgotten to focus on what really matters: how to help those who struggle most to reach good outcomes in old age – and indeed throughout their lifecourse, as most problems that manifest in old age have their origin in earlier life. This book is a call for a new focus on them, and away from the obsession with different manifestations of model ageing that pervade societies, polities, markets and media – and large sections of scientific research on ageing. Therefore, this book also strives to be a manifesto – for greater understanding of how we all contribute to modelling ageing and older people, and for awareness of the consequences of such modelling. We know virtually nothing about ‘turning’ an ‘unsuccessful’ ager into a successful one at population level. Intervention studies have very occasionally informed national or regional campaigns that have had some effect at population level, but these are very rare exceptions. Such large-scale campaigns are less and less likely as polities worry more and more about the cost implications of ageing populations,

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but researchers are partly to blame, too: in their inclination to understand the ‘successful’ agers, and those who are amenable to ‘age successfully’, they have left the ‘unsuccessful’ agers largely untouched by social science aimed at practical applications and interventions. Even randomised controlled trials that seek to establish the impact of interventions tend to gravitate towards populations who are interested and available to participate, that is, people who are by definition already ‘successful agers’ in the light of some important criteria, such as social connectedness and keenness to keep learning and to take charge of their lives. There is now widespread consensus that ‘ageing begins in the womb’, but many gerontologists are loath to come forward as advocates for heavier spending on children, despite the fact that this is the single most effective and sensible way of trying to ensure better lives at older ages (there appears to be a long time-lag here, but the effects of investing in children are more immediate if we consider family systems – for instance, less pressure on older adults to support younger family members if supports to children are improved). However, there are some promising signs that ‘geroscience’ is becoming more oriented to understanding and developing interventions for still-young populations (where the rate of biological ageing has been shown to be remarkably variable) because ‘early identification of accelerated aging before chronic disease becomes established may offer opportunities for prevention … and testing the effectiveness of therapies’ (Belsky et al, 2015, p E4109). Of course, much more can be done to improve the outcomes for disadvantaged groups in mid-life and old age, too (such as improvements in the lowest pensions and access to good-quality long-term care), but these attempts are increasingly overshadowed by exhortations to individual responsibility. We also need to remain sceptical about the extent to which ‘successful’ and ‘active’ agers, who are presented as the ideal to aspire towards, are bearing the brunt of the requirements to alleviate the costs of population ageing. Many of them have a much greater degree of choice than the ‘unsuccessful’ agers to calibrate their involvement in the successful/model ageing enterprise, in accordance with their

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wishes and preferences. For instance, a healthy, well-off grandparent can choose to devote himself to grandchild care (and many of course do, entirely voluntarily) or siphon some of his monetary wealth towards supporting the young parents who might struggle to pay for childcare, thereby freeing himself to pursue his own interests while still having satisfied any expectations of intergenerational support that the young parents might harbour. A poor grandparent, in contrast, does not have such a choice. He can either give the care, possibly at a very high (opportunity) cost to his own health, time use and well-being, or desist from giving care, which might happen at the expense of family conflict as the expectations and needs of younger family members are not met. The low-income grandfather appears to have the same choice as the high-income one (to give care or not), but in reality his ‘choices’ can boil down to unattractive alternatives that have negative consequences for the grandfather (and possibly for the younger family members if, for example, the grandfather’s poor health means that he cannot take the grandchild outside during the day). In short, model ageing requirements are blind to social differences and therefore treat different socioeconomic strata inequitably. The biggest problem with model ageing is that it will become a new driver of social exclusion, because not everybody can adhere to it to an equal extent. Those who cannot adhere to model ageing may be blamed for their ‘deviant’ behaviour and perhaps even deemed undeserving of supports (Holstein and Minkler, 2003). The combination of the drive towards active ageing and growing inequalities (in employment, incomes, assets, care work, health status) is set to have extensive consequences. Successful and active ageing, with their focus on approving and cheering on the ‘winners’, are fundamentally incompatible with the goal of more egalitarian policies and more equal outcomes as we age. Polities would be wiser and fairer to focus on combating inequalities across the lifecourse, with particularly strong orientation to combating early-life disadvantage, without forgetting the gaping differences in outcomes in old age between socioeconomic groups. Because model ageing has the potential to reinforce existing inequalities, those engaged in the politics and science of ageing have a

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moral duty to seek a new focus on the people and groups who struggle most to achieve increased longevity and other positive outcomes that are within reach of more privileged groups in society. Our societies and polities are lagging behind demographic trends in many respects: we still use pathetically limiting language and notions about ageing and old people (this includes polar notions such as old people are a burden/dividend; powerless/greedy; out-of-touch/wise). We structure the lives of older adults in ways that are out of step with what many of them want to do and are capable of doing: some need and want to retire in the fullest sense of the word, others never to stop working. We expect both too much and too little from these ‘older people’: we are not prepared to see them as a thoroughly heterogeneous population: hence the striving to model them. The way in which we conduct research on older adults is hemmed in by preconceived notions of what they are interested in, how they occupy themselves, what makes their lives meaningful; in other ways, by models of ageing. The business, political, administrative and academic endeavours to model ageing will continue for a long time. I encourage everyone to approach these endeavours critically, as they are driven by powerful and well-resourced groups that do not operate in the interest of the older adults who are most in need of help, but first and foremost in their own interest as merchants of knowledge, products and policies on the market-places of ageing.

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Index

anti-model agers 61, 62, 63, 64–5, 85–6 apps 28 ‘authentic ageing’ 70

A Abbott, A. 10 abduction 9–10 Aboriginal people, Australia 69–70 active ageing 98–9 as a concept 11 critique of 35–59 definition of 40 EU policy 42–55 measurement of 54–8 moving beyond 96–102 social determinants of 77–8 UN policy 37, 38–9 virtuous circle of 79, 79 WHO policy 37, 38, 39–41 see also model ageing Active Ageing Index 54–5 activity theory 14 adverse contexts 7–8, 63 age discrimination 29, 51 age management strategies 51 age-friendly environments, EU policy 45 ‘ageing well’ 70 ageing, pace of 24–5 ageism 29, 51 agency 78 individual choice/agency 17, 23–7 and structure 81–5 Alzheimer’s disease 22, 24 analytic induction 10 Andor, Lázló 52 ‘anti-ageing’ industry 28–9, 82, 87–8, 90

B Baltes, M. 22–3 Baltes, P. 22–3 Belsky, D. 24–5 benefit system 51 Berkman, L. 86 Berridge, C. 30–1 Bhaskar, R. 8 biomarkers 24–5 biomedical model of ageing 17–18 Bowling, A. 19–20, 36, 80, 82 Brandt, M. 77 Brundtland, Gro Harlem 39 businesses: ‘anti-ageing’ industry 28–9, 82, 87–8, 90 Byrnes, M. 26, 29

C Calasanti, T. 77 cancer, age-related 24 capabilities approach 65 cardiovascular health 24 care costs 4 EU policy 43 care provision 65–6, 86 autonomy in long-term care 45 EU policy 45, 46–9 immigrant women, as care providers 90 social investment approach to 46–7

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unpaid care 2, 4, 53, 67, 91 and work responsibilities 51 Cato 14 childcare, by grandparents 55, 101 children, as target for health promotion 25, 100 cholesterol 24 Christakis, N. 82 chronic illness, and ageing 17–18, 22, 27 Cialis 28 Cicero 14 co-production 65, 67 cognitive function 16, 22, 28, 49 coherence 80–1 conducive contexts 7, 8, 63 Cooney, T. 77 Cosco, T. 13 cosmetics/cosmetic surgery 28 Council of the European Union 43–4, 44–6, 50–1 critical realism 8 cultural differences 21 cytokines 24

employment 7, 16, 51 and care responsibilities 51 extension of working lives 7, 42, 50, 52, 58, 70–2, 99 epistemological underpinnings 8–10 Erikson, E. 22 Erlinghagen, M. 72–4 European Commission 7, 28, 42, 44, 46, 47–8, 49, 54–5, 65 European Council 42–3, 44, 50–1 European Innovation Partnership (EIP) on Active and Healthy Ageing 37–8 European Union (EU): active ageing policy 37–8, 42–55 European Year of Active Ageing and Solidarity between Generations (2012) 43, 54

F Federal Volunteer Service (Bundesfreiwilligendienst), Germany 74–5 Ferraro, K. 77 final salary pension schemes 85 Finland 71–2 Flatt, M.A. 28–9 Foster, L. 35–6, 57–8 Fourth Age 21 Fowler, J. 82 Fry, C. 21

D de Medeiros, K. 26–7 decision making, participation in 53 defined contribution pension schemes 85 dementia 22, 25 Denmark 55, 66–7 Depp, C. 13 Dieppe, P. 19–20, 80, 82 dietary supplements 28 Dillaway, H. 26, 29 disability 17–18, 21–2, 65 disease prevention, EU policy 44, 48 disengagement theory 14

G gender blindness 2–3 generations, solidarity between 43–4 genetic influences on ageing 24–5, 26 Germany 56, 74–5 Gerontologist, The 29–31 gerontologists 87 and anti-ageing practitioners 28–9 gerotranscendence 22 Gilleard, C. 21, 58, 78, 85 grandparents, and childcare 55, 76, 101

E ‘Eastern’ cultures, and successful ageing 21 education 16, 83–4 Ellis, C. 85 empirical material 9

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INDEX Guiding Principles for Active Ageing and Solidarity Between Generations (Council of the European Union) 44–5

Karisto, A. 71–2 Katz, S. 28, 77

L lay perspectives on successful ageing 19–20, 21 Liang, J. 21 lifelong learning, EU policy 50, 53 lifestyle factors 25–6 and model ageing theory 92–3 lipid levels 24 lipoprotein levels 24 locus of control 81 Luo, B. 21

H Hank, K. 55, 72–4 ‘harmonious ageing’ 21 Havighurst, R. 14 ‘health experts’ 5–6 health promotion 83 EU policy 44 Finland 71–2 young people 25, 100 Hello Brain 28 Higgs, P. 21, 28, 58, 78, 85 Holstein, Martha 75–6 homogenous outcomes, paradox of 3 housing provision, EU policy 45 Hutchinson, S. 22

M Martinson, M. 30–1 Masoro, E. 25–6 McFarquhar, T. 36 McLaughlin, S. 18 meaningfulness 80–1 men, unpaid care by 2, 76 Minkler, M. 75–6 model ageing 59, 61–3, 85–6 agency and structure in 81–5 attributes of ‘model agers’ 78–81, 79 dimensions of 64–5 and independent living 65–70 social determinants of 77–8 and social productivity 72-6 theory of 87–96 and working longer 70–2 model agers 62–3, 78–81, 79 model behaviour of older people 4–5, 54, 57 Montross, L. 18

I Iliffe, S. 80 immigrant women, as care providers 90 independence, paradox of 2 independent living 7, 65–70 EU policy 44–50 individual choice/agency 17, 23–7 individuals, and model behaviour 56–7 inequalities 67, 97, 101–2 and active ageing policies 57–8 and model ageing theory 92–3 interpretive theory 88–9 isolation 16 Italy 76

N

J

neoliberalism 26, 29 Neugarten, B. 20 ‘neuroculture’ 28 Nimrod, G. 22 non-volunteering 74–5

Jeste, D. 13, 18 Journals of Gerontology (Psychological Sciences and Social Sciences) 31

K

O

Kahn, R. 14–17, 18, 26–7, 29–30, 31–2, 33, 77

Older Americans Act (1960s) 73 Ossewaarde, M. 5–6

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social policy x and active ageing models 35–59, 98–9 effect on outcomes 84 and gender 2 and model ageing theory 90–1 turning the problem into the solution 4,90–1 and volunteering 73–4 social productivity 7, 16, 72–6 EU policy 52–4 socioemotional selectivity theory 23 Soo-Jung, P. 21 Soondool, C. 21 South Korea 21 Spain 55 Stenner, P. 36 Stowe, J. 77 Strawbridge, W. 18 strokes, risk of 25 structure, and agency 81–5 successful ageing 1, 33, 36, viii–x and active ageing 59 as a commodity 27–32 critique of concept 17–33 definition issues 13, 17–20 and individual control 23–7 meaningless as a concept 21–3 moving beyond 96–102 social determinants of 77–8 ubiquity and longevity of concept 13–17 see also model ageing successful agers 91, 96–7, 100–1

P Palmore, E. 14 pension age, increases in 7, 42, 50, 52, 58, 70–2, 84–5, 99 Pfeiffer, E. 17, viii–x Phelan, E.A. 18–19 physical activity/exercise 16 Poland 55, 72 popular press, and successful ageing 29–30 Pruchno, R. 20, 29–30 psychological attributes 20, 80

R Ranzijn, R. 69–70 re-ablement approach 66–9, 91 rehabilitation 66 Reichstadt, J. 19, 97 restorative care services 66 retirement age: increase in 7, 42, 50, 52, 58, 70–2, 99 United States 84–5 Rohwedder, S. 48–9 Romani people 69 Rowe, J. 14–17, 18, 26–7, 29–30, 31–2, 33, 77 Rubinstein, R. 26–7

S Schafer, M. 77 self-efficacy 16, 80 service provision, EU policy 45 sexuality 28 SHARE (Survey on Health, Ageing and Retirement in Europe) 72–4 Silbereisen, R. 56 SOC (Selective Optimisation with Compensation) model 22–3 social class 81, 83, 91 and active ageing 40 and model ageing theory 91, 93–4 social class blindness 2–3, 78 social factors 16, 27 social investment approach 46-7, 65, 66, 68 social learning theory 81

T Tate, R. 18 tax system 51 Tomasik, M. 56 Tornstam, L. 22 transcendent perspective 22 transport, EU policy 45 turning the problem into the solution 4, 90–1

U UN (United Nations): and active ageing policy 37, 38–9

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INDEX Principles for Older Persons 38 World Assembly on Ageing (1982) 38 UNECE (UN Economic Commission for Europe) 54–5 United States: retirement ages 84–5 and successful ageing 21 volunteering 73 usual aging 15

Y young people, as target for health promotion 25, 100 youth unemployment 52

V Viagra 28 Vienna International Plan of Action on Ageing 38 virtuous circle of active ageing 79, 79 vocational education/training 50 volunteering 4, 42, 72–6 EU policy 53 non-volunteering 74–5

W Walker, A. 35–6, 57–8 WHO (World Health Organisation): ‘International Year of Older Persons’ (1999) 38 and active ageing policy 37, 38, 39–41 Active Ageing Policy Framework (2002) 39–41 Ageing - Exploding the Myths 38–9 World Report on ageing (2015) 41 Williams, S. 28 Willis, R. 48–9 wisdom, age-related 23 women: immigrant women, as care providers 90 and social policy 2 unpaid care by 2 working conditions 51 working lives, extension of 7, 42, 50, 52, 58, 70–2, 99

119