3DOI: 10.1891/0198-8794.29.3
C H A P T E R 1
Theories of Aging From a Life-Course and Life-Span PerspectiveAn Overview
Heather Fuller-Iglesias, Jacqui Smith, and Toni C. Antonucci
Life-course and life-span theoretical perspectives have important implications for gerontological studies. Both frameworks address patterns of change over time that inform our understanding of the process of aging. In considering health inequalities in later life, both life-course and life-span perspectives play an integral role in determining micro- and macrolevel infl uences on health and well-being in late life. In this chapter we consider the theoretical under-pinnings of a life-long approach to health disparities, major themes in the life-course and life-span perspectives on aging, and cumulative inequalities and disparities on well-being and health.
Theoretically, there is now a broad consensus across many disciplines in the social (sociology, psychology, philosophy, economics, and demogra-phy) and medical sciences (biology, genetics, medicine, public health, and epidemiology) that in order to understand the phenomena of old age and aging processes it is important to take a life-span developmental and life-course perspective. Economists sometimes call this a life-cycle perspective. For some research disciplines, this idea has a long history, in others the history spans several decades, and for a few it remains counterintuitive. Historically, phases (e.g., childhood and old age) and experiences (e.g.,
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education and health) of the life course were considered somewhat inde-pendently, because few believed that the normative events of early life had consequences for old age.
There are many similarities between the two perspectives, the most obvi-ous one being that both advocate taking a long-term, multilevel, contextual, and dynamic view of aging. Life-span theories draw attention to the length of the life of an individual and to the idea that processes and trajectories of development and aging are lifelong (Lerner, 2002). Life-course theories, in con-trast, differentiate between subgroups in society and focus on the social path-ways that defi ne the sequence of events, transitions, roles, and experiences in the lives of individuals (e.g., Alwin & Wray, 2005; Settersen, 2007). While life-span researchers are interested primarily in understanding microlevel (endogenous) processes within the aging individual (e.g., the aging brain and mind), life-course researchers typically analyze the macrolevel ( exogenous) processes that characterize the infl uence of groups, organizations, and institu-tions on the individuals within them.
Despite these differences in topical emphases and levels of measure-ment, in general, there is much concordance between the life-span and life-course perspectives. Together these perspectives present a comprehensive theoretical framework of human development over time. Recent advances in both suggest that there is considerable value in integrating the premises and conceptualizations of both theories and expanding them to form a truly multidisciplinary framework.
The life-span and life-course perspectives each, by moving beyond the study of development as isolated and age specifi c, recognize that all age periods (including old age) are dynamic and cumulative. To under-stand the human experience it must be viewed across time. Research should examine both micro- and macro-infl uences, consider gains as well as losses, and identify factors of risk and resilience. These frameworks can be seen as integral not to preventing aging, but rather to promoting opti-mal development at all ages, including old age. In sum, because aging is a lifelong process and old age is the result of a lifetime of experiences, it is essential to study old age within a life-span and life-course perspective. In-creasingly researchers in many of the disciplines involved in gerontology are adopting this general position. We believe that only by adopting. This per-spective can we fully understand the health inequalities that are evident in later life.
The next section of this chapter outlines important major themes from life-span and life-course perspectives of aging and describes how they are integral to understanding the aging society.
Theories of Aging From a Life-Course 5
MAJOR THEMES IN THE LIFE-COURSE AND LIFE-SPAN PERSPECTIVES ON AGING
It can be argued that the primary distinction between life-span and life-course theories is the disciplinary lens that logically guides a divergence; on the weight placed on comprehending individual versus social contextual processes. The central themes that are listed in Table 1.1 highlight a few of these disciplinary differences. Presenting such a tabular distinction harbors the dangerous con-notation that life-course and life-span researchers occupy opposing camps, a viewpoint that we especially do not intend to convey. Instead, our intention in this section is to provide a didactic overview of a select illustrative set of salient themes that guide the choice of specifi c topics and methods among researchers in different fi elds. As illustrative examples, they can not refl ect the eclectic, conceptual state of contemporary research on aging and the many models of biopsychosocial co-construction of aging. Life-span researchers, for example, increasingly utilize study designs that examine the role of social context, subgroup variation, and cohort in the examination of psychological outcomes (Heckhausen, 1999). Similarly, life-course researchers have moved toward the incorporation and examination of individual-level processes in their models and analyses (e.g., Berkman, Glass, Brissette, & Seeman, 2000; Mayer, 2003). Both perspectives are fundamentally important for gaining a fuller understanding of health inequalities in later life.
THEMES IN LIFE-COURSE RESEARCHLife-course theory takes a macrolevel, group, or societal view of developmental infl uences. It is a theoretical framework for addressing the temporal sequence of age-graded roles and expectations that are embedded in social institutions
TABLE 1.1A Selection of Major Themes to Illustrate the Life-Course
and Life-Span Perspectives
Major Themes
Life Course Perspective Life Span Perspective
Age, cohort, & historical effects Individual differences
Accumulation of (in)equalities Adaptivity and plasticity
Life Course & Life Span PerspectivesLinked lives
Differential trajectories and pathways of aging
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and history (Elder, Johnson, & Crosnoe, 2003; Mortimer & Shanahan, 2003). The life-course perspective makes a unique contribution in understanding, at the population or group level, the roles of age stratifi cation, cohort and historical period effects, and the accumulation of (in)equalities over time.
Age, Cohort, and Historical EffectsNormative age structuring and age stratifi cation are ideas in the forefront of life-course theories and research. In general, these concepts describe the fact that most societies use chronological age formally and informally to structure the experiences, roles, and statuses of individuals (Dannefer & Uhlenberg, 1999; Riley, 1987). In a formal way, social institutions defi ne, segment, and construct individual lives in the interconnected domains of education, family, and work over the life course (Mayer & Tuma, 1990). Because some social institutions (e.g., education, work, retirement) are typically created for spe-cifi c age groups, chronological age also stratifi es the ways that opportunities are, or sometimes are not, made available to individuals in a population. At an informal level, individuals and subgroups create beliefs and attitudes about age categories (e.g., young, middle age, old), aging, and the kinds of behavior appropriate to individuals of different ages.
Kohli (1986) proposed that the life course itself has become increasingly institutionalized. He considers the normative age-graded structural pattern-ing of education, work, and retirement as evidence that the life course has become a modern social institution. This institutionalization of the life course suggests that there is a standard life pattern that is guided by rules about how individuals structure their lives that are upheld by an infrastructure of so-cial and legal norms and organizational systems (i.e., education: Kohli, 2007; Kohli & Meyer, 1986). Some are more advantaged by the institutionalization of these life-course patterns while others are not. The three central features of the institutionalization of the life course are chronologization (the saliency of age and time), institutionalization (ways in which the life course is structured by organizations, institutions, and the state), and standardization (the resulting normativity of life-course patterns). In effect, the societal context infl uences and implements a standard life course. Each of these features contributes to inequalities and different pathways across the life course.
The principle of time and place refl ects the notion that the life course of individuals is embedded and shaped by the historical times and places they experience over their lifetime (Elder et al., 2003). The primary emphasis of the principle of time and place is the importance of historical effects on human development. Major historical events have the power to not only transform societies, but also have great impact on development at the generational and individual levels. A prime example of how time and place have signifi cance
Theories of Aging From a Life-Course 7
is the effect of the Great Depression (Elder, 1974). Individuals living in the United States were all affected by this major historical stressor. However, a cohort effect––differentiation of the lives of different birth cohorts as a result of historical change—also occurred as a function of the differential timing of the Great Depression in the lives of children, adolescents, and young adults; some cohorts were more vulnerable than others. Similarly, African Americans were differentially affected by the Civil Rights Movement depending upon their age and cohort. Young people had new opportunities opened to them such as access to education, while old people were not able to take advantage of this new access ( Jackson, 1993). The preceding examples illustrate how time and place (i.e., birth year and historical context) can result in differing outcomes between cohorts. A period effect occurs when a historical event has a similar effect on multiple birth cohorts, such as 9/11 and Hurricane Katrina.
In contrast to the principle of time and place that focuses on historical infl uences on development and aging in different generations, the principle of timing in lives focuses on time in relation to individual trajectories. This principle highlights the fact that the effects of life transitions, events, and be-havioral patterns on human development vary according to the timing in a person’s life (Elder & Shanahan, 2005). In effect, whether the timing of a tran-sition or life event is normative or nonnormative directly affects the individu-al’s developmental outcomes. Elder describes four concepts that are related to timing in lives ( Elder et al., 2003): (1) Social pathways that refer to patterns of education, career, family, and living arrangements that are socially ascribed and followed by individuals and groups within a society; (2) Trajectories that refer specifi cally to the sequences of roles and experiences that make up an individual’s development throughout the life course; (3) Exit transitions, changes in state or role, which refers specifi cally to times in the developmental trajectory when the individual makes a normative change; and, (4) Transitions that generally refl ect on time role changes, such as becoming a parent during the childbearing years or becoming a widow in old age. These turning points can involve substantial changes in the direction of an individual’s life and generally refl ect nonnormative or unexpected life events. An example of such a turning point is deployment to a war combat zone or becoming a widow in early adulthood. Each of these concepts represents the temporal nature of the life course and points to the importance of considering the differential impact of inequalities.
Accumulation of Equalities and InequalitiesStatus disparities are fundamental aspects of virtually all societies and social groups. Status is structured and ascribed on many dimensions, for example, by wealth, knowledge, competence, physical strength, health, group membership
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(e.g., ethnic group, immigrant, sex, age), and perceived contribution to a group. A person’s position in the social stratifi cation system is the most consis-tent predictor of his or her behavior, attitudes, and life chances. Some authors describe this as an individual’s life course capital (e.g., O’Rand, 2003). One consequence of the social and historical structuring of the life course is that it is associated with a hierarchy of opportunities and exposure to constraints and risks for individuals and groups within a population. At a single point in time, this contributes to observations of heterogeneity in resources, such as wealth, education, and health. Some individuals have greater access to resources and more opportunities than others. Because of their birth cohort and position in the life course, some individuals benefi t from technological advances or periods of economic growth whereas others do not. Furthermore, personal histories of differential opportunity and exposure are transferred from one generation to the next in the contexts of families and social groups.
Additionally, disadvantages may accrue over the life course and have a cumulative effect on outcomes late in the life, such as health and longevity (Glymour, Ertel, & Berkman, 2009). Social disadvantage is likely to be related to stress exposure. Cumulative disadvantage is the term used to refer to dis-advantages that sum over the life course and predict worse health in old age. Much of the research on cumulative disadvantage focuses on socioeconomic status, race, ethnicity, and gender (House, Latz, & Herd, 2005; Marmot, 2006; O’Rand, 2003; Smith & Kington, 1997). Older adults with lower edu-cation levels experience worse health sooner than their higher SES counter-parts (Marmot, 2006; Willson, Shuey, & Elder, 2007). Moreover, Shuey and Willson (2008) found a cumulative disadvantage for Blacks in that they did not experience the same health benefi ts from advanced education that Whites did. House and colleagues (2005) suggest that understanding social dispari-ties in health is a key problem for life-course researchers and is essential to understanding health and illness in old age.
Race and ethnicity are important group level factors to address in ag-ing research as they encompass biological, environmental, historical, cultural, and social infl uences. Within the United States, ethnic and racial minorities show relatively poorer status in old age as compared to their majority White counterparts ( Jackson, Brown, & Antonucci, 2004). Of note is the fact that based upon current estimates of mortality and life expectancies, older minority populations are growing rapidly and will continue to do so ( Jackson & Sellers, 2001). Some data indicate a crossover effect in that some minority populations of advanced ages, for example Blacks (e.g., Gibson & Jackson, 1992), may be more robust in comparison to Whites, perhaps refl ecting different aging processes and selection over time for hardier individuals (Manton, Patrick, &
Theories of Aging From a Life-Course 9
Johnson, 1987). However, at every point earlier in the individual life span most members of racial and ethnic minority groups are at greater mortality and morbidity risk than Whites ( Jackson & Sellers, 2001).
A life-course perspective illuminates the fact that current and aging cohorts of underrepresented race–ethnic minorities have been exposed to conditions that will profoundly infl uence their social, psychological, and health statuses from childhood to adulthood and older ages in the years and decades to come (Baltes, 1997; Barresi, 1987). Indeed, historically gerontolo-gists have described the double (race, age) and triple (race, age, and gender) jeopardy experienced by some groups.
THEMES IN LIFE-SPAN RESEARCHThe life-span perspective complements the life-course perspective with a greater focus at the individual level. The life-span approach as defi ned by Bal-tes (1997; Baltes & Goulet, 1970; Baltes, Reese, & Nesselroade, 1988) con-sists of a family of proposals that attempts to describe the patterning of growth, stability, and change in behavior throughout the entire life course. The em-phasis is on understanding the general principles of development and change at all ages, interindividual differences in change trajectories, and the modifi -ability (plasticity) of development and aging. This three-component emphasis on questions about development and aging (communalities, interindividual differences, and intraindividual plasticity) is a core feature that distinguishes the life-span approach.
Because of the complexity and plasticity of the conditions shaping the course of human development, the general approach of life-span theorists has always been (a) to highlight the pluralistic and dynamic nature of contextual infl uences on individual change, and (b) to consider individual development itself as a changing phenomenon. With regard to the fi rst issue, life-span theo-rists are in agreement with life-course theorists. Thinking about the changing individual interacting with a changing world is more unique to the life-span perspective.
Individual Differences in FunctioningMany life-span researchers emerge from the research tradition of exploring individual differences in social relationships (e.g., social support), cognitive ability (e.g., intelligence), and disposition (e.g., personality), and the intricate ways that these individual characteristics shape the life-span development of the person. Further, they highlight the importance of examining individual differences in intraindividual change. The focus on individual differences
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serves to highlight the heterogeneity of functioning within age and social groups. Indeed, in some instances there is greater variation within groups than between groups. Whereas much research on health inequalities focuses on group differences in pathological versus nonpathological groups, a life span perspective points to the importance of individual differences within each of these categories. We often neglect to examine the range of normal healthy functioning or the potential to optimize health. In addition, within pathological functioning there are also well-known individual differences in the range and progression of disease (e.g., in dementia, diabetes, and cardiovascular disease).
Adaptivity, Plasticity and ResilienceLife-span development is adaptation by defi nition. Adaptation includes an evolving balance of gains and losses across the life course. An important adap-tive task across the life span is the allocation of resources to address functions of growth, maintenance, and regulation of loss (Baltes, Lindenberger, & Staudinger, 2005). This dynamic between gains and losses is moderated by the interaction between biological and cultural resources and strategies of self-regulation (e.g., life management strategies of selection, optimization, and compensation). Baltes has noted that while the role of culture increases with age, current cultural infrastructure lacks the appropriate support mecha-nisms to promote successful development into late life. As individuals age, they move from using their capacities for growth to using their capacities for maintaining the skills that they have acquired, as well as the prevention of loss of those skills or specifi c efforts to recover things that have been lost. However, lifelong development encompasses not only advances in adaptivity but also presents challenges and even losses of adaptive capacity across the life span. Individual differences infl uence the capacity to adapt to their life circumstances. In addition, people in different social groups may be exposed to and be required to adapt to different life circumstances.
Plasticity refers to within-person variability (Gollin, 1981; Lerner, 1984; 2002). Such variability is an indication of the individual’s potential for differ-ent levels of functioning or development. Physiological systems that adjust our heart rate depending on energy expenditure and temperature sensitivity in relation to environment changes exemplify this notion (for other examples see Bornstein & Suess, 1998). In some psychological domains (e.g., self and personality) the capacity to adapt to a changing environment implies resil-ience, another exemplifi cation of intraindividual variability (fl exibility; e.g., Eizenman, Nesselroade, Featherman, & Rowe, 1997; Nesselroade, 1991). In other domains (e.g., cognitive functioning), interest lies in determining an
Theories of Aging From a Life-Course 11
individual’s potential (or reserve capacity) to learn new things or increase the level or speed of performance. The concept of plasticity (and possible changes in the range of plasticity across the life span) underlies questions about modifi cation principles associated with optimizing behavior and development. Rowe and Kahn (1987) have argued that successful aging “is a generalized capacity to respond with resilience to challenges from one’s mind, body, and environment.” Because old age is a stage of increased psy-chosocial stressors, such as the death of loved ones, the onset of physical health declines, and increased chronic and disabling diseases, it may be the case that certain forms of adversity become more normative in old age. Old age presents more challenges than other stages of the life span; plasticity and resilience in late life addresses the ability to compensate for age-related losses. It is likely that plasticity and resilience are infl uenced by and infl uence accumulated life inequalities.
LIFE-COURSE AND LIFE-SPAN THEMESThough life-course and life-span research have developed across distinct trajectories, there are research topics in which these two theoretical frame-works have overlapped. Both life-course and life-span perspectives make important contributions to the understanding of interdependencies or links between the lives of individuals within society and differential pathways and trajectories of aging. Linked Lives and differential pathways and trajectories of aging are examined within the context of individual and group differences.
Linked LivesThe principle of linked lives refers to the interconnectedness of individuals as they develop and adapt. Human lives are lived interdependently and sociohis-torical infl uences are expressed through a network of shared relationships and exchanges of social support (Antonucci, 2001; Elder, 1998; Smith & Christakis 2008). According to life-course theory the social context affects individuals both directly and indirectly. This indirect route is by way of social relations and interconnectedness between individuals. Sociohistorical infl uences may be experienced by one family member but indirectly affect other family mem-bers. For example, women who fought for women’s rights during the Feminist Movement may transmit infl uences of this historical event to their children, despite the fact that their children did not experience the sociohistorical event fi rsthand. One family member’s tragedy or triumph (e.g., terminal illness, job promotion) fundamentally infl uences other members of the family. Similarly, living in a family with one child or 10 children, or with a developmentally
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disabled child, infl uences all members of that family. Empirical investigations of the effects of linked lives are relatively recent, but refl ect increasing sophis-tication in methodological and analytical strategies, such as dyadic dependent statistical models (Roberts, Smith, Jackson, & Edmonds, 2009).
The convoy model of social relations (Antonucci, 1985; Kahn & Antonucci, 1980) offers a life-course perspective on the role of linked lives in development and aging. The convoy model is grounded within a life-span perspective recognizing that these relations are both individual and cumulative and that they refl ect a lifetime of experiences and exchanges. Family and inter-generational relations are conceptualized as longitudinal in nature, shaped by personal (e.g., age, gender, personality) and situational (e.g., role expectations, resources, demands) characteristics. One can think of personal characteristics as representative of the life-span perspective’s focus on the individual and situ-ational characteristics as representative of the life-course perspective’s focus on the broader context. Both infl uence the structure and exchange of social sup-port that, in turn, can buffer the effects of stress and infl uence health and well-being. The positive support families provide accumulates over time, can help an individual feel competent to cope with stress, succeed in achieving multiple goals, and face the challenges of life. For the aging process, the convoy model highlights the infl uential nature of the interconnectedness of individuals. It is not only individual factors or the broader contextual factors that predict aging, but also the direct interactions and reciprocal infl uence between individuals in families with linked life trajectories. These linked lives can be positive or negative promoting optimal aging or accumulating inequalities.
Differential Pathways and Trajectories of AgingBoth life-course and life-span researchers use longitudinal data to examine hypotheses about different patterns of change over time associated with the effects of biogenetic, life history, social, and personal factors. While re-searchers from a life-course perspective typically examine subgroup differences in social pathways of aging, those from a life-span perspective typically focus on individual differences in trajectories of intraindividual change. This distinction is an overgeneralization: in fact, proponents from both perspectives use the terms trajectories and pathways. Nevertheless, it serves to highlight the rea-sons for different questions, statistical methods and selection of predictors of age-related change. The examples described below illustrate this point.
When life-course researchers consider trajectories of aging, they embed the trajectories in social pathways defi ned by social institutions (e.g., subgroups with different levels of education or socioeconomic status) and relationships that provide social support (e.g., family). Life-course trajectories are charted by
Theories of Aging From a Life-Course 13
linking a sequence of events, states, or transitions across successive years (e.g., the states of employment, marriage, disability, cognitive status, and health). Questions about cohort differences in patterns of trajectories (e.g., trends in disability or transition to retirement) are prevalent in life-course research.
Life-span researchers, on the other hand, generally consider trajectories at the level of the individual and model developmental changes in behavior and functioning over time. The subsequent categorization of trajectory types might be based on a standard measure of individual differences (e.g., intel-ligence, personality) or functional status at baseline. Frequently, researchers characterize trajectories post hoc regarding whether they refl ect pathological, normative, or successful patterns of aging (e.g., Rowe & Kahn, 1987; Smith & Baltes, 1997). Life-span researchers are also particularly interested in deter-mining whether trajectories of change in a functional domain are age- and /or death-related (terminal decline) and whether different types of trajectories (e.g., stability vs. change) are observed in different life phases (e.g., the young old vs. oldest old). For example, theories of terminal decline suggest that multiple domains of psychological functioning show incremental negative trajectories that are larger and qualitatively different from normal age-related changes in behavior, especially during a window of 5 to 7 years before death in very old age. Birren and Cunningham (1985; Berg, 1996) suggested that terminal decline may represent the emergence of a cascade of structural change. Examination of this phenomenon is important because it opens a window on different emergent mechanisms that may underlie change in function (e.g., ones not necessarily related to early-life factors.)
The two perspectives are also characterized by different sets of questions about change linked to aging. Whereas the life-course perspective poses ques-tions about levels of subgroup disparities in trajectories of aging (e.g., the social gradient of health or mortality), the life-span perspective asks questions about the distribution of interindividual differences in the level, rate (slope), and profi le of developmental change trajectories.
Both perspectives ask whether the range of disparities and distribution of functioning observed in a sample expands or contracts across the life course. The various positions on these questions refl ect different lenses on the forces of heterogeneity across the life course. One position argues that early adult life is a phase when within-cohort heterogeneity and social pathways expand greatly and that the consequences of this expansion are maintained for the rest of life. Young adulthood, for example, is a life phase that stimulates the initiation of a wide range of life-course trajectories in terms of education, work, family, and health behaviors (e.g., Elder, 1998). Gender is also associated with different life-long careers and life conditions in old age (Moen, 1996; Smith & Baltes, 1998).
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Humans are very susceptible to infl uence in their early years, but with age are thought to become increasingly stable in important respects. Furthermore, the social and cultural opportunities for change linked to the life course gen-erally decline with age.
A second position on the distribution of social disparities and interin-dividual differences suggests that heterogeneity may increase with age (e.g., Dannefer, 1988). The combined effects of an individual’s unique experiences over more years should magnify differences between them. Genetically based differences would also have had more time to be expressed and to contribute to divergence. Moreover, older adults, somewhat freer from social constraints, might be more likely to select their own course of action.
Counter to these two positions, however, are proposals regarding reduced heterogeneity with age, especially among the oldest old. Selective mortality contributes to a corresponding reduction in observed heterogeneity, at least for those factors and aspects of functioning that predict mortality (Vaupel et al., 1998). We turn next to a consideration of a selection of contemporary evidence informed by these perspectives.
CUMULATIVE EQUALITIES AND DISPARITIES ON WELL-BEING AND HEALTH
Effects of Social Class, Racial, and Ethnic Minority AgingNumerous studies over the past few decades have indicated that individu-als of lower socioeconomic status have worse health than individuals of higher socioeconomic status (e.g., Adler, Boyce, Chesney, Folkman, & Syme, 1993; Marmot, Shipley, & Rose, 1984; Preston & Taubman, 1994). Findings show evidence of this effect of socioeconomic status (SES) at all ages of the life course, and interestingly enough suggest that there are age-graded group differences in that individuals of low SES are more likely to have health problems at younger ages than individuals of higher SES (House et al., 1994). This research suggests that inequalities in health status by SES vary systematically across the life course. This life-course variation is par-ticularly salient in old age; House and colleagues (2005) have shown that the compression of morbidity is specifi c to higher SES groups while lower SES groups are more likely to experience multiple health problems earlier in old age.
Though it was originally suggested that these health disparities were due to a lack of access to proper medical care, investigations have indicated that the causes are much more complicated and signifi cantly infl uenced by the individual’s resources and other environmental factors (Adler et al., 1993;
Theories of Aging From a Life-Course 15
Marmot et al., 1984; Pappas, Queen, Hadden, & Fisher, 1993). Furthermore, this health disparity is not merely a case of the “haves” versus the “have-nots” but rather there is a social gradient effect at all levels of SES and even in the face of universal access to health care and despite access to suffi cient resources, increasing social status remains related to better health (Marmot, 2006). Group differences in SES are due to complex contextual effects leading to differing life-course trajectories of health and sharply divergent life expec-tancies. While there is strong evidence for the social gradient effect in health disparities, the challenge to current and future research is in determining the causes of these inequalities. In effect, the divergence in social capital accrued over the life course has signifi cant implications (Frytak, Harley, & Finch, 2003). The life-course approach to aging suggests that it is imperative to in-vestigate the implications of cumulative lifelong infl uences on development in old age. Promoting better health in old age will not be as simple as providing lower SES individuals with adequate health care access, but rather necessitates interventions in public, family life, and individual life styles, and is best initi-ated at earlier rather than later stages of the life course.
It is widely recognized that many ethnic minorities live in a culture of prejudice and discrimination that both infl uences the psychological resources available to them as well as their physical and mental health (cf. Jackson, Antonucci, & Gibson, 1990). The life-course perspective notes that the effects of discrimination across the life course may differ in form and intensity as a function of birth cohort and timing (Williams & Williams-Morris, 2000). A number of additional factors may contribute to these disparities, ranging from biological dispositions (Baquet & Ringen, 1987) to dietary habits (Hargreaves, Baquet, & Gamshadzahi, 1989), to a failure to receive adequate health care ( Jones & Rice, 1987). The specifi c mechanisms, however, that produce these differential outcomes are less clear (LaVeist, 2000; Williams, 1999; for an exception, see recent work of Jackson, Knight, & Rafferty, 2009.).
Aging research on ethnic minorities also addresses contextual experiences that may be unique to some ethnic groups. Research on aging immigrants indicates that in addition to the challenges faced by ethnic minorities, this group also experiences strains related to the migration experience (such as language barriers, for example; Angel & Angel, 2006). Interestingly enough, researchers have noted an unlikely effect termed the Hispanic Paradox in which the longer Latino immigrants reside in the United States, the worse off their health becomes (Markides & Eschbach, 2005) indicating the im-portance of examining the interaction of context and time along with the contribution of biology. The utility of a life-course perspective is further noted in considering that because of inadequate access to resources and /or
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sociohistorical experiences of war or political unrest in their native countries, many immigrants may bring with them a life-course path that has a signifi -cant impact on the aging process.
When considering group differences, it is critical to recognize the role that race, ethnicity, and culture play over the life course and particularly for the aging experience ( Jackson & Govia, 2008). Longstanding ethnic diversity, as well as recent immigration patterns, indicates that special attention needs to be paid to these differences. Group level differences related to ethnicity and race are evident in the aging process, and indicate the need for a perspective that integrates biopsychosocial infl uences across the life course. As society becomes increasingly diverse, a culturally sensitive approach to aging (e.g., health, self, commuting issues) will be even more critical ( Jackson, Brown, & Antonucci, 2005).
Effect of Linked LivesThe infl uence of linked lives on health in old age is impressive and should be considered when addressing health disparities in late life. Specifi c fam-ily relationships have been shown to have differing effects on health and well-being. Married people report better overall physical health, lower levels of depression, better social support, and relationship quality compared to unmarried adults (Murphy, Glaser, & Grundy, 1997; Umberson & Wil-liams, 1999). As a group, married adults are more active, suffer lower rates of chronic illness, and are less likely to engage in risky health behaviors compared to unmarried groups of adults (Lyyra, Törmäkangas, Read, Ran-tanen, & Berg, 2006; Mendes de Leon, Appels, Otten, & Schouten, 1992). They report lower levels of depression, stress, and loneliness and greater life satisfaction than adults who are not married (Diener, Suh, Lucas, & Smith, 1999; Dykstra & de Jong Gierveld, 2004). Conversely, adults who are divorced and widowed report more mental health issues, including depres-sion, loneliness, and suicidal ideation, compared to married and never-married adults (Dykstra, 1995; Williams, 2003). Among adults who have never married, men experience higher levels of loneliness compared to unmarried women, although no such gender differences emerge among married adults (Dykstra, 1995; Peters & Liefbroer, 1997). However, longitudinal studies of these associations suggest that distress and negative psychological assessments sub-side or are ameliorated over time (Booth & Amato, 1990).
Intergenerational relationships, especially the parent–child relationship, is one of the most long-term and emotion-laden social ties (Bowlby, 1980; Cairns, 1977; Fingerman, 2001). Gerontologists have suggested that offspring experience both increased feelings of autonomy and closeness toward parents
Theories of Aging From a Life-Course 17
across adulthood (Fingerman, 2001). Across the life span, the parent–child tie is characterized by a paradox of solidarity and confl ict (Fingerman, 2001; Luescher & Pillemer, 1998). Interpersonal problems in this tie appear to be normative (Clarke, Preston, Raksin, & Bengtson, 1999; Fingerman, 2001; Luescher & Pillemer, 1998). Much less is known about how this family tie affects the health of either party. The parent–child relationship may directly infl uence health in old age on various levels such as induction of stress, care-giving, and access to resources. On some level, health disparities may be a result of the extent of resources and /or support provided through social and family relationships.
Health Over the Life CourseThe benefi ts of studying health during old age within a life-course and life-span framework are considerable. Typically health and illness have been studied with a focus on acute illness and onset of a diagnosed illness. Studies often examine the progression of disease prospectively as opposed to the lifelong tra-jectory leading up to the onset of the disease. Pearlin, Lieberman, Menaghan, and Mullan (1981) proposed a now classic model describing how the experi-ence of stress affects health and well-being. According to their stress model, individuals experience stressors that affect their health, however, moderating factors such as social relations may reduce the stressors and mediating factors, such as social support, may reduce the interaction between the stressor and health. For aging individuals then, health status is determined by the ability to mediate or moderate the relation between stressors and health. For example, stressors may be mediated by psychological and social resources that reduce the effect of the stressor on health. A life-course perspective is central in exam-ining this link between stressors and health because it has been found that chronic stressors are more likely than acute stressors to have signifi cant effects on health (George, 2003; Krause, 2000). The cumulative impact of prolonged chronic stress exposure and the physiological response may cause declines in overall health status over time (Robles & Kiecolt-Glaser, 2003). Older adults not only have a longer life course in which to experience chronic stress, but are also more likely to have chronic conditions that are exacerbated by stress, perhaps creating greater vulnerability to stress with age (House et al., 2005).
Because the persistence of hardships over the life course can result in cumulative damage to health and well-being, and chronic stress over the life course has signifi cant repercussions for health in old age (Kahn & Pearlin, 2006), it is essential to examine health and aging from a life-course perspec-tive. George (2003) suggests the importance of using the life-course approach to study risk factor trajectories and their infl uence on health. This approach is
18 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
not yet common, but has promising possibilities for understanding health in late life. For example, Barrett (1999) found that women who remarried after a divorce had higher depression levels than women who were continuously married, indicating the signifi cance of not just marital status, but marital history in predicting depression. The value of longitudinal research in exam-ining health and well-being in old age is critical. Life-course research on health now emphasizes the importance of considering historical and cohort effects. For example, the current cohort of older adults experiences relatively high rates of lung cancer, a fi nding that, when considered absent of the historical context, could lead researchers to interpret this as part of the aging process. In reality, however, historical context has an important infl uence as the current cohort of older adults came of age in the decades before the ramifi cations of smoking was fully understood; high rates of lung cancer are actually the result of a high rate of long-term smoking for that cohort.
Due to their living longer, older adults are more likely to have chronic diseases and experience multimorbidities of diseases (Crimmins, 2004). Health in old age is sometimes determined by rates of mortality, but more recent trends in research have focused on morbidity of disease, disability, and frailty (Fried, Ferrucci, Darer, Williamson, & Anderson, 2004). Comorbid-ity refers to the multiple concurrent health problems that many older adults face. Because the risk of multimorbidity increases with age, it is important to delineate the various pathways into multimorbidity and frailty in old age, especially because there is an asynchrony in the onsets of the various diseases (Yancik et al., 2007). Threats to health clearly increase over the life course and, to some extent, are related to individual lifelong experiences. They are likely to be cumulative in that risk increases with age and earlier ill-health is likely to contribute to later ill-health, and the risk is more likely to be multi-plicative than additive. Evidence suggests that events, experiences, and rela-tionships can either help offset or exacerbate vulnerabilities.
CONCLUSIONThe current state of the art in research on aging requires a merger between life-course and life-span perspectives and a joint consideration of the themes in Table 1.1. While there is still much to learn about aging, much more is now known as a result of research designed from a life-span and life-course perspective than was known when these approaches were originally proposed in the mid-20th century. At the individual level, for example, we understand that biological, social, and cognitive development and change is not only or always cumulative and linear. It can also be nonlinear, dynamic, progressive and regressive, adaptive and maladaptive, usual and unusual. Initially, the
Theories of Aging From a Life-Course 19
scientifi c fi eld rather naively believed that once set upon a path, development unfolded in a manner that was essentially predetermined. Similarly, while life-course theorists understood that institutions, events, and historical periods infl uence the individual’s development, not much thought was given to how these experiences would infl uence the developing individual, cumulatively or interactively. The life-span and life-course perspectives were in different disciplines and researchers from the two camps rarely communicated with the other. As this book attests, this separation is a luxury we can no longer afford or justify.
As knowledge accumulates, it is increasingly evident that a combination of life-span and life-course perspectives will be most informative to the explo-ration health inequalities in later life. As the following chapters indicate, this approach provides a broad, clear lens on those factors infl uencing aging and health inequalities.
AcknowledgmentsThe authors gratefully acknowledge support from the MacArthur Re-
search Network on an Aging Society.
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Contributors
Cleopatra M. Abdou, PhD, Institute for Social Research, University of Michigan
Toni C. Antonucci, PhD, Elizabeth M. Douvan Collegiate Professor of Psychology, Institute for Social Research, Life Course Development Program, University of Michigan
Lisa F. Berkman, PhD, Director, Center for Population and Development Studies, Thomas D. Cabot Professor of Public Policy and of Epidemiology, Harvard School of Public Health
Edna Brown, PhD, Assistant Professor, University of Connecticut
Philippa Clarke, PhD, Research Assistant Professor, Survey Research Center, Institute for Social Research, University of Michigan
Sha Juan Colbert, MPH, School of Public Health, University of Michigan
Karen A. Ertel, ScD, Research Fellow, Department of Society, Human Development, and Health, Harvard School of Public Health
Elizabeth Fauth, PhD, Research Assistant Professor, Utah State University
Heather Fuller-Iglesias, PhD, Institute for Social Research, Life Course Development Program, University of Michigan
Denis Gerstorf, PhD, Assistant Professor, Pennsylvania State University, and DIW Berlin (German Institute for Economic Research), Germany
M. Maria Glymour, ScD, Assistant Professor, Department of Society, Human Development, and Health, Harvard School of Public Health
James S. Jackson, PhD, Director, Institute for Social Research, Daniel Katz Distinguished University Professor of Psychology, University of Michigan
Contributors xiii
Kiarri N. Kershaw, MPH, Department of Epidemiology, University of Michigan
Katherine M. Knight, PhD, Institute for Social Research, University of Michigan
Peter A. Lichtenberg, PhD, ABPP, Director, Institute of Gerontology, and Professor of Psychology & Psychiatry and Behavioral Neuroscience, Wayne State University
Jessica M. McIlvane, PhD, Associate Professor, School of Aging Studies, University of South Florida
Briana Mezuk, PhD, Assistant Professor, Department of Epidemiology and Community Health, Virginia Commonwealth University
Toni P. Miles, MD, PhD, Health and Aging Policy Fellow—Senate Finance Committee 2008–2009, Professor, Family & Geriatric Medicine, University of Louisville
Jane A. Rafferty, PhD, Institute for Social Research, University of Michigan
Nilam Ram, PhD, Assistant Professor, Pennsylvania State University, and Max Planck Institute for Human Development, Berlin, Germany
Lindsay H. Ryan, PhD, Research Fellow, Survey Research Center, Institute for Social Research, University of Michigan
Jürgen Schupp, Dr. rer. soc., Professor, DIW Berlin (German Institute for Economic Research), and Free University, Berlin, Germany
Jacqui Smith, PhD, Professor of Psychology, Department of Psychology and Research Professor, Survey Research Center and Research Center for Group Dynamics, Institute for Social Research, University of Michigan
Jacquelyn Y. Taylor, PhD, PNP-BC, RN, Assistant Professor, Yale University School of Nursing
Gert G. Wagner, Dr. rer. oec., Professor, DIW Berlin (German Institute for Economic Research), and Max Planck Institute for Human Development, Berlin, Germany
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