Culture and Old Age

Although culture is often used to describe the fine and performing arts (e.g., opera, literature, paintings), this book relies on the social science perspective on culture—the unwritten rules one must know to function in a given social group. The anthropologist Clifford Geertz (1973) defined culture as “an historically transmitted pattern of meanings embodied in symbols, a system of inherited conceptions expressed in symbolic forms by means of which [people] communicate, perpetuate, and develop their knowledge about and attitudes toward life” (p. 89). For Geertz and other scholars who study culture, the “rules” of a culture are transmitted and reinforced through the actions of others within the culture. Think, for example, of how you learned to shop for groceries. Most likely, you were not given a formal set of rules or lessons on how to shop for items, pay for them, and package them to take with you. In the United States, shopping generally involves visiting a large grocery store; taking a shopping cart; selecting items based on a preestablished, nonnegotiable price; placing items (sometimes enough to last several days or weeks) in the cart; waiting in line at a cashier to pay; and having a store employee place purchased items in paper or plastic disposable bags. In other countries, people might visit individual food sellers every day for fresh items such as vegetables, eggs, bread, fish, and so on, bringing with them their own bags to take the items home. The buyer and seller may negotiate (sometimes called “haggling”) about the price. There may be no lines to wait in (i.e., the most aggressive and determined person wins). As this example illustrates, it may be only when we have an experience outside our cultural expectation that we realize something is “different.” The “right” way to do something, like shop for groceries, is so culturally ingrained that we never have bothered to think that other people do it differently.

The same can be said for aging. Cultural definitions of who is “old” are transmitted in very subtle ways, so most people do not give much thought to it. In fact, one way that “aging” has been described is as a cultural interpretation of a biological phenomenon. In other words, biological changes that a person undergoes over time, such as graying hair, wrinkles, and changing vision, are given a cultural meaning. Consider gray hair. Advertising in the United States reinforces the idea that gray hair for women is unattractive. In contrast, advertisements encourage men to keep a “touch of gray” as a sign of distinction and power. In Bangladesh, though, women who have gray hair are associated with power and status, since advancing age is how women assume positions of authority within households (Ahmed, 2014). In short, while gray hair is a product of biological change, the meaning of gray hair is culturally determined.

“Old” can be also defined through one’s role in society or relationship to others. In the Bangladesh example, higher status may be conferred on people of advancing age not just because of appearance, but because of their position within the household. A woman in Bangladesh builds a family through marriage, children, and grandchildren. Her change in role from daughter-in-law to parent to grandparent further establishes her as “old” (in a positive way), regardless of chronological age.

Chronological Age

Of course, another way that “old” is defined is through chronological age. While the number of birthdays a person has had might seem like a straightforward way of defining the boundaries of “old,” chronological age has its challenges. We all have had the experience of meeting someone, making a mental estimate of their age based on appearance or other observable traits, and then being surprised to learn that their chronological age differed from what we thought. This is because chronological age is a poor marker for many things. A person’s physical environment (e.g., climate, exposure to harsh conditions), lifestyle choices (e.g., alcohol and tobacco use), and genetics all can influence how a person ages biologically; physical manifestations that may appear to be a reflection of chronological age may, in fact, be determined to a greater degree by things other than the passage of time.

Chronological age became important in the late 19th century during the development of social programs called the “welfare state.” For citizens of the United States, the term “welfare” typically connotes a particular kind of government-funded program for people who are poor. However, the “welfare state” is a much broader concept. It describes the collection of social-assistance policies and programs provided by a government that takes the place of support traditionally provided by the family or by religious institutions. Such policies emerged as a result of industrialization and often included public old-age pensions, health care programs, family allowances, sickness and maternity/birth benefits, and unemployment compensation. Eligibility for programs such as when one can start earning a retirement pension (or must mandatorily retire) or the age at which someone is considered an adult is determined by chronological age. Some countries, such as Thailand, have a relatively low mandatory retirement age of 60 (see Social Security Administration, 2014). Many African countries use age 50 as the point when one is officially considered “old” (Naidoo et al., 2010). In the United States and several Western European countries, pension eligibility ages are being raised to reflect increasing life expectancy of retirees. For example, eligibility for Social Security in the United States has recently increased from 65 to 67 and will continue to increase incrementally over the next several years. The same can be said for Germany, where, in 2017, the retirement age was 65, although that age also gradually will be raised over the next several years (Organization for Economic Co-operation and Development [OECD], 2019).

Ageism

Defining “old” is more difficult than one would think. While many people might associate later life with positive qualities such as wisdom or gained experience, more negative views of age—ageism—are present in many cultures. Ageism describes the systematic discrimination of people because of their age or the appearance of age (Cruikshank, 2013). Ageism can be intentional, whereby a person is openly ridiculed or devalued because of his or her age; or unintentional, as when someone thinks they are being kind to an older person by using terms such as “elderly,” “senior citizen,” or “cute,” or calling a person “young lady” when she is clearly not a young lady. In the latter example, making a point of pretending someone is “young” underscores the idea that being “old” is bad or undesirable. Ageism can also be either external, which describes an outsider’s behaviors toward someone else, or internal, which occurs when an older or even a middle-aged person uses self-deprecating words as a way of apologizing for being older, such as when a person who forgets a name says they are having a “senior moment.” (Cruikshank, 2013). Ageism is problematic because ageist attitudes and portrayals in the media and other forms of popular culture ascribe negative attributes to older people, positioning them as weak, dependent, incompetent, and as somehow “less” than younger people. It is important to keep in mind that ageist portrayals can have negative consequences for older persons. Ageism positions older people as burdens, nullifies positive contributions that people make throughout their life course, and sets up a young/old dichotomy that separates people rather than bringing them together. Because of the pervasiveness and harmful effects of ageism worldwide, the World Health Organization (WHO) has launched a global campaign to combat it (Ayalon & Tesch-Römer, 2018).

Myths About Old Age in Different Cultures

Along with ageism, it is also important to be aware of myths—both positive and negative—about aging in various cultures across historical time. Many students new to gerontology and aging believe there was a time in the past when older people were revered and held in high respect within the community. However, rather than age alone being an indicator of respect, many scholars have suggested that social class, status, and value to society were stronger indicators of respect (Thane, 2000). For example, an older person who had mastered a unique skill (e.g., calligraphy) might be held in high esteem, whereas an older person who held a common skill (e.g., rice farming) might not. Since the poor comprised the majority in many cultures, people with wealth and social position, regardless of age, held much higher levels of respect than older persons from lower social classes.

Another common myth is that older persons are still revered in some parts of the world, especially East Asia. For example, in 1966 Japan officially established Respect for the Aged Day, celebrated on the third Monday in September. Although this day recognizes the importance of respecting older persons, to be respected is not the same as to be revered. In addition, while older persons may receive a formalized form of respect that includes honorific titles such as “aunt” or “father,” many countries struggle with combatting mistreatment of older persons, including elder abuse. The WHO estimates that 15.7% of people aged 60 and above worldwide are victims of elder abuse. It believes this percentage is much lower than the actual occurrence, since many people may be unwilling to report such abuse (WHO, 2019a). Of the types of elder abuse (physical, sexual, psychological, or financial, and neglect) included in the WHO’s research study database, neglect was most common; countries cited as having the highest median levels of elder neglect were Egypt, Israel, Spain, and China.

The high prevalence of neglect speaks to similar myths regarding the revered status of older persons, specifically in countries that practice filial piety versus countries where older people are not cared for by family in the same way. Filial piety (literally, “the devoted child”) describes a Confucian and Buddhist value of respect for one’s ancestors, elders, and parents. According to Charlotte Ikels (1993), China’s traditional, precommunist culture of the early 20th century was based on Confucianism, “an ethic of familism that not only served as the standard to guide proper family organization for many centuries but was also codified into law” (p. 124). This system emphasized vertical family ties—those between the generations—as more important than horizontal ties, such as those between spouses, which were viewed primarily as a means by which to continue the lineage (or vertical line) through offspring. Confucian filial piety requires that each person respect his or her place in the family and show proper levels of respect to others according to their place (e.g., child to parent, adult to elder; Canda, 2013). While filial piety continues to be part of the cultural framework of many countries, this does not mean that older persons who live in these countries are without challenges or that all children are willing and able to provide care for older parents. China, for example, enacted legislation requiring children to be involved with their aging parents and to visit parents at least once a year (Cheung & Kwan, 2009). This raises a question: If legislation is necessary to ensure that children are looking after their parents, is filial piety as powerful a norm as we have assumed?

In contrast, families in Western countries often are viewed as having abandoned their older family members, since multigenerational households are not the norm in many of those countries. However, living arrangements of family members in developed countries are more a reflection of Western cultural values by both older and younger family members than of their views toward care for older family members. For example, people in the United States place great value on independence in family relationships across the life cycle, which translates into a preference for patterns such as “intimacy at a distance” (living near family members but not together) and older adults not wanting to “be a burden” on their children. This value is reflected in contemporary living arrangements in many developed countries, such as retirement communities or “in-law suites” (freestanding apartments within a larger house), and has a long history. Historian and gerontologist Thomas Cole (1992), in his cultural history of aging in Western Europe, points out that older Europeans have long preferred to live near but not with their adult children. In addition to citing historical European records of parents signing formal contracts with their primary heir to guarantee future care should the parent require assistance, Cole points to Shakespeare’s King Lear as an example of a cautionary tale about living with one’s children. In the play, Lear divides his kingdom between two daughters (Regan and Goneril) who profess (albeit insincerely) the magnitude of their love for him. Later, they take away Lear’s land and money, which leads to several tragic outcomes.

What to Call Older Persons

Finally, it is important to consider terms used to refer to older persons. Although the term “the elderly” is frequently used to describe older persons, often in a well-intentioned way, it could be considered offensive for several reasons. “Elderly” implies dependence, weakness, and frailty. It is a term generally used by people who do not consider themselves to be “elderly” to emphasize need, to garner sympathy, or to underscore helplessness. In effect, what the term “elderly” does is to stereotype a large group of people, generally those aged 65 and above. Although one easily can still find the word in print in various publications, several academic journals in the aging field prohibit its use (de Medeiros, 2018). The American Medical Association Manual of Style and the Journal of the American Geriatrics Society have taken a strong stand against ageist and ablest language. Authors are asked to avoid use of “elderly,” “aged,” “elders,” or “seniors,” and to use specific age ranges instead. While such a strong stance might initially seem like “political correctness” gone awry, it is important to remember that several studies report that people aged 65 and above overwhelmingly reject the terms “elderly” and “old,” preferring the term “older persons” (Falconer & O’Neill, 2007).

Urban and Rural

Whether one lives in an urban or rural area likely will affect many aspects of aging. Tony Champion and Graeme Hugo (2017) point to the following differences between urban and rural areas. Urban areas are characterized by manufacturing, construction, and administrative and service occupations, while agriculture is the focus of rural areas. People in urban areas tend to have higher levels of education, access to services and information, and in-migration than rural areas. In contrast, rural areas tend to have higher fertility and mortality rates than do urban areas. In 2018, 55% of the world’s population lived in an urban area. This is expected increase to 68% by 2050 (U.N. Department of Economic and Social Affairs, 2018). In addition, the United Nations reports that, with 37 million people, Tokyo is the world’s largest city, followed by New Delhi, India (29 million); Shanghai, China (26 million); Mexico City, Mexico (22 million); Sao Paulo, Brazil (22 million); and 20 million each for Cairo, Egypt; Mumbai, India; Beijing, China; and Dhaka, Bangladesh.

The move from rural to urban areas is rooted in industrialization. One of the most important social changes influencing the need for, and development of, a welfare state is industrialization, which requires large concentrations of workers for factories and thus often induces a substantial migration from poorer rural farmlands to urban areas. This migration introduces a new way of life: Individuals are separated from the land and, frequently, from their extended families. Whereas rural farmers often have kin for neighbors, ensuring others nearby who can provide social and economic assistance when necessary, urban dwellers typically find themselves among strangers, separated from their traditional social-support networks. This new social living condition requires some mechanism to replace that lost family support, and this mechanism became the welfare state. The process that unfolded for Western Europe and the United States in the late 19th and early 20th centuries is similar to what is happening in the developing nations of the world today. In many countries, the migration of young people to cities in search of better jobs and a higher standard of living has resulted in isolation of older people in rural areas, which in turn has led to changes in family care. Sometimes, working-age parents need to leave their children to be raised by their grandparents. Other times, children who traditionally may have provided care for their parents (filial piety) are no longer close by and therefore unable to assist with care needs. This has resulted in millions of the rural older population, the so-called “left behind,” being without reliable family support or care. (While this term appears to have originated in China, it is a common phenomenon in a growing number of developing countries.)

Country Classifications

Although classifying countries or regions is complicated, the categorization is based generally on the area’s level of economic development. The U.N. Statistics Division (2019) cautions that such designations should be understood as a “statistical convenience” rather than a judgment and that no single, established standard exists for economic classification of nations. For our purposes, think of the designations as the result of a two-step process. First, the World Bank calculates a gross national income per person for each country, and then places each into one of four categories: low income, lower-middle income, upper-middle income, and high income. In the next step, high-income countries are defined as developed countries, and all remaining (low- and middle-income) countries are classified as developing countries. As a point of reference, the threshold for high-income (developed) countries in 2018 was a gross national income per person of greater than US$12,055; at the other end of the continuum, low-income countries were at or below US$995 per person, with the other groups in between (lower-middle income from US$996–$3,895 and upper-middle income from US$3,896–$12,055); see World Bank (2018). Even though these categorizations are only statistical conveniences, they do provide a general sense of the level of resources available in a country to address important needs, including those related to having an aging population.

A commonly used alternative to the World Bank categorization comes from the United Nations, which currently designates all of Europe and North America (Canada and the United States) plus Australia, New Zealand, and Japan as more developed countries; all others are less developed (or sometimes referred to in shorthand as “developed” and “developing”). Within the group of less developed countries is a special designation for least developed countries (LDCs). Several criteria are used to distinguish the nations in that category: (a) very low income per person, (b) economic vulnerability, and (c) poor human development indicators (population nutritional status, mortality, literacy, and education). LDCs currently include 34 African nations, 14 Asian countries, and Haiti (U.N. Department of Economic and Social Affairs, Population Division, 2017). For our exploration of global aging, these designations help to differentiate countries and regions of the world on a number of dimensions, including the current age of the country.

To Get Educated

Aging is a new, powerful social force—never seen before in human history—that already is changing the way Western societies are structured and how their citizens will live out their lives. For the first time in history, large numbers of the human species are living beyond their working years and confronting the personal and family issue of what to do with their time. Retirement is a concept that was unknown to most of our ancestors living during the first 70 centuries that civilized societies have been on Earth; now it must be designed and adapted to by more and more people. Part of being an educated person is having knowledge about this revolution in longevity.

Self-Interest

The world is globalizing—becoming, in the words of Marshall McLuhan (1962), a “global village.” The twin revolutions in technology and communication that allow people in one part of the world to know what is happening in all other parts—and to go there quickly, as tourists, as temporary workers, or as permanent migrants—mean that we are not only connected but also collected with each other in important ways. If the economic and political well-being of the United States (or any other nation) is heavily dependent on the work and consumer behavior of 1.4 billion Chinese, the technical knowledge of 1.3 billion Indians, the religious tolerance of 260 million Indonesians, or even the political aspirations of 82 million Iranians, attention must be paid to what is going on in their countries. In the 2012 campaign for the Republican nomination for U.S. president, one of the candidates, Herman Cain, famously denied that it was of any importance that he should know the name of the president of Uzbekistan (he did not). But Uzbekistan is an important part of the connected world, and what happens among its 30 million residents may not remain isolated there. It can be quickly communicated, transmitted, or migrated to a neighborhood near you.

As aging transforms developing nations demographically and socially, it will create profound economic and developmental changes in these emerging world powers, along with exciting opportunities for the realization of human potential. Whatever is happening to the smallest, least-visible countries will affect the developed world in ways we can hardly imagine today. It is in the interest of all people that such far-reaching and fundamental changes be understood sooner rather than later.

The Smart Move

Each of us has a perspective on life and the world that is limited and shaped by our experience. Such limited perspectives can have unpleasant (even destructive) consequences when the nature, motives, and intents of others are misinterpreted by some—leading to prejudice, discrimination, racism, war, and even genocide. It is an article of faith of most educated people that expanding one’s experience and broadening one’s perspective can reduce such misunderstanding and destructive behavior. Learning about global aging will not, by itself, lead to world peace. However, it could contribute to a fuller, more accurate picture of how other people live, raise their families, care for their parents, and live out their lives. If that knowledge impresses us with the realization that aging is a universal experience, that all families, communities, and societies—no matter how different they may seem from our own—struggle as we do to cope with its results, and that many older people find it a productive, fulfilling time of life, we may begin to perceive our commonalities as greater than our differences. That would be the beginning of wisdom at least.

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AGING IN THE VILLAGE (MESO) LEVEL CONTEXT: TRADITIONAL PATHWAYS TO POWER

Rural society in Bangladesh is gerontocratic. What this means is that it is organized around a hierarchy based on age. Villages comprise paras (neighborhoods), and each para consists of several households (baris). A bari (household) constitutes several dwellings built around a courtyard. Though the extended family occupies a bari, the entire neighborhood is considered kin. When a bride first enters the bari as a daughter-in-law, she occupies the lowest rung of the ladder. Her mobility is restricted by purdah (a custom that defines relationships between men and women through segregated boundaries). Her conduct is regulated and proscribed by the shalish, an indigenous village court system, which consists of an all-male jury. Young and inexperienced in the ways of her shoshur bari (in-laws’ household), she knows that she has to please everyone in the entire neighborhood, especially her mother–in-law. But she also knows that as she ages, she will climb the ladder to one day gain a position of authority, just like her mother-in-law.

Though purdah is oppressive to women in many ways, restricting access to education and jobs, opportunities for gaining authority exist even in this traditional system. When she sets foot in her in-laws’ household, the young bride is primed for leadership through two pathways, both of which widen as she ages. First, she can look forward to greater geographic mobility. Purdah restrictions decrease with age. This resulting physical freedom is linked to increased kin ties, considered a tangible source of social capital in rural society. As a woman ages, her network expands to go beyond the neighborhood. Where they entered as outsiders, older women become insiders and have increased kin ties: they not only may arrange marriages of their own children, they also may arrange marriages of other young people in the village.

Second, in gerontocratic culture, increased equity in gender relations is an inevitable result of getting older. If, as the young daughter-in-law, Alveera kept quiet when addressed by male relatives, as a middle-aged woman, she now has a number of younger men, including her son(s) and nephews, who occupy a lower status. Aging also means that older women are addressed with an honorific, which specifically signifies the status that can only come with age. When she talks, these men have to listen respectfully, even if they do not agree with her. If she was compelled as the young bride to be subservient to her elders, as an elder now herself, she can expect subservience and seva (service) from those who are younger. In return, she is in the privileged position of conferring her blessings on the next generation.

Third, some older women like Alveerah are also midwives, and bringing children into the world is viewed as holy in village society. This status that emanates from her is also conferred on her husband. Such men often willingly take on household responsibilities, a switch in gender roles, because they know that their wives are compelled to leave the household at short notice without any definite indication of when they will return. Linked to the greater physical mobility allowed for midwives is the increase in kin ties. As they deliver babies, midwives create a permanent relationship with the infant and its parents. A younger woman who serves as an apprentice can look forward to the day when she gets older and also can “do work that gains Allah’s blessings.”

In addition to being a midwife, Alveerah also manages her own grocery store. She earns income through her entrepreneurial activities, has savings in the bank, and serves as the treasurer in the women’s collective, where she has been a member for the past 10 years. She argues with the male relatives in her village about gender wage equity and the need for women to run for public office—something that no woman, of any age, would have been able to do in the past. This transformation has taken place because of structural changes in the national (macro) arena.

THE NATIONAL (MACRO) LEVEL CONTEXT: MODERN ROUTES TO POWER

In the four and a half decades since Bangladesh, a Muslim-majority nation of over 160 million people, gained independence, gender and development programs at the national level have contested the gender order. The fertility rate has decreased from 6.9 births per woman of childbearing age in 1970 to 2.1 (replacement rate) in 2016 (Bangladesh Bureau of Statistics, 2016). In 2015, the primary school completion rate for girls was 79%, higher than that of boys, which was 69% (World Bank, 2016), and maternal mortality has decreased from 574 per 100,000 births in 1990 to 178 in 2016. The percentage of girls enrolled in secondary school in 2016 was 73.1, higher than that of boys (63.8%) (Bangladesh Education Report, 2016). Approximately 34 million women utilize microcredit (Microcredit Regulatory Authority, 2015); it extends to about 60% of all poor households (Nahar, 2013), which, as a programmatic ideal, challenges the structure of patriarchal gender relations. Women’s entrepreneurial activities have increased female mobility and their household income (Pitt, Cartwright, & Khandker, 2006). Women now can obtain microcredit loans with no collateral. With loans as small as $40, they increase their entrepreneurial skills and improve their household welfare. Defying oppressive notions of purdah, women now leave the bari for entrepreneurial activities, work in the fields alongside men, and run for public office. At least 3.6 million Bangladeshi women are employed in the garment industry, now the second largest in the world. Women’s labor force participation increased from 4% in 1974 (Heintz, Kabeer, & Mahmud, 2018) to 33.1% in 2017.

These dramatic improvements underscore an even more dramatic reality: A tenacious and visionary women’s movement is effectively forging alliances with all sectors of civil society in Bangladesh (Ahmed, 2006). Few know that older women like Alveerah constitute its popular leadership base. The success of the national family planning program is a result of the continuing discourse that older women led all over Bangladesh about Islamic principles and reproductive health. The reach of the movement is best understood by the effervescence of the adda (public discussions) led by such older village women; their vitality continues to change a male-dominated society on a daily basis. For these leaders of a widespread movement for social change, their adda goes beyond reproductive health to gender wage equality; more profoundly, village women now want to define Allah in their own terms.

How does Alveerah express her authority when she argues with male elders in her village? The shape and form of this new women’s leadership combines oral traditions of village culture with modern perspectives. These women challenge patriarchal beliefs and make men understand (boojhano) through sheer eloquence and wit. In fact, boojhano was repeatedly mentioned by men as an important mechanism in how they reframed masculinity and became more aware of gender injustice. Villagers respect and see these qualities as evidence of forensic ability and leadership. Discussion (or adda) is not only a traditional way of resolving disputes; it is a forum for reflection. Villagers learn through a dialogue in a town meeting format that is rich in metaphor.

The level of analysis that these women leaders use, however, is entirely modern. It is a systematic analysis of village patriarchy, or the male-dominated system, that leads them to challenge patriarchal Islam by reframing religion. In particular, these older women reframe traditional notions of sin. They refer to the “patriarchal definition of Islam” as “a long list of don’ts.” Such women use their gerontocratic authority to castigate a husband who refuses to allow his wife to have property in her own name as “having sin in his heart.” In fact, men who commit such infractions, along with those who are violent, can be tried in a reformed village court that now includes women jurors, yet another innovation of the traditional system.

To summarize, modern transformations at the national level have built on traditional village mechanisms to give older women power, thereby priming poor women, at the lowest rung of society, for leadership. Getting older still has its problems: After years of hard labor, Alveerah complains of back problems, and the fees of the nearest doctor who lives in the city are too high for her. Notwithstanding, fundamental improvements at the national level, combined with the traditional respect for age, have given poor women opportunities for leadership that they could not even have imagined 40 years ago. It is not surprising that, happy and proud to be considered old, Alveerah feels she is in the prime of her life.

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