Demography of aging

Book Reviews Demography of Aging, by Linda G. Martin, Samuel H. Preston. National Academy Press, Washington, DC. 1994. 411 pp.$39.00 (paper). Changes in the population age structure will be one of the most important social policy issues of the next half century. In the United States, the percentage of all Americans age 65 and over is estimated to increase from less than 13 percent today to nearly 22 percent by 2030. Adapting to the impending demographic changes will have profound e€ects on the quality of life of all citizens regardless of age in the next century in both developed and developing nations. In this volume of ten individually-authored papers, the National Research Council's Committee on Population maps out the major social and economic themes in the emerging ®eld of ``the demography of aging.'' This state-of-the-art assessment covers research priorities and devotes considerable attention to international issues. In ®rst substantive chapter, Ronald Lee describes the challenges for social policy that are posed by an aging population. He points to the surprisingly large consequences of the age patterns of consumption, production, and social transfers. Chapter 3 focuses on worldwide trends in labor force participation at older ages and reviews the literature that has attempted to explain them. The main ®nding is that although most workers have a choice with respect to retirement age, the choice is constrained by personal health factors, government retirement and disability policies, and employer pension plans. According to the authors, the retirement routes for Americans are many and varied. For many older adults, the transition to retirement involves part-time employment (``bridge jobs''), usually on a new job, in a new line of work, and at a lower pay. In chapter 4, the authors examine the economics of the aged, including income and consumption, poverty, wealth, intergenerational economic relations, and their implications. Compared to other developed countries, not only is income more unequally distributed among older Americans than among younger Americans, it is far more unequally distributed among older Americans than among older people in other countries. In comparison with people of other countries, U.S. married couples aged 65 and over are by far the most a‚uent. An important point made by the authors is that despite impressive gains on average, the key factor to be emphasized in regard to the economic status of the elderly is their heterogeneity. Also, the authors note, the most noteworthy accomplishment of the past 30 years is the large and sustained decrease in poverty among the U.S. elderly. In chapter 5, the author addresses what might be called ``family demography of the elderly.'' The extent of kinship ties among older people and the degree of residential proximity among kin, including residence in the same household is reviewed. The emphasis is on ties between older persons and their children. In chapter 6, the authors explore the factors that in¯uence the type of care received by 7 million disabled older Americans. This population consitutes about 24 percent of those aged 65 and over. In this chapter, the authors explore the alliance of the three major sources of personal care in the U.S.: the family, the marketplace, and the state. Speci®cally, they examine how the volume and type of care and support received by older persons is distributed across these sectors, and the range of factors that a€ect this distribution. In chapter 7, the authors outline a framework for analyzing the relationships among individual health-related behaviors, genetic predisposition, disease incidence and fatality, population aging, and levels of mortality and morbidity. The authors' present evidence that rates of dis-

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ability have recently declined at older ages in the United States. In chapter 8, the authors review recent evidence about the extent and sources of socioeconomic di€erences in mortality and health among older persons in the United States. Their discussion of socioeconomic measures focusing on educational attainment will be of particular interest to students. The authors note that educational attainment is the only socioeconomic variable having a signi®cant relationship to cigarette smoking, blood pressure (women only), and high-density lipoprotein (HDL) cholesterol in the Stanford Five-City Project. Also covered is the extent to which childhood environments play in explaining adult health. The authors note that ``Socioeconomic di€erences in adult health were principally a re¯ection of socioeconomic di€erences in child health, operating via selection e€ects, would obviously not alleviate social responsibility for such di€erences, although it would change the age focus of social concern (p. 300).'' Poverty and low status exact a health toll not only through absolute deprivation of material resources but also through interpersonal stresses and impaired relationships, some of which may re¯ect relative deprivation as much as absolute deprivation. According to the authors, these in¯uences accumulate over a lifetime. The authors also note that the bulk of blackwhite di€erences in mortality and health status are explicable in terms of the unequal distribution of the groups on variables such as education and income (p. 311). In chapter 9, the authors examine the geographic distribution of the elderly population in the U.S. and the factors that contribute to its change over time (especially migration). The ®rst section of the chapter summarizes patterns of elderly geographic concentration in the country, including regional and urban/metropolitan patterns. The second section focuses on patterns of elderly and nonelderly population redistribution and on patterns of migration that contribute to redistribution at various spatial levels of analysis. The third section examines the research about migration. The authors note that the principal motives for migration at ages 70 and over appear to be related to family proximity and diminished health. The fourth section examines international comparisons. The ®nal section speci®es some of the gaps in the research literature. In the ®nal chapter, the authors focus on themes covered in earlier chapters but with emphasis on developing countries. Apart from Africa, many of these nations are aging as rapidly as the United States, and many of the same problems are evident. On a regional basis, the epidemiological transition appears most advanced in Latin America and the Caribbean. This chapter concludes as earlier ones do with a useful summary of data resources and research challenges. In summary, Demography of Aging is a truly valuable collection of essays that provides a state-of-the-art account of the global issues surrounding the social impact of the changes in the age structure. With few demonstrable weaknesses (e.g., absence of an index), the book is an excellent contribution and must reading for students, researchers, and policymakers. The volume will be of particular interest to the readers of Social Science and Medicine given the attention many of the contributors devote to international demographic issues and trends. In ten chapters, the book o€ers outstanding scholarly analyses of the social and economic impact of the rapidly changing demography of aging and identi®es valuable data sources for further investigation. School of Community Health Portland State University P.O. Box 751 Portland, Oregon 97207-0751

PII: S0277-9536(98)00001-X

Mark S. Kaplan