Aging and Health Care: A Social Perspective

James Gladstone was in the University of Toronto Gerontology Program.

Neena Chappell, Laurel Strain, and Audrey Blandford have written a very clear and informative book on health care issues related to the elderly. Not only does the book contain extensive Canadian data, but italso addresses important issues emerging from the data.

In the early chapters, the authors place their discussion of aging in a societal and historical context. They refer to demographic shifts and the implications that increased longevity have for the availability of health care services. They distinguish physical health, mental health, and subjective health, and make a further distinction between physical health per se, and whether a physical condition actually interferes with daily functioning. Moreover, they point out that elderly persons are not a homogeneous group in terms of age and gender. In the middle chapters, they focus on three role transitions — the empty nest state, retirement, and widowhood — and discuss the influence that these transitions have on both men and women. The book reviews “informal” types of support offered to the elderly by friends and family, as well as more “formal” types of support provided by institutions. Reference is also made to the well-being of caregivers. The later chapters outline some public and private health programs. The authors describe some specific health and social services located in the community, and point to the benefits of co-ordinated services.

Aging and Health Care is not a how-to manual and does not attempt to tell its readers how to interact with older persons, or how to negotiate with bureaucracies. Rather, the book is more research and academically oriented; findings from Canadian and American studies are cited and practical implications are either implied or stated directly. In some cases, topics could have been covered more fully. For example, little mention is made of the informal types of assistance provided to institutionalized elderly, and while physicians are justifiably referred to as major providers of formal health care, no mention is made of other health care professionals, such as nurses or social workers. Notwithstanding these limitations, Aging and Health Care does accomplish its stated goals of gathering and presenting information that has relevance for academics, administrators, and practitioners. The authors do more than just list a series of subjects and statistics; they raise questions and concerns that are meaningful and thought-provoking.