Reflections on Gerontology, Minorities, and Immigrants from the 1960s to the 2020s

Abstract:

In this article, I take a brief look at my understanding of the development of gerontology, mostly social gerontology, from the 1960s to today, through my career as a gerontologist since 1976. I comment on conceptual development, the quest for successful aging, ethnic minority and Hispanic aging, and the internationalization of gerontology. My views are based upon my decades of research as well as experience as the founding and current editor of the Journal of Aging and Health, which I founded in 1989.

Key Words:

health, Hispanics, minorities, immigrants, life course, successful aging

I began my career in 1976 as a gerontologist at the University of Texas Health Sciences Center in San Antonio, where part of my job was to conduct a survey of around 500 older people in a transitional area of San Antonio, two thirds of whom were Mexican Americans and one third non-Hispanic Whites. With two follow-up surveys completed in 1980 and 1984, we developed the first longitudinal study of older Mexican Americans, the results of which helped to establish a productive research program that included the Three-generations Study of Mexican Americans in San Antonio in the early 1980s, and later on the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE), our long-term study of older Mexican Americans in the Southwestern United States.

Below I provide an overview of my understanding of how gerontology has evolved from the 1960s to today, with some focus on conceptual development and ethnic minority aging. I also offer thoughts on changes in gerontology I’ve witnessed as editor of the Journal of Aging and Health across the past 35 years. Then I draw conclusions and provide my perspective on where we are as a field and what I see as challenges and opportunities for us with respect to our near future, especially in light of the recent and growing internationalization of gerontology.

The Search for the Good Old Age, Life Satisfaction, and Successful Aging

In my view, gerontology came of age in the 1960s with the lively debate between disengagement theory, originally proposed by Cumming and Henry (1961), and activity theory, which predated disengagement as it was originally articulated in 1953 by Havighurst and Albrect. But it was during the 1960s when it received serious attention that was stimulated to a great extent by the debate with disengagement theory (Havighurst et al., 1968; Lemon et al., 1972; Wylie, 1970).

By far the most popular outcome of this research was the operationalizing of subjective well-being in terms of life satisfaction, morale, or adjustment to various aspects of aging and old age. Most prominent among dimensions of well-being was life satisfaction, usually measured by the Life Satisfaction Index (LSI-A) proposed by Neugarten and colleagues (1961). George Maddox also published influential papers on the relationship between activity and morale (Maddox, 1963; Maddox & Eisdorfer, 1962). And in 1975 Powell Lawton published the updated Philadelphia Geriatric Center Morale Scale (Lawton, 1975).

All of this coincided with the establishment of the National Institute on Aging in the 1970s, along with increases in its funding programs.

Measures of depressive symptoms replaced life satisfaction and morale as the favored outcomes of gerontological studies in the 1980s and beyond. In 1977 Radloff had published “The CES-D Scale: A self-report depression scale for research in the general population,” which quickly became the favorite measure of psychological well-being of gerontologists and others studying the general adult population. Before long, researchers lost interest in life satisfaction as the CES-D (Center for Epidemiologic Studies Depression Scale) captured “depression,” an outcome that could be impacted, whereas people had begun to think there wasn’t a whole lot that could be done about life satisfaction.

As a continuous measure, the CES-D captured the average number of depressive symptoms in populations. A score of 16 and over was thought to approximate clinical depression, though experts have cautioned against calling it depression. Gerontologists and other social scientists found a useful measure of depressive symptomatology—psychological distress—or overall psychological well-being at any age. Funding agencies welcomed applications using the CES-D, something that can somehow be impacted. And Radloff’s paper has been cited more than 60,000 times, which must be a record for any publication proposing a new measure.

At the same time, theoretically oriented gerontologists had begun debating what constitutes successful aging while broadening their formulations. In 1989 Carol Ryff proposed a positive view of successful aging as consisting of dimensions of well-being such as “self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth” (Ryff, 1989, p. 35). This and other formulations of successful aging that emphasized positive aspects of aging have been widely offered by others (see, for example, Baltes & Baltes, 1993; Rowe & Khan, 1987; Vaillant & Mukamal, 2001). Also, the focus of health-oriented gerontologists and demographers shifted away from extending life to extending “active,” “healthy,” and “happy” life, the major focus of the health expectancy field. Healthy life expectancy has become a favorite measure of a population’s health that is easily quantified and monitored (Stiefel et al., 2010). Others have proposed and calculated disability-free and disabled life expectancy (e.g., Farina et al., 2021). Such formulations of aging have become dominant among gerontologists, demographers, epidemiologists, and others (Jagger et al., 2020).

Conceptual Approaches to Aging in Ethnic Minority Populations

In the 1970s and into the 1980s the dominant perspective on aging among African Americans centered on the notion of “double jeopardy,” or the double-disadvantage of being Black and old or growing old. Instead of originating in a scholarly tradition, the double jeopardy hypothesis had its origins in attempts of certain advocacy groups (National Council on Aging, 1972; National Urban League, 1964) to highlight the disadvantage of older Blacks in such important areas as income, health, housing, and life satisfaction.

Dowd and Bengtson (1978) attempted to formalize the double jeopardy hypothesis and evaluate it with data on middle-age and older Blacks, Mexican Americans, and non-Hispanic Whites in Los Angeles. Their formulation suggested that disadvantages of minority populations earlier in life (middle-age) in income, health, primary group relations, and psychological well-being would widen in old age. Their cross-sectional analysis found some support with regard to income and self-rated health but not in primary group relations or psychological well-being. But larger studies with national data and more objective measures of health and better measures of income found consistent evidence that both income and health differences between Blacks and Whites actually decline in old age, supporting what had been called the “age-as leveler” rather than the double jeopardy hypothesis (Ferraro, 1987; Markides, 1983; Ward, 1983).

No such consistent evidence was found between Hispanics and non-Hispanic Whites. Both Ferraro (1987) and Markides (1983) suggested that the decline among Blacks might be partly attributable to the often-observed racial mortality crossover in that Blacks who survive to advanced old age may be disproportionately more physically (and socially) robust than Whites who survive to advanced old age (Manton & Poss, 1977; Wing et al., 1985). I was so fascinated by this literature that, with the help of a colleague, I developed a “selective survival” perspective and outlined its consequences on health, suicide rates, and status of older adults among high mortality populations (Markides & Machalek, 1984).

While the double-jeopardy hypothesis made much sense intuitively, assessing it empirically was often difficult due to a reliance on cross-sectional data. A conceptually broader perspective that subsumed race/minority status and age was the multiple hierarchy stratification perspective, which also included class and gender (Bengtson, 1979). In this formulation the bottom of the hierarchy would be occupied by poor, older women from minority populations, while the top would be occupied by upper- or middle-class and middle-age White men, with others falling somewhere in between.

While this formulation has received some attention in recent literature (see, for example, Brown et al., 2016), a parallel formulation that has achieved considerable prominence is “intersectionality,” which had its origins in Black feminist theory (Collins, 2002; Crenshaw, 1989) and has received increasing attention in studies of health inequality and race/minority status (e.g., Evans, 2019; Green et al., 2017; Richman & Zucker, 2019). Attention by gerontologists and life-course researchers has been somewhat limited (Calasanti & Giles, 2018). But intersecting age with gender, minority status, and socioeconomic status sounds a great deal like the multiple hierarchy stratification perspective.

A more dominant life-course or aging perspective has been cumulative disadvantage/ advantage theory. As a life-course perspective, it owes a great deal to the work of Glen Elder (1994) and views differentiation throughout the life course, including the influence of early life conditions (Ferraro et al., 2016).

Attempts to cross-fertilize social science and age theory have been made by O’Rand (1996) and by Dannefer (2003) and has been applied by gerontologists to life-course differentiation with respect to race/ethnicity and minority status, and to some extent to immigrant status (Markides & Rote, 2019). And a synthesis of intersectionality and life-course analyses to better understand unequal aging was recently offered by Holman and Walker (2021) who also have noted its relevance to other groups defined by disability, LGBT status, and other statuses differentiated by discrimination and related factors.

Hispanic Health and Aging

Work on Hispanic health and aging in the 1980s was motivated by our studies in San Antonio but also by our conceptual work, which proposed a Hispanic Epidemiological Paradox of a relatively favorable mortality and health profile of Hispanics despite relatively lower socioeconomic status and associated risk factors (Markides & Coreil, 1986). The paradox was attributed primarily to a healthy immigrant effect and possibly strong family systems.

By the 1990s the evidence began showing lower mortality rates for the Hispanic population than for non-Hispanic Whites, but there were questions about the quality of the population’s mortality data as well as attributing possible advantages to a “salmon bias,” or the tendency of less healthy Hispanic older people to return to their home countries. While the salmon bias found some support, it was too small to account for the population’s mortality advantage (Turra & Elo, 2008). And, importantly, by 2010 the National Center for Health Statistics was able to publish for the first time official life tables on the Hispanic population that were based upon data adjusted for misclassification of ethnicity on death certificates and other data artifacts.

These life tables estimated a two-and-a-half-year advantage in the life expectancy of the Hispanic population over that of non-Hispanic Whites, and a much larger advantage over the life expectancy of the African-American population (Arias, 2010). And with considerable attention by scholars as well as the media, the Hispanic Paradox has become an established hypothesis that has guided the field of Hispanic health.

So, what about the field of Hispanic aging? What did data from the Hispanic EPESE have to say about the Hispanic Paradox? Our data have clearly suggested that, while Mexican Americans, as well as other Hispanics, are long-living populations, they do so with poorer health and more disability at older ages. Clearly part of the story of the healthy immigrant effect is that immigrants to the United States arrive with better health but lose their advantage within 10 to 20 years by adopting the native U.S. population’s bad health behaviors and high obesity rates (Antecol & Bedard, 2006). But the Hispanic EPESE and other data had always found evidence of high rates of obesity, as well as diabetes in older Mexican Americans at younger ages. And data on trends in the health of Mexican Americans ages 75 and older found substantial increases in self-reported diabetes among men and women from the early 1990s until the middle-2000s (Beard et al., 2009; Markides & Gerst, 2011).

This increase in the prevalence of self-reported diabetes was accompanied by significant increases in activities of daily living (ADL) disability and cognitive impairment, as well as slight increases in obesity and hypertension. These increases were opposite to the experience of the non-Hispanic White population, which was experiencing improvements in the health of older people at that time. We concluded that the older Mexican-American population (really at all ages) was at a similar stage in the epidemiological transition that the non-Hispanic White population had been in in the 1970s and early 1980s, when increases in life expectancy were accompanied by increases in the prevalence of morbidity and disability (see, also, Markides & Eschbach, 2011).

And the healthy immigrant effect, including convergence to native levels, has found its parallel in Australia and Canada, the other two traditional immigrant destinations where immigrants went to stay. Importantly the healthy immigrant effect applies mostly to voluntary immigrants but not to refugees such as the Vietnamese population in the United States and elsewhere (Markides & Rote, 2019).

The Internationalization of Gerontology

I started the Journal of Aging and Health in 1989, a time when gerontology was dominated by the United States and to some extent by Australia, Canada, and Western European countries. During the journal’s first few years only a handful of submissions and published papers came from countries other than the United States, namely Canada, Sweden, and Denmark. And by far the favorable health outcome at that time was physical disability typically measured by ADLs and Instrumental Activities of Daily Living (IADLs). Measures of depressive symptoms such as the CES-D were the most popular mental health measures, not just at the Journal of Aging and Health, but at other mainstream social and behavioral gerontology journals.

By the 1990s social and health gerontologists increasingly incorporated measures of physical function/mobility that included a timed short walk, repeated chair stands, balance measures, and measures of strength such as a handgrip measure (Guralnik et al., 2000). These performance measures have become very popular because they predict important outcomes such as disability and mortality in a variety of populations in longitudinal studies and are relatively easy to administer in respondents’ homes.

In the United States a major development was the establishment of the Health and Retirement Survey (HRS) in the early 1990s to follow large samples of middle-age and older Americans longitudinally. And before long the English Longitudinal Study was established and then the SHARE (Survey of Health, Aging, and Retirement in Europe) longitudinal studies collected data on 20 European countries. Health and Retirement longitudinal sister studies have since been established in numerous other countries throughout the world.

With such increasing interest in aging and health in so many parts of an aging world, we have seen a major internationalization of gerontology, especially health gerontology, most profoundly so in the first couple of decades of the 21st century. During the 3-year period of 2020–2022, for example, the Journal of Aging and Health received an average of 1,300 new submissions per year, more than 70% of which originated in other counties, led by China, Brazil, and India, in that order. Other developing countries submitting significant numbers have included Mexico, South Africa, Malaysia, Thailand, Iran, and others. My understanding from speaking to other editors is that other journals have had similar experiences.

Of course, the internationalization of the field has been a welcome development and promises to give a boost to gerontology conceptually, through longitudinal cross-country and cross-region comparisons. In my opinion this has not happened yet as many of the papers originating in the developing world are replicating analyses on outcomes done in the United States and other western countries, some of which were abandoned some time ago, such as searching for the correlates of life satisfaction and self-rated health. But many important and methodologically sophisticated publications have increasingly originated in some developing countries, especially China.

And what are recent trends in health gerontology from an editor’s viewpoint? The most obvious trend in recent years has been the replacement of disability by cognitive function and dementia as the key outcome of interest, no doubt to a great extent due to the huge increase in recent decades in Alzheimer’s disease funding by the National Institute on Aging. Another trend here and elsewhere has been the diversification of outcomes, which might indicate successful aging. These continue to include such measures as depressive symptoms, and increasingly measures of cognitive function, sleep, resilience, and social isolation and loneliness, the latter becoming especially prominent because of the pandemic. And there has also been increasing attention paid to contextual factors such as neighborhoods, the community context, and the built environment.

Concluding Thoughts

This overview of gerontology, more specifically social gerontology, is as I see it based on my limited and personally biased perspective as a social gerontologist based in a medical center in the United States. As such what I see as important in our field is based on my long-term research on minorities, mostly Mexican Americans, but also as editor of a major journal. In terms of conceptual development regarding ethnic minority aging, a great deal of progress has been made by viewing advantage/disadvantage and inequality throughout the life course with a major focus on how early life conditions influence people’s lives in their later years. And a synthesis of cumulative advantage/disadvantage and intersectionality perspectives (e.g., Holman & Walker, 2021) is relevant to understanding unequal aging beyond race/ethnicity to include such statuses differentiated by gender, social class, sexual identity, disability, religious affiliation, and others. In health gerontology we now speak about “health disparities,” for example, to encompass all of the above and other factors in the United States well as in other western countries. And especially in the United States the goal goes beyond equality to focus on achieving equity as in the Diversity, Equity, Inclusion, and Accessibility (DEIA) efforts by educational and scientific institutions.

Gerontologists and others will continue searching for the formulas for successful aging that go beyond defining “success” as not being physically disabled. Who is to say that Stephen Hawkins, for example, did not age successfully? Formulations such as the one proposed by Carol Ryff and discussed earlier present a viable blueprint for any group, community, or society anywhere.

With respect to ethnicity and ethnic minority status we have seen progress in examining diversity in understudied groups such as those of Asian, Middle-Eastern, and other origins not just in the United States but also in other Western countries. And increasingly gerontologists in developing countries and regions are turning to investigating ethnic and minority diversity in their own backyards. The internationalization of gerontology is welcome for a variety of reasons, including that research in the developing world promises to improve the lives of older people. It also provides an opportunity for us to broaden our perspectives to the benefit of all. And in speaking of internationalization, an important and rapidly growing trend that needs more serious attention by gerontologists and others are the millions of people being uprooted from their home environments and transplanted to new environments. The lives of aging refugees as well as the lives of older people left behind in troubled regions by outmigration deserve considerably more attention.

As a gerontologist for almost five decades, I have seen quite a bit of progress in our understanding of the aging process, especially by more serious study of the life course and the influence of early life conditions on later life. And in health gerontology we have made significant progress in incorporating the influence of the social and community context in our work. Perhaps an important challenge for the future will be the incorporation of the societal context in our understanding of aging, as well as contributing to the improvement of the lives of older people everywhere, as well as the lives of all at all ages.

Acknowledgements: I am grateful to Mark Luborsky, editor of this special issue of Generations for inviting my contribution and for useful and encouraging feedback throughout the development of this manuscript.

Kryiakos S. Markides, PhD, is the Annie & John Gnitzinger Professor of Aging in the School of Public and Population Health at the University of Texas Medical Branch in Galveston. He may be contacted at: kmarkide@utmb.edu.

Photo credit: Shutterstock/AJR_photo

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