October 24, 2016

Unequal Aging in America

Rhonda smithBy Rhonda Smith

PhD student, Sociology, University of Nevada Las Vegas

If I had two minutes with the presidential candidates, I would ask for one thing: the Reauthorization of the 1965 Older Americans Act.

As a former Director of an Area Agency on Aging, I bore witness to the health disparities suffered by our rural, aging population, particularly their need for nutrition assistance, in home aid, incontinence management, medical transportation, adequate housing, and medication assistance.

Can you imagine being trapped in your home simply because you do not have a ramp to get in and out of your home? Can you imagine being on a waitlist for food assistance and the impact it has on an individuals’ emotional and physical well being? Can you imagine having to make the decision about whether to take medication for diabetes or use the money to eat or pay rent?

This is a reality for many of our elderly in today’s America. One’s socioeconomic status, gender, location, and race all effect the resources an individual may have access to, greatly affecting the life course trajectories of every individual, with the final culmination of the effects of social inequality in old age.

Lyndon B. Johnson and his plans for a “Great Society” addressed issues of poverty and racial injustice as well as obstacles to opportunity, education and a higher quality of life for all of its citizens. Johnson attempted to address inequality in an aging America through the 1965 Older Americans Act (OAA):

Although older individuals may receive services under many other Federal programs, today the Older Americans Act is considered to be the major vehicle for the organization and delivery of social and nutrition services to this group and their caregivers. The OAA also includes community service employment for low-income older Americans; training, research, and demonstration activities in the field of aging; and vulnerable elder rights protection activities.

In 1964 the poverty rate was 19%, but after the Great Society Initiatives in 1969, the poverty rates fell to 12%. This low has not been seen again since the late 1970s when the government began cutbacks to social welfare.

Over 50 years later, America finds itself at the place where the schism between being rich or poor has never been greater. This further division has led to greater social inequality as a nation and the focus of policy makers should highlight the significance of age as it concerns health disparity. The intersection of race, class, gender, age and place is never clearer than when examining the stratification of end of life care.

Society has often relied on information and awareness campaigns to combat the effects of, for example, an unhealthy diet or lack of exercise. This tactic can sometimes lead to the tendency to blame the victim. It may seem that people without many resources readily make the decision to ignore these guidelines. However, we must realize self-efficacy may not be the key component to unhealthy lifestyles; but it is the location within the social structure that often dictates how successfully people are able to implement healthy lifestyles.

It may not be that a man is not willing to combat his high cholesterol or diabetes with a proper diet; it is that he cannot afford a “healthy diet.” This most vulnerable population is at risk of continued health disparity combined with societal discrimination, which assumes a willful rebellion on the part of an American underclass. This entrapment of class leads to poorer health and shorter life expectancy.

Through our social relationship, first in our families and later in our social institutions such as the workplace, religion and medicine, aging Americans have acquired habits and skills which either help or hinder their access to healthcare. That is, if one has learned subordination, they will be less likely to ask for second opinions. The experience of racism and sexism may find a white patient not trusting their Latina physician, for example. Due to class subordination, others may not question billing issues or accept the decisions of insurance providers without appeal. Whatever shape stratification takes within the lives of an aging population, it is a reflection of experiences of a lifetime.

As of this writing, Congress has failed to reauthorize the 1965 Older Americans Act. According to the continuing resolution package released by the Senate in in September:

[The] Senate provides funding for federal programs, including OAA, until December 9, but it also includes a 0.5 percent across-the-board cut for all programs to stay within FY 2017 budget caps

Congress has expressed a lack of concern not acting swiftly to reauthorize the Older Americans Act. It is essential for our legislature to understand the powerful association between poor housing, sanitation, and poor working conditions as it relates to disparities in actual health of individuals. This understanding is crucial to policy reform and effectiveness of these reforms to an aging population. It is unconscionable for our government to ignore the needs of our aging poor. Therefore, I ask for a call to action in our Congress to Reauthorize the 1965 Older Americans Act.


Thanks for the post. The status of the aged is symptomatic of what is valued in our society. We rather spend billions for useless wars than take care of our aged population. In some societies, as anthropologists have taught us, the aged are revered. Here, like everything else, it all comes down to money. If you don't have money you are invisible. It is not easy to be old, it is a very difficult time of life. My mother, who is 101, is a lucky one. She lives in an assisted living home. Even there things are difficult. It is far far worse (no comparison) when you live at home alone. What my mother has, every elderly person in this country should be entitled to: live your final years in security and some happiness.

Great post. Thank you

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