Introduction

Abstract

This chapter explores both conceptual and theoretical issues that impinge on understanding aging and anti-aging in modern society. It analyzes how knowledge formation of aging, with particular reference to “anti-aging” in contemporary Western society, is socially constituted and positioned by powerful taken-for- granted assumptions. These assumptions have provided a power/knowledge base for biomedical disciplines. Given this objective, this book explores theoretical issues about the ontological status of knowledge, examining and moving beyond conventional biomedical philosophical dualisms of “aging as decline”/“decline as aging” and anti-aging as its cure. Indeed, Michel Foucault’s notion that we are governed by means of social processes by which we affirm our freedom is highly pertinent. The informed use of “thinking tools” from social theory is part of the epistemic aim to debunk and shatter those taken-for-granted assumptions about constructions of aging, its biomedical contestations, and theoretical relationships of macro/micro, local/global, and object/subject to issues of culture, body, and power/knowledge.

Introduction

This book explores both conceptual and theoretical issues that impinge on understanding aging and anti-aging in modern society. It analyzes how knowledge formation of aging, with particular reference to “anti-aging” in contemporary Western society, is socially constituted and positioned by powerful taken-for- granted assumptions. These assumptions have provided a power/knowledge base for biomedical disciplines.

Given this objective, this book explores theoretical issues about the ontological status of knowledge, examining and moving beyond conventional biomedical philosophical dualisms of “aging as decline”/“decline as aging” and anti-aging as its cure. While biomedicine still retains a dominant position in highlighting aging as a disease, there is a small body of movement called anti-aging that suggests the reverse.

They suggest the cause of the “disease of old age” was rooted in the process of cell growth and nutrition. The cell, they asserted, was immortal; only its development within the body caused its degeneration and death. Focusing on cells termed phagocytes, they contended that they poisoned the body and led to decline. In response, he advocated a diet rich in lactic acid, which, he declared, would lead to the eradication of intestinal putrefaction and the destruction of microbes that caused the body to decay. Proponents such as Aubrey De Grey have suggested that the road to longevity and the elimination of death lies in the perfection of biomedical cell nutrition.

Believing that he could retain the youthfulness of tissues through proper nutrition and stimulation, he envisions a time when cells would never age. There would be, according to him, no senescence or death, but simply everlasting youth. Whether this is utopia or realism needs critical questioning. The idea that anti-aging is about life extension and eternal youth costs an extraordinary resource for research. Yet, the idea of anti-aging gives us the question, do anti-researchers understand aging? It really is a contested concept and not as uniform as anti-aging researchers such as De Grey advocate. It is about understanding the aging process and whether any intervention would work and the ethical, economic, and cultural implications that manifest from it which impinges on understanding the biomedical model in its totality.

Indeed, Michel Foucault’s (1977) notion that we are governed by means of social processes by which we affirm our freedom is highly pertinent. The informed use of “thinking tools” from social theory is part of the epistemic aim to debunk and shatter those taken-for-granted assumptions about constructions of aging, its biomedical contestations, and theoretical relationships of macro/micro, local/global, and object/subject to issues of culture, body, and power/knowledge.

The critically acclaimed sociologist C. Wright Mills, in The Sociological Imagination (1959), powerfully illustrates that the sociologist seeks, first, to understand the relationship of personal troubles and public issues and the intersection of biography and history; then, these polarities, and the ways in which sociologists address them, define the central problems of social theory in modernity. Mills further argues that the role of the sociologist is to reveal the connections between what is going on in the world and what may be happening within ourselves—in other words, “to grasp history and biography and the relations between the two within society.” Mills believed that sociologists develop a quality of mind that enables them to show individuals how their own private troubles may be linked to features of the “public world” of modernity.

Modernity itself was both a “war of liberation” and a “war against mystery and magic” (Bauman, 1992a, b, x). It was thought that the world should be despiritualized and instead replaced with “Big Science” (Bauman, 1992a, b, x). The “master narrative” of “progress” became the new “God,” “rational” replaced “irrational,” and truth became the new “mission.” In modernity, the ultimate goals of progress and the mastery of nature became assumed and unquestioned, just as God had gone unquestioned in religious faith (Bauman, 1992a, b, xiv).

The late Zygmunt Bauman has suggested that a distinguishing characteristic of modernity was the desperate search for a structured world, in which a search for social facts, such as the ways in which individuals come together in societies through a “social contract” or the ways in which “social facts” may determine individual behavior, continue to be debated along with newer concerns with levels of analysis, freedom, determinism, and morality. Indeed, in recent years, the German philosopher Jürgen Habermas (1992) has presented us with the doctrine of dialogical morality in modernity, which suggests that the identification of freedom must be arrived at collectively by all those agents likely to be affected by its adoption.

As a rival to the modernist preoccupation with macro grand narratives of “progress” and “reason,” postmodernism became increasingly fashionable in its epistemological war against grand narratives. It brought with it an “anything goes” social context “which renounces purity, mastery of form and elitism and is more playful, ironic and eclectic in style” (Thompson, 1992, 227).

Postmodernism not only affects culture but also impinges on a range of developments in all areas of Western society, such as politics, industry, and the media and the rise of social movements, ultimately leading to the development of a postmodern world characterized by “fragmentation, multiplicity, plurality and indeterminacy” (Thompson, 1992, 223). If this characterization is correct, it has had strong implications for the Enlightenment aims and values of modernist approaches of social theory. It is the acceptance that modern aims of universalism are futile and the recognition of “pluralism of cultures, communal traditions, ideologies, ‘forms of life’ or ‘language games’” (Bauman, 1992a, 102).

Whereas for modernists such as Habermas (1992), universalism of collective action is central to determine social change in a social world, for postmodernism (Powell & Longino, 2001) microprocesses of individualization, subjectification, and aging are part of fragmented social spaces, through which identities are formed and performed, that will run counter to macro processes.

Henceforth, the interpretation of the positioning of aging as macro- and fixed explanations or micro- and fluid existentialism lies at the heart of modern-postmodern debates within contemporary culture that are plugged into a contestation of “aging”: how is aging defined? What constitutes the aging process? How relevant is science in its understanding? This demands interrogation from transparent theoretical perspectives. Yet, at the same time, biomedical ambiguities do coexist regarding the aging process. One the one hand, the decline narrative is dominant through ageist discourses in society; while the “cure” for aging is its reversal: anti-aging. To suggest, anti-aging highlights that people can age without growing old. This needs theoretic disentanglement.

Yet, clearly what is striking is that one of the major problems of understanding aging in recent years is that it has evidently not been directed by social theory (Powell & Longino, 2002). Indeed, theoretical innovations in gerontology have, according to Vern L. Bengston et al. (1997), lagged well behind other sociological master narratives of race, class, and gender. Linda George (1995, 77) consolidates this by claiming that gerontological research has been “theoretically sterile.” For example, in a study of published refereed articles in eight leading North American gerontology journals (as listed in the Social Science Citation Index) from 1990 to 1995, Bengston et al. (1997) claimed that 80% of the refereed articles lacked a theoretical framework.

Bengston et al. (1997) further argue that social gerontology, dimension of gerontology, has been “itty-bitty” in its development of theoretical frameworks to assist an understanding of an important issue such as aging: “it is intellectually irresponsible for a program of research to proceed without a theory” (Bengston et al., 1997, 73).

Ironically, part of the problem about lack of social theory in the study of aging relates to the field of gerontology itself. Gerontology as a scientific discipline has been dominated with a preoccupation with biomedical sciences and its constituent elements of “decline” models of biology and psychology (Estes & Binney, 1989; Longino & Powell, 2004). Gerontology based on social theories of aging sees aging as a socially constructed category with differential epistemological prisms: for example, functionalism and feminist gerontology. However, while both definitions are fundamental to the complexities of aging in the social world, the theoretical interpretations of aging are in their “infancy” (Estes et al., 2003; Alley et al., 2009).

If we take the disciplinary dimensions of gerontology, we can illuminate both the relevance and importance they have for understanding the social constructions of aging, as well as raising questions about the development of theorizing from wider social theory. We can suggest that gerontology has two focal points in its broad conceptualization: (1) gerontology as science and (2) gerontology as social theory.

Gerontology as “Science”

One of the cornerstones of modern gerontology has been a belief in “science” and “progress” as constituting “discursive practices that give rise to epistemological figures, sciences and possibly formalised systems” (Foucault, 1972, 191). Such powerful discourses systematize networks of ideas about the “nature” of aging, the reasons for particular behaviors, and the ways individuals may be classified, selected, and controlled (Alley et al., 2009). The “project of modernity” has inspired the disciplinary development of gerontology to reconstruct aging on the basis of individual abilities, needs, and functions. The aging subject is constructed as an object of knowledge and as a seeker of that knowledge. This tension gives gerontology its character. On the one hand, it produces the subject as an empirically verifiable entity, and on the other, it produces a critical inquiry into the empirical conditions that justify the existence of subjects. Hence, we get a developmental duality of an empirical and transcendental entity. Indeed, knowledge formation in Western gerontology, in particular, is modeled and characterized by quantitative, positivist, and scientific discourses (Katz, 1996; Powell, 2001b; Biggs & Powell, 2001; Powell & Biggs, 2000; Longino & Powell, 2004; Alley et al., 2009). Traditional forms of medical-scientific expertise and knowledge under the rubric of the “biomedical model” have attempted to foster the understanding of aging and construct “worldview” “truths” about aging that are perceived as “master narratives” (Powell, 2001b). Master narratives are dense forms of discourse containing alleged universal truths, totalizing views and symbols with which to explain and understand almost every aspect of social life. These narratives play a central role in the construction of physical and symbolic boundaries, and it is through them that social groups come to know and understand the social world and constitute the classification of perceived aging identities (Biggs & Powell, 2001).

Such scientific narratives construct a particular positioning of aging. For example, Bytheway (1995) suggests the notion of “growth” is a central scientific discourse relating to the true changes to the biological body associated with human aging. Growth is seen as a positive development by biologists (Bytheway, 1995) in that a baby grows into a child who grows into an adult, but then, instead of growing into old age, the person declines. This scientific sanctioned perception is that growth slows when a person reaches “old age” and is subsequently interpreted as decline rather than as change, which is taken for granted with earlier life-course transitions. These narratives can be understood as textual formations composed by a complex set of truth codes and conventions through which scientifically grounded and privileged forms of true knowledge strive to present their worldviews as universal and hence valid for the whole of society.

Hence, aging is a site upon which power games are played out mainly through such narratives. As Biggs and Powell point out: “… narratives are not simply personal fictions that we choose to live by, but are discourses that are subject to social and historical influence” (2001, 113).

Coupled with this, the totalizing views of biomedical science, as Longino and Powell (2004) have pointed out, make a particular representation of the world seem so natural that aging, for example, cannot be imagined as an alternative discourse except as an abnormality that can be understood only through biomedical science.

However, the objectivity and neutrality of scientific knowledge expressed in broad approaches such as the biomedical model can be understood as rhetorical surfaces that obscure subterranean, politically structured orders. Coupled with this, it has become increasingly clear that a “scientific” knowledge formation lacks appropriate language for discussing theoretical and philosophical concerns or appreciating their historical and contemporary cultural contexts (Kastenbaum, 1993). Therefore, as Katz (1996) has identified, aging is not just a scientific process, and for this reason, it cannot be singularly analyzed via “disciplines” such as “biomedical gerontology.” Furthermore, according to Katz (1996, 55), the effects of the “decline” analogy can be seen in the dominance of biomedical arguments about the physiological “problems” of the “aging body.” Indeed, the master narrative of biological decline hides the location of a complex web of intersections of negative ideas constituting a culture of aging (Powell, 2001c).

Foucault suggests that the surveillance of bodies was central to the development of modern regimes of power and knowledge or what Estes (1979) calls “aging enterprises”—which are institutions created to manage the “problems” of aging, from social services to nursing care to social work with older people (Powell & Biggs, 2003; Bengtson et al., 2009). Katz (1996, 27) asks: “How … was the figure of the aged body central to the modern constitution of old age an development of biomedical knowledge?” (emphasis in original).

I address this in Chaps. 2 and 3, with an eliciting of scientific assumptions, but it is a question constantly reflected upon throughout the book. The biomedical model is a powerful discipline and practice, but for Powell and Biggs, it obscures wider understanding of gerontology: “It appears … that established and emerging “master narratives” of biological decline yet linked through the importance of techniques for maintenance … via medicalized bodily control. However, this focus on medicalization … has tended to obscure another … discourse on aging … the association between old age and social theory [emphasis in original]”. (2000, 95)

Gerontology as Social Theory

The theoretical concerns of positivist biomedical disciplinarity have significant implications for the social discourses that impinge upon the social construction of aging. How have these social discourses and policy implications been interpreted via social theories of gerontology?

A striking feature of theoretical frameworks of aging is that the majority of studies are relatively small in scale (Moody, 1998). Despite Functionalist (Cummings & Henry, 1961), Marxist (Phillipson, 1982, 1998; Walker, 1981), feminist (Arber & Ginn, 1995), and “postmodern” (Featherstone & Wernick, 1995; Gilleard & Higgs, 2000) forms of gerontological analysis, gerontology has remained “theoretically sterile” in comparison with other social science disciplines such as political science and criminology (George, 1995); as an apparently “applied” field of gerontological study, it has remained “itty-bitty” (Bengston et al., 1997) in theorizing aging. Bengston and Schaie (1999) also claim that theoretical developments in gerontology have at best a limited history (1999, 41). Katz (1996, 42) consolidates this by claiming that the use of aging in ways that are informed by the cultivation of wider social theories of postmodernism and Foucauldian studies, for example, is relatively unknown territory.

In order to add and develop the relationship of aging and contemporary social theory in an area left “uncharted,” this book contributes to, and strengthens, the critical interconnection between aging and contemporary social theories of aging body, power/knowledge, discourse, and subjectivity. While, for example, postmodernism and Foucauldian theory are challenging, other disciplinary fields in social science, mainstream social gerontology are impermeable (Estes et al., 2003). Surrounded by its biomedical paradigms, gerontology fails to recognize that its most imaginative developments come from the critical and cutting edge theories of those scholars who transcend so-called fixed disciplinary boundaries. It is therefore timely that this book is written when serious questions (Phillipson, 1998; George, 1995; Bengston et al., 1997; and Biggs, 1999) are being raised about the limited development of wider social theory in social gerontology.

Despite this, the “biomedical” study of aging has dominated the disciplinary development of gerontology which has masked the historical development in theorizing aging (Katz, 1996). The biomedical model problematizes aging as a pathological “problem” tied to discourses of “decline,” “dependency,” “decay,” “abnormality,” and “deterioration” (Powell, 2002). Thus, the problem orientation to aging is historically configured in biomedical sciences and discourses that specialize in the medical reductionism of gerontology (Powell, 2001a; Powell & Biggs, 2000; Biggs & Powell, 2001). As Foucault pointed out: “It [is] a matter of analyzing … the problematizations through which being offers itself to be, necessarily, thought—and the practices on the basis of which these problematizations are formed” (Foucault, 1977, 11).

The biomedical problematization of aging has secreted wider questions of power, inequality, and culture, and the growth in “social aspects” of aging has developed as a direct challenge to the authority of biomedical power and knowledge. The purpose of this book is not only to challenge such knowledge formation but also to map out the terrain of evocative modern and postmodern theories and their contestations and insights for understanding aging. It has only been in the past few years that social theory has been taken seriously within gerontology (Estes et al., 2003; Bengtson et al., 2009).

The embryonic state of a sociological analysis of aging can be judged from the lack of refinement of the term “age.” In Western societies, an individual’s age is counted on a chronological foundation, beginning from birth to the current point of age, or when an individual has died. Counting age is a social construction because it is a practice underpinned by conceptions of time in regional, national, and global spaces (Powell, 2001b), which came to be of increasing importance with the development of industrial capitalism (Phillipson, 1982).

Furthermore, age has three main focal points of interest to its theorization. First, age and aging have a biological and physiological dimension, so that over time and space, the appearances of physical bodies change (Longino & Powell, 2004). Second, the aging of an individual takes place within a particular period of time and space. Third, as individuals, society has a number of culturally and socially defined expectations of how people of certain ages are supposed to behave and how they are positioned and classified. “Old age,” for instance, is difficult to define, especially for the state and its institutional branches. For example, for the United Kingdom’s “Department of Pensions and Work,” the legal concept of “pensionable age” has defined “old age” at 67 (Biggs, 1999).

The Department of Health’s National Service Framework defines “old age” at 50 (Powell, 2001c), yet the same UK department states that those people requiring intensive health services such as hospitals have been predominantly those older people aged 75 and over (Age Concern England, 1997; Phillipson, 1998). The British state is uncertain what old age can be defined as, but it is clear that biomedical models of aging and their viewpoints do influence societal perceptions of aging that impinge on social processes such as life zones of “health,” “work,” and “retirement” (Phillipson, 1998).

It is particularly apt, then, to attempt to ground developments in a social theory that can be applied to questioning what we understand by “aging.” It is also clear that theoretical perspectives need to be documented and analyzed in the light of the triumvirate of social, political, and economic transformations in Western society over the past 50 years. Indeed, the book also reflects on the modern/postmodern duality and how this continual provocative debate in social theory impinges on aging studies and anti-aging, by paying particular attention to examples drawn from biomedicine, social theory, popular culture, and power relations.

Modern and Postmodern Theories of Aging

What is a theory? A theory asks why a particular analogy is used to explain what is meant by aging and how the assumptions contained within biomedicine and policy spaces influence our understanding of the position of older people in contemporary society. Theories of aging are important in establishing frameworks for understanding, interpreting, and problematizing aging; how the processes of aging are contested and negotiated; and the interplay between various levels at which social relations take place—including hitherto neglected aspects of aging experience such as inequality, body and identity, technologies of power, and subjectivity.

Ironically, the solutions to the “problems of aging” are tractable to disciplines such as gerontology, because they seem to promise answers to age prejudice and marginalization (Chudacoff, 1989). For example, biomedical “solutions” address fears about mental and physical incapacity (Longino & Powell, 2004).

Medicine, with its focus on individual organic pathology and interventions, has also become a powerful and pervasive force in the definition and treatment of aging. The resulting “biomedicalization of aging” (Estes & Binney, 1989) socially constructs old age as a process of decremental physical decline and places aging under the domain and control of biomedicine. It also encourages certain forms of the politics of aging: a focus on age as a question of social welfare and a particular interpretation of the effects of risk and individualization. Theories of aging, albeit in contrasting ways, see these phenomena as indicating particular sites of resistance in which dominant biomedical conceptualizations of aging are to be contested and alternative explanations can be intimated.

For example, in stark contrast to the biomedical approach, the “political economy of old age” theoretical approach examines the structural inequalities that shape the everyday experience of growing old in modern society (Phillipson, 1998).

The book is not just about biological or psychological aging and the contestations of anti-aging, which is about how the body changes over time and allegedly can be stopped by regenerative medicine; but it is also about the discourses and processes that impinge on social construction of aging through prisms of sociological theories. The emphasis is placed upon the processes of aging rather than aging itself. It is anticipated that the epistemological and ontological debates discussed throughout the book will provoke thoughtful questions and potential explanations for the social construction of aging.

Understanding aging plays a crucial part in the identity formation of older people in the representations of the human body. When a new body of thought which focuses on the unlimited capacity of the body to transcent aging, it requires critical assessment. The anti-aging literature comes about because of an increased insecurity of aging in a culture that puts premium on youth.

Outside of the discipline of social gerontology, feminism has focused on the ways younger women’s bodies were controlled and dominated within patriarchy. According to Twigg (2000), feminism has focused our attention as to how women represent the body itself. The current interest in the body and embodiment in social and human sciences encompasses a range of themes and theoretical traditions (Powell, 2001c). Historically, the discipline of sociology ignored the centrality of the body in terms of its prioritized “rational” or scientific analysis of modern social systems (Oberg & Tornstam, 1999; Wahidin & Powell, 2001). Indeed, the sociological tradition has focused upon the social forces that impinge upon the construction of personal biographies and the society in which sociologists live (Mills, 1959). The sociological aspirations of Karl Marx, Emile Durkheim, and Max Weber distanced them from a study of the body in order to generate intellectual respectability to ideas about social order and social change (Turner, 1989). Sociology simultaneously distanced itself from biological reductionism, which, as part of the “project of modernity,” attempted to talk of the body as an object to be predicted and controlled. Coupled with this, the modernist preoccupation with theorizing and constructing grand narratives in theories of aging has also tended to exclude an analysis of the body. As Powell (2001b) points out, theorizing occupies a commanding position in sociological analysis; with a preoccupation with abstraction, bodies are things to be transcended or ignored.

Moreover, gerontology continues to be in the thrall of a biomedical discourse on aging (Powell & Longino, 2001); although concerned with the fixed limitations of the aging body, it restricts an ontologically flexible understanding of aging. Conversely, we can question how the aging body acquires meaning and also how the meaningful body itself, in its turn, influences and limits signifying processes and social efforts as related to society and culture.

The central focus is not on the body as a natural given, or as the conglomerate of neurons, hormones, and genes, but rather as a concrete social and cultural practice of everyday life. Traditionally, the body in its actual realities has been generally neglected within the social sciences and humanities (Shilling, 1993; Katz, 1996). The investigation of the body was more or less relegated to biology and the medical sciences. In recent years, however, the body has made a major comeback within all realms of scholarly and scientific research (Shilling, 1993), especially those fields that have traditionally focused on the “inanimate” aspects of reality. For example, literary critics, film theorists, political scientists, historians have shown an upsurge in interest in a variety of “bodily matters”. That is, in the concrete, corporeal dimensions which render us all recognizable human beings, the physical aspects of our individual and collective embodied specificity and experiences.

Before we discuss how and why the aged is now constructed as medical problem and before we explore how the recent demographic shift has contributed to the perception of the old as a burden to modern society, we need to recognize that ageism has always existed in many countries, and not only Western ones, and that tensions between generations have a long history (Calasanti, 2020). Through the history there were various ways of confronting the elderly and their imminent death, ranging from older people’s recognition of the need to accept their fate, through senicide, that is, the extreme institution which in the past existed in many cultures, to the separation of the elderly in residential facilities, which is a modern phenomenon. The first type of approach can be founded in the Antiquity premise that human worth is aligned to productivity. The idea that the old should not reject the opportunity of ending their lives when they are not anymore useful for society was expressed by Socrates, when he argued, as reported by Plato, that old people who are not productive citizens ought not to fear of death but accept their fate as their responsibility to the state. Socrates, who showed an enormous courage in accepting his sentence to die at the age 72, knew that “when a man has reached [his] age…. the fragilities of old age will be realized.” He believed that since the man’s greatness consists in accepting his human conditions with responsibility, when he cannot be a productive citizen, he should acknowledge it and accede to his death (Socrates, quoted in Choron, 1963:43–6).

Senicide, or geronticide, that is, killing of elderly to death, was one of the institutions to solve a problem who should live and who should die. It was a practice of the killing of the elderly who were already at an age of perceived uselessness, which was usually performed by members of their tribe or their family (Holland-Batt, 2020). It illustrates the potential for violence in any society as soon as “any category of humans is placed outside the pale of those whose life has value, nothing more natural than to kill them” (quoted in Rose, 2022:60). Geronticide was done in various way; in many past societies, old persons were simply neglected or abandoned, so that they would die without becoming burden for their families. For example, a Germanic tribe, Heruli, in the period from 400 to 800 CE, killed the sick and elderly (Pyali, 2017). The killing of the old was also practiced in Sardinia, where women known as accabadoras (terminators) would bludgeon or suffocate the elderly. It was experienced in Japan, where the apocryphal practice of ubasute involved abandoning elderly relatives on a mountaintop to die of exposure (Holland-Batt, 2020:20). Likewise, in the Arctic regions of Greenland, Canada, and Alaska, Inuit, a group of peoples inhabiting these regions, used to practice senicide by leaving their elderly on the ice to die. Senicide among the Inuit people was rare, except during famines and the last known case of an Inuit senicide was in 1939 (Pyali, 2017). The only country where it is claimed that probably some cases of senicide still occur even today is the southern district of the state of Tamil Nadu in India. Although thalaikoothal, a practice in which the elderly are given cold oil baths to reduce the body temperature, then fed coconut water and milk to prompt renal failure, is unconstitutional in India, apparently it can still be found in some places. Soumya’s report from 2016 noted that the only difference between a few observed cases of thalaikoothal at the time and the past practices was that ‘earlier the family conducted it as a ritual, now it is more of a silent affair’ (quoted in Pyali, 2017).

In addition, the senicidal thinking, expressions, and symbols can provide a conceptual framework for an extreme form of ageism. For many centuries, such a perspective has been present in various cultural expressions, extending from folk legends through novels and dystopian literature to folk horror films. For example, the fictional tradition of ättestupa, which—according to Nordic legends and sagas—refers to sites where during prehistoric times ritual of suicide of elderlies took place, came into use in a 2019 Midsommer movie. Likewise, a popular Japanese folktale refers to a fictional ritual of obausteyama in which old women are abandoned at the top of mountains by their sons (Danely, 2015). Also fictional visions of senicide can be found in novels. In dystopian literary narratives, the ruling generation typically justifies overt violence toward the aged through the lens of economic rationalism; the elderly are viewed as “burdensome ‘parasites’ who are expensive to maintain” (Cruikshank, 2003:23). For instance, in Trollope’s science fiction novel, The Fixed Period (1882), which is set on the island of Britannula, off the coast of New Zealand, in the distant year of 1980, the elderly are separated into a collage for retirement at 65 and, then, so they do not to endure the indignities, and weakness, and selfish misery of extreme old age, they are euthanized at the age of 67 and half. This radical solution that all old citizens should be executed is proposed by the enlightened rulers of Britannula who, when faced with the problem posed by medical progress, that is, with the growing aging population, prioritized the quality over the quantity of life. In Huxley’s Brave New World (1932), the elderly are killed at 60, then cremated and recycled into fertilizer. The subject of the cost of longevity is also explored in Lionel Shriver’s recent novel, Should We Stay or Should We Go, which asks how long we want to live and how we wish to die. The novel argues that for anybody “to survive in a state of advanced decay is unnatural,” laments that the aging population is a “burden on younger taxpayers,” and makes the aged “feel literally guilty for living and also dying for too long” (Shriver, 2021:48).

This work of fiction, by raising the issue of potential conflicts of interests between old and younger generations, has exposed how the growing realization of the cost that the expanded life span has been inflicting societal ageism.

In many Western countries, the prediction of the approaching “demographic agequake” has been adding to the intergenerational tensions, which started from at least the 1990s and were later enhanced by the financial crisis of 2008. With the “silver tsunami” getting politicians worried, the aging population has been defined as the greatest threat to today’s societies. Viewing the aged as a social problem, as several studies show, has been on policy agendas or parties’ manifestos in the UK, USA, and Australia (Bristow, 2019; Calasanti, 2020; Walker, 2018). In other words, scapegoating of the older generation, justified by the demographic change, has been used by policymakers as a way to cut back on welfare entitlements. As the rhetoric around the old has changed, “old people have moved from being seen as deserving and entitled, to being undeserving dependents, especially those who are the most economically vulnerable” (Calasanti, 2020). However, this recent ageism which has been brought to surface by fears and threats signaled by the metaphor of the “silver tsunami,” would have not been possible without the presence of the long established stereotypes, prejudice, and negative attitudes toward the aged in modern society.

The demographic shift has forced Western societies to realize that in the next several Decades, they will be facing many new ordeals. These forthcoming challenges are seen as a result of the expected very unbalanced age structure, with the huge numbers of elders, especially those over age 85, and small increases in the population aged below 64 years. It is projected that in the UK, by 2066, there will be a further 8.6 million residents aged 65 years and over, taking the total number in this group to 20.4 million and making up 26% of the total population, while in the USA, the number of people over 85 is expected to nearly quadruple over the next four decades (Colby & Ortman, 2015). Moreover, it is estimated that in the UK, in 30 years’ time from now, around 20% of people aged over 80 will have some form of dementia (Lloyd, 2000) which means that many people dying in old will spend several years in poor health and would require extensive care. For many Western countries’ challenge of an increasingly larger share of retired people who are not contributing to the labor market and whose demands for medical and social care will continue to increase, is an urgent financial problem. As we live longer, the question arises if we can afford pensions that need to last more than twice as long as when they were first introduced in the beginning of twentieth century. Thus, the quality of provision to older citizens and their postretirement welfare become a real in social problem in all modern nations (Grant & Scott, 2016).

However, the political elites’ answers to this real problem facing developed countries have been, as many policy scholars suggest, neither adequate nor correct (Bristow, 2019; Calasanti, 2020; Walker, 2018). Western societies, while worried and scared of the expected arrival of “demographic time bomb” and fearful of its consequences (that is, the increased health costs, social care cost, and pensions cost), have constructed a narrative of generational inequality in which the aged are defined as a social problem or a burden on the public purse (Bristow, 2019). While claiming that the expanded longevity has brought new costs and problems for the state, political and cultural elites of many developed countries have employed the generational war rhetoric—“Baby Boomers” versus “Millennials”—to justify welfare cuts (Bristow, 2019; Gibney, 2017). From the first decades of the twenty-first century, with the post-war baby boomers (the generation born between 1946 and 1956) coming of age and with the “golden cohort” (the generation born between 1925 and 1934) slowly leaving or being hidden in care homes, it has been the generation of baby boomers that has become to be seen as unwanted burden for Millennials (the generation born between 1981 and 1994 or, in some classifications, as late as 2000).

By constructing divisive intergenerational rhetoric and using it to call for welfare reforms, policy makers and campaigners for intergenerational equality have attacked the older adults as “the entitled generation” that damages the economy, undermines the standard of living, and makes their societies dysfunctional (Gullette, 2015:25). In media, the baby-boomers generation has often been presented as greedy, self-indulgent individuals with gilded pensions and overpriced houses (Bristow, 2019). In several books, it has been claimed that the baby boomers, by meeting all of their housing, healthcare, and financial needs at the expense of their children, have been forcing the next generation to take back seat (Willetts, 2011). The baby boomers have been labeled a “generation of sociopaths” who have “mortgaged the future” and “betrayed America” (Gibney, 2017:12). Some writes, while pitting the young and painting the picture of the baby boomers as the selfish generation responsible for many contemporary problems, from climate change to deprivation of younger generations of many benefits; ‘exacerbate generational warfare, arguing that older people in need of life-saving measures should be permitted to die in favour of younger people’ (Holland-Batt, 2020:22). With the duty-to-die campaign’s argument that the older people should “go cheaply” by refusing medical treatment gaining notoriety and moving out of bioethics, the generational gap between millennials and the baby boomers has been further expanded (Gullette, 2015:25).

As these presentations illustrate, policy makers and campaigners for intergenerational equality, by making the baby boomers generation guilty of “stealing” the future from younger generation, have constructed a narrative of intergenerational divide that suited their political agenda. Political elites, together with champions for intergenerational equality, blamed baby boomers of the failure to protect the interests of the future generation and demand that “politics must act to address that” (Willetts, 2011:34). By declaring that younger people’s economic problems, unsatisfying jobs, inability to afford houses can be solved just by “mugging grandmas” who do not deserve what they have, they have inflated intergenerational conflicts over resources without offering any real solutions to the societal problem (Bristow, 2019). “Policies couched in the language of ‘intergenerational equity’ do not seek to redistribute resources from old to young; rather, they aim to curtail the entitlements of older people in order to cut public spending overall” (Bristow, 2019:214). In other words, intergenerational equality calls for fair treatments of young people should be viewed with suspicion, as in reality these demands for improvement of intergenerational equality are simply arguments to reduce spending on pensions and health for elderlies (Bristow, 2019; Calasanti, 2020; Walker, 2018). This divisive rhetoric of intergenerational divide wants us to believe that there is conflict between old and young; thus, in order to activate generational frictions, it accords the lower value or status to older people. As backing of the rhetoric of a generational “war” by ageism has made ageism into a new acceptable prejudice (Bristow, 2019), the scapegoating of the aged has become very harmful experience for the elderly. With “the baby boomers” notion becoming a term of abuse and with the setting of young people against older generation, many of the baby boomers sense that “everybody hated old people; it was acceptable, encouraged even because of a paid-off mortgage and free education and ruination of the planet” (Wood, 2021:34). They feel that, by being blamed for forgetting about younger generations and for forgetting to “act their age,” they are scapegoated and forced to accept their declining status and social invisibility. While this type of narrative is unacceptable when used with regard to other groups in society, it is apparently still acceptable to discriminate against the baby boomers.

Nonetheless, even if the stigmatization of the baby-boomer generation, which is no coincidence, but rather constructed for political purposes, is socially acceptable, it still does necessary mean that the intergenerational conflict is really felt by two concern generations. Researchers documented that although young do not see anything positive in being “old,” they “hold very different, even positive views of elder family members” (Calasanti, 2020). Of course, younger people do not have much knowledge about aging, but they do not necessarily accord the lower value older people (Chung & Park, 2019).

Empirical studies also show that there are vital bonds across generations, that young people do not see their grannies as responsible for their economic fate, and that young adults do not accept discrimination against older people as a remedy for their difficulties (Bristow, 2019).

Furthermore, the interests of old and young are not necessarily entirely opposed; for example, in the USA, 13% of grandparents provide care on a regular basis to grandchildren, while 62% help children and grandchildren financially (Calasanti, 2020). Moreover, the interests of old and young are not necessarily in conflict not only because older generations often provide the essential support and help to their children and grandchildren, but also because all groups can equally suffer from politicians’ use of the intergenerational argument to justify austerity politics and welfare state reform. As the propagated divisive rhetoric does not explain social issues in terms of structural and other divisions, such racism, gender, ethnicity, thus it leaves many real problems unaddressed.

Conclusively, the existence of conflicts between generations can be questioned because of the imprecision and misuse of the concept of generation itself, which makes it rather problematic to identify generational’ interests. The notion of generation is “a muddled concept,” rarely defined beyond chronological age and often used interchangeably with age (Bristow, 2019: 65). However, despite this notion’s confusing status, it, mainly because of the symbolism attached to generations, can be used to sell specific political programs by blaming a selected age cohort for problems which might be more realistically handled by addressing class or other divisions. Yet the notion of generation, understood as something more than merely collections of a people of the same chronological age, can be of the significance. This importance of the concept of generation is connected with the uniqueness of each generation in terms of its historical and cultural context of experiences that occur during their members’ formative adult years. In other words, generations only make sense “when we try to define them, not by the dates in which they happen to be born, but by the social events that characterized the time at which they came of age” (Bristow, 2019: 74).

Such a conceptualization of generations explains the specificity of each generation in terms of the different character of their respective social, economic, and cultural circumstances. Without denying that there are many differences in each demographic cohort’s in terms of its social compositions, aspirations, expectations, and experiences, the uniqueness of generational experience can contribute to some common features shared by members of a given generation. An unique generational participation in the same historical and social circumstances can endow “the individuals sharing in them with the common mentality and sensitivity” (Mannheim, 1973:291). The distinctiveness of generational context translates itself into a set of embodied practices and tastes, attitudes, preferences, and dispositions, which are sustained by collective memories and enforced by control, through rituals of exclusion, over access to collective resources (Misztal, 2003). The uniqueness of generational experience is reflected in generational differences, ranging from differences in health to life expectancy to differences in attitudes. For example, the “golden cohort,” in contrast to the previous generations, was exposed to rationing in their adolescent and early adult years (between 1940 and 1954) and had the specific health, eating, and smoking habits (Murphy, 2009). In comparison to the “golden cohort,” the baby boomers have lived in more stable and affluent societies with a culture defined by the proliferation of television, and they—by the virtue of their sheer demographic power—have impacted on their respective countries’ economic and cultural life more than the previous generation. At the same time, when an older generation comes to be identified with nothing more than chronologic age, ageism easily surfaces as the reliance on such a distorted notion of generation, by ignoring differences of class, gender, ethnicity, and race, can facilitate the rhetoric of generational conflict.

This brings us to the final argument behind our questioning of seeing the aged as a social problem. More specifically, the rhetoric of intergenerational divide is flaw because demographic characteristics or chronological age cannot be seen as the sole explanatory factor behind people’s interest. In other words, it is flaw because it is based on the incorrect assumption of the uniformity within age groups, as though the differences between generations were greater than those within them. Especially critical for us here is the misleading assumption of the homogeneity of the old cohort as group, the elderlies. Today’s increasing heterogeneity of a growing group of older adults includes structural inequalities and subjective differences. In modern societies, later life becomes a site of growing diversity which is constituted by “both division and difference where discourses and practices oriented toward choice of autonomy, self-realization and pleasure are becoming as prevalent as those oriented toward decline, hardship and inequality” (Gilleard & Higgs, 2020:5). To fully grasp the heterogeneity of the aged, we need to recognize subjective differentials, and social divisions such as gender, class, ethnicity, and race, as well as diversities that are structured by social relations of after-working life, the type of households, and the fluctuations of the economies of contemporary developed societies (Gilleard & Higgs, 2020). Given the ways that advantages and disadvantages add up over the life course, “it comes as no surprise that we observe the greatest disparities in old age” (Calasanti, 2020). For instance, in the USA, the greatest income inequalities exist among the older population (Calasanti, 2020). Although now, in contrast to the past, the living standards of pensioners and those of the general population in the majority of modern nations are similar (Gilleard & Higgs, 2020), still there are differences of wealth within the aged cohort. Moreover, although there are some older people who are quite wealthy, a large proportion of the elders are financially insecure. In the UK, for example, the proportion of elderly people living in severe poverty is five times what it was in 1986, and this rise, from 0.9% of the elderly population in severe poverty to around 5%, is the largest increase among western European countries (Ravallion, 2015), while in the USA, a 62% of beneficiaries rely on Social Security for 50% of their incomes (Calasanti, 2020). Apart from differences in financial wealth, education, occupation, gender, ethnicity, and race, also identity and subjectivity play a critical role in sourcing social difference. While social divisions imply an externally ordered hierarchy of resources, power, and status, subjective factors can shape life styles, cultural interests, and the level of engagement in paid and in unpaid work as, for example, one-third (36.5%) of US older citizens spend between 100 and 499 hours a year volunteering (Calasanti, 2020).

However, the heterogeneity of the aged goes beyond all the above factors as the body creates new differences in health and frailty in later life (Gilleard & Higgs, 2020). With aging, the body acquires much greater importance as both site and source of social divisions. Thus, the body should be included, in addition to the structural accounts of social, into our consideration of the heterogeneity of the aged cohort. Given the role of the body, with health and frailness, as a marker of division and difference, in what follows, we will explore the corporeal signs of frailty and infirmity at the old age.

By including the human body as a marker of division and by acknowledging that the cost of an aging population also needs to be understood in terms of the age-related health inequalities, we explore how old people’s health predicaments—more specifically, frailty and social death—become forms of exclusion. With getting older, when the body ceases to be the shelter and instead becomes a threat, that is, when there is the greater the risk of frailty and irremediable illnesses, comes the “fourth” age, which encapsulates the “bleaker aspects of old age” (Gilleard & Higgs, 2015:268). The features of the “fourth” age as a period where “human agency is no longer visible” (Gilleard & Higgs, 2015:268) will be further explored in the final chapter of this book. Here I focus only on the single aspect of the “fourth” age, that is, on frailty of people who are in this “horrific, disgusting and tainted by mortality stage” (Gilleard & Higgs, 2015:137). The assessment of frailty, which divides “too old” (the “fourth” age) from those who are merely “older” (still in an earlier period of aging—the “third” age), is used as a tool for rationing of care in later life (Gilleard & Higgs, 2017, 2022). After discussing frailty as a source of distinction and exclusion in later life, the chapter explores fears often connected with frailty, that is, a fear of social death. Even though frailty and social death can overlap, social death, as it marks the end of independent and socially rewarding life, should be discussed by itself as the extreme case of a further separation of those who are very old from those in the proximity of death.

When I started writing this part on longevity, the world’s oldest person celebrated her 119th birthday in Japan nursing home. On the 3rd of January 2022, Kane Tanaka became the oldest of a large and growing group of centenarians in Japan, a country with the fastest-aging societies on earth, where life expectancy is at 87.74 for women and 81.64 for men, and a nation that annually celebrates the Respect for the Aged Day (The Guardian 3.01.2022).

Her case illustrates not only the increased longevity and that women make up the vast majority of centenarians but also that the expanded longevity comes with the limitations of the body and the loss of autonomy. In other words, despite the medical advances and despite generally better health conditions and expanded life span of today’s older people, in later life, they face many challenges, ranging from the increased risk of frailty to the deteriorations of cognitive and physical powers to social death. Yet, the pervasiveness of the anti-aging movement picks out examples of very long lives and talks of extending them via more scientific research. This is of course with odds from the same tradition of the biomedical model which states that frailty affects the aging body leading to decline. The biomedical model wants it both ways: aging is about decline and anti-aging is about rejuvenation (Powell, 2023).

Presently, frailty, which accumulates with age, due to the progress of medicine, starts later and proceeds at a slower rate than in the past, consequently only around 10% of people aged over 65 and between 25% and 50% of those aged over 85 live with frailty (Age UK website). The baby boomers, who in 1965 were signing “I hope I die before I get old” (Wolpert, 2011: 222) and approved Dylan Thomas’s advice that “Old age should burn and rave at close of day,” are not a topic of this section because on the average they have not yet reached the “fourth” age (Wolpert, 2011: 222). The majority of them are still in the “third” age, which embraces a narrative or “good” or “successful aging” and offers a chance of rewarding social life and inclusion. Here we are interested in those who are already in the “fourth” age, that is, in people who failed to “age well” and who now suffer from chronic and degenerative diseases of aging and experience a fear a loss of social agency exclusion. Typically, these people are aged over 85, and although even this group’s health and frailness vary, they on the average experience the body’s incapacities which create new health difficulties and inequalities.

While the baby boomers are seen to be a social problem, those older and frail people tend to be perceived as a burden or bed-blockers whose claims on life-extending health and social care from public resources are questioned. With the growing applications of the term of frailty as a major source of “social division, separating those who are merely older from those who are too old” (Gilleard & Higgs, 2017:1681), there is increasing evidence that the very old people are often seen as the subjects to the age-related rationing in health care (Lloyd, 2000). Such a rationing of health care is presented as “fair” approach on the basis of the idea that rationing should favor the young “because the old will already have experienced enough good health in order to each old(er) age” (New and Mays, quoted in Lloyd, 2000:174). However, it is difficult for the public to accept that not everybody who needs care gets, especially when it is clear that old people are blocking beds in hospitals in the UK mainly because the British social care is in a crisis and the health system is overwhelmed (Lanchester, 2021). For the last 20 years, despite 17 white papers, green papers, and reviews of funding concerning social care (Clarke, 2021), the systematic crisis of the health and care system has been caused of daily problems and reality of rationing of health services. Only just recently, the efforts and calls to address the issues in the health and care system have been recognized. As the age-related body’s frailness and incapacities divide those who are fit and who are aging successfully from those who are already frail and not “aging successfully,” with the UK not well functioning health and social care, health inequalities becoming more noticeable (Gilleard & Higgs, 2017).

This potential for divisions and inequalities in treatment is constructed with a help of the application of the category or notion frail and development tools for its assessment. As the increased reliance on frailty poses challenges to today’s older people and the health and care system, it is important to examine its potential impact on health policies as well as on shaping older people’s status and self-perception. The notion of frailty has been at the center of attention of various theoreticians and practitioners concerned with services for older people for a couple decades. For researchers in the age studies, the term frailty exists alongside “successful aging” as one of “the leading paradigms of our time” (Grenier, 2020:2338). In such debates, frailty, as the symbolic marker between activity and decline, refers to functional decline and general weakening, risk of falling, and diminishing capabilities. The simplest illustration of the body’s deterioration due to the age-related physical impairment is the case of older persons’ vulnerability to falling which is a “powerful metaphor of declining” (Kingston, in Katz, 2015:168). As subsequent injuries from falling can result in death, and as the fall rate and cases of death by injury increase with age, it is not surprising that dying from injuries connected with falling among people aged over 75 is one of the most common causes of death in the UK (Katz, 2015:166).

Yet the notion frailty, despite the growing interest in the application of this term in many settings, including clinical ones, is still a problematic concept as there is an absence of universally agreed definition of frailty and as it is the term which originated from “lay’ or everyday language. Moreover, the concept of frailty has a long history in “lay” language, which goes back to “Middle English when frailty was used to refer to weak morals” (Gilleard & Higgs, 2022: 207). Today, however, according to many dictionaries, frailty in everyday language stands for infirmity, being weak, delicate, failing, feeble, debilitated, incapacitated, crippled, and wasted, while the Wikipedia defines it as a state which “embodies an elevated risk of catastrophic declines in health and function among older adults.” All non-clinical or “lay” definitions, like clinical ones, stress that frailty is a condition associated with aging; however, they also tend to add that frailty as “something to be feared” (Grenier, 2020:2345). Unsurprisingly, older people do not identify themselves with the word “frail” or with the phrase “living with frailty,” even though it is not always claimed that living with frailty necessarily means incapability of living an independent and socially rewarding life. They reject these expressions because such phrases resonate with their deep fear of losing independence, dignity, and control over their lives, in short with a fear of social death (Britain Thinks, 2015).

This lack of relevance of the notion of frailty for older adults themselves has been observed in Frailty Language and Perceptions, a report by Britain Thinks for Age UK and the British Geriatrics Society. The report discovered that older people themselves do not use the word “frail” or the phrase “living with frailty.” The term “frailty” is not part of older people’s vocabulary as they worry about negative connotations of this notion. They resist stigma and stereotypes of older age and therefore express a rather strong aversion to the term “frail.” Moreover, clinical attempts to assess frailty do not resonate with older people (Britain Thinks, 2015). Subsequently, older people’s unwillingness to accept the label “frail” was addressed in 2016, in the International Association of Gerontology and Geriatrics’ (IAGG) Global Aging Research Network (GARN) report warns older people about frailty and tells them that “solutions are available, so do talk to your doctor.” “Beware of Frailty” cautions the older person about the risks and perils of frailty (i.e., weakness, weight loss, slow walking speed, fatigue) and asks “the elderly” to seek medical help (Grenier, 2020:2345).

In contrast, to older people’s resistance to the term, Britain Thinks’ report discovered, the notion of frailty is accepted and increasingly used by professionals and specialists in health and social care to describe a physiological state resulting from a combination of age-related co-morbidities daily (Powell, 2023). Despite the recent reliance of the notion of frailty in geriatrics and other clinical disciplines to address medical issues and the production of frailty assessment tools, the meaning of concept of frailty is not always precisely defined. Yet despite the multiplicity of meanings, most clinicians agree that frailty comprises three fundamental elements: “that it is a condition or syndrome rather than a disease; that it “results from a multi-system reduction in reserve capacity; and that this failure results in the decline of physiological systems” (Gilleard & Higgs, 2022:205). For example, in geriatric medicine, frailty is defined as “common clinical syndrome in older adults that carries an increased risk of poor health outcomes including falls, incident disability, hospitalization and mortality” (Powell, 2023). Professionals and specialists use the term “frailty” in clinical settings to describe a “spectrum of physical and mental health states and to assess risk or to put together a care plan for elderly persons” (Powell, 2022). For geriatricians and care professionals, frailty describes those people who are approaching the end of their lives, malnourished, and highly dependent on care. They also, in contrast to “lay” older people, have knowledge of Comprehensive Geriatric Assessment (CGA) or the Clinical Frailty Scale (CFS), that is, the tools used to identify frailty in older patients in order to provide an acute frailty service to ensure appropriate care for frail older people.

The increasing prevalence of the usage of the term and employment of the frailty assessment methods in general practice in England’s NHS raise a questions about unintended consequences of the appropriation of a lay term with its potential to facilitate stereotyping of older age for how patients are viewed. As there are now, for example many written instructions to support the care of frail older people in NHS setting, some specifying that people aged 65 and over should be routinely screened for frailty, it is essential to know how healthcare professionals use and make sense of the term frail. Gilleard and Higgs’ (2022) qualitative study, which explored how health professionals perceive frailty, discovered that the health professionals negotiate an “ideological dilemma”—a tension between contradictory sets of meanings and consequences for action—based on their “lay” and clinical experience of the term frailty. Their investigation shows that the appropriation of a “lay” term into clinical practice with a specific clinical meaning, and the viewing of “an entire person through a lens of frailty, resulted in the creation of an ideological dilemma which “could have a negative impact on the assessment of frailty depending on the system of assessment used” (Gilleard & Higgs, 2022: 204). Hence, Gilleard and Higgs (2022: 220) “recommend that frailty at the very least be used with a critical appreciation pertaining to its lay connotations and its impact as a negative label. While the participants in this study found the term frailty useful to communicate quickly with professional colleagues, their shared knowledge of its stigmatizing connotations rendered it a term they were uncomfortable using with patients themselves, for fear of causing offence, or making a patient feel bad about themselves.”

In other words, since the labeling of the patient as frail can profoundly challenge someone’s sense of self, maybe there is little justification for the assessment of the elderly in this way for their eligibility for care, especially as the assessment tools for frailty are not perfect and can be used without any consultation with elderly patients or their knowledge.

Such a labeling can also be potentially damaging in terms of health outcomes and can negatively affect how older people are perceived by others. Older people, even though they often lack any knowledge of the classification practices connected within the clinical use of the term frailty, are nonetheless afraid of the stigma associated with the term. Moreover, as now, in the context of the extended longevity, aging raises the risk of developing not only frailty but also deteriorations of cognitive capabilities and dementia; the fear of a potential loss of autonomy, independence, and dignity is more strongly felt. Although living with frailty doesn’t necessarily mean incapability of living an independent life, nonetheless as frailty and social death can come together, their potential overlap (Powell, 2023).

This increases older people’s deep fear of being powerless and without social agency. Such a fear of loss of social agency can be seen as one of the factors behind the widespread fear of social death, often associated with dementia in later life.

The notion of social death describes older people’s fear of being denied of the benefits of living in society and being treated “as if they were already dead” (Glaser & Strauss, 1965).

The term social death, which since the 1960s has been used to describe the opposite of well-being (Kralova & Walter, 2016), refers to a situation when the person is treated as if already biologically dead (Sudnow, 1967). Social death implies a distinction between physical and social death; it is not the same thing as physical death as it does not always occur at the same time as physical death. The notion of social death is sometimes understood as reflecting dehumanizing consequences of dying in modern hospitals (Sudnow, 1967), and mainly it is defined more broadly as social practice of treating the elderly as being socially dead (Glaser & Strauss, 1965). However, in both ways of conceptualization of this notion, the term social death preserves its relevance for detection of any inequality or denial of human rights. When the individual is biologically alive but when others, by implying that the older person has no choice, does not fit into the social context in an acceptable way, conferred upon her the status of social death, such a change in social relations can be detrimental to well-being of the elderly. In other words, people who are judged and treated by others as close to physical death can become aware of dying, and this, together with their subsequent withdrawal and rejection of social interaction, when interpreted again by others as indicating social death, can move them even closer toward biological death (Caswell & O’Connor, 2015).

The term social death, in all its meanings, is about the marginalization of old and very frail people at the end of life. By capturing older people’s social exclusion and changes in the nature of their social relations and their dispowering experiences at the end life, the notion of social death allows us to grasp the level of discrimination and unfairness in the treatment of elderly. The status of social death is imposed by others and comes with painful consequences as it increases the awareness and fear of a dying person of becoming irrevocably lost to one’s self as an active agent, which both determine the nature of social interaction (Glaser & Strauss, 1965). Much of the fear of death “settles on the loss of agency that is associated with frailty, particularly mental frailty and the perceived abjection of an undignified journey towards non-existence” (Gilleard & Higgs, 2015:267). The increasing fear of loss of social agency in later life, and thus a fear of undergoing a premature social death, is especially linked to a fear of dementia. Today, in the UK, a number of people living with dementia is over 907,000 and the number of dementia cases is projected to increase by 75%, to almost 1.6 million in 2050 (Gregory, 2022). As “all people with dementia, or all those who appear to be frail and elderly, are also socially dead” (Caswell & O’Connor, 2015:250), the significance of social death among older mental frail people cannot be overlooked in any attempt to challenge unfair and unequal treatment of elderly. As age is the biggest risk factor for dementia, and as older and frail people with dementia are often seen “as good as dead” (Caswell & O’Connor, 2015), the fear of social death is a gripping feeling in later life. Several studies identified the elderly as a group particularly prone to undergoing this kind of social death, especially in the context of care and residential homes (Gilleard & Higgs, 2015).

Social death is a form of exclusion, exemplified by the symbolic role of the nursing home. In the UK, only around a third of people with dementia live in residential care settings, while the majority lives in their own homes and are often cared by members of their families. However, when the condition progresses and full-time care is required, many people with dementia are moved into care and nursing homes, with the average prevalence of people living with dementia in care homes, 63% of men and 71% of women (Alzheimer’s UK). What’s more, in both cases, living with dementia home or in residential care, inequalities and precarity in the care process affects all because of a lack sufficient support for family caregivers and because the systems of care are often are often fragmented. For example, in the USA, national-level policies and programs that support family caregivers are limited, while in the UK, policies are also often not adequate (Powell, 2022).

Social death is about attitudes of families, friends, and medical professionals’ toward people judged to be at the end of life. As people living with dementia are progressing through stages of a terminal illness, their isolation and separation from loved ones have an irreversible impact on their conditions, especially as some of them are not continuously in periods of social death. Moreover, the fate of people with dementia in residential homes across the UK was disproportionately disrupted by the Covid pandemic (see Chap. 9). However, while old people with dementia fared worst of all during the coronavirus crisis, other groups’ well-being have also been impacted.

In the UK, the Covid pandemic has not only just negatively impacted on the older population’s health and mental conditions, but it has also disrupted younger generations’ daily lives, routines, and opportunities to develop and participate in education, work, and social life (Lee, 2020). During the Covid pandemic, like in all crises, who “shall be saved and who shall die is settled by institutions” (Douglas, 1986:56); hence, psychological and socioeconomic scars inflicted by Covid-19 policies on old and young reflect the state’s decisions who should suffered and who should be spared in this recent health crisis. In the UK, the governmental handling of the pandemic has contributed to intergenerational tensions as both groups, old and young, believed that their own generation was abandoned to their fate in order for another generation’s problem to be dealt with. In what follows, we explore what psychological and socioeconomic legacies may have Covid-19 policies left on young and older generation and whether Covid has worsened the relationship between these generations.

After illustrating the expansion of the intergenerational divide in the context of the coronavirus epidemics, it will be argued that the Covid pandemic has also provided new opportunities for debates on how to overcome intergenerational divisions and improve the relationship between old and young.

At the beginning of the Covid pandemic in the UK, the population were warned that the virus did not discriminate and that “everyone is at risk,” and the underlining narrative about threats posed by the coronavirus was “we are all in it together,” or “we are on the same boat” (Cooper & Szreter, 2021:7–13). Yet soon it was discovered that the risk of dying from Covid doubles with every 6 years of age, which means that people over 75 years are 10,000 times more at risk than those who are under 15 (Spiegelhalter & Masters, 2021;Woolhouse, 2022).

Subsequently, the aged were marked as vulnerable and frail by two decisions: one by introducing frailty test and another lockdown. Even days before the first lockdown, without any wider consultations, the Clinical Frailty Scale (CFS) was adapted by the National Institute for Health and Care Excellence (NICE) to help decide if patients should be offered or denied acute care during the Covid crisis. The NHS staff in England was asked to follow the NICE guideline saying that on admission to hospital, all adults should be assessed for frailty and that other comorbidities and underlying health conditions are also taken into account (Owen, 2020). As the Covid-19 pandemic has sharpened and made more difficult to negotiate “ideological dilemma” involved in the clinical use of the term frailty, the usage of Clinical Frailty Scale (CFS) to assess which patients should be denied acute care and about the emergence of illegal “do not resuscitate” notices in care homes and in hospitals has been criticized by many bodies (including the healthcare regulator, the Care Quality Commission, and various charities). Subsequently, the UK healthcare regulator branded such a procedure and related actions unacceptable. However, even though in 2020 the National Institute for Health and Care Excellence (NICE) issued a new guidance in which it advised NHS trusts to “sensitively discuss” with the old and frail people the possibility of their acceptance of “do not attempt cardiopulmonary resuscitation,” it did not ensure many old and frail people that they, like people under the age of 75, would not be denied lifesaving Covid care such as ICU care.

While the introduction of the frailty scoring system could have made older people to feel as being labeled and assessed in terms of their eligibility for care, the announcement of the first lockdown (23rd of March 2020) added to their psychological suffering and discomfort. Although the policy of self-isolation of older people was presented as being grounded in the available scientific evidence and therefore could not be seen as being discriminatory, many elderlies felt lonely and left to themselves. The UK government, aiming to construct and preserve a spirit of intergenerational solidarity and in order for its health policies not to be seen as contributing to intergenerational tensions, undertook attempts to enhance a cooperative mood with a help of a new catchphrase: “Don’t Kill Granny with virus.” Since the end of August 2020, this slogan called on younger groups to take into consideration that the elderly are more susceptible to the Covid risk and, therefore, older people need to be protected. “Don’t Kill Granny,” by asking younger adults to keep distance, wear masks, and not to take the virus back home to vulnerable relatives, appealed to lower the level of risks and threats confronted by older people. This message, by telling younger people to “protect their grannies,” expected them not think about old people as being expendable and emphasized the value of solidarity between the generation.

Nonetheless, many young people who thought that coronavirus would not affect them, and who hoped for return of “normality,” were angry with a forceful front-pages message warning them not to “infect their grandparents.” Other Millennials rejected the governmental instruction as incorrectly assuming that they “want the elderly to sicken and die” (Ellen, 2020) and as propagating that younger generations acted irresponsibly. Felling that they “more than shouldered its burden in this pandemic,” young adults refused to accept the official narrative that they have not “done their bit” (Chetwynd-Cowieson, 2020). With the growing fatigue and negative consequences of the lockdown, a social mood in England was slowly becoming more complex. On the one hand, there was the societal recognition of the “golden cohort” generation, members of which are always admired for their war and life efforts, as illustrated, for example, by the public admiration and knighthood for Captain Tom Moore, the British World War II veteran who raised more than £ 33 million for the NHS by walking daily in his garden in 2020. On the other hand, the main solidaristic rhetoric underwent a substantial erosion until finally it has been replaced by narratives inspired by ageism.

In contrast to the admiration for Captain Tom Moore in the official media, social platforms, such as hashtags #boomerremover, were undermining the generational solidarity. Even though the facts remained the same (i.e., Covid is far greater threat to the elderly, frail, and infirm than to the young and healthy), certain sections of social media were “all busy stockpiling either ageist prejudices or paranoiac visions about the young wishing the old dead” (Ellen, 2020:27). Ageism was deeply embedded. The analyses of Twitter data posted through 4 months of 2020, and related to older adults, showed ageist content was prevalent on Twitter in the context of the coronavirus pandemic (Xiang et al., 2020). While the daily average of ageist content was less than 20%, yet almost three-quarters of jokes aimed at older adults, half of which were “death jokes” (Xiang et al., 2020). Jokes targeting older people were also circulated on other platforms; for example, in the context of the coronavirus pandemic, there was a widely shared photo of a bus full of older women and men with a text: ‘To save the economy, the government will announce next month that the Immigration Department will start deporting seniors (instead of illegals).” Such jokes, cartoons, or messages on Twitter and on other social platforms, by presenting older adults as nothing more as than “a living symbol of time running out” (Martens et al., 2004:1534) and as susceptible to the negative effects of the coronavirus infection, justified pushing older people aside as not such an important problem. Additionally, these messages, by misreporting risks and acceptable ways of controlling the pandemic, claimed that older generation puts pressure on an already stressed health care system. What’s more, by portraying younger persons as immune to the virus, and hence without any costs to a society, social media could negatively impact on the solidarity between generations.

However, not only public discourses on social media platforms contributed to the expansion of the generational divide. With the growing warnings of the grave economic fallout from the pandemic, in the USA, official narratives that accelerated the intergenerational tensions ranged from the Lieutenant Governor of Texas’s assertion that “it would be better that older people die in the pandemic if that would protect the economy for younger people,” to phrases stating that “saving old lives just to ruin young ones” to frequent complains about the pandemic policy doing “the harm to our children” (Calasanti, 2021). In the UK, a Conservative MP suggested that, in order to save younger generations’ future, we should rank life according to who most “deserves.” After accusing the governmental program of lockdown of aiming to “abolish death,” he said: “We should accept that death happens, that old died, at some stage we need to accept that people of 80 or 70 died” (Charles Walker, a Conservative MP, on BBC Newsnight, 12.10.20). In this spirit, a group of Conservative Party members of the House of Lords voiced their rejection of the lockdown restrictions as imposing a totally unnecessary limitations on individual freedoms and claimed that: “Anyone who wishes to resume normal life, and take the risk of catching the virus, should be free to do so” (Ridley, 2020).

Then again, the Covid crisis not only deepened already existing intergenerational tensions and inserted new stereotypes, prejudice, and discrimination against older adults. But it has also added to social inequalities, to the disparities between regions and ethnic groups, to the poverty levels among children and pensioners, to the increase in domestic violence, and to longer hospitals waiting lists (Hetherington, 2021). However, the public attention was not very much disturbed by the pandemic’s trapping more people in poverty and making their already difficult economic and health situations much tougher. What worried the public was the Covid’s threat to drive a “war of the generations” in the post-pandemic decade. This new risk of intergenerational tensions was exposed by younger generation’s criticizing long lockdowns across western Europe for imposing misery on them (Butler & Bannock, 2021). In this process of questioning the consequences of lockdowns, young adults were joined by experts in public health.

For example, claiming that the British long lockdown did more harm than good, Woolhouse (2022:8) points that as a result of that policy “children and young adults who were robbed of their education, jobs, and normal existence, as well as suffering damage to their prospects, while they left to inherit a record-breaking mountain of public debt” (Woolhouse, 2022:8). Following this type of argument, the public was informed that “Covid has involved an upturning of the contract between the generations: children have been conscripted to protect adults, and have paid the price. To protect people from a disease whose median victim was 83 years old, children missed 18 months of interacting with one another, at the stage of life when they need it most” (Lanchester, 2021:13). With the growing realization and evidence of difficulties, sufferings, and misery indirectly caused by Covid on younger people, the issue of the increase in intergenerational unfairness has been brought to the public attention. Because of potential psychological scars of Covid on teenagers and because of worries that Covid may have left lasting impact on young people’s mental health, they are often now seen as “a sacrificed generation” (Butler & Bannock, 2021).

Much evidence and studies from many countries illustrate that teenagers and younger people who, despite the fact that they are the least likely group to become ill from coronavirus, suffered disproportionately during the Covid pandemic. They experienced the biggest educational disruption in modern history, a surge in unemployment and the psychological effects of lockdown isolation. All recent studies from developed countries show that many months of lockdowns destabilized their mental well-being, education, and job prospects. For example, an investigation reported by Ayalon et al. (2020) suggests that younger adults are at greater risk of psychological distress and loneliness during Covid-19 lockdowns than older adults. A study by the EU’s foundation documents that 64% of young Europeans are at risk of depression, up from 15% before the Covid crisis (quoted in Butler & Bannock, 2021). Also the British studies documented that during the Covid pandemic young people’s mental health deteriorated, that the impact of loneliness, academic stress, and chronic insecurity means that many teenagers and young adult felt “burnout” and experienced very high levels anxiety connected with their worries about their future (Butler & Bannock, 2021). While accusing the UK governments of failing them, some young adults said that their “whole generation has just been pushed aside as a problem to deal with later.” Also young people from other European countries expressed their misery and disappointment as they do not have received financial support for lost jobs and felt to be “the lowest priority” or simply abandoned by their governments (Butler & Bannock, 2021).

At the end of the pandemic’s second year, when—even though vaccines worked—there were still restrictions in place, many people experienced the growing “Corona fatigue.” In November 2021, as with the threat of new variant tougher restrictions were introduced, thousands of people, especially non-believers in the vaccination program, took to street in several European cities. For example, Brussel, Copenhagen, and Rotterdam saw demonstrations and protests against new constraints and rules, such as Covid passes or mandatory vaccination for some. Although among protesters there were also young people who felt disadvantaged, depressed, and convinced that their interests and needs did not count, the major factor motivating demonstrators was not the intergenerational conflict or ageism but rather their anti-vaccination stand or tiredness with restrictions. Moreover, the majority of younger people not only accepted the importance of following Covid-19 measures and regulations as they recognized that vaccines alone will not stop Covid, but they also came slowly to realize that in many respects, the pandemic has presented them and older generation with the same difficult challenges.

The growing recognition by younger adults that they share with older people the same feeling of being left alone to deal with negative experiences of loneliness and mental vulnerability has offered a chance of new understanding and link between two generation. Despite the pandemic imposing separation between old and young generations, “the two groups at either end of the age spectrum could be bonding because both feel disfranchised by the government’s response to Covid” (Hill, 2021). Older people have not been cautioned about the risk of isolation and have not been told to be beware of frailty as the classification method helping to work out which patients should be denied acute care, rather they have been asked to shield themselves, while the threat of various Covid related disruptions to young people’s lives and subsequently to their mental conditions have not been properly assessed. In short, for both generations, the deepest cost of the pandemic is in the area of mental health. And because of this sharing experience, the pandemic, despite that the Covid presents the higher risk to the elderly than to young and despite that the crisis has exposed intergenerational tensions, has also lied down bases for mutual understanding.

In the post-lockdown time, that is, in rather not yet a totally usual time with a threat of Covid still around, the generations were mixing more than in the normal times as in this transitional period, old and young often worked together, especially in the UK voluntary sector (Hill, 2021). In the second part of 2021, both groups were often actively engaged in charities projects designed to overcome various problems that emerged during the pandemic. This working relationship has eroded negative stereotypes and led to new bonds between the two generations. Since such an “unusual bonding between those in their 60s and older, and those in their early 20s and younger, has been partly galvanised by the enforced separation of the generations during lockdown, leading the age groups to value each other in a way they had not previously” (Hill, 2021), it can be said the pandemic has enhanced opportunities for generations to get to know each other and thus it has facilitated alliances and links between generations. Hence, the Covid-19 pandemic, by potentially doing both; exposing many intergenerational tensions and showing the importance of fostering intergenerational allegiance, could help us to recognize a need rethinking obligations toward the old and enhance a search for the quality care of the elderly from moral perspective. To seize this opportunity and prevent the risk returning to the same crisis situation, various questions have been proposed for a further examination by the proposed public inquiry into the government’s handling of the pandemic. While some call for “national discussion about how the old are going to make it up to the young” (Lanchester, 2021:13), others, including the independent Joseph Rowntree Foundation, request public inquiry into the pandemic’s impact on the UK’s levels of poverty and ethnic inequalities, while the Bereaved Families for Justice group demands justice for the elderly victims of the Covid policies. It seems that unless we also openly discuss the issue of generational obligations and relationships, claims of unequal impact that Covid has had on young and old would continue to undermine a mood of social cooperation and solidarity.

To conclude, the Covid pandemic has not only shed light on the consequences of the generational divide, but it has also, by burning down old stereotypes and signaling a need for the elimination of fears faced by both the young and older people, showed the opportunity for construction of new intergenerational bonds. In order to learn a lesson from the recent health emergency and to realize of the importance of social solidarity in managing the processes of aging and dying, there is a need for further discussions of biomedicine which played a key role in articulating its truths about aging and saw itself as cure and savior through anti-aging and the extension of unlimited life (despite of Covid). Its history is unknown, the next chapter attempts to make windows were there were once walls regarding such history.