The Well-Being of the Elderly in Asia: A Four-Country Comparative Study

11. The Vulnerable and Their Potential Disadvantages

Chapter 11 THE VULNERABLE AND THEIR POTENTIAL DISADVANTAGES Albert1. Hermalin, Mary Beth Ofstedal, andKalyani Mehta T he vulnerability of the older population is a persistent theme within gerontology. This arises quite naturally from consideration ofthe biological processes and underlying socioeconomic dynamics. Despite the ability of many older people to maintain robust health to advanced years, frailty and health-induced limitations increase with age. Transitions to older ages also produce social and economic threats that can arise from insufficient income and loss of economic power, widowhood, and diminished contact with children. These general concerns have often been translated into identifying the groups among the elderly that are most vulnerable to these processes and that may be at greatest disadvantage. In many societies this has led to a focus on the oldest-old, on those who may have limited resources-the less educated and women, and on those with limited support networks-the widowed, those with few or no children, or the isolated rural elderly. Ofcourse, a given group may face multiple threats, which is especially true for women, who tend to have lower education, less labor force experience, a higher likelihood of being widowed, and diminished family power. The general strategy of our analyses in the previous six chapters has been to treat the well-being of the elderly more generally, examining the full 461 462 The Well-Being ofthe Elderly in Asia range of outcomes associated with social support, work, income and health, and the factors associated with these different outcomes. In this chapter we reverse the procedure, identifying specific adverse outcomes for each dimension and measuring the extent to which groups thought to be particularly vulnerable to experiencing these outcomes are doing so relative to the over-all population ofthe elderly. Proceeding in this fashion can be particularly helpful for policy and program decisions. It can illuminate which identifiable groups within a society are not being served well by existing programs, indicate the magnitude of the problem through the group size and its relative disadvantage, and suggest possible remedial actions, ranging from specific local actions to changes in major national social security and health programs. It can also indicate how the current mix of needs might change in the future with the emergence of new cohorts of elderly with different sociodemographic characteristics. Methods and Measurement Issues In carrying out the analytical strategy ofthis chapter the metaphor ofmedical screening is useful: deciding who will be tested, for which conditions, and what diagnostic tests will be employed. These three elements are critical to the goal of identifying the vulnerable groups and measuring the degree of their disadvantage: defining the sociodemographic groups to be examined; selecting from among the disadvantages those to which they are most vulnerable ; and establishing indicators to test the degree to which they are disadvantaged relative to the total older population or other groups. Table 11.IAlists the vulnerable groups, which represent demographic and socioeconomic categories of people likely to have above-average levels of one or more disadvantages. These vulnerable groups are identified on the basis of a priori knowledge about the process of aging, previous studies, or reports in the mass media. Also shown in the table is the percentage that a given group represents of all the elderly in each of the four countries. The groups are defined across a range of dimensions, from the basic biological processes establishing sex and age, to location and social status, to a number offamily-related dynamics such as marital status, numbers ofchildren , and living arrangements. For many of the groups the defining characteristics are established at birth or early in life; but for several, like the widowed or divorced, late life events may be the source of group membership. In every case the meaning ofbelonging to a particular group is also a function of the cultural and socioeconomic setting, which greatly affects social status, The Vulnerable and Their Potential Disadvantages 463 education level, and other key life dynamics. Similarly, disadvantages associated with a particular group may result from events that accumulate across the life span. For example, lack ofeducation is likely to diminish employment opportunities, marriage prospects, and access to health services, resulting in a profile at older ages oflower earnings and assets, a smaller social network, and poorer health. Rudkin (1993, p. 224), in her analysis of gender differences in economic well-being among the elderly in Indonesia, attributes the disadvantage ofolder women to economic...