Adams, Rae B.

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Clinical Sociology ReviewVolume 8 | Issue 1 Article 161-1-1990Aging and Health Care: Social Science and PolicyPerspectivesRae B. AdamsAbilene Christian UniversityFollow this and additional works at: http://digitalcommons.wayne.edu/csrThis Book Review is brought to you for free and open access by DigitalCommons@WayneState. It has been accepted for inclusion in Clinical SociologyReview by an authorized administrator of DigitalCommons@WayneState.Recommended CitationAdams, Rae B. (1990) "Aging and Health Care: Social Science and Policy Perspectives," Clinical Sociology Review: Vol. 8: Iss. 1, Article16.Available at: http://digitalcommons.wayne.edu/csr/vol8/iss1/16BOOK REVIEWS 183mounts in the society, the average functional level of differentiationdecreases and the society goes through a period of regression. [Thereis] more behavior by certain subgroups that impairs the functioning ofother subgroups and more symptoms of all types. (251, n. 29).The family process that transmits levels of differentiation works as follows:people of common levels of differentiation tend to marry. Some of their childrenmay have similar levels of differentiation-undifferentiation, and some siblingsare more or less differentiated. Those siblings less differentiated tend to marrysimilar partners and have children, one or more of whom are even less differ-entiated. These also marry on an equal level of differentiation. After severalgenerations this process yields a highly undifferentiated family and one memberwho is caught up in the group anxiety and acts out the provocations of the group(ch. 8).Murray Bowen, M.D., is clinical professor at Georgetown University Med-ical Center and director of the Georgetown University Family Center. He wasa pioneer in the development of family systems theory and in research andtreatment of schizophrenia. Michael Kerr, M.D., is clinical associate professorat Georgetown University Medical Center, Washington, D.C., and director oftraining at the Georgetown University Family Center.Bowen has written an epilogue to the book in which he states his "40-year odyssey in developing family systems theory and therapy, also known asthe Bowen theory" (339). True to the theory of differentiation, Kerr wrote themajor portion of the book without Bowen's knowledge of its content. They areintellectually linked and remain separate in their scholarly development. A briefbook review cannot adequately cover the impact, wisdom, depth, beauty, andimportance of the Kerr-Bowen book.Aging and Health Care: Social Science and Policy Perspectives, edited byMarcia G. Ory and Kathleen Bond. London, New York: Routledge, 1989.255+ pp.Rae B. Adams, Ph.D., C.C.S.Abilene Christian UniversityIn the Foreword to the book, Matilda White Riley and T. Franklin Williamsstate that "there is a growing feeling that too many books on the health aspectsof 'aging' are being published . . . . It is as if some outside voice were tellingus, 'More books will not solve our problems.'" So why another book on agingand health care? The justification is that the contents of this text are drawn from184 CLINICAL SOCIOLOGY REVIEW/1990empirical studies and, as such, the text makes a significant contribution to thosewho work in the field to serve a rapidly growing-older population.For the most part, the twenty-six articles resulted from grants received fromthe National Institute on Aging and the National Center for Health ServicesResearch. It would be ideal to review each article in some detail; however, thisreview will be limited to a chronological presentation of the book as presentedby the editors.IntroductionEncompassed within a comprehensive introduction written by Ory andBond, are five common themes. These are summarized as follows:1. Health and health care for older persons constitute a complex set ofdynamic interactions and linkages.2. While families and others in the informal support system are the primaryproviders of service, the distinctions between the informal and formalcare systems are not always clear.3. Presently, most social science and policy research is engaged in speci-fying the sources and consequences of different types of health care forolder persons.4. The process of aging itself has an influence upon risk factor identificationand modification; however, social and behavioral risk factors change overthe course of a life.5. Generally, political realities and ethical considerations set the contextfor research questions and solutions.Part I. Epidemiology and Models of Health CareIndividuals and social factors that affect the quality of health care for theolder population are examined in this section. Kaplan and Haan investigatethe demands for health care services by older adults in the community. Datagathered from a population of 7,000 adults over a period of twenty-two years(the Alameda County study) are used to track social and behavioral risk factorswhich adults encounter as they age. The conclusion drawn is that the healthexperience of older adults is "influenced by a broad range of risk factors" andthat the evidence presented by the study "does not suggest that poor health,dependence, and social isolation are inevitable consequences of getting old."In response to the question, "Is there a role for prevention?" the answer is thatBOOK REVIEWS 185with appropriate intervention in behavioral, social, or socioeconomic risk factorsthere could be significantly improved health and quality of life for older adults.In the second article, Wan provides an overview of factors that influencehow older people utilize the formal health care system—physicians, hospitals,nursing homes, and home health services. If future researchers respond to Wan'seight recommendations, his contribution could have influence on the field farbeyond this article.Part II. Older People and Formal Health Care SystemsThis portion of the book addresses how and to what degree older personsutilize the formal health care system. Mossey, Havens, and Wolinsky assess theconsistency with which older adults use formal health care systems. The authorsreport that there is more consistency in the use of physicians than in hospitalcare; however, contrary to stereotypes, the use of either is a "relatively rareevent for most older individuals."Eisdorfer, Mullner, and Cohen examine the increased role the hospital playsfor older adults and how this role has changed over the past few years. Theauthors suggest that geriatric hospital care could be improved if, in addition tocritical care, long-term and rehabilitation needs were given greater attention.Utilizing existing data, George and Maddox examine the nursing home as asocial institution. The processes by which persons are placed in nursing homesand the living environments are discussed. However, the primary focus is onhow the social and behavioral aspects of the experience affect both patients andtheir caregivers. To quote the authors, "A long-term care institution is more thanan address—it is an environment with its own social structure and norms. Fewof the behaviors and outcomes of nursing home residents can be understoodwithout taking the features of that environment into account" (136).Part III. Older People and Informal Health Care SystemsData from a community study of frail elderly is examined by Tennstedtand McKinlay to support numerous other findings which show that most olderadults receive the greater portion of care from family and friends rather thanfrom the formal support system. While such knowledge has been deduced bymost observers, the empirical data presented provides credibility to support suchcasual observation.Gallagher, Lovett, and Zeiss address the issue of the physical and mentalcondition of the informal caregiver in relation to the decision to place the patientin institutional care. The authors point out that the caregiver's own condition is186 CLINICAL SOCIOLOGY REVIEW/1990frequently the deciding factor and that little is known about appropriate inter-vention for caregivers that might influence the quality of life for both caregiverand patient. Further research is suggested.Part IV. The Interplay between Formal and Informal CareThe balance that is needed between formal and informal care is addressedby Soldo, Agree, and Wolf, while Kane and Kane (based on the assertion that thehealth of the elderly and the care they receive is a dynamic system) suggest thata better means of transitions between these systems would benefit the patient.In the epilogue, written by Mechanic, future challenges are identified for thosein the health care system that serves older adults. And, like most of the authors,he recommends future research.The Reviewer's ConclusionI know of no better way to express my own sentiments related to the text,and to show my appreciation to the editors and other authors, than to "borrow"a quote from the Foreword by Riley and Williams:All too few studies have focused on the impact of health care on thenumerous biological, psychological, and social changes that people ex-perience as they grow older. Nor has adequate attention been paid tothe different types of care available to people as they move along theirown life course through the health care system. For its contributiontoward filling some of this void, we salute this volume. (ix)Children in Recovery, by Rosalie Cruise Jesse.Linda Price and Tyrone PriceDept. of Social ScienceUniv. of Maryland Eastern ShoreWhat a daunting task Rosalie Cruise Jesse faced when she wrote Children inRecovery: to tell the story of the effects of alcoholism on the family. Alcoholismis of interest to clinicians and researchers from many disciplines. Investigatorshave looked at alcoholics and have seen different faces: a person with a genet-ically transmitted disease, one with an aculturally determined behavior pattern,a victim of ethanol molecules attacking liver cells or distorting central and

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