Book Review: Ethnicity and old age: Expanding our imagination

The Ageing in a Global Context series seeks to inform questions which are fundamental to research and policy in the global aging population, contribute to the discussion surrounding globalization and transnationalism, and examine interdisciplinary relationships in gerontology. Ethnicity and Old Age: Expanding Our Imagination by Dr. Sandra Torres is part of this series and endeavors to pull the field of ethnicity into the center of extant discussions in gerontological research given ethnicity’s pivotal relationship within demography and social determinants of health. More specifically, this book takes aim to carefully interrogate the intersectionality of ethnicity and aging, and characterize the knowledge that has been published over the past two decades, to inform scholars and the scientific community in social gerontology.

The first chapter submits a thoughtful rationale to the reader on the timeliness of this topic and why this book pulls ethnicity and aging into the foreground—the world is increasingly becoming more globalized. Torres weaves together her training, professional experiences, and axioms as she delimits the overall structure of the book and the foci of each chapter. The book is largely organized into two parts: the former presents a foundation for theorizing (discovery phase) and the latter presents a scoping review (research and justification phase) to examine what is known and what is left to discover about ethnicity. The second chapter sets the foundation for subject inquiry by establishing how increase in life expectancy and growth in the population of older adults has direct implications for health care, chronic diseases, economic prosperity, and resources allocation. The demographic of the aging population within the crucible of globalization, transnationalism, and international migration requires examination of what constitutes ethnicity. The existing definitions and theoretical frameworks of ethnicity need to adapt to this shifting demographic to study the hybridization of cultures, multinational identities, and multilayered histories. Torres argues that the shifting societal and population structure presents new challenges that the field needs to critically examine now.

Chapter 3 tackles the semiotic underpinnings and social construction of race and ethnicity as constructs, along with their historical and modern uses. Race can be used as a classification (census), signifier (discourse), or a synonym, whereas ethnicity is “always a situationally determined, subjective matter” that is suffused with a belief (p. 55). This chapter dives into the rich complexities in race theory drawing from debates among sociology and anthropology theorists and proceeds to cross-examine the essentialist and structuralist perspectives. Race and ethnicity are group memberships that ultimately shape our external and internal identities while socializing our interactions and own understanding of group differences. Most importantly, the conflation of race and ethnicity or substitution of one for the other diminishes the historical significance and extant structural and political inequalities that are borne from institutional uses of such categories. Torres stresses that context matters and ethnicity is particularly relevant among the aging population since this group has accumulated decades of experiences that are informed by various cultural and historical circumstances.

In the latter portion of the book, a scoping review in English is conducted for specific fields of inquiry within the nexus of ethnicity and old age across the past 20 years. Chapter 4 reviews the literature on health inequalities across 117 studies. The results are organized into themes that include general health, physical functioning/disability/mobility, specific diseases, mental health, and cognitive functioning. The overall findings summarize how older adults belonging to ethnic and racial groups have poorer health compared with non-ethnic or racial counterparts. There were several notable trends in the literature. The vast majority of studies were based in the United States and compared African American/Black and Hispanic with non-Hispanic White. However, there were few studies based in Europe despite large ethnic populations suggesting a differential focus, interest in this field, and/or funding priorities. The majority of the studies used ethnicity and race interchangeably in examination of health inequity and treated ethnicity and race as being steeped in biology or socioeconomic status. Finally, Torres calls into question selection bias in measurement since most studies used large-scale, longitudinal, quantitative surveys in a small number of minority ethnic groups subserved by histories of oppression and discrimination. However, the reduction of race and ethnicity into a single dimension negates the heterogeneity of the intersection between aging, class, gender, and ethnicity. Most importantly, no study confirmed if selection of ethnicity or race aligned with the participant’s self-identification based on predefined criteria (i.e., U.S. Census).

Chapter 5 expands beyond the prior search topic to examine the literature on health and social care among 55 studies. Torres codified the results into several themes: (a) access and usage of care services; (b) aptitudes, preferences, and experiences of relevance to health and social care; (c) suitability of different programs/interventions/services; and (d) types of self-care practices in which older minority ethnic groups engage. Similar to chapter 4, the patterning source of these articles arises from the majority of studies being carried out in the United States comparing African Americans, Hispanic, and Asian-Pacific Islander to the White majority. Relatedly, except for one study, the context of race and ethnicity is not defined nor explicitly elaborated with respect to location or self-identification. Torres observes that most studies assume ethnicity and race are important to study in relationship with health and social care but lack elaboration on why observed inequalities in access, utilization, and treatment exist (i.e., root causes). Paradoxically, no studies examined the impact of perceived discrimination on access and use of health and social care, especially in U.S.-based studies where systemic oppression and prejudice directly influences mortality outcomes. The chapter concludes with a recommendation for targeted inquiry in asking older adults from ethnic backgrounds how they use health and social service when they opt to use them, but also why they may refrain from utilizing them in spite of poorer health outcomes when compared with their counterparts.

Chapter 6 explores the literature on social relations and caregiving among 52 studies and derived two themes: social relations and social support/help and caregiving (and receiving). Predictably, resulting trends were consistent with the two prior chapters as characterized by a majority of the studies being conducted in the United States, using quantitative designs, and conventional membership classification of race and ethnicity. Torres argues that the agnostic use of ethnicity which ignores social, cultural, and historical contexts fails to inform the evidence about ethnicity’s role. This includes “social relations that older people engage in, the support and help they receive, the caregiving that adult children offer to their parents, and the caregiving that older people offer to other older people” (p. 141). Torres acknowledges that few studies, if any, examined the influence of race and ethnicity on friendships, or intimate/romantic relationships, the role of discrimination, caregiving preferences, and if caregiving responsibilities are negotiated with families. The examination of race and ethnicity on social relationships and caregiving in older adults was present but only in a cursory manner. Torres clarifies that her aim was not to critique the quality or rigor of the topic-specific scholarships in the preceding three chapters. Rather the scoping review seeks to advance our current understanding of ethnicity and race as it relates to aging by taking stock of what is known and how the information is characterized.

The final chapter of the book briefly revisits the author’s journey in the introduction, situates the work conducted in social gerontology, and restates the book’s dual aims of discovery and research/justification in ethnicity scholarship. The new challenges brought on by globalization, international migration, and transnationalism require a re-examination of how race and ethnicity are currently defined. In their current form, it is evident both definitions need to evolve/adapt to critically study aging. Torres thoughtfully summarizes and identifies seven obstacles after synthesizing the early theoretical foundation and the results of the scoping review. These included (a) the lack of a clearly defined research agenda in ethnicity, (b) use of convenient samples and arbitrary groups based on ascendant definitions, (c) eschewing defining structure and culture in studies, (d) overreliance on a limited number of methodologies, (e) limiting choice of publication dissemination platforms, (f) using unidimensional definitions of race and ethnicity, and (g) a lack of analytical clarity. Torres integrates examples from various studies captured in the scoping review to emphasize her point about each obstacle. These seminal obstacles are expansive and it is unrealistic to expect that any study will be able to single-handedly surmount them. Rather, they serve as guideposts for scholarly inquiry and cerebration into age and ethnicity from the perspectives of study design, data collection, analysis, and dissemination.

This book would have widespread utility as a secondary text in an upper level undergraduate or graduate level course in sociology, demography, psychology, or health science disciplines. It could also serve as the foundation of a seminar on aging and/or diversity. In addition, this book may serve as an invaluable resource to private and federal foundations, institutions, and agencies for setting funding priorities that target diverse populations and health disparities. The relevancy of this book extends beyond social gerontology into any field that examines race, ethnicity, and aging. The latter half of this book’s title, “Expanding Our Imagination,” encourages the reader to innovate and challenge the conventions of current definitions to arrive at new understandings. The increasing diversity of the world population is no longer irreducible to colorful abstractions (i.e., White vs. Black), obfuscated homogeneous umbrellas (i.e., Asian or Latino), place attachment (native vs. immigrant), or hierarchical dichotomies (i.e., majority vs. minority). Race and ethnicity are not parochial group memberships, nor should they be conflated with each other or culture. Future scholars have to be sagacious and deploy scholarship that freely embraces and examines the complexities associated with “other” and “mixed categories” (race or ethnicity). Race and ethnicity as societal constructs innervate every facet of life and are often inextricable from generational groups, sex, gender, history, and geographic dimensions. They should be studied in relation to each other. The field of ethnicity and race scholarship can help to serve as a theoretical foundation for future studies but can also inform new findings by situating them in the larger context of aging and globalization.