This well-written and commanding book sets out to explain how cumulative losses throughout the lifecourse and in old age lead to exclusion in later life, by examining the influence of the intersecting dimensions of health, income, quality of life, place and ageing identity. The introductory chapter by Malcolm Dean unequivocally explains the ethos behind the book with the statement, ‘the book you are reading concentrates on loss’ (p. 3), and each subsequent chapter provides substantiation of how that loss comes to be, and the impact that it has. The second chapter by Thomas Scharf focuses on inequalities in income in older age. This excellent chapter not only provides evidence of the extent of financial hardship experienced by older people, but also brings out the personal level by presenting a case study of one older person living in extreme poverty. Anna Coote's next chapter on health and wellbeing links well into the previous chapter by reminding us of the relationship between poverty and poor health in later life; and Sue Adams's discussion in Chapter 4 of the importance of ‘home’ in the experience of growing older draws attention to another kind of loss, that of control over ‘where and how one lives in older age’ (p. 77). Again the use of a case study highlights the disparities that exist in terms of access to affordable and appropriate housing for older people.
Chapter 5 goes to the heart of ageism. Baroness Julia Neuberger challenges us to address the many inconsistencies that exist in society in our attitudes to older people, from the way we patronise the very old as ‘national treasures’, and reject political leaders who are deemed ‘too old’, whilst simultaneously applauding those well-known older figures who continue to appear in the media simply because they do not look their age. In Chapter 6, Bryan Appleyard reiterates some of the previous chapter's discussion of anomalies in society's perception of (good) youthfulness versus (bad) ageing, but goes a step further by arguing that quality of later life is dependent on how younger people perceive old age. He suggests that only when younger people's attitudes to ageing change will older people be accepted and valued. In Chapter 8, Alan Walker seeks to explain how extremes of inequality in later life have come to exist in British society and suggests that the causes of unequal ageing are rooted in inequalities that stem from earlier in the lifecourse, so that a preventative approach would be more appropriate than dealing with the outcomes. Finally, Paul Cann's concluding chapter explains in greater detail how we might address inequalities in health, quality of life, income, housing and ageism.
Whilst the book critically addresses diverse issues, one of its many strengths is the commonalities that thread through the chapters. For example, one constant criticism by those who study later life is the treatment of all older people as a homogeneous group. Throughout this book the heterogeneity of later life is highlighted and applauded by including gender, class, ethnicity, race, education and sexual orientation. Most notable is the common theme of urging older people themselves to engage in challenging the misperceptions of ageing, and to root out discrimination on the basis of ageing. As Bryan Appleyard says, ‘Discrimination in every form has the effect of convincing discriminates that they are, indeed, different’ (p. 137). This is not a purely polemical book that seeks only to illuminate the issues posed by cumulative losses in later life, but one that is grounded in evidence. Every chapter commences with bullet-point issues salient to the subject matter, and concludes with five things that can be done to address these issues, so that the reader is left in no doubt that this book is intended to be more than just descriptive of the current situation for older people.
My only criticism is that there is some repetition as with, for example, discussions of functional ageing disparities, but this becomes apparent only when reading the book at one sitting, so that perhaps one other ‘criticism’ is that the book is so eminently readable that it has to be read in one sitting. I have rarely come across a book on the included subjects so well written that I did not want to put it down until it was read to the end. This book is written with passion, and the authors do not hold back from trying to engage policy makers, ageing lobbyists, and researchers on alleviating inequalities in later life. Yet it is one that is grounded in the real world, with persuasive suggestions on how to improve the lives of older people, and how, if not to completely eradicate inequalities, at least to even them out.