Demography, Aging, and Public Policy: A Policy Oriented Curriculum Component

Douglas A. Wolf

This syllabus was prepared for the Spring 1998 semester at Syracuse University, that started on January 13, 1998. Any dates for required materials from students reflect that starting date.

Objectives and Course Format

This course is intended to provide students with an understanding of the basic tools of demographic analysis; to acquaint them with key facts about demographic trends in the United States and elsewhere, and with the connections among fundamental demographic forces and population aging; to survey a series of topics in "social demography" and "social gerontology" of particular importance in aging societies; and to consider some of the policy issues that arise in connection with population aging.

The course will be conducted using a combination of lecture and discussion. The material presented in the first weeks of the course consists mainly of demographic concepts and tools, and is somewhat technical in nature; these weeks will inevitably be conducted mainly in lecture format. Later, as we consider material drawn from applied demographic and gerontological research, and the associated policy issues, class discussion will occupy a larger share of our time.

Readings

This course will entail a substantial amount of reading. The following books are available from the Orange Bookstore: Harry Moody, Aging: Concepts and Controversies, (Pine Forge Press, 1994) and Population Reference Bureau, Population Handbook, Fourth Edition.

The books will be supplemented by outside readings from books, journals, magazines, and newspapers. Most will be made available in a photocopied course reader available at the Campus Copy Center. Several will be distributed in class. An extensive supplementary reading list on the topics covered in this class follows this syllabus.

Course Requirements and Grading

Students are expected to attend class, read the required reading prior to the class in which they will be presented and discussed, and to participate in class discussions. Generally, a list of discussion questions will be distributed to accompany the following week's readings. There will also be several written assignments, two oral presentations, and a final exam.

Grading for the course will be based on the following:

  1. The quality of class participation: 15% of the course grade.

  2. Country case study report: each student will prepare a short (6-8 page) report on population aging in a country of their choice (other than the United States, which I will be using as an example in lectures); the process of choosing the countries will be managed such that there are no duplications. The report should provide a description of the current population profile of the country and discuss the demographic forces that are contributing to population aging. Other issue that could be addressed is the consequences of projected trends in underlying demographic factors. I will provide you with data produced by the United Nations Population Division that will be more than adequate for this assignment. The same data are available in published form in the library. Further information on this assignment, including examples of this type of report (such as the "Aging Trends" articles routinely published in the Journal of Cross-Cultural Gerontology), will be supplied. Percentage of course grade: 20% Due Date: February 17.

  3. Research summary/critique paper: This, again, is to be a short (6-8 page) paper that summarizes and critiques the views presented in two published research papers, with respect to a well-specified research question. The supplementary reading list distributed with this syllabus is intended to serve as a guide to the selection of research papers for use in this assignment. Among the many substantive questions that could serve to motivate this assignment are "why do women provide more care to family members than men?" "does home-based long-term care lead to savings in public programs?" "do older people undermine local school budgets?" "is the Family and Medical Leave Act of 1993 costly to employers?" "is there a theoretical upper bound on longevity?" and so on. Percentage of course grade: 20% Due Date: March 31.

  4. "Opinion" or "advocacy" essay: Unlike the research summary/critique assignment, this assignment will ask you to argue a position, but one that is grounded in fact. This should be modeled on the "op-ed" style of writing, and might deal with a research issue suggested by the readings and/or current policy issue. Further details will be provided in class. Percentage of course grade: 20% Due Date: April 28.

  5. Final Exam: there will be a final exam, given during the scheduled slot of exam period, to which you may bring your notes (on lectures, texts, readings, etc.). The intent will be not to test your ability to solve problems (or to do calculations); rather it will be a test of your ability to think about, and draw conclusions among, the ideas and readings covered in the course. Percentage of course grade: 25%.

Topical Agenda (subject to elaboration/change)

The following agenda lists a sequence of topics to be covered during the semester. Associated with each topic area are a list of questions and issues to be addressed, and a list of readings. The readings will form the basis of class discussion.

(1). Overview of course, demographic concepts, tools, data, and measures.

Reading: PRB, Population Handbook, Chapters 1-4, 11.

(2). Demographic perspectives on population aging in the United States: Patterns, Origins, Projections, and Consequences.

Issues/Questions

How "old" is the U.S. population, and how does this compare with past and projected future patterns? To what extent is population aging a result of changes in mortality and in fertility patterns? Can we do anything about it? How does changing age structure of the population influence individual lives? Collective behavior? The economy?

Readings

  • Preston, Samuel. 1996. American Longevity: Past, Present, and Future. Center for Policy Research Policy Brief No. 7. Syracuse, NY: Syracuse University.

  • Bean, Frank. 1983. "The Baby Boom and Its Explanations," The Sociological Quarterly, 24: 353-365.

  • Vaupel, J. 1986. "Passage to Methuselah: Some Demographic Consequences of Continued Progress Against Mortality," American Journal of Public Health, 76: 430-433.

  • Easterlin, Richard. 1980. "Conclusion." Chapter 9 in Birth and Fortune. New York: Basic Books.

  • Espenshade, Thomas. 1994. "Can Immigration Slow U.S. Population Aging?" Journal of Policy Analysis and Management, 13: 759-768.

(3). Mortality patterns, trends, and differentials.

Issues/Questions

What are the patterns of mortality by age; trends in death races; life expectancy and the Life Table; differential mortality by gender, race, and other factors.

Readings

  • Hadley, Evan. 1992. "Causes of Death among the Oldest-Old." Chapter 9 in R. Suzman, D. Willis, and K. Manton (eds.), The Oldest Old. Cambridge: Oxford University Press.

  • Nathanson, C.A. 1984. "Sex Differences in Mortality," Annual Review of Sociology, pp. 191-213.

  • Manton, K.G. and Burton Singer. 1994. "What's the Fuss about the Compression of Mortality?" Chance, 7: 21-30.

(4). Disease and Disability; assessment of functional status; active life expectancy.

Issues/Questions

Diseases and conditions of old age; activities of daily living and "active life expectancy"; the "longer life-better health" tradeoff controversy; cognition.

Readings

  • Moody, pp. 10-15

  • Spector, William D. 1990. "Functional Disability Scales." In B. Spiker (ed.), Quality of Life Assessments in Clinical Trials. New York: Raven Press, pp. 115-129.

  • "Long-Term Care." 1993. Chapter 21 in President's Health Security Plan [particularly section on eligibility criteria]. New York: Times Books.

  • Crimmins, Eileen, et al. 1997. "Trends in Disability-Free Life Expectancy in the United States, 1970-90," Population and Development Review, 23: 555-572.

(5). Issues in the biology and genetics of aging.

Issues/Questions

Why do we live so long? Why and how do we age? Is there a genetic "clock"? Are there genetic influences on social organization?

Readings

  • Moody, pp. 35-65.

  • Kirkwood, T.B.L. 1995. "The Evolution of Aging," Reviews in Clinical Gerontology, 5: 3-9.

  • Emlen, Stephen T. 1995. "An Evolutionary Theory of the Family," Proceedings of the National Academy of Science, 92: 8092-8099.

(6). Household composition and living arrangements of the elderly.

Issues/Questions

In what kinds of living arrangements are the elderly found? What factors influence the decision to live in the community versus in a nursing home? Who do the elderly live with? What are the consequences of sharing residential space?

Readings

  • Burch, Thomas K. and Beverly Matthews. 1987. "Household Formation in Developed Societies," Population and Development Review, 13: 495-512.

  • Pynoss, Jon and Stephen Golant. "Housing and Living Arrangements for the Elderly." Chapter 16 in Handbook of Aging and the Social Sciences, (Fourth Edition). New York: Academic Press.

  • Wolf, D. 1995. "Changes in the Living Arrangements of Older Women: An International Study," The Gerontologist, December: 724-731.

(7). Care of the "frail" elderly (Moody, pp. 127-152)

(a): Norms, expectations, attitudes, and preferences

  • Brody, E. 1985. "Parent Care as a Normative Stress," The Gerontologist, 25: 19-29.

  • Silverstein, Merrill and Tonya Parrott. 1997. "Attitudes Toward Public Support of the Elderly," Research on Aging, 19: 108-132.

  • Mattimore, T.J. et al. 1997. "Surrogate and Physician Understanding of Patients' Preferences for Living Permanently in a Nursing Home," Journal of the American Geriatrics Society, 45: 818-824.

(b): Patterns of care

  • Matthews, Sarah H. (1987). "Provision of Care to Old Parents: Division of Responsibility Among Adult Children," Research on Aging, 9: 45-60.

(c): The policy environment

  • "Overview of the Medicare and Medicaid Programs." 1997. Health Care Financing Review, Medicare and Medicaid Statistical Supplement

  • Bishop, Christine and Kathleen Skwara. 1993. "Recent Growth of Medicare Home Health," Health Affairs, Fall: 95-110.

  • Harrington, Charlene, et al. 1997. "The Effect of Certificate of Need and Moratoria Policy on Change in Nursing Home Beds in the Untied States," Medical Care, 35: 574-588.

(d): Work-caregiving tradeoffs; The Family and Medical Leave Act of 1993

  • Ruhm, Christopher. 1997. "The Family and Medical Leave Act," Journal of Economic Perspectives, 11: 175-186.

  • Pavalko, E.K. and J.E. Artis. 1997. "Women's Caregiving and Paid Work: Causal Relationships in Late Midlife," Journals of Gerontology: Social Sciences, 52B: S170-S179.

(e): How should the 'burden' of elder care be distributed?

  • Moody, pp. 71-94

  • Garber, Alan. 1996. "To Comfort Always: The Prospects of Expanded Social Responsibility for Long-Term Care." In Victor R. Fuchs (ed.), Individual and Social Responsibility. Chicago, IL: University of Chicago Press, pp. 143-171.

  • Wolf, D. "Efficiency in the Allocation and Targeting of Long-Term Care Resources."

(8). Migration of the elderly; proximity of family members and its consequences

Readings

  • Litwak, Eugene and Charles F. Longino. 1987. "Migration Patterns among the Elderly: A Developmental Perspective," The Gerontologist, 27: 266-272.

  • Clark, Rebecca L. and Douglas A. Wolf. 1992. "Proximity of Children and Elderly Migration." In Adrei Rogers (ed.), Elderly Migration and Population Redistribution. London: Belhaven Press, pp. 77-96.

  • Robbins, Mark D., William W. Duncombe, and Douglas A. Wolf. "Can State and Local Governments Influence Elderly Migration?"

(9). Ethical Issues in Aging

Issues/Questions

Is euthanasia acceptable? Assisted suicide? Can the wishes of older people be ascertained and adhered to? Should we screen for genetic predisposition to Alzheimer's disease? What are the limits on uses of information so obtained?

Readings

  • Moody, pp. 99-125.

  • Asch, David. 1996. "The Role of Critical Care Nurses in Euthanasia and Assisted Suicide," New England Journal of Medicine, 334: 1374-1379.

  • Danis, M., et al. 1991. "A Prospective Study of Advance Directives for Life-Sustaining Care," New England Journal of Medicine, 324: 882-888.

  • Hudson, Kathy, et al. 1995. "Genetic Discrimination and Health Insurance: An Urgent Need for Reform," Science, 270 (October): 391-393.

(10). The demography of kinship; implications of changing marital and family patterns

Issues/Questions

What will the patterns of "available kin" look like in the future? In what ways are these patterns a product of recent trends in age at marriage; likelihood and timing of divorce; childbearing patterns in and out of marriage; remarriage? How are intergenerational relationships affected by divorce, remarriage, step- and half-sibling ties?

Readings

  • Wachter, Ken. 1997. "Kinship Resources for the Elderly," Philosophical Transactions of the Royal Society of London (Series B): 1811-1817.

  • Wolf, Douglas. 1990. "Kinship and Family Support in Aging Societies." In Economic and Social Implications of Population Aging. New York: The United Nations.

  • Furstenberg, Frank, et al. 1995. "The Effect of Divorce on Intergenerational Transfers: New Evidence," Demography, 32 (August): 319-333.

  • Amato, Paul, et al. 1995. "Helping between Parents and Young Adult Offspring: The Role of Parental Marital Quality, Divorce, and Remarriage," Journal of Marriage and the Family, 57 (May): 363-374.

(11). The politics of age and generational "warfare"

Issues/Questions

Age-group competition; the elderly as an interest group; popular imagery regarding the elderly; is there an "old-age crisis"?

Readings

  • Moody, pp. 189-250.

  • Annual Report of the Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund (Medicare).

  • Preston, S. 1984. "Children and the Elderly: Divergent Paths for America's Dependents," Demography, 21: 435-457.

  • Button, T. 1992. "A Sign of Generational Conflict: The Impact of Florida's Aging Voters on Local School and Tax Referenda," Social Science Quarterly, 73: 786-798.

  • Peterson, Peter. 1996. "Will America Grow Up Before it Grows Old?" The Atlantic Monthly, May.

 

Reading List Suggested readings.

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