Encyclopedia of Gerontology and Population Aging

Living Edition
| Editors: Danan Gu, Matthew E. Dupre

Geographical Gerontology

  • Zhixin FengEmail author
  • David R. Phillips
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-69892-2_632-1

Synonyms

Definition

Geographical gerontology (GG) refers to a burgeoning multidisciplinary subject that encompasses the application of geographical perspectives, concepts, and approaches to the study of ageing, old age, and older populations (Skinner et al. 2018). Human geography and social gerontology have together influenced the development of the field of geographical gerontology, and the thematic scopes of geographical gerontology are presented in Fig. 1. This body of work includes gerontological work by geographers which involves examination and explanation of how geographical approaches can be used to research and understand gerontologically related issues such as demography and population geography (issues such as the spatial patterning of demographic ageing, patterns of migration, and movements in and of ageing populations), health geography (i.e., health-care services and infrastructure), and social geography (such as living arrangements and environments of older people and their families), and geographically orientated work by gerontologists from different disciplines including social work, social policy, public health, nursing, planning, and a full range of social and health sciences (Andrews et al. 2007, 2009; Skinner et al. 2015, 2018).
Fig. 1

A thematic diagram of geographic gerontology. (Source: Adapted from Skinner et al. (2018))

Overview

Origins and History of Geographical Gerontology

Many Western countries in Europe entered the phase of being “ageing societies” in the 1800s and have been demographically ageing for over two centuries. It is sometimes held to be unavoidable that older people will have to face increasing chronic conditions (noncommunicable diseases and mental health problems) and financial and social issues related to their longer lives and particular in the “oldest-old” years. Against widespread backgrounds of problems among population, resources, and environmental sustainability, an ageing population can add pressures to health and social care systems, welfare systems, and governments (Andrews et al. 2009). With ever limited resources, this provides challenges for governments and older people and their families. The ageing of societies is however rather controversial. The ageing population is often positioned as a potential catastrophe by “apocalyptic demography” that treats people living longer as a burden to societies with negative long-term effects (Bytheway and Johnson 2010; Gee 2002; Longino 2005). This can be referred to as the “moral panic” perspective, in which concern is aroused over a social issue (Scott 2014). On the other hand, a much more positive view of ageing can be found embedded in the policy objectives such as “active ageing” from WHO and the European Commission, WHO’s (2015) new definition of “healthy ageing,” a replacement of “active ageing,” or “successful ageing” from academics (i.e., Rowe and Kahn 1987; Bulow and Soderqvist 2014; WHO 2015; European Commission 2016). In addition, the world’s largest ageing population country, China, has an idiom: “an old person is like a treasure to the family” to indicate that many people (used to) show respect to their seniors. Ageing is a complex, diverse, and social and geographically influenced concept.

The early concerns of gerontology often focused on physiological and psychological features of ageing with gerontology as an initial development as a health science that closely aligned to medical and clinical geriatrics (Kontos 2005). Over time, gerontology has developed simultaneously as a social science; even the tradition of gerontology has remained strong. “Social gerontology,” as a widely known subfield of gerontology, has perhaps become the larger focus involving older people in their social and family contexts, using sociological, psychosocial, economic, anthropological, geographical, political, social theory, and other perspectives to explore a broad range of issues in older peoples’ health, health care, welfare, and social and cultural life (Enright 1994; Andrews et al. 2009). The perspectives have helped shape social gerontology in dynamic ways that make gerontology today a multidisciplinary subject.

How do geography and gerontology engage to form geographical gerontology? Many quasi-spatial/geographical perspectives have been employed in different disciplines including but not confined to epidemiology, social medicine, and public health (Diez-Roux 2002). The two have long individual histories, but GG has an established and growing body of research on geographical aspects of ageing by academics from the social sciences (Skinner et al. 2015, 2018). Geography as a dedicated academic subject has many fields, and, within human geography, Harper and Laws (1995) provided a landmark review to highlight how advances within human geography could create new possibilities for geographers involved in ageing and older people. The place-embedded implications and uneven spatial distribution of population ageing among different geography scales (household, group, community, country, global levels) and settings (rural-urban or metropolitan) have become increasingly evident to policy makers and academics as Skinner et al. (2015) discuss in their review two decades later. The core of geographical gerontology is the relationships between older people and the spaces and places in which and through which age and ageing occur (Cutchin 2009). These very perspectives have also made geographical gerontology a multidisciplinary subject.

The development of geographical gerontology has close relations and parallels with the development of human geography as a discipline. Many features of geographical gerontology could be dated to the 1960s, alongside the quantitative revolution and the shift from more descriptive geography to an empirical scientific geography (Burton 1963; Warnes 1981; Rowles 1986). Until the 1990s, geographical gerontology tended to focus on the spatial perspective of population ageing, the location and movement of older people, retirement migration, and the associations with their environment and services at different scales using descriptive analysis (Warnes 1981; Rowles 1986). It was a first phase of empirical accumulation of geographical gerontology as other emerging field of research (Rowles 1986; Andrews and Phillips 2005). During this period, the objectives of geographical gerontology were debated by scholars. In Rowles’ (1986) review, a focused was detected on the relationship between older people and their living environments at different scales. He called for research on the meaning of place for older people, the spatial distribution of older populations, and the perspectives that could reflect those in social gerontology regrading to appreciate different ages and cultures of older persons (Rowles 1986; Andrews and Phillips 2005). There had also been a growing body of work on provision for older persons, for example, the development of private residential care, their emergence as businesses, locational concentrations and their associations with changes in government policies, and the risks associated with some trends, especially in the UK (see, e.g., Phillips et al. 1987; Phillips and Vincent 1988) and elsewhere (Rosenberg and Everitt 2001). As Andrews et al. (2018) note, a common hope or aim of much of this research was that policy makers and service planners might note the trends analyzed and better tune and target future policies and programs. Warnes also pointed out that the global evolution in population ageing (and its implications), locational dimensions in the circumstances of older people’s lives, and temporal change in the interaction between older people and the environment had not been given enough attention by geographers; and he suggested that geographers needed to change their priorities and objectives from the theoretical needs of human geography to the needs of older people (Warnes 1990; Andrews et al. 2007). In later progress, Harper and Laws (1995) recognized the growing contributions of geographical gerontology and the advances within human geography that could create new possibilities for geographical research on ageing and older people. They argued that geographical gerontology required to learned theoretical and methodological lessons from the cultural turn in human geography and great adoption of social theory and the possibilities within the field for closer engagement with postmodern perspectives (such as feminism, postmodernism, and political economy) to underpin geographical gerontology research should be considered.

By the mid-1990s, the analysis of spatial patterns in population ageing and the movement of older populations, thematic concentrations in the areas of health, health care and caregiving, and the different settings and environments of ageing among geographical gerontology were well-established (Skinner et al. 2015). Some 10 years after Harper and Laws’ (1995) review, Andrews and his colleagues (2007) reviewed the process of geographical gerontology between 1995 and 2006; they found that geographical gerontology was constituted of multiple fields of empirical interest studies working with multiple academic disciplines during this period. Indeed, geographical gerontology’s focus was on dynamics, distributions, and movements in older populations’ health, and postmodern perspectives and qualitative approaches were developed to explore the complex relationships between older people and the varied places within which they live and are cared for (Andrews et al. 2007, 2009). A more formal recognition of geographical gerontology has broadened and deepened the scope of geographical interests in ageing, particularly in social and cultural geography (Del Casino 2009; Skinner et al. 2015). It has enriched theoretical and methodological pluralism, particularly in the discipline within feminism, postmodernism, and post-structuralism (Andrews et al. 2007, 2009).

Subsequently, in the twenty-first century, the microscales of the subjective experiences of older persons in a wide variety of health and care settings have been further explored by human geographers, for example, finer microscale to reflect human experience in places, which transcend space, place, and scale to obtain a picture of older people’s life courses and different concepts of cross- or multiscale issues that geographers could pursue in particular locations (Skinner et al. 2015). In addition, the contemporary theoretical orientations, like relational geographies of ageing and nonrepresentational geographies of ageing, are the growing interest of geographers (Skinner et al. 2015). Interests in therapeutic landscapes as relating to older persons are also growing (Winterton 2018).

Significance of Geographical Gerontology

The twenty-first century is the era of both stabilizing and booming population ageing, depending on the different areas of the globe and sometimes among different social groups. It is estimated that there will be 3.14 billion people aged 60 and above in 2100, and the number of the oldest-old, defined as 80+, will increase to 909 million (United Nations DESA Population Division (UNDESA) 2017). From a geographical gerontology perspective, place, space, scale, landscape, territory, and other factors of geographical constructs can shape the experiences of older people. Patterns of ageing are varied at different spatial/geographical levels across countries around the world. Populations have been ageing in more developed countries for over a century, and the ageing process started recently in less developed and developing countries, especially LAMICs (Kinsella and Phillips 2005). Economic, social, cultural, and political from the geography perspective could be reflected by varied ageing process. Why and how place and space matter are key questions for many scholars (particular geographers) in the field of geographical gerontology.

While geographical gerontology may be broad, the data from UNDESA (2017) can be used to illustrate how geographical gerontology can be applied in real-world settings. From a geographical gerontology perspective, it is clear that population ageing is varied around the world (returned to in the Policy section below). The old-age dependency ratio, measured by the ratio of population aged 65+ per 100 population aged 15–64, can be an indicator, if imperfect, of likely pressure on “productive” population (the “productive” ages 15–64). A lower ratio could reflect better pensions and better health care for residents, and a higher ratio could indicate more financial stress between working people and dependents. Table 1 shows the old-age dependency ratio by region and subregion between 1950 and 2100. In general, the old-age dependency ratio in the world increased from 8.37 to 12.64 between 1950 and 2015, and it is predicted that old-age dependency ratio will reach 39.75 in 2100. This indicates that there will be 2.5 adults aged 15–64 taking financial responsibility for one older people in 2100, comparing to 10 adults aged 15–64 taking financial responsibility for one older people in 2015. That will be a huge potential financial stress in the future. In Table 1, geographical gerontologists may focus various features and raise many research questions. These could be on space patterns of old-age dependency ratios across different regions; do the geographical patterns of different regions increase in the same direction? Why do more developed regions have higher old-age dependency ratios than the less or least developed regions? What factors are associated with increasing old-age dependency ratios in different regions; and are these factors the same or different in different regions (a geographic perspective); from the gerontological perspective, are more developed regions age-friendly regions? Will health-care services be sufficient for the coming ageing of populations in different regions? Will older people age in place as different regions grow older? What policies could be implied for high old-age dependency ratios? In order to answer these questions, theoretical developments in geographical gerontology could be applied. Readers could develop their own interesting questions from Table 1.
Table 1

Old-age dependency ratios by region and subregion 1950–2100

Region and subregion

1950

1970

1990

2010

2015

2030

2050

2070

2090

2100

World

8.37

9.29

10.10

11.65

12.64

18.03

26.17

33.04

37.85

39.76

More developed regions

11.87

15.46

18.74

23.74

26.68

37.43

42.97

41.80

45.10

47.24

Less developed regions

6.54

6.57

7.43

8.95

9.75

14.80

23.53

31.60

36.60

38.45

Least developed countries

5.91

5.46

5.97

6.23

6.29

7.20

13.19

25.02

31.68

33.52

Less developed regions, excluding least developed countries

6.62

6.70

7.61

9.34

10.28

16.34

25.90

33.18

37.79

39.63

Less developed regions, excluding China

6.23

6.50

6.87

8.00

8.47

11.95

19.86

29.42

34.75

36.72

High-income countries

12.29

15.66

18.30

22.81

25.69

36.34

43.37

43.58

46.38

48.86

Middle-income countries

6.92

7.25

8.12

9.64

10.49

16.17

25.27

32.58

37.29

39.06

Upper-middle-income countries

7.24

7.68

9.01

11.41

12.89

22.25

34.79

39.52

43.84

45.23

Lower-middle-income countries

6.50

6.72

7.06

7.83

8.18

11.37

18.66

27.89

32.92

34.92

Low-income countries

5.65

5.38

5.95

6.23

6.22

6.41

11.41

23.31

30.64

32.50

Sources: United Nations DESA/Population Division (2017). (https://population.un.org/wpp/Download/Standard/Population/)

This example has illustrated what geographical gerontologists consider in a real world, and it also leads to the important questions of geographical gerontology: space and place. Why and how space and place matter? People’s physical and mental capacities may vary across his/her life course and into older age, also strongly determined by the environments in which people live; environments also determine how well people adjust to loss of function and other forms of stress that people may experience at different stages of life and in particular in his/her later life (World Health Organization (WHO) 2018a). This has great implications for the technical definitions such as old-age dependency ratios and shows the limitations of using age cutoffs to define such ratios. In many cases, persons aged 65+ will still be active and will hardly be dependent. In many countries, especially the low- and middle-income group, a lower age dependency cutoff may be used, and in many countries in sub-Saharan Africa, for example, ages between 50 and 55 are used to represent older age, to reflect local epidemiological and demographic circumstances.

How space and place matter to older people and reflect on older people can also be influenced by length of residence. Many continue to value and enjoy their homes; they value the natural environment and would like to participate in outdoor leisure activities. Many value the place of which they have many memories and where they may have lived in for many years; they may have established close relationships in a retirement community, but how far are their requirements for physical and emotional supports met in residential care settings? (Andrews et al. 2007, 2009, 2018). In comparison to younger adults, older people are sometimes (erroneously) felt to be less able to adapt and more reliant on resources available in and around their living residence and dependent on the support of others locally (Muramatsu 2003; Robert and Li 2001; Feng et al. 2012; Phillips and Yeh 1999). A place with accessible wide range of health services and social support is very important to one’s sense of security and belonging, particularly for people in later life (Hanlon 2018; Menec et al. 2011). The quality of space and place that older people live could contribute to differential health, well-being, and welfare of older people, which becomes a major concern for geographical gerontologists.

Key Findings

In geographical gerontology both historic and contemporary, three main focuses have been the spatial concentration and distribution of ageing population, spatial patterns of health outcomes among older adults, and health service availability, access, and utilization.

The Spatial Concentration and Distribution of Older Populations

The spatial concentration and distribution of older population have long been interested by geographers, demographers, and social gerontologist. As previous statement, the patterns of ageing vary at different scales including local, national, and global levels. The global pattern of ageing has been estimated and described in UNDESA, and many countries have their own census datasets to illustrate the ageing pattern at national levels (e.g., the United States Census Bureau in the USA, Office for National Statistics in the UK, National Bureau of Statistics of China in China) (see, e.g., Kinsella and Phillips 2005). In addition, several countries operate longitudinal studies of ageing which allow academics to access individual dataset and conduct ageing studies at different levels (individual, household, or community levels).

Illustrating global patterns of ageing, Figs. 2 and 3 show the proportions (usually in percentages) of persons aged 60+ in 2015 and 2050 (projected), respectively, from the UNDESA using the GIS mapping. It is apparent that only Japan currently has more than 30% of its population aged 60+ years, and almost all African countries, most countries in Central America, South, and Southeast Asia, have fewer than 10% of population in this age group (Fig. 2); looking forward, however, in 2050, Japan will still have more than 30% of its population aged 60+ years, joined by many countries in East and Southeast Asia, Europe, and some in Latin America (Chile) (Fig. 3). There are to be huge geographical changes in distribution of the 60+ population globally in 2015 and 2050, especially impacting the current low- and middle-income countries with concomitant challenges of health and social care and support.
Fig. 2

Percentage of population aged 60+ in 2015. Source: authors’ calculations, Probabilistic Population Projections based on data in UNDESA (2017) World Population Prospects: The 2017 Revision World. Population Prospects: The 2017 Revision (https://esa.un.org/unpd/wpp/Download/Probabilistic/Population/). The country borders do not reflect the endorsement or the view of the publisher, the editor, or the author

Fig. 3

Percentage of population aged 60+ in 2050. Source: authors’ calculations, Probabilistic Population Projections based on data in UNDESA (2017) World Population Prospects: The 2017 Revision World. Population Prospects: The 2017 Revision (https://esa.un.org/unpd/wpp/Download/Probabilistic/Population/)

The country borders do not reflect the endorsement or the view of the publisher, the editor, or the author.

At a smaller geographical scale (within a nation), spatial patterns of ageing population are also varied. Taking the UK as an example, life expectancy at birth has nearly doubled over the last 100 years in the UK (Office for National Statistics 2015). Figure 4 shows the number of people aged 100 years and over (centenarians) per 100,000 population for England, Scotland, Wales, and Northern Ireland between 1987 and 2017. In 1987, the proportions of centenarians in England, Wales, and Northern Ireland were 7 per 100,000, and the proportion of centenarians in Northern Ireland was 5 per 100,000. In 2017, Wales has the highest proportion at 26 per 100,000, followed by England at 22, and Scotland at 17, and Northern Ireland has the lowest at 15 (Office for National Statistics 2018).
Fig. 4

Number of people aged 100 years and over per 100,000 population, for England, Scotland, Wales, and Northern Ireland, 1987 and 2017 in the UK. Sources: adapted from Office for National Statistics, National Records of Scotland, Northern Ireland Statistics and Research Agency https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/bulletins/estimatesoftheveryoldincludingcentenarians/2002to2017

Global ageing is the result of the continued decline in fertility rates and increased life expectancy (Kinsella and Phillips 2005; Phillips and Feng 2018). Improved medical technology and healthier behaviors have also influenced the life course which could result in longer life expectancy, although current evidence on continuing increases in life expectancy is mixed. The varied patterns of ageing in the world and the proportion of centenarians in the UK will reflect different epidemiological factors, medical services and technology, and especially socioeconomic and environmental conditions, plus diets and health behaviors, excluded and included populations, the very crucial “social determinants of health” (Marmot 2015). All of these are squarely within the research interest of health geographers and especially the socio-spatial variations.

The Spatial Patterns of Health Outcomes Among Older Adults

Although global ageing is generally increasing (life expectancy may be static or even decreasing in some countries (i.e., Russia)), it is generally of more interest to know whether older people’s later life is in good or less good health (Gatrell and Elliott 2015). It is recognized that older people are at higher risk of having chronic and disabling conditions than younger adults, and older people’s health varies in different population groups as well as at different geographical scales (Wiles 2018). In addition, health outcomes are not only affected by individual characteristics but also by the surrounding environment where individuals live and work (Jones et al. 2000). The “area effect” which refer to either there is an independent effect for a place-based variable (or so-called geographical effect) such as per capita GDP or a difference between places that is not reducible to individual characteristics (or so-called geographical differentials) has been well studied (Jones et al. 2000). They also reflect the social determinants of health as mentioned above.

Chinese studies using multilevel models provide some examples. Zeng et al. (2010) analyzed the 2002 and 2005 waves of the Chinese Longitudinal Health Longevity Study (CLHLS) to examine the impacts of environmental factors (at the community level) on older people’s health outcomes (activities of daily living (ADLs), cognitive impairment, and mortality). The community level information included labor force participation rate, per capita GDP, illiteracy rate, average temperature in January and July, yearly rainfall, hills or mountains covering, and air pollution. Generally speaking, their findings found that communities’ GDP per capita, adult labor force participation rate, and illiteracy rate were associated with physical, mental, and overall health and mortality among older persons in China. More specifically, they found that higher per capita GDP and lower community rates of illiteracy decreased the odds of cognitive impairment; higher per capita GDP increased the rate of ADL disability. Higher labor force participation among persons aged 15–64 years in the community reduced older persons’ risk of ADL disabilities, cognitive impairment, health deficits, and death over a 3-year follow-up. Air pollution increased the odds of disability in ADLs, cognitive impairment, and health deficits. More rainfall reducing the odds of ADL disability and cognitive impairment and low seasonal temperatures increased the odds of ADL disability and mortality; high seasonal temperatures increased the odds of cognitive impairment and deficits. All these clearly indicate the importance of spatial differences in socio-environmental factors for older persons health locally.

Feng et al. (2012) used the same CLHLS dataset (CLHLS 2008) and found that higher income inequality at province level was associated with poorer self-rated health among older people. Feng et al. (2015) also found that higher provincial levels of economic development have a negative influence on the survival of the rural older people (CLHLS 2002–2008). Feng et al.’s studies also explored the geographical differentials of health in China. They found that province with the best health was Zhejiang whose residents had the lowest risk of reporting poor health, while Hainan had the highest risk of reporting poor health nationally (Feng et al. 2012, 2013) (see Fig. 5). However, there are no geographical differentials in survival status among older people in China (Feng et al. 2015). Evandrou et al.’s 2014 study used the Chinese Health and Retirement Longitudinal Study (CHARLS 2011) to study the individual and province inequalities in health in China. Their results indicated that persons who lived in economically developed provinces, albeit with lower health expenditures and less developed health-care institutions, were less likely to report difficulties with ADLs, and older people living in a province with a higher proportion of old people are more likely to report difficulty with ADLs. In terms of geographical differentials, Zhejiang province again has the lowest risk of reporting poor health in their study even with the different datasets (Evandrou et al. 2014). These geographical findings have gerontological policy implications as to how to improve older people’s living environments (such as narrowing income inequalities, reducing air pollution, developing social security) to improve their health outcomes in later life.
Fig. 5

Differential relative odds of poor self-reported health for provinces derived from models 1 and 7 compared to the national average set at 1 (Source: adapted from Feng et al. (2012)

Health Services, Access, and Utilization

The interconnections between older people and the spaces and places are one of the central tenets of geographical gerontology (Hanlon 2018), and a place with accessible wide range of health services and social support is very important to one’s sense of security and belonging, particularly for people at their later life (Hanlon 2018; Menec et al. 2011). Older persons, in general, have higher demands for health care than younger age groups, and they also face various distinct disadvantages in accessing affordable, appropriate, and quality care (United Nations 2018). The WHO (2015) in the first World Report on Ageing and Health emphasizes the need for health systems to be structured, so they are much better aligned to the health and social care needs of older persons. Currently, this is the exception rather than the rule, especially for the growing older populations in low- and middle-income countries.

Older people who have good physical functioning are generally able to retain better control over their lives and are more likely to remain living in their own homes than in residential or institutional care. This refers to “ageing in place” (“the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level” (Centers for Disease Control and Prevention 2009). “Ageing in place” requires older people’s homes or communities to have the health and social supports and services older people need to live safely and independently as long as they wish and are able. “Ageing in place” has somewhat different meanings in different parts of the world. In Eastern Asian countries, for example, it is part of cultural beliefs for older people to age in place. Children take the responsibility to support and look after of their parents as they age, and children will move in with their parents when their assistance is needed (i.e., filial piety, the “code” of intergenerational duty in China and similar societies (Phillips and Feng 2015; WHO 2015: Box 1.4); in Western countries, there has been greater reliance on governments, charities, or other organizations to provide the support and the services to help people to remain in their own homes. Increasingly, the global view is that policies should support “ageing in the right place” (Golant 2015), in other words, “the ability to live in the place with the closest fit with the person’s needs and preferences” (WHO 2015, p. 225). This very important extension of the concept recognizes how being in the correct environment can strongly affect how comfortably and successfully ageing may progress.

From a GG perspective, health services, access, and utilization have been traditionally been concerned with regard to distance to doctors and hospitals (Skinner et al. 2015; Joseph and Phillips 1984). In addition, the neighborhoods in which older people live also determine whether their needs for basic services may be met. Based on the latest Health Survey for England data, Savage (2017) reported that older people in the most deprived areas are twice as likely to lack the basic help they need compared with those in the richest neighborhoods, which reflect inequalities in access to social care in England, sometimes called a “post-code lottery.” Such socio-spatial variations in accessibility to services are replicated in many communities worldwide.

The importance of local climate and environmental conditions for older person’s health was mentioned previously. The findings indicate that local planning and design standards as well as social conditions can be very influential in older persons’ health. Indeed, differences in temperatures, local pollution, and many other aspects potentially related to climate change have been associated with differences on older persons’ health and well-being (Phillips and Feng 2018). This may relate to severe weather events seen in almost all areas, flooding, earthquakes, resultant tsunamis, and longer-term risks through changed conditions favoring diseases such as the spread of malarial risk zones (McCracken and Phillips 2016; WHO 2018b). A well-known example of the effects of extreme temperatures was the estimated 70,000 excess deaths among older persons in the very hot summer in Europe in August 2003 (WHO 2018b; Robine et al. 2003). Immobile older persons with pre-existing health problems, persons aged 75+, and especially those living in poorly insulated accommodation were at greatest risk of dying in these extreme temperatures (Vandentorren et al. 2006; Poumadère et al. 2005). All these risks point to the importance of intersectoral planning in accommodation design, health services accessibility, and responses for the needs of older persons.

GG can be a central platform in helping these policy areas. Moreover, many aspects of geographical gerontology are seen in the activities of NGOs such as Global AgeWatch Insights. Their Global AgeWatch Index is a good example of analysis of 96 countries, compared and ranked in terms of income security, health status, capability, enabling environment, and also given an overall ranking. A related example is Pension Watch, a knowledge hub focusing especially on tax-financed pensions. It is hosted by Global AgeWatch Insights and provides information via a global pension database, showing comparative data for many countries based on UN and World Bank data. This is a very good resource for comparing nations policies and practices in terms of public social pensions which can give a good perspective on the resources available to older persons internationally. Both these indexes and databases provide very useful resources for comparative geographical gerontology studies.

A further policy-related area involving GG is comparative epidemiological transition (McCracken and Phillips 2017). Epidemiological and demographic changes can be studied at regional, national, and local scales. Indeed, at the national/regional scale, GG has been showing how the traditional ageing areas such as Europe and Japan are reaching more steady states in demographic terms and even face population declines. The complex interactions with falling birth rates and apparent levelling off increases in life expectancy provide rather different ageing profiles for countries in this group. Many countries and territories in the Asia-Pacific region are also following suit, including China, Singapore, Taiwan, Hong Kong, and Thailand. By contrast, the low- and middle-income countries are sometimes quite rapidly showing themselves as the locales of current and future ageing in this century, including many large countries such as India and several in sub-Saharan Africa. Their changing demographic and epidemiological/health profiles bring new and often unanswered challenges in terms of resources and provision of care for older persons. Research on changing patterns of demographic ageing and short-, medium-, and long-term changes provide essential information for policy makers in many areas, including health, welfare, housing, transport, and a range of public and private services. Information on changing needs, attitudes, and demands of older consumers is also increasingly being valued in terms of retail provision and planning for older consumers as population profiles change.

GG has a role in many other areas especially in comparative study of older people’s well-being and use of services. This can be local or national level studies and can involve matters such as the role of various forms of social support, social exclusion, loss of support, social protection, and the like (Scharf and Keating 2012; Feng et al. 2018, 2019; Gyasi et al. 2018a, b; Gyasi and Phillips 2019). Factors such as variations in health literacy can be important and how these impinge on the success or may limit global policies advocated by WHO such as universal health coverage (Amoah and Phillips 2018). Other policy-related areas to which GG has contributed include the realities of ageing in place, identity, and place attachment in later years, ageing landscapes, and therapeutic landscapes (see Skinner et al. 2018).

Prospects

Looking to the future, it is clear that geographical gerontology is an increasingly multidisciplinary subject that relates to a majority of disciplines to research on ageing and older people. In order to achieve an even more fully transdisciplinary contribution of this field, new frameworks, theories, models, or applications could be developed by researchers, to integrate and transcend disciplinarily as a goal (Cooke and Hilton 2015; Cutchin et al. 2018). Geographical gerontology requires and is achieving inputs from an increasing range of contributors from within and outside geography. As its contributions grow, shared language and concepts could unite scholars in visions, collaboration, and the production of valuable insights about ageing (Cutchin et al. 2018). In particular, the ability to harness increasingly sophisticated forms of spatial analysis and mapping using complex datasets at different scales is likely to be an ever more important facet of this subdiscipline and one which will also contribute to policy and social planning. Geographical gerontology has long contributed to planning both physical and social policy. Findings such as those from the above China studies clearly indicate the value of identifying targetable socio-spatial variables that appear to influence older persons’ health. Analysis of spatial differences in access to and use of health services is also a traditionally strong area in this respect (see, e.g., Andrews and Phillips 2005; Hanlon 2018), and this will continue as an important future focus. Other key areas will include quality of life, well-being, social care, housing, and an increasing concern with socio-spatial differences in resource allocation. In all these areas, there is a growing trend for interdisciplinary perspectives and multidisciplinary team research. Increasing interest is being paid to matters such as environment, climate, and climate change as they impinge on older populations and their families (see Haq in this encyclopedia).

Cross-References

References

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Primary Care and Population Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
  2. 2.Department of Sociology and Social PolicyLingnan UniversityHong KongChina

Section editors and affiliations

  • Danan Gu
    • 1
  1. 1.Population Division, Department of Economic and Social AffairsUnited NationsNew YorkUSA