ABSTRACT
The crisis of suffering for older Americans today, in their life-course processes of growing old through early, middle, and later years, mirrors a state of entropy in U.S. aging and health policy. Government inertia and failures, resistance to change, fragmented aging and health systems—and the often convoluted and counterproductive layered systems decision making—contribute in no small way to the very real suffering experienced by older Americans. Understanding the crisis of elder suffering in the larger context of the social ecology of living, aging, and dying in America, and the relationship of these experiences to systems, is critical both to developing insight about systems limitations, and in some cases system failures, and to designing adequate systems of elder care for the future. The role of market-based, neoliberal ideologies in the construction of the postmodern identity of the older American provides meaningful context for illuminating contemporary counter-movements in aging and public health. These new movements seek to transform the individual-centered focus of “successful aging” to a system focused on whole community and population-level perspectives for living, aging, and dying well, with comfort, palliation in a supportive environment that affirms human dignity and affords opportunities for well-being. Improving elder health, well-being, and quality of life calls for both recognition of the problem of elder suffering as social in nature, and the concomitant adoption and implementation of a broad public health strategy to modify the social and economic determinants of health in the diverse environmental contexts in which older persons are embedded. An elder-centered approach to care builds upon the strengths of social systems, incentivizing the development of local, community-based care models in response to such suffering and the building of social bonds and a more just social order. The public health strategy for palliative care will play a pivotal role in the decades to come in sustaining these models and in assuring equitable access to care for all older people.
