Life differs for seniors living in U.S., China

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I was teaching in Hong Kong last month. My students from both America and Hong Kong study elder care with me -- comparing Hong Kong, mainland China, and the United States. As I was preparing to depart from Philadelphia, several people said to me: "Oh, China! It must be wonderful to visit a society where older people are truly respected. Seniors there must have a very good life compared with that older people have here in the U.S."

Our impression that Chinese culture reveres elders generally has us believing reverence for older people alone equals a good old age. As we imagine Chinese culture creating value in late life, we implicitly create a comparison with what we think is the place of old age in America.

Myth: Society's cultural values directly define later life.

It’s true: Chinese culture does value respect for elders. The principle underlying respect for older people is called filial piety. It comes from Confucius, the famous ancient Chinese philosopher. Filial piety is the virtue of respect and care for one's elders and ancestors. But you need to look more closely at any culture and see what lies beyond cultural values in China or any society to understand the life of its elders.

Many see only part of the picture. They focus on their understanding of filial piety but forget cultural ideals can be interpreted in the complexity of modern life.

In China -- but in not Hong Kong -- for example, they have to manage the after effects of the famous One Child policy. The One Child policy attempted to control population growth with limits to the size of families. The unintended consequence is that when that one child becomes an adult, two parents and as many as four grandparents might need help. Having as many as six people depending on your care and support can be tough. That's especially true now in China as many midlife adults have to move around the country to find work, leaving their children at home with grandparents. Family roles are often reversed -- even with the renowned Chinese respect for elders. Those grandparents become primary caregivers for their grandchildren.

In Hong Kong, other social forces can shape later life. Hong Kong has the highest rate of nursing home care in the world. At any given time, about 10 percent of Hong Kong's residents over 65 live in a nursing home. Here in America, the figure is about 4 percent. Reliance on nursing homes is partly a result of Hong Kong's population density and partly because of its housing. A typical Hong Kong home is tiny. Minuscule apartments or flats as they are called in Hong Kong are the norm. Most are without room enough to house the equipment necessary to provide the care that a frail elder might need.

Here in America, I think we forget our cultural diversity and different family backgrounds when we stereotype ourselves as lacking respect for old age. It's easy to overlook all the strands that shape our American cultural values. Ethnicity and religion span a range of life-ways, encompassing values held by those in our Native American communities to our most recent immigrants and everyone in between. Rural villages and towns, cities both old and new, and suburbs with diverse populations create more varied paths for our lives than many other countries. Our diverse backgrounds and different ways of leading our lives mean the generalization that Americans have no respect for the aged is rarely true.

Myth: Older people are unhappy and dissatisfied.

One way to think about how values and principles translate into later life is to evaluate happiness and satisfaction. Our singular focus on respect for elders implies we believe respect defines the quality of our lives as we age. Our beliefs about respect suggest a good end point to evaluate. Thinking this way implies seniors who are respected are happy and satisfied with their lives. Disrespect should get the opposite result.

Younger people tell me they worry about getting old, thinking the best of life is now and the worst is yet to come. Getting older becomes a downward spiral with little future happiness, they seem to imagine that disrespect coupled with ever more limited capacity will directly drive the value experienced in old age down. But our lives as younger people are more complex than a simple equation of values and experience. Why then do we think things will be simplistic when we are older?

Back in April, Christopher Ingraham wrote a Wonkblog for the Washington Post provocatively titled "The data are in: Life under Putin is a continuous downward spiral into despair."

Ingraham comments on happiness and life satisfaction as we age, looking around the world for comparisons. His information comes from work done at the Brookings Institution with data from the Gallup World Poll done in 2012.

The Gallup poll shows older people in Russia are unhappy as they age. Happiness goes downhill there as people get older. Likely contributors: Poverty and poor health among others.

Russia's late life unhappiness is a sharp contrast to what the Gallup Poll showed about older people and happiness in America. Here, happiness and age form what the Brookings researcher Carol Graham calls a U-shaped curve. That U looks like a smile, echoing the happiness reported by both youth and elders. According to the Gallup data, American happiness bottoms out in our mid-40's -- 47 in 2012 to be exact -- and then climbs in a nice curve upward for the remaining decades of life.

Our American age and happiness curve looks a lot like that for the world as a whole. Responses from people in all the countries polled together shows happiness hits a low point at about age 40 and then again curves up. In some countries, happiness in late life swings upward less than others. In general, higher income nations do better than those with low or middle level income economies.

You might wonder how China compares to America and other countries. China too has a U-shaped happiness curve. Their curve hits bottom at an earlier age than ours but their happiness too increases as life goes on. That curve does little to support the myth that Chinese filial piety makes life markedly better for Chinese elders. Their happiness curve looks about the same as ours in old age.

Myth: Only "happy people" will be happy and satisfied as they get older.

The flip side is only certain cultures respect elders. Some characteristics that contribute to a happy late life cannot be changed. But others might be altered, depending on the society in which you age.

Brookings researchers Graham and her colleague Milena Nikolova emphasize that many factors contribute to happiness. Their blog post Why Aging and Working Makes us Happy in 4 Charts makes for good reading if you want to take apart myths about happiness in old age.

Graham and Nikolova's analysis might surprise those who think happiness is determined largely by your personality. All other things being equal, factors like gender -- women are likely to be happier than men, marriage, education, and income are all positively related to happiness as we age. These characteristics are pretty hard to change -- at all or later in life. The real surprise here is employment status is related to being happy after age 65.

The Brookings Institute study found a connection between happiness and employment for people over age 65. That relationship varied by full time and part time employment, unemployment, and retirement. Graham and Nikolova found what they call a "happiness premium" among people working past retirement age in full or part-time jobs. Being able to work -- full or part time -- definitely depends on ability and desire as well as on job opportunities. And certainly not everyone working past retirement age does it for pleasure. But it’s good to know working when you are older yields more than just a paycheck.

Myth: Happiness is the same whether we are younger or older.

The actor Maurice Chevalier was famous for saying “Old age isn't so bad when you consider the alternative.” His ironic words convey a sense of contentment that turns out to be characteristic of happiness in later life. Cassie Mogilner -- a marketing professor who works at the same university I do -- and her colleagues summarized a set of studies looking at age and happiness.

Contentment -- a peaceful happiness -- grows as we get older. The excited happiness most of us might recall from our teen-age years and certainly from when were young adults first striking out on our own fades as we age. Mogilner and her team observed this contentment in real life -- interestingly, they looked at blogs posts -- and through more usual research techniques like surveys.

As we get older, contentment seems to come from a greater focus on the present. While we might project our thinking into the future when we are younger, older folks more commonly live their daily lives in the present. It's nice to know that what these researchers found suggests that younger people can find that peaceful happiness too. Such contentment might be possible by shifting your daily focus to living in the present, a lesson from later life to be shared with younger people in any aging society including America and China.

How do you define happiness, satisfaction and quality in your life? I'd like to hear about your sense of happiness and satisfaction as you are getting older. Email me at and follow me on Twitter @SarahHKagan. Until next time, be well and stay active!

Dr. Sarah Kagan is a professor at the University of Pennsylvania School of Nursing where she specializes in geriatric issues and the care of older people. She is a visiting scholar at universities around the world and was awarded the John D. and Catherine T. MacArthur Fellowship for her work. Kagan lives in Philadelphia. Her column on aging myths appears in newspapers and on digital sites throughout Calkins Media Incorporated.

Dr. Sarah Kagan is a professor at the University of Pennsylvania School of Nursing, where she specializes in geriatric issues and the care of older people. She is a visiting scholar at universities around the world and was awarded the John D. and Catherine T. MacArthur Fellowship for her work. Kagan lives in Philadelphia. Her column on aging myths appears in newspapers and on digital sites throughout Calkins Media Inc.

Dr. Sarah Kagan is a professor at the University of Pennsylvania School of Nursing where she specializes in geriatric issues and the care of older people.