In those western countries experiencing dramatic rises in life expectancy and affluence in the second half of the twentieth century, social understandings and attitudes to the ageing process have undergone profound transformations. These have been at the core of this book so far and need to be at the heart of any reconceptualisation of a sociology of health in later life. In particular there is a need to address the issue of how the relationship between health and ageing changes as ageing also changes. As Kirkwood (1999, 2004) indicates, distinctions between ageing and disease become increasingly blurred and taken for granted understandings of ‘natural’ ageing are increasingly undermined. Cultural and historical studies have shown how attitudes towards ageing and the old vary across time and cultures (Cliggett 2005; Gullette 2004; Holmes and Holmes 1995). These are important contexts for understanding the ambivalent, sometimes contradictory, responses to the role of medical science in extending the boundaries of longevity and quality of life in old age. As we have seen in previous chapters, naturalistic approaches to ageing tend to view physical and mental decline as a final stage in life prior to death and that this ‘natural’ process has been distorted by the medicalisation of old age and death (Vincent 2006a). While this has been a familiar refrain since the writings on medicalisation of Ivan Illich (1976) there is the need to make a further distinction between ageing as a norm in the western lifecycle and what is now considered to be ‘normal’ ageing in these societies. In a similar fashion to the debate on anti-ageing medicine among gerontologists, Rose (2001) emphasises the ways in which new bio-technologies make the boundaries of

‘normal’ ageing more plastic and open to manipulation. Citing a range of interventions, from hormone replacement therapy to Viagra, he suggests that a ‘normal’ ageing process is becoming increasingly fragmented by the field of choices made available to those entering later life. For Rose ‘natural’ ageing might be seen as a chosen response (from

a range of responses on offer) to a stage of life but it is one that exists in a state of growing indeterminacy where the very success of modernist welfare states has led to longevity becoming a normal expectation and life extension something always on the horizon. The consequence of this is that experience of ageing has become increasingly heterogeneous and is accompanied by an increase in uncertainty and insecurity about what later life entails and what constitutes appropriate age related health. Furthermore, the hegemony of social and cultural norms of youth and youthfulness has popularised the ideal of the active pursuit of body maintenance deep into later life (Katz 2005). This chapter will outline the mainstays of a sociology of health in

later life in the twenty-first century. Drawing on the recognition that the separation of old age from the rest of the lifecourse is less and less feasible, the chapter will suggest that as a drawn out period of later life becomes an expectation that most people hold, the effects and dilemmas of ageing reach back further into earlier ages. In order to do this the chapter will address five areas where our understanding and experience of old age are being transformed. First, we consider the rise of the somatic society and the will to health. Second, we consider the impact of the somatic society on what we refer to as the ‘Arc of Acquiescence’ as individuals anticipate and deal with the impact of age on their bodies. Third, we examine the effect of anti-ageing techniques and medicine on the conventional understanding of the role of health within later life. Fourth, we explore the boundaries between the third and fourth ages, focusing on the way in which these crucial concepts frame later life. Finally, we assess the consequences for later life of the relationship between increased longevity, death and changing attitudes to our own mortality.