Yaşlılıkta Kırılganlık: Risk Toplumu, Bakım Düzeni ve Yapısal Belirleyiciler

Öz

Yaşlılık dönemi, bireylerin biyolojik değişimlerin yanı sıra ekonomik, toplumsal ve kurumsal koşullarla şekillenen çok boyutlu kırılganlıklarla karşı karşıya kaldıkları bir evredir. Yaşlılıkta kırılganlık, yalnızca bireysel sınırların değil, aynı zamanda toplumun kaynakları nasıl dağıttığının ve kurumların nasıl işlediğinin bir yansımasıdır. Gelir güvencesizliği, bakım yükünün adaletsiz paylaşımı ve sosyal bağların zayıflaması, yaşlı bireylerin yaşam kalitesini doğrudan etkileyen başlıca unsurlar arasında yer alır. Dolayısıyla yaşlılık, bireysel bir yaşam evresinden öte, toplumsal eşitsizliklerin en açık biçimde görünür hale geldiği bir süreçtir. Bu çalışma, yaşlılıkta kırılganlığı bireysel kısıtlarının ötesinde; risklerin toplumsal üretimi ve bakım düzenindeki yapısal eşitsizlikler çerçevesinde ele almaktadır. Çalışma, kırılganlığı yalnızca sağlık ve tıbbi boyutlarla sınırlı görmeyip, toplumsal ve kurumsal mekanizmalarla bağlantılı çok katmanlı bir süreç olarak kavramsallaştırmaktadır. Literatür taramasına dayanan bu çalışma; ekonomik kırılganlık ve yoksulluk, toplumsal cinsiyet ve bakım yükü ve sosyal dışlanma ve yalnızlık olmak üzere üç temel ekseni incelemektedir. Bulgular, piyasa ağırlıklı bakım düzeninin bu eksenlerle kesişerek kırılganlığı derinleştirdiğini göstermektedir. Böylece yaşlılıkta kırılganlık, bireysel bir yaşam evresinden öte, toplumsal kurumların işleyişi ve eşitsizliklerin dağılımıyla şekillenen yapısal bir olgu olarak tanımlanmaktadır.

Anahtar Kelimeler

• Yaşlanma
• Kırılganlık
• Risk toplumu
• Yoksulluk
• Bakım
• Sosyal dışlanma

Vulnerability in Old Age: Risk Society, Care Regime and Structural Determinants

Öz

Aging is a period in which individuals face multidimensional vulnerabilities shaped by biological changes as well as economic, social, and institutional conditions. Vulnerability in old age is a reflection not only of individual limitations but also of how society distributes resources and how institutions function. Income insecurity, the unequal distribution of care burdens, and the weakening of social ties are among the primary factors that directly impact the quality of life of older individuals. Therefore, aging is more than just an individual life stage; it is a process in which social inequalities become most clearly visible. This study examines vulnerability in old age beyond individual limitations within the framework of the social production of risks and structural inequalities in caregiving. The study conceptualizes vulnerability not only as limited to health and medical dimensions but also as a multilayered process linked to social and institutional mechanisms. Drawing on a literature review, the analysis focuses on three fundamental axes: economic vulnerability and poverty, gender and care burden, and social exclusion and loneliness. The findings demonstrate that the market-oriented care system intersects with these axes, deepening vulnerability. Thus, vulnerability in old age is defined as a structural phenomenon shaped by functioning social institutions and the distribution of inequalities.

Anahtar Kelimeler

• Aging
• Vulnerability
• Risk society
• Poverty
• Care
• Social exclusion

Kaynakça

1. Agyemang, F. A. (2021). Long-term care in Africa: Trends and challenges. AARP International Journal. AARP International. google scholar
2. Ayalon, L., & Tesch-Römer, C. (2018). Introduction to the section: Ageism—Concept and origins. In L. Ayalon & C. Tesch-Römer (Eds.), Contemporary perspectives on ageism (pp. 1–10). Springer. https://doi.org/10.1007/978-3-319-73820-8_1 google scholar
3. Bauman, Z. (2019). Akışkan modernite (D. S. Çavuş, Trans.). Can Yayınları. (Orijinal eser 2000’de yayımlandı) google scholar
4. Beck, U. (1992). Risk society: Towards a new modernity. Sage. google scholar
5. Bettio, F., Simonazzi, A., & Villa, P. (2006). Change in care regimes and female migration: The ‘care drain’ in the Mediterranean. Journal of European Social Policy, 16(3), 271–285. https://doi. org/10.1177/0958928706065598 google scholar
6. Brodolini, F. G., Verashchagina, A., & Bettio, F. (2012). Long-term care for the elderly: Provisions and providers in 33 European countries. Publications Office of the European Union. google scholar
7. Butler, J. (2004). Precarious life: The powers of mourning and violence. Verso. google scholar
8. Cacioppo, J. T., & Hawkley, L. C. (2009). Perceived social isolation and cognition. Trends in Cognitive Sciences, 13(10), 447–454. https://doi.org/10.1016/j.tics.2009.06.005 google scholar

9. Campbell, J. C., & Ikegami, N. (2003). Japan’s radical reform of long-term care. Social Policy & Administration, 37(1), 21–34. https://doi.org/10.1111/1467-9515.00321 google scholar
10. Ciziceno, M. (2024). Who will take care of them? A reflection on Southern welfare regimes. Social Relations Review, 8(1). google scholar
11. Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens, F. (2011). Help wanted?: Providing and paying for long-term care. OECD Publishing. https://doi.org/10.1787/9789264097759-en google scholar
12. Daly, M., & Ferragina, E. (2018). Family policy in high-income countries: Five decades of development. Journal of European Social Policy, 28(3), 255–270. https://doi. org/10.1177/0958928717735061 google scholar
13. Daly, M., & Lewis, J. (2000). The concept of social care and the analysis of contemporary welfare states. British Journal of Sociology, 51(2), 281–298. https://doi.org/10.1111/j.1468-4446.2000.00281.x google scholar
14. Damme, M. van, Spijker, J., & Pavlopoulos, D. (2025). A care regime typology of elder, long-term care institutions. European Journal of Ageing, 22(20). https://doi.org/10.xxxx/ejag.2025.#### ← (DOI kontrol edilmeli) google scholar
15. Dykstra, P. A. (2009). Older adult loneliness: Myths and realities. European Journal of Ageing, 6(2), 91–100. https://doi.org/10.1007/s10433-009-0110-3 google scholar
16. Ellingsæter, A. L. (2012). Cash for childcare: Experiences from Finland, Norway and Sweden. International Journal of Sociology and Social Policy, 32(7/8), 444–455. https://doi. org/10.1108/01443331211249046 google scholar
17. Esping-Andersen, G. (1999). Social foundations of postindustrial economies. Oxford University Press. google scholar
18. Fang, L., Wang, Y., & Song, X. (2020). Development of long-term care insurance in China: Policy evolution and challenges. International Journal of Health Planning and Management, 35(2), 456–469. https://doi.org/10.1002/hpm.2918 google scholar
19. Fineman, M. A. (2010). The vulnerable subject and the responsive state. Emory Law Journal, 60(2), 251–275. google scholar
20. Fineman, M. A. (2014). Vulnerability, resilience, and LGBT youth. Temple Political & Civil Rights Law Review, 23(2), 307–329. google scholar
21. Fraser, N., & Gordon, L. (1994). A genealogy of “dependency”: Tracing a keyword of the U.S. welfare state. Signs, 19(2), 309–336. https://doi.org/10.1086/494886 google scholar
22. Gailán, C., Rubio, M., Escaroz, G., & Alejandre, F. (2023). Care and support systems in Latin America and the Caribbean. UNICEF. google scholar
23. Gibb, C. (2018). A critical analysis of vulnerability. International Journal of Disaster Risk Reduction, 31, 327–334. https://doi.org/10.1016/j.ijdrr.2018.05.010 google scholar
24. Glasby, J., & Littlechild, R. (2009). Direct payments and personal budgets: Putting personalisation into practice. British Journal of Social Work, 39(1), 60–79. https://doi.org/10.1093/bjsw/bcm093 google scholar
25. Glendinning, C. (2012). Home care in England: Markets in the context of under-funding. Health & Social Care in the Community, 20(3), 292–299. https://doi.org/10.1111/j.1365-2524.2011.01054.x google scholar
26. Harrington, C., Jacobsen, F. F., Panos, J., Pollock, A., Sutaria, S., & Szebehely, M. (2017). Marketization in long-term care: A cross-country comparison of large for-profit nursing home chains. Journal of Health Politics, Policy and Law, 42(2), 169–197. https://doi. org/10.1215/03616878-3766737 google scholar
27. Hochschild, A. (2000). Global care chains and emotional surplus value. In A. Giddens & W. Hutton (Eds.), Living with global capitalism (pp. 130–146). Jonathan Cape. google scholar
28. Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316. https://doi.org/10.1371/journal. pmed.1000316 google scholar
29. International Labour Organization. (2018). Care work and care jobs for the future of decent work. International Labour Organization. google scholar
30. İzdeş Terkoğlu, Ö., & Memiş, E. (2022). Impact of elderly care on “sandwiched-generation” women in Turkey. New Perspectives on Turkey, 66, 88–121. https://doi.org/10.1017/npt.2022.9 google scholar
31. Jarzebski, M., Elmqvist, T., & Gasparatos, A. V. (2021). Ageing and population shrinking: Implications for sustainability in the urban century. npj Urban Sustainability, 1(17). https://doi.org/10.1038/ s42949-021-00020-5 google scholar
32. Karadeniz, O., & Durusoy Öztepe, N. (2013). Türkiye’de yaşlı yoksulluğu. Çalışma ve Toplum, 3(38), 77–102. google scholar
33. Kaya Akdoğan, H., & İlhan, N. (2024). Factors associated with caregiver burden in family caregivers of older adults: A cross-sectional study. Florence Nightingale Journal of Nursing, 32(3), 254–260. https://doi.org/10.5152/FNJN.2024.23358 google scholar
34. King, E. M., Randolph, H. L., Floro, M. S., & Suh, J. (2021). Demographic, health, and economic transitions and the future global need for caregiving. World Development, 140, 105371. https:// doi.org/10.1016/j.worlddev.2020.105371 google scholar
35. Kittay, E. F. (2019). Love’s labor: Essays on women, equality, and dependency (2nd ed.). Routledge. https://doi.org/10.4324/9780429499631 google scholar
36. Kolodziej, I. W., Reichert, A. R., & Schmitz, H. (2018). New evidence on employment effects of informal care provision in Europe. Health Services Research, 53(4), 2027–2046. https://doi. org/10.1111/1475-6773.12765 google scholar
37. Künemund, H., & Rein, M. (1999). There is more to receiving than needing: Theoretical arguments and empirical explorations of crowding in and crowding out. Ageing & Society, 19(1), 93–121. https://doi.org/10.1017/S0144686X99007205 google scholar
38. Kwon, S. (2009). Future of long-term care financing for the elderly in Korea. Journal of Aging & Social Policy, 21(2), 119–134. https://doi.org/10.1080/08959420902733148 google scholar
39. Leitner, S. (2003). Varieties of familialism: The caring function of the family in comparative perspective. European Societies, 5(4), 353–375. https://doi.org/10.1080/1461669032000127642 google scholar
40. Levitas, R. (2006). The concept and measurement of social exclusion. In C. Pantazis, D. Gordon, & R. Levitas (Eds.), Poverty and social exclusion in Britain (pp. 123–160). Policy Press. google scholar
41. Lyon, D., & Glucksmann, M. (2008). Comparative configurations of care work across Europe. Sociology, 42(1), 101–118. https://doi.org/10.1177/0038038507084828 google scholar
42. Mackenzie, C., Rogers, W., & Dodds, S. (Eds.). (2014). Vulnerability: New essays in ethics and feminist philosophy. Oxford University Press. google scholar
43. Nazlıer-Keser, E. (2019). Türkiye’de yaşlı yoksulluğu sorununa yönelik bir değerlendirme. Toplum ve Sosyal Hizmet, 30(2), 739–764. https://doi.org/10.33417/tsh.578944 google scholar
44. Ochiai, E. (2009). Care diamonds and welfare regimes in East and South-East Asian societies: Bridging family and welfare sociology. International Journal of Japanese Sociology, 18(1), 60–78. https://doi.org/10.1111/j.1475-6781.2009.01119.x google scholar
45. Organisation for Economic Co-operation and Development. (2020). Spending on long-term care. OECD Publishing. https://doi.org/10.1787/92ed6a8c-en google scholar
46. Organisation for Economic Co-operation and Development. (2021). Pensions at a glance 2021: OECD and G20 indicators. OECD Publishing. https://doi.org/10.1787/ca401ebd-en google scholar
47. Organisation for Economic Co-operation and Development. (2023). Health at a glance 2023: Longterm care spending and unit costs. OECD Publishing. https://doi.org/10.1787/7b69a37d-en google scholar
48. Organisation for Economic Co-operation and Development. (2024a). Is care affordable for older people? OECD Health Policy Studies. https://doi.org/10.1787/5d38b2e5-en google scholar
49. Organisation for Economic Co-operation and Development. (2024b). Society at a glance 2024: OECD social indicators. OECD Publishing. https://doi.org/10.1787/82fee3f0-en google scholar
50. Özen, Y. (2020). Body work and later-life care in Turkey: A qualitative study of paid and unpaid carers of older people. Ageing & Society, 40(10), 2106–2127. https://doi.org/10.1017/ S0144686X19000496 google scholar
51. Peng, I. (2019). Eldercare policies in East Asia: Institutional configurations and policy development. Journal of Aging Studies, 49, 89–98. https://doi.org/10.1016/j.jaging.2019.04.001 google scholar
52. Peterie, M., & Broom, A. (2024). Conceptualising care: Critical perspectives on informal care and inequality. Social Theory & Health, 22(1), 53–70. https://doi.org/10.1057/s41285-023-00113-0 google scholar
53. Razavi, S. (2011). Engendering social security and protection: Challenges for making social security and protection gender equitable. Friedrich Ebert Stiftung. google scholar
54. Saraceno, C. (2016). Varieties of familialism: Comparing four Southern European and East Asian welfare regimes. Journal of European Social Policy, 26(4), 314–326. https://doi. org/10.1177/0958928716657278 google scholar
55. Silver, H. (1994). Social exclusion and social solidarity: Three paradigms. International Labour Review, 133(5–6), 531–578. google scholar
56. Tamiya, N., Noguchi, H., Nishi, A., Reich, M. R., Ikegami, N., Hashimoto, H., & Campbell, J. C. (2011). Population ageing and wellbeing: Lessons from Japan’s long-term care insurance policy. The Lancet, 378(9797), 1183–1192. https://doi.org/10.1016/S0140-6736(11)61176-8 google scholar
57. ten Have, H., & Patrão Neves, M. (2021). Vulnerability. In H. ten Have & M. Patrão Neves (Eds.), Dictionary of global bioethics. Springer. https://doi.org/10.1007/978-3-030-38077-8 google scholar
58. Türkiye İstatistik Kurumu. (2024). Yoksulluk ve yaşam koşulları istatistikleri, 2024. Türkiye İstatistik Kurumu. google scholar
59. Tronto, J. C. (1993). Moral boundaries: A political argument for an ethic of care. Routledge. google scholar
60. Tronto, J. C. (2013). Caring democracy: Markets, equality and justice. NYU Press. google scholar
61. UN Women. (2021). Progress of the world’s women 2021–2022: Families in a changing world. United Nations. google scholar
62. UN Women. (2022). Financing care systems and care policies in Latin America and the Caribbean. UN Women Regional Office. google scholar
63. UN Women & International Labour Organization. (2025). Guidelines for care policies from a gender, territorial and intersectional perspective. UN Women Regional Office & ILO Regional Office. google scholar
64. United Nations Development Programme. (2024). Human development report 2023–24: Breaking the gridlock: Reimagining cooperation in a polarized world. UNDP. google scholar
65. Victor, C., Scambler, S., & Bond, J. (2009). The social world of older people: Understanding loneliness and social isolation in later life. Open University Press. google scholar
66. Weiss, R. S. (1973). Loneliness: The experience of emotional and social isolation. MIT Press. google scholar
67. World Bank. (2022). Poverty and shared prosperity 2022: Correcting course. World Bank. https:// doi.org/10.1596/978-1-4648-1896-4 google scholar
68. World Health Organization. (2021). Global report on ageism. WHO. google scholar
69. Xiao, C., Patrician, P. A., Montgomery, A. P., Wang, Y., Jablonski, R., & Markaki, A. (2024). Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: A concept analysis. BMC Nursing, 23(115). https://doi.org/10.1186/s12912-024-01715-6 google scholar