This chapter presents specific issues faced by older adults in response to adaptations to chronic illness and disability. Some individuals have congenital disabilities and others acquire a disability early in life and are able to adjust fairly easily, aging with their disability. On the other hand, some individuals acquire a disability later in life and may experience great difficulty making the adjustments to their condition. The chapter presents information on the age-related concerns of older adults, components and perceptions of aging, assessment issues associated with older adults, vocational interests, and death and dying perspectives. It also discusses the implications for service delivery in the context in which older adults are served along with laws and regulations that apply to the population. Aging and geriatric persons often utilize a variety of services from multiple entities (e.g., social, legal, medical, financial, and counseling).

Poverty and disability are interconnected and are cyclical in nature. That is, persons with disabilities and chronic illnesses are disproportionately represented among those living in poverty and poverty disproportionately affects individuals with disabilities. Socioeconomic status is the most powerful predictor of chronic disease, disability, and mortality. The intersection between poverty and disability and chronic illness is influenced by a host of factors including employment status, educational attainment, lack of insurance, lack of access to medical care, race, ethnicity, sexual orientation, and gender identity. Persons with disabilities living in poverty may have to contend with multiple risks associated with limited resources, high stress, neurobehavioral effects, and exposure to various traumas. This chapter examines how poverty, disability, and chronic illness influence one another, describes the impact of poverty, contributing factors that precipitate and result from living in poverty, and the relationship between poverty and disability, and discusses implications and strategies for counseling.