In the previous chapter, we examined some of the cultural and contextual factors impacting development in late adulthood. This stage of life is typically characterized as starting in the mid 60s and continuing into the 80s, 90s, or until the end of the natural lifespan. In this chapter, we look at developmental theories, models, and research about older adults, and strive to understand how to apply these theories to work with adults in late adulthood. As it is important to always view developmental theories with a critical eye, we include both critiques of the theories presented, and recent and relevant research and writings about how these theories inform our understanding of older adults. Using the case of Rose, our fictional client introduced in the previous chapter, we will present psychosocial development theory (Erikson), human potential stages (Cohen), bioecological theory (Bronfenbrenner), and the ecological theory of aging (Lawton). We include additional cultural and contextual factors of aging impacting development, and conclude with thoughts from two experts from the field, Dr. William Barkley and Dr. Nina Nabors.
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Work plays a major role in our lives. It provides an organizing force in our activities and helps form our self-concept. Who we are and how we see ourselves is influenced by our work. The study of aging focusing on the employment and retirement issues of middle-aged and older workers is called industrial gerontology (Sterns & Alexander, 1987). The aging of the work force creates such issues as choosing to work longer, early retirement by choice or imposed, career patterns, finances, and health and disability. This chapter addresses many of these issues. As the population ages, the nature of work and retirement need to adjust accordingly. There is a greater need than in times past for nations to develop policies, work-places to identify strategies to maximize the value of an aging workforce, and individuals to plan for what work life and retirement pathways best suit their needs.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.
This chapter discusses clinical work with the geriatric/older adult partial hospitalization program (PHP)/intensive outpatient program (IOP) cohort, aged 65 and older and reviews the cohort’s age-related issues, which include an interplay of medical problems and dementia. It presents the younger clinician’s challenges in assuming the role of helper with this population and also reviews applications of the games of treatment planning and group therapy. Older adults decline in function and physical health and develop more and more medical conditions that are both stressors and causes of mental health symptoms. Many older adults have more and more sources of chronic pain, which diminish their quality of life throughout the day. Dementia is another medical condition connected with depression, anxiety, and psychosis that will be encountered in the older adult cohort. The clinician should respect boundaries in general by treating older adult patients as adults with self-determination.