This chapter traces the development of concepts and theories in the sociology of aging from the 1940s through the mid-1970s through seven themes. The first theme describes the importance of age in social structure and the place of the aged in changing societies. The second theme focuses on the issue of ‘successful aging’: how to define, measure, and achieve it. The third theme highlights the tension between social structure and individual agency in the activity versus disengagement theory controversy. The fourth theme concerns the social meanings of age, age cohorts, and generations, as well as interactions between age groups. The fifth theme focuses on families, aging, and intergenerational relations. The sixth theme of age stratification deals with the interplay between cohort succession and the aging of individuals. The seventh theme addresses the life course as a socially constructed process.

This chapter presents an illustration of the complexities involved in studying ethnic and racial influences on psychosocial processes and how they are intimately tied to physical outcomes in later life. It focuses on psychology as a discipline, minority aging research during the last several decades has revealed the need for multidisciplinary and intersectional conceptual and research approaches. The chapter also focuses on the age, gender, socioeconomic, cultural, and racial and ethnic graded influences on life course development that eventuate in unequal burdens of psychological and physical health morbidity and mortality for certain groups in late life. No section on psychology could be complete without a discussion of religion and spirituality among racial and ethnic minorities. Generational processes are clearly implicated in ideas about the cyclical nature of poverty and health behaviors that are intricately linked with environmental factors and social influence.

The concept of Mild cognitive impairment (MCI) makes a lot of sense in that individuals are typically not “normal” one day and “demented” the next. In theory, especially for progressive neurodegenerative conditions, such as Alzheimer’s disease (AD), frontotemporal dementia (FTD), the development of dementia may take months or years. The clinical syndrome of MCI due to AD can be identified via a neuropsychological evaluation or less-sensitive cognitive screening measures. Much of what we are learning about MCI, and therefore refining its diagnostic criteria, is coming from two large-scale studies of cognition and aging: Alzheimer’s Disease Neuroimaging Initiative (ADNI) and Australian Imaging, Biomarkers and Lifestyle (AIBL). According to the most recent research diagnostic criteria for MCI due to AD, evidence of beta-amyloid deposition, neuronal injury, and/or other biochemical changes needs to be seen to increase confidence of the etiology of MCI. Cholinesterase inhibitors remain the primary pharmacological treatment for AD.

Social support from close relationships is one of the most well-documented psychosocial predictors of physical health outcomes. Social support is distinguishable from other health-relevant social processes including social integration and social negativity. This chapter reviews epidemiological work on social support and health, and explores the major life-span models that have implications for understanding these issues. Importantly, the link between social support and mortality was consistent across age, sex, geographical region, initial health status, and cause of death. In order to elaborate on the developmental processes over time that might impact social support from close relationships and health, a life-span model of support has been proposed that attempts to integrate prior work and models across disciplines. Most social support interventions also target individuals who are most at risk or who already have psychological, behavioral, or medical problems.

Mounting evidence has shown that an array of proinflammatory cytokines and mediators is frequently elevated in aging populations, including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP). In addition to chronological aging, sterile inflammation can be associated with a number of age-related disorders and diseases, including cardiovascular diseases, cancers, type 2 diabetes mellitus (T2DM), bone diseases, neurodegenerative diseases, chronic obstructive pulmonary disease (COPD), and frailty. Many types of cancer are also related to or are preceded by chronic inflammation at sites of tumor development. Although more studies are required, evidence to date suggests that drugs that target age-related chronic inflammation and related fundamental aging processes, including cellular senescence or the age-related increase in mammalian target of rapamycin (mTOR) activity, might play an important role in reducing age-related disability, frailty, and multiple chronic diseases as a group.

This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book focuses on theoretical and conceptual developments in research on aging, both within and across disciplines. Recent years have brought major investments in longitudinal data, investments essential to understanding aging as a dynamic, multifaceted, and interactive process. The book summarizes what is meant by theory, and why theory is so important to advancing aging-related research, policy, practice, and intervention. The theory portrays the relationships among the complex variables suggested by a theory. A good theory identifies the problem and its most important components based on the separate findings and empirical generalizations from research. As the field of gerontology and research on aging continue to rapidly expand, the need for a strong theory will only grow.

Wisdom tends to provide a sense of mastery and meaning in life that sustains well-being even under adverse circumstances. This chapter provides a summary of explicit and implicit wisdom theories. It explores the contextual life-course approach to address the divergent trajectories of personal wisdom development, with focuses on the importance of social support networks and role models. The chapter also explores the associations among wisdom and culture, religion/spirituality, and well-being in old age. Most wisdom literature concurs that advanced cognitive development is necessary but not sufficient for wisdom to arise. In older adult samples of mixed educational and socioeconomic backgrounds, wisdom, assessed as analytic and synthetic wisdom modes and an integration of cognitive, reflective, and compassionate wisdom dimensions was positively associated with subjective well-being, even after controlling for physical, health, socioeconomic status, financial situation, physical environment, and social involvement.

This chapter provides insight into the demographics of aging, and an overview of potential benefits and challenges of using technology to help older adults. It outlines four interconnected challenges of an aging population. With the expected increase in care needs that coincides with an aging population, the first challenge is the question of how to provide relevant high quality-care to older persons. Second, with fewer caregivers available in relation to the growing population in need, we can expect that the relative burden of care experienced by caregivers will increase. The third challenge is to increase the relative number of healthy and independent seniors by taking a more proactive approach with prevention and health maintenance strategies. The final challenge addressed concerns the development of health care systems and policy changes that are more inclusive of needed assistive technologies and medical devices.

This chapter reviews the typical changes in cognitive functioning that occur with aging. It presents an overview of the concept of crystallized and fluid intelligence. More recently intelligence has been conceptualized as consisting of multiple abilities, not adequately represented by a general quotient. The Seattle Longitudinal Study was the first major longitudinal study of cognitive changes with age. The chapter discusses changes in specific cognitive abilities with age. The inhibitory deficit hypothesis was presented as an explanation for changes with attention with age. One consistent finding has been that processing speed declines with advancing age. Visuospatial and language abilities remain fairly stable compared to other abilities. Memory comprises several types of memory, which are affected differentially by aging. Executive functioning also consists of several separate skills, affected differently by aging. Lastly, the chapter discusses two important implications of cognitive changes with age, driving and mandatory retirement ages.

This chapter briefly discusses housing and housing education activities that offer several unique perspectives on understanding issues of housing for older adults. The housing education activities are as follows: (1) Find a Nursing Home, (2) Field Trips to Senior Facilities, (3) Household Disaster Planning Kits, (4) Long-Term Care Residence Disaster Planning and (5) Applying Anti-Racist Pedagogy to the Exploration of Senior Housing. Activity 1, simulates some of the challenges older adults and their families face by actively engaging participants in the process of evaluating nursing home quality. Activity 2, provides hands on context to understanding the diverse housing options in the senior housing continuum. Activity 3, addresses an often overlooked concern for persons aging in place. Activity 4, similarly addresses the issue of emergency preparedness, this time in the context of conducting research and a focus on institutional rather than individual planning.

Social workers, both in the community and within the Veterans Administration (VA), provide a comprehensive range of services to a broad demographic of veterans. Service provision for veterans can address a wide range of issues including aging, homelessness, reintegration, sexual assault, physical and psychological war injuries, and substance abuse. Research-informed practice allows social workers to effectively address the special needs of veterans. This chapter discusses the landscape of social work practice with veterans and the interconnectedness of research, policy, and service delivery. It offers an introduction to working with veterans from a practice, policy, and research perspective. Social workers should have a working knowledge of military culture, the impact of deployment, subsequent redeployments, reintegration, and adjustment to civilian life. It is essential for social workers to have knowledge about the physical and psychological aspects of trauma, particularly war-related trauma.

Social connectedness—formal participation in activities, groups and informal contacts with friends, neighbours, and other residents—is important for everyone in a community to thrive, but is critical for the health and well-being of older residents. An "age-friendly" community promotes active, healthy, socially connected aging through inclusive policies, infrastructure, and services. It is easier for older people to involve in the community when it has age-friendly features, such as reliable public transportation; safe, welcoming gathering places; and accessible services. One way that some states, counties, cities, towns, and villages structure a commitment to age-friendly municipal planning is by joining the AARP Network of Age-Friendly Communities. This chapter presents original findings from a study the authors did to explore the strategies age-friendly communities employ to encourage people to spend time with others in their community. It discusses benefits of age-friendly communities; AARP network of age-friendly communities; and age-friendly network communities and social connectedness.

Experiential learning activities ranging from intergenerational service-learning to age-simulations and role-playing have also been shown to reduce ageist attitudes and increase empathy for the experiences of older adults. Devising or locating activities that are relevant, appealing, and appropriate can be a challenge for new faculty and veteran educators alike. Moreover, the inherently interdisciplinary nature of aging studies requires instructors to access expertise in a broad range of disciplines and content areas. This book A Hands-on Approach to Teaching About Aging should prove useful for anyone incorporating aging content into his or her courses, regardless of experience teaching aging-related material. The peer-reviewed activities in this book provide instructors from disciplines including but not limited to counseling, family studies, gerontology, geriatrics, medicine, psychology, public administration, public health, nursing, social work, sociology, and speech pathology with teaching strategies to readily engage students in the exploration of aging and older adults.

Most of the oldest old experience physical and cognitive decline and suffer the loss of independence. This chapter concerns those 85 and beyond who are the “oldest old”. Often called the “Fourth Age” of life, a time of decline and disability, this life phase begins whenever health starts to decline dramatically, and for some this is well before 85. Acceptance of advancing age and its accompanying decline in health is a central developmental theme of the fourth age. Protective factors include adequate access to services and social support, nutritious food, spiritual beliefs, and regular exercise and activities. Risk factors for poor outcomes derive mainly from failing health. The chapter explains the theories of loss and grief that can guide practice with the oldest old and possible interventions useful for work with oldest-old adults experiencing loss.

Research is a key component in every discipline and is often considered the most difficult to teach and the most boring to learn. Many undergraduate and graduate courses in research methods are across two semesters, which include a course on statistics and then a course on research methods, with a melding of the two during the second course. Universities are encouraging undergraduates to complete a research project with a professor in order to show their abilities prior to joining the workforce or attending graduate school. This chapter discusses research education activities. In Activity 1, Diversity of the Aging Experience, students utilize their newly acquired knowledge of research methods to locate current research on older adults. Activity 2, Final for Biology of Human Aging Course, incorporates acquired knowledge on biological aspects of aging and links an individual to each biological aging process.

This concluding chapter discusses grandparenthood and provides a brief description about the book. In this book, authors have presented multiple perspectives bearing on a deeper, multileveled understanding of grandparenthood, including the cultural/historical, developmental, ecological, cultural and cross-cultural dimensions, as well as from a clinical/family systems perspective. It attempts to understand the current and changing nature of grandparenthood, including the impact of changing historical and interpersonal contexts as well as the diverse roles that grandparents perform in families. Indeed, families today are different than before. With the increase in longevity and life expectancy leading to greater expansion of research on aging and the family, coupled with the growth of the grandparenthood literature, it is clear from the chapters in the book. The chapter concludes with future directions.

When one considers the prospects of aging, considerations of variables that could be found to help individuals age more gracefully are paramount to appreciate. This chapter provides an overview in regard to the importance of animals in our lives; more specifically, it addresses how animals help support individuals in their later years. It is amazing to appreciate that the warm heart, cold nose, and wagging tail of a four-legged creature would make such an impact. The chapter gives attention to considerations for people who may want to adopt pets in their later years as well. It provides a brief description on: pets and older family members; why we love animals; what is the human–animal bond?; physiological and psychological benefits of human–animal interactions; and understanding the human–animal bond. It also briefly discusses how to select a pet.

This chapter briefly outlines the history and structure of the Older Americans Act (OAA). It reviews the aging network of services and the network's development. In addition, the chapter provides an overview of the first major change in the operation of the OAA since its inception in 1965. The objectives of the OAA in Title I set the stage for a service philosophy that continues today, nearly 50 years after its enactment. The other titles of the act address specific policy initiatives and programs that address the policy intent of the act. Since its inception, the OAA has been an entitlement program based upon age and, more recently, special status such as being a family caregiver. Funding levels of OAA continue to be limited and most aging network services and programs are required to use additional resources to support the programs of importance to older adults.

Activities promoting positive interactions between young adults and older adults are often embedded in gerontology courses. This chapter outlines details for four activities promoting positive interactions with older adults. Activity 1, Intergenerational Speed Greeting, is based on the idea of "speed dating" and gives younger and older adults an opportunity to come together and answer questions around shared experiences. Students engaging in Activity 2, Life History Interview Project, conduct multiple life history interviews with an older adult living in a nursing home or in assisted living and then compare these interviews with an older adult relative. Activity 3, Service Learning Fair (SLF) in Gerontology, introduces students to the range and scope of gerontology-related agencies and services. Activity 4, Site Visits as a Requirement for an Introductory Gerontology Course: "Social and Demographic Implications of Aging", allow students to visit and tour an organization within the aging network.

This chapter explores the health of individual older people and how they behave when they feel ill. Throughout history, humans have sought many means of improving their health and delaying death, but just as modern biomedicine has begun to gain the upper hand on a broad range of communicable diseases, most the world’s national populations are aging and in need of a different sort of health care intervention, one for older people with chronic diseases and disabilities that is just beginning to be made a priority around the world. The health status of an older person is influenced by many social and behavioral factors, including lifelong health habits (such as diet and exercise), genetics, exposure to occupational and environmental hazards, and psychological stress. The quality and availability of health care throughout life also play a role in health in later life, though not as much as most of us might think.

Environment encompasses more than the home where an older person lives; it also includes emotional attachments to the broader community called place. Whether people live alone or with family members or friends, home is an important consideration throughout their lives. This chapter first explores what is meant by home, including similarities and differences between private homes and institutions. It considers place and housing in the context of dwelling types and recent social movements. Environmental theory in gerontology and aging in place provide a framework to explore ways in which home environments can help or hinder people as they age. The chapter also looks at ways in which environments can enable or disable people by their physical features (e.g., accessible entryways) and explore concepts related to age-friendly communities. It finally provides a brief vignette that introduces some of the themes surrounding home, place, and housing for older persons.

To facilitate learning about aging, we as teachers must first tear down these beliefs students (and ourselves) have internalized through years of exposure to inaccurate media representations of aging. The activities presented in this chapter help to do just that. Activity 1, Aging as Portrayed in Children's Picture Books, challenges students to think critically about the earliest messages people receive about aging. Activity 2, Aging in the Movies, students examine the ways in which aging is portrayed in various popular films. In imAGES: Intervention Program to Prevent Ageism in Children and Adolescents, students work in multigenerational groups to examine sources and contents of their beliefs about aging and work together to generate an awareness campaign about aging to disseminate locally. Finally, Activity 4, Examining the Social Clock through YouTube, facilitates challenges to the idea that there is a "typical" path people follow through life.

Public policy is an essential component to quality of life for older adults and provides funding and guidelines for the agencies and staff that provide services. This chapter provides activities that help students to develop a better understanding of public policy and aging. Activity 1, Examining Organizations that Benefit Older Adults in the Local Community (Rodriguez), provides a venue for students, community, and educators to "explore the local network of organizations that exist for older adults". In Activity 2, Letter to A Legislator: Civic Engagement for Gerontology Students (Temple), students have the opportunity to "write a persuasive letter to a legislator to support or oppose a proposed aging related social policy". Activity 3, What Will Your Future Look Like? Financing Retirement Exercise (Baker & Brown) provides a means for students to understand how "events in the economy, political spheres, and personal health status can influence their retirement income".

Throughout history, humans have used many means, organized in a variety of social systems, to cure their ills and improve their health, but just as modern biomedicine seems to be gaining the upper hand on a broad range of communicable diseases, many of the world’s populations are aging and in need of a different sort of healthcare model and intervention, which are just now beginning to be understood. Healthcare systems in different parts of the world can be categorized into one of these three broad types: folk, traditional, and modern medicine. The chronic diseases of late life remain incurable, but we are learning how to manage them, and we know that, through their public health efforts, societies are crucial actors in preventing disease and promoting health. In many countries, both developed and developing, we see the growth of health literacy, medical consumerism, medical pluralism, and an acceptance of self-directed care.

This chapter considers several aspects of aging as a global phenomenon, starting with the role of culture in shaping how we view old age and then turning to the far-reaching social and economic impacts of an aging world within countries and across regions. It provides a framework for thinking about how culture influences aging. The chapter examines some basic economic concepts as a way to help understand how systems and supports for older persons function within countries. It provides a very basic overview of some population-wide economic terms that are helpful in looking at global aging across countries and regions. In addition to economics, geography also plays an important role in global aging. The chapter provides a context for issues and concepts related to global aging, and addresses why it is worthwhile to study global aging, regardless of one’s career plans or academic major.

This chapter focuses on sources of evidence for evidence-based policy development. It explores some of the dilemmas with developing an evidence base and provides a range of empirical sources within the aging and disabilities arenas that can be used in building an evidence-based approach to policy development. The journey, however, will not be without struggle—since philosophical paradigms, and social and economic factors will interface and play a role in the development of evidence-based policy. The chapter helps the reader to be aware of healthy people 2020 benchmarks that are used to guide program planning and policy development. Benchmarks currently have been established in order to identify where health goals for the nation and individual states should be, and the program is evaluated routinely by local and state health departments. Healthy people 2020 is also used to gauge the impact of health policy.

When it comes to aging, medical conditions quickly become one of the most important issues facing people. As people grow older, they are more likely to have medical conditions that require attention and that can hinder their ability to perform the daily tasks of living. Improved medical care and prevention efforts have contributed to dramatic increases in life expectancy in the United States during the past century. They have also produced a major shift in the leading causes of death for all age groups, from acute illnesses and infectious diseases to chronic conditions and degenerative illnesses. This chapter describes medical conditions experienced by older adults and outlines the major features of continuing care retirement communities, assisted living communities, and nursing homes. It also highlights the difficulty many people face in paying for the long-term care they need and discusses the significant financial burden of long-term care.

There are positive and negative aspects of life at every age throughout the life span, and aging is no exception. This chapter presents a more balanced view of older adults’ mental health and cognitive abilities, one that moves away from the stereotypes. It focuses on mental health and cognitive abilities as people age, with a presentation of the many positive characteristics of older adults’ psychological and emotional well-being as well as difficulties some may face, such as depression and dementia. The chapter also describes how personality changes over the life span and how the creative arts can positively impact the lives of older adults. Finally, it discusses factors that can positively and negatively affect older adults’ mental and cognitive abilities. The Practical Application presented at the end of the chapter focuses on unique challenges faced by individuals currently around 80 and above due to mental health stereotypes and stigmas.

Older adults and their families are highly heterogeneous. This chapter addresses diversity both within and among older adult populations and considers ways to improve service provision through flexibility and awareness. The concepts of cultural competence and cultural humility are introduced, and strategies for increasing one’s level of cultural competence are explored. It is important to note that diversity is not only about race and ethnicity but also includes age, ability, gender, geographic location, religion, sexual orientation, socioeconomic status, and so forth. Similarly, different perspectives and backgrounds are found among professionals working throughout the field of aging. Activities in this chapter promote recognizing that diversity is not the sole domain or concern of marginalized groups, that everyone has a culture and a social lens through which they view the world, and that this lens influences not only their perspective but also the way they interact with those around them.

Older adults experiencing cognitive decline and any of the dementias are suffering in ever increasing numbers. With the aging of the baby-boom generation, the incidence of cognitive decline and dementia will exponentially escalate over the coming years. With this coming tsunami of dementia, older adults experiencing dementia, as well as their family members and caregivers, will need the services of psychologists. Psychologists are needed to help families recognize the importance of end-of-life planning for an older adult when first diagnosed with a dementia. When an older adult understands that he or she has responsibility for and choice in the decision to abuse a psychoactive substance, there is a greater probability of successful treatment and recovery from a substance abuse problem. Psychologists are in a unique position to assess whether older abuse is occurring and, when discovered, to intervene with advocacy initiatives.

The growth of the aging population in the United States is expanding, but our knowledge of sexuality among older adults is not keeping pace, allowing the ongoing perpetuation of myths about sexuality and aging. Aging couples may benefit when they understand that they may not be able to restore the sexual health they remember from their teens, 20s, or 30s but can expect to determine realistic, attainable goals that may include a variety of changes in routine, expansion of their sexual repertoire, and the incorporation of medications. This chapter briefs on the social context of aging, myths about sexuality in older adults, and challenges to sexual activity as people age. It then describes biological, psychological, and relationship changes and aging; and sexual behavior in residential healthcare. Older adults need to be counseled about practicing safer sex as 12% to 22% of all new AIDS diagnoses occur in this population.

Because older adults have the highest rate of suicide in the United States, it is important to understand the epidemiological trends, prevalence, and incidence rates of older adult suicidality. This chapter deconstructs myths and misconceptions related to suicide among older adults. It presents a brief overview of empirically grounded strategies for effective assessment and treatment of this population. Although suicide risk increases with age, it is not uncommon for professionals to provide a lower standard of care and service to older individuals. It is critical to be aware of the factors that contribute to suicide in this group in order to design effective suicide prevention and intervention programs and to effectively assess for suicide risk in older adults. It is equally important to be aware of the factors that protect against suicide in this group in order to support and enhance these qualities in an effort to reduce suicide rates.

This chapter explores changes that occur to the brain, beginning with an overview of modern technologies that are used to answer questions about brain functioning in older adults. Next it summarizes the changes that occur to the brain with normal aging. Finally, the chapter presents an overview of neuroplasticity. Although the human brain clearly loses volume with age, the brain also shows plasticity that can be used to maintain functioning in old age. Research in the coming decades can use the principles of neuroplasticity described previously to enhance the functioning of older adults, whether they are experiencing normal age-related change or damage to the brain following strokes or other neurological events. Neuroimaging methods will continue to be developed that allow us to determine what happens to the brain with age, and in response to neurological events, and how neuroplasticity enables the brain to adjust to such changes.

This chapter describes the addition of a new developmental stage. In the past, the years comprising the ages 60 to death were considered a single developmental stage, termed “elderly.” Owing to longer life spans, the elderly stage was divided into two stages, the young elderly (60–75) and the old elderly (75 to death). Certainly, 60-year-old individuals have different developmental tasks than 90-year-olds. This chapter describes the distinction between aging with a disability and acquiring a disability while aging. In the first, many individuals with disabilities (IWDs) have congenital disabilities or early-onset disabilities and, therefore, on becoming elderly have lived most of their lives with a disability. Acquiring a disability while elderly requires a change of identity. Acquiring a disability in late life is the only life stage for which disability is somewhat “expected” or “normative.”

The topic of death has tremendous biopsychosocial complexity. This chapter discusses it under the social aspects of aging because familial, societal, and cultural norms provide the context for understanding the how, when, and where of our deaths as well as our experiences of bereavement and grief. And yet, near the end of life, it is important to note that each person prepares for and faces the challenges differently. The varying illnesses and physical conditions combined with the individual uniqueness that we bring to the dying and bereavement processes create this biopsychosocial complexity. The challenge of our legal, health care, and community systems is to meet these diverse individual needs while evolving with society's changing norms. The chapter aims to introduce readers to the tremendous biopsychosocial complexity of understanding death and loss, in consideration of the diversity found among older adults.

Much of what has been accomplished in elevating elder rights and abuse prevention internationally has been accomplished by nongovernmental organizations (NGOs) that work in collaboration with the United Nations (UN), are supported by the UN, or that focus on influencing UN policy and programs. The UN also has “specialized agencies”, committees, councils, and commissions that play significant roles in promoting elder justice. UN entities employ a wide range of strategies to address aging issues, which are International Assemblies, Sustainable Development Plans, Treaties and Conventions, Public Awareness Events and Observances, and Special Procedures. American advocates have much to gain from participating in the systematic, deliberative, and inclusive processes that the UN and international NGOs have applied to aging, elder rights, and elder abuse prevention. This includes the UN's tripartite approach to age as a matter of human rights, public health and social development.

At one time, we used “old age” as a diagnosis for a resident passing. However, this is far from the truth. The body is made to operate for a long time and can do so, barring any disease or pathological processes. The problems associated with these diseases and pathological processes can accelerate death. The two groups that study aging individuals are physicians and gerontologists. This section describes the ten body systems. It discusses the phenomena that can be applied to the aging population such as changes in collagen; reduced reserve; gradual changes in the immune system; temperature response changes; postural imbalances; decalcification of the bones; decreased bone and muscle mass; urinary system; decreases in bowel function control; frequent anorexia; hearing and vision; skin; and memory. The section provides a brief description on the differing theories of aging, and the effects of exercising on aging persons.

Improving the lives of older adults is the primary goal of those who work in the field of gerontology, and doing so invariably also improves the quality of life of those who spend time with them, whether they are family members, friends, neighbors, or those who work with and for older adults. This chapter explores the many career opportunities within the field of gerontology and explains how the study of aging can be applied to any position in any field. It outlines educational pathways, professional organizations, credentialing opportunities, and job-seeking resources for those interested in a career in gerontology. The chapter also highlights the importance of entrepreneurship and innovation to help address the unmet needs of older adults. The Practical Application offers concluding remarks about the unlimited opportunity in the field of gerontology.

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).

This chapter reflects on how this book focuses on aging as a global phenomenon and attempts to see how our local knowledge plays in Indonesia or Bolivia, to compare what we think we know about our own ageways with what can be learned about the thoughts of other cultures on the subject. This chapter identifies 13 major global themes and describes how the world community—through the United Nations and nongovernmental organizations—is responding to the burdens that economic and demographic changes are placing on older people and their families. The chapter concludes with a call to readers for global leadership.

This chapter focuses on older people’s living environments—where and how they live. Their living environments include the communities in which they live, with whom they share their accommodations, and the type of housing in which they live. As with most aspects of older adult life, great diversity is common in all of these areas. The opening scenarios indicate just that, with some older people aging in place, others moving to retirement communities with enticing amenities, and yet others sharing their accommodations with others. This chapter discusses living arrangements, housing options, and age-friendly communities for older adults. It stresses the importance of living environment to older people and outlines the factors that influence their decisions about where to live. The chapter also outlines the advantages and disadvantages of living alone and investigates the issue of homelessness among older adults.

Religion is both a personal belief system and a sociocultural organization that is part of the social and emotional lives of most of the world’s people. Religion is often cited by older people as a source of support and reassurance, comfort and consolation. This chapter discusses key concepts of aging related to religious beliefs and practices in five major world religions: Hinduism, Buddhism, Judaism, Christianity, and Islam. It assesses the presence of similar beliefs and practices important in the aging experience across these same religions. Hinduism views aging as a life stage with different tasks from younger ages. Buddhism considers aging as the opportunity to recognize and adjust to the impermanent nature of life. Judaism and Christianity both point to aging as a time to connect or reconnect to God, who provides comfort in suffering. Islam views care of older people as a duty and an opportunity for reciprocal giving.

This chapter covers five main areas that are essential to the knowledge-base of the assisted living administrator: Accessibility, Fire Safety, and Disaster Preparedness; Models of Care; Universal Design and Aging in Place; Home and Community-Based Service Alternatives to Assisted Living; and Information and Communication Technology. Area 1 provides the assisted living administrator with a brief review of selected federal regulations, laws, and statutes related to disaster preparedness and accessibility as well as information about National Fire Protection Associations. Area 2 provides information on methods of service delivery in assisted living communities. Area 3 is focused on universal design and aging in place. Area 4 is designed to provide assisted living administrators with information about home and community-based services as components of long-term care and assisted living services. Area 5 includes an introduction and descriptions of information and communication technology.

This chapter provides brief description on malnutrition and aging, and nutrition and homelessness. It discusses nutritional impact of substance abuse, and nutrition assessment and intervention. The chapter explores the impact that homelessness and food insecurity has on the nutritional status of older adults. Interventions must be tailored to accommodate the patient’s financial resources, medical conditions, and ultimately his or her own personal goals in order to be effective. Patients may be completely disengaged from nutrition education and focused on other priorities, which are essential for survival, that is, shelter and safety, thus making nutrition education the least effective intervention for that patient at that moment in time. Ideally, the homeless geriatric person would be monitored and re-evaluated; however, follow-up may be unrealistic. What does nutrition assessment look like in action? The chapter provides a case study to describe this question.

This chapter covers the organizational management domain of practice and discusses three main areas that are essential to the knowledge-base of the assisted living administrator: The Assisted Living Industry: Context, History, and Overview; Policy, Licensing, and Regulations; and Organizational Overview. Area 1 focuses on the basic concepts of assisted living, including historical background, nomenclature, definitions, and a description of the industry. Assisted living administrators need to be familiar with these fundamental concepts as a basis for understanding their role and responsibilities. Area 2 focuses on laws and regulations regarding assisted living and the similarities and differences across states. Area 3 provides an overview of the organizational patterns and models. Understanding the concept of "aging in place" in the context of assisted living is essential. This area highlights the need for today's assisted living administrators to be well-informed and remain attuned to the evolving needs, practices, and models in the industry.

Alzheimer's disease (AD) and Traumatic Brain Injury are classified as neurocognitive disorders in the DSM®-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). For the purposes of illustrating the utility of the Intersectionality/Resiliency Formulation for diagnosis and effective treatment, this chapter highlights these diagnoses in detail along with their major differential diagnostic issues. It focuses on two of the most prevalent forms of neurocognitive disorder, in confidence that the lessons learned are widely applicable to persons with other neurocognitive disorders regardless of their age or situation. The chapter elaborates on the complex challenges of aging and its relationship to mental health diagnosis because the developmental phase of elderhood has come to be marginalized in society, resulting in a scarcity of mental health providers who have interest in caring for this population.

Even the most enduring public policy and aging-related legislation, such as Social Security—about 85 years old and definitely geriatric—requires constant refinement in order to be responsive to changing needs. Another major piece of legislation, Medicare, is both age-related and aging over more than a half century, and requires constant attention if it is to survive and prosper in the coming years. Related to Medicare is the Affordable Care Act which could be a bold step toward Medicare for all or some other legislation that implements universal access to healthcare and extends both life expectancy and health expectancy. There are many age-related public policies and legislation in need of nurturing, change, or elimination. The two pieces of major legislation, Social Security and Medicare, have improved the lives of millions of Americans and have lasted more than a half century.

Research on aging uses rigorous quantitative, qualitative, and mixed methods to answer questions about the experiences, causes, and consequences of aging for individuals, families, communities, and societies. The accumulation of knowledge and deepened understanding that come from research are an improvement over the everyday speculations that we naturally develop as we navigate our lives. Producing valid knowledge requires well-reasoned choices about how a study should be designed. While research in any field must be carefully planned and carried out according to well-established standards, gerontology researchers face some unique challenges. This chapter reviews the logic of research on aging, and summarizes some of the distinctive issues in the field, including the age-period-cohort problem, the multiple ways in which age can be conceptualized as an explanatory variable, and the importance of longitudinal studies.

Public policy needs to be responsive to the increasing diversity in America, with many cities and even states becoming “minority majorities”. No other country in the world has been so bold (despite the limited success) with attempts to integrate minorities and immigrants. Nonetheless, racial/ethnic discrimination in healthcare and our society in general has had a demonstrable negative effect on the health outcomes among African American, Hispanic American, Asian and Pacific Islander and Native American elders. Approval of lesbian, gay, bisexual, and transgender rights has spread quickly throughout the country, though there remain stubborn pockets of resistance. In general, though, aging throughout the world is being recognized as a challenge, and public policies and legislation are being developed and refined to meet the challenges that are accompanying it. Societies are rapidly aging, which is good news, as we all would like to live a long and fulfilling life.

There are medical screenings—tests with the potential for the early diagnosis of medical problems—and prophylaxis—medical prevention. Medical screenings and prophylaxis have benefits, but they also have risks—medical, psychological, and financial. This chapter examines the four different cancers such as lung cancer, breast cancer, prostate cancer, and colorectal cancer and their related screenings, and then additional diseases and prophylaxis measures. The topic of Clinical Preventive Services and Aging is best not left solely to clinicians for decision-making. The chapter offers a summary of age- and sex-related recommendations, based on current United States Preventive Services Task Force recommendations and other related research. It describes the benefits and risks of the annual physical; defines accuracy, reliability, and effectiveness of screening tests; reviews immunization guidelines; defines shingles and analyzes the use of Zostavax versus Shingrix; reviews aspirin prophylaxis; examines the Polypill and Polymeal; and evaluates Medicare prevention coverage.

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.

Age is relative, as the saying goes, so how do we know when we are “old”? Some of us may turn 40 and start to proclaim, “I feel so old! I’m falling apart.” Others may celebrate their 80th birthday and ask, “I wonder what is next? I’m so excited about what I am still learning and experiencing.” As we have discussed in this textbook, the age ranges that represent different stages of development have shifted over time. Since as recently as 100 years ago in the United States, the average lifespan was 47 years old and so today our perceptions of “old age” have certainly changed. Today, people in Western societies are living longer and longer. Within gerontological research, it is typical to distinguish among the “young-old“ (50–64 years), the “old“ (65–74 years) and the, and the “old-old“ (75+ years; Cronin & King, 2010). Our previous chapters discussed middle adulthood reaching into the lower to mid 60s; we now focus our discussions on this phase of life to include the ”old” and the ”old-old.” In this chapter, we explore the cultural and contextual factors that impact this final stage of lifespan development. As individuals move into their later phases of life, how do they experience the developmental process? How do beliefs around old age, physical and mental health, death and dying, and the role of “elder” in families and cultures impact the experiences of the old and very old? We will focus on the case of Rose, a recent widow of a partner of 40 years who is beginning to experience dementia.

This chapter examines how age matters to individuals and groups, and to social life and the organization of the life course. It illustrates how age is used to categorize and judge oneself and others, and how age is used to create distinct life phases and allocate social roles and activities in education, work, retirement, and family. This structure is reinforced through laws and policies, the design of institutions and physical environments, and social expectations. This structure can result in ageism, age segregation, and age conflict. Age must be understood in connection to gender, race, and social class. Differences among older people may not only reflect their unique experiences but also social processes that perpetuate inequality. Cohorts create new patterns of aging and the life course based on their unique composition and historical location. One can better anticipate the future of aging by studying cohorts who are now young.

Political processes are the activites through which people decide upon and enact the shared rules by which we live including how we collect and share resources, how we will be governed, and by whom. At the highest federal levels through the local and individual decisions, politics involves social values, choices, negotiations, and compromise. Politics intersect with aging in two ways: older people are active participants in political processes, as voters, civic volunteers, and elected officials; and policies designed to meet the needs of an aging population are topics of debate and compromise. This chapter helps the reader to identify the key roles of historic changes in views of aging on aging policy and to understand the successes and challenges of the old-age welfare state. It appreciates the extent to which social circumstances other than age, including race, ethnicity, and social class, drive political and civic behavior.

The field of health promotion has come a long way since it was initially defined as exercise, nutrition, and smoking cessation. Moreover, older adults were typically excluded from early writings on health promotion and disease prevention. They were old after all, perhaps resistant to change and without much of a future. Health promotion and aging now covers dozens of topics. Health professionals need to be careful about defining good health among older adults. Health promotion is a more proactive approach than primary prevention, which tends to imply a reaction to the prospect of disease. Directing a client’s anger or frustration into political advocacy work is a proactive, health-promoting enterprise that benefits both the individual and society. Medicare, Medicaid, and Social Security have had a tremendous impact on health. It is important, therefore, to review these legislative acts, as many people do not even understand the difference between Medicare and Medicaid.

Aging and physical vulnerability go hand in hand, so it is not surprising that older adults pay particular attention to what they eat and drink. Dehydration, constipation, hypertension, overweight, and malnourishment are just some of the age-related challenges facing older adults. Nutrition screenings examine characteristics known to be associated with dietary and nutritional problems, in order to identify high-risk individuals. One such screening initiative resulted in the production of a manual that begins with a checklist, “Determine Your Nutritional Health”. The manual includes a variety of screening tools on nutrition and related topics, including body mass index, eating habits, functional status, cognitive status, and depression. Medicare recognizes that not only is obesity a disease, but it is an epidemic in America. By offering free weight-management counseling for older adults, this is a step in the right direction.

With increased age comes increased likelihood of disability as people live longer and do not encounter fatal diseases. Unfortunately, this positive association between age and disability sometimes leads to a negative image of aging. Disability occurs when physical or mental health declines associated with aging, illness, or injury restrict ability to perform activities of daily living. This chapter discusses the effect of disability on biopsychosocial functioning throughout the lifespan, the effect of culture, race, and ethnicity on behaviors, attitudes, and identity, and the effects of discrimination and stereotypes on behaviors, attitudes, and identity. It describes the influence of sexual orientation on behaviors, attitudes, and identity, the impact of transgender and transitioning process on behaviors, attitudes, identity, and relationships, and the principles of culturally competent social work practice. The chapter ends with discussion of sexual orientation concepts and gender and gender identity concepts.

This chapter provides important clues about the directions in which one may go in the next 10 to 20 years as baby boomers grow older, Gen Xers and millennial ponder their future aging, women deal with their futures, and young immigrants and minorities move into middle age and become the workforce of the U.S. economy. It also raises a central premise that, regardless of the current political and social differences in time, one will share a collective fate: living longer with greater insecurities and arriving at the inevitable conclusion that someone must work and pay the taxes for the public benefits that one can demand from government. The chapter raises the economic realities facing all Americans as a crucial component for sorting out the 21st-century complexities of politics of aging that is largely based on older white voters.

This chapter discusses the indicators of normal and abnormal physical, cognitive, emotional, and sexual development throughout the lifespan. Because growth and development are generally predictable, social workers should know the milestones of healthy development and the signs of potential delay or disability. The chapter presents the theories of sexual development, spiritual development, and racial, ethnic, and cultural development throughout the lifespan. It discusses the effects of physical, mental, and cognitive disabilities throughout the lifespan, the interplay of biological, psychological, social, and spiritual factors, and the principles of attachment and bonding. The chapter then discusses the effect of aging on biopsychosocial functioning, the impact of aging parents on adult children, parenting skills and capacities, the effects of addiction and substance abuse on individuals, families, groups, organizations, and communities, and the factors influencing self-image (e.g., culture, race, religion/spirituality, age, disability, trauma). It ends with discussion of psychoanalytic and psychodynamic approaches.

There are three great forces that define the many challenges and opportunities facing everyone who lives in the United States: a politics of aging that includes generational tensions; conflicts over diversity and the need for immigrants; and the class divisions emanating from an economics of aging that may see greater poverty among the elderly. All these forces will make it difficult to reconcile the competing demands and tensions of a population that is becoming older and multiethnic and that faces a constant influx of legal and illegal immigrants and refugees. The chapter visualizes these three forces and the overall conceptual approach of this book. As one looks to the future sometime between 2042 and 2050 several trends will emerge from these forces: politics of aging will influence national priorities; immigration and refugee affairs will have a demographic impact; and the economics of aging will be felt by all.

This chapter reveals the personal stake one has in the face of three forces of a nation dealing with rapid demographic changes. It addresses long-term care policy and the realities of care giving in a nation where one does not raise their children to be long-term caregivers. As such, many Americans will find themselves receiving care from non-English-speaking immigrants. The chapter examines the nature of retirement security and insecurity and the new realities of living longer while relying on personal responsibility to ensure that one cannot find themselves in poverty as they grow old. It focuses on three groups: Latinos and Mexican American elderly; women, including those who are growing older; and millennials and other younger generations, who will face the consequences of our actions and inactions. The chapter presents a road map which is based on a very different narrative, and addresses politics and economics of aging.

This chapter posits that the United States can, in fact, learn from other countries. It prides ourselves on exceptionalism and the notion that the world has all to learn from and that the unique history, heritage, and innovations keep us ahead of the global curve. Yet, in the 21st century, one will increasingly find that other nations face the same challenges: sustaining their economies, dealing with threats of climate change and terrorism, managing the technological pressures on social norms, and giving hope to their citizens for better lives. The chapter provides an overview of global aging, the challenges facing other nations, and the preoccupations the United States shares with the world. Revising a public narrative to incorporate these new elements is imperative if the politics of a majority-minority nation are to give us a resurgence of economic prosperity and social stability in 2050.

The profound demographic trends reshaping the United States will amplify the three forces described in the first chapter: a new politics of aging where older voters hold sway and happen to be heavily White; a contentious politics of immigration and refugee debates that confound ones movement toward a majority-minority society; and a growing sense of personal and economic insecurity that will result in greater poverty and vulnerabilities for people of all ages, races, and political affiliations, regardless of their views about immigrants. One might move forward in the coming years toward mitigating the current tensions and conflicts around aging, diversity, immigration, and economic insecurities. Before addressing how one can overcome current tensions and reunify a heterogenous nation, one should ask: Why does all this matter? What stake does one have in how this country faces these demographic pressures and social forces?.

As the field of human sexuality continues to expand and interface more positively with mental health, physical health, and our culture at large, increasing numbers of helpful resources are becoming available for sex educators, lay folks, and anyone seeking updated and positive information. This final chapter provides lists (with some synopses) of essential sexual health-related websites, TED Talks, podcasts, books, and educational resources for eye movement desensitization and reprocessing (EMDR) therapists and clients. National and regional sexual health training organizations are also listed for further learning. Additionally, although directly addressing children’s sexual health was out of the scope of this book, educational resources for children and teens regarding sexual health are included in this chapter. Please keep in mind that as the field and agents of sexual health continue to expand, these resources may quickly become outdated or replaced by more current versions. Try to locate the most current websites and/or editions of the listed resources to learn about updates or revisions.