Robert Butler coined the term “ageism”. Butler described ageism in three realms: stereotypes and prejudices against older adults, discrimination against individuals, and institutional practices and policy that disadvantage older adults or perpetuate discrimination. He believed that ageism accounts for disregard for older people's rights seen in public policy. He saw it in the failure of institutions to address the needs of older people or protect their rights, citing as evidence government's failure to protect older people against mistreatment or to enforce nursing home regulations. He saw it in the lack of attention to older people in disaster preparedness plans and in the institutional ageism that leaves many older people impoverished and vulnerable. Although Butler and others saw ageism as standing alongside other “isms” other forms of injustice and discrimination it never achieved their traction. This chapter explores why. The chapter discusses elder abuse, ageism in healthcare, workplace, and public policy and politics.

This introductory chapter presents a brief description of the book and its contents. It begins with description of the concepts of truth, justice, and the American way. This book assumes that advocates for older people can increase their effectiveness by achieving a clearer understanding of Americans’ not-so-self-evident nor inalienable rights. It explores how social justice and human rights principles have applied to older adults in the past and are viewed today. The book examines how the interests of older adults compare to and are intertwined with those of other groups. In essence, it frames elder justice as the intersection between aging policy and policy that promotes human rights and justice. Finally, the chapter describes the organization of the book and presents a brief overview of each chapter.

Sexuality is “a central aspect of being human throughout life [encompassing] sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.” The absence of conversations about sexuality in later life is in large part an outcome of ageism. It relegates older adults to “other,” it diminishes their quality of life, and it leads to a lack of attention to the serious consequences of sexual abuse and sexually transmitted infections, including HIV. This chapter explores the topic of healthy sexual expression in older adults and identifies some of the barriers to older adult sexuality, including societal disregard and disapproval, lack of accommodation in residential care facilities, and certain health issues. It highlights the importance of safe sex practices and education about sexuality and aging. The practical application presented at the end of the chapter focuses on older adult sexuality within the context of residential care facilities.

Older adults who are not only living longer, but actually in better health too, could boost the economy by virtue of their longer periods of productivity, their ability to earn and save more income over time, and their purchases and consumption of more goods. Furthermore, because of their accumulated wisdom, skills, and talents, they have much that they can contribute to our social environment. This chapter focuses on the longevity dividend and the importance of mobilizing all sectors of the society to realize the opportunities and address the challenges of an aging society. It includes demographic information related to aging in the United States as compared with that of other countries, as well as a discussion about the detrimental effects of ageism on older adults and on society as a whole. It is especially important for gerontology professionals to understand and avoid ageism.

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.

Everyone at every stage of their life benefits from community services and support. Different life stages call for different contributions. Many older adults certainly benefit from the services that their communities can provide for them. Yet, with their life-time experience and knowledge, older adults have much to give, too. Everyone benefits when they have reliable and safe ways to access opportunities to contribute to their communities. This chapter focuses on how older adults contribute to their communities and how they receive support. It outlines the many volunteer programs available to older adults and describes the services and programs primarily available through the federal government’s Aging Services Network, established by the Older Adults Act. The chapter also explores the issue of need and unmet need for services. The Practical Application presented at the end of the chapter highlights the tremendous contributions older adults make through their extensive volunteer work.

Life expectancy has risen dramatically in many countries around the world, including in the United States. Maintaining, and even enhancing, health and wellness is a lifelong process that requires awareness of one’s state of health and wellness and continually learning and making changes to maximize it. This chapter explains the importance of proper nutrition, physical activity, and good sleep hygiene to the health of older adults and differentiated between the nutritional needs of older and younger adults. It also offers an overview of the recommended vaccines and screening tests older adults should undergo as they age. The chapter concludes with a discussion about reducing the risk of developing chronic diseases by avoiding negative health behaviors and engaging in positive ones. Given the difficulty people have making major changes to behaviors that affect their health, the Practical Application offers some insight into individual motivation for wellness.

This chapter focuses on Americans at risk for poor economic and health outcomes as they age—women, people of color, and lesbian, gay, bisexual, and transgender (LGBT) individuals. It identifies older women, people of color, and members of the LGBT community as being at risk for poverty during their later years. The chapter then explains the impact of caregiving responsibilities, partner status, and living arrangements on economic security of older adults at risk and highlights the detrimental effect of health inequities on their health outcomes. It stresses the importance of preventive health services for older adults at risk. Understanding the needs and risks of women, people of color, and LGBT individuals is an important part of working in the field of gerontology. The Practical Application presented at the end of the chapter focuses on how to develop that understanding.

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.

Medicare and Medicaid are often confused with each other, likely due to their similar names. Older adults can benefit from both Medicare and Medicaid, if they meet the respective eligibility requirements of each program, in which case they are deemed dual-eligible beneficiaries. Although both programs relate to healthcare services, they are distinct programs. Medications play an essential role in the health of older adults. “Geriatric health care professionals and their patients rely heavily on pharmacotherapy to cure or manage diseases, palliate symptoms, improve functional status and quality of life, and potentially prolong survival.” This chapter outlines the various components of the Medicare and Medicaid programs. It describes some of the medication-related problems older adults experience and offers insights into how to avoid them. Managing multiple medications is particularly challenging for older adults; it is, therefore, the focus of the Practical Application presented at the end of the chapter.