Urban-dwelling African American older adults are disproportionately victimized by systems, which relegate them to disparities in health, education, and economic security as well as inequitable access to resources that support overall wellness (Brown, 2010; Jackson et al., 2004; Kahn & Pearlin, 2006; Zhang et al., 2016). The COVID-19 pandemic of 2020–2021 revealed poorer outcomes and a “double jeopardy” for African American older adults who suffered poor health outcomes (Chatters et al., 2020). As a result, avenues to promote healthy aging through health and wellness literacy, self-empowerment, and social-community connections are critical (Chatters et al., 2020; Pourrazavi et al., 2020; Waites, 2013). A qualitative study was conducted with African American older adults in Detroit to understand how to promote health literacy and overall wellness for those who are aging in place. An empowerment-oriented wellness framework (Dunn, 1961; Dunn, 1977; Hettler, 1976) was employed. Findings indicated that these African American older adults aging in the urban communities strived to maintain their independence while recognizing that they may need some assistance as they age in place. While some elders defined themselves by their disability and expressed feelings of being pushed aside by family and society, many rejected stereotypes associated with aging and reinforced a sense of pride and empowerment. They called for programs to: 1) assist older adults with health literacy and a comprehensive understanding of overall wellness; and, 2) provide activities and tools to support proactive overall wellness; and 3) employ strategies that actively encourage social engagement as well as outreach to their less engaged peers. Participants also suggested that a strategy to enlighten younger generations about the “senior world,” and aging is also crucial.
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- Go to article: Helping Older African Americans Thrive in Urban Communities: Empowering Lessons From DetroitSource:
Ageism is the most prevalent form of prejudice, and it affects older adults and younger people similarly (Bratt et al., 2020). Ageism occurs when someone is discriminated against based on their age, and this can happen at both ends of the life span (Raymer et al., 2017). This chapter focuses on topics such as ageism and reverse ageism; age-related mental health concerns; the effects of race, class, ethnicity, gender, and sexual identity related to aging and ageism; and competencies related to working with older clients. Cultural concepts focusing on the liberation counseling framework are discussed, as are aging and counseling ethics. Topics are discussed in the context of the life span as a whole and looking at the client from a humanistic model. Implications for counseling students, educators, and practitioners are provided.
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.
This chapter focuses on aging as a natural process that affects every one of us. It provides an interdisciplinary overview on how older adults’ health needs and the relationships for them change with the aging process, conspiring their biopsychosocial vulnerabilities and assets during the later life years. Most importantly, it discusses the developmental aspects of aging, the meaning of age, issues affecting older adult people, and the significance of relationship support to successful aging. In doing so, the chapter surveys the demographics of aging and the evidence from aging-related research important to the health resourcing of older adults. Finally, the chapter considers a case illustration on the implications of aging to healthcare resourcing from family, cultural, and social policy perspectives.
The frequency of pain and pain undertreatment in older persons has been increasingly brought to the forefront of the care of older adults in long-term care settings. Pain is a subjective experience and there are no specific tests to objectively measure it. Older adults who may be not able to communicate effectively about their pain are of particular importance to caregivers in long-term care settings. Older adults with untreated chronic pain also become less likely to engage in independent activities; their activities become more narrow and debility increases. The social worker can provide education to families about the physiological changes that occur in older adults that contribute to the absorption of medications, as well as comorbidities such as multiple diagnoses, chronic disease presence, and polypharmacy. In addition, the social worker can contribute to greater understanding of the need for pain management to avoid losses in physical function (ambulation), self-care, mental acuity, and socialization.
- Go to chapter: Trauma-Informed Care and Adverse Childhood Experiences with Older Adults in Nursing Facilities
Social workers in nursing homes are asked to include questions about trauma when gathering information from residents at the time of admission. Questions about the person’s past life can include a long list of likely traumatic events, e.g., living through a hurricane, and individual episodes of trauma, e.g., rape. For some older adults, trauma can be found in their childhood experiences, having a family member with a mental health or substance use disorder, violence in the community, poverty, and systemic discrimination. The effects of childhood abuse can be life-long and can include the need for resolution at the end of life. Older adults who have had adverse childhood experiences and/or childhood sexual abuse who have protective factors have an improved outcome in navigating symptoms and risks such as poor physical and/or mental health and suicidality when they have greater self-acceptance and higher extraversion. This chapter discusses the effects of these experiences on older adults, protective factors that help residents who are affected, and helpful interventions for social workers and the facility care team.
The importance of diagnosing depression and providing subsequent treatment to nursing home residents has been acknowledged and supported by the Centers for Medicare & Medicaid. The Mood section of the Minimum Data Set (
MDS) 3.0 includes the Patient Health Questionnaire, Nine Questions ( PHQ-9), in order to help identify depression. Depression is also associated with other chronic diagnoses such as Alzheimer’s disease, Parkinson’s disease, cancer, and arthritis. Substance use is often seen in the nursing home as a co-morbidity of depression for older adults. Depression and the diagnosis of depressed mood is a significant concern for social workers in long-term care. The social worker should be familiar with key signs and symptoms of depression, as well as the current modes of intervention, drug treatment, and psychotherapy.
The health status of an older person is the result of many factors, including lifelong health habits, genetics, and exposure to occupational and environmental hazards. The quality and availability of health care throughout the life course also plays a significant role in health in later life. These social determinants—the circumstances of our lives, including the neighborhoods in which we live—affect health risks and outcomes over the life course. Individual health behaviors are affected by the practices and habits of the people in one’s immediate social world, but they are also determined by the social circumstances of one’s life. This chapter explores the broad range of individual behaviors and social determinants that shape health in later life. It also examines the policies and practices within the U.S. health care system that shape access to and quality of health care for older adults.
This study proposes a novel cooperative caring model for older adults with dementia. Crucially, in this model, nurses need to understand older adults with dementia as active contributors to caring interactions rather than passive recipients of care. Our approach emphasizes that a caring relationship develops by virtue of complementary cooperation, one through which both parties make positive contributions to the other party's actions. With such an approach, the active role of older adults with dementia is revealed, which creates a positive cycle wherein both parties change.
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).
The family is the most basic social institution throughout the world. Families are studied in many disciplines, including anthropology, demography, economics, family studies, geography, gerontology, psychology, public health, social work, and sociology. This chapter explores what contemporary families look like around the globe, with a special focus on older members. This is a challenge, because one of the major characteristics of families is their diversity. The chapter begins with a brief example of the variability in contemporary definitions of the family. It then examines how population aging and global interconnections (specifically, economic and social factors) have changed the structure of families. Next, the chapter examines the living arrangements of older adults and their families, and looks at relationships within families. Finally, it explores macro- and microlevel factors that influence family functioning, and presents two important emerging roles of older adults in families.
Health educators constitute an important profession that is necessary for promoting health, but is not sufficient. They must learn how—and be allowed—to collaborate with health providers who may not recognize their worth, and with patients/clients who may resist their guidance. Health professionals and older adults need to be informed about a great many health education topics. This chapter explores a few of these topics: smoking, alcohol, medication usage, injury prevention (fall prevention and motor vehicle/pedestrian safety), sexuality and intimacy, and sleep. Older adults can share intimate support in many ways. Practical health research findings are reported on in academic journals or popular media almost every day of the year and it is a challenge for health educators, providers, and patients/clients to stay current. A collaboration among the three groups is essential. Perhaps the most successful outcome of health education had to do with smoking cessation.
Empowerment for an older person means having the opportunity to learn, discuss, decide, and act on decisions. From the perspective of the health professional or health educator, empowerment of older patients in the clinic setting or clients at a community site means not only to provide service to them, but also to collaborate with them, to encourage their participation. Certain personality characteristics, such as patience, tolerance, and a positive attitude, enhance the health educator’s chances for collaborating successfully on a health goal. There are health-promoting strategies that may help. For those who are behavior management-oriented and like recordkeeping, the health contract might be helpful. There are support groups to help with chronic diseases, caregiving, coping with loss, and alcohol or other addiction problems. Empowerment, with its rewards and risks, is fast becoming a requirement in the era of chronic healthcare conditions that must be managed, sometimes for decades.
According to the surgeon general’s report, regular exercise and physical activity improved health in a variety of ways, including a reduction in heart disease, diabetes, high blood pressure, colon cancer, depression, anxiety, excess weight, falling, bone thinning, muscle wasting, and joint pain. This chapter reports on studies showing evidence that exercise demonstrates considerable promise for older adults in a variety of areas of disease prevention and improved physical and cognitive function. Exercise as a weight maintenance strategy, though, becomes less efficient as we age. The best exercises for weight control are a combination of aerobics and strength building. The four components of a community exercise class are aerobics, strength building, flexibility and balance, and health education. The acceptance of the importance of exercise is now universal, including all age groups; however, the practice of exercise does not match the knowledge of its worth, and it becomes increasingly challenging with age.
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.
This chapter reviews the basic concepts related to the delivery of social work services and the many roles of the social worker in restorative and long-term care (
LTC) settings. The efforts of the health care social worker generally involve assisting patients/clients/consumers and their families in these transitional LTCand restorative settings. According to the National Association of Social Workers, health care social workers in these types of facilities should follow practice standards in administration, advocacy, clinical practice, consultation, and education and follow personnel practices such as staying in compliance with governmental regulations as well as the professional code of ethics. The activities performed in LTCsettings and restorative care services can cross a spectrum of care. This chapter focuses mainly on the needs of older adults in these settings; however, other populations such as children, adolescents, and persons with disabilities may also receive these services.
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.
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.
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.
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 LGBTcommunity 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 LGBTindividuals 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.
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.
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.
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.
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 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.
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.
Athletes are believed to be at greater risk for eating disorders than the general population. When examining the rates of autism spectrum disorder (ASD) among those with or without an eating disorder, an ASD diagnosis was found to be more common among those with an eating disorder. Accurately identifying older adults who may have an eating disorder has its challenges. Eating disorders understood in the context of physical disabilities reveal not so much an issue with respect to effectively and accurately diagnosing an eating disorder but in regard to the degree that body image issues can be pronounced among those who have a physical disability. Refusing to eat or engaging in fasting for spiritual reasons was a common practice during medieval times. The difference between those who benefit from having a religious faith and those who do not may lie in the difference between religion and spirituality.
This chapter begins with a description of multiple systematic reviews and meta analyses of problem-solving therapy (
PST) interventions. The number of studies evaluating PSThas increased over the past decade, so more reviews has been conducted. The chapter discusses PSTfor various mental and physical health problems and depression. Following this it also discusses PSTin primary care and among older adults. It briefly describes PSTfor diabetes self-management and control; vision-impaired adults and social problem-solving therapy in school settings. The chapter describes PSTas a transdiagnostic approach. It briefs the listing of PSTinvestigations and supports the characterization of this approach as a transdiagnostic intervention. The chapter also demonstrates its flexibility of applications. Finally, it highlights certain aspects of the recent outcome literature featuring various clinical problems (e.g., health and behavioral health disorders), populations (e.g., older adults, children, ethnic minorities), and modes of delivery (e.g., telehealth).
Diverse components of the aging networks have been involved in research, education, and practice in the area of emergency and disaster planning. This chapter covers a broad array of topics related to the well-being and the rights of older adults, including elder justice, the Ombudsman program, and legal assistance. It is important to view the supports for older adults from the perspective of empowerment and autonomy rather than from where we have been in the past with programs that foster dependence and operate from a paternalistic attitude about aging, including the view that professionals know what is best and, at the very least, someone other than the older adult knows what is right and what is needed. The aging networks can achieve this by promoting programs that are “active aging” focused and grounded in the social determinants of health as the organizing principle.
The older adults most at risk for poverty are those who have experienced cumulative disadvantage as a result of low education attainment, entering the workforce for the first time during an economic recession, health problems that limit their ability to work over long periods of time, and involve extraordinary expenses for either themselves or family members and other vagaries of life. This chapter reviews the social insurance programs that support older Americans, poverty rates, modern retirement compared to “old-fashioned retirement”, gender differences, income equality, and the broad reach of Social Security. It also covers the mechanics of Medicare and Medicaid. There are three Voices in the chapter. One addresses the “comfortable retirement” and its differential meaning and possibility, another focuses on women 50 and over, and the final Perspective piece covers the broad reach of Social Security and its importance to families of all ages.
- Go to chapter: Older Americans Act Legislation and an Expanding Consumer Base: The Evolution of a Network
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.
- Go to chapter: Our Aging Future—Persistent and Emerging Issues for the Aging Networks: A Call to Action
This chapter addresses emerging and persistent issues that need attention for the benefit of today's elders and the elders of tomorrow. It discusses several persistent and emerging issues that need to be addressed by the aging networks and by the field in general. The persistent issues include: ageism; professional competencies; the aging workforce on all levels; and LTSS in the community. The emerging issues include: goodness of fit and changing cohorts; diversity; and innovation and the aging networks. Services and programs of the aging network are components of the home- and community-based care system that, by definition, is a long-term care system. As the field of gerontology grows and the population of older adults continues to increase, the need for a gerontologically educated workforce becomes a critical factor in our ability to provide a good old age for everyone in our society.
The broad array of community-based services for older adults has developed over time as a result of the Older Americans Act (OAA) and the Administration on Aging (AoA) and the funding allocated to this act by Congress. With an expanding consumer base, the result of population aging, the aging networks have had to evolve over time, and while there have been and will continue to be some growing pains, there continues to be concerted efforts on many fronts to be support for providing services and programs that increase the quality of life for older adults. This chapter explores the expanding consumer base of the aging. It describes how long-term services and supports (LTSS) can be better managed and paid for to support those who need long-term support and services. Finally the chapter discusses how aging networks can and will evolve over time to serve the changing cohorts of older adults.
While high-income nations have experienced increasing life expectancy as a consequence of better healthcare and healthier lifestyles, this does not mean that the size of the aging population will be the highest globally. The issue of HIV and older adults will continue to be a public health issue across the globe and will require the attention of factors related to socioeconomic context as well as sexual health and education. Regardless of the income of specific nations, families provide essential and important support for elders. The support of the oldest-old and those who require long-term supports and services earlier in life will be the most pressing issue for all nations going forward—rich and poor alike. These issues, in and of itself, is a great reason to participate and learn about international issues and global aging so that we can in fact face the challenge of change in our aging world.
This chapter briefly discusses the history of the Caregiver Support Act and its specific components and explains how the Caregiver Support Act provides resources to older adults and people with disabilities. It provides an overview of the current status of family members serving as caregivers, with special attention to grandparents raising grandchildren. It then discusses a current profile of relative caregivers raising children in the United States; reasons for the increase in relative caregiving; and issues facing grandparents raising grandchildren. It also provides some background into the literature and promotes an awareness of issues that grandparents face as primary caregivers. A literature review examines some of the current issues and services needed. The chapter discusses resources and services designed to meet the needs of grandparents raising grandchildren, and reviews programmatic responses through the national resources. Finally, the chapter outlines some best practice interventions for review in the text.
This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.
Policy and Program Planning for Older Adults and People With Disabilities, 2nd Edition:Practice Realities and Visions
This book attempts to build students’ understanding of policy development through a critical analysis and review of policy frameworks, and the policy implementation process. The book is organized into four parts comprising twenty-one chapters. Part one of this book lays out a background as to the current and future demographic trends of older adults and makes the case for the reader that there are a variety of philosophical, political, economic, and social factors that affect public policy development. The chapters help the reader to explore a range of perspectives that define, shape, and impact the development and implementation of public policy. It intends to prepare the reader to critically analyze public policies related to aging. Part two provides an overview to major federal policies and programs that impact older adults and people with disabilities. It examines some historical developments leading up to the actual development and implementation of the policies. Policies include social security, medicare, the Older Americans Act, and the Americans with Disabilities Act, the Community Mental Health Centers Act, and Freedom Initiative. The last part of the book outlines specific programmatic areas that flow from aging policies, and specific components that flow from federally mandated policies. Each chapter contains same basic outline: an overview of the programs, specific features and strengths of the programs, gaps and areas for development, and challenges for the future.
Physical activity for older adults has become a central feature of our culture. Physical activity programs intended for older adults call for an understanding of the social, psychological, and physical factors that influence their receptivity and effectiveness in supporting individual well-being. This chapter is organized into three sections, each addressing older adult social integration and physical activity in specific ways that are applicable to health professionals. Section one defines key terms, presents concepts on aging, and offers evidence to enhance well-being through social integration and physical activity. Section two provides a practical approach to working with older adults through physical activity that includes benefits, guidelines, recommendations, opportunities and barriers to physical activity, and a resource guide to best practices and approaches for older adults. In section three, two cases, based on individuals the authors have worked with, provide physical activity progressions and considerations for social integration.
Digital social networking is essentially limitless, but it requires an Internet connection, a device, and the ability to use the technology. This chapter addresses the following questions: To what extent do older adults take advantage of the Internet and social media for their social interactions?; Is it possible to reduce the epidemic of social isolation through these technologies?. It is organized as follows: It first reviews some facts about how older adults are adopting new technologies and the barriers that prevent their adoption. It then introduces new research areas which utilize modern technologies and have implications for combating the modern-day social isolation epidemic. Finally, the chapter discusses some cautions and research areas that need to be addressed before advocating digital socialization among older adults. The chapter also share some interesting discussion exchanges among members of the Gerontological Society of America posted in its open forum a few months ago.
This chapter explores what major factors contribute to and detract from older adults’ ability to sustain sexual and romantic satisfaction well into the last half of their lives. It pays particular attention to the ways in which being single can both inhibit and be a positive part of this new stage of love, sexuality, and intimacy for older adults. The chapter concentrates on the demographic traits of the post-50 population that affect sexual and romantic longevity; however, it discusses toward some of the psychosocial variables that can impact sex after 50 (such as societal stigma and personal communication styles between partners) as well as some of the more inevitable obstacles to sex older men and women experience. It also looks at how institutional practices such as the current state of long-term care facilities often have policies that inhibit their residents’ ability to be sexually active.
Socially isolated older adults often lack opportunities to establish the social connections that support positive health and well-being. Volunteering, either formal or informal, is one strategy to prevent and even address social isolation among older adults. The act of volunteering, particularly for older adults, is well researched and has been found to be associated with many positive health and well-being outcomes, including improved physical and mental health, increased physical activity and socialization, the development of personal resilience against stress, gains in knowledge and skills, and reduced mortality risk. This chapter presents vignette illustrating the personal significance of volunteer work is based on the experience of a volunteer participating in a Retired and Senior Volunteer Program. It discusses some existing pathways that can lead an older adult into formal and informal volunteer service and opportunities for engagement that can be either accessed locally or replicated through new program efforts.
Many of today’s lesbian, gay, bisexual, and transgender (LGBT) older adults grew up in a time of intense homophobia and transphobia, when homosexual behavior was both criminalized and seen as a disease. The risk of social isolation for current LGBT older adults is likely increased as they are more than twice as likely to live along and four times less likely to have children than their non-LGBT peers. This chapter provides a brief description on: health well-being, and risks of social isolation for LGBT older adults; families of choice, social supports, and social networks; and disclosure management and access to services. Like all older adults, LGBT individuals need social connections to thrive as they age. Programs do exist to meet the social needs of LGBT elders. Fortunately progress is being made both within mainstream social and health services organizations and with increased development of specialized programs for LGBT older adults.
- Go to chapter: International Perspectives on Social Relationships, Social Isolation, and Well-Being Among Older Adults
International Perspectives on Social Relationships, Social Isolation, and Well-Being Among Older Adults
The interpersonal environment in which older adults are embedded strongly influences their health and well-being. A state of social isolation can be defined as the absence of a meaningful interpersonal environment. This chapter presents some important theoretical and methodological distinctions. It looks at the association between several key aspects of the interpersonal realm, on the one hand, and selected positive and negative well-being outcomes, on the other. It examines the contribution of the construct of network type, a composite measure of social relations, to the study and the understanding of the interpersonal domain of older people, and its role in well-being. Following this, it considers another indicator of social relations—this time, a scale of social connectedness—and how this measure disentangles the effects of social relations and social activity on well-being. Finally, the chapter presents findings on the implications of changes that occur in the interpersonal environment on the mental health.
Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.
- Go to article: Improving Social Work Student Competence in Practice With Older Adults Affected by Substance Misuse: Spotlight on the Bronx
Improving Social Work Student Competence in Practice With Older Adults Affected by Substance Misuse: Spotlight on the Bronx
Through the lens of a case study, this article suggests ways to increase social work student competence in gerontology and substance abuse treatment to better meet needs of growing numbers of diverse clients in urban settings. Focusing on a client residing in the Bronx, New York, it explores how changing demographics and a lack of workforce preparedness can combine in an urban context to increase risks for older adults and reduce quality of life in late life. Aiming to reduce knowledge and service gaps, suggestions are made on how to improve social work student competence. These include interpreting client cases through a theoretical framework to deepen understanding about the intersection of advancing age and substance use and improving treatment skills.Source:
This concluding chapter summarizes the major points regarding elder abuse (EA) presented in the preceding chapters. It concludes the chapter by taking one last opportunity to encourage exploration and initiation of system-level efforts to solve a major public health problem. The socioecological framework for violence prevention utilized within domestic and global public health work is applicable and extendable to EA. Throughout this book, the authors have argued that EA is a public health problem and that EA may well be among the most under-recognized and under-resourced population health problems of the early 21st century. Public health has frameworks, tools, approaches, relationships, structures, systems, and a variety of agents and organizations poised to address the problem of EA. The imprimatur of the growing population of older adults and the character of demographic transitions occurring globally provide the perfect rationale for action—now.
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 book fills a gaping void in the selection of textbooks to use in graduate courses on the psychology of aging. It serves as a primer for any graduate student who is going to work in a clinical setting with older adults, or in a research lab that studies some aspect of the psychology of aging. The book introduces students to the background knowledge needed in order to understand some of the more complex concepts in the psychology of aging. Additionally, it provides clear explanations of concepts (e.g., genetics of aging research, neuroimaging techniques, understanding of important legal documents for older adults). The book focuses solely on older adults, providing in-depth coverage of this burgeoning population. It also provides coverage on cognitive reserve, neurocognitive disorders, and social aspects of aging. The book is intended for graduate students or upper-level undergraduate students in psychology, biology, nursing, counseling, social work, gerontology, speech pathology, psychiatry, and other disciplines who provide services for, or perform research with, older adults. It is organized into four sections. Section I presents introduction to the psychology of aging. Section II gives a core foundation in biological aspects of aging. It covers general biological theories of aging, common physical health problems in older adults, and normal changes that occur to the brain with aging. Section III describes the psychological components of aging such as changes in personality and emotional development, mental health aspects of aging, normal changes in cognitive functioning, cognitive reserve and interventions for cognitive decline, neurocognitive disorders in aging, aging's impact on relationships and families, and working in late life and retirement. The final section presents the social aspects of aging, which includes death, bereavement, and widowhood, aging experience in ethnic and sexual minorities, and lastly, aging and the legal system.
This chapter introduces some of the concepts that are important in the psychology of aging. It starts by discussing definitions of older adulthood and some characteristics, as a whole, of older adults. It then reviews the data on the projected increase in older adults in the United States and internationally. The chapter discusses the importance of birth cohort and continues to be an important theme throughout this book. Specifically, it reviews characteristics of the Baby Boom generation since most of the current generation of older adults were born in that era. Erik Erikson and Paul Baltes are two researchers who have made substantial contributions to the development of aging studies. The chapter then reviews development of the professional field and training resources that are available to students and professionals, and ends with a discussion of research methods that attempt to untangle the effects of age, cohort, and time of measurement.
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 discusses several topics relevant to older adults' mental health including access and use of mental health services, prevalence of common mental health diagnoses, assessment of mental health symptoms, and empirically supported treatments for older adults. Although some topics presented in this chapter need additional research focused specifically on an older adult population, several conclusions can be drawn from the material. First, several studies have documented that older adults use mental health services less frequently than other age groups, although it is unclear why this is the case and likely involves a combination of barriers/access to treatment and stigma. Second, several of the mental health problems discussed may present differently among older adults, such as the specific symptoms of depression that older adults endorse. Third, assessment instruments for older adults need to be selected cautiously to ensure that adequate validity and reliability has been established for this population.
Health professionals are often called upon to intervene in complex ethical dilemmas that involve respecting an older adult's autonomy while also considering protective interventions to ensure safety. This chapter addresses the foundational ethical competencies for psychologists and geropsychologists including the unique challenges associated with surrogate decision making, legal, clinical, and psychosocial interventions specific to working with vulnerable older adults, ethical dilemmas that can emerge within various situations including assessment and integrated care settings, detection and intervention strategies in cases of elder abuse, neglect, and exploitation, and ethical approaches to research with older adults. Finally, the authors discuss the multicultural dimensions that influence how ethical and legal issues are conceptualized and addressed. The micro-and macrosystems in which older adults live and thrive require a level of cultural sensitivity, an understanding of aging processes, and knowledge about professional ethics and legal standards involved in decision making.
This chapter aims to discuss the cohort effects, health disparities and cultural stressors, and factors contributing to the resiliency and growth of ethnic, sexual, and gender minority older adults. Being part historian, student, and investigator can help clarify how these multifaceted aspects of identity affect the experiences of older adults in your personal and professional lives. The intersectionality of these factors makes for complex, inspiring, and sometimes distressing stories about overcoming adversity, achieving new heights, and at times sitting with the pain and frustration of discrimination and prejudice. The diversity within older adult populations also affords invaluable research opportunities to improve our knowledge of aging and enhance our provision of care. Moreover, developing a greater appreciation for older adults, including their strengths and hard-fought battles, can help us appreciate the privileges and civil rights we often take for granted.
Cognitive decline that is significant enough to interfere with independent living is known as dementia, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) introduced the term major neurocognitive disorder to refer to this condition. This chapter reviews the most common causes of neurocognitive disorders in older adults. It begins with a discussion of delirium, which should be ruled out whenever an older adult is showing signs of cognitive decline. Next, it presents an overview of the current diagnostic terminology, including mild cognitive impairment (MCI), dementia, and the DSM-5 diagnoses of mild neurocognitive disorder and major neurocognitive disorder. The chapter next reviews traumatic brain injuries (TBIs), Alzheimer's disease, Lewy body disease, Parkinson's disease, vascular disease, frontotemporal degeneration, which includes a behavioral variant and a language variant, and alcohol-related dementia.
This chapter reviews age-related changes in personality and emotional functioning. There are several theoretical approaches to studying personality, and most of them have examined the extent to which the theory applies to older adults. For example, Joan Erikson's proposal of a ninth stage of psychosocial development, as well as ways in which attachment processes may be important in late life, and ways in which coping strategies change with age, all represent the application of existing theories to later life. The chapter focuses on emotional functioning in late life. Overall happiness and life satisfaction tends to increase with age. Older adults also show more effective strategies for regulating emotions, including situation selection and attentional deployment toward more positive features of the situation. Some of these changes can be accounted for through two theoretical models: socioemotional selectivity theory and the strength and vulnerability integration (SAVI) model.
This chapter presents a broad and general overview of the structural and physiological changes that occur with aging as well as the underlying pathophysiology of age-related diseases. The body comprises eleven organ systems that include the integumentary, muscular, skeletal, nervous, circulatory, lymphatic, respiratory, endocrine, urinary/excretory, reproductive, and digestive systems. As such, the ensuing sections are arranged by organ system and structured to cover age-related physiological changes and common disorders. Older adults experience a myriad of physiological changes as they age. While some of these physiological changes are benign, other changes increase the risk of age-associated pathophysiological changes, which can result in significant functional impairment or morbidity. These pathophysiological changes are not to be considered part of the normative aging process. Thus, it is essential that providers distinguish between the two states.
Interacting with persons with progressive declines in cognitive function poses a wide range of challenges, not only for families and care providers, but for the person with dementia as well. This chapter briefly discusses two activities that offer participants opportunities to develop and apply positive approaches to interacting with persons with dementia. In Activity 1, Dementia Communication and Empathy, participants are asked to role play scenarios where persons with dementia endeavor to communicate with their caregiver. Insight and increased empathy are promoted through the challenges participants' experience, not only in understanding the message being communicated, but also the challenges of conveying even a simple message while impaired by physical and/or cognitive limitations. Activity 2, Enhancing Students' Therapeutic Interaction Skills with Older Adults with Dementia, brings participants into the community to interact directly with persons with dementia.
This chapter briefly discusses health care and health care education exercises that provide students the opportunity to engage with various aspects of the health care system and for future health care professionals to engage with elders to minimize potential ageist attitudes. The health care education exercises are: (1) An Evidence-Based Team Approach: Benefits of a Gerontological Interdisciplinary Team, (2) Bingocize®: An Intergenerational Service- Learning Initiative to Improve Older Adults' Functional Fitness While Engaging Undergraduate Students and the Community, (3) Medical Students Community Engagement, and (4) What Would You Do? Getting Resources for Your Older Adult. Activity 1 helps to encourage nursing students and other future health care workers to interact with other disciplines in order to provide the best possible care for older adults and their families. Activity 2 encourages students to interact with older adults through exercise programs.
It is vital that those who will interact with older adults in professional and health settings be well prepared to understand the variability of people's aging experiences. In teaching about physical aging, therefore, it is important to balance providing students with an understanding and empathy for the physical challenges some older adults might face with the important caveat that not all older adults are in poor health, nor do the stereotypical notions of physical aging happen to all, or even most, older adults. This chapter briefly discusses the housing education activities that offer the opportunity to provide such balance to students. The housing education activities are (1) How it Feels to be Old, (2) Hands on Experience with the Americans with Disabilities Act (ADA), (3) Hearing Aids and Pizza, and (4) Thinking Critically about Autonomy and Dependency in Aging.
Our ideas about spirituality and our connection to others, the universe, and the world around us vary over time, and, because spirituality is tied to the search for meaning, it becomes an interesting platform for gerontologists and their work with older adults. The two activities in this chapter bring both breadth and depth to the issue of spirituality in the context of end-of-life issues and, specifically, a direct assessment that connects students to their own selves and older adults. In Activity 1, Spiritual Assessment, Beran brings to the classroom a tool that allows students to reflect on their own spirituality and then compare that to an understanding of the broad concept of spirituality. In Activity 2, Exploring Cultural Death Practices Through Group Presentations, Claver and Goeller provide an opportunity for students to become more engaged in considering death and dying and later life in a cultural context.
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".
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.
Digital tools are becoming an integral part of the health care system. This chapter explores the functionality necessary to promote older adults’ engagement with digital health tools, health behavior concepts that may be used to promote adoption, and suggests interventions to promote usage. The primary focus is on addressing factors that are within the practitioner’s ability to influence, such as digital health tool user education and proper selection of technology, while recognizing that some barriers to adoption, such as lack of high-speed Internet connections in rural areas, will require federal, state, and local community involvement. In addition, the chapter explores practical considerations when deploying technologies to diverse groups of older users and their caregivers. Finally, it examines methods in which providers may seek reimbursement for digital health services within their practices.
This chapter enhances the understanding of the multifaceted challenges that individuals, especially older adults, seeking housing with a criminal background face. It reviews the ways in which individuals, especially older adults, can be vulnerable in terms of safety and security in their housing settings. Older adults may be particularly concerned about security and safety at home because their homes have been shown to be places where they can be victimized, either by telephone scams, door-to-door solicitation, bullying in age-congregate settings, and witnessing other crimes occurring in their residences. The chapter discusses ways in which forensic practitioners can support vulnerable populations, including older adults. It also discusses the complexities of affordable and safe housing using case examples and descriptions focusing on the older adult population. The chapter provides further recommendations on other areas of assessment and intervention that forensic social workers can conduct.
- Go to article: Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.
Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
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 focuses on using humanistic sandtray as a structured play therapy intervention with clients aged 9 years and older. Humanistic sandtray therapy is a type of play therapy that can be used with clients of many ages, from preadolescents to older adults. This approach to sandtray emphasizes the primacy of the therapeutic relationship and views the relationship as the curative factor in therapy. In sandtray, therapists and clients benefit from the symbolic nature of the experience because it increases safety and provides clients with a metaphorical and indirect mode of expression. The chapter illustrates the case example to help clients go deeper into their inner experiencing and awareness so that they might move in the direction of becoming a more fully functioning person. Fully functioning people are moving in the direction of increasingly trusting their inner experiencing and becoming open to a wide range of emotions.
This chapter combines the increasing number of studies that pertain to the stereotype embodiment theory (SET) and reflects upon to represent the current state of this theoretical perspective and how it can help explain age stereotypes’ contributions to health and aging. It describes the history, cultural context, and nature of age stereotypes and age self-stereotypes in a largely ageist society. The chapter presents SET, which provides a framework for explaining how age stereotypes are acquired to subsequently influence health outcomes. It discusses replication studies conducted in different countries, as well as meta-analyses, to demonstrate the validity of this theory as well as to illustrate the meaning and impact of its components. The chapter illustrates how SET may be applied to shape future healthy aging research, policy, and practice. Empirical evidence supports the importance of age stereotype self-relevance among older adults.
Scholars studying social connectedness draw on the sociological theory of social capital. In recent years, social scientists have proposed theoretical and conceptual models to explore the role of social connectedness in the specific context of aging. Recent data on the social networks of older adults paint a rich picture of the individual, or egocentric, social networks of the elderly community-dwelling population. This chapter discusses the theory of social capital, and explores the main effects and stress-buffering models of social connectedness and health. Although social capital theory has effectively guided empirical research, new ideas and concepts in aging research are generating interest among scholars, and are taking the field in innovative directions. A series of studies based on the Veterans Affairs Normative Aging Study (NAS), an ongoing study of aging established in 1963, documents a relationship between air pollution and various health conditions such as increased blood pressure and inflammation.
- Go to chapter: Theories That Guide Consumer-Directed/Person-Centered Initiatives in Policy and Practice
This chapter explores a paradigm shift in policy and practice related to the delivery of services and supports to older adults or adults of any age with disabilities-the growth of person-centered (PC) and participant-directed (PD) practice initiatives. It discusses new theoretical approaches, particularly the Consumer-Directed Theory of Empowerment (CDTE), which are salient to explaining the growth and impact of PC and PD initiatives as an evolving practice model that represents a paradigm shift from past approaches to working with older adults and persons with disabilities. Research is needed on recent practice and policy changes that have implications for the continued development and examination of theories that support PC and PD care. With both the aging and the increasing diversity of the US population combined with federal policy initiatives related to LTSS, the demand for PC and PD initiatives will continue to grow.
This chapter includes a discussion of the practice-oriented framework for service use delineated by Yeatts, Crow, and Folts and the caregiver identity theory articulated by Montgomery and Kosloski. Throughout history, family members, most often women, have been the primary providers of care for individuals, young and old, who are in need of assistance. What has occurred in the past century is significant growth in the number of family members who are providing care and expansion of the responsibilities that these family caregivers now assume. The steady expansion of family caregiving has been mirrored by the steady expansion of research focused on caregivers and interventions to support them. The behavioral model of services utilization has been used to study the use of a wide range of health services by older adults and caregivers.
This chapter discusses prominent theoretical models that link age-related changes in emotional processes with changes in cognition. It also discusses the dynamic integration theory (DIT), which outline how older adults may optimize emotional experience to compensate for reduced affective complexity resulting from declines in fluid cognitive processing. The chapter evaluates the current evidence for and the potential contributions of these theories. It introduces neuroscientific perspectives and reviews how these perspectives interpret age-associated changes in the brain in terms of cognitive-emotional processing. Aging Brain model (ABM) and DIT, therefore, provide more neurologically based explanations for age-related changes in emotional processing, whereas socioemotional selectivity theory (SST) postulates motivation as the cause of such changes. Another theory that might be relevant to the aging literature is the arousal competition biased theory, which posits that the affective state of the perceiver may also play a role in the salience of information.
Health promotion efforts will play a powerful role as we work to enhance function and reduce morbidity by intervening on modifiable risk factors such as physical activity (PA), inactivity, social engagement, and nutrition. This chapter examines the state of the art of theoretical foundations for health behavior change that are used to design and implement health promotion programs for older adults. The principles of social cognitive theory (SCT) have been used frequently in health behavior interventions. The chapter uses the ecological model as a guide to describe the level(s) targeted by each theory. It presents the most prominent multilevel approach, the social-ecological model. Recently, there has been a push toward broader ways of thinking about behavior change using structural approaches that target all levels of the social-ecological model. The chapter presents theories targeted at each level and argues for the use of multilevel interventions whenever possible.
This chapter begins with analysis of life-span development and life-course perspectives as applied to research on older adults and their families. It examines theories that are useful for guiding such research, thus yielding broader and deeper understanding of the ways older adults and their relatives negotiate family roles, responsibilities, and interactions in the context of both traditional and pluralistic family configurations. The chapter also examines the promise and problems associated with two key theoretical approaches that have been particularly effective in guiding family gerontology research in recent years, intergenerational solidarity and conflict, and intergenerational ambivalence. These approaches are strong in their own right and have the further advantage of linking well with life-span development and life-course perspectives. The chapter focuses on their theoretical tenets and principles, empirical applications, and strengths and limitations, with a critical assessment throughout. It considers theoretical and empirical directions for future research in family gerontology.
- Go to chapter: Theories of Help-Seeking Behavior: Understanding Community Service Use by Older Adults
This chapter focuses on the prominent psychosocial theories and models used to predict service utilization. It begins with a discussion of Andersen’s Behavioral Model of Health Services, the most commonly used framework for predicting formal service use among older adults. The need-use gap has been documented in use of mental health services, home and community-based services (HCBS) among non-Whites, among caregivers of older adults, and in the use of adult day care, respite care, personal care, meals, and transportation services. The chapter focuses on help-seeking behavior models that were not necessarily developed for or frequently used with older populations, but have the potential for enhancing the study of service use in late life. Developing new theories and further elaborating and testing existing models are essential for unraveling the use-need paradox and helping reduce the barriers to programs and services that, when accessed, can contribute to increased well-being of older adults.
- Go to chapter: Special Populations: Medication Use in Children and Adolescents, Older Adults, and Women and Pregnancy
Special Populations: Medication Use in Children and Adolescents, Older Adults, and Women and Pregnancy
This chapter focuses on the unique characteristics presented by three special populations that frequently receive psychotropic medications–children and adolescents, older adults, and women who are pregnant or plan to become pregnant. It is intended to sensitize social work practitioners to the unique considerations frequently encountered with these populations and to highlight the importance of combining medication therapy with counseling when addressing the mental health needs of these special populations. The chapter also provides a sampling of some Diagnostic and Statistical Manual for Mental Disorders (5th ed.; DSM-5) diagnoses frequently identified in children and highlights the medications commonly used to treat the mental disorders. Assessing and determining the medications to use to assist children and adolescents suffering from a mental disorder is never easy. Two conditions that present a particular challenge for prescribers and other members of the collaborative team are attention deficit hyperactivity disorder (ADHD) and conduct-related disorders.
Psychologists work with micro-level and macro-level orientations. Clinical psychologists with a micro-level orientation focus on individuals, families, and small groups when performing psychotherapy. Community psychologists have a macro-level orientation. The aging population presents many opportunities for psychologists, both those engaged in scholarship and those working clinically with older adults, and for community psychologists addressing issues relating to social structures and organized communities of older adults, economic issues such as poverty and access to medical services, and issues relating to senior housing. Contemporary theory indicates that it is equally important for psychologists working with older adults to focus on the positive aspects of aging when addressing the psychopathological problems older adults are experiencing. Erikson’s stage theory originally had seven stages: basic trust versus basic mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus role confusion; intimacy versus isolation; and generativity versus stagnation.
The medical model of psychopathology currently guides psychiatrists and many psychologists who are treating older adults experiencing psychological problems. Use of this model causes contradictions and distortions for the treating clinician and limits the effectiveness of treatment for older adults experiencing psychological problems. There are three areas of concern that illustrate these contradictions and distortions. The first area of concern is the fact that only two classes of psychiatric diagnoses meet the characteristics of a disease. The second area of concern is how the current use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continues a tradition among psychiatry, managed-care companies, and insurance companies that puts pressure on psychiatrists, psychologists, hospitals, and psychiatric rehabilitation facilities to treat in the most cost-effective and short-term manner. The third area of concern is the relationship that has occurred between psychiatry and pharmaceutical marketing forces.
This book offers chapters with case vignettes in which creative career interventions are applied. Each of these chapters provides a thorough exploration of the career-related challenges and needs of each unique group. The book provides an overview of the unique needs of several populations including high school and community college students; dual-career couples; stay-at-home mothers; working parents; midlife and older adults; caregivers; unwed and teen mothers; formerly incarcerated individuals; lesbian, gay, bisexual, and transgender (LGBT) individuals; veterans; culturally diverse men and women such as African American, Asian American and Latino persons; and other populations. Each population chapter opens with a case vignette in which a client’s story is presented for readers to consider. These cases highlight the diverse array of career and lifestyle-related concerns that clients may bring to counseling. The vignettes are revisited at the close of the chapter to illustrate potential ways of helping clients resolve their concerns. The book contains more than 50 innovative career interventions that are located at the end of the book. These interventions can help one to have greater insight into how creativity can be used when working with clients facing career changes and challenges.
This chapter discusses the historical overview of older adults, challenges faced by older workers and the future trends. It opens with a case study of a 65 years old man who is a former high school coach and history teacher. People are delaying retirement and working longer for a number of reasons including such factors as significant changes in Social Security. An employer’s perception of older adults as lacking flexibility in adapting to changes or learning new job tasks and skills can contribute to older adults being overlooked for promotions and advancement. Ageism is still a significant negative force in the work world and is visible in hiring practices, promotion decisions, and terminations. Discrimination in the workplace can impact an individual’s physical and emotional health. The perception that other employees have regarding older adults can create issues that contribute to discrimination in a workplace setting.
The heightened awareness of coming of death, and the anticipation of dying, results in many older adults experiencing an existential crisis. For some older adults approaching or in the age bracket of 75 to 84 years of age, the expectation of death becomes acute and triggers a need for end-of-life planning, also referred to as advance care planning. Palliative care is considered a good death because it keeps an older adult comfortable, provides counseling, and is a means to control pain that a dying older adult would otherwise experience. There is a significant need for psychologists to provide counseling to older adults experiencing disenfranchised grief because adults experiencing this type of grief suffer from difficulty experiencing their loss when it is not validated by others. Euthanasia is accomplished by an older adult’s request to his or her physician based on the intention of ending pain and suffering when terminally ill.
The importance of the field of geropsychology (psychology of aging) is seen in the ever-increasing demographics of older adults. A psychologist needs to understand the various life stages that define different cohorts of older adults. Older adults are affected by the forces of stigma and ageism, which are of four types: personal, institutional, intentional, and unintentional. A majority of older adults experience age discrimination and stigmatization after the age of 65. The use of medical model of psychopathology causes contradictions and distortions, one of which is the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Assessment of deficits in olfactory functioning are potentially useful for a psychologist who is attempting to differentiate between cognitive disturbances of normal aging and mild cognitive impairment (MCI). Sexual interest remains high throughout old adult developmental stages, but sexual activity declines in most men as they age. While older adults are more likely to avoid illicit substances, many older adults having chronic pain from cancer or arthritis need opioid medications. Older adult abuse is a multifactorial phenomenon as the abuse may be emotional, financial, physical, sexual, or self-induced. Environmental geropsychology is based on Lewin’s field theory model Lawton and Nahemow’s ecological model, and an environmental geropsychologist focuses on the environmental component to develop interventions to change older adults’ interpersonal and intrapersonal experiences. Heightened awareness of coming of death results in an existential crisis for many older adults causing a loss of their sense of purpose for their lives.
This chapter talks about psychoactive substances that are commonly misused or abused by older adults. It is important for a psychologist to understand the psychopharmacological dynamics of each substance, how they are administered by an older adult, the symptoms of intoxication and withdrawal, and the psychosocial consequences experienced by the older adult misusing or abusing psychoactive substances. Unlike younger adults, older adults are more likely to avoid illicit substances such as cocaine, heroin, methamphetamine, psychedelics such as lysergic acid diethylamide (LSD) or mescaline, and designer drugs. Historically, the psychoactive substance of choice was alcohol. There are two general types of opioid psychoactive substances: naturally occurring opioids and synthetic opioids. Naturally occurring opioids include opium and its derivatives morphine and codeine, and heroin, which is a chemical manipulation of morphine. Unfortunately, many older adults suffer with chronic pain from cancer, arthritis, or injuries, causing a need for opioid medications.
A psychologist must confront many prejudices against older adults that are manifested in most people in non-older adult cohorts. Clinical psychologists specializing in geropsychology work with individual older adults; family members of older adults, including spouses/partners, siblings, and adult children; and caregivers when treating the psychological problems experienced by older adults and dealing with issues of caregiving to older adults experiencing mental illness, dementia, and/or psychological reactions to co-occurring medical illnesses. Unfortunately, despite the fact that older adults are affected by the forces of ageism and stigma, and the fact that community psychologists strive to understand and improve social inequalities and to enable empowerment of marginalized people, there is a significant dearth of research in the field of community psychology. There are four types of ageism: personal, institutional, intentional, and unintentional. The majority of older adults have experienced age discrimination and stigmatization at some time after the age of 65.
As with most issues with media psychology, the travails of social media involve separating the hype from the truth. One of the curious things about social media is that, unlike some other previous forms of feared media such as rock music, rap, comic books, or video games, social media has been relatively effectively embraced even by older generations. This chapter discusses two corollaries regarding the duration and intensity of moral panics surrounding new technology and media. First, the degree and intensity of moral panics can be predicted by the degree to which they tap into existing moral concerns, such as sex, violence, or privacy. Second, the degree and intensity of moral panics are mitigated by the extent to which older adults embrace the new technology. As with many issues of digital privacy, it is one social media and Internet users will wish to consider carefully before they leap.Source:
Primary care providers (PCPs) often assess for complex needs and refer to specialty geriatric clinics focused on the unique needs of older adults. Being familiar with the components of a geriatric assessment is important for providers working in primary care as is familiarity with available community resources. The presence of behavioral health providers in primary care settings often helps bridge this gap, raising the likelihood of patients receiving a thorough geriatric assessment, referral, and follow-up as part of an integrated care plan. Facilitating effective referrals and coordinating services for geriatric patients is one of the primary interventions available to behavioral health specialists (BHSs) in primary care settings. Geriatric assessments require that the BHS remember that patients have autonomy. Geriatric depression is frequently comorbid with anxiety and often complicated further by the presence of comorbid physical illness or cognitive impairment that may limit pharmacological treatments and interfere with recommended behavioral interventions.
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.
- Go to article: The Lived Experience of Community-Dwelling Older Adults With Chronic Obstructive Pulmonary Disease (COPD) in a Rural Community in Northern Thailand
The Lived Experience of Community-Dwelling Older Adults With Chronic Obstructive Pulmonary Disease (COPD) in a Rural Community in Northern Thailand
The purpose of this study was to describe the experience of community-dwelling older adults living with chronic obstructive pulmonary disease (COPD) in a rural community in Northern Thailand. The study was grounded in Parker and Barry’s model of community nursing practice model based on the concepts and values of respect, persons in their wholeness, and caring in nursing. Data were generated and analyzed using Giorgi’s phenomenological approach. Four themes were revealed: confronting a life-threatening illness, caring for self, keeping meaningful relationships, and living guided by spiritual beliefs. The meaning of the experience was synthesized as finding balance between living with a threatening illness and living meaningful lives.
Policies that promote social ties, social networks, activities, and the involvement of older adults in communities would simultaneously combat isolation and age discrimination and benefit society as a whole. Discrimination marginalizes and disenfranchises older adults, and in doing so treats them as a problem to be solved rather than as equal members of the community who are entitled to the same basic human rights. Social Security is the primary source of income for most older Americans and is particularly important for minorities, older women, and those who have had lifetimes of low earnings. Continuing care communities and assisted-living facilities which could enable many to remain in the community are unaffordable for the majority of older adults. The Medicare program continues to focus on acute rather than chronic care and thus fails to address the health care needs of many older adults.
The issues evoked by an aging world pose new challenges with regard to employment, health, retirement, families, and the economy. Societies respond to these challenges in varying ways and these responses can be subsumed under the rubric of social policies. Human rights apply to everyone; they do not diminish with age. This book discusses many of the key issues and concerns confronting older adults in the United States and the policies formulated to deal with them. The ways in which these policies reflect human rights is key in each chapter. The first chapter presents the background on social policy and human rights and how they pertain to and impact older adults. The second chapter focuses on the Older Americans Act (OAA), the foundation of aging policy in the United States, as well as on the federal government involvement by discussing the White Housing conferences on aging. While the third chapter addresses economic supports for older adults, the fourth chapter examines policies associated with liberty and security. The fifth and sixth chapters discuss physical and mental health, and focus on employment and the workplace. This is followed by a discussion on the social policy and the family and by examining how policy relates to vulnerable populations of older adults. The penultimate chapter of the book explores the ways in which various countries are developing policies for their older population and how these reflect human rights. The last chapter looks at the future policy challenges that must be met in order to ensure that rights of older adults are addressed.
- Go to chapter: The Framework for Federal Involvement: The White House Conference on Aging and the Older Americans Act
The Framework for Federal Involvement: The White House Conference on Aging and the Older Americans Act
The Older Americans Act (OAA) passed in 1965 provides a foundation for such involvement through its original mandate to serve all older Americans through a plethora of services and supports designed to help maintain the independence, security, and well-being of older adults. In 1958, legislation was introduced that asked for a White House Conference on Aging, which would bring together persons from all parts of the country to make policy recommendations that would focus on the economic security of older persons. Indicators show that it has been helping homebound elderly at risk of nursing home placement to stay at home, and it has continued to build the capacity of state agencies and Area Agencies on Aging (AAAs) to implement comprehensive systems of care. To improve its performance, the Administration on Aging (AOA) is focusing on improving efficiency, improving client outcomes, and further targeting services offered to the vulnerable elderly.
The right to life, liberty, and security is most profoundly challenged by guardianship, which is a procedure that can severely constrict the older adult’s ability to act on his or her own and according to that individual’s own wishes. The Uniform Adult Guardianship and Protected Proceedings Jurisdiction Act (UAGPPJA) of 2007 attempts to improve the guardianship process by making it more uniform across states, and it is particularly important when a guardianship involves several states. The costs of programs such as continuing care, assisted living, and the village model remain too expensive for the majority of older Americans and federal assistance through subsidies is very limited. Transportation is a critical service necessary for many older adults to remain in the community. Efforts are being made to develop appropriate accessible transportation for older adults and those with disabilities.
The rights to health and health care in the event of illness, disability, or old age are detailed in Article 25 of the Universal Declaration of Human Rights (UNDHR). These rights are fundamental to the well-being of older adults as their needs for medical care increase with age. As episodes of acute illness decline, chronic conditions increase with age, impacting both individuals and society. Chronic conditions such as arthritis and heart disease permeate many areas of a person’s life, often increasing demands for an array of support. Medicare was developed in the 1960s to address the needs of the aging population with regard to health care. Medicaid, Title XIX, under the Social Security Act was passed in 1965 to provide health care for those below the poverty line. Consumer-directed care programs have the older person responsible for hiring the care provider and determining the services he or she wants.
Vulnerability places older adults at grave risk of having many of their human rights violated. These are persons who have faced discrimination throughout their lives, and if they become dependent with age they are bound to face increasing inequalities. Vulnerability itself can be a precursor to the most extreme violation of human rights, elder abuse. The inequality that women face throughout their life span makes them particularly vulnerable to having rights ignored in their later years. In addition to being more likely to be living alone, older women are nearly twice as likely as older men to be poor. Long-term care is a significant burden for older women, as they are more likely than men to be both caregivers and care receivers. Medicare plays an important role in the lives of older women who comprise more than half of all beneficiaries.
Social policy is enacted to address social problems and inequalities in society. Policy involves choices concerning benefits, allocations, and the sectors that are involved in the allocations. It also includes decisions about the institutions that are responsible for addressing specific concerns and problems. Values are important influences on policy, with three of the most prominent being equality, equity, and adequacy. As such, social policy based upon a human rights framework would provide every individual with guarantees for having needs met in a just society that recognizes such needs as fundamental to addressing human rights. A rights-based framework for understanding policy focuses on how rights are emphasized rather than on how human needs are met. Policies that focus on older adults often emphasize traditional values, such as beneficence and paternalism, that can actually undermine their status and human rights.
This chapter discusses some countries and their policies to highlight the ways in which older adults are impacting society. Each of the countries discussed has developed policies to meet the needs of their older citizens with varying recognition and emphasis on their human rights. The policies of each reflect underlying sociocultural and economic factors and the ways in which aging and the aged are perceived in their society. Meeting the economic challenge of an older population along with changes in family structures requires planning and policies in several areas. Pensions, accessible health care, family assistance, housing and community services, and formal support programs that can assist older adults in their homes are among the areas where reforms are most needed. Specialists and long-term care facilities are rare, and there is a noticeable absence of mental health services in most countries.
The field of counseling is an exciting and challenging career choice. It is a profession that has a prolific history of enabling person-centered counseling approaches for individuals, couples, partners, and families, and facilitates therapeutic services for children, adolescents, adults, and older adults. This book offers an excellent resource for graduate-level coursework that relates to an orientation to the counseling profession, professional issues, and special topic seminars, as well as other counseling-related coursework. It provides both contemporary insight and practical strategies for working with the complexity of real-life issues related to assessment, diagnosis, and treatment of diverse clients and their families. The book provides professionals with chapters organized into the 10 CACREP and CORE content areas that address the awareness, knowledge, and skills required to work with children, adolescents, individuals, groups, couples, families, and persons from diverse cultural backgrounds. The content areas are: professional counseling identity, ethical and practice management issues, case management and consultation issues, multicultural counseling awareness, counseling theories and techniques, career counseling and human growth, assessment and diagnosis, counseling couples, families, and groups, counseling specific populations, and contemporary issues in counseling.
This chapter discusses the major mental health disorders experienced by older adults, identifies the most effective counseling approaches and psychotropic medications used to address the mental health needs of older adults, and provides an overview of best practice counseling and treatment interventions used to address the mental health needs of older adults. In an overview of the literature regarding major depression and dysthymia, Zalaquett and Stens examined the effectiveness of four commonly used individual therapies for treating older adult depression: cognitive behavior therapy (CBT), interpersonal therapy (IPT), brief dynamic therapy (BDT), and reminiscence therapy (RT) and life review (LR) therapy. Counselors can develop brief checklists to assist clients in tracking their symptoms. Counselors should also educate themselves about the signs of excessive alcohol and substance abuse, noting that some medical conditions may have similar symptoms to drug or alcohol abuse.
Old age brings with it unique challenges in diagnosis, treatment, and care; dementia complicates these issues even more. Improving the management and care of persons with dementia has positive implications for patients, caregivers, and physicians alike. Two types of secondary complications can be analyzed in relation to dementia: conditions that arise outside of the dementia and then conditions that appear to develop due to the neurological degeneration inherent in dementia. Examples of psychiatric complications include depression, anxiety, and psychosis. Medical problems consist of issues such as stroke, cardiovascular problems, cancer, infections, orthopedic issues, diabetes, nutritional disorders, vision and hearing problems, as well as general pain. The high comorbidity of dementias with other psychiatric and medical issues can complicate the diagnosis and treatment of patients with dementia. Issues in the central nervous system (CNS) have long been looked at as possible predictors of dementia.