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.

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

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 PST has increased over the past decade, so more reviews has been conducted. The chapter discusses PST for various mental and physical health problems and depression. Following this it also discusses PST in primary care and among older adults. It briefly describes PST for diabetes self-management and control; vision-impaired adults and social problem-solving therapy in school settings. The chapter describes PST as a transdiagnostic approach. It briefs the listing of PST investigations 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.

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.

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.

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.

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.

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 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.