The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.
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For older adults, the phenomenon of death is accepted and does not induce the fear experienced by younger adults. Older adults who do not engage in end-of-life planning may receive unwanted, unnecessary, costly, and painful medical interventions or withdrawal of desired treatment. Many older people feel that the goal of palliative care is to make the best possible dying experience for the older adult and his/her family. In addition to palliative care, an older adult will most likely find himself or herself in an intensive care unit as part of his or her terminal care. Euthanasia, or hastened death, is seen by some as an alternative to palliative care. A psychological aspect of death that an older adult is concerned with, in addition to place of death, is whether he or she will die in his or her sleep or die suddenly, making the death experience an individual phenomenon.
This chapter focuses on informal caregiving among minority groups. It also focuses on context of caregiving and discuss the various specific challenges caregivers of minority older adults face. The chapter examines some of the specific caregiving interventions tailored for families of color and discuss the implications for practice, policy, and research. Medical advances and greater longevity point to healthier and longer lives for many, but both formal and informal caregiving remain a concern as individuals age and develop conditions that require care. Caregivers are often able to realize the positive aspects of caregiving when they are not struggling with financial or social support challenges. Despite the vast literature on caregiving in general, research pertaining to the needs and experiences of racial/ethnic minority older adults and their caregivers is limited, particularly for American Indians, Pacific Islanders, specific Asian American and Latino subgroups, and religious minorities groups such as Muslim Americans.
This chapter discusses current thinking in the field of social support and social relationships, and physical and mental health among older racial and ethnic minorities. Social relationships are an important predictor of health and psychological well-being across the life course. Many minority older adults will face the continued challenges of declining functional status due to physical and mental health conditions over the course of their lives. Most empirical studies on social support among older racial and ethnic minority adults explore the association between social support and both physical and mental health. The wealth of studies on social support among minority older adults has much to offer with respect to understanding the correlates of emotional support and patterns of assistance. The biological mechanisms explaining the link between social support and physical health outcomes have been largely unexplored among older racial and ethnic minority groups.
- Go to chapter: Informal Social Support Networks of African American, Latino, Asian American, and Native American Older Adults
Informal Social Support Networks of African American, Latino, Asian American, and Native American Older Adults
This chapter provides a selective review of research on social support among older African American, Hispanic, Asian American, and Native American adults. It focuses on social support as a dependent variable in relation to different sources and types of aid provided to older African American, Hispanic, Asian American, and Native American adults. The chapter highlights the findings in three specific areas: marriage and romantic relationships, extended family and non-kin as sources of informal social support, and black-white differences in informal social support. Informal social support networks are critical for individuals of all ages but especially for older adults who are dealing with difficult life circumstances. Older African Americans depend on informal social support networks of family and friends for assistance in emergency situations, as well as for help with various tasks of daily life. Elderly Asians often utilize kin and social support networks for a variety of reasons.
Improved nutritional status is an important component of efforts to improve the health of older adults, whose ability to consume a healthy diet is affected by comorbidities and behavioral, cognitive, and psychological factors. In addition to genetics and nutrition intake, nutritional status of the elderly could be affected by socioeconomic factors, such as education and income levels, and environmental factors, such as proximity to stores and transportation, that can affect food variety and availability. Nutrition and aging are connected inseparably because eating patterns affect progress of many chronic and degenerative diseases associated with aging. Anthropometric measurements are often used for nutritional assessment of older adults and are reliable across ethnicities. The Mini-Nutritional Assessment (MNA) tool was developed to evaluate the risk of malnutrition among frail older adults. Dietary patterns may better capture the multifaceted effects of diet on body composition than individual nutrients or foods.
- Go to chapter: Racial/Ethnic Minority Older Adults in Nursing Homes: Need for Culturally Competent Care
This chapter summarizes and discusses the findings of the predictors of nursing home admissions and the issues regarding access among four groups of racial/ethnic minority older adults: blacks/African Americans; Hispanics/Latinos; Asians/Pacific Islanders; and American Indians/Native Americans. It provides a summary of the need for providing culturally competent nursing home care and future directions for alleviating racial/ethnic disparities and segregation in nursing home care. Minority older adults were once disproportionately underrepresented among nursing home residents. With the demographic revolution among racial/ethnic minorities and older adults, the number of racial/ethnic minority nursing home residents will continue to increase. Improvement in the quality of nursing home care for racial/ethnic minorities also requires culturally competent care. In providing culturally competent nursing home care, nursing home administrators and staff should involve community representatives from faith/spiritual communities and from civic and cultural organizations in the facility’s planning, monitoring, and quality-improvement meetings.
Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.
Social work is an applied discipline with a long tradition of using the theories and methods of social sciences to enhance practice, policy, and research. In their professional roles, social workers practice work with minority older adults and their families in diverse community-based and institutional settings that encompass social and health services. The conduct of social work practitioners and researchers in working with human populations is guided by the Code of Ethics of the National Association of Social Workers. A more sustained and concerted effort is required to ensure that there is a sufficient supply of gerontologically trained social workers to meet the growing demands of a more aged and diverse society. Social work researchers and practitioners will need to be responsive to the impact of government social spending cuts on the availability and delivery of services to their elderly clients who are most in need.
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.
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.
Housing communities for older adults are not a contemporary concept. The guiding concept of creating older communities is the desire to give older adults an alternative concept of housing that will allow them to sustain themselves economically, while giving choice and an element of control over their health care, social networks, and physical environment. Many older adults choose retirement communities for an added sense of personal security and continued independent living as a beginning preparation for their ultimate mortality. Aging in place encompasses an older adult staying in his or her home throughout the aging cycle or moving to housing that provides limited services such as an option for communal dining, cleaning services, and transportation. Like aging-in-place strategies, continuing care and assisted living facilities provide medical and nonmedical living services to older adults who are unable to live independently because of medical illness, cognitive decline, or disability.
Medical problems challenge older adults’ abilities to cope with illness, and at times they experience co-occurring psychological disorders. Therefore, social workers must provide services to assist older adults who are experiencing acute or chronic medical conditions. Older adults experiencing arthritic pain often experience a co-occurring depression. The major cancers experienced by older adults are breast cancer; chronic lymphocytic leukemia; lymphocytic lymphoma; colorectal cancer; lung cancer; mouth, head, and neck cancers; multiple myeloma; prostate cancer; skin cancers; and vulvae cancer. Those older adults suffering from diabetes have a greater chance of co-occurring vascular and cardiovascular conditions and a greater rate of institutionalization and subsequent mortality. Coordination with family members and caregivers about self-care issues, medicine compliance, safety issues, health socialization, and exercise is important because social workers often overlook psychoeducation with medically ill clients.
- 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.
Stigma is the foundation that distorts the many social constructs affecting how social workers view older adults. Many socially constructed optics produced by stigma can bias social workers’ views of older people. It is important for a social worker to understand that race, ethnicity, and sexual orientation are social constructs that bias clinical care. Additionally, stigma associated with race, ethnicity, and sexual orientation produce psychosocial stressors that converge on older clients, which exacerbate their physical and psychological health statuses. The stigma of mental illness serves to increase the suffering of older people struggling with psychological problems while increasing the suffering of family members, loved ones, and caregivers who experience courtesy stigma. The stigma of suffering from mental illness may also prevent an older person from seeking treatment for his or her psychological problems. Older adults suffering from dementia also suffer from the negative reactions to them because of their diagnosis.
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.
Clinical gerontological social work practice with older adults is a rapidly growing field encompassing many practice venues. The social work mission with older adults encompasses micro practice, mezzo practice, and overriding macro policies affecting an older adult. Because of the increasing population of older adults, gerontological social work education must be expanded to meet the needs of this population. Collingwood, Emond, and Woodward (2008) propose a theoretical orientation that is adaptable to a social worker assisting older adults. The case of Georgina is an example of how a social worker must understand and implement knowledge of developmental stage theory, environmental influences, and resilience theory when working with an older adult in crisis. A social worker working with older adults must employ advocacy skills and provide concrete services, as well as psychotherapeutic interventions.
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.
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.
- 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.
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.
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 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.
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 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.
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.
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 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 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.
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.
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.
- 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.
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.
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.
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.
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.
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.
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.
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.
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.
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".
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.
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 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 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.
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.
When it comes to aging, medical conditions quickly become one of the most important issues facing people. As people grow older, they are more likely to have medical conditions that require attention and that can hinder their ability to perform the daily tasks of living. Improved medical care and prevention efforts have contributed to dramatic increases in life expectancy in the United States during the past century. They have also produced a major shift in the leading causes of death for all age groups, from acute illnesses and infectious diseases to chronic conditions and degenerative illnesses. This chapter describes medical conditions experienced by older adults and outlines the major features of continuing care retirement communities, assisted living communities, and nursing homes. It also highlights the difficulty many people face in paying for the long-term care they need and discusses the significant financial burden of long-term care.
There are positive and negative aspects of life at every age throughout the life span, and aging is no exception. This chapter presents a more balanced view of older adults’ mental health and cognitive abilities, one that moves away from the stereotypes. It focuses on mental health and cognitive abilities as people age, with a presentation of the many positive characteristics of older adults’ psychological and emotional well-being as well as difficulties some may face, such as depression and dementia. The chapter also describes how personality changes over the life span and how the creative arts can positively impact the lives of older adults. Finally, it discusses factors that can positively and negatively affect older adults’ mental and cognitive abilities. The Practical Application presented at the end of the chapter focuses on unique challenges faced by individuals currently around 80 and above due to mental health stereotypes and stigmas.