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 reviews biodemographic theories of aging that attempt to answer the proverbial ‘why’ and ‘how’ questions in gerontology. Biodemography of aging represents an area of research that integrates demographic and biological theory and methods and provides innovative tools for studies of aging and longevity. The historical development of the biodemography of aging is closely interwoven with the historical development of statistics, demography, and even the technical aspects of life insurance. The chapter also reviews some applications of reliability theory to the problem of biological aging. Reliability theory of aging provides theoretical arguments explaining the importance of early-life conditions in later-life health outcomes. Moreover, reliability theory helps evolutionary theories explain how the age of onset of diseases caused by deleterious mutations could be postponed to later ages during the evolution this could be easily achieved by simple increase in the initial redundancy levels.
This chapter describes the interpretive perspective in all its richness and variability in guiding research and advancing understanding of a wide range of phenomena in aging and life-course research. It discusses the interpretive perspective with other variants of social science theorizing, particularly normative perspectives on aging and life course-placing its development in historical context. The chapter addresses the contentious issue of causal explanation, as understood in diverse disciplinary contexts. It highlights some prominent normative theoretical approaches in social gerontology, by way of providing a comparative context for our primary consideration of the interpretive perspective. A given theoretical perspective in gerontology can focus solely on macro level, structural phenomena, on micro-level behavior and social interaction, or on understanding of the links between macro and micro phenomena.
This chapter traces the development of concepts and theories in the sociology of aging from the 1940s through the mid-1970s through seven themes. The first theme describes the importance of age in social structure and the place of the aged in changing societies. The second theme focuses on the issue of ‘successful aging’: how to define, measure, and achieve it. The third theme highlights the tension between social structure and individual agency in the activity versus disengagement theory controversy. The fourth theme concerns the social meanings of age, age cohorts, and generations, as well as interactions between age groups. The fifth theme focuses on families, aging, and intergenerational relations. The sixth theme of age stratification deals with the interplay between cohort succession and the aging of individuals. The seventh theme addresses the life course as a socially constructed process.
There can be little doubt that older people have today assumed a special place in the American social policy and political landscape. They constitute a large and growing population, they are increasingly well organized, and they are the recipients of public benefits that are the envy of every other social policy constituency in the nation. This chapter reviews and assesses different theoretical approaches that may help account in all or in part for these fairly recent and remarkable developments. The organization here centers on six distinct theoretical avenues for better understanding these political and policy developments: the logic of industrialization and policy development, the role of political culture and values, the presence of working-class mobilization, the impact of individual and group participation, the weight of state structure, and the effects of policy in shaping subsequent events.
This chapter discusses the assessment and laboratory findings, imaging, diagnosis and management of ascites. A common complication of cirrhosis is ascites, or the accumulation of fluid in the abdominal cavity. Ascites that develops from cirrhosis is associated with portal hypertension. The patient with cirrhosis and ascites may complain of increased weight gain, lower extremity edema, and abdominal bloating or distension. Physical examination findings may reveal a distended or even tense abdomen, positive fluid wave, dullness to abdominal percussion, and peripheral edema. Routine laboratory testing, such as complete blood count, complete metabolic panel, and liver function testing, should be performed with new-onset ascites and at routine return visits. Patients with cirrhosis and ascites can develop electrolyte imbalances and renal failure. Ultrasound is helpful to determine whether ascites is present if there is any uncertainty upon physical examination. Patients should abstain from alcohol consumption and avoid using nonsteroidal anti-inflammatory drugs.
This chapter provides new data and a critical look at the comparative assessment of different ethnic groups’ overall levels of savings given their different experiences in the labor market. It focuses on how employers differentially treat minorities to their disadvantage with a multiple regression analysis that identifies the independent negative impact of being a minority on retirement sponsorship and pension plan participation. Minorities have lesser access to employer-sponsored retirement plans because they are particularly affected by the substitution of defined benefit (DB) plan coverage for less secure and less comprehensive defined contribution (DC) plans. Social Security is an important source of retirement income for all Americans. Minorities are disproportionately employed in lower-paid industries and occupations, which have lower rates of retirement account coverage. Qualitative research and interdisciplinary collaborative studies of minority retirement behavior have emerged.Source:
- Go to chapter: What Does Knowing About Genetics Contribute to Understanding the Health of Minority Elders?
This chapter discusses the identification of individual differences in health behaviors and health status among minorities. Sickle cell disease (SCD), a genetic disorder, may serve as an optimal model for understanding issues of aging in minority populations. SCD is an important model of multifactorial conceptualization of genetic-based chronic disease among aging populations. Generally, molecular genetic methodologies are called to mind when people consider the role of genetic factors in health and disease. Behavioral genetic methods will be particularly useful if one begins studying minorities from the perspective that there is significant heterogeneity within populations of minorities. Conceptual and methodological discussions of heterogeneity within minority populations are particularly timely given the changing sociodemographic features of ethnic/racial populations related to health disparities. Socioeconomic status and education have been found to be important variables associated with the development of chronic illness.Source:
Delirium, also known as acute confusional state, organic brain syndrome, brain failure, and encephalopathy, is a common occurrence among medical and surgical patients and causes extensive morbidity and mortality. This chapter provides an updated review of delirium, including pathophysiological correlates, clinical features, diagnostic considerations, and contemporary treatment options. The defining features of delirium include an acute change in mental status characterized by altered consciousness, cognition, and fluctuations. The chapter explores the risk factors for delirium. These can be divided into two categories: predisposing factors and precipitating factors. Imbalances in the synthesis, release, and degradation in gamma-aminobutyric acid (GABA), glutamate, acetylcholine, and the monoamines have also been hypothesized to have roles in delirium. GABA is the primary inhibitory neurotransmitter in the central nervous system (CNS) and medications such as benzodiazepines and propofol have known actions at GABA receptors and have been associated with delirium.