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 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.
- 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.
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.
This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.
- Go to chapter: Introduction: Psychology—Rising as a Discipline to Meet the Challenges of an Aging, Increasingly Diverse Society
Introduction: Psychology—Rising as a Discipline to Meet the Challenges of an Aging, Increasingly Diverse Society
This chapter presents an illustration of the complexities involved in studying ethnic and racial influences on psychosocial processes and how they are intimately tied to physical outcomes in later life. It focuses on psychology as a discipline, minority aging research during the last several decades has revealed the need for multidisciplinary and intersectional conceptual and research approaches. The chapter also focuses on the age, gender, socioeconomic, cultural, and racial and ethnic graded influences on life course development that eventuate in unequal burdens of psychological and physical health morbidity and mortality for certain groups in late life. No section on psychology could be complete without a discussion of religion and spirituality among racial and ethnic minorities. Generational processes are clearly implicated in ideas about the cyclical nature of poverty and health behaviors that are intricately linked with environmental factors and social influence.
This chapter examines the Older Americans Act (OAA) through the prism of the coming nexus of aging and ethnic/racial diversity. It explains that the OAA can serve as a foundation for building a home- and community-based set of services for all older adults and persons with disabilities and for addressing aging in the 2lst century. The OAA is the primary federal program providing a host of services that enable older persons and their families to live in their homes and communities with a measure of dignity and independence. The OAA, Administration on Aging (AOA), and aging network today provide five major categories of services: access to social and legal services, nutrition, home- and community-based long-term social and supportive services, disease prevention and health promotion, and vulnerable elder rights protections. The OAA and the AOA remain secondary players in national agenda setting for an aging population.
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.
- Go to chapter: Minority Aging Before Birth and Beyond: Life Span and Intergenerational Adaptation Through Positive Resources
Minority Aging Before Birth and Beyond: Life Span and Intergenerational Adaptation Through Positive Resources
This chapter presents an integrative approach to the psychological study of minority populations and the reduction of health disparities through positive nonmaterial resources. It provides a brief introduction to positive psychology and to the concept of early life origins of disease, highlighting the value of integrating these seemingly disparate literatures as a lens for studying health and broader aging processes among minority populations. Minority status whether based on ethnicity, gender, socioeconomic status (SES), citizenship, religion, or other factors is a robust determinant of health, well-being, and success across the life span and intergenerationally. Positive psychology is relevant to health and development particularly physiological and psychological adaptation to stress across the life span, and even across multiple generations among humans in general and among minority populations in particular. Health inequalities are the result of unique challenges to successful psychological and physiological adaptation faced by minority group members.
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.
Primary progressive aphasia (PPA) is the term applied to a clinical syndrome characterized by insidious progressive language impairment that is initially unaccompanied by other cognitive deficits. This chapter describes several variants of PPA and more than one etiology. It explains three main variants of PPA, namely, semantic Variant of PPA (svPPA), nonfluent/agrammatic variant of PPA (nfvPPA) and logopenic variant of PPA (lvPPA), and also describes criteria for their diagnoses. The defining symptom of PPA is the presence of a language impairment for at least 2 years in the absence of any other significant cognitive problem. Assessment of other cognitive domains is challenging because many tests of memory, attention, executive functioning, and visual-spatial skills rely on language processes in some manner. There are no drug therapies proven to arrest progression of signs and symptoms of PPA due to frontotemporal lobar dementia (FTLD) or Alzheimer’s disease (AD) pathologies.
This chapter examines racial and ethnic differences in disability in the United States with a focus on their patterns, trends, and determinants. Disability is responsible for massive social and economic costs to individuals, families, and health care systems. Racial and ethnic differences in health are one of the most widely studied topics in U.S. health disparities research. The risk of disability among older Asians is an understudied area, despite the growth of this population subgroup in recent years due to increased volume of immigration from Asia to the United States. There is an ongoing interest in measuring and understanding the patterns and causes of racial/ethnic differences in disability in the United States. Rising obesity may play an important role in the findings for Hispanic women and for the trend in disability for all race/ethnic groups.
Dementia is an umbrella term for conditions such as Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and frontotemporal dementia (FTD). Under that umbrella, FTD, also known as frontotemporal lobar degeneration (FTLD), can be further categorized to define a group of neurodegenerative disorders resulting from a progressive deterioration of the cells in the anterior temporal and/or frontal lobes of the brain. More specifically, ventromedial-frontopolar cortex is identified with metabolic impairment in FTD. This chapter elaborates on the history, epidemiology, pathophysiology, clinical features, treatment, and outcomes of FTD. The history and background section of each of the FTD categories highlights the evolution of the disease conceptualization. The FTD subtypes are conceptualized in three categories: neurobehavioral variant, motor variant, and language variant. The chapter illustrates the features of all three categories of FTD.
- Go to chapter: Structural and Cultural Issues in Long-Term Services and Supports for Minority Populations
This chapter examines the history of long-term services and supports (LTSS) programs to document their racially and ethnically disparate impact, and explain the current research on the access and quality of LTSS used by older adults in communities of color. LTSS are a set of health and social services delivered over a sustained period to people who have lost or never acquired some capacity for personal care. The high costs of LTSS have led a smaller number of low-income older adults to consume a large share of Medicaid expenditures. Cultural beliefs about family responsibility to care for older adults as well as attitudes toward the use of formal and/or public health and long-term care services can shape older adults’ use of LTSS. The coming sociodemographic shift of older minority adults calls attention to other structural and cultural issues that facilitate or inhibit the appropriate use of LTSS.
A growing body of research documents racial and ethnic disparities in physical and mental health among older Americans. This chapter discusses larger stress process literature and reviews research on discrimination as a source of stress that is an influential determinant of racial and ethnic differences in the health status of older Americans. It provides a brief overview of disparities in health among older Americans. The chapter discusses the biology of stress, elaborates on key elements of the general stress process framework, and highlights findings pertinent to the health of older minorities. It reviews the research on personally mediated discrimination and health that includes findings from both age-diverse samples and those specific to older adults. The chapter also reviews the literature on coping with discrimination and the contribution of institutionalized discrimination to health inequalities. Lacking are investigations on the joint impact of perceived discrimination and residential segregation.
The concept of Mild cognitive impairment (MCI) makes a lot of sense in that individuals are typically not “normal” one day and “demented” the next. In theory, especially for progressive neurodegenerative conditions, such as Alzheimer’s disease (AD), frontotemporal dementia (FTD), the development of dementia may take months or years. The clinical syndrome of MCI due to AD can be identified via a neuropsychological evaluation or less-sensitive cognitive screening measures. Much of what we are learning about MCI, and therefore refining its diagnostic criteria, is coming from two large-scale studies of cognition and aging: Alzheimer’s Disease Neuroimaging Initiative (ADNI) and Australian Imaging, Biomarkers and Lifestyle (AIBL). According to the most recent research diagnostic criteria for MCI due to AD, evidence of beta-amyloid deposition, neuronal injury, and/or other biochemical changes needs to be seen to increase confidence of the etiology of MCI. Cholinesterase inhibitors remain the primary pharmacological treatment for AD.
This chapter provides new insights, direction, and applicability of qualitative research methods in social network analysis, with special emphasis on the minority elder population. It describes how specific qualitative approaches may be applied and contribute to increased understanding in social network analysis. The chapter provides a list of suggested future directions to address issues that are void in the literature on social networks and minority elders. The social networks of older adults provide them with the greatest amount of care and support. Any definition of social networks needs to be grounded in both microstructural and macro-structural perspectives. The social networks of minority elders are uniquely shaped by the cultural norms and values associated with the diverse racial and ethnic groups with which they identify. The conceptual guidance from the life course perspective can also inform understanding the structure and function of social networks among minority elders.
This chapter suggests that the dysexecutive syndrome associated with vascular dementia (VaD) is caused by impairment in separate but related cognitive concepts; that is, pathological inertia, mental bradyphrenia, disengagement, and temporal reordering. During the late 19th and early 20th centuries, cerebrovascular dementia was a well-established clinical syndrome. Multi-infarct dementia (MID) generally became associated with all types of vascular syndromes. Recent research suggests the presence of considerable overlap between the neuropathology underlying Alzheimer’s disease (AD) and VaD. Patients diagnosed with VaD tend to produce hyperkinetic/interminable perseverations, suggesting an inability to appropriately terminate a motor response. Other aspects of the dysexecutive syndrome associated with VaD revolve around constructs related to interference inhibition, flexibility of response selection, and sustained attention. From the view point of diagnosis, the neuropathology of VaD often differentially impacts the frontal lobes, whereas the neuropathology associated with AD revolves more around circumscribed temporal lobe involvement.
- Go to chapter: Two Approaches to Developing Health Interventions for Ethnic Minority Elders: From Science to Practice and From Practice to Science
Two Approaches to Developing Health Interventions for Ethnic Minority Elders: From Science to Practice and From Practice to Science
This chapter focuses on more integrated approach or process for developing a health intervention for ethnic minority groups that incorporates accepted principles of medicine and scientific methodology. The changing demographic has led to complex challenges in the U.S. health care system. The delivery of effective health care services hinges on health care professionals’ ability to recognize varied understandings of and approaches to health care across cultures. Health care providers may employ different strategies to increase participation of service users by bridging barriers to communication and understanding that stem from these racial, ethnic, cultural, and linguistic differences. In the context of health or health care improvement, little debate exists concerning the recognized need to help ethnic minority patients maintain and restore health. There are two general approaches for developing culturally appropriate health interventions. The first approach is from science to practice and the second approach is from practice to science.
This chapter discusses the history, organization, development, and the future of Medicare and applies Andersen’s Behavioral Model of Health Services Use to understand utilization among the elderly and conduct a systematic literature review. It analyzes racial/ethnic disparities in health care utilization among the elderly using Andersen’s model and discuss the implications of the current proposals for changes in Medicare for health care utilization especially among minority aging. Racial/ethnic differences in seniors’ use of medical care were sizable before the Medicare program. The focus on deficits and controlling the cost of government has in turn increased the focus on health care and entitlement programs like Medicare. Medicare is important to ensure access to health care for the elderly, particularly the poor and minorities. However, with the rising health care costs and changing demographics, it is clear that Medicare needs some type of reform to ensure its continuing viability.
This chapter provides selective review of research on religion and spirituality across three groups of racial and ethnic minority older adults African American, Asian American, and Hispanic/Latino. It discusses major denomination and faith traditions, as well as information about types and patterns of participation and their sociodemographic correlates. The chapter examines informal social support provisions within faith communities and the types of assistance exchanged. It also examines associations between religion, spirituality and physical/mental health, and psychological well-being. Religion and spirituality, through a variety of psychosocial mechanisms and pathways are thought to have largely beneficial impacts on physical and mental hea.
Dementia pugilistica (DP) is a form of chronic traumatic encephalopathy (CTE) that involves gross impairment of cognitive and motor functioning due to repetitive blows to the head from boxing. Rapidly increasing in popularity among fight fans and fighters is mixed martial arts (MMA). In the area of sport-related concussion, there are two other frequently used terms that are necessary to distinguish from DP and CTE: postconcussion syndrome (PCS) and second impact syndrome (SIS). The classical clinical signs and symptoms of DP include combinations of dysarthria, incoordination, gait disturbance, pyramidal and extrapyramidal dysfunction, and cognitive impairment. Some media reports about concussion and the potential link between repetitive concussions and long-term problems include eye-catching and emotionally provocative titles. This chapter has provided an overview of the many complex issues surrounding the effects of repeat concussive trauma, particularly in sports.
This chapter focuses on aging and health issues in all of America’s major minority populations including African Americans, Hispanics/Latinos, Asian Americans, as well as Native Americans. It addresses the issues of health inequality and health advantage/disadvantage. The chapter introduces relatively new areas of inquiry including long-term care, genetics, nutrition, health interventions, and health policy issues. In addition to possible genetic factors, the literature has emphasized the influence of poverty and socioeconomic status as well as stressors associated with minority group status. The system of long-term care services will need to be restructured to take into account issues affecting minority populations such as health care coverage, housing and income supports, as well as cultural issues as filial piety and trust. The field of minorities, aging, and health has been dominated by a health inequality perspective that has been illustrated by the application of cumulative disadvantage/cumulative inequality theory.
- 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.
The Transmissible spongiform encephalopathies (TSEs) form a group of illnesses, characterized by a pathological form of the native prion protein, which results in a rapidly progressive neurodegenerative illness. They also are responsible for Gerstmann-Strâussler-Scheinker (GSS) syndrome and fatal familial insomnia (FFI), and they have been produced experimentally in several other animals. Creutzfeldt-Jakob disease (CJD) is the most common TSE in humans. Human prion diseases have three etiologies: (a) sporadic, (b) genetic, and (c) acquired. Human prion diseases are important to understand because of their underlying pathophysiology, public health implications, and clinical features that often result in misdiagnosis. This chapter reviews the historical discovery of prion diseases and the formulation of the prion hypothesis. It explores prion hypothesis and the neuropathogenesis of prion diseases. The chapter ends with a description of the diagnosis, prognosis, and experimental treatment of human prion diseases.
- Go to chapter: Older Adults of Color With Developmental Disabilities and Serious Mental Illness: Experiences and Service Patterns
Older Adults of Color With Developmental Disabilities and Serious Mental Illness: Experiences and Service Patterns
This chapter focuses on the factors that intersect with race and ethnicity in shaping the experiences of families from racial and ethnic minority communities. It presents a conceptual framework using a Venn diagram that shows the intersection between aging and having a serious mental illness (SMI) or developmental disabilities (DD), limited services for these aging populations, and being a person of color with SMI or DD. People with DD and SMI are now experiencing increased life expectancy due to improved medical and technological advances. However, understanding the needs of aging adults with DD and SMI from diverse communities in the United States and their caregiving families is particularly challenging, because historically, there have been racial and ethnic disparities in the use of specialty health care services. Older adults with DD and SMI from racial minority groups are disadvantaged on multiple domains.
Dementia with Lewy bodies (DLB) is a clinical syndrome characterized by progressive dementia, cognitive fluctuations, visual hallucinations (VH), and parkinsonism. In 1961, Okazaki, Lipkin, and Aronson reported two patients with dementia and parkinsonism with cortical neuronal inclusions similar to the brain-stem Lewy bodies (LB) seen in Parkinson’s disease (PD). LBs are intra-cytoplasmic neuronal inclusions containing α-synuclein and ubiquitin. There are other associated pathological features in DLB such as spongiform change neuronal loss, and Alzheimer’s disease (AD) pathology includes amyloid plaques and neurofibrillary tangles (NFTs). DLB and other entities such as PD and multiple system atrophy (MSA) have been grouped under the term synucleinopathies due to the existence of α-synuclein inclusions in the brain. The central feature required for a diagnosis of DLB is the presence of dementia: a progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function.
This chapter describes an overview of the procedures that a neuropsychologist may apply to a range of similar referrals in the area of civil capacities. It explores the presentation of a framework developed by the American Bar Association/American Psychological Association (ABA/APA) working group on capacity issues and provides more specific guidance regarding assessment tools. Decision making is a complex cognitive process that involves multiple brain regions and brain systems. Injuries to the prefrontal cortex are common in dementia and are often linked to changes in decision-making abilities. Key differences between clinical assessments and those for capacity evaluations include knowledge of relevant legal and ethical issues, a functional assessment, and an ability to present neuropsychological data to lay readers. Research on medical consent capacity and financial capacity highlight the importance of the assessment of calculation, executive function, and verbal memory as part of any test battery.
Chronic alcohol use has been related to various linked disorders when used in excess, particularly when this excessive use becomes chronic. It is important for clinicians to clarify the amount and type of alcohol being consumed and the frequency of this consumption when considering its potential role in any neuropsychological profile. The most commonly reported terms found in the literature include alcohol-induced persisting dementia (APA), alcohol-related dementia, and Korsakoff’s syndrome (KS). This chapter provides some synthesis of this literature to offer some clarity on cognitive dysfunction as it relates to alcohol and the manifestation of dementia as a result of chronic use, including discussion of the classic KS and related presentations. Alcohol dependency is commonly associated with a number of neurological impairments including deficits in abstract problem solving, visuospatial and verbal learning, memory function, perceptual-motor skills, and even motor function.
- Go to chapter: Age in Place and Place in Age: Advancing the Inquiry on Neighborhoods and Minority Older Adults
This chapter focuses on potential new lines of inquiry that emerge from the synthesis of research in ethnic geography, urban studies, race/ethnicity, and age/life course. It emphasizes the importance of integrating work from ethnic geography into studies of minority older adults and their neighborhoods. There has been a long tradition of work on the role of neighborhoods for minority older adults, ranging from their health-protective elements to their challenges for older adults. Research on neighborhood context for minority older adults could benefit from an expanded view of age in studies of place. Research on minority older adults and neighborhoods could also benefit from an expanded focus on place in studies of age, namely integrating research from ethnic geography. Integrating research from multiple levels of context, ranging from cross-national migration to attachment to place, opens a new vista of inquiry on minority aging and neighborhoods.
This chapter provides an overview of key theoretical considerations that are important to understanding mortality and longevity differences across groups. It focuses on the historical and social contexts as well as the life course processes that are most important in understanding patterns and trends of race/ethnicity, aging, and mortality/longevity in the United States. The chapter provides a new empirical analysis of race/ethnicity and U.S. adult mortality risk, focusing on key demographic and socioeconomic factors that influence mortality differentials across groups. It also focuses on critical research needs and on the ways that social and health policy might effectively influence future mortality and longevity trends for all race/ethnic subgroups in an increasingly diverse and aging society. The understanding of race/ethnic patterns and trends of mortality and longevity must also consider the ways in which the life course unfolds in unique ways across groups.
This chapter provides definitions and scope of the problem of eliminating disparities in end-of-life (EOL) care. It provides a translation of the theories and research that can be used to guide social work practice with minority older adults. The chapter suggests that when working with minority elderly, the psychosocial needs of the patient and family become even more critical in decisions that may affect the timing of death. The term end-of-life care traditionally refers to the last phases of an illness before death; however, experiences across the earlier course of the illness are critical to shaping the anticipation, expectations, and preparedness for care during the terminal phases of illness. In terms of EOL care decision making and the disparity in hospice utilization across racial groups, Critical Race Theory (CRT) offers insight for looking at race relations in a broader context than the traditional perspective.
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: Understanding Age at Onset and Self-Care Management to Explain Racial and Ethnic Cardiovascular Disease Disparities in Middle- and Older-Age Adults
Understanding Age at Onset and Self-Care Management to Explain Racial and Ethnic Cardiovascular Disease Disparities in Middle- and Older-Age Adults
This chapter examines conceptual frameworks and theories on racial and ethnic health disparities that can apply to cardiovascular diseases (CVD) among middle-age and older age adults; investigate age at onset/diagnosis of CVD as it varies by race and ethnicity, with some explanations as to why these disparities exist; understand difficulties with CVD self-care/management by race and ethnicity, with some explanations as to why these disparities exist; and discuss future directions, considering data, prevention, and intervention, and policy needs. Several conceptual models and theories can address racial and ethnic CVD disparities among middle-age and older age adults, including the social determinants of health (SDOH) model, the social-ecological model, and life course theory. An earlier age at onset/diagnosis of CVD for racial and ethnic minorities potentially leads to earlier health declines and earlier death because of access to care and self-management difficulties.
- Go to chapter: Does Health Care Quality Contribute to Disparities? An Examination of Aging and Minority Status Issues in America
Does Health Care Quality Contribute to Disparities? An Examination of Aging and Minority Status Issues in America
This chapter focuses on the changing health care policy climate. These changes can either reduce current barriers or create new challenges to health care. The Patient Protection and Affordable Care Act (ACA) has reformed the Medicare payment system and incorporated the voice of older minority adults in shaping the performance of their local health care delivery system. Health care access inequity and policy-based remedies have historic roots in U.S. civil rights legislation. The civil rights of older adults and their access to health care were resolved through Medicare. ACA policy creates an opportunity to reframe health disparities research as a consumer issue. However, the terms health disparities, older minorities, and barriers to care are not usually viewed as consumer issues. Standardization of health care practice creates research opportunities for social gerontologists to evaluate policy and its impact on health care access disparities.
This book provides a multidisciplinary compendium of research pertaining to aging among diverse racial and ethnic populations in the United States. It focuses on paramount public health, social, behavioral, and biological concerns as they relate to the needs of older minorities. The book is divided into four parts covering psychology, public health/biology, social work, and sociology of minority gang. The book focuses on the needs of four major race and ethnic groups: Asian/Pacific Islander, Hispanic/Latino, black/African American, and Native American. It also includes both inter- and intra-race and ethnic group research for insights regarding minority aging. The chapters focus on an array of subject areas that are recognized as being critical to understanding the well-being of minority elders. These include psychology (cognition, stress, mental health, personality, sexuality, religion, neuroscience, discrimination); medicine/nursing/public health (mortality and morbidity, disability, health disparities, long-term care, genetics, nutritional status, health interventions, physical functioning); social work (aging, caregiving, housing, social services, end-of-life care); and sociology (Medicare, socioeconomic status (SES), work and retirement, social networks, context/neighborhood, ethnography, gender, demographics).
- 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.
This chapter provides a review of public policy and public programs related to important aspects of the welfare state in the United States, with particular attention to the impact of various policies and programs related to income support, health care, and housing on low-income and minority Americans. It focuses on the guiding principles that motivate the various parties in today’s welfare state debates and investigate how the basic structure of the way social welfare is guaranteed in the United States affects low-income and minority individuals. The chapter also focuses on the general features of our economic, political, and social systems that place minority Americans at serious risk of poverty and ill health throughout life, including its waning years. The welfare state represents a relatively late development in human social, economic, and political history. Social Security is particularly important for minority Americans.
This chapter considers aging in place both within larger community and societal contexts as well as through description of the unique experiences of older Latinos or Hispanics, African Americans, Asian Americans, Native Americans, and Pacific Islanders. In addition to racial and ethnic status, aging in place may also be influenced by changes in longevity, family demographics, caregiving, and household structures. Most considerations of aging in place emphasize the importance of the fit between the physical environment and the individual to successfully age. The recent addition to the model of the individual life course and historical change now offers a means to recognize three particularly influential components of aging in place relevant for African Americans, Latinos, Asian Americans, Native Americans, and Native Hawaiian/Pacific Islanders: social capital, the impact of the social environment, and acculturation. The characteristics of assisted-living residences or assisted-living facilities vary across the United States.
This chapter presents a case for examining aging in the United States through an inter-sectionality lens. It begins by presenting age, gender, and race/ethnicity as social constructions, followed by a conceptual overview of intersectionality to highlight strengths as well as challenges in this approach, particularly as it relates to health. The chapter reviews the most current thinking on gender and minority health, with special attention to social roles and contextual factors, and methodological approaches. The social construction of gender has been widely addressed in the sociological literature, with identified insights for better understanding health and the aging process. Research on gender and physical health outcomes draws much greater scholarly attention than mental health in later life. The intersectionality paradigm has provided new directions for identifying the importance of gender as a key element for predicting health across the life course.
Frontotemporal dementia (FTD) is the third leading cause of dementia in large pathological series but tends to have an earlier age of onset than Alzheimer’s disease (AD) and Lewy body dementia, the most frequent and second most frequent forms of dementia. Semantic dementia (SD) includes impairment in the understanding of the meanings of words and difficulty in identifying objects. Semantic primary progressive aphasia, also known as SD, includes difficulties with naming and single-word comprehension although grammar and fluency are often spared. SD is a disorder that involves loss of semantic memory, anomia, receptive aphasia, and an actual loss of word meaning. The chapter presents some assessment tools that are those conducted by a psychologist or a neuropsychologist. Such an evaluation should include a clinical interview and neuropsychological examination. SD has been associated with ubiquitin-positive, TAR-DNA-binding protein-43 (TDP-43)-positive, tau-negative inclusions.
This chapter discusses various factors that influence cognitive aging in racial/ethnic minority groups. It presents evidence regarding the relationships between cognition and self-rated health, cardiovascular disease, hypertension, and mortality. The chapter explains the role of language and bilingualism as it relates to minority cognitive aging. To advance the current knowledge regarding cognitive aging in minorities, appropriate research designs are vitally important. Cross-group research has generated literature on cognitive aging in racial/ethnic minority groups. The cognitive aging advantages of improved educational quality associated with desegregation appear to have been diminished by negative aspects of the school environment, such as racism experienced by African American students. The inclusion of racial/ethnic minorities in cognitive aging research challenges scientists to use appropriate research designs and broaden research questions by examining within-group variability to better describe the diverse aging population.
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.
Vascular dementia (VaD) is an umbrella term representing a clinical grouping with inherent heterogeneity in its clinical manifestations reflecting a variability in its underlying etiology. This chapter discusses specific presentations that can fall under the VaD heading. It includes discussion of multi-infarct dementia (MID) and dementia associated with lacunar states (LSs), as well as Binswanger’s disease (BD), which remains embroiled in controversy. The chapter discusses cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and moyomoya disease due to their clinical overlap. The etiology of MID is in many ways the same as the etiology of cerebrovascular disease (CVD) in general and even late-life dementia. The term MID itself is used to describe a disorder characterized by a stepwise deterioration of cognitive functioning associated with strokes or accumulated transient ischemic attacks (TIAs).
This chapter provides an overview of recent population estimates, trends, and projections of older adults, with a specific focus on minority populations. It explains aging trends among several specific minority groups and discusses their different profiles in general demographic terms. The chapter focuses on older immigrants from Latin America and Asia, although there are significant streams of immigration from Europe, the Middle East, Africa, and other regions of the world. Minority elders represent the fastest growing segment of the older population in the United States, and as a result, the older adult population is becoming racially and ethnically more diverse. In addition to race and ethnic minority classifications, persons immigrating to the United States may be considered a minority group. The sex ratio among minority elders differs substantially from that of the total population, due to gender imbalances in immigration patterns and variability in the female survivorship advantage across groups.
Scholarship on ethnic minority families and aging has wrestled implicitly or explicitly with the understanding of a theoretical dichotomy not uncommon in the field of sociology as a whole: the role that culture plays as either an epiphenomenon and/or as an integral element of the social structure. Interpretations of that basic structural versus cultural duality may derive from broader ideological perspectives, but they may also reflect a superficial framing of the concept of culture in scholarly analyses of ethnic minority families. This chapter presents a review of ethnographic literature on minority families and aging that is grounded in both racial/ethnic and feminist perspectives. It discusses three major topics that emerged as most salient in recent ethnographic studies: the concepts of familism, family obligations, and filial piety; the role of living arrangements, urban/rural space, and the neighborhood context on family experiences; and intergenerational relations, health, and caregiving.
The general topic of successful aging (SA) has long been a major theme in gerontology and has been an especially prominent and growing aspect of gerontological research and program development over the past 25 years. This chapter focuses on substantial empirical research that builds on the general concept of SA to inform theory evolution and various forms of program development at the individual and community level. There has been very substantial theoretical work, over several decades, on the interrelated but differentiated dual approaches of the life-course and life-span perspectives on aging. Usual aging was seen as laden with risk of disease and disability mediated by lifestyle-related increased lipids, glucose, and blood pressure, and decreased renal, pulmonary, cardiac, immune, and central nervous system (CNS) function. A successfully aging society can be seen as one that is productive, cohesive, secure, and equitable.
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.
This chapter illustrates that aging in place is richer and more dynamic than simply understanding aging as loss and place as a static physical environment. The conceptual cornerstone of environmental gerontology is Lawton and Nahemow’s Ecological Model of Aging, otherwise known as the ‘competence-press model’ of aging. The concept of aging in place has evolved from the simple homeostatic notion of person-environment (P-E) fit to a more dynamic conceptualization that considers people, places, the programs they embody, constructive selective and accommodative processes, and the goals that motivate the entire enterprise, as they all evolve over time. The ecological framework of place (EFP) identifies a variety of factors that are hypothesized to affect P-E fit, including characteristics of individuals, places, and time.
Studies in model organisms strongly support the idea that proteostasis is critical for healthy longevity and that enhanced proteostasis is associated with longevity both across species and within species. This chapter provides an overview of the evidence supporting the theory that loss of protein homeostasis is a conserved mechanism of aging. It also provides an overview of current evidence that loss of proteostasis is a central driver of aging and age-related disease, based on studies from a variety of model systems and clinical data. Although the link between loss of proteostasis and disease is strongest in age-associated neurodegenerative disorders, there is growing evidence that misfolding and aggregation of proteins also contribute to other age-related diseases, as well as functional decline in numerous tissues and organ systems accompanying the aging process. The heat shock response (HSR) has been strongly implicated in aging in several organisms, including yeast, worms, and flies.
The therapeutic alliance works based on the idea that the social worker is a willing participant whose primary concern is to support an older client’s effort for desired change. When considering theoretical orientations to treating an older adult that are consistent with the short-term constraints found in most mental health agencies, one is faced with a multitude of theories, some extended for older adults, most created for younger adults. Cognitive behavioral therapy (CBT) and various interpersonal psychotherapies are effective for older adults, though an older adult’s response to these therapies may have a different temporal course and require modifications in technique. Constructivist theory is a conceptual framework that is foundational to existential therapy, CBT, and narrative therapy. However, for older adults, reminiscence is a strength-based strategy employed to validate a sense of intimacy with the past, to integrate the many transitions of life, and as a preparatory method for death.
The process of assessing an older adult occurs on two levels. The first level takes place when an older client presents for assessment. The second level of the assessment process is used for gathering facts that are analyzed for diagnosis, treatment planning, and disposition. Most social workers treating older adults will be younger than their clients. Therefore, clinical authority and respect may become an issue. It is common to treat older adults experiencing hearing deficits who have trouble perceiving high frequencies. The social worker must evaluate the status of the client’s housing, transportation, food, clothing, recreation opportunities, social supports, access to medical care, kinship, contact with neighbors, and other environmental resources that the client or social worker considers important. During the collection of this data, the opportunity will arise while discussing social relationships to collect historical information on the client’s psychosocial development.
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.
This chapter discusses prismatic history a selective, select account of theory building in the field, which ideally stirs gerontological imaginations about future theoretical work. Several of gerontology’s founders promulgated or borrowed theories to guide research on aging. Based on work in pathology, cytology, and immunology, Metchnikoff formulated ‘phagocytosis‘, an interdisciplinary theory of aging hypothesizing that large intestinal white blood cells destroyed microbes that hastened premature senility in humans, apes, dogs, and plants; the construct anticipated various degenerative and wear-and-tear theories. Biologist Vincent Cristofalo, endorsing no unified biological theory of aging, reduced models into groupings of stochastic and developmental-genetic theories. Gerontologists demolished disengagement theory in Unripe Time. Not even a giant like Robert Havighurst could salvage parts of activity theory in order to sustain his pioneering theory of successful aging.
Social support from close relationships is one of the most well-documented psychosocial predictors of physical health outcomes. Social support is distinguishable from other health-relevant social processes including social integration and social negativity. This chapter reviews epidemiological work on social support and health, and explores the major life-span models that have implications for understanding these issues. Importantly, the link between social support and mortality was consistent across age, sex, geographical region, initial health status, and cause of death. In order to elaborate on the developmental processes over time that might impact social support from close relationships and health, a life-span model of support has been proposed that attempts to integrate prior work and models across disciplines. Most social support interventions also target individuals who are most at risk or who already have psychological, behavioral, or medical problems.
Mounting evidence has shown that an array of proinflammatory cytokines and mediators is frequently elevated in aging populations, including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP). In addition to chronological aging, sterile inflammation can be associated with a number of age-related disorders and diseases, including cardiovascular diseases, cancers, type 2 diabetes mellitus (T2DM), bone diseases, neurodegenerative diseases, chronic obstructive pulmonary disease (COPD), and frailty. Many types of cancer are also related to or are preceded by chronic inflammation at sites of tumor development. Although more studies are required, evidence to date suggests that drugs that target age-related chronic inflammation and related fundamental aging processes, including cellular senescence or the age-related increase in mammalian target of rapamycin (mTOR) activity, might play an important role in reducing age-related disability, frailty, and multiple chronic diseases as a group.
- 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.
This chapter describes the fundamental evolutionary theories that seek to explain the presence of aging despite its apparent detrimental effects on individual fitness and explores key evidence and shortcomings of these theories. It focuses on the observed trade-offs between life span and reproduction, highlighting potential molecular mechanisms by which selection can fail to eliminate, or even promote, patterns of senescence. An underexplored avenue by which selection can act on aging, mate choice, and sexual selection is then discussed leading to the development of a verbal model whereby mate choice could promote senescence as a by-product of honest sexual signaling. The chapter then explores how the described evolutionary theories pertain to human diseases, and identifies the critical absence of some important evolutionary processes in the evolutionary theory of aging and disease. Finally, it provides an in-depth understanding of why species age, and implications on human aging.
This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book focuses on theoretical and conceptual developments in research on aging, both within and across disciplines. Recent years have brought major investments in longitudinal data, investments essential to understanding aging as a dynamic, multifaceted, and interactive process. The book summarizes what is meant by theory, and why theory is so important to advancing aging-related research, policy, practice, and intervention. The theory portrays the relationships among the complex variables suggested by a theory. A good theory identifies the problem and its most important components based on the separate findings and empirical generalizations from research. As the field of gerontology and research on aging continue to rapidly expand, the need for a strong theory will only grow.
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.
The book summarizes what is meant by theory, and why theory is so important to advancing aging-related research, policy, practice, and intervention, and can keep researchers and practitioners in gerontology abreast of the newest theories and models of aging. It addresses theories and concepts built on cumulative knowledge in four disciplinary areas, biology, psychology, social sciences, and policy and practice, as well as landmark advances in trans-disciplinary science. Since longevity is indirectly governed by the genome it is sexually determined, and because aging is a stochastic process, it is not. Chapters cover major paradigm shifts that have occurred in geropsychology, theories in the sociology of aging, evolutionary theories pertaining to human diseases, theories of stem cell aging, evidence that loss of proteostasis is a central driver of aging and age-related diseases, theories of emotional well-being and aging, theories of social support in health and aging, and other theories such as environmental gerontological theories and biodemographic theories. Many chapters also address connections between theories and policy or practice. The book also contains a new section, "Standing on the Shoulders of Giants", which includes personal essays by senior gerontologists who share their perspectives on the history of ideas in their fields, and on their experiences with the process and prospects of developing good theory.
Efforts to understand the biology and cause of human aging are as old as recorded history. Even during the Age of Enlightenment, and the major discoveries made in biology in the 20th century, the fundamental cause of aging is still a mystery. Age changes can occur in only two fundamental ways-either by a purposeful program driven by genes or by stochastic or random events. But, once reproductive maturation is reached, thought is divided with respect to whether the aging process results from a continuation of the genetic program or whether it occurs by the accumulation of dysfunctional molecules. The quantitative variation in physiological capacity, repair, and turnover accounts for the differences in longevity both within and between species. Because longevity is indirectly governed by the genome it is sexually determined. Because aging is a stochastic process, it is not.
This chapter looks toward the future of theory development in research on aging, and offers some perspectives that will be helpful to graduate students, postdocs, and junior investigators. It highlights some directions for theory development and theory-driven research and application that are likely to be the most fruitful arenas for explanatory inquiry in the decade to come. These include: successful and positive aging; longevity, health, and well-being in aging; environments, and transactions among aging individuals and their environments; the life course and its effects on aging; and variations in trajectories of aging. Within the realm of health, we want to make special note of the surge in aging research on social genomics and epigenetics, which is certain to continue growing in the future and is in need of theories to explain the interplay between genes and environments as well as the transmission of effects across multiple generations.
Wisdom tends to provide a sense of mastery and meaning in life that sustains well-being even under adverse circumstances. This chapter provides a summary of explicit and implicit wisdom theories. It explores the contextual life-course approach to address the divergent trajectories of personal wisdom development, with focuses on the importance of social support networks and role models. The chapter also explores the associations among wisdom and culture, religion/spirituality, and well-being in old age. Most wisdom literature concurs that advanced cognitive development is necessary but not sufficient for wisdom to arise. In older adult samples of mixed educational and socioeconomic backgrounds, wisdom, assessed as analytic and synthetic wisdom modes and an integration of cognitive, reflective, and compassionate wisdom dimensions was positively associated with subjective well-being, even after controlling for physical, health, socioeconomic status, financial situation, physical environment, and social involvement.
This chapter reviews research on terminal decline in multiple domains of function and considers the extent to which terminal decline pervades and cuts across many different domains of function. Although late life is typically characterized by extensive functional declines, there are considerable individual differences in terminal decline trajectories. Working through the existing literature, the chapter evaluates what is known regarding the key predictors of individual differences in terminal decline. It outlines some open questions and avenues for future inquiry. Focusing on the role of the historical context, the chapter considers how terminal decline differs and/or is changing across cohorts. Terminal decline is not only found in domains assessed through objective or performance-based measures, but also observed in psychosocial domains typically assessed using self-report measures. Evidence is also accumulating that genetic risk factors are related to individual differences in onset and rate of terminal decline in the cognitive domain.
This chapter focuses on three major areas of investigation into the role of religion and spirituality in older people’s lives: age differences in the nature of religious and spiritual belief and practice; health benefits that accrue to older people who profess a religious faith and engage in spiritual activities; and influences on social and intergenerational relationships and support resulting from membership of a faith tradition. Social gerontology’s recent concern with religion and spirituality in later life has had a relatively limited impact on theorizing about aging and social relationships. Hinduism is also widely regarded as an age-friendly religion, which ascribes a distinct more mature stage of being to the last stages of life, in preparation for the transition to a new life beyond death. The chapter concludes with a stress on the importance of conducting research on religion, spirituality, and aging in non-Western and non-Christian cultures.
Gerontology has an uneasy and codependent relationship with chronological age. This chapter describes the meanings and uses of age in research on aging, focusing mainly on concepts and theories but also making a few observations on methods. To advance theories of social phenomena, investigators must reveal the relevance and irrelevance of age in contemporary social life. Researchers often use age as a proxy for things that are highly age-related but have not been measured-say, some biological, psychological, or social aspect of development. Age-based explanations are about maturation, but cohort-based explanations are about historical events and social change. Larger life phases can be the basis for ageism and age stereotypes-common images or perceptions of people of different ages, and their physical, psychological, and social characteristics. Stereotype embodiment theory (SET) has advanced recent research on ageism and age stereotypes.
Work and retirement are simultaneously constructed at the institutional, organizational, and individual levels. This chapter explores the changes in trust relationships the defined benefit-defined contribution (DB-DC) transition signaled. It shows how risk management of retirement income was reframed. The chapter addresses the changes in the structure of the labor market and the nature of work that have coincided with the third era of retirement. It explores cultural dimension by analyzing the role of ‘trust’ as a key underlying cultural concept in the social construction of retirement. Cultural understandings of work and retirement require both intertemporal and intergenerational features of exchange relationships. The passage of the Employee Retirement Income Security Act (ERISA) in 1974 was the legislative response to workers’ and retirees’ loss of benefits through plan defaults. The later-life experiences of workers with discontinuous work histories, self-employed workers, and contingent workers are part of the untold story of retirement.
This chapter considers the major paradigm shifts that have occurred in geropsychology as it has progressed over the course of the 20th century. It also considers the consequences of increased interdisciplinarity for studies of aging within the discipline of psychology. The chapter describes the recent interest in research-based psychological interventions in the aging process, and of the more recent influence of advances in neuroscience. The study of aging, however, was early on recognized in the context of American psychology, and the division of adulthood and aging was one of the first 20 substantive divisions of the American Psychological Association (APA). The development of structural and functional Magnetic resonance imaging (MRI) has had a revolutionary enhancement of neuroscience, allowing for the first time the conduct of direct tests of the relationship between age changes in behavior and brain changes during normal and pathological aging.
The consequences of aging on stem cell function vary greatly among tissues, involving defects in activation, self-renewal, and differentiation. This chapter discusses current theories of stem cells aging, focusing on the molecular and cellular determinants leading to loss of stem cell function with age and on the consequences for tissue regeneration and homeostasis. A better understanding of the underlying mechanisms of aging is now opening new avenues of research that explore rejuvenation strategies based on counteracting the determinants of stem cell aging. Common aging determinants across stem cell pools raise hope that universal rejuvenation strategies can be applied, while tissue-specific consequences of stem cell aging will help to select local interventions to reestablish organ function. The chapter discusses the emerging concept of stem cells as immune modulators. Finally, it elaborates the theory that declining adult stem cell function precipitates normal aging.
- Go to chapter: The Multiplicity of Aging: Lessons for Theory and Conceptual Development From Longitudinal Studies
This chapter offers a new perspective on the development of theories of aging by proposing that the complexity of the aging process requires accounting for its multiplicity, specifically, its multiple time frames, multidirectionality, multidimensionality and interplay of factors, and multilevel influences. It takes advantage of the increasing number of longitudinal studies in the aging and developmental field to outline some lessons about the way theories on aging may be developed in the future to gain a more comprehensive picture of development and aging. The chapter proposes the principle of multidimensionality and interplay of factors as a third way of developing heuristic theories. It reviews several longitudinal studies that show that interplay between biological, psychological, and social factors affects important outcomes, such as subjective health or well-being.
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.
Older adult abuse is a multifactorial problem that includes problematic relationships among the older adult and spouse/partner, cohabitating with adult children, and caregivers left unsupervised with an older adult. Researchers focusing on the etiology of abuse of older adults need to place a greater emphasis on the characteristics of the abuser as a predicting variable rather than the characteristics and stereotypes of the victim as the responsible predictor of the abuse. The perpetrators of abuse against older adults, in most cases, are those who have an interpersonal relationship with the older adult. Nurses are in an ideal position to be vigilant about the status of older adults under their care, evaluating risk factors for abuse on assessment of the older adult, as well as looking for signs of abuse during their care. Older adults are usually viewed as victims of crime, rather than perpetrators of crime.
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.
Psychologists need to be alert to the phenomenon of avoiding discussing sexuality with older adult patients because they embrace the idea that older adults are asexual, or because they lack the knowledge of older adult sexuality. Heterosexual women who remarry in later life report higher levels of sexual activity that transition to higher levels of emotional intimacy as compared to prior married life when they were younger. Men in general tend to maintain sexual interest and sexual activity throughout their adult developmental stages, from 35 years of age to the old-old adult developmental stage. Sexual interest remains high throughout these developmental stages, but sexual activity declines in most men as they age. Approximately 16.5" of sexually active older adults have a diagnosis of HIV infection. HIV-infected older adults are heterosexual older adult men and older adult women, gay males, lesbians, and transgendered older adults.
Contemporary psychotherapy addresses behavioral issues of an older adult by focusing on the degree to which an older adult is able to cope positively with the environmental stressors converging on him or her. An environmental geropsychologist focuses on the environment component of Lewin’s equation and develops interventions to change older adults’ interpersonal and intrapersonal experiences with psychosocial stressors with interventions aimed at the environment. The theory of affordances states that the perceptions that older adults have of their physical environments have functional significance for older adults, and shape older adults’ behaviors. The tri-dimensional intervention model states that there is a comprehensive interaction among the cognitive, conative, and affective components in an older adult’s environment. All three components are the targets for intervention by an environmental geropsychologist. The conative component is the aspect of the brain that acts on one’s thoughts and feelings.
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.
A psychologist’s first task when assessing an older adult for dementia is to discriminate between normal cognitive decline, mild cognitive impairment (MCI), and dementia. Teaching an older adult how to increase positive neuroplasticity is a useful intervention that will improve functioning in an older adult experiencing mild cognitive impairment, and will delay the progression of cognitive deterioration in an older adult experiencing dementia. 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 that may progress to Alzheimer’s disease. Alzheimer’s disease is a chronic, debilitating disease process that begins with inclusions of abnormal proteins in neurons in the brain, although this stage of the illness does not demonstrate any cognitive impairment in the older adult.
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.
Caring for the geriatric population can be a challenging endeavor, especially when considering the numerous issues that they may have to cope with on a daily basis. This chapter reviews the topic of medication adherence and describes several promising technologies aimed at improving such within the larger scope of medication therapy management (MTM). These tools at our disposal today greatly benefit our elderly population in particular, by better equipping them to manage their chronic health conditions and addressing their unique challenges. As improvements in adherence monitoring technology become more affordable and available, the business of health care will evolve into a more integrated enterprise between patients and their health care providers. Although the future direction and successful impact of many of these adherence technologies looks promising, they will only be possible if both medical and nonmedical professionals find ways to safely and effectively adopt them.
This chapter provides insight into the demographics of aging, and an overview of potential benefits and challenges of using technology to help older adults. It outlines four interconnected challenges of an aging population. With the expected increase in care needs that coincides with an aging population, the first challenge is the question of how to provide relevant high quality-care to older persons. Second, with fewer caregivers available in relation to the growing population in need, we can expect that the relative burden of care experienced by caregivers will increase. The third challenge is to increase the relative number of healthy and independent seniors by taking a more proactive approach with prevention and health maintenance strategies. The final challenge addressed concerns the development of health care systems and policy changes that are more inclusive of needed assistive technologies and medical devices.
Cognition itself is broken down into several domains including visuospatial reasoning, executive functioning, naming, memory, attention, language, abstraction, and orientation. The impairment of these domains of cognition is the strict definition of cognitive impairment, and when identified, must be explored to determine the underlying cause. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) helps clinicians in the process of diagnosing the cause of cognitive impairment. In the DSM-5, cognitive disorders are broken down into major neurocognitive disorders and minor neurocognitive disorders, as well as delirium. Technology is growing rapidly and can be considered an important aid in providing care for elderly people with dementia. Technology use among the elderly population is expected to increase over time, but even those seniors with extensive experience will find it difficult to keep up financially and skills wise owing to the rapid rate at which technology improves.
Pain management in the elderly remains a very complex and challenging issue to tackle. Much research is still required to assess the applicability and effectiveness of each of these described pain management modalities in our geriatric population. The advances in pharmacotherapy and drug delivery systems, while definitely promising, unfortunately do not bypass the uncertainty of drug pharmacokinetics and pharmacodynamics in the older population. This chapter briefly discusses the technological applications for pharmaceuticals and devices for pain management. It also describes the technological advancements in nonpharmacological management of pain, both acute and chronic. Nonpharmacological approaches include behavioral (cognitive behavioral therapy, biofeedback, and psychotherapy); physical or biomechanical (physical therapy, massage, chiropractic or osteopathic manipulations, exercise, thermal applications, such as heat and cold); interventional (e.g., surgery, acupuncture, injections such as botulin, nerve ablation, nerve blocks, epidural steroid injections); and finally neuromodulation approaches including the physical application of various electrical, ultrasound, and magnetic devices.
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.
- Go to chapter: Friend Power—A View From the Front Lines: The Importance of Relationships in the Lives of the Disabled, People With Dementia, and Older Adults
Friend Power—A View From the Front Lines: The Importance of Relationships in the Lives of the Disabled, People With Dementia, and Older Adults
As we grow older, we may lose lifelong friendships we once had through illness and death or loved ones moving away. A sense of community and the feeling of belonging are indispensable elements in the bigger picture of whole body health. Of course, casual friendships or paid professionals such as aides, social workers, case managers, and music therapists can help, but one very close friend can do so much more to relieve stress and depression. Working with people with dementia, having an authentic friendship with one individual, forces us to listen, to slow down. It is a gift to both partners in the friendship. Learning to listen and slow down often positively affects our other relationships. Plus, we often forget that for people with dementia, emotional memory remains strong. Therefore, it is likely that a strong emotional connection can be the basis for a new and fulfilling relationship.
Myriad statutory, procedural, and technological innovations have been made in the criminal and civil justice systems to increase access to courts and legal services for older people and people with disabilities. This chapter describes basic legal concepts that pertain to individual rights and explains some of the criticisms that have been leveled against aging and elder abuse policy on legal grounds. It points out the role that courts play in interpreting rights, determining when they have been violated, and finding that statutes and executive actions are invalid. It focuses on a few examples that have attracted scrutiny, particularly with respect to elder abuse and neglect. Among the constitutional amendments that are most relevant to elder justice are the Fifth, which limits the government's authority to infringe on life, liberty, and the pursuit of property without due process, and the Fourteenth, which provides equal protection under the law.
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.