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- Go to chapter: Standing on the Shoulders of Giants: Personal Perspectives on Theory Development in Aging
This chapter provides a brief introduction to approaches to coping theory-from its early roots in psychodynamic defense mechanisms, through cognitive and personality approaches to coping styles, to more current work on coping and adaptive processes. The coping process approach recognizes that coping strategies are influenced not only by person characteristics such as personality, values, and developmental history but also by environmental demands and resources. The chapter develops a definition of ‘resilience’ as the ability to recognize, utilize, and develop or modify resources at the individual, community, and sociocultural levels in the service of three goal-related processes: maintenance of optimal functioning, given current limitations; development of a comfortable life structure; and development of a sense of purpose in life. A common assumption of life-span developmental theories is that the increasing physical and sometimes cognitive limitations with age necessitate changes in adaptive processes.
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.
- Go to chapter: Theories of Environmental Gerontology: Old and New Avenues for Person–Environmental Views of Aging
This chapter provides some integrative perspectives to some of the enduring conceptual challenges in the area, such as place dimension while we age; what available theories in the ecology of aging are telling us; and what kind of new impulses refinement in this area are needed. It argues that the current trend toward intensive measurement designs in the daily ecology and the related increasing use of ambulatory assessment, taking into account short-term, interindividual variability in areas such as cognitive and emotional functioning, and daily stress experiences, may benefit from environmental gerontology perspectives. As we see it, environmental gerontology rests on three main principles two more related to the concept level and one more related to research strategy: importance of person-environmental (P-E) transaction and developmental co-construction; importance of explicitly considering the environment, with a focus on the physical-spatial dimension; and importance of optimizing ecological validity in research.
The lifelong manifold process of aging implicates biological, psychological, social, and environmental factors that interact over time and across place in complex ways to direct and temporally organize the shapes and boundaries of lives. As such, aging is a long, broad, and deep process: long, because it occurs continuously across the life span; broad, because it continuously integrates diverse factors from across levels of observation; deep, because it is never fully and directly observable as an ongoing generative process. Over the last two decades, theory building in aging inequality has focused on defining the role of health in the aging process. Arguably, health is now the core metric of aging; the diverse and complex patterns of disease, disability, and mortality with age have become the central problem for aging researchers, especially those concerned with social inequality and its pervasive and enduring effects.
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.
This chapter begins with analysis of life-span development and life-course perspectives as applied to research on older adults and their families. It examines theories that are useful for guiding such research, thus yielding broader and deeper understanding of the ways older adults and their relatives negotiate family roles, responsibilities, and interactions in the context of both traditional and pluralistic family configurations. The chapter also examines the promise and problems associated with two key theoretical approaches that have been particularly effective in guiding family gerontology research in recent years, intergenerational solidarity and conflict, and intergenerational ambivalence. These approaches are strong in their own right and have the further advantage of linking well with life-span development and life-course perspectives. The chapter focuses on their theoretical tenets and principles, empirical applications, and strengths and limitations, with a critical assessment throughout. It considers theoretical and empirical directions for future research in family gerontology.
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.
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.
- Go to chapter: Theories of Help-Seeking Behavior: Understanding Community Service Use by Older Adults
This chapter focuses on the prominent psychosocial theories and models used to predict service utilization. It begins with a discussion of Andersen’s Behavioral Model of Health Services, the most commonly used framework for predicting formal service use among older adults. The need-use gap has been documented in use of mental health services, home and community-based services (HCBS) among non-Whites, among caregivers of older adults, and in the use of adult day care, respite care, personal care, meals, and transportation services. The chapter focuses on help-seeking behavior models that were not necessarily developed for or frequently used with older populations, but have the potential for enhancing the study of service use in late life. Developing new theories and further elaborating and testing existing models are essential for unraveling the use-need paradox and helping reduce the barriers to programs and services that, when accessed, can contribute to increased well-being of older adults.
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.
This chapter combines the increasing number of studies that pertain to the stereotype embodiment theory (SET) and reflects upon to represent the current state of this theoretical perspective and how it can help explain age stereotypes’ contributions to health and aging. It describes the history, cultural context, and nature of age stereotypes and age self-stereotypes in a largely ageist society. The chapter presents SET, which provides a framework for explaining how age stereotypes are acquired to subsequently influence health outcomes. It discusses replication studies conducted in different countries, as well as meta-analyses, to demonstrate the validity of this theory as well as to illustrate the meaning and impact of its components. The chapter illustrates how SET may be applied to shape future healthy aging research, policy, and practice. Empirical evidence supports the importance of age stereotype self-relevance among older adults.
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 includes a discussion of the practice-oriented framework for service use delineated by Yeatts, Crow, and Folts and the caregiver identity theory articulated by Montgomery and Kosloski. Throughout history, family members, most often women, have been the primary providers of care for individuals, young and old, who are in need of assistance. What has occurred in the past century is significant growth in the number of family members who are providing care and expansion of the responsibilities that these family caregivers now assume. The steady expansion of family caregiving has been mirrored by the steady expansion of research focused on caregivers and interventions to support them. The behavioral model of services utilization has been used to study the use of a wide range of health services by older adults and caregivers.
- Go to chapter: Social Movements and Social Knowledges: Gerontological Theory in Research, Policy, and Practice
This chapter provides a perspective on the development of theory, research, policy, and practice through 1960 to 1980. During these decades, social movements uprooted conventional theory and methodology in the social sciences. The chapter begins with two early, leading practitioners who reflect the social work and social welfare origins of social gerontology: Ollie A. Randall and Louis Lowy. It then turns to disciplinary thought, giving credit to those who institutionalized gerontology in the academy, establishing credibility, funding, and growth of this respected discipline. The chapter focuses on the diverse epistemological standpoints and social contexts of scholars, not just as multidisciplinary thinkers, but as public intellectuals and activists. It concludes with a critical commentary on developments through the 1980s to the present, the tenuous footholds of social movements, and advances in critical theory.
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.
This chapter discusses prominent theoretical models that link age-related changes in emotional processes with changes in cognition. It also discusses the dynamic integration theory (DIT), which outline how older adults may optimize emotional experience to compensate for reduced affective complexity resulting from declines in fluid cognitive processing. The chapter evaluates the current evidence for and the potential contributions of these theories. It introduces neuroscientific perspectives and reviews how these perspectives interpret age-associated changes in the brain in terms of cognitive-emotional processing. Aging Brain model (ABM) and DIT, therefore, provide more neurologically based explanations for age-related changes in emotional processing, whereas socioemotional selectivity theory (SST) postulates motivation as the cause of such changes. Another theory that might be relevant to the aging literature is the arousal competition biased theory, which posits that the affective state of the perceiver may also play a role in the salience of information.
The first theories of emotion and aging began simply, following assumptions established in biological and cognitive aging research. This chapter outlines findings and theories generated in the early years of gerontology, when the formal study of emotions and aging had just begun. The selective optimization with compensation (SOC) model acknowledges the reduced reserve capacities that often accompany aging and that lead to fewer domains of functioning. The amygdalar aging hypothesis, for example, posits that age-related declines in the amygdala are responsible for age-related reductions in negative emotional experiences. The study of emotion and aging has burgeoned in recent years, with researchers carefully distinguishing between different types of emotion regulation strategies and assessing various aspects of emotional well-being. Theories on emotion and aging have varied, with some focused on deterioration and decline, and others on gains.
Perhaps end-of-life considerations for homeless elderly could be considered a topic of fictional creation, a sociomedical unicorn. Because, depending on one’s perspective, the curse or blessing of homelessness is the failure to even reach an age that is generally acknowledged as “geriatric”. Advance care planning is the process by which one decides what types of treatment one prefers at the end of life, but also who can speak on his or her behalf should the person become unable to speak for himself or herself. This chapter discusses advance care planning with aging homeless at end of life. It provides brief description on challenges in accessing healthcare for homeless aging, perceptions of dying of the aging homeless, and spiritual and religious consideration at end of life. The chapter then discusses palliative and hospice care delivery for the geriatric homeless. It also discusses innovative palliative care delivery models.
Cardiovascular disease (CVD) remains the leading cause of death in older homeless people. Traditional CV risk factors, such as hypertension, diabetes, smoking, and hyperlipidemia, and nontraditional CV risk factors, such as substance abuse, psychological stress, and lack of diagnostic and preventative medical care, contribute to CVD in this population. Barriers to CV prevention and treatment in homeless individuals include their environment, lack of access to care, substance dependence, mental illness, food insecurity, and medication non-adherence. Healthcare models that provide Housing First and just-in-time care by non-judgmental multidisciplinary teams have been shown to improve the CV health of people who are homeless. CV health requires prevention, as well as prompt intervention, and close follow-up. CV healthcare practice adaptations for homeless clients include ascertaining living conditions, improvising the physical exam, scheduling longer clinic appointments with frequent follow-up, prioritization of the plan of care, and simplification of the medication regimen.
- Go to chapter: Infectious Diseases in Homeless Geriatrics Population: Part II: Bacterial Infections, Tuberculosis, and Arthropods Infestation
Infectious Diseases in Homeless Geriatrics Population: Part II: Bacterial Infections, Tuberculosis, and Arthropods Infestation
Homelessness is a rising healthcare problem. Secondary to poor living situations and limited access to healthcare services, homeless people are at increased risk for exposure to various communicable diseases, including viral and bacterial infections, tuberculosis, and arthropod carried diseases. This chapter briefly discusses infectious diseases such as bacterial infections, tuberculosis, and arthropods infestation in homeless geriatrics population. The bacterial infections covered in the chapter are urinary tract infections, bacterial pneumonia, and foot infections. The arthropods infestations include lice, scabies mites, bed bugs, delusional parasitosis. There are other causes of bites and lesions aside from lice, scabies mites, and bed bugs. Spiders, mosquitoes, ticks, fleas, and ants also pose risks for homeless people, particularly those who live outdoors. Homeless people can have a difficult time avoiding bites from mosquitoes and ticks, which can carry diseases.
Homelessness is a rising healthcare problem. Secondary to poor living situations and limited access to healthcare services, homeless people are at increased risk for exposure to various communicable diseases. The diseases found in the homeless population include viral infections, hepatitis A, hepatitis B, hepatitis C, HIV/AIDS, and influenza. Homelessness, on one hand, increases the prevalence of infectious diseases, and aging, on the other hand, makes the elderly more vulnerable to infections. Homelessness is associated with numerous behavioral, social, and environmental risks that expose persons to many communicable diseases, including viral infections, which may spread among the homeless, and aside from posing a threat to individuals’ health can lead to outbreaks that can become serious public health concerns. Homeless populations may be at higher risk for West Nile virus and other mosquito-borne diseases due to their increased exposure to the outdoors and their limited access to preventive measures.
Geriatric homelessness (GH) is a significant and growing social, political, economic, and humanistic issue throughout the United States. This chapter presents case studies that will highlight the GH in four urban areas and among veterans. It defines geriatric homelessness, outlines its general dimensions, explicates its two primary etiologies (loss of employment and the lack of affordable housing in the areas where most homeless persons are located), and gives examples of the diversity of the problem and attempts at solutions in four cities and among veterans. The case examples show that the solution to the medical and psychological issues in the GHP involves much more than traditional medical practices and therapies. The solutions, involving among others politics, economics, and housing, are those of communities and localities acting to positively affect the lives of individuals and families of all ages, particularly the growing population of GHPs in the United States.
Skin problems are one of the most common presenting complaints of homeless persons to emergency departments and community clinics, estimated at 20% of such visits. Adult homeless suffer the usual skin diseases common to nonhomeless adults, but in addition can suffer more frequent infections, dermatitis, and wounds related to their compromised living status. This chapter focuses on the diagnosis, treatment, and triage of common skin complaints in homeless adults. Hospital admission should be considered whenever fever, chills, tachycardia, hypotension, or severe or rapidly progressing infection or other admission criteria are present. Additionally, if outpatient treatment is unrealistic given limited social or logistical challenges, admission may be appropriate even without the aforementioned standards, in order to ensure appropriate critical treatments and resolution. The chapter provides case example for infestations, bites and infections, wounds, neoplasms, and rashes.
The ethical and legal issues that arise in the care of the geriatric homeless population are complex not only because they involve nuances unique to either population, but because the combination of being undomiciled and aged leads to significant unique vulnerability. The usual dilemmas in geriatrics of creating an acceptable process for informed consent, judging adequate decision-making capacity for treatment acceptance and refusal, determining appropriate substitute decision makers, preserving privacy and confidentiality, promoting advance care planning, and allocating healthcare resources are made more challenging in the homeless. Complicating factors include ongoing psychiatric comorbidities and serious medical illnesses, which change a patient’s mentation and cognitive capacities. Therefore, appropriate assessment and treatment in these complex cases no doubt requires input from an interprofessional team. This chapter presents a case with changing psychiatric, ethical, and legal issues to illustrate how such complex tensions arise and may be resolved in a homeless geriatric patient.
This chapter provides brief description on malnutrition and aging, and nutrition and homelessness. It discusses nutritional impact of substance abuse, and nutrition assessment and intervention. The chapter explores the impact that homelessness and food insecurity has on the nutritional status of older adults. Interventions must be tailored to accommodate the patient’s financial resources, medical conditions, and ultimately his or her own personal goals in order to be effective. Patients may be completely disengaged from nutrition education and focused on other priorities, which are essential for survival, that is, shelter and safety, thus making nutrition education the least effective intervention for that patient at that moment in time. Ideally, the homeless geriatric person would be monitored and re-evaluated; however, follow-up may be unrealistic. What does nutrition assessment look like in action? The chapter provides a case study to describe this question.