Social Gerontology: A Multidisciplinary Perspective

Cover......Page 1
Title Page......Page 4
Copyright Page......Page 5
Content......Page 6
Preface......Page 13
About the Authors......Page 19
Contributors......Page 20
Acknowledgments......Page 21
1 The Growth of Social Gerontology......Page 22
1.1 The Field of Gerontology......Page 23
1.1.1 Why Study Aging?......Page 24
1.1.2 Careers in Aging......Page 25
1.2.1 Diversity and Terminology......Page 27
1.2.3 What Is Ageism?......Page 29
1.3 An Active Aging Framework......Page 30
1.4.1 Environmental Press......Page 32
1.5.1 Changes in Life Expectancy......Page 34
1.5.2 Maximum Life Span......Page 35
1.5.3 Who Are the Oldest-Old?......Page 36
1.5.4 Centenarians......Page 37
1.5.5 Population Pyramids......Page 39
1.5.6 Support Ratios......Page 40
1.6.1 Elders of Color......Page 41
1.6.2 Geographic Distribution......Page 42
1.7 Longevity in Health or Disease......Page 44
1.8.1 Development of Gerontology as a Scientific Discipline......Page 46
1.8.3 Research Methods......Page 47
1.8.6 Sequential Designs......Page 48
1.8.7 Problems With Representative Samples of Older Persons in Research......Page 49
1.9 Implications for the Future......Page 50
Summary: The Growth of Social Gerontology......Page 52
2 Aging in Other Countries and Across Cultures in the United States......Page 54
2.1.1 The Phenomenon of Global Aging......Page 55
2.1.2 Economic Implications of Aging for Industrialized Countries......Page 61
2.2 Modernization and Older Adults’ Roles in Traditional Societies......Page 63
2.2.1 Resources Held by Older Adults......Page 64
2.2.3 Modernization and Intergenerational Relations in China......Page 67
2.2.5 Modernization and Intergenerational Relations in Other Asian Countries......Page 68
2.3 Immigrants from Traditional Cultures to the United States......Page 71
2.3.1 The Challenges of Biculturalism......Page 72
2.3.2 Mental Health......Page 73
2.3.3 Living Arrangements of Older Immigrants......Page 74
2.3.4 Financial Dilemmas Facing Immigrant Elders......Page 75
Summary: Aging in Other Countries and Across Cultures in the United States......Page 76
3 The Social Consequences of Physical Aging......Page 78
3.1 Biological Theories of Aging......Page 79
3.1.3 Immunological Theory......Page 80
3.1.4 Free Radical Theory......Page 81
3.1.5 Mitochondrial DNA Mutation Theory......Page 83
3.2.2 Caloric Restriction......Page 84
3.3 Research on Physiological Changes With Age......Page 86
3.3.1 Normal Changes Within the Body......Page 87
3.3.2 Changes in Organ Systems......Page 88
3.3.3 Changes in the Musculoskeletal and Kinesthetic System......Page 90
3.3.4 Changes in the Respiratory System......Page 91
3.3.5 Cardiovascular Changes and the Effects of Exercise......Page 92
3.3.7 Changes in the Endocrine System......Page 94
3.3.8 Changes in the Nervous System......Page 95
3.4 Changes in Sensory Functions......Page 97
3.4.1 Changes in Vision......Page 100
3.4.2 Changes in Hearing......Page 104
3.4.4 Sense Changes in Taste and Smell......Page 108
Summary: The Social Consequences of Physical Aging......Page 110
4 Managing Chronic Diseases and Promoting Well-Being in Old Age......Page 113
4.1.1 Important Terminology in Health and Aging Study......Page 114
4.1.2 Defining Disability......Page 115
4.1.3 Causes of Death in Old Age......Page 118
4.1.4 Successful Aging......Page 119
4.2.2 Chronic Disease......Page 120
4.2.3 Health Disparities and Social Determinants......Page 122
4.2.4 Negative Impacts of Chronic Illness......Page 123
4.3 Heart Disease and Other Common Chronic Conditions......Page 124
4.3.2 Strokes and Other Cerebrovascular Problems......Page 125
4.3.4 Diabetes......Page 128
4.4 Arthritis and Osteoporosis......Page 130
4.4.1 Impact and Management of Arthritis......Page 131
4.4.2 Chronic Pain......Page 132
4.4.3 Osteoporosis......Page 133
4.4.4 Problems With the Kidneys and Urinary Tract......Page 135
4.5.1 Chronic Obstructive Pulmonary Disease or Respiratory Problems......Page 137
4.5.2 Problems With the Intestinal System......Page 138
4.5.4 HIV/AIDS in the Older Population......Page 139
4.6 Medication Use and Misuse......Page 142
4.7.1 Older Drivers......Page 143
4.7.2 Falls and Their Prevention......Page 145
4.8 Health Promotion for Older Adults......Page 147
4.8.1 The Relationship Between Health Practices and Health Outcomes......Page 148
4.8.2 Exercise Is Central to Health Promotion......Page 150
4.8.3 Motivation to Change Health Behaviors......Page 152
4.8.4 Improving the Impact of Health Promotion Programs......Page 154
4.9 Implications for the Future......Page 157
Summary: Managing Chronic Diseases and Promoting Well-Being in Old Age......Page 159
5 Cognitive Changes With Aging......Page 161
5.1.1 Primary Mental Abilities......Page 162
5.1.3 Problems in the Measurement of Cognitive Function......Page 163
5.1.4 Longitudinal Studies of Intelligence......Page 164
5.1.5 General Slowing Hypothesis......Page 165
5.1.7 Factors That Affect Intelligence and Learning......Page 166
5.2.1 Working or Primary Memory......Page 167
5.2.2 Permanent Long-Term Memory......Page 168
5.3.1 Tip-of-the-Tongue States......Page 171
5.4.1 The Positivity Effect in Information Processing......Page 173
5.4.2 Executive Function......Page 174
5.5.1 Cognitive Retraining......Page 176
5.5.3 External Cognitive Aids......Page 179
5.6 Wisdom and Creativity......Page 181
5.6.2 Perspectives on Creativity......Page 182
5.7 Implications for the Future......Page 183
Summary: Cognitive Changes With Aging......Page 184
6 Personality and Mental Health in Old Age......Page 186
6.2 Stage Theories of Personality......Page 187
6.2.2 Erikson’s Psychosocial Model......Page 188
6.2.3 Empirical Testing of Stage Theories......Page 190
6.2.4 Dialectical Models of Adult Personality......Page 191
6.3 Trait Theories of Personality......Page 192
6.4.1 Self-Concept......Page 193
6.5 Successful Aging......Page 195
6.5.1 Cognitive Functioning and a Sense of Purpose......Page 197
6.5.2 A Critique of the Successful Aging Paradigm......Page 198
6.5.3 Alternatives to the Model of Successful Aging......Page 199
6.5.4 Resilience......Page 200
6.5.5 Positive Aging......Page 201
6.6 Mental Disorders Among Older Persons......Page 202
6.6.2 Depression......Page 203
6.6.3 Therapeutic Interventions for Depression......Page 207
6.6.4 Suicide Among Older People......Page 211
6.7 Anxiety and Paranoia......Page 212
6.7.1 Schizophrenia and the Severely Mentally Ill......Page 213
6.7.2 Dementia......Page 214
6.7.3 Parkinson’s Disease......Page 216
6.8.1 Potential Causes and Risk Factors......Page 218
6.8.2 The Alzheimer’s Diagnosis......Page 223
6.8.3 Treatment of AD......Page 225
6.8.4 Caring for People With AD......Page 229
6.9.1 Heavy Alcohol Consumption......Page 231
6.9.2 Drug Misuse and Abuse......Page 235
6.9.3 Gambling......Page 237
6.10 Use of Mental Health Services......Page 238
6.11 Integrated Models of Care......Page 239
6.12 Implications for the Future......Page 240
Summary: Personality and Mental Health in Old Age......Page 241
7 Love, Intimacy, and Sexuality in Old Age......Page 243
7.1 Attitudes and Beliefs About Sexuality in Later Life......Page 244
7.2 Myths and Reality About Sexuality in Later Life......Page 245
7.2.2 Methodological Issues......Page 246
7.2.3 Later Studies of Sexual Activity and Satisfaction......Page 247
7.3 Older LGBTQ Partners......Page 249
7.3.2 Older Lesbians......Page 250
7.3.3 Older Gay Males......Page 251
7.3.4 Transgender Older Adults......Page 252
7.3.5 Implications for Service Providers......Page 253
7.4 Women and Age-Related Physiological Changes......Page 254
7.4.1 Perimenopause, Menopause, and Hot Flashes......Page 255
7.4.3 Alternatives to Estrogen to Treat Menopausal Symptoms......Page 256
7.5 Men and Age-Related Physiological Changes......Page 257
7.5.1 Impotence......Page 258
7.5.2 Sexupharmaceuticals and Aging......Page 259
7.6.1 Diseases of the Prostate......Page 260
7.6.2 Impact of Other Diseases on Sexuality......Page 262
7.6.4 Alcohol Use......Page 264
7.7.2 Effects of Long-Term Care Facilities......Page 265
7.7.3 Facilitating Older Adults’ Intimacy and Sexuality......Page 266
7.8 Implications for the Future......Page 267
Summary: Love, Intimacy, and Sexuality in Old Age......Page 268
8 Social Theories of Aging......Page 270
8.1 The Importance of Social Theories of Aging......Page 271
8.2.1 Role Theory......Page 272
8.2.2 Activity Theory......Page 273
8.3.1 Disengagement Theory......Page 276
8.3.2 Gerotranscendence Theory......Page 277
8.4.1 Age Stratification Theory......Page 278
8.4.3 Political Economy of Aging......Page 281
8.4.4 Life-Course Perspective......Page 283
8.5 The Second Transformation of Theory......Page 284
8.5.2 Social Constructionism......Page 285
8.5.3 Critical Theory and Feminist Perspectives......Page 287
8.5.4 Postmodernist Theories of Aging......Page 289
8.5.5 Successful Aging as a Positive Perspective......Page 292
Summary: Social Theories of Aging......Page 293
9 Importance of Social Supports for Older Adults......Page 295
9.1.1 The Impact of Informal Networks and Social Supports on Well-Being......Page 296
9.1.4 Social Isolation......Page 298
9.2 Older Family Members......Page 301
9.2.1 Defining Family......Page 302
9.2.2 The Growth of the Multigenerational Family......Page 304
9.2.3 Older Spouses and Partners......Page 306
9.2.4 Marital Quality......Page 307
9.2.5 Divorce in Old Age......Page 308
9.2.6 Remarriage and Cohabitation in Old Age......Page 309
9.2.7 Dating in Old Age......Page 310
9.3 LGBTQ Informal Supports......Page 312
9.3.3 LGBTQ Partnerships in Old Age......Page 313
9.3.5 Legal Issues and LGBTQ Social Supports......Page 316
9.4 Older People Living Alone......Page 318
9.5 Childless Older Adults......Page 319
9.6 Sibling Relationships and Other Kin......Page 321
9.7 Intergenerational Relationships......Page 322
9.7.1 Adult Children......Page 323
9.7.2 Grandparenthood and Great-Grandparenthood......Page 324
9.7.3 Grandparent Households......Page 326
9.7.4 Legal Issues Related to Grandparent Caregiving......Page 331
9.8 Friends and Neighbors as Social Supports......Page 333
9.8.1 Friendship and the Life Course......Page 334
9.9 Interventions to Strengthen or Build Social Supports......Page 335
9.9.1 Personal Network Building......Page 336
9.9.3 Intergenerational Initiatives......Page 337
9.10 Relationships With Pets......Page 340
9.11 Implications for the Future......Page 341
Summary: Importance of Social Supports for Older Adults......Page 342
10 Opportunities and Challenges of Informal Caregiving......Page 344
10.1 Who Are Informal Caregivers?......Page 345
10.2.2 Complex Levels of Care......Page 347
10.2.3 The Future of Family Caregiving......Page 348
10.3.2 Factors That Intensify Burden......Page 349
10.3.3 Primary Costs for Families......Page 350
10.3.4 Physical Health Costs......Page 351
10.4 Gains for Caregivers......Page 352
10.5.2 Spouses or Partners as Caregivers......Page 355
10.6 The Gendered Nature of Family Care......Page 356
10.6.2 Women in the Middle......Page 357
10.7 LGBTQ Caregivers......Page 359
10.8 Caregivers of Color......Page 360
10.8.2 Latina Caregivers......Page 361
10.8.4 Native American/American Indian Caregivers......Page 362
10.9 Caregiving for Persons Living With Dementia......Page 363
10.10.1 Family and Medical Leave Act......Page 364
10.10.2 The National Family Caregiver Support Program (NFCSP)......Page 366
10.11 Supportive Services for Family Caregivers......Page 367
10.11.1 Caregiver Assessment......Page 368
10.11.2 Service Utilization......Page 369
10.11.3 Multicomponent Interventions......Page 370
10.11.6 E-Supports......Page 372
10.11.7 Respite Care......Page 374
10.11.8 Future Service Directions for Family Caregivers......Page 375
10.12.2 Types of Mistreatment and Warning Signs......Page 377
10.12.3 Most Common Types of Mistreatment......Page 378
10.12.4 Assessment and Reporting......Page 385
10.13 Underpaid Caregivers: Direct Care Workers......Page 387
10.13.1 Who Is a Direct Care Worker?......Page 388
10.13.3 Impact on Quality of Care......Page 389
10.13.4 Advocacy and Policy Change......Page 391
10.14 Implications for the Future......Page 392
Summary: Opportunities and Challenges of Informal Caregiving......Page 394
11 Living Arrangements and Social Interactions......Page 395
11.1 Person–Environment Theories of Aging......Page 396
11.2.1 Rural Older Adults......Page 398
11.2.2 Suburban Older Adults......Page 399
11.2.3 Urban Older Adults......Page 400
11.3 Relocation......Page 401
11.3.1 Relocation Stress......Page 402
11.4.2 Aging in Place or in Community......Page 403
11.4.3 Aging-Friendly Communities......Page 405
11.5.2 Assisted Living......Page 412
11.5.3 Adult Family Homes......Page 415
11.5.4 Skilled Nursing Facilities (SNFs)......Page 416
11.5.5 Culture Change in Long-Term Care......Page 419
11.6 Social and Health Services to Promote Aging in Place in the Community......Page 420
11.6.1 Home Health Care......Page 422
11.6.2 Adult Day Care and Adult Day Health Care......Page 423
11.6.4 Aging in Place on the Streets......Page 424
11.6.5 Aging in Place Among Older Prisoners......Page 428
11.7 Implications for the Future......Page 429
Summary: Living Arrangements and Social Interactions......Page 431
12 Enhancing Older Adults’ Lives Through Technology......Page 433
12.1.1 Who Has Access to Technology?......Page 434
12.1.2 Caregiver Use of Technology......Page 436
12.2 Smart Homes......Page 437
12.2.2 Practicalities of Smart Homes for Older Adults......Page 438
12.2.3 Online News and Information......Page 439
12.3.1 Lifelong Learning Opportunities......Page 440
12.4.2 Self-Monitoring Technologies......Page 441
12.4.3 Health Connectivity......Page 443
12.4.4 Therapy for Psychological Well-Being......Page 444
12.6.2 Suggestions for Elder-Appropriate Games......Page 445
12.6.3 Ethical Considerations of Game Technology......Page 448
12.7 Implications for the Future......Page 449
Summary: Enhancing Older Adults’ Lives Through Technology......Page 450
13 Productive Aging......Page 451
13.1.1 Critique of the Concept of Productive Aging......Page 452
13.1.2 Productivity in Its Broadest Context......Page 453
13.2 Retirement......Page 454
13.2.3 Satisfaction With Retirement......Page 455
13.2.5 Those Who Don’t Retire......Page 459
13.3 Employment Status......Page 461
13.3.2 Barriers to Employment......Page 462
13.4 Sources of Income and Economic Status......Page 464
13.4.1 Sources of Income......Page 465
13.4.2 Poverty Among Old and Young......Page 466
13.4.3 Hunger Among Older Americans......Page 467
13.4.4 Public Assistance......Page 468
13.5.1 The Role of Leisure......Page 469
13.5.2 Religious Participation, Religiosity, and Spirituality......Page 470
13.5.3 The Value of Spiritual Well-Being......Page 474
13.5.4 The Importance of Spiritual Assessments......Page 475
13.6 Civic Engagement......Page 477
13.6.1 Conservative and Progressive Views on Civic Engagement......Page 478
13.6.3 Creating Opportunities......Page 479
13.6.4 Membership in Voluntary Associations......Page 480
13.7 Volunteerism......Page 481
13.7.1 Differences in Volunteerism by Race and Socioeconomic Status......Page 483
13.7.2 Cognitive, Physical, and Social Benefits of Volunteerism......Page 484
13.7.3 Rewards Connected to Time in Volunteerism......Page 485
13.8 Lifelong Learning Programs......Page 486
13.9 Political Participation......Page 487
13.9.1 Voting Behavior......Page 488
13.9.2 Senior Power......Page 489
13.9.3 Age-Based Politically Influential Groups......Page 490
13.10 Implications for the Future......Page 492
Summary: Productive Aging......Page 494
14 Death, Dying, Bereavement, and Widowhood......Page 496
14.1.1 The Role of Medical Technology......Page 497
14.1.2 Where Older Adults Die......Page 498
14.1.3 Attitudes Toward Death......Page 499
14.1.4 Variation in Attitudes by Age and Gender......Page 500
14.2.1 Stage Model of Grief Associated With Dying......Page 501
14.2.2 Phases of Grief......Page 502
14.3.1 Defining a Good Death......Page 503
14.3.2 Pain Management......Page 504
14.3.3 Palliative Care......Page 506
14.3.4 Hospice Care......Page 510
14.4 The Right to Die......Page 516
14.4.2 Active Euthanasia......Page 517
14.4.3 The Advance Directive and Living Will......Page 522
14.4.4 National Organizations and End-of-Life Care......Page 529
14.4.5 Cost and Ethical Issues......Page 530
14.5.1 Bereavement and the Grief Process......Page 531
14.6 Widowhood......Page 535
14.6.1 How Widowhood Affects Elders......Page 536
14.6.2 Factors Affecting the Widowhood Experience......Page 537
14.6.3 Gender Differences in Widowhood......Page 538
14.6.4 Support for Widows and Widowers......Page 539
14.8 Implications for the Future......Page 540
Summary: Death, Dying, Bereavement, and Widowhood......Page 542
15 The Resilience of Elders of Color......Page 544
15.1.1 Defining Ethnicity and Culture......Page 545
15.1.2 Differentiating Key Concepts......Page 546
15.1.3 The Dramatic Growth of Elder Populations of Color......Page 547
15.2.1 Cumulative Advantage/Disadvantage......Page 550
15.2.2 Health Disparities and Health Care Disparities......Page 551
15.2.3 Elders of Color in Gerontological Research......Page 552
15.3 Older African Americans......Page 553
15.3.2 Health of African American Elders......Page 555
15.3.3 Social Supports and Living Situations for African American Elders......Page 560
15.4 Older Latinos......Page 561
15.4.2 Health of Latino Elders......Page 563
15.4.3 Social Supports and Living Arrangements for Latinos......Page 567
15.5 Older American Indians/Native Americans......Page 569
15.5.1 Historical Context......Page 570
15.5.2 Economic Status of AI/NA Elders......Page 571
15.5.3 Health of AI/NA Elders......Page 572
15.6 Older Asian/Pacific Islanders......Page 576
15.6.1 Diversity Within API Populations......Page 577
15.6.3 Economic Status of API Elders......Page 579
15.6.4 Health of API Elders......Page 581
15.6.5 Social Supports and Living Situations for API Elders......Page 584
15.7 Implications for Services for All Elders of Color......Page 586
15.8 Implications for the Future......Page 588
Summary: The Resilience of Elders of Color......Page 589
16 The Resilience of Older Women......Page 591
16.1.1 A Feminist Perspective......Page 592
16.1.2 Gaps in Research on Women......Page 593
16.2 Older Women’s Economic Status......Page 594
16.2.2 Unemployment and Underemployment Across the Life Course......Page 595
16.2.3 Social Security and Gender Inequities......Page 597
16.2.4 Private Pensions and Gender Inequities......Page 599
16.3.1 Higher Incidence of Chronic Health Problems......Page 603
16.3.2 Health Conditions Older Women Commonly Experience......Page 605
16.3.3 Health Insurance and Gender Inequities......Page 608
16.4 Older Women’s Social Status......Page 609
16.4.2 Widowhood......Page 610
16.4.3 Informal Networks and Social Support......Page 611
16.5 The Aging Body......Page 613
16.6 Implications for the Future......Page 615
Summary: The Resilience of Older Women......Page 616
17 Social Policies to Address Social Problems......Page 618
17.1.2 Federal Spending and the Political Climate......Page 619
17.2 Variations Among Policies and Programs......Page 621
17.3 Factors Affecting the Development of Public Policies......Page 622
17.3.1 Values and Social Policy......Page 624
17.3.2 Economic Context......Page 625
17.4 Development of Public Policies for Older People......Page 627
17.4.1 In the Wake of the Social Security Act......Page 628
17.4.2 Program Expansion in the 1960s and 1970s......Page 629
17.4.3 Program Reduction in the 1980s and 1990s......Page 630
17.4.5 The Market and Personal Responsibility in the 21st Century......Page 631
17.4.6 Politicization of Age-Based Entitlement Programs......Page 632
17.5 Social Security and Supplemental Security income......Page 633
17.5.1 Retirement Protection for Many Elders......Page 634
17.5.2 How Social Security Is funded......Page 638
17.5.3 The Future of Social Security......Page 639
17.5.4 Social Security Politics Historically......Page 640
17.5.5 Supplemental Security Income (SSI)......Page 644
17.6.1 Private Pensions......Page 645
17.7.1 Social Services Block Grants (Title XX)......Page 646
17.7.2 Older Americans Act (OAA)......Page 647
17.8.1 Age-Based Versus Needs-Based Programs......Page 650
17.8.3 Intergenerational Inequity Framework......Page 651
17.8.4 Interdependence of Generations Framework......Page 652
17.8.5 Government’s Role Versus Individual Responsibility......Page 653
17.9 Implications for the Future......Page 654
Summary: Social Policies to Address Social Problems......Page 655
18 Health and Long-Term Care Policy and Programs......Page 658
18.1.1 Spending and Outcomes......Page 659
18.1.2 Societal Values Influence Costs......Page 660
18.2 Medicare......Page 661
18.2.1 What Does Medicare Cover?......Page 662
18.2.2 The Growth of Managed Care Under Medicare......Page 663
18.2.3 Medicare’s Success......Page 665
18.2.4 A Disconnect in Older Adults’ Needs for LTSS......Page 667
18.2.5 Medicare-Funded Home Health Care......Page 668
18.2.6 Trends in Medicare Spending and Medicare Solvency......Page 670
18.2.7 Medicare Reform and Prescription Drug Coverage......Page 672
18.3.1 Services Provided by Medicaid......Page 675
18.3.2 Who Qualifies for Medicaid?......Page 676
18.3.3 Medicaid and Long-Term Services and Supports (LTSS)......Page 677
18.3.4 Medicaid-Funded Home Health Care......Page 678
18.3.5 The Medicaid Home- and Community-Based Waiver Program (HCBS)......Page 679
18.3.6 Consumer Direction Through Medicaid Programs......Page 681
18.3.7 Paying Privately for LTSS......Page 682
18.3.8 Policies and Programs to Promote Innovative Health and LTSS......Page 684
18.4 Benefits of the Affordable Care Act for Older Adults......Page 685
18.4.1 ACA Innovations to Support the Triple Aim......Page 687
18.4.2 Changes to Medicaid Under the ACA......Page 689
18.5.1 The Federal Commission on Long-Term Care......Page 690
18.6 Implications for the Future......Page 692
Summary: Health and Long-Term Care Policy and Programs......Page 695
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