Unit 5.1 Discussion: Programs in Support of Those in Later Adulthood

Learning Objectives

This chapter will help prepare students to

LeRoy and Rachel had three children, but he was not a good husband. He was seldom at home, and when he was, he was often drunk. After a stormy seven years of marriage that included numerous incidents of physical and verbal abuse, Rachel moved out and got a divorce. She and the children moved to Florida, along with her parents, so that LeRoy could not continue to harass her and the children. LeRoy’s drinking and smoking increased. He was smoking more than two packs a day, and he sometimes also drank a quart of whiskey.

A few years later, he fathered a child for whom he was required to pay child support. At age 39, he married Jane, who was only 20. They had two children and stayed married for six years. Jane eventually left because she became fed up with being assaulted when LeRoy was drunk. LeRoy now had a total of six children to help support, but he seldom saw any of them. LeRoy continued to drink and also ate to excess. His weight went up to 285 pounds, and by age 48 he was no longer able to keep up with the other construction workers. The construction company discharged him.

The next several years saw LeRoy taking odd jobs as a carpenter. He didn’t earn much, and he spent most of what he earned on alcohol. He was periodically embarrassed by being hauled into court for failure to pay child support. He was also dismayed because he no longer had friends who wanted to get drunk with him. When LeRoy was 61, the doctor discovered he had cirrhosis of the liver and told LeRoy he wouldn’t live much longer if he continued to drink. Since LeRoy’s whole life centered on drinking, he chose to continue to drink. LeRoy also noticed that he had less energy and frequently had trouble breathing. The doctor indicated that he probably had damaged his lungs by smoking and now had a form of emphysema. The doctor lectured LeRoy on the need to stop smoking, but LeRoy didn’t heed that advice either. His health continued to deteriorate, and he lost 57 pounds. At age 64, while drunk, he fell over backward and fractured his skull. He was hospitalized for three and a half months. The injury permanently damaged his ability to walk and talk. He is now confined to a low-quality nursing home. He is no longer allowed to smoke or drink. He is frequently angry, impatient, and frustrated. He no longer has friends. The staff detests working with him; his hygiene habits are atrocious, and he frequently yells obscenities. LeRoy frequently expresses a wish to die to escape his misery.

Elroy Karas is 14 months younger than his brother LeRoy. Elroy’s early years were in sharp contrast to LeRoy’s. Elroy had a lean, almost puny, muscular structure and did not excel at sports. LeRoy was his parents’ favorite, and also dazzled the young females in school and in the neighborhood. Elroy had practically no dates in high school and was viewed as a prude. He did well in math and the natural sciences. He spent much of his time studying and reading a variety of books, and he liked taking radios and electrical appliances apart. At first, he got into trouble because he was not skilled enough to put them back together. However, he soon became known in the neighborhood as someone who could fix radios and electrical appliances.

At RCA, Elroy began dating a secretary, Elvira McCann, and they were married when he was 36. Life became much smoother for Elroy after that. He was paid well and enjoyed annual vacations with Elvira to such places as Hawaii, Paris, and the Bahamas. Elroy and Elvira wanted to have children, but could not. When Elroy was in his early 40s, they adopted two children, both from South Korea. They bought a house in the suburbs and a sailboat. Elroy and Elvira occasionally had some marital disagreements but generally got along well. In their middle adult years, one of their adopted sons, Kim, was tragically killed by an intoxicated automobile driver. That death was a shock and very difficult for the whole family to come to terms with. But the intense grieving gradually lessened, and after a few years Elroy and Elvira put their lives back together.

Now, at age 67, Elroy is still working for RCA and loving it. In a few years, he plans to retire and move to the Hawaiian island of Maui. Elroy and Elvira have already purchased a condominium there. Their surviving son, Dae, has graduated from college and is working for a life insurance company. Elroy is looking forward to retiring so that he can move to Maui and spend more time on his hobbies—photography and making model railroad displays. His health is good, and he has a positive outlook on life. He occasionally thinks about his brother and sends him a card on his birthday. Since Elroy never had much in common with LeRoy, he seldom visits him.

A Perspective

Later adulthood is often the age of recompense (our return for the way we lived earlier). How we live in our younger years largely determines how we will live in our later years.

14-1aWhat Is Later Adulthood?

Later adulthood is the last major segment of the lifespan. The age of 65 has usually been cited as the dividing line between middle age and old age (Santrock, 2016). There is nothing magical or particularly scientific about 65. Wrinkles do not suddenly appear on the 65th birthday, nor does hair suddenly turn gray or fall out. In 1883, Germany set 65 as the criterion of aging for the world’s first modern social security system (Sullivan, Thompson, Wright, Gross, & Spady, 1980). When our Social Security Act was passed in 1935, the United States followed the German model by selecting 65 as the age of eligibility for retirement benefits.

Gerontologists—doctors who specialize in medical care of older people—have attempted to deal with these age-related differences among older people by dividing later adulthood into two groups:  young-old—ages 65 to 74 years; and  old-old—ages 75 and above (Santrock, 2016).

14-2 Describe the Physiological and Mental Changes That Occur in Later Adulthood

14-2aSenescence

The process of aging is called  senescence. Senescence is the normal process of bodily change that accompanies aging. Senescence affects different people, and various parts of the body, at different rates. Some parts of the body resist aging more than others. In this section, we will look at the aging process in later adulthood.

Appearance

Changes in physical appearance include increased wrinkling, reduced agility and speed of motion, stooping shoulders, increasing unsteadiness of the hands and legs, increased difficulty in moving, thinning of hair, and the appearance of varicose veins. Wrinkling of the skin is caused by the partial loss of elastic tissue and of the fatty layer of the skin.

Senses

The acuity of the senses generally deteriorates in later years. The sense of touch declines with age due to drying, wrinkling, and toughening of the skin. The skin also has increased sensitivity to changes in temperature. Since the automatic regulation of bodily functions responds at a slower rate, older people often “feel the cold more.” Exposure to cold and to poor living conditions may cause abnormally low body temperature, which is a serious problem for some older people. They cannot cope as well as younger people with heat either, and therefore cannot work as effectively in moderately high temperatures as younger people can.

The sense of hearing gradually deteriorates. The ability to hear very high tones is generally affected first. As time goes on, the level of auditory acuity becomes progressively lower. Many older people find it difficult to follow a conversation when there is a competing noise, as from a radio, television, or other people talking. An impairment in hearing is five times more likely in those aged 65 to 79 than it is in individuals aged 45 to 64 years. Men are more apt to experience hearing impairments than are women (Santrock, 2013b). People who have a hearing impairment are apt to feel lonely and isolated, as they cannot as readily join in conversations. Sometimes such an impairment and related feelings of isolation facilitate the development of personality quirks that make people harder to get along with, which further increases their loneliness. (We see once again how the physical and social environment can affect emotional development.)

Vision also declines. Most people over age 60 need glasses or contact lenses to see well. The decline in vision is usually caused by a deterioration of the lens, cornea, retina, iris, and optic nerve. The power of the eye to adjust to different levels of light and darkness is reduced, and color perception is also reduced. Older people are likely to have 20/70 vision or less, they are not as able to perceive depth as others are, and they cannot see as well in the dark, a problem that keeps many of them from driving at night. Half of the legally blind persons in the United States are over 65 (Papalia & Martorell, 2015).

In many older people, the eyes eventually appear sunken due to a gradual loss of orbital fat. The blink reflex is slower, and the eyelids hang loosely because of reduced muscle tone.

Cataracts are a common concern of older people. A cataract is a clouding of the lens of the eye, or of its capsule, that obstructs the passage of light. The consequences of a cataract for visual functioning depend on its location. The most common form of a cataract involves hardening of cell tissues in the lens. Cataracts prevent light from passing through and can thus cause blurred vision and blindness. In severe cases, double vision may result. Cataracts generally can be surgically removed and a substitute lens implanted. More than half of older adults develop cataracts (Papalia & Martorell, 2015). Fortunately, with the development of corrective lenses and new surgical techniques for removing cataracts and implanting artificial lenses, many vision losses can be fully or partially restored.

A frequent cause of blindness among older people is glaucoma, which occurs when fluid pressure in the eye builds up. This pressure, if untreated, damages the eye internally. If this disease (which seldom has early symptoms) is detected through routine vision checkups, it can be treated and controlled with eyedrops, medication, surgery, or laser treatments.

The senses of taste and smell have reduced functional capability during advancing years. Much of this reduced sensitivity appears to be related to illness and poor health rather than to a deterioration of sense organs due to age. Taste is often based on what people can smell. More than four out of five persons over 80 years of age have major impairments in smell, and more than half have practically no sense of smell at all (Papalia & Martorell, 2015). Because food loses its taste for those who have serious impairments in smell and taste, those affected eat less and are often undernourished.

The vestibular senses, which function to maintain posture and balance, also lose some of their efficiency. As a result, older people are more prone to fall than younger adults. Older people are also more apt to suffer from dizziness, which increases the likelihood they will fall.

Teeth

As people grow older, their gums gradually recede, and the teeth increasingly take on a yellowish color. Periodontal disease (a disease of the gums) becomes an increasing problem. Many older people eventually lose many of their teeth; the problem is more severe for people from low income levels, who often have financial and transportation barriers to receiving dental care (Santrock, 2016). Having teeth replaced with dentures takes several weeks of adjustment, and the person is not able to eat or sleep as well during this period. Poor teeth or the use of dentures may also be traumatic, as it indicates that the person is aging physically. A person’s disposition can be adversely affected. On the other hand, for some people dentures improve their appearance and may lead to an improved self-concept. Many of the facial evidences of later adulthood can be prevented by proper dental care throughout life or by using dentures. Dental health is related to a combination of innate tooth structure and lifelong eating and dental health habits.

Voice

In later adulthood, the voice may become less powerful and more restricted in range. Public speaking and singing abilities generally deteriorate earlier than normal speaking skills. These changes are partly due to the hardening and decreasing elasticity of the laryngeal cartilages. Speech often becomes slower, and pauses become longer and more frequent. If there are pathological changes in the brain, slurring may occur.

Skin

The skin in many older people becomes somewhat splotchy, paler in color, and loses some of its elasticity. Some of the subcutaneous muscle and fat disappears, resulting in the skin hanging in folds and wrinkles.

Psychomotor Skills

Older people can do most of the same things that younger people can do, but they do them more slowly. A key factor in the high accident rates of older people is a slowdown in the processing of information by the central nervous system (Papalia & Martorell, 2015). It takes older people longer to assess their environment, longer to make a decision after assessment, and then longer to implement the right action. This slowness in processing information shows up in many aspects of older people’s lives. Then rate of learning new material is slowed, and the rate at which they retrieve information from memory is reduced.

Have you ever been irritated when an older person was driving a car slowly in front of you? Perhaps you even blasted your car horn in an attempt to hurry that person along. We need to remember that older people are probably functioning at the pace that is safe for them.

Physical exercise and mental activity appear to reduce losses in psychomotor skills, such as in the areas of speed, strength, and stamina. Regular exercise also helps to maintain the circulatory and respiratory systems and helps people be more resistant to physical ailments that might be fatal, such as heart attacks.

Intellectual Functioning

The notion that there is a general intellectual decline in old age is largely incorrect. Most intellectual abilities hold up well with age. Older people do tend to achieve somewhat lower scores on IQ tests than younger people, and the scores of older people gradually decline as the years pass (Santrock, 2016). In explaining such differences, Papalia and Martorell (2015) note that a distinction needs to be made between performance and competence. While older people show a decline in performance on IQ tests, their actual intellectual competence may not be declining. Their lower performance on IQ tests could be due to a variety of factors. With their diminished capacities to see and hear, they have more difficulty perceiving instructions and executing tasks. Due to their reduced powers of coordination and agility, they may perform less well. They may be more fatigued, and fatigue has been found to suppress intellectual performance. Speed is a component of many IQ tests, and older people have a decline in speed because it takes them longer to perceive, longer to assess, and longer to respond (Santrock, 2016). In addition, when older people know they are being timed, their anxiety increases, as they know that it takes them longer to do things than it used to; such increased anxiety may actually lower performance (Papalia et al., 2012).

Ethical Question 14.1

When older adults lose the capacity to drive a vehicle, it severely restricts their social interactions, is an assault on their mental well-being, and lessens their independence.

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The reduced performance by older people on IQ tests may also be partly due to a lessening of continuing intellectual activity in later adulthood. It appears that the reduced use of one’s intellectual capacities results in a reduction of intellectual ability. Such a proposition underscores the need for older people to remain intellectually active.

A  terminal drop in intelligence—that is, a sudden drop in intellectual performance—often occurs a few weeks or a few months before death from a terminal illness (Papalia & Martorell, 2015). A terminal drop is not limited to older people; it is also found in younger people who have a terminal illness.

Nervous System

Although there is little functional change in the nerves with increasing age, some of the nerve tissue is gradually replaced by fibrous cells. Reflex and reaction times of an older person become slower. The total number of brain cells may decrease, but the brain continues to function normally unless its blood supply is blocked. The brain weight of an average 75-year-old person is similar to that of a middle-aged person (Santrock, 2016). People with certain medical conditions (such as cerebral arteriosclerosis) will have progressive deterioration of brain tissue. If such deterioration takes place, the person may have a loss of recent and/or past memories; may become apathetic may be less coordinated in body movements; may give less attention to grooming habits; and may have some personality changes (such as being more irritable, confused, and frustrated). In many older people, the cortical area of the brain that is responsible for organizing the perceptual processes gradually shows degenerative changes.

Digestive System

With increased age, there is a reduction in the amount of enzyme action, gastric juices, and saliva, which upsets the digestion process. Complaints about digestive disorders are among the most common complaints of older people. Since the digestive system is highly sensitive to stress, to emotional disturbances, and to anxieties that accompany old age, many of the digestive disorders may be due to these factors rather than to age. The regularity of bowel movements is also more of a problem in later adulthood, resulting in diarrhea or constipation.

Respiration

As people age, their lungs decrease in size, resulting in a decrease of oxygen utilization. Some air sac membranes are replaced by fibrous tissue, which obstructs the normal exchange of gases within the lungs. The maximum breathing capacity and maximum oxygen intake in a 75-year-old are about 40 percent of those of a 30-year-old (Santrock, 2016). Moderate exercise throughout life is important for keeping oxygen intake and blood flow at their highest levels, thereby slowing down the aging process.

Heart

The heart and the blood vessels are the body parts in which aging produces the most destructive changes. The heart and arteries are the weakest link in the chain of life, as most of the other organs would probably last for 150 years if they received an adequate blood supply (Santrock, 2016). The heart is affected by aging in a variety of ways. It shrinks in size, and the percentage of fat in the heart increases. The heart muscles tend to become stringy and dried out. Deposits of a brown pigment in the cells of the heart partly restrict the passage of blood and interfere with the absorption of oxygen through the heart walls. The elasticity in the valves of the heart is reduced, and deposits of cholesterol and calcium in heart valves also decrease valve efficiency.

The heart of an older person pumps only 70 percent as much blood as that of a younger person (Santrock, 2016). The rhythm of the heart becomes slower and more irregular. Deposits of fat begin to accumulate around the heart and interfere with its functioning. Blood pressure also rises. These changes are not necessarily dangerous, provided the heart is properly treated. A nutritious diet, moderate exercise, adequate sleep, and a positive mental attitude will help keep the heart functioning properly.

In later life, the coronary artery has a tendency to harden and become narrow, which may lead to a partial blockage. The coronary artery is the site of many heart attacks that are brought on by increased emotional stress or physical effort. Hardening of the coronary artery may also increase blood pressure and may reduce the flow of blood to many parts of the body. Poor circulation of blood may cause a variety of problems. For example, poor circulation to the brain may lead to brain deterioration and to personality changes. Poor circulation to the kidneys may result in kidney problems and even kidney failure.

Reserve Capacity

As people age, their reserve capacities decrease. As a result, older people cannot respond to stressful demands as rapidly as younger adults. An older person who used to be able to mow the lawn, and then go waterskiing, may now exhaust the capacity of the heart by mowing the lawn. Young people usually recover fairly rapidly from the flu or pneumonia, while older people may succumb to these illnesses. Because older people no longer have fast reflexes, vigorous heart action, and quick-responding muscles, they are at a greater risk of being victims of certain accidents (e.g., traffic accidents that occur while crossing the street). As the reserve capacity continues to diminish, those affected become less able to care for themselves and more dependent on others.

Sexuality: Conceptualizing Sexual Response

Masters and Johnson (1966) identified four stages of sexual response in females and males: excitement, the plateau stage, orgasm, and resolution. There are many similarities in the physical responses of men and women. These include the two major body changes that result from individual stimulation—myotonia, or muscle tension; and vasocongestion, or blood engorgement.

Ethical Question 14.2

Nongenetic Cellular Theories

This category of theories postulates that changes take place in cellular proteins after they have been formed. Such changes cause some cells to die, which results in aging.

An example of this category of theories is the  accumulation theory, which asserts that aging results from the accumulation of harmful substances in the cells of an organism. When the accumulation builds up, the cells eventually begin to die. The specific substances involved have not yet been identified.

Physiological Theories

These theories explain aging as being due to either the breakdown of an organ system or an impairment in physiological control mechanisms. An example of this category of theories is the  stress theory, which asserts that aging is due to the accumulated effects of the stresses of living. Each stress encountered is thought to leave a small residual of accumulants and impairments, with the result that bodily systems age. This theory is consistent with clichés about how stressful events will turn a person’s hair gray or cause one’s hair to fall out.

Evaluation of Theories of Aging

Everyone grows old, so the conclusion is obvious that nature has a built-in mechanism that promotes aging. We still do not know what this mechanism is. As yet, sufficient evidence has not been presented to prove which (if any) theory is valid.

How Far Can the Lifespan Be Extended?

Some people are now living beyond 100 years. Today, people over 100 are a fast-growing segment of the population. Is there a fixed limit on the lifespan? Experts disagree with one another (Papalia & Martorell, 2015). Some assert there is no fixed limit on how long people may live, while others believe that genetics plays at least a partial role in human longevity, and therefore the idea of an exponential increase in the human lifespan is unrealistic.

One promising line of research to extend the lifespan centers on dietary restriction. Drastic caloric reduction (while still including all necessary nutrients) has been found to significantly extend the life span (Papalia & Martorell, 2015).

14-4 Describe Common Diseases and Major Causes of Death among Older Adults

14-4aDiseases and Causes of Death among Older People

Most older people have at least one chronic condition, and some have multiple conditions. The most frequently occurring chronic conditions are arthritis, hypertension, hearing impairments, heart disease, orthopedic impairments, cataracts, diabetes, visual impairments, and sinusitis (Papalia & Martorell, 2015). Older people see their doctors more frequently, spend a higher proportion of their income on prescribed drugs, and once in the hospital, stay longer. As might be expected, the health status of the old-old (75 and over) is worse than that of the young-old.

The medical expenses of an older person average four times more than those of a young adult (Papalia & Martorell, 2015). One of the reasons medical costs are high is that older adults suffer much more from long-term illnesses—such as cancer, heart problems, and diabetes.

Over a period lasting from as few as 5 years to as many as 20, the disease destroys brain cells. The changes in behavior displayed by those afflicted may vary. Brownlee (1991) notes:

One sufferer refuses to bathe or change clothes, another eats fried eggs without utensils, a third walks naked down the street, a fourth has the family’s beloved cats put to sleep, while yet another mistakes paint for juice and drinks it. The outlandish acts committed by Alzheimer’s patients take as many forms as there are people who suffer the disease. Yet, in every case, the bizarre behavior serves as a sign that the sufferer is regressing towards unawareness, a second childishness. (p. 40)

Researchers in recent years have made tremendous strides in identifying the causes of Alzheimer’s disease. Several different genes have been identified as being linked to the disease, and there may be more genes involved. Yet having one or more of these genes does not necessarily mean one will develop this disorder. Therefore, researchers believe, there must be some as yet unidentified, triggers. Possible triggers are viral infections, biochemical deficiencies, high levels of stress, toxic substances, exposure to radiation, and nutritional deficiencies. Scientists are aware that genetic tendencies are a contributing factor, because relatives of Alzheimer’s patients have an increased risk of having the disease (Papalia & Martorell, 2015).

Examination of the brains of victims has revealed a distinctive tangle of protein filaments in the cortex, the part of the brain responsible for intellectual functions. This research shows that the disease has biochemical causes and leads to the conclusion that aging does not automatically include senility.

Diagnosing Alzheimer’s disease is difficult because the disorder has symptoms that are nearly identical to other forms of dementia. The only sure diagnosis at the present time is the observation of tissue deep within the brain, which can be done only by autopsy after death. Doctors usually diagnose the disease in a living person by ruling out other conditions that could account for the symptoms.

The most prominent early symptom of the disease is memory loss, particularly for recent events. Other early symptoms (which are often overlooked) are reduced ability to play a game of cards, reduced performance at sports, and sudden outbreaks of extravagance. More symptoms then develop—irritability, agitation, confusion, restlessness, and impairments of concentration, speech, and orientation. As the disease progresses, the symptoms become more disabling. The caregiver or caregivers eventually have to provide 24-hour care—which is a tremendous burden for caregivers. As the disease progresses in its final stages, a nursing home is often necessary. Near the end, the patient usually cannot recognize family members, cannot understand or use language, and cannot eat without help.

Brownlee (1991) briefly describes the mental and physical trauma that patients’ caregivers and family members experience:

They live in a private hell, one that cannot be discussed with neighbors and friends in too much detail because the details are so devastating. They grieve even as their loved ones plunge them into a maelstrom of unreality, where mothers streak through the living room wearing nothing but a shower cap and garter belt and grandfathers try to punch their baby granddaughters. (p. 48)

In addition, the patient’s inability to reciprocate expressions of caring and affection robs relationships of intimacy.

Scientists are now investigating a number, of hypotheses as to what triggers Alzheimer’s. One intriguing finding is that victims of Down syndrome (a severe form of mental retardation due to a chromosome defect) who survive into their 30s frequently develop symptoms indistinguishable from Alzheimer’s. Such a similarity may provide a clue as to what triggers Alzheimer’s. A recent clue is the discovery, of fragments of amyloid in brains of persons who have died from the disorder. Amyloid is a very tough protein that in normal amounts is necessary, for cell growth throughout the body. Some researchers hypothesize that abnormal patches of this protein in the brain set up a chain reaction that progressively destroys brain cells: This amyloid protein is an abnormal product formed from a larger compound called the amyloid precursor protein, or APP.

Researchers are attempting to develop a test to detect Alzheimer’s disease in its early stages. Detecting the disease early would enable people to plan for their future care and make arrangements for their families while they still retain control of their mental faculties. Furthermore, if in fact Alzheimer’s disease results from an accumulation of the amyloid protein, and if the early accumulation of this protein can be detected, then it is likely that drugs can be developed to treat the disorder by blocking the formation of amyloid in the brain. There are high hopes that the causes of Alzheimer’s can be found soon and new treatments developed.

Already, early diagnosis and treatment can slow the progress of the disease and improve the quality of life. Cholinesterase inhibitors (such as Aricept) can stabilize or slow symptoms for six months to a year, in one-third to one-half of patients (Papalia & Martorell, 2015). Behavioral therapies can improve communication, slow the deterioration in capabilities, and reduce disruptive behaviors. Certain drugs can lighten depression, relieve agitation, and assist patients in sleeping. Proper nourishment, appropriate exercise, physical therapy, and social interaction may slow the progression of the disease. Memory training and memory aids in the early stages may improve cognitive functioning. Especially helpful to patients and their families are emotional and social support provided by groups and professional counseling.

14-4cLife Expectancy

The average life expectancy in ancient Rome and during the Middle Ages was between 20 and 30 years. Some people lived to be 70 or 80, but infant mortality was very high, and famine, diseases, and wars took the lives of many more. The life expectancy for Americans has gradually been increasing due to better sanitation, nutrition, and disease control. In the middle of the 19th century, Americans lived for an average of 40 years. At the turn of the 20th century, the average was 49 years. The average life expectancy in 2015 was 79 years (Mooney, Knox, & Schacht, 2015). These gains have resulted from improvements in infant survival, medical care, diets, and sanitation. Two significant factors leading to these gains have been the immunization effort against many diseases that used to kill (such as whooping cough, polio, and diphtheria) and the development of antibiotics that reduce the severity of such illnesses as strep throat, bronchitis, and pneumonia.

Ethical Question 14.3

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Factors associated with a shorter life expectancy are as follows:

1. Parents and grandparents died of an illness fairly early in their lives—such as a heart attack or a stroke before age 50.

2. Parents or grandparents had diabetes, thyroid disorders, breast cancer, cancer of the digestive system, asthma, or chronic bronchitis.

3. Being unmarried for most adult years.

4. Being overweight.

5. Not exercising regularly.

6. Having a sedentary job.

7. Drinking heavily (more than four drinks per day).

8. Smoking—cigarettes, pipe, or cigars.

9. Being aggressive, intense, and competitive.

10. Often being unhappy, or worried, or feeling guilty.

11. Not completing high school.

12. Living in an urban environment that has moderate to high levels of smog.

13. Experiencing frequent illness.

14. Experiencing high levels of stress without routinely using stress management techniques.

15. Engaging in activities that are high risk for the AIDS virus (Santrock, 2016).

If social workers do not care for themselves, their ability to care for others will be sharply diminished or even depleted. This chapter describes a number of intervention strategies that social workers (and social work students) can and should use to maximize their own physical, emotional, intellectual and spiritual well-being. Significantly, these intervention strategies are precisely the strategies that social workers should convey to their clients so that these clients can improve their lives (Cox & Steiner, 2013; Smullens, 2015).

14-5bPhysical Exercise

For people who have had poor health-maintenance habits, it is nearly never too late to change. Many studies have shown that older people benefit from a variety of exercise programs that include walking, swimming, and weight lifting. There is also evidence that as people grow older, continued exercise reduces the degree of physical and mental slowness that occurs in many older people. However, before middle-aged and older adults embark on exercise programs (if they have been relatively inactive for a number of years), they should have physical examinations to identify heart conditions and other medical problems that may be aggravated by exercise.

14-5cMental Activity

Just as physical exercise maintains the level of physiological functioning, mental exercise maintains good cognitive functioning. As mentioned, there are some age-related declines in cognitive functioning, but if a person is mentally active, the declines begin to appear at a later age and are less severe.

Our society needs to put more emphasis on ensuring that older people are exposed to intellectual stimulation. Some nursing homes and retirement communities now have daily programs that provide such stimulation; national issues or local issues are discussed, and guest speakers on a variety of subjects are sometimes brought in.

Traveling is yet another way for older people to stay mentally active. Some organizations, such as the AARP (formerly the American Association of Retired Persons) and Road Scholar, offer travel tours within the United States and to other parts of the world.

The more mentally and physically active we are, the better our physical health, emotional well-being, and intellectual alertness.

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Most authorities on aging now believe that intellectual decline in later adulthood is largely a myth. It thus appears that our society is wasting a precious resource—an older population with extensive experience, training, and intelligence. Our society needs to develop more educational programs to help older people maintain their intellectual functioning, and we must find additional ways to allow older people to be productive, contributing members of society.

14-5dSleep Patterns

Many older people have one or more sleep disturbances, such as insomnia, difficulty in falling asleep, restless sleep, falling asleep when company is present, frequently awakening during the night, and feeling exhausted or tired after a night of fitful sleep.

What is a healthy sleep pattern for older people? The stereotype that older people need more sleep appears to be erroneous. It appears that older people in fairly good health require no more sleep than do those in middle adulthood (Santrock, 2016).

Sleep disturbances that older people experience tend to be a result of anxiety, depression, worry, or illness. Restless sleep is common for those who are inactive, those who catnap too much, and those who have physical discomforts (such as arthritic pain).

Some normal changes occur in sleep patterns for older people. Deep sleep virtually disappears. Older people generally take a longer time to fall asleep and have more frequent awakenings. More important, older people distribute their sleep somewhat differently. They generally have several catnaps of 15 to 60 minutes during the day. Catnaps are normal, and caution should be used in attempting to use sleep medication to keep an older person asleep for eight hours throughout the night, as they need less sleep when they have catnaps. People develop their sleep patterns according to their physical needs and according to the responsibilities and activities they have.

14-5eNutrition and Diet

The majority of older people have inadequate diets (Newman & Newman, 2015). Because of the relationship between diet and cardiac problems, physicians recommend that older adults eat a low-fat high-protein diet.

Some older people have a tendency to overeat. One way for people to occupy their free time is to eat, and most older people have a lot of free time. The caloric requirements decrease somewhat in the later years, and the excess calories turn into fat, increasing the risks of heart disease and other medical conditions.

Numerous programs have been developed to improve the nutritional health of older people. Many communities, with the assistance of federal funds, now provide meals for older people at group eating sites. These meals, usually lunches, are generally provided four or five times a week. These programs not only improve the nutrition of older people but also offer opportunities for socialization. Meals on Wheels is a service that delivers hot and cold meals directly to housebound recipients who are unable to prepare their own meals, but who can feed themselves.

14-5fStress and Stress Management

Learning how to manage stress is important for the physical and emotional health of all age groups. Because of its importance, we will discuss stress and techniques to manage stress in considerable detail.

Stress is a contributing factor in a wide variety of emotional and behavioral difficulties, including anxiety, child abuse, spouse abuse, temper tantrums, feelings of inadequacy, physical assaults, explosive expressions of anger, feelings of hostility, impatience, stuttering, suicide attempts, and depression (Seaward, 2014).

Stress is a contributing factor in most physical illnesses (Seaward, 2014), including hypertension, heart attacks, migraine headaches, tension headaches, colitis, ulcers, diarrhea, constipation, arrhythmia, angina, diabetes, hay fever, backaches, arthritis, cancer, colds, flu, insomnia, hyperthyroidism, dermatitis, emphysema, Raynaud’s disease, alcoholism, bronchitis, infections, allergies, and enuresis. Stress-related disorders have been recognized as being our number-one health problem (Seaward, 2014).

Learning how to relax is important in treating and facilitating recovery from both emotional and physical disorders. The therapeutic value of learning how to manage stress has been dramatically demonstrated by Simonton and Matthews- Simonton (1978), who have had considerable success in treating terminal cancer patients by teaching them how to manage and reduce stress.

The increased recognition of stress management in treating physical and emotional disorders is gradually altering the traditional physician-patient relationship. Instead of being passive participants in the treatment process, patients are increasingly being taught (by social workers and other health professionals) how to prevent illness and how to speed up their recovery from illness by learning stress management strategies (Seaward, 2014).

People who are successful in managing stress have a life expectancy that is several years longer than those who are continually at high stress levels (Seaward, 2014). Effective stress management is a major factor in enabling people to live fulfilling, healthy, satisfying, and productive lives.

Conceptualizing Stress

Stress can be defined as the physiological and emotional reactions to stressors. A stressor is a demand, situation, or circumstance that disrupts a person’s equilibrium (internal balance) and initiates the stress response. There are an infinite variety of possible stressors: loss of a job, a loud noise, toxic substances, retirement, arguments, the death of a spouse, a move to a nursing home, hot or cold weather, serious illness, a lack of a purpose in life, and so on. Every second we are alive, our bodies are responding to stressors that call for adaptation or adjustment. Our bodily reactions are continually striving for homeostasis, or balance.

Selye (1956), one of the pioneer researchers on stress, found that the body has a three-stage reaction to stress:

· (1)

the alarm phase,

· (2)

the resistance phase, and

· (3)

the exhaustion phase.

Selye called this three-phase response the  general adaptation syndrome (GAS).

· Increased breathing and heartbeat rates

· A rise in blood pressure

· Increased coagulation of blood, which minimizes potential loss of blood in case of physical injury

· Diversion of blood from the skin to the brain, the heart, and contracting muscles

· A rise in serum cholesterol and blood fat

· Decreased mobility of the gastrointestinal tract

· Dilation of the pupils

These changes result in a huge burst of energy, better vision and hearing, and increased muscular strength—all changes that increase our capacity to fight or to flee.

A major problem of the fight-or-flight reaction is that we often cannot deal with a threat by fighting or by fleeing. In our complex, civilized society, fighting or fleeing generally runs counter to sophisticated codes of acceptable behavior. The fight-or-flight response was once functional for primitive humans, but now seldom is.

In the resistance phase, bodily processes seek to return to homeostasis. During this second phase, the body seeks to repair any damage caused by the stressors. In handling most stressors, the body generally goes through only the two phases of alarm and repair. In the course of a lifetime, a person goes through these two phases hundreds of thousands of times.

The third phase, exhaustion, occurs only when the body remains in a state of high stress for an extended period of time. If the body remains at a high level of stress, it is unable to repair damage that has occurred. If exhaustion continues, a person is apt to develop a stress-related illness.

Changing One’s Thinking about a Distressing Event

Some events cannot be changed. For example, Juan Garcia (age 64) has experienced such a severe deterioration in his eyesight that he is no longer able to drive his truck (by which he earned a living) or even a car. Ophthalmologists have informed him that his eyesight will slowly continue to deteriorate and that the condition is not reversible. Since Juan cannot change the situation, the only constructive alternative is to accept it and find meaningful activities unrelated to driving. It is counterproductive to complain or get upset about something that cannot be changed. Acceptance of the situation will also improve Juan’s disposition.

Highlight 14.7

Law of Attraction, and Becoming All That You Can Be

The Law of Attraction asserts that a person’s thoughts (both conscious and unconscious) dictate the reality of that person’s life, whether or not he or she is aware of it. The Law further asserts that if you really want something and truly believe it’s possible, you’ll get it. Furthermore, if you place a lot of attention and thought on something you don’t want, you’ll probably get that, too. For example, if you continue to worry and dwell on your belief that your romantic life “is in the pits,” that belief system (along with the way you present yourself in accordance with this belief system) will lead you to have unhappy romantic relationships.

Think of the qualities you admire in others. A partial list might include honesty, a good listener, happy, contented, good sense of humor, charming, good problem solver, reliable, punctual, someone who helps you out when you need help, takes good care of her or his physical self, empathetic, perceptive, respectful of differences in others, usually has a smile, and focuses on the strengths of others.

The Law of Attraction asserts we are always sending out vibes/vibrations of what we are thinking/feeling. If we are thinking bad thoughts, we will have bad feelings and will be sending out negative vibes. It we are thinking good/positive thoughts, we will have good feelings and will be sending out good vibes.

We like to be with people who send out good vibes—and who have the qualities we admire. We generally do not like to associate with people who are sending out bad vibes.

In order for a salesperson to be successful, he or she needs to be sending out good vibes so that customers will want to converse with him or her. In order for a social worker to be effective with clients, he or she also needs to be sending out good vibes so that clients will want to converse with him or her. This rule applies to most professionals: physicians, attorneys, psychologists, psychiatrists, guidance counselors, teachers, and so on.

The Law of Attraction asserts that if you present yourself as exhibiting the positive qualities that are listed above, many doors will be opened up for you, and you will be successful, happy, contented, relaxed, and so on.

Are you willing to make a commitment to presenting yourself to others as having the positive characteristics you admire in others?

Taking One’s Mind off the Distressing Event, Usually by Thinking about Something

Else There are a variety of ways to stop thinking about a distressing event.

1. Relaxation Techniques. Deep-breathing relaxation, Imagery relaxation, progressive muscle relaxation, meditation, and biofeedback are effective techniques for reducing stress and inducing the relaxation response (becoming relaxed). For each of these techniques, the relaxation response is facilitated by sitting in a comfortable position, in a quiet place, with closed eyes (Davis, McKay, & Eshelmen, 2000).

Deep-breathing relaxation helps you stop thinking about day-to-day concerns by concentrating on your breathing processes. For 5 to 10 minutes, slowly and gradually inhale deeply and exhale, while telling yourself something like, “I am relaxing, breathing more smoothly. This is soothing, and I’m feeling calmer, renewed, and refreshed.” Continued practice on this technique will enable you to become more relaxed whenever you are in a tense situation—such as before giving a speech.

Imagery relaxation involves switching your thinking from your daily concerns to focusing (for 10 to 15 minutes) on your ideal relaxation place. It might be lying on a beach beside a scenic lake in the warm sun. It might be relaxing in warm water while you read a magazine. Savor all the pleasantness, the peacefulness—focus on everything that you find calming, soothing, relaxing. Sense your whole body becoming refreshed, revived, and rejuvenated.

A variety of meditative approaches are being used today. (Deep-breathing relaxation and imagery relaxation are two forms of meditation.) Benson (1975) has identified four basic components common to meditative approaches that induce the relaxation response:

· (1)

being in a quiet environment free from external distractions;

· (2)

being in a comfortable position;

· (3)

having an object to dwell on, such as a word, sound, chant, phrase, or imagery of a painting (a good word to dwell on is “peace”); and

· (4)

having a passive attitude in which you stop thinking about day-to-day concerns.

This last component, Benson asserts, is the key element in inducing the relaxation response.

Meditation is an excellent way to relax and reduce stress levels.

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Many people who are untrained in mindfulness focus their thoughts on ruminating about the past (in which they compulsively focus their attention on past distressing events); or they worry about the future; or they focus on trying to make decisions about courses of action they might take to alleviate distressing situations; or they focus on judging others; or they criticize themselves for things they did or failed to do. Such thought processes generally lead to anxiety, discomfort, frustration, and a high level of stress.

There are a number of benefits to mindfulness meditation. It has been found to: reduce rumination (that is, reduce thinking negatively about past, present, or future events), reduce stress, boost working memory, improve affect, decrease depression, increase focus and suppress distracting information, increase cognitive flexibility, increase the ability to communicate one’s emotions to a partner, enhance self-insight, increase intuition, decrease anxieties, increase physical well-being, increase information processing speed, promote empathy increase compassion for others, improve self-concept, and increase quality of life (Kabat-Zinn, 2012).

There are a large number of different mindfulness exercises. The following is an example of an exercise you can try. Find a quiet, comfortable place to sit down. This might be on a chair, or on a cushion on the floor. If it is a cushion on the floor, you may choose to cross your legs. Take a posture that is upright, but not rigid. Your back should be straight, with the curve in the lower back that is naturally there. For the next several minutes, just focus on your breathing. Your eyes may be closed, or open. Do not try to control the flow of your breathing—just focus on the air going in and out of your body.

Notice how the air feels as it enters and exits. Notice how your stomach and rib cage rises and falls as you breathe in, and then out. Also, acknowledge your feelings, images, memories, and thoughts—and allow them to float along, like a gentle moving white cloud on a very pleasant day. Allow your thoughts to come and go without judging them. Then focus again on your breathing. Expect your mind to wander—acknowledge the thoughts, images, and memories—without placing a judgment on them. Return to focus your attention on your breathing, and feel your body gradually relaxing as you breathe in and out. Remember that mindfulness meditation is about practicing being mindful of whatever happens. It is NOT about getting ourselves to stop thinking. With mindfulness, we are trying to be with ourselves as we already are, not trying to change ourselves into some preconceived notion of how we ought to be instead. Seek to practice this meditation technique a few times a day. Gradually, as the days pass, increase the time that you meditate to around 20 minutes at a time.

Two additional mindfulness exercises will be mentioned.

Body scan. Start with your toes and focus your attention and awareness on whatever you sense in this body part. Gradually then focus your attention on your ankles and be aware of whatever you sense about this body part. Gradually do the same for calves, then your knees, then your thighs, then your pelvis, then your stomach, then your chest, then your neck, then your face, and finally the top of your head.

Walking Meditation. As you taking a walk, focus on the movement of your body as you step after step. Be aware of all of the movement that is taking place—perhaps first your heels, then your toes, then your ankles, then your calves, your knees, your thighs, your arms, and so on.

(Mindfulness is closely related to relaxation techniques.)

4. Pleasurable Goodies. Pleasurable goodies relieve stress, change our pace of living, are enjoyable, make us feel good, and are, in reality, personal therapies. What is a “goody” (pleasurable experience) to one person may not be to another. Common goodies are being hugged, listening to music, going shopping, taking a bath, going to a movie, having a glass of wine, taking part in family and religious get-togethers, taking a vacation, and singing. Such goodies add spice to life and remind us we have worth.

Personal pleasures can also be used as payoffs to ourselves for jobs well done. Most of us would not seek to shortchange others for doing well, so we ought not to shortchange ourselves. Such rewards are a motivator to move on to new challenges.

Highlight 14.8

A Strategy to Improve Your Self-Concept

Having a positive self-concept is critical to having a happy, and gratifying life. When you have a low self-concept, you are always worried how others are judging you. You are worried that you won’t be able to succeed. You worry that you lack the abilities and skills to deal with the challenges that life may throw at you. You are scared of life and other people, and this fear holds you back from living life to the fullest.

If you have a positive self-concept, you will feel confident in yourself and your abilities. You will be willing to take more risks in life. You will sense that you have the ability to handle any challenges that life may throw at you. You will rarely worry what others think of you. This sense of confidence in yourself allows you to take full advantage of what life has to offer. Benefits of a positive self-concept include

· You will be more ambitious as you have confidence you will achieve your goals.

· You will set higher goals, as you are optimistic you have the capacities to achieve high goals.

· You are more resilient to life’s challenges as you are less likely to give in to defeat or despair.

· You will have a more gratifying social life, as you feel good about yourself and you seek out new people to talk with. Each new person may become a new friend, partner, customer, or romantic interest.

· You will probably have better physical health, as viewing oneself positively tends to lead to a healthier lifestyle.

· You are apt to treat others with more respect, as you do not perceive them as threats. When you treat others with respect, they are apt to reciprocate by treating you with respect.

· If you are confident in yourself, you are apt to attract and associate with confident, healthy, and successful people.

· Feeling confident in yourself, you will worry less, and have more energy and time to engage in creative and constructive activities.

· You will be more apt to utilize constructive feedback from others, as such feedback will not be viewed by you as being an emotionally crippling event.

· You will take more calculated risks. People who are willing to take more calculated risks tend to be more successful in their work and in their personal life.

· You will be happier, as having a positive outlook leads to looking forward to each new day.

How can you improve your self-concept? One strategy is to focus on establishing good mental habits by doing the following:

· List on a sheet of paper your good qualities—what you like about yourself.

· Then list what you dislike about yourself.

· Then, for each negative quality that you just mentioned, list the positive things you will tell yourself whenever you start “awfulizing” about a negative quality. (The refuting positive quality may be a positive quality that you listed above about yourself.)

· Practice developing this new habit: whenever you start awfulizing about negative characteristics about yourself, refute them by focusing on your positive qualities.

Remember, a low self-concept stems from negative self-talk. One way to develop a positive self-concept is to identify the underlying negative self-talk and then challenge it with positive thoughts about yourself.

Application of Theory to Client Situations

Social workers are one of the groups of helping professionals, along with psychologists, psychiatrists, and guidance counselors, who are involved in developing and providing stress management programs. Social workers have a variety of roles in stress management. They can serve as educators in providing stress management educational programs to individuals and groups. Some physicians now refer patients who are experiencing high levels of stress, or those who have stress-related illnesses, to such programs. Social workers can incorporate relaxation training and biofeedback training in their counseling sessions with clients, particularly those experiencing high levels of stress; if highly stressed clients learn to relax, they are often more effective in solving their difficulties. Social workers can serve as brokers in referring highly stressed individuals to stress management programs, and they can serve as group facilitators in leading therapeutic groups that emphasize stress management. Social workers can also serve as initiators and consultants in developing stress management programs in schools, businesses and industries, and in medical settings.

Psychological Aspects of Later Adulthood

Chapter Introduction

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Learning Objectives

This chapter will help prepare students to

In many ways, Sandra Lombardino has been a martyr. She took a marriage vow to stay married for better or worse until death. She has fulfilled that vow, despite the urging of her friends and relatives to seek a divorce. Several years ago, Benedito was diagnosed with cirrhosis of the liver and had to stop working. He now receives a monthly disability check. Despite his illness, Benedito has continued to drink heavily and has developed high blood pressure and diabetes. He is grossly overweight and is often incontinent. The drinking and illnesses have caused brain deterioration; he now has difficulty walking, talking, and grooming himself, and he frequently hallucinates. His behavior has resulted in a loss of friends. Benedito has been pressured into attending a number of alcoholism treatment programs, including Alcoholics Anonymous, but he has always returned to drinking.

Sandra Lombardino is in a quandary about what she should do. She is angry that she has to spend most of her waking hours caring for someone who is obnoxious and verbally abusive. She resents not being able to travel and to leave home to do volunteer work. Sometimes she wishes her husband would die so that she could get on with her life. At other times, she feels guilty about wishing he would die.

She has contemplated getting a divorce, but such a process would mean her husband would get half of the property that she has worked so many years to acquire. She has also considered placing Benedito in a nursing home, but she feels an obligation to care for him herself and realizes that the expenses of a nursing home would deplete her life savings. Mrs. Lombardino feels that the cruelest injustice would be for her to die before her husband dies, so that she would be robbed of her chances to achieve her retirement dreams.

A Perspective

People need to make a number of psychological adjustments at all ages for their lives to be meaningful and fulfilling. Later adulthood is no exception.

15-1 Describe the Developmental Tasks of Later Adulthood

15-1aDevelopmental Tasks of Later Adulthood

Most of the developmental tasks that older people encounter are psychological in nature. We will discuss a number of these tasks, using a couple, Douglas and Norma Polzer, as an example.

1. Retirement and lower income. In 2002, Douglas Polzer retired from his job as a road construction foreman in Dubuque, Iowa. Two years earlier, his wife, Norma, had retired from the post office. Retirement brought a number of changes to their lives. For several months after retiring, Douglas had difficulty finding things to do with his time. His work had been the center of his life. He seldom saw his former coworkers, and he had practically no hobbies or interests. When he was working, he always had stories to tell about unusual situations that happened. Now he no longer had much to talk about. Another problem for the Polzers was that they now had a lower standard of living. Their main sources of income were social security benefits and Norma’s federal pension.

2. Living with one’s spouse in retirement. Prior to retiring, Norma and Douglas did not see each other very much. Both worked during the week, and Norma worked on Saturdays. Each tended to socialize with his or her coworkers. Norma and Douglas tended to annoy each other if they were together a lot.

After Douglas retired, both were generally at home. Since Norma had always done most of the domestic tasks, she kept busy. Finding things to do was not very difficult for her.

For the first few months after Douglas retired, he followed Norma around the house telling her how she should do her work. That didn’t go over very well. They got on each other’s nerves and had a number of arguments. As time passed, Douglas became more interested in fishing, taking walks, and getting together with his retired friends. Gradually, with Douglas being gone more, the arguments faded.

3. Affiliating with individuals of one’s own age group or with associations for older people. The Polzers joined the Senior Citizens Leisure Club in Dubuque. Norma participated more frequently than Douglas did. The club has a variety of activities: luncheons, speakers, bus tours, painting and craft sessions, bowling, and golf. The club also has a small library.

4. Maintaining interest in friends and family ties. Norma and Douglas formed a number of new friendships with people they met in the club. Through conversing with such friends, Norma and Douglas were able to gain new perspectives on the adjustments they had to make.

Most of the Polzers’ friends, prior to retiring, were coworkers. After retirement, they gradually saw less and less of these friends, because their interests were growing in different directions. These former friends still talked a great deal about what was happening at work, and both Norma and Douglas now found such conversations boring.

The Polzers usually got together on Sunday with their son, Kirk, and his family, who lived in Dubuque. Their daughter, Devi, had left home at age 17 to marry. After she had three children, she obtained a divorce and was on public assistance for four years until she remarried. She moved to California and had two more children. The Polzers seldom saw her, but their relationship with her had improved since her adolescent years. Doug and Norma wished they could see Devi and her children more.

5. Continuing social and civic responsibilities. Douglas serves as a volunteer night watchman for the county fair that is held for four days during the summer. After they retired, Doug and Norma became more active in attending their church and participating in church activities. Doug became a church elder, and Norma became more active in the women’s aid society.

Norma’s world again changed. For the first time in many years, she was living alone. Douglas’s death was very hard for her. She felt guilty because she had wished he would die. Initially, she was lonely. But as the months passed, she gradually started putting her life back together. She became active again in the church and in the seniors’ leisure club. Sharing her grief with other club members helped. As the years passed, more of her friends died, and Norma found herself attending more funerals.

7. Finding satisfactory living arrangements at the different stages of later adulthood. After Douglas died, Norma became depressed and had less energy. Kirk helped, but he had his own family, career, and home to care for. Norma realized she was slowing down physically. After two years, Kirk began to encourage her to sell the house and move into an apartment complex that was especially built for older people. Norma resisted for more than a year. Then, in 2008, Norma slipped on the stairs and broke her leg. She had to crawl to the telephone. Kirk came and took her to the emergency room, where her leg was put in a cast. When she got out of the hospital, Kirk took her to his home. Norma’s house was put up for sale.

Having to leave her house was almost as great a loss as when Douglas died. She spent two months with Kirk’s family, but she did not get along with Kirk’s wife. Each had different ways of doing things and different ideas on how children should be raised. When relationships became severely strained, Norma moved to an apartment for older people. The move meant that many cherished possessions had to be discarded. Norma began to realize that if her mental or physical condition deteriorated further, her next move would be to a nursing home; at times she thought she would rather die than enter a nursing home. The move also meant that Norma had to establish new relationships. Fortunately, the move went more smoothly than Norma had hoped, and she was warmly welcomed by the staff and the residents.

8. Adjusting to changing physical strength and health and overcoming bodily preoccupation. For many years, Norma had struggled to get used to gray hair, wrinkles, and all the other physical changes of aging. Her arthritis often caused swelling and pain in her joints, and she no longer had as much energy and stamina as in the past.

9. Reappraising personal values, self-concept, and personal worth in light of new life events. A major adaptation task of older people is to conduct an evaluative life review. During this review, they reflect on their failures and accomplishments, their disappointments and satisfactions, and hopefully come to a reasonably positive view of their life’s worth. The failure to arrive at a positive view can result in a case of overt psychopathology.

After Norma became settled in her apartment, she again had a lot of free time. She was now 76 years old, and her health was declining. She spent a lot of time thinking about the past. She had enjoyed the early years of retirement, but she acknowledged that the five years since Douglas’s first stroke had been rocky.

15-2 Understand Theoretical Concepts about Developmental Tasks in Later Adulthood

15-2aTheoretical Concepts about Developmental Tasks in Later Adulthood

In this section, we will examine various theoretical concepts relating to the developmental tasks of later adulthood.

15-2bIntegrity versus Despair

The final stage of life, according to Erikson (1963), involves the psychological crisis of integrity versus despair. The attainment of integrity comes only after considerable reflection about the meaning of one’s life.  Integrity refers to an ability to accept the facts of one’s life and to face death without great fear. Older people who have achieved a sense of integrity view their past in an existential light. They have feelings of having achieved respected positions during their lifetimes and have inner senses of completion. They accept all of the events that have happened to them, without trying to deny some unpleasant facts or to overemphasize others. Integrity involves an integration of one’s past history with one’s present circumstances, and a feeling of being content with the outcome. In order to experience integrity, older people must incorporate lifelong sequences of failures, conflicts, and disappointments into their self-images. This process is made more difficult by the fact that the role of older people is devalued in our society. There are a lot of negative attitudes expressed in our society that (often erroneously) suggest older people are incompetent, dependent, and old-fashioned. The death of close friends and relatives and the gradual deterioration of physical health make it additionally difficult for older people to achieve integrity.

The opposite pole of integrity is despair.  Despair is characterized by a feeling of regret about one’s past and includes a continuously nagging desire to have done things differently. Despair makes an attitude of calm acceptance of death impossible, as those who despair view their lives as incomplete and unfulfilled. Either they seek death as a way of ending a miserable existence, or they desperately fear death because it makes any hope of compensating for past failures impossible. Some older people who despair commit suicide.

Men, particularly older men, are more apt to commit suicide than are women (Papalia & Martorell, 2015). The highest rate of suicide is found not among male adolescents or male young adults, but among older men (Papalia & Martorell, 2015). One of the reasons the suicide rate among older men is so high is that men are more apt than women to view their chosen career as providing the primary source of meaning in life; when men with this perspective retire, they are more apt to despair and to select suicide as a way to end their misery.

15-2cThree Key Psychological Adjustments

Peck (1968) suggests that three primary psychological adjustments must be made in order to make later adulthood meaningful and gratifying. The first adjustment involves shifting from a work-role preoccupation to  self-differentiation. Because retirement is a crucial shift in one’s life, a new role must be acquired. The older person has to adjust to the fact that she or he will no longer go to work and needs to find a new identity and new interests. People who are in the process of making this adjustment must spend time assessing their personal worth. (A woman whose major work has been being a wife and a mother faces this adjustment when her children leave home or her husband dies.) A crucial question to resolve at this point is, “Am I a worthwhile person insofar as I can do a full-time job or can I be worthwhile in other different ways … ?” (Peck, 1968, p. 90). In making this adjustment, people need to recognize that they are richer and more diverse than the sum of their tasks at work.

The third adjustment involves shifting from self-preoccupation to  self-transcendence. The inevitability of death must be dealt with. Although death is a depressing prospect, Peck (1968) indicates that a positive acceptance can be achieved by shifting one’s concerns from “poor me” to “What can I do to make life more meaningful, secure, or happier for those who will survive me?”

15-2dLife Review

Most older persons conduct evaluative life reviews in which they assess their pasts and consider the future in terms of the inevitability of death. Frenkel-Brunswick (1970) referred to this life review as “drawing up the balance sheet of life.” The two key elements in this review are

· (1)

concluding that the past was meaningful and

· (2)

learning to accept the inevitability of death.

Those who psychologically achieve this are apt to be content and comfortable with their later years; those who conclude that life has been empty, and who do not as yet accept death, are apt to despair.

A life review involves a reconsideration of previous experiences and their meaning, and often includes a revision or an expanded understanding (Haight, 1991). This reorganization of the past may provide a more valid picture for the individual, providing a new and more significant meaning to his or her life.

15-2eSelf-Esteem

Self-esteem (the way people regard themselves) is a key factor in overall happiness and adjustment to life. According to Cooley’s (1902) “looking-glass self” concept, people develop their sense of who they are in terms of the way others relate to them. If older people are treated by others as if they are old-fashioned, senile, dependent, and incompetent, they are apt to view themselves in the same way. With losses of friends and relatives through death, the loss of the work role, and a decline in physical appearance and in physical abilities, the elderly are vulnerable to a lowering of self-esteem.

For older persons to feel good about themselves, they need feedback from others indicating that they are worthwhile, competent, and respected. Like people in all other age groups, older people thrive by demonstrating their competence. People tend to feel competent when they exert control over their own lives. The more options they have, the more in control they are, and the higher their self-esteem will be.

Privacy is a factor in furthering competence and self-esteem. People who have a private place to go can decide when they want to be with other people and when they want to be alone. In a nursing home, those who have a private room can retreat to it whenever they find something distasteful, or too noisy, or whenever they want to rest. A private room gives them a way to control their environment.

15-2fLife Satisfaction

Life satisfaction is a sense of psychological well-being in general or of satisfaction with life as a whole. Life satisfaction is a widely used index of psychological well-being in older adults. Older adults who are in good health and have an adequate income are more likely to be content with their lives than those who have poor health and limited incomes (Santrock, 2016b). Older people who have extended social networks of friends and family are more satisfied than those who are socially isolated (Santrock, 2016b). An active lifestyle is also associated with psychological well-being in older adults. People who play golf, go out to dine, go to the theater, travel, exercise regularly, go to church, go to meetings, and are actively involved in the community are more content with their lives than are those who stay at home and lead sedentary lifestyles (Santrock, 2016).

15-2gLow Status and Ageism

In most primitive and earlier societies, older people were respected and viewed as useful to the community to a much greater degree than is the case in our society. Industrialization and the growth of modern society have robbed older people of their high status. Prior to industrialization, older people were the primary owners of property. Land was the most important source of power; therefore, older people controlled much of the economic and political power. Now, people earn their living in the job market, and the vast majority of older people own little land and are viewed as having no salable labor. In earlier societies, older people were also valued because of the knowledge they possessed. Their experiences enabled them to supervise planting and harvesting and to pass on knowledge about hunting, housing, and crafts. Older people also played key roles in preserving and transmitting the culture. But the rapid advances of science and technology have tended to limit the value of the technological knowledge of older people, and books and other memory-storage devices have made older people less valuable as storehouses of culture and records.

Our society does not allow many older people to experience their later years positively. We don’t respect their experience and wisdom, but instead dismiss their ideas as irrelevant and outdated.

15-3 Summarize Theories of Successful Aging

15-3aTheories of Successful Aging: The Strengths Perspective

Three theories about how to age successfully are the activity theory, the disengagement theory, and the social reconstruction syndrome theory.

15-3bActivity Theory

Here, an older adult volunteer advises a Special Olympics participant. The more physically and mentally active older adults are, the more successfully they will age. Volunteering provides a positive means of staying active. (Special Olympics was founded in 1968 in Chicago by Anne McGlone Burke, a special education teacher, with the support of Eunice Kennedy Shriver, the sister of President John F. Kennedy.)

15-3dSocial Reconstruction Syndrome Theory

Social reconstruction syndrome theory was developed from the  social breakdown syndrome conceptualized by Zusman (1966). According to Zusman, social breakdown occurs for older people because of the effects of labeling. Society has unrealistic expectations that all adults should work and be productive; younger people label older people as incompetent or lacking in some ways; older people accept the label and view themselves in terms of the label; they then learn behavior consistent with the label and downplay their previous skills. As a result, they become more dependent and incompetent, and feel inadequate.

Kuypers and Benston (1973) assert that this negative interaction between older people’s environment and self-concept explains many of the problems of aging in our society. To break the vicious cycle of this labeling process, they recommend the  social reconstruction syndrome, which includes three major recommendations. First, our society should liberate older people from unrealistic standards and expectations. The belief that self-worth depends on a person’s productivity has adverse consequences for those who are retired. Kuypers and Benston recommend that society be reeducated to change these unrealistic standards. Fischer (1977) specifies the direction such reeducation should take:

The values of our society rest upon a work ethic—an ethic of doing—that gives highest value to people in the prime of their productive years. We should encourage a plurality of ethics in its place—not merely an ethic of doing, but also an ethic of feeling, an ethic of sharing, an ethic of knowing, an ethic of enduring, and even an ethic of surviving, (p. 33)

The second recommendation of Kuypers and Benston (1973) is to provide older people with the social services they need. Such services include transportation, medical care, housing, help with house-keeping, and programs that provide physical and mental activity.

15-4 Understand the Impact of Key Life Events on Older People

15-4aThe Impact of Life Events on Older People

We will discuss a number of life events that affect life in later adulthood. These events directly affect the behavior of older people and often limit the alternatives available to them.

15-4bMarriage

Because people are living longer, many marriages are lasting longer as well. Today, 50th wedding anniversaries are much more common than they were in the past. But divorces are more common too.

Couples who are still married in their later years are less likely than younger couples to see their marriages as full of problems (Papalia & Martorell, 2015). There could be a variety of reasons. They may well have worked out their major conflicts. Because divorce is now quite accessible, those marriages that survive many years may be the happier and more conflict-free ones. Or the difference may be one of development, as people learn to cope better with crises and conflicts.

Being in love is still important for successful marriage in late adulthood (Papalia & Martorell, 2015). Spouses at this age also value open expression of feelings, companionship, respect from one another, and common interests.

Gilford (1986) found that people over age 70 tend to consider themselves less happily married than those aged 63 to 69; it is possible that decline in physical health aggravates the strains on marriage. Gilford also found that older women tend to be less satisfied with marriage than are older men, partly because women generally expect more warmth and intimacy from marriage than men do.

Married older people are happier than the unmarried, and considerably happier than the widowed and the divorced. The extent to which older people, particularly women, are satisfied with their marriage influences their overall sense of well-being. Health and satisfaction with one’s standard of living also positively correlate with an overall sense of well-being. Chronic illness has a negative impact on the morale of couples, even when only one member is ill.

The healthy partner may become depressed, angry, or frustrated with the responsibilities of taking care of the ill spouse and maintaining the household. The poor health of one spouse may also reduce the opportunities for enjoyable activities, may drain financial resources, and may reduce sexual involvement. Other crises and life events (such as retirement) can also generate considerable marital turmoil and conflict.

Poor health can also lead to role changes in the lives of older couples. The spouse who first develops a serious life-threatening illness is usually the husband—as women tend to be younger than their spouses and to live longer. If one spouse develops an illness (such as Alzheimer’s disease) in which there is progressive deterioration of mental and physical capacities, the other spouse has to take on increasing decision-making and caregiving responsibilities. Gilford (1986) found that spouses (especially wives) who must care for mates with disabilities may experience anger, isolation, and frustration. They are also more apt to develop a chronic illness themselves.

15-4cDeath of a Spouse

The death of a spouse is traumatic at any age. It is more apt to occur in later adulthood, as death rates are considerably higher in this age group. The surviving spouse faces a variety of emotional and practical problems. The survivor has lost a lover, a companion, a good friend, and a confidant. The more intertwined their lives have become, the deeper the loss is apt to be felt. In most marriages, household maintenance responsibilities are divided. The survivor now finds he or she has a lot more tasks to do, some of which were never learned.

15-4dWidowhood

Because women tend to live longer than men and tend to be younger than their husbands, they are more likely to be widowed. The effects of widowhood are poignantly summarized by a 75-year-old widow: “As long as you have your husband, you’re not old. But once you lose him, old age sets in fast” (quoted in Papalia & Olds, 1992, p. 514).

Widowed people of both sexes have higher rates of depression and mental illness than married people. Men are more likely to die within six months of a wife’s death, and women are more apt to develop a chronic illness after a husband’s death (Papalia & Martorell, 2015).

People who adjust best to widowhood are those who keep busy, perhaps by taking on new, paying positions, doing volunteer work, or becoming more deeply involved in other activities (such as seeing friends or taking part in community programs). Participating in support groups for widowed people is also beneficial (Papalia & Martorell, 2015).

15-4eNever Married

Only about 5 percent of older men and women have never been married. Papalia and Martorell (2015) cite research indicating that those who have never been married tend to be more independent, have fewer social relationships, and express less concern about their age than do older people who have been married.

15-4fRemarriage

Our society has generally opposed the idea of older adults dating and remarrying. We think of younger people hugging and kissing each other, but such behavior by an older couple is often met with stares or crude remarks. Children of older people are sometimes opposed to their mother’s or father’s remarrying. (They may be concerned about inheritance, or they may believe that starting a new relationship is being unfaithful to or dishonoring the parent who has died.) Yet remarriage in later adulthood is increasing (Papalia & Martorell, 2015).

For a variety of reasons, our society should change its negative attitude about remarriage in later adulthood. Married older people are happier than those who are living alone. They have companionship, can share interests, provide emotional support, and can assist each other with household tasks. It is also cost-effective for society to support single older people in remarrying as they are then less likely to need financial assistance and social services and are less likely to be placed in nursing homes (Papalia & Martorell, 2015).

15-4gGay and Lesbian Relationships

There is little research on gay and lesbian relationships in latter adulthood; this is largely because the current cohort of older persons grew up in an era when living openly in a gay-lesbian relationship was rare. In 2004, Massachusetts became the first state to offer regular marriage licenses for gay and lesbian couples.

After 2004, more and more states legalized same-sex marriages. In June 2015, the United States Supreme Court, in a landmark ruling, said that same-sex couples have a constitutional right to marriage. The 5–4 U.S. Supreme Court decision means all 50 states must perform and recognize gay marriages.

Internationally, the following countries now allow same-sex marriage, in addition to the United States: Netherlands, Belgium, Canada, Spain, South Africa, Norway, Sweden, Argentina, Iceland, Portugal, Denmark, Uruguay, New Zealand, Brazil, and France. Same-sex marriage is also legal in some jurisdictions in Mexico, England, Scotland, and Wales. With increased acceptance of same-sex marriages, more gay and lesbian couples are feeling freer to participate in research on their experiences.

Gay and lesbian relationships in later life tend to be diverse, but generally strong and supportive. A number of these individuals have children from earlier marriages—some have adopted children. Those who have maintained close relationships with a gay and lesbian community tend to adapt to the later years with relative ease.

Some older gays and lesbians are impacted by discriminatory acts by some persons, strained relationships with family of origin, and insensitive policies of some social agencies. If a partner falls ill or dies, there are challenges in dealing with health-care providers, inheritance issues, and lack of access to a partner’s social security benefits (Papalia & Martorell, 2015).

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15-4hFamily System Relationships

There is a popular belief that older people disengage somewhat from their adult children and their grandchildren. There is also a belief that there is a generation gap (conflict in values) between older people and younger family members. These beliefs suggest that older people may have strained and somewhat unfavorable family relationships.

Research reviewed by Kail and Cavanaugh (2007), however, suggests that most older people’s family relationships are generally quite positive. The findings suggest that family relationships with older people are substantially better than generally believed.

In most instances, older people and their adult children do not live together for a variety of reasons. Many younger people live in small quarters that make it inconvenient to house another person. Older people are reluctant to move in, as they fear they will have little privacy. They may fear that there will be somebody else’s rules to follow and that they may not have visitors when they wish. They may resent having to account to their children for how they spend their time. They may fear their children will put pressure on them to make lifestyle changes, such as giving up smoking, changing their eating habits, or reducing the intake of alcoholic beverages. They may also fear inconveniencing or becoming a burden to their children’s families. And, many simply do not want to leave their own home, where they feel comfortable and have pleasant memories.

Although most older people do not live with their children, they tend to live close to them and to see them frequently. Most older people do not want to live with their children. Of the few who do, most are female and widowed (Santrock, 2016).

As discussed earlier, our society’s views about the contributions of older people are exactly opposite to those held by many other societies. In those societies, the advice and knowledge of older people are actively sought, and older people usually live with their children and receive needed care. In our society, middle-aged adults tend to feel that their first priorities are to meet their own needs and the needs of their children. The fact that many adults would rather see their parents cared for in a nursing home than living with them suggests that they do not feel as great an obligation to their parents as do members of many other societies. The question of whether to place one’s partially incapacitated older parent in a nursing home or to provide care in one’s own home is a question that many middle-aged adults struggle with.

Parenting Adult Children

Parents are usually the primary caregivers for adult children who have a mental illness, a moderate cognitive disability, or some other disability. Parents of divorced adults see their children more often after the divorce than they did before, and often take them into their homes.

In a study of 29 healthy, white, midwestern, middle-class and working-class married couples age 60 and over, Greenberg and Becker (1988) found that the subjects’ children were a daily topic of conversation. “Although they had left home years ago, these children remained psychologically present in their parents’ thoughts and conversations” (p. 789). These parents helped their children in a variety of ways—inviting divorced daughters to live with them, helping care for grandchildren, helping with household projects, paying for treatment for drug abuse, and lending or giving money for a variety of purposes.

Suitor and Pillemer (1988) found that when an adult moves into the home of his or her older parents, the parents report that they get along quite well. Such harmony may be explained in at least two ways. People who get along with others are those most likely to choose to live together. In addition, older parents may exaggerate the harmony in an effort to make reality match their wishes. When parents and children do not get along very well, the parents’ marriage is sometimes adversely affected. Grandparents who are providing care to their grandchildren or to their adult children refute the societal myth that older adults are freed from active parenting and its stresses.

Grandparenthood

Neugarten and Weinstein (1964) identified five major styles of grandparenting in our society. The  fun seeker is a playmate to the grandchildren in a mutual relationship that both enjoy. The  distant figure has periodic contact with the grandchildren, generally on birthdays and holidays, but is quite uninvolved with their lives. The  surrogate parent assumes considerable caretaking responsibilities, usually because the grandchildren’s parents are working, or because the mother is single and working. The  formal figure leaves all child-rearing responsibilities to the parents and limits his or her involvement with the grandchildren to providing special treats and occasional babysitting. The  reservoir of family wisdom takes on an authoritarian role and dispenses special resources and skills.

The tacit “norm of noninterference” by grandparents tends to evaporate in times of trouble faced by their adult children and their grandchildren. Grandparents tend to perform the role of family “watchdogs.” They stay on the fringes of the lives of their children and grandchildren, with varying degrees of involvement. During times of crisis (such as serious illness, money problems, or divorce), they tend to become much more involved by stepping in and playing more active roles. During good times, they are less involved, but they are still watching.

Some gender differences have been found in the degree of grandparenting. Cherlin and Furstenberg (1986) found that grandmothers tend to have closer and warmer relationships with their grandchildren and are more apt to serve as surrogate parents than are grandfathers. The same study also found that the mother’s parents are likely to be closer to the grandchildren than the father’s parents and are more apt to become involved during a crisis. Thomas (1986) found that grandmothers tend to be more satisfied with grandparenting than are grandfathers.

The typical profile of grandparents in the United States is changing. Increasing numbers of grandchildren live with their grandparents. Adolescent pregnancies, divorce, drug use by parents, and high unemployment rates are the main reasons grandparents return to the “parenting” role. Almost half of the grandchildren who move in with grandparents are raised by a single grandmother (Santrock, 2016).

As divorce and remarriage become more common in the United States, a special concern of some grandparents is to have visitation rights with their grandchildren. In the past two decades, numerous states have passed laws giving the grandparents the right to petition a court for visitation rights, even when a parent objects.

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Great-Grandparenthood

When grandchildren become parents, grandparents move into a new role: great-grandparenthood. Because of age, declining health, and the scattering of families, great-grandparents tend to be less involved than grandparents in a child’s life. The great-grandparents who have the most intimate connections with their great-grandchildren are those who live nearby; such great-grandparents often help their grandchildren and great-grandchildren with gifts, loans, and babysitting.

Because older people are living longer, four and even five generations of families are becoming more common.

15-5 Understand Guidelines for Positive Psychological Preparations for Later Adulthood

15-5aGuidelines for Positive Psychological Preparation for Later Adulthood: The Strengths Perspective

Growing old is a lifelong process. Becoming 65 does not destroy the continuity of what a person has been, is now, and will be. Recognizing this should lessen the fear of growing old. For those who are financially secure and in good health and who have prepared thoughtfully, later adulthood can be a period of at least reasonable pleasure and comfort, if not luxury.

Jimmy Carter (James Earl Carter Jr.) was born October 1, 1924, in the small rural community of Plains, Georgia. Carter graduated from the U.S. Naval Academy in Annapolis in 1946. After seven years as a naval officer, he returned to Plains, where he ran a peanut-producing business. In 1962, he entered state politics. Eight years later, he was elected governor of Georgia in 1976, he was elected president of the United States. Although he had some noteworthy accomplishments as president, there were serious setbacks economically and in foreign affairs. Inflation, interest rates, and unemployment rates were at near-record highs. During Carter’s four-year administration, the economy went into a recession. In 1979, more than 50 members of the U.S. Embassy staff in Iran were taken as hostages by militants. Despite 14 months of trying, the Carter administration was unable to secure release of the hostages. (With the help of Canadian officials, the next president of the United States, Ronald Reagan, was able to secure the release of the hostages.) After a devastating defeat for reelection in 1980, Carter retired from political, life—and left being very unpopular.

But the best was yet to come. He did not throw in the towel. Today he is a professor at Emory University in Georgia and a leading advocate for Habitat for Humanity, which helps build houses for low-income families. He established the Carter Center, which sponsors international programs in human rights, preventive health care, education, agricultural techniques, and conflict resolution. Carter and the Carter Center have secured the release of hundreds of political prisoners. He has become an elder statesman, a roving peacemaker, and a guardian of freedom. He oversaw the Nicaraguan elections that ousted the dictatorship of the Sandinistas. He brokered a ceasefire between the Serbs and the Bosnian Muslims. He has pressured China to release political prisoners. He was the first former U.S. president to visit Communist Cuba. He has helped set up fair elections in China, Mozambique, Nigeria, Indonesia, and several other developing countries. In addition, he has written 31 books. In 2002, at age 78, he was awarded the Nobel Peace Prize. Clearly, Carter’s accomplishments in later adulthood surpass his accomplishments in his earlier years.

3. Finances. Health and income are two factors closely related to life satisfaction in later adulthood. When people feel good and have money, they can be more active. Those who are active—who go out to eat, go to meetings or museums, go to church, go on picnics, or travel—are happier than those who mostly stay at home. Saving money for later years is important, and so is learning to manage or budget money wisely.

4. Interests and hobbies. Psychologically, people who are traumatized most by retirement are those whose self-image and life interests center on their work. People who have meaningful hobbies and interests look forward to retirement in order to have sufficient time for these activities.

5. Self-identity. People who are comfortable and realistic about who they are and what they want from life are better prepared to deal with stresses and crises that arise.

6. Looking toward the future. A person who dwells on the past or rests on past achievements is apt to find the older years depressing. On the other hand, a person who looks to the future generally has interests that are alive and growing and is therefore able to find new challenges and new satisfaction in later years. Looking toward the future involves planning for retirement, including deciding where one would like to live, in what type of housing and community, and what one looks forward to doing with his or her free time.

7. Coping with crises. If a person learns to cope effectively with crises in younger years, these coping skills will remain useful when a person is older. Effective coping is learning to approach problems realistically and constructively.

15-6 Summarize Material on Grief Management and Death Education

15-6aGrief Management and Death Education

In the remainder of this chapter, we will discuss reactions to death in our society, including social work roles in grief management and guidelines for relating to a dying person and to survivors.

15-6bDeath in Our Society: The Impact of Social Forces

It is generally a mistake for survivors to seek to appear strong and emotionally calm following the death of a close friend or relative. Usually such people want to avoid dealing with their loss, and there is a danger that when they do start grieving they will experience more intense grief—partly because they will feel guilty about denying that they are hurting, and partly because they will feel guilty because they de-emphasized (by hiding their pain and feelings) the importance of the person who died.

15-6cThe Grieving Process

Nearly all of us are currently grieving about some loss that we have had. It might be the end of a romantic relationship, or moving away from friends and parents, or the death of a pet, or failing to get a grade we wanted, or the death of a friend, a colleague, or a family member.

It is a mistake to believe that grieving over a loss should end in a set amount of time. The normal grieving process is often the lifespan of the griever. When we first become aware of a loss of great importance to us, we are apt to grieve intensively—by crying or by being depressed. Gradually, we will have hours, then days, then weeks, then months when we will not think about the loss and will not grieve. However, there will always be something that reminds us of the loss (such as anniversaries), and we will again grieve. The intense grieving periods will, however, gradually become shorter, occur less frequently, and decrease in intensity.

Two models of the grieving process will be presented here: the Kübler-Ross (1969) model and the Westberg (1962) model. These models help us to understand the grief we feel from any loss.

The Kübler-Ross Model

This model posits five stages of grief:

1. Stage One: Denial. During this stage, we tell ourselves, “No, this can’t be. There must be a mistake. This just isn’t happening.” Denial is often functional because it helps cushion the impact of the loss.

2. Stage Two: Rage and Anger. During this stage, we tell ourselves, “Why me? This just isn’t fair!” For example, terminally ill patients resent that they will soon die while other people will remain healthy and alive. During this stage, God is sometimes a target of the anger. The terminally ill, for example, blame God as unfairly imposing a death sentence.

3. Stage Three: Bargaining. During this stage, people with losses attempt to strike bargains to regain all or part of the loss. For example, the terminally ill may bargain with God for more time. They promise to do something worthwhile or to be good in exchange for another month or year of life. Kübler-Ross indicates that even agnostics and atheists sometimes attempt to bargain with God during this stage.

4. Stage Four: Depression. During this stage, those having losses tell themselves, “The loss is true, and it’s really sad. This is awful. How can I go on with life?”

5. Stage Five: Acceptance. During this stage, the person fully acknowledges the loss. Survivors accept the loss and begin working on alternatives to cope with the loss and to minimize its impact.

The Westberg Model

· Emotions Erupt. As the realization of the loss becomes evident, the person expresses the pain by crying, screaming, or sighing.

· Anger. At some point, a person usually experiences anger. The anger may be directed at God for causing the loss. The anger may be partly due to the unfairness of the loss. If the loss involves the death of a loved one, there is often anger at the dead person for what is termed “desertion.”

· Illness. Because grief produces stress, stress-related illnesses are apt to develop, such as colds, flu, ulcers, tension headaches, diarrhea, rashes, and insomnia.

· Panic. Because the grieving person realizes he or she does not feel like the “old self,” the person may panic and worry about going insane. Nightmares, unwanted emotions that appear uncontrollable, physical reactions, and difficulties in concentrating on day-to-day responsibilities all contribute to the panic.

· Guilt. The grieving person may blame himself or herself for having done something that contributed to the loss, or feel guilty for not doing something that might have prevented the loss.

· Depression and Loneliness. At times, the grieving person is apt to feel very sad about the loss and also to have feelings of isolation and loneliness. The grieving person may withdraw from others, who are viewed as not being supportive or understanding.

· Reentry Difficulties. When the grieving person makes efforts to put his or her life back together, reentry problems are apt to arise. The person may resist letting go of attachments to the past, and loyalties to memories may hamper the pursuit of new interests and activities.

· Hope. Gradually, hopes of putting one’s life back together return and begin to grow.

· Affirming Reality. The grieving person puts his or her life back together again, and the old feeling of having control of one’s life returns. The reconstructed life is not the same as the old, and memories of the loss remain. However, the reconstructed life is satisfactory. The grieving person resolves that life will go on.

Figure 15.1Westberg Model of the Grieving Process

Evaluation of Models of the Grieving Process

Kübler-Ross and Westberg note that some people continue grieving and never do reach the final stage (the acceptance stage in the Kübler-Ross model, or the affirming reality stage in the Westberg model). Kübler-Ross and Westberg also caution that it is a mistake to rigidly believe everyone will progress through these stages as diagrammed. There is often considerable movement back and forth among the stages. For example, in the Kübler-Ross model, a person may go from denial and depression to anger and rage, then back to denial, then to bargaining, then again to depression, back to anger and rage, and so on.

15-6dHow to Cope with Grief

The following suggestions are given to help those who are grieving:

· Crying is an acceptable and valuable expression of grief. Cry when you feel the need. Crying releases the tension that is part of grieving.

· Talking about your loss and about your plans is very constructive. Sharing your grief with friends, family, the clergy, a hospice volunteer, or a professional counselor is advisable. You may seek to become involved with a group of others having similar experiences. Talking about your grief eases loneliness and allows you to ventilate your feelings. Talking with close friends gives you a sense of security and brings you closer to others you love. Talking with others who have experienced similar losses helps put your problems into perspective. You will see you are not the only one with problems, and you will feel good about yourself when you assist others in handling their losses.

· Death often causes us to examine and question our faith or philosophy of life. Do not become concerned if you begin questioning your beliefs. Talk about them. For many, a religious faith provides help in accepting the loss.

· Seek to accept the inevitability of death—yours and that of others.

· If the loss is the death of a loved one, holidays and the anniversaries of your loved one’s birth and death can be stressful. Seek to spend these days with family and friends who will give you support.

· You may feel that you have nothing to live for and may even think about suicide. Understand that many people who encounter severe losses feel this way. Seek to find assurance in the fact that a sense of purpose and meaning will return.

· Intense grief is very stressful. Stress is a factor that leads to a variety of illnesses, such as headaches, colitis, ulcers, colds, and flu. If you become ill, seek a physician’s help, and tell him or her that your illness may be related to grief you are experiencing.

· Intense grief may also lead to sleeplessness, sexual difficulties, loss of appetite, or overeating. If a loved one has died, do not be surprised if you dream the person is still alive. You may find you have little energy and cannot concentrate. All of these reactions are normal. Do not worry that you are going crazy or losing your mind. Seek to take a positive view. Eat a balanced diet, get ample rest, and exercise moderately. Every person’s grief is individual; if you are experiencing unusual physical reactions (such as nightmares), try not to become overly alarmed.

· Medication should be taken sparingly and only under the supervision of a physician. Avoid trying to relieve your grief with alcohol or other drags. Many drugs are addictive and may stop or delay the necessary grieving process.

Questions about Grief, Death, and Dying

Arriving, at answers to these questions is one way to work toward becoming more comfortable with your own eventual death.

1. Which of the following describe your present conception of death?

1. Cessation of all mental and physical activity

2. Death as sleep

3. Heaven-and-hell concept

4. A pleasant afterlife

5. Death as being mysterious and unknown

6. The end of all life for you

7. A transition to a new beginning

8. A joining of the spirit with an unknown cosmic force

9. Termination of this physical life with survival of the spirit

10. Something other than what is on this list

2. Which of the following aspects of your own death do you find distasteful?

1. What might happen to your body after death

2. What might happen to you if there is a life after death

3. What might happen to your dependents

4. The grief that it would cause to your friends and relatives

5. The pain you may experience as you die

6. The deterioration of your body before you die

7. All your plans and projects coming to an end

8. Something other than what is on this list

3. If you could choose, what age would you like to be when you die?

4. When you think of your own eventual death, how do you feel?

1. Depressed

2. Fearful

3. Discouraged

4. Purposeless

5. Angry

6. Pleasure in being alive

7. Resolved as you realize death is a natural process of living

8. Other (specify)

5. For what, or for whom, would you be willing to sacrifice your life?

1. An idea or moral principle

2. A loved one

3. In combat

4. An emergency where another life could be saved

5. Not for any reason

6. If you could choose, how would you prefer to die?

1. A sudden, violent death

2. A sudden but nonviolent death

3. A quiet and dignified death

4. Death in the line of duty

5. Suicide

6. Homicide victim

7. Death after you have achieved your life goals

8. Other (specify)

7. If it were possible, would you want to know the exact date on which you would die?

8. Would you want to know if you had a terminal illness?

9. If you had six more months to live, how would you want to spend the time?

1. Satisfying hedonistic desires such as sex

2. Withdrawing

3. Contemplating or praying

4. Seeking to prepare loved ones for your death

5. Completing projects and tying up loose ends

6. Considering suicide

7. Other (specify)

10. Have you seriously contemplated suicide? What are your moral views of suicide? Are there circumstances under which you would take your life?

11. If you had a serious illness and the quality of your life had substantially deteriorated, what measures do you believe should be taken to keep you alive?

1. All possible heroic medical efforts should be taken.

2. Medical efforts should be discontinued when there is practically no hope of returning to a life with quality.

3. Other (specify)

12. If you are married, would you prefer to outlive your spouse? Why?

13. How important do you believe funerals and grief rituals are for survivors?

14. If it were up to you, how would you like to have your body disposed of after you die?

1. Cremation

2. Burial

3. Donation of your body to a medical school or to science

4. Other (specify)

15. What kind of funeral would you prefer?

1. A church service

2. As large as possible

3. Small with only close friends and relatives present

4. A lavish funeral

5. A simple funeral

6. Whatever your survivors want

7. Other (specify)

16. Have you made a will? Why or why not?

17. Were you able to arrive at answers to most of these questions? Were you uncomfortable in answering these questions? If you were uncomfortable, what were you feeling, and what made you uncomfortable? For the questions you do not have answers to, how might you arrive at answers?

Second, tell the dying person that you are willing to talk about any concerns that he or she has. Let the person know that you are emotionally ready and supportive, that you care, and that you are available. Remember, the person has a right not to talk about concerns if he or she so chooses. Touching or hugging the dying person is also very helpful.

Third, answer the dying person’s questions as honestly as you can. If you do not know an answer, find someone who can provide the requested information. Evasion or ambiguity in response to a dying person’s questions only increases his or her concerns. If there is a chance for recovery, this should be mentioned. Even a small margin of hope can be a comfort. Do not, however, exaggerate the chances for recovery.

Fourth, a dying person should be allowed to accept the reality of the situation at his or her own pace. Relevant information should not be volunteered, nor should it be withheld. People who have terminal illnesses have rights to have access to all the relevant information. A useful question that may assist a dying person is, “Do you want to talk about it?”

Fifth, if people around the dying person are able to accept the death, the dying person is helped to accept the death. Therefore, it is therapeutic to help close family members and friends accept the death. Remember, they may have a number of concerns that they want to discuss, and they may need help to do this.

Sixth, if you have trouble with certain subjects involving death, inform the dying person of your limitations. This takes the guesswork out of the relationship.

Seventh, the religious or philosophical viewpoint of the dying person should be respected. Your own personal views should not be imposed.

15-6gHow to Relate to Survivors

These suggestions are similar to the suggestions on relating to a dying person. It is very helpful to become accepting of the idea of your own death. If you are comfortable about your own death, you will be better able to calmly listen to the concerns being expressed by survivors.

It is helpful to initiate the first encounter with a survivor by saying something like, “I’m sorry,” and then touching or hugging the person. Then convey that if he or she wants to talk or needs help, you’re available. Take your lead from what the survivor expresses. You should seek to convey that you care, that you share his or her loss, and that you’re available if he or she wants to talk.

When a person’s spouse dies, he or she is apt to feel sad, lonely, and isolated.

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It is frequently helpful to share with a survivor pleasant and positive memories you have about the person who has died. This conveys that you sincerely care about and miss the deceased person and also that the deceased person’s life had positive meaning. Relating your memories will often focus the survivor’s thoughts on pleasant and positive memories of his or her own.

Continue to visit the survivors if they show interest in such visits. It is also helpful to express your caring and support through a card, a little gift, or a favorite meal. If a survivor is unable to resume the normal functions of living, or remains deeply depressed, suggest seeking professional help. Joining a survivor self-help group is another possible suggestion.

The religious or philosophical viewpoint of survivors should be respected. You should not seek to impose your views on the survivors.

15-6hHow to Become Comfortable with the Idea of Your Own Eventual Death: The Strengths Perspective

Perhaps the main reason people are uncomfortable about death is that in our culture we are socialized to avoid seeing death as a natural process. We would be more comfortable with the idea of our own death if we could talk about it more openly and actively seek answers to our own questions and concerns. Comfort with the idea of our own death helps us be more supportive in relating to and understanding those who are dying. If you are uncomfortable about death, including your own eventual death, here are some things you can do to become more comfortable.

Ethical Question 15.5

Ethical Dilemma

Whether to Insert a Feeding Tube

Dave got up, looked in a mirror, and noticed his thinning gray hair, the wrinkles on his face and hands, and the tire around his waist. In concluding that the best part of his life had passed by, he again wondered anxiously what the future would hold for him, and he contemplated what he should do with all of his time. He had no idea.

For the next few weeks, he followed his wife, Jeanette, around the house. Dave began giving Jeanette suggestions on how she could be more efficient and productive around the house. After a few weeks of such advice, Jeanette angrily told Dave to “get off her back.” He visited the print shop where he used to work but soon realized everyone was too busy to spend time talking with him. He also stopped socializing with the printers, since they tended to talk about work. He felt useless. As the months went by, he spent most of his time sitting home and watching TV. Occasionally, he went to a neighborhood bar, where he drank to excess.

Dave and his wife had never given much attention to long-range financial planning. They both had worked for many years and tended to spend their paychecks shortly after they received them. When they bought their house in 1997, they gave little thought to how they would make their mortgage payments after retiring. Dave had hoped the Social Security system would take care of his bills.

Dave and Jeanette were in for a shock when they retired. The monthly Social Security checks were much less than they had anticipated. They stopped going out to eat, to movies, and to ball games. A few months after Dave retired, they realized they could no longer make the mortgage payments. They put the house up for sale and sold it four and a half months later, at a price lower than what the house was worth. Both were sad about leaving their home, but financially they had no other choice. They moved into a two-bedroom apartment. Both became even more inactive, as they no longer had yard work and now had fewer home maintenance tasks. One neighbor frequently played a stereo late into the night, and the Pearsalls had trouble sleeping.

In February 2004, Jeanette had a major heart attack. She was in the hospital for nearly two weeks and then was placed in a nursing home. Dave missed the companionship of his wife and became deeply depressed. He wished she could come home, but her medical needs wouldn’t allow that, so he visited her every day. Dave had never learned to cook, and because he was depressed, his diet consisted mainly of cheese sandwiches and TV dinners. In November 2004, Jeanette suffered another heart attack and died.

Dave now became even more depressed. He no longer shaved or bathed. He no longer cleaned his apartment, and neighbors began to complain about the odor. Dave gave up the will to live. He seldom heard from his son, Donald, who was living in a distant city. Dave sought to drown his unhappiness in whiskey. One night in January 2011, he passed out in his apartment with a lighted cigarette in his hand, which set his couch on fire. Dave died of smoke inhalation.

Dave’s later years raise some questions for our society. Have we abandoned elders to a meaningless existence? Is it a mistake for older people to count on Social Security to meet their financial needs when they retire? How can our society provide a more meaningful role for older people?

This chapter will focus on the social problems encountered by older people. The plight of older people has now become recognized as a major problem in the United States. Older people face a number of personal problems: high rates of physical illness and emotional difficulties, poverty, malnutrition, lack of access to transportation, low status, lack of a meaningful role in our society, elder abuse, and inadequate housing. To a large extent, older people are a minority group. Similar to other minority groups, older people are victims of job discrimination and are subjected to prejudice that is based on erroneous stereotypes.

16-1 Summarize the Specific Problems Faced by Older People and the Causes of These Problems

16-1aOlder People: A Population-at-Risk

Human societies have different customs for dealing with incapacitated older people. In the past, some societies abandoned their enfeebled old. The Crow, Creek, and Hopi tribes, for example, built special huts away from the tribe where the old went to die. The Eskimos left incapacitated older people in snow banks, or sent them off in a kayak. The Siriono of the Bolivian forest simply left them behind when they moved on in search of food (Moss & Moss, 1975). Even today, the Ik of Uganda leave older people and the disabled to starve to death (Kornblum & Julian, 2012). Generally, the primary reason such societies have been forced to abandon older people is scarce resources.

Although we might consider such customs to be barbaric and shocking, have we not also abandoned older people? We urge them to retire when many are still productive. All too often, when a person is urged to retire, his or her status, power, and self-esteem are lost. Also, in a physical sense, we seldom have a place for large numbers of older people. Community facilities—parks, subways, libraries—are oriented to serving children and young people. Most housing is designed and priced for the young couple with one or two children and an annual income over $60,000. If older people are not able to care for themselves and if their families are unable or unwilling to care for them, we store them away from society in nursing homes. About one out of 10 older people is living in poverty (Mooney, Knox, & Schacht, 2015). (The poverty rate for older adults is lower than that of the total population.)

Older people may face many problems, such as severe financial constraints, physical disabilities, and perceptual limitations.

AP Images/Beth A. Keiser

Older people are erroneously thought to be senile, resistant to change, inflexible, incompetent workers, and a burden on the young. Given opportunities, older individuals usually prove such prejudicial concepts to be wrong. They generally react to prejudice against them in the same way that racial and ethnic minorities react—by displaying self-hatred and by being self-conscious, sensitive, and defensive about their social and cultural status (Santrock, 2016). As we have mentioned previously, individuals who frequently receive negative responses from others eventually tend to come to view themselves negatively.

16-1bProblems Faced by Older People

Individuals are dramatically affected by their interactions with other micro, mezzo, and macro systems. The following section will address a range of problems suffered by older people within the macro-system context. This involves two dimensions. The first concerns problems older people as individual micro systems suffer within the macro environment. These include poverty, malnutrition, health difficulties, elder abuse, and lack of transportation. The other dimension of problems affecting older people focuses on the macro systems providing them with support and services. Often, cost is of chief concern. For example, the general population might experience rapidly rising taxes to cover a range of services for older people, including medical care. Examining both perspectives can enhance your understanding of human behavior in preparation for assessment and practice.

A point to remember is that unlike other minorities, older people have problems that we all encounter eventually (assuming we do not die prematurely). By the time most of today’s college students reach middle age (presumably their peak earning years), a larger proportion of the adult population will be retired, because older people are the fastest-growing segment of our population. Those who are retired depend heavily on Social Security, Medicare, and other government programs to assist in meeting their financial and medical needs. If we do not face and solve the financial problems of older people now, we will be in dire straits in the future.

16-1cEmphasis on Youth: The Impact of Social and Economic Forces

Our society fears aging more than most other societies do. Our emphasis on youth is illustrated by our dread of getting gray hair and wrinkles or becoming bald and by our being pleased when someone guesses our age to be younger than it actually is. We place a high value on youthful energy and action. We like to think we are doers. But why is there such an emphasis on youth in our society?

By 2030, the number is projected to be 72 million—a 90 percent increase in 20 years, compared to a 30 percent growth in total population during the same period (Santrock, 2016).

Several reasons can be given for the phenomenal growth of the older population. The improved care of expectant mothers and newborn infants has reduced the infant mortality rate. New drugs, better sanitation, and other medical advances have increased the life expectancy of Americans from 49 years in 1900 to 78 years in 2015 (Santrock, 2016).

The increased life expectancy, along with the baby boom followed by the baby bust, will significantly increase the median age of Americans in future years. The median age is indeed increasing dramatically. The long-term implications are that the United States will undergo a number of cultural, social, and economic changes.

16-1eThe Fastest-Growing Age Group: Old-Old

Because our society is having more success in treating and preventing heart disease, cancer, strokes, and other killers, more and more older people are living into their 80s and beyond. People 85 and over constitute the fastest-growing age group in the United States (Mooney, Knox, & Schacht, 2015). Older Americans are living longer, due in part to better medical care, sanitation, and nutrition. The proportion of the old-old in our society is projected to increase substantially in the next few decades as the baby boomer generation reaches age 75 and older. The number of people age 85 and older, currently 15 percent of the total older population, is the most rapidly growing segment of the U.S. population (Mooney, Knox, & Schacht, 2015).

Those who are 75 and over are creating a number of problems and difficult decisions for our society. Many of the old-old suffer from multiple chronic illnesses. Common medical problems of the old-old include arthritis, heart conditions, hypertension, osteoporosis (brittleness of the bones), Alzheimer’s disease, incontinence, hearing and vision problems, and depression. The old-old with major health problems are putting strains on family resources. The old-old need more of such community help as Meals on Wheels, home health care, special busing, and homemaker services. The older an older person becomes, the higher the probability that he or she will become a resident of a nursing home. The cost to society for such care is high—more than $80,000 a year per person to provide nursing home care (Mooney, Knox, & Schacht, 2015). Despite the widespread image of families dumping aged parents into nursing homes, most frail older people still live outside institutional walls, being cared for by a spouse, child, or other relative. Some middle-aged people are now simultaneously encountering demands to put children through college and to support an aging parent in a nursing home.

“Can we afford the very old?” is a favorite conference topic for doctors, bioethicists, and other specialists. Rising health-care costs and superlongevity have ignited a controversy over whether to ration health care to the very old. For example, should people over age 75 be prohibited from receiving liver transplants or kidney dialysis? Discussion of euthanasia (the practice of killing individuals who are hopelessly sick or injured) has also been increasing. In 1984, Governor Richard Lamm of Colorado created controversy when he asserted the terminally ill have a duty to die. Dr. Eisdor Fer (quoted in Otten, 1984) stated, “The problem is age-old and across cultures. Whenever society has had marginal economic resources, the oldest went first, and the old people bought that approach. The old Eskimo wasn’t put on the ice floe; he just left of his own accord and never came back” (p. 10).

16-1fEarly Retirement: The Impact of Social and Economic Forces

Maintaining a high rate of employment is a major goal in our society. One instrument used in the past to keep the workforce in line with demand was mandatory retirement at a certain age, such as 65 or 70. In 1986, Congress (recognizing that mandatory retirement was overtly discriminatory against older adults) outlawed most mandatory retirement policies. In many occupations, the supply of labor exceeds the demand. An often-used remedy for the oversupply of available employees is the encouragement of ever earlier retirement. Even though employers can no longer force a worker to retire, many exert subtle pressures on their older employees to retire.

Many workers who retire early supplement their pension with another job, usually at a lower status. About 85 percent of Americans 65 and older are retired, even though many are intellectually and physically capable of working (Papalia & Martorell, 2015). Our Social Security program supports early retirement at the age of 62. Pension plans of some companies and craft unions make it financially attractive to retire as early as 55. Perhaps the extreme case is the armed forces, which permit retirement on full benefits after 20 years of service, or as early as age 38.

Although early retirement has some advantages to society, such as reducing the labor supply and allowing younger employees to advance faster, there are also some disadvantages. For society, the total bill for retirement pensions is already huge and still growing. For the retiree, it means facing a new life and status without much preparation or assistance. Although our society has developed education and other institutions to prepare the young for the work world, it has developed few comparable institutions to prepare older people for retirement.

In our society, we still view people’s worth partly in terms of their work. People often develop their self-image in terms of their occupation. Because the later years generally provide no exciting new roles to replace the occupational roles lost on retirement, retirees cannot proudly say, “I am a …” Instead, they must say, “I was a …” The more a person’s life revolves around work, the more difficult retirement is apt to be. Retirement often diminishes people’s social contacts and their status and places them in a  roleless role. People who were once valued as salespeople, teachers, accountants, barbers, or secretaries are now considered noncontributors in a roleless role on the fringe of society.

Several myths about the older worker have been widely believed by employers and the general public. Older workers are thought to be less healthy, clumsier, more prone to absenteeism, more accident-prone, more forgetful and slower in task performance (Papalia & Martorell, 2015). Research has shown these beliefs to be erroneous. Older workers have lower turnover rates, produce at a steadier rate, make fewer mistakes, have lower absenteeism rates, have a more positive attitude toward their work, and exceed younger employees in health and low on-the-job injury rates. However, when older workers do become ill, they usually take a somewhat longer time to recover (Papalia & Martorell, 2015).

A key question about early retirement is the age at which people want to retire. Gerontologists have studied this question. Younger workers generally state they prefer to retire before age 65. Older workers indicate they desire to retire later than the conventional age of 65 (Newman & Newman, 2015). The explanation for this difference appears to be partly economic. Because Social Security benefits and pension plans are usually insufficient to provide the same standard of living as when a person was working, older people see an economic need to continue working beyond age 65. An additional explanation is sociopsychological. With retirement often being a roleless role in our society, older workers may gradually identify more and more with their work and prefer it over retirement.

Adjustment to retirement varies for different people. Retirees who are not worried about money and who are healthy are happier in retirement than those who miss their income and do not feel well enough to enjoy their leisure time. Many recent retirees relish the first long stretches of leisure time they have had since childhood. After a while, however, they may begin to feel restless, bored, and useless. The most satisfied retirees tend to be physically fit people who are using their skills in part-time volunteer or paid work (Papalia & Martorell, 2015).

Workers who are pressured to retire before they want to may feel anger and resentment, and may feel out of step with younger workers. Also, workers who defer retirement as long as possible because they enjoy their work may feel that no more work is an immense loss when they are pressured to retire. On the other hand, some people’s morale and life satisfaction remain stable through both their working and retirement years.

Ariel Skelley/Photographer’s Choice/Gettyimages

Older adults who adjust best to retirement have adequate income, are healthy, are active, are better educated, have an extended social network that includes both family and friends, and usually were satisfied with their lives prior to retiring. Those having the most difficulty adjusting to retirement are those with poor health, inadequate income, and who must adjust to other stresses (such as the death of a spouse) (Santrock, 2016).

The two most common problems associated with retirement are adjusting to a reduced income and missing one’s former job. Those who have the most difficulty in adjusting tend to be rigid or to overly identify with their work by viewing their job as their primary source of satisfaction and self-image. Those who are happiest are able to replace job prestige and financial status with values stressing self-development, personal relationships, and leisure activities.

16-1gFinancial Problems of Older People

One out of 10 older people lives in poverty. A significant number lack adequate food, essential clothes and drugs, and perhaps a telephone in the house to make emergency calls. Only small minorities of older people have substantial savings or investments.

Poverty among older people varies dramatically by race, sex, marital status, ethnicity, and age. Women, the old-old, people of color, and those who are widowed or single are most likely to be poor (Mooney, Knox, & Schacht, 2015).

Older women are more likely to be poor than older men. Nearly half of older Hispanic women, and four out of 10 older African American women, are living in poverty (Mooney, Knox, & Schacht, 2015). Women of color were more likely to have been working in low-paying jobs with no retirement plan.

The most important source of income for the vast majority of older people is Social Security benefits, primarily the Old Age, Survivors, Disability, and Health Insurance (OASDHI) program. This program is described later in this chapter. About 95 percent of older adults receive Social Security; for 18 percent of them, Social Security is their only income (Mooney, Knox, & Schacht, 2015). About 14 percent of Americans age 65 and older are in the paid labor force. This figure is substantially lower than in 1950, but represents an increase since 1993 (Mooney, Knox, & Schacht, 2015).

Sullivan and his associates (Sullivan, Thompson, Wright, Gross, & Spady, 1980) emphasize the importance of financial security for older persons.

Financial security affects one’s entire life-style. It determines one’s diet, ability to seek good health care, to visit relatives and friends, to maintain a suitable wardrobe, and to find or maintain adequate housing. One’s financial resources, or lack of them, play a great part in finding recreation (going to movies, plays, playing bridge or bingo, etc.) and maintaining morale, feelings of independence, and a sense of self-esteem. In other words, if an older person has the financial resources to remain socially independent (having her own household and access to transportation and medical services), to continue contact with friends and relatives, and to maintain her preferred forms of recreation, she is going to feel a great deal better about herself and others than if she is deprived of her former style of life. (pp. 357–358)

16-1hThe Social Security System

The Social Security system was not designed to be the main source of income for older people. It was originally intended as a form of insurance that would supplement other assets when the retirement, disability, or death of a wage-earning spouse occurred. Yet many older people do not have investments, pensions, or savings to support them in retirement, and therefore Social Security has become their major source of income.

The Social Security system was instituted in the United States in 1935. Money is paid into the system from Social Security taxes on employers and employees. In 1935, life expectancy was only somewhat over 60 years. Life expectancy, however, has increased to 78 in 2010. Social Security taxes have sharply increased in recent years, but the proportion of older people is increasing even faster. Some projections have the Social Security fund being depleted around 2020 (Santrock, 2016).

The  dependency ratio is the number of societal members who are under 18 or are 65 and over compared with the number of people who are between 18 and 64. With the older adult proportion of the population increasing, nonworkers will represent a ballooning burden on workers. Authorities predict that by the year 2020 the dependency ratio will decline from the current level of about three workers for every nonworking person to a ratio of about 2 to 1 (Mooney, Knox, & Schacht, 2015). This dramatic increase may lead to foundering pension plans and increased taxes as governments struggle to finance elder care programs.

Some problems now exist with the system. First, as mentioned, the benefits are too small to provide the major source of income for older people. Even with payments from Social Security included, an estimated 80 percent of retirees are now living on less than half of their preretirement income. And the monthly payments from Social Security are generally below the poverty line (Mooney, Knox, & Schacht, 2015). Second, it is unlikely that the monthly benefits will be raised much. Our society faces some hard choices about keeping the Social Security system solvent in future years. Benefits might be lowered, but this would further impoverish the recipients. Social Security taxes might be raised, but there is little public support for this. The amount of salary that is subject to Social Security taxes has been rising significantly each year since 1970.

The future of the Social Security system is unclear. It is likely to continue to exist, but reduced benefits are possible. Young people are well advised to plan for retirement through savings and investments that will supplement Social Security payments.

16-1iDeath

Preoccupation with dying, particularly with the circumstances surrounding it, is an ongoing concern of older people. For one reason, they see their friends and relatives dying. For another, they realize they’ve lived more years than they have left.

The older person’s concern about dying is most often focused on the disability, the pain, or the long period of suffering that may precede death. People generally would like a death with dignity. They would prefer to die in their own homes, with little suffering, with mental faculties intact, and with family and friends nearby. Older people are also concerned about the cost of their final illness, the difficulties they may cause others by the manner of their death, and whether their resources will permit a dignified funeral.

In modern America, many people die in nursing homes or hospitals surrounded by medical staff (Papalia & Martorell, 2015). Such deaths often occur without dignity. Fortunately, the hospice movement has been developing in recent years in an attempt to foster death with dignity. A hospice is a program that is designed to allow the terminally ill to die with dignity—to live their final weeks in a way they want. Hospices originated in the Middle Ages among European religious groups that welcomed travelers who were sick, tired, or hungry (Sullivan et al., 1980).

Hospices serve patients in a variety of settings—in hospitals, in nursing homes, in assisted-living facilities, and in the dying person’s home. Hospices provide both medical and social services, and make extensive efforts to allow the terminally ill to spend their remaining days as they choose. Hospices sometimes have educational and entertainment programs, and visitors are welcome. Pain relievers are extensively used, so that the patient is able to live out his or her final days in relative comfort.

Hospices view the disease, not the patient, as terminal. Their emphasis is on helping people use the time that is left, rather than on trying to keep people alive as long as possible. Many hospice programs are set up to assist people in living their remaining days at home. In addition to medical and visiting nurse services, hospices have volunteers to help the patient and family members with such services as counseling, transportation, filling out insurance forms and other paperwork, and respite care (that is, staying with the patient to provide temporary relief for family members).

· Sexual abuse: nonconsensual sexual contact with an older person

· Self-neglect: behaviors of a frail, depressed, or mentally incompetent older person that threaten her or his own safety or health, such as failure to eat or drink adequately or to take prescribed medications

· Abandonment: desertion of vulnerable elder by anyone who has assumed the responsibility for care or custody of that person

· Violating personal rights: violation of an older person’s rights, including the right to privacy and to make her or his personal and health decisions (Papalia & Martorell, 2015)

One of the more notable victims of elder abuse was Mickey Rooney. He began as a child movie star and acted in more than 200 movies. In March 2011, he gave an emotional testimony on elder abuse before a U.S. senate panel. Rooney said he had been victimized for years by two of his stepchildren. He stated they bullied and threatened him, making him “effectively a prisoner in his home.” He added they took his money, denied him his medication, and withheld food from him. Rooney told the senators if it can happen to him, it can happen to anyone.

Every state is mandated by the federal government to provide adult protective services similar to those provided for children. An adult protective services program serves adults—primarily older people and adults with physical or mental disabilities—who are being neglected or abused. (This program is described in more detail later in this chapter.)

16-1kHousing

More than 95 percent of older people do not live in nursing homes or any other kind of institution. More than 70 percent of older men are married and live with their wives. Because women tend to outlive their spouses, more than 40 percent of women over age 65 live alone. Nearly 80 percent of older married couples maintain their own households—in apartments, mobile homes, condominiums, or their own houses. In addition, nearly half of single older people (widows, widowers, divorced, never married) live in their own homes (Papalia & Martorell, 2015). When older people do not maintain their own households, they most often live in the homes of relatives, primarily children.

Older people who live in rural areas generally have a higher status than those living in urban areas. People living on farms can retire gradually. People whose income is in land, rather than a job, can retain importance and esteem to an advanced age.

Fortunately, many mobile home parks, retirement villages, and apartment complexes geared to the needs of older people have been built throughout the country. Many such communities for older people provide a social center, security protection, sometimes a daily hot meal, and perhaps help with maintenance. The fastest-growing housing option for older people is assisted-living facilities. Such facilities offer private living units, with the safety of around-the-clock staff.

16-1lTransportation

Many older people do not drive. Some cannot afford the cost of a car, whereas others have physical limitations that prevent them from driving and maintaining a car. The lack of convenient, inexpensive transportation is a problem faced by most older people.

16-1mCrime Victimization

Having reduced energy, strength, and agility, older people are vulnerable to being victimized by crime, particularly robbery, aggravated assault, burglary, larceny, vandalism, and fraud. Many older people live in constant fear of being victimized, although reported victimization rates for older people are lower than rates for younger people. The actual victimization rates for older people may be considerably higher than official crime statistics indicate, because many older people feel uneasy about becoming involved with the legal and criminal justice systems. Therefore, they may not report some of the crimes they are victims of. Some are afraid of retaliation from the offenders if they report the crimes, and others dislike the legal processes they have to go through if they press charges. Some older people are hesitant to leave their homes for fear they will be mugged or for fear their homes will be burglarized while they are away.

16-1nMalnutrition

Older people are the most uniformly undernourished segment of our population (Papalia & Martorell, 2015). Chronic malnutrition of older people exists because of transportation difficulties in getting to grocery stores; lack of knowledge about proper nutrition; lack of money to purchase a well-balanced diet; poor teeth and lack of good dentures, which greatly limit the diet; lack of incentives to prepare an appetizing meal when one is living alone; and inadequate cooking and storage facilities.

16-1oHealth Problems and Cost of Care

As noted earlier, the proportion of older people in our society is increasing dramatically, and the old-old (age 85 and over) is the most rapidly growing age group. Today, there is a crisis in health care for older people. There are a variety of reasons for this.

In addition, older people who live in the community often have transportation difficulties in getting medical care. Those living in nursing homes sometimes receive inadequate care, because some health professionals assume that such patients haven’t much time to live and, as a result, providers may be less interested in providing high-quality medical care. Medical care for older people is becoming a national embarrassment because of the low quality of care that is often provided.

16-2 Describe the Current Services to Meet These Problems and Identify Gaps in These Services

16-2aCurrent Services: Macro-System Responses

Present services and programs for older people are primarily maintenance in nature, as they are mainly designed to meet basic physical needs. Nonetheless, there are a number of programs, often federally funded, that provide services needed by older people. Before we briefly review many of these programs, we will look at the Older Americans Act of 1965, which set forth objectives for such programs.

16-2bOlder Americans Act of 1965

The Older Americans Act of 1965 created an operating agency (Administration on Aging) within the Department of Health, Education, and Welfare (now the Department of Health and Human Services). This law and its amendments are the basis for federal aid to states and local communities to meet the needs of older people. The objectives of the act are to secure the following for older people:

· An adequate income

· Best possible physical and mental health

· Suitable housing

· Restorative services for those who require institutionalized care

· Opportunity for employment

· Retirement in health, honor, and dignity

· Pursuit of meaningful activity

· Efficient community services

· Immediate benefit from research knowledge to sustain and improve health and happiness

· Freedom, independence, and the free exercise of individual initiative in planning and managing their own lives (U.S. Department of Health, Education, and Welfare, 1970)

Although these objectives are commendable, they have not been realized for many older people. However, some progress has been made. Many states have offices on aging, and some municipalities and counties have established community councils on aging. Numerous universities have established centers for gerontology, which focus on research on older people and training of students for working with older people in such disciplines as nursing, psychology, medicine, sociology, social work, and architecture. ( Gerontology is the scientific study of the aging process from physiological, pathological, psychological, sociological, and economic points of view.) Government research grants are being given to encourage the study of older people and their problems. Publishers are now producing books and pamphlets to inform the public about older people, and a few high schools are beginning to offer courses to help teenagers understand older people and their circumstances.

Numerous programs, often federally funded and administered at state or local levels, provide funds and services needed by older people. Some of these programs are briefly described in the following sections.

16-2cOld Age, Survivors, Disability, and Health Insurance (OASDHI)

Payments to beneficiaries are based on previous earnings. Rich as well as poor are eligible if insured. Benefits can be provided to fully insured workers as early as age 62—although those who seek benefits before the full retirement age receive smaller benefits. The full retirement age is gradually increasing for those who are born after 1937, as shown on the following chart:

16-2dSupplemental Security Income (SSI)

Under the SSI program, the federal government makes monthly payments to people in financial need who are 65 years of age or older or to persons of any age who are legally blind or disabled. In order to qualify for payments, applicants must have no (or very little) regular cash income, own little property, and have little cash or few assets (such as jewelry, stocks, bonds, or other valuables) that could be turned into cash.

The SSI program became effective on January 1, 1974. The word supplemental in the program’s name is used because, in most cases, payments supplement whatever other income may be available to the claimant. Because OASDHI monthly payments are often low, SSI sometimes supplements even that income source.

SSI provides a guaranteed minimum income (an income floor) for older people, the legally blind, and persons with a disability. Administration of SSI has been assigned to the Social Security Administration. Financing of the program is through federal tax dollars, primarily from income taxes.

16-2eMedicare

In 1965, Congress enacted the Medicare program (Title XVIII of the Social Security Act). Medicare helps older people pay the high cost of health care.

It has two parts: hospital insurance (Part A) and supplementary medical insurance (Part B). Everyone 65 or older who is entitled to monthly benefits under the OASDHI program gets Part A automatically, without paying a monthly premium. Nearly everyone in the United States 65 or older is eligible for Part B; Part B is voluntary, and beneficiaries are charged a monthly premium. Persons with a disability under age 65 who have been getting Social Security benefits for 24 consecutive months are also eligible for both Part A and Part B, effective in the 25th month of disability.

Part B helps pay for physicians’ services, outpatient hospital services in an emergency room, outpatient physical and speech therapy, and a number of other medical and health services prescribed by a doctor, such as diagnostic services, X-rays or other radiation treatments, and some ambulance services.

Each Medicare beneficiary has the choice of selecting, from an alphabet soup of health plans, which plan he or she will be in. The variety of plans includes preferred provider organizations, provider service organizations, point-of-service plans, private fee-for-service plans, and medical savings accounts. (Details can be obtained from your local Social Security Administration office.)