Gerontology reflection/respond

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Nancy R. Hooyman University of Washington

Kevin Y. Kawamoto

H. Asuman Kiyak

Aging Matters An Introduction to Social Gerontology

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Library of Congress Cataloging-in-Publication Data

Hooyman, Nancy R. Aging matters : an introduction to social gerontology / Nancy Hooyman, H. Asuman Kiyak, Kevin Kawamoto. pages cm ISBN-13: 978-0-205-72764-3 (student edition : alk. paper) ISBN-10: 0-205-72764-6 (student edition : alk. paper) 1. Gerontology. 2. Aging. 3. Older people—United States. I. Kiyak, H. Asuman, II. Kawamoto, Kevin. III. Title. HQ1061.H5826 2015 305.26—dc23 2013031899

10 9 8 7 6 5 4 3 2 1

ISBN 10: 0-205-72764-6 ISBN 13: 978-0-205-72764-3

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In dedication to students, faculty, practitioners and older adults committed to enhancing how we age across the life course— with special acknowledgment of our colleague and coauthor,

Dr. Asuman Kiyak, who died before the completion of the book —NRH, KK

With hope that my grandson Gus will inherit a world that supports active aging

—NRH And to family and friends of all ages whose wisdom

and love have enriched the world we all share. —KK

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vii

Preface xv

An Introduction to Social Gerontology 1

Why Study Gerontology? 2 A Life Course and Strengths Perspective 3 A Multidisciplinary Perspective 4

Key Terms 4 How Do We Define Age? 5

How Do We Study Older Adults? 6

Research Methods 6 Summary  9  •  Key Terms  9  •  Review Questions  9

1 The Older Population in the United States 10

Changing Demographics of the U.S. Population 11

Changes in Life Expectancy 12 Gender Differences in Life Expectancy 14 Racial Differences in Life Expectancy 14

Maximum Life Span 16 Population Pyramids 17

Support and Dependency Ratios 19

The Rapid Growth of the Old-Old and Oldest-Old 19

Who Are the Oldest-Old? 20 Centenarians and Super-Centenarians 21

The Role of Genes 22 The Role of the Environment 23

Increasing Diversity among the Older Population 23

Elders of Color 24 Lesbian, Gay, Bisexual and Transgender (LGBT) Elders 25

Geographic Distribution 25 Geographic Distribution among Elders of Color 27 Educational and Economic Status 28

Longevity in Health or Disease? What Does the Future Hold? 29 Summary  30  •  Key Terms  31  •  Review Questions  31   Media Resources  31  •  References  31

2 Global Aging and Older Immigrants in the United States 34

Global Trends in Aging 35 Global Aging, Median Age, and Population Pyramids 37 What It Means To Be Old around the World 40

Baby Boomers in Japan 42

Economic Implications for Industrialized Countries 43

Older Europeans in the Workforce 43

Older Adults in Traditional Societies and the Impact of Modernization 45

Modernization Theory 47 Modernization and Elders’ Declining Social Status 47 Impact of Modernization on Respect and Care toward Elders in Asian Cultures 49

Immigrants to the United States 51 Immigrant Elders’ Changing Roles and Expectations 52 Financial Dilemmas Facing Immigrant Elders 53 Immigrant Elders in Multigenerational Households 53 Additional Challenges Faced by Older Refugees 55

Summary  56  •  Key Terms  56  •  Review Questions  57    Media Resources  57  •  References  57

Contents

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viii Contents

Problems with the Intestinal System 83 Oral Diseases 84 HIV (Human Immunodeficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome) 84

Accidents 85 Older Drivers 85 Falls and Their Prevention 86

Use of Physician Services 87 Hospital Utilization 87 Medication Use 87

Health Promotion 88 Exercise as Central to Health Promotion 89 Nutrition 90 Programs That Work 90 Improving the Impact of Health Promotion Programs 91

Summary  92  •  Key Terms  93  •  Review Questions  94   Media Resources  94  •  References  94

4 Mental and Emotional Well-Being 100

Aging and Cognitive Function 101 Intelligence and Aging 102 What Else Besides Age Affects Intelligence? 102 How Aging Affects Learning and Memory 103 Executive Function in Older Adults 105

Factors That Affect Learning in Old Age 106 Strategies to Promote Older Adults’ Learning 106 Age-Related Changes in Memory 106

Improving Cognitive Abilities 108 Memory Mediators 108 External Cognitive Aids 109 Physical Exercise 109 Do Chemical Aids Improve Memory? 109

Wisdom and Creativity 110

Personality in the Later Years 111 Stage Theories of Personality 111

Erikson’s Psychosocial Model of Personality 111

Trait Theories of Personality 112 Emotional Expression and Regulation 112

3 Physical Well-Being: Physiological Changes and Health 60

Biological Theories of Aging 61 Can Aging Be Reversed or Delayed? 62

“Normal” Physiological Changes with Age 63

Changes in Body Composition 63 Changes in the Skin and Hair 64 Organ Systems 64

Musculoskeletal and Kinesthetic Systems 64 Respiratory System 65 Cardiovascular Changes 65 Urinary System 66 Gastrointestinal System 66 Endocrine System 67 Immune System 67 Nervous System 67

Physiological Changes and Sexuality 68 Women and Age-Related Physiological Changes 68 Men and Age-Related Physiological Changes 68

Sleep Patterns 69 Sensory Functions 69

Vision 70 Hearing 71 Taste and Smell 73 Touch 73

Defining Health and Functional Ability 73 Are Disability Rates Declining? 75 Chronic and Acute Diseases 75 Health Disparities 76 Primary Causes of Death in Old Age 76

Common Chronic Diseases 78 Heart Disease and the Cardiovascular System 78 Strokes and Other Cerebrovascular Problems 79 Cancer 79 Arthritis 80 Osteoporosis or “Weak Bones” 81 Chronic Obstructive Pulmonary Disease or Respiratory Problems 82 Diabetes 82 Problems with the Kidneys and Urinary Tract 83

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Contents ix

Disengagement Theory 145 Continuity Theory 146

Newer Social Theoretical Perspectives 147 Age Stratification Theory 147 Social Exchange Theory 149 Life-Course Perspective 150 Political Economy Theory of Aging 151 Social Constructionism 152

Recent Developments in Social Gerontological Theory 153

Social Phenomenology 153 Feminist Gerontology 155

Summary  157  •  Key Terms  157  •  Review Questions  157 Media Resources  158  •  References  158

6 Family, Friends, and Other Informal Supports 160

We All Need Informal Social Support 161 The Benefits of Social Supports 161 Do Social Supports Change as We Age? 162 What Factors Affect Our Social Relationships? 164

The Centrality of Family Supports 164 Families Are Changing 165 The Growth of the Multigenerational Family 166

Older Partners as Social Support 168 Older Adults and Marriage 168

Marital Satisfaction 170 Divorce in Old Age 170 Remarriage and Other Late-Life Romantic Relationships 170 Dating in Old Age 171

Never-Married Older People 171 Childless Older Adults 171 Lesbian, Gay, Bisexual, and Transgender (LGBT) Partners 172

What We Now Know about Older LGBT Families 173 Effects of Race, Class, and Cohort with Sexual Identity 174 Barriers to Supports for LGBT Elders 175 Working with LGBT Elders 176

Self-Concept and Self-Esteem 113 Successful, Robust, Resilient, or Positive Aging 114

Mental Disorders among Older Persons 115

Depression 116 Risk Factors for Depression 116 Diagnosing Depression 116 Therapeutic Interventions 117

Suicide 118 Anxiety 118 Paranoia and Schizophrenia 119 Older Adults Who Are Chronically or Severely Mentally Ill 119 Dementia 120

Reversible and Irreversible Causes of Dementia 121 Alzheimer’s Disease (AD) 121 Differentiating AD from Normal Age-Related Memory Changes 121 Potential Causes of and Risk Factors for Alzheimer’s Disease 121 The Importance of a Thorough Diagnosis 122 Stages of Alzheimer’s Disease 123 Drug Therapy 124 Behavioral Treatment and Environmental Interventions 124 Parkinson’s Disease 125

Substance Use 125 Alcoholism 125 Drug Abuse 127

Summary  128  •  Key Terms  129  •  Review Questions  130 Media Resources  130  •  References  131

5 Social Theories of Aging 138

The Importance of Social Theories of Aging 139

Social Gerontological Theory before 1961: Role and Activity 141

Role Theory 141 Activity Theory 144

The Next Stage of Theory Development: Disengagement and Continuity Theory 145

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Modifying the Home Environment 210 Respite Care 210 Electronic Supports 211

Future Service Directions 211

When Caregiving Becomes Too Much 212

Placement in Long-Term Care Facilities 213 Elder Mistreatment 213

Financial Abuse and Exploitation 215 Reporting and Other Legal Requirements 215

Underpaid Caregivers: Direct Care Workers 217

Economic and Health Disparities Faced by Direct Care Workers 218 Future Demand 219

Summary  220  •  Key Terms  221  •  Review Questions  221 Media Resources  221  •  References  222

8 Productive Aging: Leisure, Spirituality, and Civic Engagement 226

Defining Productive Aging 227

Leisure 228

Religious Participation, Religiosity, and Spirituality 229

Defining Religion, Religiosity, and Spirituality 229 Religious Affiliation: Age, Gender, and Race 230 Religiosity 232

Benefits of Religious Participation and Religiosity for Older Adults 232 Other Factors to Consider regarding Religion and Health 233

Spiritual Well-Being 233 Implications for Health Care Providers 235 Stages of Spiritual Growth 235

Civic Engagement 236 Civic Engagement: Toward What End? 237 Membership in Voluntary Associations 237

Patterns of Membership 237 Senior Centers: Are They Prepared for Changing Demographics? 238

Sexuality, Intimacy, and Emotional Support 176

What We Know about Older Adults and Sexuality 177

Other Types of Family Supports 178 Relationships with Adult Children 178 Sibling Relationships 179 Grandparenthood and Great-Grandparenthood 179 Friends and Neighbors as Social Supports 182

Programs to Strengthen or Build Neighborhood and Community Supports 183 Intergenerational Programs 184

The Unconditional Love of Pets 185 Summary  186  •  Key Terms  187  •  Review Questions  187 Media Resources  188  •  References  188

7 Informal and Family Caregiving 193

What is Informal Caregiving? 194 What Kind of Informal Care Do Some Older Adults Need? 194 Who Are Informal Caregivers? 196 Losses and Gains of Informal Care 197

Costs of Informal Caregiving 197 Benefits of Informal Caregiving 199

Adult Children as Caregivers 200 The Gendered Nature of Caregiving 200 Women in the Middle 201

Spouses/Partners as Caregivers 202 Family Caregivers of Color 202 Friends as Caregivers 204 Caregiving for Persons with Dementia 204 Grandparents as Primary Caregivers 204 Legal Issues Related to Grandparent Caregiving 206 Legislation and Policies to Support Family Caregivers 207

Services and Support for Caregivers 208 Why Don’t Caregivers Use Services? 209 Effective Evidence-Based Interventions 209

Psychoeducational Groups, Skills Training, and Treatments 210 Support Groups 210

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Contents xi

10 Economic Well-Being: Retirement, Employment, and Poverty 283

Retirement 284 Baby Boomers and Changing Expectations of Retirement 285 The Timing of Retirement 287

Employment 289 Unemployment 289 Barriers to Employment 291

Economic Status 292 What Are the Major Sources of Income for Older Adults? 293

Social Security 293 Assets 295 Pensions Other Than Social Security 295 Earnings 296 Public Assistance 297

Social Class and Poverty in Old Age 297 Are Older Adults Poorer Than Other Age Groups? 298 Limitations of Official Poverty Statistics 299 Poverty Variations by Race, Gender, and Sexual Orientation 300 Hunger Is Increasing among Older Americans 301

Changing Conceptions of Work and Retirement 302 Summary  304  •  Key Terms  305  •  Review Questions  305 Media Resources  306  •  References  306

11 Community Well-Being: Living Arrangements and Social Interactions 309

The Aging Experience in Rural, Urban, and Suburban Areas 310

How and Where Elders Live Affects Their Well-being 310 Relocation 312

Volunteering 240 Benefits of Volunteerism 242 Race, Social Class, and Volunteering 243

Lifelong Learning Programs 244 Political Participation 245

Do Older Adults Become More Politically Conservative with Age? 245 Voting Behavior 246 Are Older Adults a Powerful Political Constituency? 247 AARP—The Largest Membership Organization in the Country 248

Looking toward the Future of Productive Aging 250 Summary  250  •  Key Terms  251  •  Review Questions  251 Media Resources  252  •  References  252

9 Loss and Grief in Old Age 256

Loss and Grief within the Context of Aging 257

The Nature of Grief 259 Typical Losses Faced by Older Adults 259

Relocation 260 Retirement 261 Caring for a Relative with Chronic Illness or Disability 262 Caring for Adult Children with Chronic Illness or Disabilities 263 Living with Chronic Illness or Disability 265

Death of Loved Ones 265 Death of a Partner 265 Death of Siblings 268 Death of Friends 269

Approaching One’s Own Death and the Dying Process 269

The Dying Process 271 Desire for a Good Death 272 End-of-Life Care: Palliative Care and Hospice 272 Culturally Appropriate End-of-Life Care 273 The Right to Die 275

Hastened Death and Physician Aid-in-Dying 275 Patients’ Legal Options regarding Their End-of-Life Care 277

Summary  278  •  Key Terms  279  •  Review Questions  279 Media Resources  279  •  References  280

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Technology in the Workplace 346

Technologies to Help Aging in Place 347

Universal Design and Smart Homes 347

Can Computer Games Promote Elders’ Well-Being? 352

Computer Games and Physical Exercise 353

Summary  354  •  Key Terms  354  •  Review Questions  354 Media Resources  355  •  References  355

13 Policies to Promote Older Adults’ Well-Being 357

Understanding Policies, Programs, and Regulations 358

Separating Fact from Fiction about Age-Based Policies 359 Criteria by Which Policies Vary 359 Factors That Influence the Development of Public Policies 360

Values Affecting Social Policy 360 Intergenerational Inequity versus Interdependence 361

Historical, Economic, and Political Context 362

The First Policies to Benefit Older Americans 1930s–1950s 362 Expansion of Age-Based Programs in the 1960s and 1970s: “Compassionate Stereotypes” about Older Adults 363 Cost Efficiency and Program Reductions in the 1980s and 1990s 363 Since 2000: Market and Personal Responsibility and Reduced Government Spending 364

Social Security: An Income Security Program 364

The Goals of Social Security 365 The Cross-Generational Nature of Social Security 365

Housing Patterns of Older People 314 Independent Housing 314 Aging in Place 316

Age-Friendly/Livable Communities 316 Flexible Housing and Universal Design 317 Additional Innovations for Aging in Place 318

Planned “Retirement” Housing 320 Continuing Care Retirement Communities 321 Assisted Living 322 Private Homes That Offer Long-Term Supports 323 Skilled Nursing Facilities (SNFs) 324 Culture Change in Long-Term Care 325

Social and Health Services to Promote Aging in Place 327

Home Care 328 Adult Day Care and Adult Day Health Care 328

Housing Policy and Growing Housing Needs 329

Homelessness: Aging in Place on the Streets 329 Aging in Place among Older Prisoners 331

Summary  331  •  Key Terms  333  •  Review Questions  333 Media Resources  333  •  References  334

12 Enhancing Older Adults’ Well-Being through Technology 336

Information and Communication Technologies 337

Intergenerational Communication 339 Lifelong Learning 340 News and Information 341

Managing Health Online 342 Health Information on the Internet 342 Health Plans Online 344 Telehealth 345 Health Consultation Online 346

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Contents xiii

14 Careers in Aging 391

Why Consider a Career in Aging? 392

The Wide Range of Jobs in Aging 396

Preparing for a Career in Aging 397 Academic Programs in Aging 398

Workforce Initiatives in Medicine, Nursing, and Social Work 399 Interdisciplinary Teams 399

Internships and Other Training Opportunities 400 Journaling as a Self-Discovery Tool 401

A Multidisciplinary, Multigenerational Outlook 401 Summary  405  •  Key Terms  405  •  Review Questions  405 Media Resources  406  •  References  406

Glossary 407 Credits 417 Index 421

The Future of Social Security 366 Proposed Changes to Social Security 367 Proposals to Reduce Gender Inequities in Social Security 368

Social Services through the Older Americans Act 369

Medicare and Medicaid 372 Medicare 372

Medicare-Funded Home Health Care 375 Medicare Reform and Prescription Drug Coverage 376 The Future of Medicare 377

Medicaid 378 Medicaid-Funded Skilled Nursing Home Care 379 Medicaid-Funded Home Health Care 380

Directions in Long-Term Services and Supports 382

Long-Term Care Insurance 382 Policies to Promote Innovative Health and Long-Term Care Services 383 Benefits of Health Care Reform for Older Adults 384

Summary  386  •  Key Terms  387  •  Review Questions  387 Media Resources  388  •  References  388

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xv

Preface

Why This Introductory Text for Undergraduates? Since 1987, Nancy R. Hooyman and H. Asuman Kiyak’s textbook Social Gerontology: A Multidisciplinary Perspective has impacted thousands of students’ learning about aging. It is always rewarding to hear from students and faculty in different colleges and universities nationally and interna- tionally about how the textbook changed their knowledge and attitudes toward older adults, fostered the personal rewards that come from gaining insight into older people’s lives, influenced career choices, or provided a compre- hensive resource for future reference. It is deeply gratify- ing to  have created a text that both undergraduate and graduate students find helpful and even inspiring, both personally and professionally. Indeed, it was that type of feedback that encouraged and motivated Drs. Hooyman and Kiyak to complete nine editions of Social Gerontology: A Multidisciplinary Perspective.

Along with the positive feedback, we would often hear comments such as “I would love to use your text but it is too dense, heavy, or long for my undergraduate class,” “I wish you had a user-friendly undergraduate version of your text,” or “When are you going to do an undergraduate version of your text?” Even though we knew that Social Gerontology was used by some instruc- tors for upper-division courses, we consistently received feedback that it is not always appropriate for lower- division or community college courses. This book, Aging Matters: An Introduction to Social Gerontology, specifically responds to this criticism by attempting to meet the need for a user-friendly, readable, and evidence-based undergraduate social gerontology text. It also reflects our knowledge from teaching undergraduates—as well as research on changing attitudes toward aging—that exposing undergraduates, especially those in their early twenties, with content on aging and experiences with elders, can promote their positive attitudes, beliefs, and values about older adults. It may even influence them to consider a career working with older adults and their families.

Largely because of the visibility and influence of aging baby boomers, the issues of aging are increasingly

attracting the attention of the media, politicians, busi- nesses and industry, and the general public. Accordingly, a growing number of colleges and universities now offer coursework in gerontology. The goal of many of these courses is to prepare students to understand the process of aging and the diversity among older people, and to be able to work effectively with older adults and their families. These courses also attempt to enhance students’ personal understanding of their own and others’ aging. Frequently, students take such a course simply to meet a requirement, but they quickly learn how relevant the aging process is to their own or family members’ lives.

We recognize that only a small proportion of students who read Aging Matters may pursue a specialized career in aging. But all of them are living in an increasingly older and more diverse society. Indeed, no matter what career path or work setting they choose, they will be interacting with older adults—even if they say that they don’t ever want to “work with those older people.” As citizens of our aging society and world, they need to see the connection between learning about the aging process and understanding their own behavior, the behavior of their parents, grandparents, neighbors, and work colleagues, and eventually the behav- ior of their clients, consumers, or patients across all work settings and fields.

Despite the increased visibility of more positive images of older adults, we live in an ageist society and many of us have internalized ageism. Undergraduates are not immune to holding negative views, myths and stereotypes about aging, and these need to be countered with factual information. Many undergraduates have not had positive opportunities to interact with older adults, particularly if their grandparents or great-grandparents were at a geographic distance when they were growing up. Given this likely context, we try to provide a bal- anced approach of both the gains and losses that often accompany the aging process. It is important for under- graduates to know that there are growing numbers of healthy active older adults and that a relatively small proportion of our society’s elders is homebound or in skilled nursing homes. For example, we frequently remind the reader that we are all aging and that people can, to some extent, influence their own experience of

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xvi Preface

Aims and Focus Aging Matters is intended to be useful to a wide range of disciplines, including nursing, social work, sociology, psy- chology, health education, architecture, psychology, human services, and the allied health professions. Accordingly, we present the study of social gerontology from a multidis- ciplinary perspective. We illuminate the diversities of the aging experience related to the cultural, biological, physi- ological, emotional, cognitive, economic, and social aspects of aging so that students readily see how all these multiple facets interact to influence our social functioning and phys- ical and mental well-being. We hope to convey that aging is a fascinating process (and subject to study), because these changes occur differently in each one of us. It is important for students to understand how changes within the aging individual, such as sensory modifications or issues of loss and grief, affect elders’ daily interactions  with social and physical environments. Through research evidence, case studies, personal illustrations, and timely excerpts from the media, we illustrate how dramatic increases in the num- bers and proportion of older people in our population and worldwide have numerous implications for families, the neighborhood, and communities; the workplace; housing; health and social services; political processes; educational and recreational services; religious institutions; volun- teerism; and the use of technology—and that these changes occur across multiple generations and the life course. Similarly, we emphasize that effectively addressing these complex changes requires a multidisciplinary approach.

Throughout this book, a unifying theme is the impact of these dynamic interactions between older people and their environments, including inequities based on age, gender, race, social class, and sexual orientation, on their quality of life and physical and mental well-being. But we also emphasize the remarkable resilience of older adults, many of whom have faced lifelong inequities. The differen- tial effects that these changes have on three rapidly growing, but historically underserved, populations—women, LGBT adults, and elders of color—are frequently recognized, as well as the inner strength and resilience of these groups acknowledged. Culturally competent approaches to under- stand and respectfully meet the needs of an increasingly diverse older population are also identified.

We have tried to present up-to-date content, drawing upon current research, government reports, and Web sites. But because the field—and especially social, health, and long-term care policies and programs—changes so rapidly,

aging. Our lifestyles during young adulthood can affect our health, cognitive and emotional well-being, and social lives in later years. We refer to recent research that demonstrates the role of individual choices and behav- iors in whether we age in a healthy, active manner, or with multiple chronic diseases and without supportive social networks. But we also point to the necessity of policies, programs and communities to support aging in a healthy manner.

To help counter negative stereotypes, we emphasize that the majority of older adults continue to live in and be an integral part of their communities and contribute substantially to our cultural, family, and work lives. Recent research findings are presented on extending both years and quality of life by preventing or managing chronic diseases, enhancing active aging, and maintaining pro- ductivity (i.e., contributing to society in a wide range of ways) through both paid and unpaid activities. Examples of older adults’ vital roles as family members as well as their civic engagement and volunteer activities, includ- ing cross-generational alliances related to solving social problems, are included.

But we also remind the reader that not all groups in our society, particularly those that are historically disadvantaged, low-income, or with limited education, have opportunities to experience healthy or active aging; instead, they face societal and economic barriers to pro- ductivity and civic engagement, to health promotion initiatives, even to having adequate food on the table. Therefore, we do not gloss over the very real problems of poor health, chronic illness, poverty, hunger, or inad- equate housing that face many older adults—especially women, elders of color, immigrants, the oldest-old, and those living alone—and the social and health inequities and social structures that create such problems. Aging Matters includes numerous examples of how the eco- nomic and social well-being of older adults has been negatively affected by the worldwide recession while social and health services to support elders’ well-being are cut nationwide and basic policies such as Medicare and Social Security are threatened. Growing numbers of older people must continue to be employed, or return to work, because of lost retirement income, the high cost of health care, unexpected rises in their housing costs, or even home foreclosures. Quite simply, students learn that aging matters as a social justice issue as well as a demo- graphic challenge and that fundamental policy-level changes are needed to ensure well-being in old age.

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• Points to Ponder for students to respond indi- vidually or in small groups to questions about the content

• Reflection Breaks for students to think about issues privately or explore them with others

• Easily readable and updated tables, charts, and graphs

• An increased number and mix of color photos con- veying positive and negative images of older adults

• Discussion questions at the end of each chapter to promote a review of key concepts and critical thinking

• A list of key terms defines key terms introduced in that chapter along with a comprehensive glossary at the end of the book

The book is designed to be completed in a semester, but readers can proceed at a faster or slower pace and select only the chapters most relevant to their focus of study.

Consistent with the multidisciplinary nature of gerontology, this book is organized in sections that first address demographic changes within the United States, other countries, and other cultures, and then the biological, psychological, and social aspects of aging. The Introduction briefly reviews the book’s underly- ing themes, key terms, and research methods used to study aging and older people. Chapter 1 encompasses the changing demographics of the U.S. population, with attention to gender and racial differences in life expec- tancy and the increasing diversity of the older population by race, sexual orientation, age, and social class. Chapter 2 discusses the demographic characteristics and eco- nomic implications of aging globally and the distinctive challenges faced by older immigrants and refugees in the United States. Chapter 3 covers normal age-associated biological and physiological changes, including sensory functions, that affect older people’s daily functioning as well as their risk of chronic diseases, disability, and accidents; how they cope with the most common chronic health conditions; and their use of health and long- term services and supports services, including models of chronic disease management, care transitions, and health promotion. It also addresses older adults’ sexuality and intimacy, a topic that may alter many undergradu- ates’ conceptions of older adults. Chapter 4 deals spe- cifically with normal age-related changes in intelligence, learning, memory, and personality as well as increases in creativity and wisdom that often occur with age. It

some of the issues raised in this edition will inevitably be out of date by the time the text is published. And statistics on demography, diversity, and social-economic status will have undoubtedly altered because of the rapidly changing environmental context. Similarly, some Web site URLs may change over time. Given this, we encourage students to keep up with these changes by reading journals, periodi- cals, reports, and Web sites that report on recent research findings and policies related to aging and older adults.

Features and Organization of the Text For those of you who have used Hooyman and Kiyak’s Social Gerontology, Aging Matters is not simply a scaled- back version of the ninth edition. More than 20 educa- tors nationwide reviewed the outline and provided us with insightful recommendations about how to write a text that fits for undergraduates. Here are just a few of the ways the two books differ.

• New content has been added likely to appeal to under- graduates: for example, the use of technology among older adults as well as by those who are planning com- munities, housing, and services to support aging in place in the community and age-friendly communi- ties; expanded and updated content on LGBT aging and on older immigrants; and a concluding chapter on careers in aging.

• Chapters have been consolidated to reduce both their number and length.

• Although committed to ensuring that our content is evidence based and up-to-date, the number of cita- tions is reduced to ensure readability and all citations occur at the end of the relevant paragraph.

• We have tried to use a writing style and tone that is user- friendly and to which undergraduates can easily relate.

• Each chapter includes boxed or highlighted content to help undergraduates relate to material that might otherwise seem quite distant or abstract to them and apply it to their lives. These include:

• A list of learning objectives at the beginning of each chapter

• Case studies or vignettes of older adults and high- lights from current news stories about elders in order to bring to life many of the concepts discussed in these chapters

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xviii Preface

job, for example, can have a devastating effect on a person’s life, especially as that person grows older and experiences a confluence of losses. As students read this chapter, they may be surprised to learn how many types of losses—in addition to the death of loved ones—we all experience across our life course. We also address issues salient to dying, including end-of-life care, advance care planning, and death with dignity.

The last section, Chapters 10–13, looks at the aging individual within the larger society. Chapter 10 covers retirement, employment/unemployment, economic sta- tus, poverty, and hunger, which are creating increasing challenges for growing numbers of older adults. It closes on a more optimistic note by briefly discussing chang- ing conceptions of work and retirement that create new opportunities in old age. Chapter 11 examines where and how older adults live: different types of community- based living options as well as residential facilities, the use of technology to strengthen social connections and design age-friendly homes and communities to support aging in place, and the distinctive needs of homeless elders and older prisoners. Chapter 12 on technology, including increasing computer use by elders and uni- versal design that help people age in place, is likely to change widely held images that older adults do not use such devices. Given the dramatically changing political arena, Chapter 13 on income maintenance, health, and long-term services and supports policies and programs— particularly Social Security, Medicare, and Medicaid— reflects contemporary debates related to federal and state budgets. It also reviews the Aging Network of basic services funded by the Older Americans Act and points to benefits for older adults funded by health care reform or the 2010 Patient Protection and Affordable Care Act (ACA). The last chapter, Chapter 14, on careers in aging, is particularly relevant to students wondering by the end of this book what kinds of jobs and careers they might find where they could work with older adults and  their families. We hope that by the time they read Chapter 14 they will have realized that they will interact with older adults and their families in nearly every job setting.

We chose the title Aging Matters not only because the content relates to matters of aging, but also because we believe that the many topics and issues that we dis- cuss in this book should matter—be of interest and con- cern—to people of all ages and from all walks of life. By the end of this book, students will realize that we are all affected in some way by an aging society and, perhaps

also reviews mental disorders faced by some older adults, such as depression and anxiety; the growing incidence of suicides and substance use; and the latest research on dementia, along with practices for supporting elders with such psychological disorders.

With this foundation in how physical and psy- chological changes affect the social aspects of aging, Chapters  5–8 focus on older adults’ social well-being. Chapter 5 briefly discusses a range of social theories of aging that have shaped the types of research questions asked and, to some extent, how older adults are viewed in our society and how policies and programs are struc- tured. These theories are also salient to understanding many of the issues faced by older adults in the context of family, friends, neighbors, and other multigenerational supports, current living arrangements, and community- based innovations in long-term care, productivity, and social/civic engagement in the later years, and the con- ditions under which people die. Chapter 6 addresses one of the primary components affecting how we age— informal social supports, including pets as a form of support. Whether we have friends, partners, neighbors, or children, oftentimes the intergenerational nature of these interactions affects our physical and mental well- being in old age. LGBT families are also specifically addressed. For older adults with chronic illness, disabil- ity, and increasing care needs, their social well-being is profoundly influenced by the availability of informal and formal caregivers. Chapter 7 addresses these care- givers who provide the majority of hands-on long-term personal care—family members, particularly adult chil- dren and partners, and direct care staff, and their need for supports for their vital roles, including a range of interventions. Issues of elder mistreatment by family members are acknowledged. Chapter 7 also recognizes the vital role that grandparents play as primary caregiv- ers for their grandchildren and the distinctive challenges they face. Chapter 8 explores “productive” activities such as leisure, religious participation and spirituality, civic engagement, volunteerism and lifelong learning, and political activism that can be life enhancing and build upon older adults’ strengths and resilience.

Chapter 9 discusses a subject—loss and grief—that touches the lives of all people. We include loss and grief as part of the social aspects of aging as they are profoundly social experiences that affect not only the person directly experiencing the loss but also the larger community. Loss is presented as broader than death. The loss of a home or a

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before printing. The MyTest is available to adopters at www.pearsonhighered.com.

PowerPoint™ Presentation (0205826229) These PowerPoint slides combine text and graphics for each chapter to help instructors convey sociological principles and examples in a clear and engaging way. In addition, Classroom Response System (CRS) In-Class Questions allow for instant, class-wide student responses to chapter- specific questions during lectures for teachers to gauge student comprehension. The PowerPoint Presentation is available to adopters at www.pearsonhighered.com.

This text is available in a variety of formats—digital and print. To learn more about our programs, pricing options, and customization, visit www.pearsonhighered.com.

Acknowledgments We are grateful to the many people who have contrib- uted significantly to the successful completion of Aging Matters, particularly to Brittany Barrett, a University of Washington undergraduate social work student, Varya Gracheva, Program Coordinator and Suzanne St.Peter, Gero-Ed Center Co-Director, both at the University of Washington, for their assistance with literature and Web site searches, art work, and updating references. Their will- ingness to do whatever tasks were necessary allowed us to concentrate on the big picture! We also thank our many colleagues around the United States who have given us valuable and candid feedback on the outline for this text. They include Laura Brown, State University of New York at Oswego; Brian Carpenter, Washington University; George Dicks, Edmonds Community College; Anna Hall, Delgado Community College; Cynthia Hancock, University of North Carolina at Charlotte; Erica Hunter, University at Albany, SUNY; Robert Johnson, University of Miami; Bruce LeBlanc, Black Hawk College; William Lugo, Eastern Connecticut State University; J. Meredith Martin, University of New Mexico; Jodi McKnight, Mid-Continent University; Julianne McMurtry, Mount St. Mary; Leah Moore, University of Central Florida; Jeanette Perlman, New York University, School of Continuing and Professional Studies; Catherine Solomon, Quinnipiac University; Alice Vestergaard, Ashford University; and Eldon L. Wegner, University of Hawaii at Manoa. We hope this new edition excites a new generation of students about seeking careers in working in some capacity with older adults and their families.

more importantly, that we as individuals or in groups can contribute to creating a society where different genera- tions live together with dignity, mutual support, and an appreciation for diversity. Such a society requires that citizens, health care providers, nonprofit organizations, businesses, governments, and other entities actively— and, in many cases, cooperatively—work toward meet- ing the needs of a growing and increasingly diverse older adult population.

Undergraduate students are at a pivotal stage of their lives as they consider potential career paths ahead of them, and we anticipate that this book will provide them with the knowledge, ideas, and critical questions to make informed decisions about next steps as well as planning for their own active aging. We also hope that a greater awareness of social gerontology and its multi- disciplinary nature will inspire and motivate students to pursue meaningful interactions with older adults in their families, neighborhoods, communities, and workplaces. For all of us, aging matters.

Student and Teacher Resources Pearson eText The eText that accompanies this textbook contains a variety of resources that will enhance your learning. Self-study quizzes, additional readings, or visual activities may be included as part of the virtual experience. Visit www.pearsonhighered.com to view digital options for this title.

Instructor’s Resource Manual and Test Bank (0205826237) For each chapter in the text, this valuable resource provides learning objectives, chap- ter outline and summary, discussion questions and classroom activities, and additional resources. In addi- tion, test questions in multiple choice, true/false, and short answer formats are available for each chapter; the answers are page-referenced to the text. The Instructor’s Resource Manual and Test Bank is available to adopters at www.pearsonhighered.com.

MyTest (0205826210) This computerized software allows instructors to create their own personalized exams, to edit any or all of the existing test questions, and to add new questions. Other special features of this program include the random generation of test questions, the creation of alternative versions of the same test, scrambling question sequences, and test previews

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xx Preface

As you will learn in Chapter 14, our third author and beloved colleague Dr. H. Asuman Kiyak helped to conceptualize this text. Unfortunately, she died from cancer early in the writing process of Aging Matters. But her commitment to the importance of our writing an undergraduate introductory text and her enthusiasm

about our approach have sustained us in our writing since her death.

Our families and good friends have been a mainstay of support throughout the preparation of this book, and we take this opportunity to express our gratitude to all of them.

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