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Human Behavior in the Social Environment: A Multidimensional Perspective, 7e

Chapter 10: Late Adulthood and Very Late Adulthood

Ashford/LeCroy/Rankin, Human Behavior in the Social Environment: A Multidimensional Perspective, 7th Edition. © 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Chapter Objectives

By the end of this chapter, you should be able to:

Describe the key developmental themes present in late adulthood, including theories of aging.

Understand the key aspects of biophysical growth and development of late adulthood (exercise, functioning age, ADL’s and IADLs, chronic conditions, medications, gender).

Describe the key themes in the psychological dimension for late adulthood (normative vs non-normative cognitive impairments, Alzheimer’s disease, depression, alcohol use, isolation).

Describe the key themes in the social dimension for late adulthood (widowhood, continuum of care, spirituality, elder abuse).

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Developmental Themes

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Developmental Themes (1 of 5)

Erikson’s theory: “Old age” is characterized by integrity versus despair.

“Third age”: 60s to early 80s; “fourth age”: 85 and beyond.

WHO predicts that the global late adulthood proportion to nearly double by 2050.

The 85 and older are the fastest-growing segment of the population.

Number of older minorities are increasing faster than older Whites.

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Developmental Themes (2 of 5)

Exhibit 10.1 General Characteristics of Older Adults by Subperiod

Subperiod	Characteristics
Young-old (65–74)	The young-old typically remain active in the community and maintain strong ties with families and friends.
Middle-old (75–84)	Chronic disease may begin (arthritis, cardiovascular, respiratory, circulatory) and added stresses through widowhood, deaths of friends, relatives, and adult children. Problems with balance that may lead to loss of mobility (e.g., walking, driving); and slowing of response time and judgment of spatial relationships.
Old-old (85+)	A predominant number of this group is dependent, frail, and experiencing more disabilities and chronic illnesses. Mobility is more likely to be limited. Social isolation tends to become greater for this cohort because they have more physical decrements, many can no longer drive themselves, and many are widowed.

Source: Adapted by authors based on Youdin (2014, p. 6)

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Developmental Themes (3 of 5)

Three key factors contribute to successful aging:

Maintaining cognitive abilities

Avoiding disease and maintaining physical functioning

Maintaining active engagement with life

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Developmental Themes (4 of 5)

Practice Guidelines: Common Concerns for Older Adults:

Concern with leaving a legacy

A change in the sense of time

Wanting to fulfill the “wise elder” function, which is closely associated with the notion of legacy

Attachment to familiar objects

Creativity, curiosity, and surprise

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Developmental Themes (5 of 5)

Exhibit 10.4 Exploring Attitudes About Age and Aging

When is a person “old”? When will you be “old”? How should you refer to a person who is “old”? What are some changes we will all experience as we become “old”? What is the worst and best part of growing older? How do you define “successful aging”?

Source: Robinson, B. (1994). Teaching Module, Appendix A: Exploring Attitudes about Age and Aging.

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Biophysical Growth and Development

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Biophysical Growth and Development (1 of 2)

Exhibit 10.5 Age-related Changes in Biological Systems

Skeletal system	Decline of spinal discs, osteoporosis.
Muscle system	Body fat increases in males (50%) and females (33%); fat redistributes, with more in the midsection.
Brain and nervous system	Loss of neurons. diminished flow of blood to the brain. Neurotransmitter changes, accumulations of cholesterol.
Sensory system	Gait and balance may be affected by the combined effects of muscular, skeletal, and neurological changes.
Circulatory system	Slight enlargement of the left ventricle of the heart.
Respiratory system	Lung capacity decreases 40%. Chest decreases in size, and the diaphragm weakens.
Integumentary system	Aging skin becomes dryer, thinner, irregularly pigmented.

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Biophysical Growth and Development (2 of 2)

Exhibit 10.5 Age-related Changes in Biological Systems

Aerobic activity	Moderate intensity 150 minutes or Vigorous-intensity 75 minutes or a mix of both	For example, brisk walking or water aerobics for a half hour five days a week. For example, jogging or running for 75 minutes once a week
Strengthening activity	Two or more days a week of all major muscle groups	For example, lifting weights or using resistance bands For example, heavy gardening or some forms of yoga
Balance activity	Three days a week	For example, walking backwards, standing on one leg, or using a wobble board.

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Health Care and Medications

Physiological problems and chronic conditions in older adults lead to a greater consumption of medications.

Adults over age 65 consume 30% of all prescription drugs and 40% of all over-the-counter drugs.

Risk of "prescribing cascade.“

Potential solutions:

The Beers criteria

The use of computerized decision tools

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Sexuality in Later Life

Older adults have active interest in sexual relationships in later life:

A good predictor of global life satisfaction

Implications for Practice:

Consider your own exposure to later-adult sexuality

These topics should be explored universally and routinely

Sexuality questions can be timed in a very natural narrative flow when gathering initial psychosocial information

Area of medical conditions and physical health

Sex education for older adults is important

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Biophysical Strengths, Hazards, and Risks

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Mobility

Exhibit 10.7 The Health Impact of Declining Mobility

Physical Health Impact	Psychosocial Impact	Quality-of-Life Impact
Weight gain Cardiovascular disease Cancer Falls and associated injuries Diabetes Worsening osteoarthritis Worsening pain	Poor cognitive function Depression Anxiety Social isolation	Declining activities of daily living and instrumental activities of daily living Loss of employment Institutionalization Hospitalization Mortality

Source: https://www.geron.org/images/gsa/documents/whatshotmobilitydisability.pdf

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Chronic Health Problems

About 90% of health expenditures for 65+ are for chronic conditions.

Some degree of impairment in personal activities of daily living.

Need assistance with instrumental activities of daily living.

The CDC's (2022) Four Top Tips for Preventing Chronic Diseases:

Quit smoking

Healthy eating

Exercise

Limit alcohol use

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The End of Life

The average age of death was 73.7 years.

Heart disease and cancer leading causes of death.

The aim of hospice is palliative care.

Home health devices may reduce medical costs:

A new wave of technology

Generally, serves to remind older adults to do something

Personal digital assistants, such as Alexa

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Advance Directives for Health Care (1 of 2)

Advance directives.

Durable power of attorney for health care:

Patient self determination Act, 1990

Practice Guidelines: Working with the Dying Person:

Adequate pain management and medical management

competent, gentle physical care

Straightforward information about their situation and options for care

Spiritual support and to engage in the comforting rituals

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Advance Directives for Health Care (2 of 2)

Exhibit 10.9 Advanced Health Care Directives

Considerations with an Advanced Healthcare Directive Health directives help individuals answer a number of difficult decisions:

Making Healthcare Choices ■ Talking to family ■ being able to take care of myself ■ being free from any pain ■ not being hooked up to machines in order to survive ■ I want to live no matter what ■ frankly, I’m not sure

If I am Dying ■ I want to be at home ■ I am OK with being in the hospital ■ I am just not certain what I want

Life Support Treatment ■ I want to try all life support treatments. I want to stay on life support machines no matter what ■ I want to try life support treatments but if treatments do not work, I do not want to stay on life support machines ■ I want my doctor to make this decision ■ I am not sure

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Cognitive Development and Information Processing

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Cognitive Development Stages of Later Life

Reintegration: The information and knowledge they apply is a function of their interests, attitudes, and values

Cognitive theory of aging is Selective optimization and compensation:

Selection

Optimization

Compensation

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Cognitive Decline and Aging

Healthy aging is defined by the WHO (2020) as “the process of developing and maintaining the functional ability that enables well-being in older age.”

Perceptual speed, memory, categorization, and information processing speed show a decline with age.

But knowledge remains stable up to age 90.

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Communication

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Communication

Communication in late life may be affected by sensory limitations.

Disorders such as Parkinson’s disease.

Some elders suffer from social isolation.

Validation therapy.

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Attitudes, Emotions, and Regulation

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Loss, Grief, and Mourning (1 of 3)

Experiences of loss, anticipation of loss, and adaptation to loss

Prolonged grief disorder

Treatments:

Cognitive behavioral therapy

Complicated grief treatment

Bereavement support groups

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Loss, Grief, and Mourning (2 of 3)

Exhibit 10.10 Factors that May Affect Experience, Behavior, and Adaptation in Loss

Environmental or Extrinsic Factors Personal losses or gain Social forces (losses or gain) Socioeconomic adversities Unwanted retirement Cultural devaluation of older persons

Intrinsic Factors Nature of personality Physical diseases Age-specific changes Experience of bodily dissolution and approaching death

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Loss, Grief, and Mourning (3 of 3)

Practice Guidelines: Coping with Loss:

Accept the loss

Adjust to the new environment

Find an appropriate way to maintain connection with the deceased, yet move on with life

“Relocate” the deceased in one’s life

Ruminating over negative events surrounding the death is not helpful in the long run

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Loneliness

Loneliness: Feeling about your experience.

Isolation: Social network size, transportation availability, and resource accessibility.

Practice Guidelines: Reducing Loneliness among Older Adults:

Social skills groups and friendship lessons

Telephone “check-in” support from volunteers

Promoting access to transportation and arranging social events

Educational or training component

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Reminiscence

An action or process of recalling the past.

Fits with continuity theory

One way older people maintain a sense of self.

Can be a socialization tool:

Can help an older person orient to the present by getting a “good grip” on the past

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Psychological Strengths, Hazards, and Risks

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Wisdom

A wise person is capable, and also sees the needs and viewpoints of others.

Wisdom is associated with:

Enhanced compassion

Reduced loneliness

Greater well-being

Older adults are more resilient to anxiety, depression, and stress-related mental health disorders.

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Cognitive Impairment, Alzheimer’s Disease, and Other Dementias (1 of 4)

The risk for cognitive impairment increases with age.

Cognitive decline is hallmark feature of neurocognitive disorders (NCD).

Alzheimer’s disease (AD) is most common form of dementia (60%)

Types of dementia:

Vascular dementia

Lewy body dementia

Frontal lobe dementia

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Cognitive Impairment, Alzheimer’s Disease, and Other Dementias (2 of 4)

Three ways in which the brain impacts cognitive aging:

Reserve

Maintenance

Compensation

Diagnosis of AD or Other Dementias

Cognitive well-being is a concern for older people and their families

“Senior moment” – describing a lapse in memory

No cure for AD, but it can change the disease's progression

Aducanumab.

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Cognitive Impairment, Alzheimer’s Disease, and Other Dementias (3 of 4)

Exhibit 10.12 Common Myths Associated with Cognitive Impairment

Normal	Possibly AD or Other Dementia
Temporarily forgetting a colleague’s name	Not being able to recall the name later
Having a word on the tip of the tongue	Substituting strange words for forgotten words
Misplacing objects in moments of distraction	Misplacing things in unusual places and having no memory of putting them there
Forgetting for a moment where you’re going	Getting lost on your own street
Having trouble balancing the checkbook accurately	Forgetting how to add or subtract numbers
Not feeling like doing a chore	Not knowing or caring that chore needs to be done
Temporarily forgetting the day of the week	Not knowing what season or year it is, even after thinking about them

Source: Adapted from the Alzheimer’s Association (www.alz.org)

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Cognitive Impairment, Alzheimer’s Disease, and Other Dementias (4 of 4)

Dementia Caregiving

Caring is very challenging

Formal caregiver services include

Support groups

Therapy

Respite care

Educational workshops

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Mental Illness in Late Life

Characteristics:

Long-standing serious mental disorder

Schizophrenia or bipolar disorder

Personality disorders

Narcissistic, dependent, obsessive-compulsive, or borderline

Psychological problem for the first time late in life

Conjunction with bereavement or with a physical illness

Late-onset disorders are most common form of depression or anxiety

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Depression

In older adults, depression may present as anhedonia.

Practice Guidelines: Helping Depressed Older People:

Enlisting help from family members and involved friends

Psychosocial treatments

Supportive social work practice

Identifying and mobilizing the individual’s strengths

Facilitating exploration of negative events

Encouraging them to engage in self-care and feasible activities

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Suicide

A significant problem in late adulthood.

Risk factors:

A sense of usefulness, social disconnectedness, psychological pain

Clues include increased isolation, giving away possessions, threats of suicide, wishes to die, saying goodbye, or expressions of worthlessness or hopelessness.

Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors).

Physician-assisted death (PAD).

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Alcohol and Other Drug Use in Late Adulthood (1 of 3)

Substance use disorder (SUD) is a growing concern among older adults.

The most commonly abused substances are alcohol, prescription drugs and over-the-counter medications.

The use of cannabis among older adults has increased sharply.

Alcohol is the most used drug among older adults.

Symptoms can look similar to depression, dementia, or other problems associated with aging.

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Alcohol and Other Drug Use in Late Adulthood (2 of 3)

Risk factors for substance use disorders among older adults:

Gender (male), ethnicity (white), marital status (unmarried, divorced, widowed), recent bereavement, avoidant coping style, chronic pain syndromes, poor overall health, polypharmacy, physical disability, medical comorbidities, history of substance abuse, and social isolation

Social support is critical for achieving and sustaining long-term recovery for AUD.

Another addiction issue for seniors is problem gambling.

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Alcohol and Other Drug Use in Late Adulthood (3 of 3)

Exhibit 10.14 Assessment Tools: Short Michigan Alcoholism Screening Test—Geriatric Version

When talking with others, do you ever underestimate how much you actually drink? After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn’t feel hungry? Does having a few drinks help decrease your shakiness or tremors? Does alcohol sometimes make it hard for you to remember parts of the day or night? Do you usually take a drink to relax or calm your nerves? Do you drink to take your mind off your problems? Have you ever increased your drinking after experiencing a loss in your life? Has a doctor or nurse ever said they were worried or concerned about your drinking? Have you ever made rules to manage your drinking? When you feel lonely, does drinking help?

Scoring: Two or more “yes” responses indicate an alcohol problem.

Source: Blow, Brower, Schulenberg, Demo-Dananberg, Young, and Beresford (1992).

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Groups and Families

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Families

Families:

Family is the first line of support when older adults need assistance.

Multiple generations in one family is an increasing phenomenon.

Sibling relationships.

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Couples

Different rates of marriage and widowhood for men and women.

Socioemotional selectivity theory.

As couples age, the risk of serious illness for one or both partners increases.

Partners tend to resemble each other in terms of subjective well-being and affective states.

The marital relationship may become strained when one or both partners become impaired.

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LGBTQ+ Elders

Around 3 million LGBTQ+ adults over age 50 in the population.

Similar to heterosexuals but have suffered varying degrees of oppression and hostility.

May not be open even with family members.

Partners may remain invisible to health and social service providers.

Often rely on “created families.”

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Widowhood

Two losses:

Loss itself, which brings grief and emotional distress

Loss of the life situation

Widowhood effect: The higher mortality risk after widowhood.

Socioeconomic status plays a significant role.

High prevalence of depression.

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Parent–Child Relationships (1 of 2)

Generally, remain in frequent contact with their grown children.

Older adults may relocate to live with or near an adult child.

Caregiving:

Hands-on assistance with ADLs and IADLs

Helping to hire and manage professional caregivers

Making decisions about care needs

Overseeing the care someone receives

Burden for low-income families and single adults caring for elderly parent.

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Parent–Child Relationships (2 of 2)

Exhibit 10.15 Contributors to Resilience in Family Caregivers

Distancing from the care situation, physically and emotionally

Regular physical exercise

Keeping up personal hobbies

Having at least one close confidant for emotional support

Personal religious beliefs

A philosophy of duty toward the parent

Sense of humor

Source: Adapted from Ross, Holliman, and Dixon (2003).

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Grandparenthood

Relationships with grandchildren mediated by the adult child/parent.

Free to be more like friends or confidants.

Grandparenting styles: (1) influential, (2) supportive, (3) passive, (4) authoritarian, and (5) detached.

American Association of Retired Persons and the Grandparent Foundation.

Kinship care.

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Communities and Support Systems

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Friendships, Neighbors, and Support Networks

Friends play a very important role in old age.

Friendships reduce loneliness and depression.

Strong feelings of kinship and bonding as well as increased motivation.

Neighbors check on each other and form informal networks to help.

Churches, senior centers, and volunteer programs.

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Retirement, Work, and Volunteering

Time when the individual begins receiving pension benefits, reduces or stops paid employment.

Age Discrimination in Employment Amendments of 1986.

Many older adults also engage in unpaid work.

Volunteering provides meaningful social roles, and enhances their life satisfaction and well-being.

Living on a fixed income:

Low-income individuals face harder retirement adjustments.

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Housing Options

Naturally occurring retirement communities (NORC).

Complications from age-related chronic conditions or disabilities.

Stresses person-environment congruence and the concept of environmental press.

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The Continuum of Care (1 of 2)

Long-term care.

Senior living and residential care options:

Independent living senior apartments

Low-income-housing tax credit

Board and care homes or adult foster homes

Freestanding assisted-living facilities (ALFs)

Continuing care retirement communities

Nursing homes

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The Continuum of Care (2 of 2)

Exhibit 10.17 Nursing Home Residents’ Bill of Rights

The right to freedom from abuse, mistreatment, and neglect

The right to freedom from physical restraints

The right to privacy

The right to accommodation of medical, physical, psychological, and social needs

The right to participate in resident and family groups

The right to be treated with dignity

The right to exercise self-determination

The right to communicate freely

The right to participate in the review of one’s care plan, and to be fully informed in advance about any changes in care or treatment or change of status in the facility

The right to voice grievances without discrimination or reprisal

Source: From AARP.org, “Fact Sheet: The Nursing Home Reform Act of 1987.”

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Multicultural, Gender, and Spiritual Considerations

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Older Adults of Color

Often face social oppression and reduced educational and employment opportunities and leading to ongoing disadvantages:

Life-course perspective

Latino, Native American, and Asian American cultures traditionally honor and provide for older people.

African American elders:

More likely to live in multigenerational and extended families

Have more active informal support networks than Whites:

Fictive kin

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Gender Issues

Ageism:

Stereotyping of older people

Prejudice and discrimination against older persons because of age

Older women:

More likely to live in poverty than older men

Deal with the double jeopardy of aging and being female (Intersection of ageism and sexism)

Older women of color may suffer the triple burden of ageism, sexism, and racism

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Spirituality and Older Adults

Spirituality connotes a level of awareness that goes beyond ordinary physical and spatial boundaries.

Provides older adults with:

A source of strength, comfort, and hope in difficult times

A sense of community and belonging

Challenge:

Concept of “spiritual” can range from nonreligious and nontheistic

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Assessing Spirituality Using the FICA

FICA:

F stands for Faith: “Do you consider yourself spiritual or religious?”

I stands for Importance: “What importance does your spirituality have in our life?”

C stands for Community: “Are you part of a spiritual community?”

A stands for Address in Care: “How would you like me, your healthcare provider, to address these issues in your health care?”

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Social Strengths, Hazards, and Risks

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Social Support for Older Adults

Personal flexibility to adjust to and accept growing dependence on others:

When the time comes that independence becomes limited, flexibility is an invaluable strength

Older adults are vulnerable to social isolation, loneliness, nutritional insufficiency, and unmet health care needs:

Those who live alone, who may not have living children or extended family, those over age 85, and those who live in poverty, in inappropriate or unsafe settings

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Elder Abuse and Neglect

Elder abuse: Both abuse and neglect, intentional or unintentional:

Physical, sexual, emotional, and financial mistreatment

Risk factors:

Caregiver stress; External stressors such as financial concerns

Dependency; social isolation

Poor hygiene and nutritional status; obvious lack of care

Older person appears hypervigilant or nervous

Caregiver displays hostility and impatience toward the elder

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Assessment of Elder Abuse

Exhibit 10.18 Assessment Tools: Assessing Elder Abuse

Question	Yes	No	Did Not Answer
Are you by yourself a lot of the time?
Has there been a time when someone did not help you when you needed help?
Has anyone tried to make you sign papers you did not understand?
Are you afraid of anyone?
Has anyone touched you in ways you didn’t want to be touched?
Has anyone yelled or threatened you?
Has anyone hurt you?

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Developmental Guidelines for Assessment in Late Adulthood (1 of 2)

Exhibit 10.19 Developmental Considerations in Assessment in Late Adulthood

Routine Observations	Development Issues (Not Problems)
Chronic health conditions Availability of appropriate health care Functioning in activities of daily living Medications used and their side effects Ability to obtain nutritious meals Opportunities for exercise Alcohol or other drug use Mental status: memory, judgment Emotional expression Availability of companionship, friendship Family support or family conflicts Neighborhood safety	Physical vulnerability Continuity of personality traits from earlier adulthood Cognitive processing speed decreases Short-term storage and recall memory Strengthening of religious beliefs (sometimes) Preference for reliable, comfortable relationships May need assistance with daily activities, residential placement, supportive end-of-life care

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Developmental Guidelines for Assessment in Late Adulthood (2 of 2)

Exhibit 10.19 Developmental Considerations in Assessment in Late Adulthood (Cont.)

Strengths and Landmarks of Development	Development Observations Requiring Attention
Maintaining interests and activities according to capability Interest in remaining as independent as possible Interest in sexual expression and companionship Desire to leave a legacy—e.g., creative work, possessions, or family Desire to maintain family and friendship connections Adapting to new roles May be more reflective or introverted	Little affect; lack of interest or enjoyment Talks of being worthless or being a burden Persistent loneliness Social isolation Paranoid ideation or delusions Slurred speech or otherwise not alert Walking unsteadily but without cane/walker Repeats same questions, gets lost, obvious memory loss Unsafe living situation Signs of physical neglect—dirty bedsores

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Epilogue: The Journey of Life

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Epilogue: The Journey of Life

Kierkegaard: “Life is lived forward, but understood backwards.”

Socrates: The path to happiness was through knowledge.

In the end, perhaps it is up to us individually to make sense of our lives and to make life something real and meaningful.

As we pause, our personal reflections on life may provide our own sense of meaning.

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Summary

Click the link to review the objectives for this presentation.

Link to Objectives

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HB 7

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